Nicole Abel, 29, assumed it was just a sore throat, the first symptom she always gets at the start of a cold. The Clapham-based marketing executive decided to plough on and go ahead with her weekend plans, telling friends she was probably just run-down after a busy work trip in Canada.
It was only four days into her return to London that Abel decided to take a Covid test, “just in case”, because she’d been on a plane and had some free tests lying around. “It really shocked me,” she says, when she tested positive. “I hadn’t even realised a sore throat was a symptom.”
Abel’s story is a common one across the capital at the moment - though many of us might not have realised it yet. While official guidelines are yet to be updated, a sore throat is currently the most common Covid symptom, with fever and loss of smell much rarer, according to health experts warning of a “twindemic” of Covid and flu this winter. Latest data shows Covid infections have increased by 14 per cent in the last week - the biggest rise since the summer - with a sore throat affecting two thirds of the UK’s current million or so cases of the virus.
“Fever and loss of smell are really rare now. So many old people may not think they’ve got Covid. They’d say it’s a cold and not be tested,” professor Tim Spector, co-founder of the Covid ZOE app, said this week as health bosses warned of a “perfect storm” for an autumn wave. So why haven’t official guidelines caught up? How high could actual Covid rates be at the moment, if so many of us don’t even realise we have it? And are rising cases just an inevitable, as the UK faces its first winter in three years with no restrictions?
For most experts, it’s too early to say. Scaremongering headlines about “devastating” new Covid waves, “perfect storm” conditions for new variants and a “double threat” of low immunity and widely-circulating winter viruses are unhelpful and often overly-dramatic, but not entirely without basis. Comments like Joe Biden’s recent declaration that the pandemic is “over” was also wrong and even more unhelpful. “We’ve got [Covid] forever: it’ll continue to pressure on the NHS forevermore,” says John Edmunds, a professor of infectious disease modelling at the London School of Hygeine and Tropical Medicine.
Predictions for the coming months are difficult and varied, but most experts agree that rising figures should at least be a “wake-up call” as Britain finds itself facing several new crises since the last wave: the NHS facing its toughest winter yet; our immune systems being weaker than ever thanks to three years without the flu; and the worst cost-of-living crisis in generation, limiting the ability of thousands to afford tests and take time off work for isolation.
The latest surge in cases is already being called “a very heavy straw on the camel’s back” for UK hospitals, with 7,000 people hospitalised with Covid in England last week alone - a 37 per cent rise on the week before and the equivalent of seven per cent of hospital beds in the UK. Despite cases rising mostly sharply in secondary-school age children as schools go back after the summer holidays, most of those hospitalised have been vulnerable and elderly patients. Nevertheless, “the fact there are people getting so seriously ill they need to go into hospital is a wake-up call to us all that Covid is still here,” Dr Thomas Waite, deputy chief medical officer for England, said this week.
Indeed, patients like Abel are among the lucky ones, relatively speaking. She had a stash of free tests at home, she’ll receive sick pay if she has to take time off work, and - so far - her symptoms are yet to worsen into a full-on fever. Many are not so fortunate. “It feels like razor blades in my throat and like I’ve been hit by a bus... I couldn’t have left the house even if I wanted to,” says Georgia Lewis, 46, a writer from Morden. She is worried about her husband, who is clinically vulnerable and just tested positive.
Zoe Watson, a GP in Walthamstow, points out that infections don’t just mean an increase in patients for the NHS, but fewer staff. “Lots of my colleagues and myself have been wiped out with horrific viruses lately - and when staff sickness happens to an already struggling NHS workforce, this has a huge ripple effect,” she says. “Staff sickness and an increased patient workload combined with the current economic crisis spells disaster for the NHS, as we all know an economic crisis mean cuts. Given that the NHS is already operating on an extremely tight budget, many people fear that this could be the final nail in the coffin.”
We all know an economic crisis means cuts... The NHS is already operating on a tight budget, many people fear that this could be the final nail in the coffin
Others are equally concerned about the financial implications of catching the virus on individuals. “I’m terrified about this winter, to be honest,” says PhD student Sarah Montgomery*, 27, who had Covid last week. As a part-time teaching associate, she is paid by the hour and only just manages to make ends meet when she’s healthy - a week off work would mean losing £200 of pay and a new pack of tests (just under £10 for five) would mean not being able to afford public transport for a week. “I can’t afford to take time but I also can’t afford to stay at home for a week because of the electricity bills,” she says. “I dread to think what’ll happen for anyone in my situation who catches Covid in the next few months.”
So is Britain facing its third Covid Christmas - or worse, a “twindemic” Christmas plagued by both Covid and flu? Dr. Hana Patel, a GP and Mental Health Coach in Dulwich, believes the answer depends on how the Government and the general public handle the virus over the next few months - particularly the flu. “This year as last year, people were mixing less due to restrictions and more people were working from home, meaning that people now have lower levels of natural immunity to flu,” she says of the particularly severe strain of flu expected to hit the UK this winter.
Dr Charles Levinson, CEO of urgent GP service Doctorcall, agrees. “We’re all aware of the dangers of Covid, but influenza is horrific and can kill thousands,” he says, pointing to the situation Down Under. “Australia [which is currently experiencing its worst flu season in five years] is usually seen as a precursor for our winter and they have had an extremely tough time.”
He and Patel believe the answer to making sure the UK doesn’t follow suit is getting high-risk members of the public vaccinated, fast. “As a GP, we are encouraging everyone who is eligible for a free flu vaccine and a Covid booster to take up the offer as soon as possible, particularly younger children at risk of flu as they have not built up their natural immunity to flu,” says Patel. She is also calling for people to be proactive in sharing booster information with others. Both “twindemic” jabs are free and can be booked online on the gov.uk website now.
Among the millions eligible for the Covid booster are the over-50s, care home residents, frontline health and social care staff and the clinically at-risk - so will it be opened up to the rest of the population after that? Edmunds says it’s too early to say but it’s certainly “not a given”: rolling out boosters is expensive and dispruptive, so it might just become a winter routine for those at high risk.
To speed up the roll-out, Levinson is among those currently calling on the Government to allow private providers to deliver Covid boosters as they do the flu jab. “At the start this was not feasible because of supply, but that is no longer an issue,” he says. “It would increase immunity coverage at no cost to the taxpayer, give extra choice to individuals or business and organisations and also have the added benefit of reducing unplanned absenteeism.”
Levinson and Edmunds believe that future lockdowns should be avoidable if vaccines are delivered quickly enough - but what if new variants emerge that the current vaccines don’t protect against? Recent weeks have seen reports of a “downscaling” of Covid testing laboratories since the unveiling of the Government’s Living with Covid plan and Edmunds says he does worry about the drop in surveillance. Among recent warnings are that the UK is “blind” to the behaviour of potential new variants and that sub-variants of Omicron are becoming immune-evasive.
“Mass-participation events like the football World Cup taking place in November, international travel growing rapidly, differing vaccination levels across the world, and with most countries having relaxed entry requirements, a rise in cases and emergence of newer variants cannot be ruled out,” immunologist Professor Denis Kinane said this week.
Levinson admits that new variants and sub-variants are indeed a fear - improved testing will be needed to help detect them. Free tests stopped being made available to the public in April and they now cost upwards of £1.70 per test, which has lowered the number of people getting tested. “We’ve really taken our eye off the ball with Covid tests... It’s going to be a problem”, virologist Professor Lawrence Young said of the testing situation this week. “We can only detect variants or know what’s coming by doing sequencing from PCR testing, and that’s not going on anywhere near the extent it was a year ago. People are going to get various infections over the winter but won’t know what they are because free tests aren’t available.”
Indeed, £1.70 might not sound like very much, but for many people up and down the country, it’s the difference between being able to eat lunch or not. “I’m going to really struggle to pay for any more tests,” says Montgomery. She will, because - morally - she couldn’t face the prospect of infecting others, but “it’s become a case of: what do I not buy instead?”
Montgomery is among increasing swathes of the public calling for tests to be made free again amid the cost-of-living crisis, and many believe additional support is needed, too. For people at the lower end of the income spectrum, it’s not just the cost of testing that worries them this winter, but taking time off work. Again, Montgomery will isolate if she tests positive again as she couldn’t face putting hundreds of her students at risk, but she’ll lose at least £200 per week she takes off off, which is “a significant amount” and will affect whether she can afford to turn on her heating.
A quick scroll on Twitter shows that Montgomery is not alone. “I have to go back to work (probably still with COVID, but I can’t afford the test) because if I don’t, we won’t have money for rent or electricity this month. I don’t get a cheque for doing the right thing, I get financially punished,” one person wrote this week. Another, a TV producer from London, recently tweeted: “I can’t afford to lose any days to Covid - don’t work, don’t get paid,” adding that she’ll be wearing the highest-protection masks she can find this winter because she “can’t afford to lose any days to Covid.”
I can’t afford to take time off but I also can’t afford to stay at home for a week because of the electricity bills
So will masks and social distancing become mandatory again? Levinson admits that while masks “should not become mandatory and they not part of the future we all want”, they can play a role. “Public advice to wear masks in crowded places such as Tube trains may be appropriate,” he says. “But we must entirely rule out any social measures beyond that.”
Adeem Azhar, co-founder of healthcare organisation Core Prescribing Solutions, agrees that a mandatory mask situation is unlikely - and even if it did happen, he thinks the public mood has moved on so much that people don’t have the patience for restrictions anyway. On an individual level, he’ll start adopting masks and social distancing if numbers continue to rise, and he wouldn’t be suprised if both measures become more heavily encouraged this winter, but much of that is already engrained in society anyway: hand-washing has improved; people don’t see vulnerable relatives if they’ve been abroad; many still wear masks on public transport. “There’s more social awareness of what’s needed [to stop the spread of Covid] now, but the narrative has changed [since the start of the pandemic] - it’s down to the individual now”.
Indeed, Azhar’s point speaks to a wider cultural split since the pandemic started two years ago. While Montogomery is among those who believe it’s our individual duty to keep Covid cases at bay to ease pressure on the NHS, Natasha Marsh*, 34, a technical recruiter from east London, says she pretty much continued life as normal when she tested positive for Covid last month. Isolation is no longer mandatory for positive cases, so she warned a couple of friends with vulnerable relatives that she had it, but otherwise spent her weekend in pubs and nightclubs as normal - a common attitude among younger generations.
“The impact of those two years of lost independence could have far-reaching consequences,” Josephine Hamson, vice president of youth research specialist Savanta, recently said of the effects on 16-25-year-olds. For many young people she works with, they already feel that the pandemic has stolen important milestones from first kisses to job opportunities; they can’t afford to lose any more.
It’s this kind of increasingly common attitude that leads many experts to suggest we won’t see a repeat of the last two Christmasses this December. Last Christmas already saw much “lighter restrictions” than in 2020, Edmunds points out, and Azhar says he expects 2022 to be “quite different” again, “probably more like back to reality... But again, that’ll be based on the numbers: is the recent rise in hospitalisations an acute problem, or will it persevere?”.
The outlook for this winter will be determined by Covid case rates and how proactively Liz Truss’ new Government decides to tackle them, but one thing’s for certain, says Edmunds: “we’ve got [Covid] forever”. Many of us might be able to live our lives relatively normally and restrictions like we saw in 2020 and 2021 might never return, but “[Covid] will be a constant drain on NHS resources forevermore, so the NHS will need more resources. It’s a whole new disease we didn’t have before, so something has to give.”
*Names have been changed to protect identities