Reflections on a second Covid year

In 2021, the Covid pandemic caused around 13 million infections and nearly 150,000 Covid related deaths in the country.

2020 ended with increasing infections of the Alpha variant resulting in high numbers of hospitalisations and deaths. A winter lockdown had been in force since October 2020 but by the December Christmas restrictions, there was a prospect of three effective vaccines: Pfizer, AstraZeneca and then Moderna.

The first vaccination was in early December 2020, paving the way for a national programme. After a bleak winter for the NHS, a recovery plan was set out between March and July 2021 in the government’s roadmap. This was designed to reopen the economy in four steps and return the country to a new normal.

Step 1 in March: for schools to reopen and people to access more recreation and visit care homes.

Step 2 in April: to open up non-essential indoor retail, hospitality businesses and some outdoor leisure facilities. Funerals and weddings could take place with certain restrictions.

Step 3 in May: to ease the limits on socialising and allow more businesses to reopen.

Step 4 in June: to remove the limits on social contact. By June, the Delta variant had accounted for 90% of Covid related deaths.

From July, the country seemed to be learning to learn to live with Covid by a strategy of vaccination and guidance.  So called “Freedom Day” was declared in mid-July.

The reopening of businesses and the removal of some social restrictions enabled people to reconnect with friends and family, while supporting some jobs and the economy. The government provided guidance for people to take responsibility for measures to reduce risks.

Progress on all fronts was being made until a new variant, Omicron, emerged on November 24 in South Africa. Since then it has spread around the world. The first cases were reported in the UK in late November. One month later,  Covid positivity rates had increased in all four UK nations to an estimated 1 in 25 people.

The government response to Omicron was first to: “analyse the data” but then a stated “not to hesitate to impose stricter measures if needed”. Some experts questioned this, believing that counter-measures should have been imposed early and hard.  Opponents pointed to emerging NHS findings that people infected with Omicron were less ill and less likely to require hospital treatment compared to patients who had Delta.

Plan B?

With public concern about the rise of Omicron, by mid-December the government had implemented its “Plan B” in England.  This included advice: to work from home where possible; to wear face coverings in public indoor settings, on transport and in schools and for those in the workplace to “consider taking lateral flow tests regularly to manage risk”. Self isolation and testing requirements also changed.

Although for 2021, many feared a repeat of Christmas 2020 restrictions, the government, seemingly at odds with its scientific advisers, gave the green light for celebrations.

Throughout the year there has been much debate about the risks in schools and the measures to counter them. Most agreed that students would benefit from being in educational establishments. Following the restrictions during the year, 2021 ended with a renewed policy of face coverings for the more senior school children from the new year.

With infection rates high, another challenge for the government at the end of 2021 has been workplace absentees and the adverse impact on services and key business. This was an issue carried forward into the new year.

Test and trace 

Throughout the year, given the huge amount of resources allocated to the test, trace and isolate system, the claim that it had reduced the number of positive cases in the community has been challenged, mainly because for many, to secure a test has been problematic. Pre-travel PCR tests remain expensive and in many cases unreliable in terms of delivery of results on time.

Vaccinations 

In England, the evidence now shows that the number of Covid deaths and hospital admissions had been reduced during the year because of the success of the UK’s vaccination programme.

The arrival of Omicron caused the  government to ramp up its vaccination booster campaign. In addition to single jabs for ages 12 and over there has been an offer of multiple jabs for over 18s. Percentage take-up in most groups has been variable. The booster programme was designed to counter reducing vaccine efficacy (WHO statement)  particularly in the older age groups.

From early 2021, many in rural areas, like Rye had to travel widely for vaccination. From February, REACT worked with the NHS Commissioners to secure local facilities. Eventually in late May, supported by Clarity pharmacists from Ticehurst and St Leonards, the Rye hub in the Tilling Green centre was established. Rye, like most centres responded to the call to support the booster programme. By the end of 2021 the centre had delivered well over 40,000 jabs, enabled in no small part by the significant contribution of some 60 community volunteers whose work has been recognised formally by Rye Town Council.

Managing the pandemic?  

Multiple reviews of the handling of the counter measures  (BMJ 2021;375:e068302)  suggest that the personal protective and social measures, including hand washing, face coverings and physical distancing have reduced the spread of Covid more effectively than the collective measures such as lockdowns, school or travel restrictions.

Importantly, it has been seen that any decision about public health measures must consider community health impacts (particularly mental health) and social needs. Expect to read more of this in 2022.

Long Covid

Despite the reduced potency of Omicron, it continues to provide the spectre of long Covid for some who are infected. There are already about one million people in the country suffering from a Covid impact that is still subject to research.

Identified lessons? 

Many lessons have emerged, but most are pending a national review.  There are far more questions than answers.

• balancing politics and science?
• clear central messages?
• mandatory measures or guidance?
• an effective test and trace system?
• need for vaccine passports?
• how to handle risks in care homes?

Expect lots more on these and other questions in 2022.

In late 2021, some comments are of particular note:

The general secretary of the World Health Organisation:
“Omicron’s emergence reminds us of how perilous and precarious our situation is. We should be wide awake to the threat of this virus.”

Professor Dame Sarah Gilbert, delivering the 44th Richard Dimbleby lecture:
“We cannot allow a situation where we have gone through so much to then find that the enormous economic losses we have sustained mean that there is no funding for pandemic preparedness. The advances we have made, and the knowledge we have gained, must not be lost.”

Into 2022

2022 starts with enormous challenges in addition to Covid, not least: climate change; fuel and food poverty for many; inflation and supply issues.

Will the pandemic run in our favour because Omicron is milder (less impacts and hospitalisations) and can now be countered by booster jabs and antivirals? Will this be enough to counter a variant that spreads faster than anything seen before? Will 2022 see the pandemic move to endemic?

A final word by Chris Whitty, the chief medical officer for England at the end of 2021:
“ONS data shows 1 in 25 people in England had Covid last week with even higher rates in some areas. The wave is still rising and hospital admissions are going up. Please protect yourself and those around you. Get boosted, use face masks indoors, maximise ventilation, wash hands.’

As always, pragmatic and to the point.

Image Credits: UK Government .