Health Check newsletter: Six lessons from the covid-19 pandemic

Empty streets during the coronavirus outbreak, Manchester, UK, April 2020

Alamy Stock Photo

On 23 March, it was two years since the UK went into its first covid-19 lockdown. Although some countries had been battling the virus for some time by then, for the UK, shuttering shops and sending people home from work was an unwelcome landmark. I thought it would be interesting to consider, with the benefit of hindsight, some of the lessons learned that could help in tackling the next pandemic.

After all, while omicron is milder than previous variants, it is quite possible that in the next few months or perhaps years, we will meet a fiercer version of the coronavirus, requiring new restrictions. Or a new pandemic could arise from a different kind of pathogen, such as a novel flu strain.

Rather than the mistakes made by politicians – of which there were plenty – I’m more interested in lessons for scientists and public health doctors. The job of working out what we should do differently next time round isn’t easy, not least because scientists disagree among themselves on many of these issues. You may also disagree with my reasoning – but for what it’s worth, here’s my take on lessons for the next pandemic.

Zero covid can work

This relates to the most contentious question of all. Some think all nations should have pursued a zero-covid strategy, suppressing the spread of the virus as much as possible and ideally stamping it out, as places such as Australia, Iceland and South Korea have done for much of the past two years. The other camp says efforts to stop the virus often did more harm than good and we should have “let it rip” from the start.

The UK arguably followed a middle way for most of the past two years, but in January switched to the let-it-rip approach, allowing the virus to spread more or less unhindered – as our news story last week describes here. Lately, other countries have been following suit – even Australia and Iceland.

But that doesn’t mean zero covid was wrong initially. Countries following this strategy have had far fewer deaths from the coronavirus than the UK. For instance, New Zealand has had about 200 deaths from covid-19, a small fraction of the per capita death rate in the UK.

If the UK and similar nations had been able to close borders and use repeated lockdowns to stamp out imported outbreaks until vulnerable people had been fully vaccinated – as New Zealand did – there would have been far fewer deaths from covid-19.

It’s not simple, though. At the time Australia and New Zealand closed their borders, in March 2020, the new coronavirus had already been seeded all over the UK and much of Europe, so it was too late to try to keep the virus out. Which brings me to…

Listen to early warning systems

Some infectious disease experts had been warning the UK government about this virus’s pandemic potential as early as January 2020. There’s an interesting first-person account of this from one such researcher, Mark Woolhouse at the University of Edinburgh, UK, in his recent book The Year the World Went Mad.

It’s debatable whether politicians could have realistically brought in radical measures like border closures back in January – before the first hospitals in Italy had been overwhelmed – without a public outcry. But given that we have now seen what covid-19 at its worst can do, perhaps it isn’t too much to hope they could do so the next time round.

Vaccinate the vulnerable first

China has pursued a zero-covid strategy ruthlessly, but now things are going wrong, with case numbers soaring in many regions. Its previous measures for keeping the coronavirus out – lockdowns and compulsory mass testing – are no longer working because omicron is so transmissible.

Sadly, in Hong Kong, death rates are so high that hospitals are running out of beds, with fears the same pattern will soon be repeated in mainland China.

This seems to be because of low vaccination rates among older people. While about 80 per cent of Hong Kong adults had been double vaccinated by the start of March, only 30 per cent of people aged over 80 had been. Their low uptake stems partly from the government failing to promote the vaccine to this age group and also from unfounded vaccine scare stories in local media.

A stark lesson comes from comparing Hong Kong with New Zealand. Both pursued a zero-covid strategy and both have been overwhelmed by omicron at about the same time. But in New Zealand, where deaths are so few, nearly 100 per cent of people aged 80 or over have had at least two vaccine doses.

This is one of the things the UK got right. When the vaccine first became available from December 2020 onwards, it was offered to people in strict order of their vulnerability, first to care home residents and health and social care workers, then by descending age in five-year bands. The health services managed to roll the vaccine out relatively equitably, which is widely thought to have saved lives, but the roll-out hasn’t been perfect – vaccination rates have been lower among pregnant people, Black people, and people of South Asian descent, for example.

In some other countries, like the US, although priority was given to the elderly and vulnerable, there was something of a scramble for the vaccine initially, and those with less resources were jabbed less quickly.

How does covid-19 spread?

By now everyone is probably bored of hearing that to avoid covid-19 we should open windows. But cast your minds back to March 2020, and that wasn’t the way we were supposed to stop this virus. Then it was all about hand-washing.

In the UK, we were told to regularly wash our hands for 20 seconds, as long as it takes to sing “Happy Birthday“ twice. Not to mention using antibacterial hand gel until our hands became raw, and sanitising every surface in sight.

What changed? Initially we thought that, like most other respiratory viruses, such as colds and flu, the coronavirus spreads mainly through contaminated hands or surfaces, with the virus being coughed and sneezed out in relatively large droplets that fall quickly, and so don’t usually spread beyond 2 metres.

Now we think that while that can happen, probably the main way the virus spreads is through tiny droplets that can float through the air for many metres. They can be generated by speech, singing or even just breathing. It might seem a small difference but it has a big impact on the precautions we take.

It makes the wearing of well-fitting face masks a safer bet than the cheaper and looser ones. It means the best thing you can do is meet people outside and if inside, aerate the room as much as possible. It’s why some people have got interested in carbon dioxide monitors, as these show how well a room is ventilated.

I have followed this evolution in thinking from the beginning of the pandemic. Scientists in the “airborne” camp would regularly complain to me that the “surfaces” lot were ignoring the accumulating evidence.

Some claimed it took so long to change minds because if the government admitted the coronavirus is airborne it would have to provide better-fitting masks for health care workers. I don’t believe most public health officials work like that. There are debates in many other areas of science that become ideologically polarised, with each side convinced the other lot have base motivations, when, in fact, people have just become entrenched in their positions.

I’m sure if a new respiratory pathogen triggered the next pandemic, scientists would not fall into the same airborne/surfaces mistake again. It is clearly time we took a new look at our assumptions on preventing the spread of flu in hospitals and care homes. Perhaps the broader lesson here is that scientists need to be more prepared to change their minds as new evidence emerges, and then communicate that fact clearly to the public.

Prioritise children

The past two years have seen an alarming rise in many countries, including the UK, of certain mental health conditions among children and teenagers. These include eating disorders, anxiety, depression and tic disorders.  Overall, the number of under-18s referred to specialist mental health services rose by about a quarter between 2019 and 2021.

It is impossible to say for sure what has caused this trend. But many child health experts believe making children stay at home instead of going to school, closing down sports and other clubs and cutting them off from their friends for long periods could have contributed.

Some of these moves were unavoidable. But in the UK, there were periods in 2020 when pubs and restaurants were allowed to be open, yet schools were closed to most children. And at the beginning of 2021, schools returned to mainly online teaching, even though by then it was fairly clear that most under-18s are at little risk from covid-19. “We must examine whether measures for schools were proportionate and equitable,” a group of leading paediatricians wrote in a letter to The Times newspaper this week.

Prepare for next time

Some of the missteps that nations such as the UK made happened because they were unprepared. For instance, initially, many countries didn’t have enough protective equipment for healthcare workers, like gloves and masks. There should be no excuse now for failing to have multiple warehouses full of such stock with appropriate use-by dates.

Much of the crucial work of the early pandemic was in coordinating scientific research, rolling out vaccine and drug trials quickly and cutting through bureaucracy to fast-track approvals for those products. Maintaining the networks that made this work possible would enable our response to the next pandemic to be that much quicker.

Covid-19 also brought with it a collective culture of public health policies that should be kept, including staying home from work when we’re sick and, if that’s not possible, wearing masks in public when we have coughs and colds. We’re all now practised at making these efforts part of our daily lives, and they will help during the next pandemic.

We must also continue the work that was going on before covid-19 arose to educate people who are hesitant to vaccinate themselves and their children against diseases. This has always been challenging, but it will be crucial to limit the fallout of any future pandemic.

 

OTHER HEALTH STORIES

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  • The long read: Why it’s time for everyone to get to know their pelvic floor better.
  • People who take the cholesterol-lowering medicine statins have a lower risk of developing Parkinson’s disease, perhaps because the drugs also protect arteries in the brain.
  • Early work in mice suggests a new way to treat pancreatic cancer that exploits immunity to tetanus from childhood vaccines.

FROM THE ARCHIVE

A persistent cough could be a sign of tuberculosis (TB), rather than covid-19, the head of the UK Health Security Agency warned last week. Last year, New Scientist reported on research that revealed the surprising origins of this ancient disease and offers hope for a better vaccine.


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