The covid-19 lockdowns undoubtedly saved many lives, however the extended restrictions additionally lowered our publicity and immunity to different infections, which may very well be set to spike within the UK this winter
29 November 2022
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I’ve been debating with a few of my colleagues about whether or not there’s a post-lockdown “immunity debt”. This is the concept that some international locations are experiencing extra respiratory infections than in pre-pandemic years due to the lasting affect of the lockdowns used to manage the unfold of covid-19.
The idea is accepted by many docs, so I used to be stunned to see that there have been a couple of articles within the press saying there isn’t a such factor as immunity debt. These had been primarily from US news websites, however there was additionally an opinion piece within the UK’s Financial Times (behind its paywall) that claimed immunity debt is a “misguided and dangerous concept”.
The confusion is partly as a result of the time period “immunity debt” means various things to completely different individuals. Fanning the flames is the truth that something to do with the coronavirus, and the way international locations responded to it over the primary two years of the pandemic, has develop into politically polarised.
It appears that at one excessive there are the covid cautious – in favour of extended lockdowns, and necessary face masks and vaccines – whereas on the different there are covid denialists, who say there was by no means any want for such measures. Or maybe I spend an excessive amount of time on Twitter.
So, what are the details? There is little doubt that within the first two northern-hemisphere winters of the pandemic there have been far fewer circumstances of winter infections, corresponding to flu, respiratory syncytial virus (RSV) and another respiratory diseases, in contrast with in pre-pandemic years.
It isn’t controversial to say that is the almost definitely rationalization for the present excessive charges of such infections in locations such because the UK and the US. Rates of flu in England, as an example, have thus far been usually greater than double the equal figures for the winters starting in 2018 and 2019. In truth, the UK Health Security Agency mentioned in September this was one cause why the nation’s flu vaccination marketing campaign was so essential this 12 months.
When it involves RSV, docs are writing papers in medical journals calculating the variety of additional circumstances of RSV as a result of immunity debt, corresponding to this one which appeared in The Lancet Infectious Diseases in September. UK paediatricians are involved that kids will face a excellent storm of well being points this winter.
By all these measures, immunity debt is a really actual phenomenon.
On the opposite hand, some commentators on social media who lean in direction of covid denialism argue that the present larger ranges of respiratory infections present that kids’s immune programs have been broken by their lack of publicity to the traditional childhood infections. To be clear, this isn’t the case.
Some kids will simply be getting the diseases they might ordinarily have had one or two years in the past, though the actual fact they’re taking place abruptly can overwhelm well being providers. UK paediatrician Alasdair Munro argues right here that there may very well be general extra infections within the years following lockdowns than there would have been if all of the circumstances had occurred as regular, due to the advanced combine of things that usually govern the rise and fall of inhabitants immunity.
Whether he’s proper or not, immunity debt doesn’t help the argument that we shouldn’t have had lockdowns. In the primary 12 months of the pandemic, the infection-fatality fee for covid-19 was over 1 per cent. It doesn’t bear fascinated by what number of deaths there would have been if the virus had been allowed to unfold unchecked.
Thanks to the arrival of vaccines and the milder omicron variant changing into dominant, the present covid-19 infection-fatality fee is assumed to have fallen under 0.04 per cent within the UK, which is the speed for seasonal influenza. This contributed to nearly all international locations abandoning most covid-19 restrictions at various timepoints in 2022.
But arguments are nonetheless raging about which was the higher covid-19 coverage initially – to lock down or let it rip. And that colors practically each new growth within the coronavirus story, together with which inhabitants teams must be provided booster vaccines and, in fact, the most recent give attention to immunity debt.
The FT opinion piece I discussed earlier tries to resolve these variations by saying that it’s true that lockdowns trigger immunity debt on the inhabitants stage, however not on the particular person stage. But to me that’s a false division.
The long-term impacts of lockdown are actually affecting people, corresponding to those that now have flu who may not have caught it in any other case. They additionally have an effect on people who’ve difficulties accessing medical care as a result of providers are overwhelmed, as is occurring in some elements of the UK.
It is feasible for 2 issues to be true: it was proper to have lockdowns and but the restrictions additionally had downsides. Pretending these downsides don’t exist when they’re staring us within the face doesn’t win any arguments.
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