Covid is Rising Again in the UK & Why are People Getting It Again?

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James Gallagher
Health and science correspondent
BBC

 

Lateral flow testImage source, Getty Images

The latest statistics show the number of people infected in the UK has more than doubled since the start of June with around 2.3 million people testing positive. You probably know someone who’s had it.

So is summer ruined? Two-and-a-half years into the pandemic we’re back facing new variants, a surge in infections, questions about whether the NHS can cope and what it means for all our lives. It’s also giving us a clearer idea of what living with Covid is going to look like.

“We’re in a bad patch at the moment,” says professor of public health at the University of Edinburgh Linda Bauld.

“It’s very disruptive to society and some are suffering severe effects, but that’s still a tiny proportion of where we were.”

Graph

The driving force behind the sudden surge in infections is the double act of BA.4 and BA.5. These two mutated forms of the virus are technically sub-variants of Omicron. The original Omicron had an impressive ability to spread and overcome the immune defences our bodies have built up to keep the virus out. BA.4 and BA.5 are even better. Their ascent started before big summer events like the Jubilee celebrations or Glastonbury so it’s not like we’ve just partied our way into a new wave.

Prof Danny Altmann, an immunologist at Imperial College London, says it’s “shocking” how much the virus is able to change to keep on infecting us. He recalls seeing the first scientific analysis of Omicron last winter: “I felt like I’d just seen the worst horror film on the planet and yet it keeps throwing up worse ones”.

The result is we’re now entering another – arguably our third – Omicron wave of the year and it’s only just July.

Slippery virus

Research in the New England Journal of Medicine showed BA.4 and BA.5 can “substantially escape” the protection from either vaccination or infection. A study in Science also showed the original Omicron was like a “stealth virus” that left limited protection if you came across Omicron again.

The new sub-variants’ slippery skills combined with our waning immunity means stories of catching Covid multiple times are now increasingly common. Plus there’s still a surprising number – one-in-five of us – who have somehow dodged Covid throughout the pandemic.

“[This virus] continues to surprise us in unpleasant ways, you would have hoped there would be more protection from one Omicron variant to another” says Prof Mark Woolhouse, who studies disease outbreaks at the University of Edinburgh.

However, the most important form of protection – against becoming severely ill, ending up in hospital and dying – is clearly holding up. If there were 2.3 million cases in the era before vaccines then the NHS would be swamped and tens of thousands of people would die. That is clearly not happening.

Jubilee celebrationsImage source, Getty Images
Image caption,

The upswing in Covid cases started before the Jubilee celebrations

But even with that protection BA.4 and BA.5 still have the potential to leave you feeling seriously rough.

“I think it’s far from a bad cold,” says Prof Susan Hopkins, from the UK Health Security Agency, who says people are “ill for between seven and 10 days”.

That has knock-on effects if you need to work – staff sickness in the NHS is another way the virus can pile pressure on the health service – or were planning to go on a nice holiday.

“What do you do if your school has no teachers or an airline has no pilots? How do you suck that up?” asks Prof Altmann.

Rising cases will also have a disproportionate effect on the clinically vulnerable and leave behind cases of long Covid.

Severity question

There are no signs this virus is any more or less dangerous that original Omicron, but we don’t know for sure.

So far there is only laboratory and animal research. A study in Japan shows BA.4 and BA.5 can grow more readily in lung cells. Hamsters had worse disease than with earlier forms of Covid.

The UKHSA has reported a “small” increase in the proportion of those infected needing hospital treatment since April. But the reason is unclear and could include waning vaccine protection or a shift in who is catching the virus.

Prof Woolhouse, who was one of the scientists to show original Omicron was milder, says “we haven’t seen definitive data” on BA.4 or BA.5 because we’re not collecting the same volume of information now.

However, variants don’t have to be worse for it to impact the NHS – they just have to infect enough people. Then the small proportion who do get into trouble still add up to a big number.

The number of people in hospital with Covid across the UK is 10,081 – up by around 2,500 in a week. More than half of those will be there for other reasons, such as a broken bone or a stroke, but they still need to be managed.

Chart showing the number of patients in hospital across the UK with covid

“I remain concerned, one more doubling [in numbers] brings the NHS into significant challenge,” says Prof Hopkins, the chief medical advisor at the UK Health Security Agency.

The hope will be that the UK follows a similar trajectory to countries like South Africa and also Portugal.

Prof Bauld: “I think we should be optimistic, in those countries that are ahead of us, things are settling down, these things do burn themselves out as they run out of people to infect.”

However, it looks as though the idea that Covid will just become a winter bug is either wrong or someway off.

“Every year we say this and then it causes a wave in the summer, driven by new variants coming along more than once a year,” warns Prof Woolhouse.

The virus may be looking more flu-like in terms of severity, but the difference at the moment is flu comes only once a year.

There is no political appetite to return to any restrictions. The big decision is going to be around the vaccination programme ahead of next winter – who gets vaccinated and equally importantly with what?

Both Pfizer and Moderna have announced updated vaccines that target the original Omicron, but that is already yesterday’s variant.

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Covid: Why are so many people catching it again?

By Robert Cuffe
Head of statistics, BBC News

 

A man at home with CovidImage source, Getty Images

In the early days of the pandemic, it was extremely rare to hear of people catching Covid twice.

The Omicron variant which first emerged in late November 2021 has changed that.

Why are more people catching Covid again?

Part of it is Omicron itself – it’s better at sneaking past defences built on exposure to older and different variants.

It’s also partly a numbers game. So many of us have already been infected at some point, that a rising proportion of new infections are a second occurrence.

But getting Covid twice in a short space of time is still pretty unlikely, despite the prevalence of the latest version of Omicron.

And for most people a second infection is less likely to make them very ill.

How likely are you to catch Covid twice?

Eventually, pretty likely – immunity fades and viruses evolve.

Most people can expect to catch the other coronaviruses – such as those which cause common cold symptoms – many times.

A positive lateral flow testImage source, Getty Images

Early in the pandemic, that didn’t seem to be the case with Covid.

Fewer than 1% of all cases recorded in the UK before November 2021 were reinfections.

But Omicron’s different structure gives it a better chance of sneaking past the body’s early defences, which were based on exposure to previous Covid strains.

So the rates of reinfection have been about 10 times higher this year compared with rates seen earlier in the pandemic.

How is the new version of Omicron different?

This new “Spring” Omicron – known as BA.2 – drove UK infections back up to record levels.

The Office for National Statistics said about one in 13 people in the UK had Covid in the week ending 2 April, although this had dropped to about one in 15 by the week ending 9 April.

This had fallen again to about one in 17 by the week ending 16 April.

Graph showing UK Covid infections

“Spring” Omicron is similar to – but even more infectious than – “Christmas” Omicron (BA.1).

If you’ve had Covid in the past few months, it’s likely to have been a version of Omicron, which in turn should give you good protection against a second bout.

The data we have so far suggest that a second Omicron infection is “rare, but can occur“. More reinfections have been seen among younger people and those who haven’t been vaccinated.

About 4.5 million people have had a Covid booster dose since the start of the year, with another two million getting their second dose.

And tens of millions of us have protection from a recent infection. About one in three of us caught Covid during the first Omicron wave.

Laboratory studies suggest that a combination of having had Omicron and being vaccinated could leave your body even better prepared to fight off a new infection than one infection alone.

How soon could I catch Covid again?

The 31-year-old healthcare worker started experiencing new symptoms, and genetic analysis of her positive tests showed that she had been infected by two different viruses – Delta in late December followed by Omicron in early January.

It’s hard to get good data on how often really early reinfections happen.

The vast majority of second positive tests within that little time are long-lasting infections rather than second infections.

So scientists don’t normally use genetic analysis to hunt for reinfections that early. It would cost a lot and mainly show that people “still had it” rather than “had it again”.

Studies, such as the one that says double-omicron infections are rare, typically start the clock ticking after three or five weeks.

Will the latest Omicron variant make me sicker?

So far, it seems that BA.2 is no more likely to put you in hospital than BA.1.

And even if you do test positive again, that “is not the same as being sick with Covid-19,” according to immunologist Prof Eleanor Riley. “It [just] means there is virus in your nose and throat.”

The protection provided by vaccination or having had a previous infection is better at stopping the virus from getting into your body and doing serious damage, than it is at keeping the virus out of your nose and throat.

Prof Riley thinks if you test positive again but feel well, “your main concern should be whether you might pass it on to someone who is particularly vulnerable”.

An infection can still land some people in hospital, particularly those with weakened immune systems or underlying health conditions.

What are people in hospital being treated for?

But despite the high numbers of Covid infections, the current wave is putting fewer people in hospital than we saw in January, precisely because so many of us now have a combination of protection from vaccination and previous infections.

During January’s peak, about 55% of people in Covid beds in English hospitals were being treated mainly for their Covid. The most recent figures, for 5 April, say that figure is down below 45%.

And the total numbers of people in hospital with Covid are roughly half of what we saw in January 2021.

The government hopes the spring booster vaccine rollout will help top up immunity for the most vulnerable, and make it even harder for Omicron to cause serious illness, whether it strikes once or twice.

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