Tdamn me, no one, even in public health or medicine, wants to talk or think about covid-19. The trauma of those pandemic years is burned into our minds. But, whether we want to deal with it or not, Covid-19 still affects us all, and is circulating at quite high levels in Britain this month. While community surveys are no longer conducted by the Office for National Statistics to estimate overall cases, hospital data from England indicates that the weekly hospital admission rate for Covid-19 is at 4.64 for every 100,000 people, with the North East region at 8.91.
These figures only cover people admitted to hospital and do not reflect those suffering at home or attending GP clinics. While during the pandemic we were mainly fixated on death rates, the longer legacy is about people who had the infection and cleared it, but are still suffering – commonly referred to as long Covid.
This chronic condition still has many questions hanging over it. We are still learning about its overall prevalence in the population (estimated at 5.5% of those infected in the UK in one study, and 15% in another study from the US), and there is ongoing research into the underlying biology and immunology behind symptoms, including efforts to identify markers for diagnosis, as well as work to promising treatments. Sufferers had to fight firstly to have their condition recognized as “real” (instead of a fabrication or a sign of mental weakness), and secondly for medical services to provide support and care.
Recent concerns about economic inactivity (ie people who could be in the workforce or looking for work but aren’t) is linked to the growing percentage of those unable to function due to prolonged Covid. A study in the Lancet in August 2021 estimated that 22% of people with prolonged Covid were unable to work, and 45% were on reduced hours. A 2023 study from the USA surveyed more than 15,000 people with previous Covid-19 infection and found that 40% who reported symptoms were unemployed. Viewing the issue from an economic perspective, the authors noted that “acute Covid is a pandemic; prolonged Covid can be a mass-incapacitating event.”
Fortunately, studies are also coming out that detect and understand the condition and how to prevent it. A recent study in the New England Journal of Medicine found that vaccination greatly reduces the chance of serious problems from prolonged Covid. The authors used health records of approximately 440,000 military veterans infected with Sars-CoV-2 in the US to look at the impact of vaccination on reducing long-term symptoms associated with the disease.
The study found that the incidence of symptoms one year after infection during the pandemic decreased from 10.42 cases per 100 people for unvaccinated individuals in the pre-Delta period, to 3.5 cases per 100 people for vaccinated individuals in the Omicron period. They estimate that about 72% of the decline in long Covid was due to the vaccines, while 28% was linked to changing variants. The authors emphasize the importance of vaccination to reduce lingering Covid symptoms, but say that even with vaccination and in the Omicron era, a significant number of people suffer from prolonged Covid after infection.
Where does that leave us? Currently in the UK, Covid is circulating at a high level. While vaccination rates were high in 2021 and in 2022, they dropped off in recent years due to limited criteria on who can get one. Very few groups eligible for an autumn booster: adults 65 and over, residents in care homes, frontline NHS and social care workers, as well as those in high-risk groups. The general population can get the Covid-19 vaccine, but it is expensive, for example at nearly £100 per dose at Boots. Compare this with the private cost of a flu shot of just under £22.
Given the limited NHS budget, decisions must be made about a cost-benefit basis about whether rolling out vaccines to the wider population (at a cost to the government of £25 per dose), or subsidizing the private cost of jabs, is worth the potential benefit. This benefit was assessed by looking at what it would cost the NHS to admit people to hospital, and what the savings could be with vaccination. Given this new study, it is worth looking at the benefit also in terms of savings to the economy of keeping people in good health and in the workforce, and reducing the costs of those who use NHS services for a long Covid search.
In the USA, Canada and AustraliaCovid boosters are free for everyone, regardless of immigration or insurance status. France It seems likely that he will continue his free booster policy until this fall. Looking at other countries’ policies, the UK is the outlier in continuing to restrict free boosters to certain groups.
As we start to look ahead to winter, I hope that research groups will start to publish revised estimates of the cost and benefit of offering the Covid booster for free, or at the lower £25 cost for which the government can purchase shots. the ones they want. Calculations should include long Covid to truly reflect the cost of not vaccinating in terms of illness and time off work, even if it does not result in hospitalisation. Avoiding the population-level effects of disease is not only good for the individual, but also for the NHS and the wider economy.
