Where are we with Covid and flu, as we go into winter?

Colorized scanning electron micrograph of a cell (green) infected with SARS-COV-2 virus particles (purple), isolated from a patient sample. Image captured at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. NIH Image Gallery Wikimedia Commons

In October 2023, the BBC published an article titled Changing Nature of Covid: Is it just a regular winter bug now? The TL/DR (too long; didn’t read) answer is ‘No. It really isn’t’.

That’s not what the article would lead you to believe. It caused a lot of comment on social media, with some wanting to praise it as a calming, reasonable article and others really dismayed at the way it seemed to seriously downplay the potential harm from Covid.

It started off by discussing a lady in her 70s who, while continuing to play golf and socialise outside, has made the decision not to socialise indoors, nor take flights. This is described as ‘Covid anxiety’, rather than a person making sensible life choices based on her own vulnerability profile – the very thing we’ve been told many times over we should be doing since all mitigations were removed in 2022: make our own personal decisions. Sneeringly referring to it as ‘Covid anxiety’ is belittling.

Further evidence of ‘Covid anxiety’ was presented as the fact that Google ‘searches’ apparently “shot up” with news of a new variant and a rise in hospitalisations. The Google trends graph for searches for Covid over the last six months has pretty much mirrored the levels of the virus in the community, which isn’t a big surprise. My WhatsApp groups are full of “there’s so much Covid around at the moment” posts, when Covid cases are indeed high; and surely people will Google Covid if they, their friends and their family are catching it. There was a spike in Google searches on 18 September 2023 – the day it was announced that the Autumn booster programme was being brought forward for over 65’s, in response to the new variant. That’s not a sign of anxiety, but simply a signal that people saw it in the news and sought more information, for legitimate reasons.

The article then went on to suggest Covid was becoming just another respiratory virus alongside flu, RSV, (respiratory syncytial virus), rhinovirus and adenovirus (the last two cause colds). It showed data that last winter there were an estimated 14,000 flu deaths and 10,000 Covid deaths; this was based on estimates from the annual flu report. However,  data from the Office of National Statistics (ONS) on deaths from Covid during those months puts the number at 13,283: remarkably similar to the flu estimate. And that was only data from October to March – flu is indeed very seasonal, only spiking in the winter. Covid, on the other hand, is not limited to the winter.

In fact, the published ONS data on deaths registered in 2022 show that there were 22,454 deaths where Covid was the UNDERLYING cause of death, and only 990 where flu was the underlying cause of death. It’s only if you include pneumonia – which caused 19,274 deaths – alongside flu, that you reach over 20,000. ‘Don’t worry, Covid is no worse than pneumonia’ doesn’t have quite the same reassuring ring to it!

So, while there may have been more flu and pneumonia deaths than Covid deaths during the winter months, Covid killed more people across the year.

The article asserted that Covid came in many ’waves‘ in 2022, but that it seems to have become more seasonal in 2023. It’s true that there has been a welcome lull over the summer, but with three very distinct peaks in October, December and March, it really doesn’t fit the profile of a regular seasonal virus.

Using the hospital data from the UK Health Security Agency dashboard, you can see what ‘flu season‘ looks like and compare it to ‘Covid season’ (the graphs are to illustrate the peaks and troughs, rather than as a direct comparison of numbers).

The article stated Covid is “well on the way to becoming seasonal” and will eventually become “just another cause of the common cold”. A lull one summer doesn’t seem to me to be evidence enough to suggest it’s becoming seasonal: we’ll need to see what happens over the winter and summer months next year. As for it being anywhere close to just a ‘common cold’: Covid has killed an average of 43 people PER DAY so far in 2023. Even in the lull of the summer, the daily Covid death count never reached zero. That’s not a common cold.

One of the professors quoted in the BBC article said, “Data is good for scientists but it can cause alarm when interpreted wrongly.” I’d suggest that we need to highlight the available data, to counter the suggestions:

  • that Covid and flu are comparable (without explaining that you mean flu and pneumonia combined): they’re not;
  • that Covid is seasonal: it’s not; and
  • that Covid is becoming as innocuous as the common cold: it’s not.

‘Experts’ quoted in the article query the value of testing: “is there any point to it?”. They answer their own question, saying, “If there is one thing we have learnt from the pandemic, it is the importance of trying to stay away from people if you are ill with a respiratory virus. That is as true for flu and other respiratory viruses as it is for Covid.”

Sadly, this is a lesson we absolutely should have learnt, but in our desperation to ‘get back to normal’, it really hasn’t sunk in. Government guidance for schools is that children should NOT be tested for Covid and should come into school even when ill, as long as they don’t have a fever. Even NHS staff are advised they should come in with respiratory symptoms, as long as they don’t have a fever. They are also not expected to test for Covid.

I’d suggest that if we’re encouraging people to keep working and keep going to school when unwell, the least we should be doing is checking they aren’t ill with Covid!

When people get flu, they tend to be too ill to go out and about, making it a less ‘spreadable’ disease. Covid is much more likely to be spread because for many, it is mild. However, for the vulnerable around you, the consequences of catching Covid can still be serious. The idea that only these people should test for Covid seems like shutting the barn door after the horse has bolted.

It is absolutely true that the risks posed by Covid in 2023 are vastly different to the risks posed in 2020. Vaccinations and prior infections mean that the overwhelming majority of us have a level of protection against severe disease and death. However, with vaccine protection waning for many who are not able to access boosters, and the long-term health risks associated with each infection, Covid is still a concern that should be taken seriously.

Those long-term health risks include the condition known as ‘Long Covid’, which is not mentioned at all in the BBC article. Every infection comes with the risk of long-lasting, often debilitating health issues. A recent study (the UK’s REACT-2 study) suggests 10 per cent of Covid infections lead to symptoms lasting more than four weeks, while five per cent lead to symptoms lasting longer than one year. The most recent ONS survey on Long Covid suggest that nearly two million people in the UK are living with this long-term condition. This has a big impact on people’s lives, not to mention the economy. With an increase of about 600,000 people becoming economically inactive due to long term sickness since the start of 2020, and 762,000 people reporting long Covid lasting longer than 2 years, it’s not something we should be brushing under the carpet.

Number of economically inactive people due to long-term sickness in the United Kingdom from May 1993 to July 2023

Belittling people – especially vulnerable people – for continuing to exercise caution, is unhelpful. Avoiding a nasty virus that is linked to increased risks of all sorts of health issues, leads to long term disability in some, and continues to kill people every day, should not be seen as a niche idea!