When – or will – life ever go back to normal?

Muiris Houston: There will be no silver-bullet moment of liberation from Covid-19

When will life go back to normal post Covid-19? It’s a question people are increasingly looking for answers to; for some it’s prompted by the horrors of a prolonged lockdown and an unspoken fear that we could be facing the same again next winter.

The short answer is that life will never return to a pre-pandemic normal. The novel coronavirus isn’t going to disappear, and so our lives will change. The real question is: to what degree?

The most likely scenario is that Covid-19 will circulate just like influenza, with a seasonal burst of infection. Many of us will require annual vaccination against the coronavirus, in the same way we need a flu jab.

Prof Adam Finn of the University of Bristol predicts an "endemic epidemic picture" as occurs with flu, where the virus "constantly changes to evade our immunity so we're always playing catch-up with it and it moves around the world with the seasons to find populations with insufficient immunity".

Endemic viruses are those that have constant presence within a geographical area. Examples include the rhinovirus and influenza virus. There are currently four endemic coronaviruses that, for most people, just cause a common cold. Whether SARS-CoV-2 will join them will be down to two main factors that control how a virus behaves in a population: the virus’s biology and the immunity of the host population.

According to Dr Grace Roberts, a research fellow in virology at Queens University Belfast, "with Covid-19, it seems that children have milder illness, while more severe disease tends to appear in people over 60. Given this, if lots of people develop immunity early in life (whether via infection or vaccination), over time this could tip the balance towards SARS-CoV-2 being a mild illness if we assume that young people retain some level of immunity throughout life".

Speaking to the UK medical magazine Pulse, Dr Peter English, chair of the British Medical Association's Public Health Committee, says there will come a point where healthcare leaders "decide to allow the virus to circulate more widely while expecting there to be fewer serious cases".

At what point can we say the damage of lockdown outweighs the health benefits?

This scenario may be acceptable to most, but in order to achieve it, vaccination uptake will need to remain high. And the more we can get the number of cases down, the fewer opportunities there will be for mutations to arise.

But what would it mean if vaccine uptake decreases and new variants reduce the effectiveness of vaccines? Poor uptake would allow the virus to evolve away from the vaccine. Dr English says this would mean an “arms race” between vaccines and the new mutations. He doesn’t expect to see a vaccine for the South African strain before “mid to late autumn”. However other experts have said they are confident modified versions of the jabs can be developed quickly.

There are so many variables at play: the efficacy of the vaccines against transmission; how successful future treatments may prove to be; whether vaccination acceptance remains high; and how the virus mutates.

Mental health

But alongside the science, there are important societal issues. At what point can we say the damage of lockdown outweighs the health benefits? When does ongoing harm to our mental health trump the number of infections? And at what point do we decide that the dire economic effects of lockdown must be reversed even as zero Covid eludes us?

Certainly, there will be no silver bullet moment of sudden liberation from Covid-19. Instead, society will have to continue to manage a complex array of risks as the pandemic evolves.

My personal guesstimate of our new normal looks something like this: an annual Covid -19 vaccination campaign; an acceptance of a certain level of morbidity and mortality from coronavirus as we currently do with influenza; and, regrettably, a big question mark over our freedom to travel internationally.