Living with Covid: where are we now?

The UK has been officially ‘living with Covid’ for over a year. Most of the news headlines about the virus that brought the world to a halt three years ago and caused over 6.9 million deaths, now surround waiting lists or the ongoing UK Covid inquiry.

In May, the World Health Organization (WHO) also announced that the Covid-19 alert status was being downgraded and was no longer considered a global health emergency, but it did state that it would still be a persistent threat.

This persistent threat is evident across Europe, as Covid-19 infections, hospitalisations and deaths continue to increase, and new variants circulate.

There are also fears that there will be a triple whammy of influenza, respiratory syncytial virus (RSV) and Covid-19 circulating at the same time this autumn and winter. That could lead to increased risk of infections and severe disease among vulnerable populations and could put more pressure on health services.

So, as the NHS and social care moves into winter facing a workforce crisis and waiting list backlog never seen before, what will living with Covid look like for healthcare professionals?

Covid-19 and vaccinations

Last month, NHS England announced that the Covid-19 vaccination programme had got off to a flying start with more than one million autumn Covid jabs delivered in a week since national bookings started.

The vaccine programme this year is not being offered (as yet) to all people over 50 and only the following groups are eligible for a booster: residents in care homes for older adults, all adults aged 65 years and over, people in a clinical risk group, pregnant women, carers, and household contacts of people with weakened immune systems.

In addition, all frontline health and social care workers and staff working in care homes for older adults are included. This is welcome news given a recent WHO study found that healthcare workers who received a Covid-19 booster last winter during the Omicron wave were 88% less likely to become ill with Covid-19 than unvaccinated health workers.

Living with Covid and healthcare staff

There is currently an information gap on Covid infection rates as the Office for National Statistics (ONS) infection survey, which used to test a random sample of the population, ended in March. Testing in hospitals is now limited to certain groups such as some NHS staff with symptoms working on inpatient wards with severely immunosuppressed patients, staff with symptoms who work in hospices, and all patients being discharged from hospitals into care settings.

Therefore, many health leaders are worried that a lack of routine Covid-19 testing and new variants circulating means they don’t know what the full impact of Covid will be, making winter planning all the more challenging. This puts a lot of pressure on the success and coverage of the Covid and flu vaccination programmes to protect the public and staff. And even with that, a cold snap in the winter could ramp up the pressure on services and staff to record levels.

The British Medical Association (BMA) is amongst the health organisation concerned about under-reporting and under-investigation of Covid-19 incidences by NHS Trusts over the coming months. As a result, it has called for mandatory face masks for patients attending healthcare setting and the reintroduction of asymptomatic testing for patient facing staff.

It has also wrote to NHS Trusts in England to remind employers of their legal obligations to undertake risk assessments and for appropriate mitigations against the risks of Covid-19 to staff and patients to be put in place.

It added: “As Covid-19 cases are likely to continue to fluctuate, protections for healthcare workers remains a key area of concern for our members and a focus for the BMA’s work.

“A failure to properly protect healthcare workers and patients poses a significant risk for spreading Covid infections in healthcare settings, but also places enormous pressure on already overstretched healthcare services. They are also crucial in ensuring that people who are clinically vulnerable to Covid-19 (such as people who are immunosuppressed) can safely access care.”

Charities representing vulnerable patients have also called on the UK government to boost Covid precautions in hospitals, such as routine Covid testing in clinical settings and asking staff to wear masks if patients feel at risk.

Rise of new variants

Last year, the Omicron variant led to less severe disease, but scientists were always concerned as there is no guarantee that the next variant would do the same.

Professor Wendy Barclay, Head of Imperial’s Department of Infectious Disease, said: “We are at a stage where we do not quite understand why some variants are mild or more severe than others and we do not know that entire breadth of opportunity for this virus. I think it is dangerous to assume that it is inevitable that the next variant will be like Omicron.

“There may be a variant that solves the problem of how to transmit in an immune population in quite a different way to how Omicron has done. You may end up with a quite severe variant, which breaks through the vaccine more and causes severe disease when it does so.”

Step in new variant, BA.2.86 – nicknamed “Pirola”. Scientists are monitoring it closely because it shows a large number of genetic mutations, raising concerns it could evade immunity from vaccination and previous infection. Yet, the government says to date only a small number of cases have been identified across the world, and more data will be needed to draw any conclusions about the effect of these mutations on transmissibility and severity of the variant.

Yet, it decided to bring forward the Covid-19 autumn vaccination campaign, as a precautionary measure to ensure those people who are most vulnerable and at higher risk of severe disease have the best available protection.

There are growing fears,  however, it will spread in the community over the winter months after an outbreak was reported at a UK care home.

Steve Russell, NHS director of vaccinations and screening, said, “With concerns arising over new Covid variants, it’s vital we adapt the programme and bring it forward for those most at risk, and so I strongly urge everyone eligible to come forward as soon as they can for this important protection in colder months.”

Long Covid and healthcare workers

WHO has also warned of the ongoing impact of long Covid, which provokes a long line of often severe and debilitating symptoms that can drag on for months or years. The condition is estimated to affect one in 10 people who contract Covid, suggesting hundreds of millions of people could need longer-term care.

In addition, ONS data suggest that healthcare workers are reporting symptoms of long Covid at a higher rate than the general population.

The BMA said it remains hugely concerned about the welfare of doctors and healthcare workers with long Covid and it is calling for:

• Financial support for doctors and healthcare staff with post-acute Covid
• Post-acute Covid to be recognised as an occupational disease in healthcare workers, with a definition that covers all of the debilitating disease’s symptoms
• Improved access to physical and mental health services to aid comprehensive assessment, appropriate investigations, treatment, and ultimately recovery from post-acute Covid
• Greater workplace protection for healthcare staff who risked their lives for others
• Better support for post-acute Covid-19 sufferers to return to work safely, including a flexible approach to the use of workplace adjustments

Professor David Strain, BMA board of science chair, said: “We know that throughout the pandemic Covid-19 had a profound and often tragic impact on healthcare workers, but now this report and the heart-breaking accounts within it lay bare the debilitating effect that the virus continues to have on those doctors living with long-term symptoms.

“Contrary to what some may associate with the term ‘Long Covid’, these doctors are not just ‘a bit tired’, nor are they ‘withdrawn due to the isolation of lockdowns’. They are living with a range of serious health conditions caused by their initial Covid-19 infection, most likely caught while they were caring for others on the front line.”

Covid-19 and waiting lists

Hospital waiting lists remain at record highs and latest figures from NHS England show the number of people waiting for treatment in England is now at 7.75 million, with nearly 3.25 million of these patients waiting over 18 weeks.

The government has laid a lot of the blame at the door of striking doctors, but the Nuffield Trust say that the waiting list grew at a higher rate last year when no strikes were taking place, compared with the period since March when doctors began taking industrial action.

It said: “The debate about whether the strikes can be blamed for the continued increase in the waiting list risks taking the focus away from the most important impact, which is on patients. People on the waiting list are bearing the brunt of the continuing industrial disputes, in terms of missed care, disruption to their lives, and anxiety about the long-term consequences. The challenge of ensuring cover for shifts, reorganising appointments and replanning clinics and operating theatre schedules impacts patients either side of strikes, as well as on the day.

“The impact on patients is likely to be compounded if the strikes continue into the winter months, as now seems likely. While NHS organisations have worked hard to manage disruption and ensure emergency care provision, this will become even more challenging during winter months, when higher demand for urgent care and staff sickness will add to the challenge.”