The world pre-2020 no longer exists.

Fundamentally, the world is different now, a health expert writes. Acting as if it isn’t, which the UK seems determined to do, may feel good in the short term but will result in a new normal worse than the old one.

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Professor Christina Pagel, Director of University College London’s clinical operational research unit, member of Independent Sage:

“I keep being asked when we can go “back to normal” or “like it was before”. My personal thoughts: We’ve added a new disease to our population, more infectious and more severe than flu.

“The world pre-2020 no longer exists – we may want it to, but it just doesn’t.

“Vaccines are amazing but do wane – especially vs symptomatic infection. Immunity from infection wanes too.

“Surely Omicron has proven that high levels of antibodies in your population are no guarantee against very high levels of illness and disruption.

“We could act as we used to and accept millions of people getting sick once or twice a year. Yearly education, business disruption. And gradually, a slightly sicker population. That seems to be the current plan in the UK and the United States.

“But that’s NOT the old normal – it’s worse.

“We can’t go back – but we can go forward if we accept we need some adaptations – driven by what we have learned.

“Learning:

1. Outdoors is pretty safe – so let’s invest research and funding into making indoor air as much like the outdoors as possible. It’s not easy, but it is possible – we did it with clean water, electricity infrastructure, CFCs, telephone and broadband... The best thing about cleaner indoor air is it works against any airborne disease and also reduces allergies.

2. Vaccinate the world as soon as possible – and keep working towards vaccines that are longer lasting and more variant proof.

3. Invest in global infrastructure to support surveillance of new variants of COVID and other new infectious diseases. There will be more.

4. Add permanent surveillance of COVID infection rates in the UK to existing programmes for flu, measles, etc. in public health.

5. Invest in understanding and treating longer term clinical impacts of COVID, including organ damage and Long COVID + treatments (e.g. antivirals) for acute phase.

6. We need to urgently increase funding and staffing for NHS if it is expected to cope with regular COVID surges and existing backlogs and years of understaffing and not enough money. This includes supporting existing staff to stay!

7. There will still be future surges. We need to have a plan to deal with these surges – as we do for other diseases. A plan which is supported by the rapid outbreak identification and rapid understanding of virulence and transmission we’ve learned to do so well in the UK!

The plan might include (temporarly) reintroduction of large scale testing (including better tests?), high quality masks in indoor spaces and – if and only if there is a serious threat from e.g. a new variant (or disease!) – further measures, such as targeted test, trace and isolate.

A plan should not mean long national lockdowns, which represent a failure of public health systems. In fact, refusing to do the learning in “learning to live with COVID” is the biggest risk for such future lockdowns.

8. We also need to invest massively in reducing inequalities: in health, in housing, in workplaces, in sick pay, in education – this will make us more resilient to future outbreaks and reduce ill health and death – from COVID and everything else! Both nationally and globally.

“Fundamentally, the world is different now. Acting as if it isn’t, which the UK seems determined to do, may feel good in the short term but will result in a new normal worse than the old one.

“I prefer for us to build a new normal that’s better than frequent sickness and disruption.”

Follow Professor Christina Pagel

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Sources

• Text: This piece was first published in PMP Magazine on 12 February 2022.
• Cover: Flickr/Pixabay. (Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)