The grim reality of ‘living with Covid’

I’m old enough to remember when people talked about ‘herd immunity’. The idea was that eventually enough people would either catch Covid or get vaccinated that the virus would no longer pose a meaningful threat. The problem, if I understand correctly, stems from the continual evolution of the virus and the related possibility for immune escape which means that it’ll keep circulating indefinitely. The next phase of this palliative reasoning was the assumption the virus would inevitably mutate towards being relatively benign. The problem, if I understand correctly, stems from the fact that transmissibility to some extent cancels out severity with more people developing what will often be a more benign illness (due in part to the effects of vaccination) leading to aggregate consequences which a less transmissible variant wouldn’t produce.

The grim reality which I suspect people are trying to avoid here is that in the absence of interventions we’re all going to catch Covid repeatedly with the potential for severe consequences in individual cases and heretofore unknown cumulative consequences, as this Imperial Immunologist has recently summarised:

With such large numbers having been infected at any given time in recent months, many suffering repeat infections at three- or four-week intervals, the potential legacy of chronic, disabling illness is an aspect making this utterly different from most other winter respiratory pathogens – such as flu or coldsNobody is certain whether long Covid from the current period will be quite the same as the early waves, but this is an experiment that none of us would wish to do on our children.

The prospect that we’re all going to repeatedly catch a virus with potentially severe consequences is one I find strangely difficult to hold in my mind. It’s such a grim prospect that the mind retreats from its full implications, though the rapid circulation of the phrase ‘mass disabling event’ illustrates that many people are thinking about this.

To take the LFT test as a measure I’m confident my Covid infection ended 12 days ago but last night I found myself with my heart racing, a head ache and getting out of breath from climbing the stairs. In general I’m getting exhausted easily and finding that a fogginess intermittently descends on me particularly when I’m doing something cognitively taxing. My infection was relatively mild and with the exception of last night there’s been clear progress with my post-infection fatigue which leaves me confident I might just have a few weeks of this at worst. But it feels clear to me this is not just the flu, even my experience of the Omicron variant after 3 vaccinations was eerily like a short, sharp flu. It leaves me wondering what happens the second time I catch it, the third time, the fourth time… I’m 36 and would hope I’ve got at least another 36 years of life ahead of me. That provides the opportunity for a lot of Covid to enter my system in the longer term.

What should we do with this? I’m increasingly convinced zero Covid (which I did believe in earlier in the pandemic) is probably untenable with a virus this transmissible, or at least the costs of pursuing it are so severe as to outweigh the gains. In general it’s always seemed obvious to me that lockdowns were a policy of failure, even if they were at points necessary in order to forestall a bigger disaster. But it doesn’t follow from this that we should do nothing. If there’s a cumulative damage likely to ensue from Covid then it’s surely rational to take steps to minimise the quantity of virus you encounter on any one occasion and the cumulative infections you’re likely to encounter over the lifetime. The degree of control we have over this as individuals is limited but it’s not non-existence and furthermore there are all sorts of measures which could collectively minimise risks without entailing the large scale disruption seen in earlier phases of the pandemic, as Christina Pagel describes:

We need to rediscover our ambition to improve public health as we did in the 18th and 19th centuries. We can introduce serious upgrades to infrastructure: better ventilation, less crowding, increased air purification and sterilisation, more green spaces, changed work practices. We can also tackle inequalities with improved sick pay and housing and population health. All of this is beneficial over and above Covid. We can do it, but we first need to stop believing in these persistent myths.

I’m increasingly depressed about the fact that British politics has now seemingly decided that long Covid suffers and the immunocompromised should be ignored because recognising their existence renders the current Ostrich strategy of literally pretending Covid doesn’t exist morally untenable. But the evidence suggests the size of the former group will only grow with time, raising the question of how, if at all, their needs will be responded to. I’m not optimistic about what the future will bring and I’m genuinely stunned that a crisis of this magnitude has produced a moral economy which is even meaner and less solidaristic than the one which preceded it.

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