Covid-19 came back into our sights with a vengeance last week when the HSE said it was “really struggling” with the surge in cases. As of Thursday, there was a 29 percent increase in new cases compared to the previous week, with more people ending up in hospital with the virus.
This puts pressure on the healthcare system because people with Covid-19 have to be treated in a special Covid ward. Locally this means that it is not Covid-19 per se This puts pressure on the system. It is the lack of facilities to treat the Covid-19 cases. Covid-19 continues to reveal a deficiency that was already there, like the flu does every winter. In addition, 5,200 employees are on the road as Covid-19 increases the pressure.
A consequence of this is that various medical procedures are cancelled. So our hospital system has come under pressure again.
Why is this happening? There are two likely reasons. First, there’s a new variant called BA.2 that’s running amok. This is 30 percent more portable than its brother, the Omicron variant, which was already 70 percent more portable than previous variants. BA.2 sweeps up everyone who didn’t catch Omicron. Not only is it more transmissible, but it also has a shorter incubation period, meaning people become infectious more quickly once infected. BA.2 is therefore the most contagious variant we have seen and is spreading like wildfire, not just in Ireland but across Europe.
Fortunately, however, the vaccines are largely holding up. If they weren’t, our hospitals and intensive care units would be full of Covid-19 patients. We’re lucky that BA.2 wasn’t there when the pandemic started. Because natural infection is protective with previous variants and vaccines, we are not currently seeing a huge increase in serious illness and therefore no increase in ICU admissions.
This surge is likely to peak soon as most of the susceptible individuals become infected and we enter late spring/early summer. That means we’re all all more outdoors, or we’re happier at keeping windows open.
As Covid-19 is now clearly a seasonal virus that spreads indoors, this increase will level off in the coming weeks. However, it remains important that people continue to wear masks in crowded indoor spaces – for example on public transport. This will help reduce spread, and even if masks aren’t perfect, they reduce the dose of virus spread, thus leading to less severe illness in people infected by someone who is contagious but is wearing a mask.
The second reason for the increase is the waning of vaccines. There is evidence of some loss of immunity to Omicron and BA.2, particularly in the elderly. That means it’s very important to get the third shot when called, or the fourth shot for those who are vulnerable or older. This will restore protection over the next few weeks as we get out of this wave.
Masks and vaccines and people staying at home if they have symptoms will help ease the pressure on our healthcare system. If you have cold or flu symptoms, you can assume it’s the BA.2 variant based on the prevalence.
The WHO’s David Nabarro said last week that we can expect flare-ups every three or four months. Covid-19 will not go away. It is likely that there will be epidemics in the future, especially as we get into autumn/winter. That might make you say, “Are we ever going to escape this?” Unfortunately, the answer is no. We have to learn to live with it. However, the good news is that we know how to fight against this virus.
What actually happened is that a new virus came to infect people. Like the flu used to come, or TB, or HIV. Like these viruses, SARS-CoV-2 is another virus that jumps from animals to humans and takes hold. In future medical textbooks, in the chapter on infectious diseases, there will be a section titled “SARS-CoV-2 and Covid-19” that shows the clinical features of the disease but also notes that Covid-19 is preventable with vaccines. and treatable with antivirals. So we don’t need to be too anxious about the future. But we must be prepared, especially if a more malicious variant should emerge.
What will that future look like in terms of living with Covid-19? First of all, vaccines will continue to be our best weapon. Next-generation vaccines are coming, including vaccines that work against every coronavirus (so-called pan-coronavirus vaccines). Companies are also testing vaccines that work even better than the ones we have. Not only may these protect you from serious illnesses like current vaccines, but they also help protect you from infection in the first place, thereby reducing transmission. This is because they not only bring out the immune troops in your lungs, but also in your nose and upper airways, so any virus that enters there is quickly killed.
These vaccines include intranasal vaccines (including the AstraZeneca vaccine, which is being reformulated). Because they are applied to the nose, they trigger a powerful immune response there and deeper in your body. We are eagerly awaiting these so-called mucosal vaccines.
We can expect vaccines to be used again for vulnerable or elderly people in late summer/early fall. This will be just like the flu shot. If the new vaccines are available by then, they will likely be deployed, but the current vaccines still offer protection.
The second key weapon we have is ventilation. We must ensure that there is adequate ventilation anywhere indoors where crowds congregate. Just as we made sure there was clean water to stop the spread of cholera and dysentery, we now need to clean the air through ventilation. This will be of great help in the winter, with the added bonus of limiting the spread of the flu.
Monitoring will also be important to spot when a new variant emerges and to be able to act quickly. Speed is key, as we saw at the start of the pandemic. Should a new variant arrive, we must act quickly to contain it. This may include mask requirements or some limited restrictions being put in place. Let’s hope these won’t be needed, but we must be prepared for the next variant that will surely come.
Another important issue we need to consider is Long Covid.
There is a real risk that the number of people with persistent symptoms after infection will increase, especially after the current surge. We need resources in the healthcare system to take care of them and research to find better ways to diagnose and hopefully treat long Covid.
All of this means that we know what to do when the surges occur. We just have to make sure we’re ready. Because one thing is certain, Covid-19 will keep coming back, but it is up to us to ensure it can be contained quickly when it does.
Luke O’Neill is Professor of Biochemistry in the Department of Biochemistry and Immunology at Trinity College Dublin
https://www.independent.ie/news/facing-down-ba2-as-it-runs-amok-41491321.html Overlooking BA.2 while it runs amok