As an epidemiologist and NHS consultant, 2022 begins much like 2021 did – I’m again analysing data on the impact of a new Covid variant that threatens to put huge pressure on our hospitals. And I’m back on the frontline in A&E, helping my NHS colleagues to deal with that pressure.
But we are actually in a much better position, and there are good reasons to be confident that 2022 will be a much better year than 2021.
Last January was perhaps the darkest time of the entire pandemic in the UK, with tens of thousands being admitted into hospital and thousands losing their lives every week.
Now, with the majority of us well protected with highly effective vaccines, we have a much lower individual risk of ending up in hospital – or worse – if we catch Covid. The combination of vaccines and a better knowledge of how to treat Covid means both hospitalisation and death rates are now much lower, with the infection fatality rate having fallen by over 80%.
And this means that, unlike last year, our children are going back to school this week, retail and hospitality businesses are open and we are able to meet our friends and families.
Although the NHS is again under massive pressure – particularly due to staff shortages – the early indications are that we are not facing a repeat of last winter with hospital admissions rising more slowly and ICU admissions and deaths mercifully still flat. The information from South Africa and the early data from the UK gives us a realistic hope that this wave will be over quicker than previous ones, and with much less loss of life.
There are reasons to be optimistic beyond just this wave, as well. Firstly, the long-promised antiviral medicines have arrived. These new Covid treatments, which have just started being used in the UK, have the potential to transform the situation as similar medicines have done with HIV and hepatitis C. They can reduce the risk of being admitted into hospital by up to 90%, are effective against all variants, can be taken orally and are much easier to distribute than vaccines. Two are already approved but many others are currently undergoing clinical trials and should be available this year.
Next, new vaccines are in development that will make it easier to manage the coronavirus variants that will inevitably emerge over the coming year. As with influenza, “multivalent” vaccines – which protect against infection from multiple variants – will probably become available later this year.
Other vaccines that target parts of the virus besides the spike protein – parts that don’t mutate as easily – are also on the horizon. There are also vaccines being trialled that can be delivered by nasal spray, inhaler, orally and using skin patches – all of which will make distribution easier and overcome needle phobia.
But the immediate priority must be to ensure that our existing and very effective vaccines are distributed more equally across the globe. We have made huge progress, with 8.5bn doses delivered to date, but far too many – especially those at high risk and frontline healthcare workers in low-income countries – have not even received their first dose.
Vaccinating the whole world in 2022 is a realistic prospect but this will require an end to hoarding in high-income countries and a temporary lifting of patents. And this is in our interests too – we won’t be able to prevent new variants completely but we can reduce the risk by ensuring everyone, everywhere is able to be vaccinated.
Sadly Covid is not going away permanently, but we can be optimistic that 2022 will be the year the pandemic ends and it becomes an endemic disease here and in most countries thanks to the very high levels of population immunity we now have – through a combination of vaccination and natural infection. There are still likely to be seasonal winter peaks, like with flu, and an annual booster jab will probably be needed to deal with new variants and waning immunity.
Like many, I have lost family, friends and colleagues. I have seen countless patients suffer from Covid – as well as from its knock-on effects on our health services – and from the lockdowns. But the huge loss of life and pain should soon be a thing of the past.
We are certainly not out of the woods yet – cases are at unprecedented levels and rising (though more slowly now) and Covid is still a serious threat to the most vulnerable – so we need to continue following the public health guidance to protect them and to help reduce the pressure on the NHS so we can continue treating all our patients.
But there is a realistic prospect that 2022 will be the year we can begin to live with the virus – and without the fear of both Covid and lockdowns that has haunted us for the past two years.
Dr Raghib Ali is a clinical epidemiologist at the University of Cambridge and an honorary consultant in acute medicine at the Oxford University hospitals NHS trust