The COVID-19 pandemic: the third wave?

Eighteen months into the COVID-19 pandemic of 2019 and we are no clearer as to its likely ultimate outcome; comparisons with the influenza pandemic 100 years ago can only take us so far. Much has been made of the assumption that the so-called Spanish flu was caused by an Influenza virus but the more we have seen of the latest novel coronavirus the more the clinical pictures have converged, raising questions as to that original diagnosis. In both cases infection was by aerosol spread, accelerated by close proximity in crowded and indoor spaces and while usually presenting as a respiratory syndrome, multi-organ damage and failure has been a common feature.

In 1918, virology was in its infancy and the prospects of mass diagnostic tests and effective vaccines not even a distant dream. While our knowledge of the behaviour of viral epidemics in history can offer some clues as to the potential for viruses and humans to adapt to each other over time, with a shift to a more benign endemicity, this cannot be a forgone conclusion. As we have seen in recent months, virus mutation may throw up more infectious and potentially more lethal variants. Worryingly, there is also the prospect that variants may also have the capacity to elude the best that vaccinology can offer. In summer 2021, we are faced with the challenge of preparing for any of these eventualities. Our handling of the pandemic so far gives little confidence that despite the science at our disposal we have the practical imagination to rise to the task.

Since the pandemic began, we have witnessed a complete spectrum of national responses ranging from the prompt and decisive intervention in countries as diverse as China, South Korea, New Zealand, Bahrain, Finland and Norway to the disastrous in the USA, a number of South American countries, India and the United Kingdom, where only an impressive performance with vaccination has saved us from total ignominy.^1,2 Yet even here we are now faced with the possibility of grasping defeat from a very late victory by government inconsistency, indecisiveness and dithering, yet again overpromising and underdelivering by putting commercial aspirations ahead of public health considerations when they are so totally interdependent.

Most recently, the failure to act promptly in the face of the new variant, with its apparent origin in India, has allowed the variant to enter and overwhelm its competitors in the UK, spreading apace among a younger population yet to be vaccinated. This has also resulted in many older and only partially vaccinated people being admitted to hospital and intensive care with the potential for 10% or more to suffer into the future from Long Covid. And while it has long been the position of government and its advisers that the virus is relatively benign among children, news has begun to emerge from India of a new syndrome, so-called PIMS, or Multi System Inflammatory System, resulting in organ failure among children some time after they might be assumed to have recovered from the acute infection.

It defies belief that with this possibility waiting in the wings, the Joint Committee on Vaccination and Immunisation has chosen to reject the vaccination of younger teenagers in the face of vaccine approval by the Medicines and Healthcare Products Regulatory Agency. Having stolen a march compared with our European neighbours, with our nationalistic approach to vaccination procurement, we are now seeing the tortoise walk past the hare as Europeans begin to vaccinate their 12-year-olds. This not only reinforces the sense that the younger generation in the UK is an afterthought whose future lives and prospects have been of little concern to a government dominated by other interests but risks yet further iterations of the virus as it circulates among young people through the summer holidays.

The pandemic of 1918/19 consisted of three waves with a small third coming at the beginning of 1920. ³ It remains to be seen whether the COVID pandemic of 2019 is a re-run or whether in our much proclaimed scientific age the lack of practical imagination and political will deal us a bleaker hand.