Is Covid still a threat four years on from the first wave?

Covid cases have fallen dramatically since the first wave hit the UK in January 2020 sparking questions as to whether it is still a threat to the UK and how well prepared Britain is to another wave.

According to new analysis, the number of cases this year are just over half what it was at this point in 2023 and around a quarter of those in 2022 – and while case numbers were lower in 2021, the country had been locked down for much of the year.

“The good news is that infection rates are much lower so far this year compared to the last couple of years even after adjusting for the reduced testing,” Professor Paul Hunter, of University of East Anglia, told i.

While cases are still being recorded, there are four reasons why Covid is not the threat it once was was four years ago.

Case numbers have fallen

Professor Hunter’s analysis found that in the first 83 days of the year – to March 23rd – there were an estimated 6.3 million Covid infections in England.

This compares to 11.6 million cases in the first 83 days of last year and 25.3 million in 2022 – calculating the figure by the number of days rather than the date to account for the leap year.

In 2021 there were 2.7 million infections, according to his estimates based on data from the UK Health Security Agency (UKHSA).

Separately, Government figures last month showed that cases were at more than a three-year low – with infections reported to have fallen further since.

As Professor Christina Pagel, of University College London, puts it: “We are now four years on from the first devastating wave of Covid in England. And things are better. They aren’t perfect – I would much much prefer a world where Covid did not exist – but they are, measurably and meaningfully, better.”

Daily hospital admissions have fallen dramatically since last year

Cases are generally now much milder

Cases have become less severe partly because the virus is fundamentally not as a potent as it was earlier in the pandemic, while the population has built up a degree of immunity from vaccinations and previous infections.

As a result, for most people, the chance of either getting very sick or dying from Covid is now much lower – while many have few or no symptoms, scientists say.

“The disease is much less severe than it was when you get an infection,” said Professor Hunter.

“Since the first wave of the Omicron variant [November 2021] most people who get an infection have no relevant symptoms over the following 35 day period, based on data from the ONS survey.

“And, even if you do have symptoms, you are much less likely to be ill enough to require hospital admission or die than even this time last year,” Professor Hunter said.

Professor Steve Griffin, of Leeds University, adds: “Four years on, it’s certainly true that the level of threat from acute disease has lessened for many people as a result of vaccination and, less ideally, accumulative infections.”

Weekly Covid fell sharply in 2021 and have remained low since

The chance of developing long Covid is much lower than it was

While long Covid continues to afflict large numbers of people, new cases have fallen considerably – partly because total Covid cases are down and partly because a smaller proportion of infections these days are leading to long Covid.

A study published in October found that the risk of getting long Covid when infected with the virus was just a tenth of what it was at the start of the pandemic.

Imperial College London’s REACT study found a combination of immunity built up from previous infections and vaccinations – and the fact that the virus is less severe now than it was earlier in the pandemic – have contributed to the declining risk.

About 2.8 per cent people who have caught the Omicron variant of Covid have gone on to develop long Covid, defined as having symptoms for 12 weeks or more.

That compares to just over a fifth with the original strain of Covid, 13.8 per cent for the Alpha variant and 9.3 per cent for Delta.

And in January, Melissa Heightman, the NHS’s top adviser on long Covid, told i that most people who are going to get long Covid have probably already had or got it – while stressing that thousands more will still get it and that any case is a case too many.

Science and vaccines have played a key role

“Positive outcomes from the past four years include incredible advances in scientific understanding and co-operation between UK scientists, clinicians, and other parties, as well as excellent clinical trials assessing vaccines and therapeutics,” said Professor Griffin.

Vaccines, in particular, have been a game-changer. They reduce the risk of becoming infected in the first place but, far more significantly, they greatly reduce the chance of becoming seriously ill or dying if you do become infected.

Covid vaccines have saved more than 420,000 lives in England and Scotland, according to analysis by the World Health Organisation (WHO) published in January.

The study estimates that jabs saved 396,532 lives in England and 24,340 lives in Scotland between December 2020 and March 2023.

As such, they reduced the death toll from Covid by 70 per cent during this period, the analysis found.

The study also estimated that vaccines saved about 1.4 million lives across Europe during that 2.5 year period – reducing the death toll by 57 per cent.

What can we expect going forward?

There will be more waves – possibly several this year, scientists have told i. At the start of the year they said the UK could be hit by up to three Covid waves this year.

Experts say another winter wave towards the end of 2024 was “almost certain” and they expect at least one – quite possibly two – more wave before then.

Thousands of people are still living with debilitating long Covid. Estimates vary but around 1.5 million people are believed to have long Covid – about 350,000 of whom report that it significantly limits their ability to undertake their day-to-day activities.

Many of those with long Covid – defined as having symptoms for three months or more – have had their symptoms for one, two and even three years.

Covid still poses a significant risk of the elderly and otherwise vulnerable members of public. Professor Hunter adds: “Hospitalisations and deaths are well down but they are still it fairly high levels.

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“In the first 89 days this year there were 28,005 hospital admissions in England compared to 72,270 last year. And deaths so far this year with Covid on the death certificate are about one half of what they were last year during the same period.”

He adds: “But even though things are a lot better now than even a year ago we are still seeing more hospitalisations and deaths than anyone would say was tolerable.”

But we still do not know about the longer term implications of having Covid – for example whether it may increase the risk of dementia or other health conditions.

Covid has also put a massive – and continuing – strain on the NHS, which was already reeling before the pandemic hit, lengthening waiting lists even more. It has also taken a huge toll on NHS frontline staff with many suffering from PTSD as a result.

The booster programme is available to fewer people than it used to be. The 2023 autumn rollout already saw a much-reduced offer compared with previous years, and the JCVI notes that autumn 2024 will probably be even smaller. Pharmacies are picking up some of the slack by offering the jabs privately but many won’t be able to afford them.

“Rather than ensuring long-term population immunity via preschool immunisation and protecting all at-risk groups the current vaccine/booster strategy is becoming not only restricted, but replaced by private suppliers,” said Professor Griffin.