The case for pessimism when it comes to COVID

When Holyrood asks Dr Christine Tait-Burkard, an assistant professor at Edinburgh University’s Roslin Institute, how long she thinks we’ll have to live with COVID, “probably forever” is the sobering reply. 

We spoke to the academic on the day Nicola Sturgeon warned that Scotland’s journey out of lockdown would likely need to be paused. Again.

The First Minister’s slowing down of the easing of restrictions came less than 24 hours after Boris Johnson was forced to postpone England’s “freedom day”, pushing it back from June 21 to July 19. 

The news was dispiriting, if not entirely surprising.

The Delta variant, first identified in India, has spread quickly and is now responsible for around 75 per cent of all positive cases in Scotland.

Compared to other variants, including Alpha, first identified in Kent, it carries twice the risk of hospitalisation, according to research from Strathclyde and Edinburgh universities. 

The good news is that the vaccines work. The not so good news is that they work best after both doses are administered. 

According to the two Scottish universities, the BioNTech/Pfizer vaccine provided 79 per cent protection against infection from the Delta variant, while the Oxford/AstraZeneca vaccine, meanwhile, offered 60 per cent protection.

Public Health England was a little more upbeat. They found that the BioNTech/Pfizer vaccine is 96 per cent effective at preventing hospitalisation after two doses, while the Oxford/AstraZeneca vaccine is 92 per cent effective against hospitalisation after two doses.

At the time of going to print, around half of Scotland has had both doses.

However, there’s still a sizeable number yet to receive their first dose.

Worryingly, those groups currently being vaccinated – people in their 30 or 40s – or waiting for their jab – people in their 20s – make up the highest proportion of all new hospital admissions.

In terms of raw numbers, it does seem as if the vaccine has blunted if not broken the link between positive cases and hospitalisation.

As Nicola Sturgeon told MSPs, the number of people being admitted to hospital with COVID has fallen from around 10 per cent of reported positive cases at the start of the year, to around five per cent now.

And that’s despite new cases increasing at a much faster rate than hospital admissions.

The rationale behind Sturgeon and Johnson’s decision to delay is to simply use the time to get more jags in more arms. 

“Doing that will give us the best chance, later in July, of getting back on track and restoring the much greater normality that we all crave,” Sturgeon told MSPs.

North of the border, June 28 had been pencilled in as the day all of Scotland would move to Level 0 in the Scottish government’s five-tier system.

Now, we likely won’t get there until the end of July, possibly later. 

And even when we get there, Level 0, despite its moniker, does not mean pre-pandemic normality.

Instead, it allows a small increase in the number of people who can meet in houses, in pubs and cafes, and a relaxation of physical distancing rules around family and friends. Nightclubs and venues would need to stay closed. 

As we get closer to full vaccination, and as we learn more about COVID-19, the strategy changes. 

“We cannot simply eliminate coronavirus,” Johnson said at his No 10 press conference, “We must learn to live with it. 

“Even if the link between infection and hospitalisation has been weakened, it has not been severed.”

Over the past year, we’ve all been waiting for this to be over, for the pandemic to end. Even these recent delays feel like a “one more heave” situation, with the promise of our old lives the reward for our sacrifice. 

But what if our old lives aren’t coming back? Could we be in for endless cycles of mutations, outbreaks, restrictions and lockdowns? 

Certainly, some of the measures in place just now are unlikely to be rolled back anytime soon.

“We will be living with some changes for quite some time,” Tait-Burkard says. “Whether that is facemasks in public, crowded places, or testing or vaccine proof for travelling.” 

One planning document circulating in Whitehall suggests some of the mitigations to stop the spread of the disease, put in place way back in March 2020, could be here for a while yet. 

Firms, the paper by the government’s scientists said, could be urged to move to home working for the long-term. 

Instead of having staff commuting, congregating in the office, and generally sharing oxygen, employers would be asked to adopt a more “hybrid approach,” with workers spending some of their time at their desk and some of their time at home.  

There could also be tougher restrictions re-introduced in the winter, in a bid to curb people meeting indoors. 

Self-isolation and taking time off work because you’ve a new cough, a temperature or a loss of taste or smell, could also be the norm for some time.

In fact, according to Tait-Burkard regular COVID testing could be with us for several more years yet.

“The virus will continue to mutate – as we see with common cold coronaviruses – but the protection that we get from vaccination as well as re-infection on top of vaccination will dampen symptoms, as we see with common cold coronaviruses,” she said.

The assistant professor added: “For children, this may mean that they never really need to get a vaccine against SARS-CoV-2 but may manage to build up immunity over time. Whether this is the current generation of children or the next one is a good question and may also depend on our willingness to take risks of flare-ups.” 

The academic said repeat vaccination for the adult population was certain until there was more understanding of how long the jabs protected us from severe disease.

She added: “It will also mean that we will eventually also move away from testing and the very tight monitoring, even though that’s probably a year if not several years down the line.”

Asked if she thought the next COVID mutation could defeat the vaccine, Tait-Burkard said: “It is a very good question and it is difficult to predict.”

She says countries with high infection rates and low vaccination numbers could provide the perfect environment for the virus to evolve. Last month, the UN pointed out that 75 per cent of all jabs had been administered in just 10 countries. There are still more than 100 countries where not a single dose has been distributed. 

“This means that the numbers game of vaccine-resistant or resilient variants, forming randomly, becomes much more likely as there are more people infected and more variant viruses made,” Tait-Burkard says. 

“However, continuous monitoring of people who present in hospital with SARS-CoV-2, and the maintenance of vaccine production facilities and the option to monitor locally, can all help and have been built up and are being built up to combat such emergent viruses. As in fact we have been doing for influenza for decades already.

“Overall, this just highlights how important it is to vaccinate the world.”

That, however, is easier said than done. It’s not just the arguments over patents and intellectual property but logistical problems with ramping up production and, in the case of Pfizer and Moderna, producing vaccines which use new technology.

It’s thought the world needs around 11 billion doses of vaccine to fully innoculate the world.

Pre-pandemic, if you were to add up all the doses made by every factory in the world that produced vaccines, you’d get a figure between 3.5 billion and 5.5 billion.

There are signs for optimism. Things are not as bad as they were, and we are, at the moment, paused rather than in reverse, but last week’s announcement is a reminder that the new normal is still years away from being anything like the old normal.   •