What do I really think about Covid?

The 'affect heuristic' – in which people make judgements and decisions by consulting their emotions: Do I like it? Do I hate it? How strongly do I feel about it? instead of really putting the time and effort into answering the harder question of What do I really think about it?

I’m not a scientist. I’m not highly educated. I do live in England (UK).

In an attempt to separate feeling from information, what follows is my own 'affect heuristic’ take on something that I simply can NOT be an expert on. This is not advice. Covid-19 is more complicated and nuanced depending on who you are and your own circumstances but here is my actual thinking based on the data as I read and understand it (for myself) as of today (11th March 2022):

73.3% of the *total UK population* have had at least two vaccine doses. For the first time in the pandemic, a Covid infection in England now (currently) carries less mortality risk than a Flu infection in England – let that sink in.

For most people in England who’ve had the vaccine this is hopeful good news; but as with all serious infections there remains a disproportionately greater risk to anyone who is Immunocompromised (including severe immunosuppression, cancer and organ transplant patients, etc…) or Clinically extremely vulnerable (CEV); or anyone unable to be vaccinated because of legitimate medical reasons.

Anyone refusing to have a vaccine is beyond my reasoning.

Today (11th March 2022) England remains officially in a “pandemic”. A downgraded threat level to “endemic⁽*⁾” would require having a more stable UK baseline rate of disease – our baseline rate is showing incremental signs of hope, so fingers crossed that can happen at some point in the future. However, variants are inevitable over time and we don’t know what they will bring (we can consider them a ‘known unknown’). Sadly almost 1/3 of people report having at least one long-covid symptom even 6-12 months after infection and we still don't know how even a low level infection may impact our immune system long term (it’s a serious ‘known unknown’ and deserves serious caution but to avoid utter panic we must also remember that even the common flu can cause complications and changes in the brain – newspapers don’t push those headlines and science is always hard at work). Thankfully the experts (scientists, virologists and data scientists/statisticians) continue to report and monitor our Covid Pandemic Data in an attempt to protect Public Health for us all. I trust in them and science. I also continue to keep one eye on long-covid research and immunology.

Every adult in England has been offered the vaccine and new guidance came into effect on 24th February 2022 for people whose immune system means they are at higher risk. The UK Government ended the official Shielded Patient List (SPL) programme in September 2021 but an eligibility criteria for new treatments including antibody and antiviral now exists.

Wearing a mask on public transport or in high-capacity indoor public spaces is NOT a legal requirement (except in hospital/care) but personally choosing to do so is respectful of the 3+ million people (over 6% of England) who are Immunocompromised, plus anyone Clinically extremely vulnerable (CEV); plus anyone with an illness or disability that actually restricts them from being able to wear a mask. And not forgetting all children under 12 who are not yet eligible for a vaccine⁽*⁾.

⁽*⁾ New source/data inserted since publication date.

So, my back-of-an-envelope calculation suggests 10% of people in England (one in ten!) therefore still deserve my/our extra consideration and respect in public-spaces. Whether they’ve been able to have the vaccine or not.

NHS England currently has enough Personal Protective Equipment (PPE) in stock and their internal ordering is business-as-usual. Whilst medical grade masks are now widely available online, if affordable, and to help plan against future infection rise or variants in colder months, it probably remains sensible for everyone to own masks capable of filtering particles with a diameter <0.3 micrometer (μm). FFP3 certified masks without a valve provide the best level of protection against very fine airborne/aerosol particles such as Covid-19.

Todays numbers (via John Burn-Murdoch of FT / LSE Data Science) have moved me from being ‘extremely cautious’ to ‘cautiously optimistic’.

Since 2020 I have acted with extreme caution towards Covid because I had the privilege of choice – the very definition of 'unnecessary risk' was different for me. I’ve been extremely lucky to have the freedom/option of making all my own decisions early and the ability to isolate for two years (choices most people have not had). I still fully expect to catch covid at some point in the future (almost everyone I know has already had it at least once or twice – all because they had to ‘go out’ to work to survive). I work remotely from home and I don’t have children. I also have the internet and follow verified sources of information so I was isolating and making careful community and business decisions weeks before our government officially locked us down in 2020 (I've always tried to do the right thing at the right time). I changed my lifestyle early and workspace accordingly – people and businesses rely on me – for me getting ill was avoidable and extreme caution was a wise necessity (I'm self-employed and don’t get Statutory Sick Pay and like many others my income has gone down because of Covid, not up). A weekly shopping delivery means I haven’t needed to leave the house. For the well-being of everyone I think I’ve left home no more than 40 times since 2020 – that is no exaggeration. I haven’t had a haircut since Jan 2020. Mentally I’m good (I was overwhelmed, unorganised, numb and psychologically exhausted throughout 2020) but I’ve kept myself occupied (mostly work related). Throughout everything I’ve read non-fiction and done a lot of thinking, I've also had the luxury of Xbox Game Pass and Netflix – I've caught up with friends mostly via phone and online. Physically I’m much weaker than I used to be. I’ve lost 6+ kilograms in weight – a lot of muscle – because I’ve not taken proper walks or exercise. But walking around an urban area cost me more in headspace than it gave me so it felt much better not too – a certain level of Hypervigilance/awareness makes me good at my job but it has psychological downsides in a pandemic.

I know that ‘I’ as an individual have taken all the steps I possibly can to keep others safe and supported, and myself sane. Despite what it has cost me in reduced physical fitness I can look myself in the mirror and be almost certain that I have not infected anyone directly. I am utterly grateful to all our frontline staff, volunteers and key workers for putting others before themselves, and to farmers, delivery drivers, postal staff, warehouse and distribution workers and all others for keeping our country fed and businesses running – thank you! I really do recognise my luck and privilege and I feel ashamed about all the people, families, parents and children who’ve had to endure our governments mess on a daily basis. I’ll continue to support and donate. All who've lost lives and all those still suffering, you are not forgotten.

"Wrong is wrong, even if everyone is doing it. Right is right, even if no one is doing it."

Out of respect for everyone listed above, and for my own peace of mind, I will be wearing an FFP3 mask on public transport and in high-capacity indoor spaces like cinemas, petrol stations and supermarkets (I remain unsure about the practicality of indoor gyms). Personally, I would much rather be criticised for being over-cautious in the name of Public Health (at no cost to anyone) rather than be under cautious or complacent (at a cost to someone, or everyone). I believe considerate citizens share my conscience but I also recognise many will not (people will be people; long live free-speech). My personal approach comes down to “If the cost is my own peace of mind, then it is too expensive.”

I’m fully vaccinated. Science considers me 75% efficacious (safe) for the full year ahead (2022). Psychologically and physiologically it's going to take me some getting used to – most people haven't had any choice but to acclimatise to a 'new normal' already. Using the boiling frog apologue, I'm a frog yet to hop back into warm water but thankfully science has handed me a thermometer already, as well as a portable Air Quality Monitor. I'm still in no rush to take unnecessary risks or even get a haircut but I will no longer hesitate to go out, visit a quiet pub or restaurant I know well (midweek), or meet for a coffee – I really do need to spend quality time with family and friends (we're all vaccinated). I’ll prioritise well ventilated venues and outdoor places (thankfully Spring and milder weather is soon upon us). I will be wearing an FFP3 mask on public transport either way. I’ll take showers on evenings instead of mornings. I reserve the right to change my mind and adapt if the data gets worse, or hopefully shifts from ‘pandemic’ to ‘endemic’.

"Act like you are infected, not avoiding infection. You won't ever know if what you did personally helped. That's the nature of public health."

The pandemic continues to be one impossible decision after another. The only choices are hard, or harder – all impossible, some less bad than others. Our health professionals have done an amazing job with the resources our nation is lucky to have. The British government have made some terrible decisions, some of them have been necessary, others have not. Only time will reveal the true consequences and enable global understanding of successes and failures.

Having money has been the UK's biggest advantage and it has made our population safer and luckier than most. Our government had the resource of money to buy vaccines early and make them available for free to our entire population. Money has also delivered free covid PCR and LFT testing for everyone. Most other countries have not been so fortunate.

From a public communications perspective we are again more fortunate than most. We have access to the BBC and the Internet. 87% of all adults in the UK use the internet daily and almost all have smartphones. Our talented Digital Government Service created the best Covid-19 Dashboard in the world and lots of people were able to access it. Even our hidden sewer wastewater provides us actionable data. All this expensive and necessary infrastructure has kept us informed, connected and safe. It is impossible to under-estimate how positive and valuable this has been for us all.

Today, England remains in a “pandemic". Yet our government acts to “encourage personal responsibility” and “common sense” by removing mitigations against the virus, withdrawing funding from the 4.7 million active users of ZOE Covid Study, and will stop supplying free Lateral Flow Tests for almost everyone on 1st April 2022. I expect the tracking and recording of covid data will suffer but I’m no expert. I know of one person who has been to a pub almost every week for the past 8 months and who hasn’t done regular LFTs so if there are lots of people like them about I can see how the overall LFT data might no longer be deemed valuable or worthwhile and why the ONS Infection Survey may now be the more reliable data source (or perhaps not). The way data is reported really matters⁽*⁾.

For as long as I can, I will remain symptom-aware and continue doing Lateral Flow Tests on day four (symptoms or not). I say day four because I've seen many twitter users suggest a) Antigen swab / Lateral flow test (LFT) often shows the positive red line ≈96 hours after initial infection point. b) swabbing tonsils and one nostrel provides a more reliable result for LFTs. c) earlier symptoms mean book a PCR test because Polymerase Chain Reaction (PCR) tests are more sensitive, especially during the early stages of infection, and results are highly accurate.

Going forward:

“If a decision is reversible, make it as soon as possible. If a decision is irreversible, make it as late as possible.” – this simple mental model has been invaluable to me throughout the entire pandemic. It is the central reason I decided to act quickly in Feb 2020 and go into semi-isolation before most people in England had even heard of coronavirus. No matter what the future holds I/we can NOT expect our government to act quickly (democracy is messy and slow) but there is absolutely nothing stopping us as individuals from keeping up with the data and moving fast to make our own informed decisions if/when our data changes.

If we as humans are compromising our physical health or our sanity, we are not adapting. We are instead weakening our ability to successfully (and biologically) respond to changes in our environment. I am not Immunocompromised. I'm vaccinated and boosted. After two years in isolation my physical and mental fitness has been impacted and my eyesight has declined through too much screen-time. For my own sanity and well-being I must get back to exercising, going outdoors and socialising. Visceral fat is an accurate predictor of obesity-related disease risk and poor lifestyles lead to vitamin deficiencies – both increase the risk of covid infection and/or long-covid – to my knowledge elevated blood glucose can facilitate virtually every step of a SARS-CoV-2 infection. As an otherwise perfectly healthy 42 year old, today’s data tells me it is now time for me to change my approach and *cautiously* start living again (not just existing, remotely).

PS. as I hit publish on this post I’m aware of some BA.2 Covid Variant charts being shared online and concerns about rising infection rates (again) but to my knowledge the actual growth is more in *incidental patient* numbers (Ie. people who went to hospital for another reason but were then incidentally/fortuitously tested and casually found to have asymptomatic covid) and that should not be too surprising or overly concerning to anyone vaccinated and boosted – I gather the best scientific consensus/explanation so far seems to be that such a result simply confirms the new variant may be more infectious/transmissible⁽*⁾ than past variants, but is still unlikely to be more severe because incidental patients would appear not to report symptoms in advance. Over the past two years we've seen Covid-19 go from an R0 of ~2.5-3 to ~6 for delta; and now whatever BA.2 may be⁽*⁾. Hospital admissions surveillance is ongoing⁽*⁾ to help us all better understand asymptomatic patient numbers relative to cases of severe disease⁽*⁾; plus the relative level of NHS staff sickness and absence⁽*⁾. Of course, any highly transmissible variant does inherently increase the likelihood of infection and with it a possibility of encountering long-covid or severe disease. There are definite risks (which are exacerbated even more so in low vaccinated or ageing populations). I’m just not currently seeing any data that suggests BA.2 is more severe or dangerous, especially for the 73.3% of the UK population who’ve had at least two vaccine doses and thus have at least some antibody percentage⁽*⁾. We already know that infection acquired immunity is inferior to the level of immunity achieved by actually getting vaccinated and boosted. One important caveat I foresee however – jabs and boosters wane over time and successful mitigation measures like masks and 'work from home' have been dropped in favour of "not so common sense⁽*⁾" and infection track and trace has less funding to operate. It would be foolish not to acknowledge uncertainty before new generations of vaccines are available. I for one will also be keeping an eye on re-infection data as studies continue to develop⁽*⁾.

If you are a Scientist, Virologist or Data Scientist/Statistician who sees errors in my sources or my attempts to understand please do correct me.

My top six covid concerns, in order of priority for our society:

1. The pandemic and lockdowns have led to a measurable reduction in average school pupil IQ and increased mental health issues across society. Our children (the future) need more support in their education and mental health services need rethinking for everyone. A functioning democracy requires all citizens to have a level of education (in terms of having the ability to navigate information and determine fact from fiction to make informed choices). The pandemic has proven we as a society have a big problem.
   
   
2. NHS Staff, Teachers and other frontline staff should be a national priority. They are burned out and many are traumatised. We need to invest in them and the future of our Healthcare and Education systems. Such investments aren't entirely separate either, surgery and cancer care will have serious delays for years until both healthcare and education is better.
   
   
3. "Low levels of infection *and* High levels of immunity" should be the goal (for the UK and globally!). Any 'high levels of infection' in either high-immunity or low-immunity populations still chance immunity resistant variants (a 'known unknown' and more possible 'unknown unknowns'). No matter what way I look at it, high levels of infection anywhere in the world should be considered a big problem and a risk for everyone globally! Covid is not over in England (UK). We must and should be helping the world vaccinate. Until everyone is safe no one is. If landmass reflected the number of unvaccinated people, this is what the world would look like. This is not the first pandemic and nor will it be the last. We need to put people before vaccine patents and pandemic profiteering. We (Humanity) should be investing in vaccine infrastructure and pandemic defence at a global level, together. Experience shows us that pandemics have the ability to impact Humanity and increase global inequality and so if we believe in Humanity we must have a plan to tackle future pandemics and we must learn from what happened.
   
   
4. It is not wise to be complacent. A novel coronavirus is not 'the Flu' and drawing direct comparisons between the two is naive and risky. Covid-19 (SARS-CoV-2) is a vascular disease – the virus enters the body through the mouth/nose (or sometimes eyes) and initial symptoms commonly impact breathing/lungs/respiratory systems (often with a few symptoms similar to the flu) but as a vascular disease Covid-19 attacks blood vessels and multiple organs and some variants are more suited for attacking the vascular system – they have more 'known unknowns' and 'unknown unknowns'. Science is always hard at work. Some ongoing studies suggest Influenza 'the Flu' virus could be a cause of Parkinson's Disease a decade later. Other ongoing studies suggest Epstein Barr Virus (EBV) could be a cause of Multiple Sclerosis and Breast Cancer; and Human Papillomavirus (HPV) could be a cause of Cervical Cancer. The number of UK cases of Hepatitis (inflammation of the liver) in children has increased since covid locked us all down⁽*⁾ and public health doctors and scientists are looking into what could be causing this – the scientific community are of course investigating covid correlations but many anticipate that a lack of exposure to more common colds/infections during lockdown has simply resulted in children being more susceptible to the previously common hepatitis causes. We can’t yet know or understand the true consequences of lockdowns, covid infection or the impact of long-covid with similar symptomatology profiles⁽*⁾. We do know FFP3 certified masks provide the best level of protection against very fine airborne/aerosol particles. We also know that infection acquired immunity is inferior to that of actually being vaccinated. But of course more scientific research⁽*⁾, data and public information journalism⁽*⁾ is needed. Disease surveillance and tracking needs continued investment and forethought – we must be proactive and aware, not reactive or complacent. Social proof influences awareness and behaviour so you really should understand and consider how that effects you⁽*⁾.
   
   
5. Our government has a credibility problem which will lead to future public health problems and greater inequality. The failure of institutions and a lack of public trust leads to vaccine hesitancy. Inequalities of wealth and social privilege give rise to an inequality of responsibilities. The wealthy and powerful must shoulder the burden of social responsibility, which in effect is the price of privilege. Vulnerable people and minority communities in our society (and oversees) need our focused support and investment.
   
   
6. Our economy is stressed in more ways than one. Our economy needs to ‘work’ in order to support investment in everything else. I understand that many will place the economy as priority #1 but points #1 to #5 provide some of the Why.

What do you really think about Covid? Without consulting your emotions, try to put the time and effort into answering the hard question(s) for your own sanity and everyone's well-being.