At the time of writing I am currently muddling through my second COVID infection, similar to my first it’s been accompanied by general fatigue, headaches, coughing and the occasional spike in temperature which has often impeded my ability to sleep. I found out that I was positive with the virus after feeling particularly sickly one morning with symptoms similar to those typically associated with COVID and after venturing into my local pharmacy to buy and administer a test I subsequently confirmed my diagnosis. Free tests previously available via the NHS are no longer available, which has been the case in the UK since the 1st of April1 2022, perhaps unfortunate timing given the current situation. Fortunately continuing innovation in this space has reduced the cost of rapid tests although it appeared not their availability in the UK as the only tests I could locate were had to be requested from the counter. Despite the promise of less invasive, quicker tests the test I bought was very much the same as the tests provided three years ago2. After administering the test and confirming the result I checked the government site for guidelines. The current recommended time is five days although with the added caveat that some may still remain infectious after 10. No further instruction on this is given, aside from paying attention to ones own symptoms and avoiding those who might be more vulnerable for an additional 5 days.
As well has been well documented the UK removed the legal requirement to self-isolate3 in 2022 and replaced these with recommendations on staying at home upon receipt of a positive test. Less well documented is the removal of certain barriers to accessing statutory sick pay (SSP)4 following a positive COVID test. Where as previously the waiting period for accessing SSP had been waived the dropping of restrictions has been accompanied by the reintroduction of the three day waiting period which pointed out by the TUC means for people self isolating with COVID risk potentially a 50% cut in the amount of SSP that can be claimed. Similar to the argument made in my previous blog post, this incentivizes workers to come into work regardless their COVID status and indeed in previous forums where the left response to COVID was discussed in some circumstances this often required much of people looking to adhere to the self-isolation guidelines to make particularly harsh compromises by using their annual leave to cover the full extent of their isolation period. As also pointed out by the TUC, there are little guidelines for how those who are either immunosuppressed or disabled are able to safely return to work.
What is often visible when considering which perspectives shape the current state of the COVID guidelines is the majority of people who fall into this category, that is to say immunosuppressed or disabled, do not believe that life will return to normal with in 57% continuing to avoid close contact with those they do not live with compared to 41% of nondisabled people. This has to some extent fed into wider patterns visible in society with in person experiences including high street spending is also lagging with a analysts predicting a 5-10% reduction in footfall from the levels seen in 20196. While some might suggest this might be down to a wider decrease in available income partly caused by the current inflation in basic commodities, this has not been accompanied by a fall in online spending suggesting a broader behavioural shift to avoiding crowded spaces. The typical contrarian response to those still suggesting the importance of taking COVID seriously is looking at the significant decline in fatality rates since the middle of 2022 however, some concerning points still stand out in the data, most notably that among diseases of the respiratory system COVID is still the number cause of death7 and the current levels of COVID related mortality still reflects levels shown towards the tail end of 2022.
Fatalities as has often been suggested do not reveal the entire impact of the disease with self-reported stats from the ONS suggesting that around 1.3 million British citizens are currently experiencing symptoms lasting longer than four weeks since their initial infection with 18% of this number stating that their ability to perform everyday tasks has been impacted “a lot”. This appears to be having an impact on British businesses with 25% of businesses surveyed citing COVID as the cause for long-term health absences8 in a subsequent survey of around 804 businesses with 4.3 million employees, 46 percent of employees were said to have symptoms of long covid with the Resolution think tank suggesting this could be partly the cause of the much vaunted “great resignation”, reflected in the UK’s current labour shortages.
However the problem appears more stark when looking at the labour force participation rate9 (the number of people judged economically active who are supplying labour for the production of goods and services above the age of 14).
This shows a notable decline from the peak of 64.25 to one of the lowest figures recorded in a decade. Now partly this can be explained by the fact that a number of business propped up by government spending initiatives during COVID turned out to be no longer economically feasible however a 2022 comment piece entitled ‘The Guardian view on Britain’s missing workers: they may never come back’ suggested deeper issues with the labour-capital couplet at the heart of British Capitalism. Sluggish wage-growth, and a labour market that increasingly seemed to favour a smaller number of employees alongside long waiting lists for surgery and long term sick absences.
One other aspect is the additional burden COVID placed upon already stretched public health services, in the UK there are currently approximately 7.5 million people awaiting treatment, roughly 11% of the population with corresponding rises in the number of people waiting for four hours in A&E. Additionally despite briefly capturing the public’s attention a few months ago, little has also been done to address what remains a persistently high level of excess mortality9. While many have blamed systemic underfunding of public health services, and indeed as previously mentioned in Marginal Notes… this did have some effect on the impact of COVID, one major issue has been the lack of accurate reporting as such certain public health trends remain either underreported or severely delayed. In a piece written in 2022 Politico10 noted:
“More than 3,500 Americans have died due, at least in part, to long Covid, according to new data from the CDC. The agency’s findings underscore the potential severity of a condition that continues to impact millions but is still poorly understood and — in some cases — dismissed entirely.”
The piece went on to describe how up to 1 in 5 people who contracted COVID-19 also had symptoms of Long COVID and how despite this it remained “prohibitively difficult” for patients to access treatment. Even those who manage to get access to a doctor often found it difficult to have their condition taken seriously with many patients being told that they were “just anxious”. It should be stated however that there have been some moves to better understand the condition with the setting up of long covid clinics (also known as Post Covid Care Centres) alongside the Biden-Harris sponsored National Research Action Plan on Long COVID which named “health equity” as a guiding principle of the work being undertaken. An intriguing emphasis as one of the points repeatedly made throughout Marginal Notes… is COVID is to a great extent exacerbated by and stems from inequalities in health, housing and labour. This however has already been met with limitations as applications to the Post-COVID Care Centres have so far exceeded the existing capacity of the clinics, leading to months or in some cases over a year of backlogs. While the 25 million dollar CARE act, which promises further funding and research is currently in the works as stated in a research article published in Nature12 there still remains many challenges concluding that
“Diagnostic and treatment options are currently insufficient, and many clinical trials are urgently needed to rigorously test treatments that address hypothesized underlying biological mechanisms, including viral persistence, neuroinflammation, excessive blood clotting and autoimmunity.”
Alongside arguing for improved public communications campaigns, further funding to sustain Long COVID research and further training and education of the next generation of COVID researchers and healthcare assistants. The article also warns of the risk of doing nothing stating that
“On the basis of more than 2 years of research on long COVID and decades of research on conditions such as ME/CFS, a significant proportion of individuals with long COVID may have lifelong disabilities if no action is taken.”
One fairly confident prediction I have had since 2022, was that by 2023 the people who still urged caution when declaring the end of the pandemic, research into the effects of Long COVID and investment in monitoring future COVID waves would be seen in a similar light to those who confronted with the complex challenge of responding to a paradigm shifting event like COVID-19 lapsed into conspiratorial murmuring. An article on The People’s CDC by the New York Times, entitled ‘The Case for Wearing Masks Forever’ which referred to the coalition of healthcare workers, scientists and educators who make up the organisation as a “rag-tag coalition of activists”, is somewhat indicative of this trend, which glosses over much of the groups research and recommendations in favour of outlandish speculating on their politics.
However while media outlets have continued to be critical of these organisations despite evidence for that their scepticism towards declaring the end of the pandemic may, given the latest uptick in cases, be well founded, perhaps what’s more concerning is how in the UK and many other countries, COVID has quietly slipped under the radar altogether, which just a handful of articles transnationally covering the latest surge. It is interest to reflect on the fact that a few months ago similar surges were detected in South East Asia14 and yet seemingly no precautionary measures were suggested with no airlines, cruises or other transnational forms of transport requiring masks or negative tests to fly.
Meanwhile in UK recent moves to scale back winter vaccinations, cease publishing the COVID R number or even publishing modelling data all the whilst the highly COVID inquiry slowly begins to work through a litany of misdemeanours and mistakes revealing a political consensus less interested in confronting COVID’s continuing presence as it is attempting to draw a line under it’s impact. The TUCs participation in the inquiry15, drawing as it does on the experiences of front line workers is a welcome contribution however the increasing importance of monitoring whether that be through waste water monitoring, tracking infections or long-term reporting on patients suffering from long covid will be crucial.