We need to discuss how we want to live with COVID-19 (and other diseases)

By Martin Michaelis and Mark Wass. At the moment, there is much discussion about whether, when, and how formal regulations should be completely removed. This question is discussed without having agreed on what the aim is. How do we want to live with COVID-19 (and other diseases)? How many preventable deaths are acceptable and why? The pandemic has provided us with a unique opportunity to challenge and improve our approach to health and disease in a fresh way that should not be wasted.

The UK is in a new phase of the COVID-19 pandemic. The infection numbers are rising sharply, but hospital admissions and deaths do not follow as they did in previous waves, most probably because more vulnerable groups are now protected by vaccination. There is nevertheless still concern that a very high number of infections could put the healthcare system under substantial pressure and cause significant collateral damage, but to which extent this will happen currently remains uncertain.

At the same time, there is a discussion about the lifting of all formal rules. The main argument for removing all legal restrictions is that we have to learn to live with COVID-19. However, it remains unclear what is actually meant by this.

‘Living with COVID-19’ could mean that we simply return to our pre-pandemic normal and accept that there will be a certain number of COVID-19 deaths in the future, sometimes more, sometimes fewer. Alternatively, it could mean that people and communities voluntarily adapt their lifestyles in a way that prevents future surges in COVID-19 cases, even in the absence of formal regulations. And it could mean everything in between these two scenarios.

A general question underlying such considerations is how many deaths we are prepared to accept, given that we can prevent them, if we control COVID-19 spread. Many argue that death at a level of the seasonal flu, which typically costs between 5,000 and 20,000 lives per year in the UK, would be reasonable.

However, this seems to be a rather arbitrary comparison that is simply chosen, because COVID-19 and the flu are both respiratory diseases caused by viruses. Apart from this, these diseases have little in common, and it is not possible to draw conclusions on how the COVID-19 pandemic will further develop from what is known about the flu.

Moreover, the dealing with COVID-19 seems to be separated from all other health topics, and our common considerations around life span and life quality. At least until very recently, an increase in life expectancy and life span was regarded as progress. We are prepared to invest tens of thousands of pounds to prolong the life of a cancer patient or a patient suffering from cardiovascular disease for a year. Moreover, we invest billions into the research into these diseases. In this context, it may be well worth considering whether reducing the number of flu deaths may be a comparatively feasible and cost-efficient way to improve life span and quality, instead of just accepting thousands of basically preventable flu deaths every year.

Along similar lines, wearing face coverings in a crowded train or in a supermarket may be an effective and cost-efficient way to reduce disease and death. In many ways, the desire to return to our pre-pandemic ‘normal’ seems to overwrite all rational considerations of how we could and should live and how even little (voluntary) adjustments may improve the overall situation for all of us. However, you should never waste a crisis and the lessons that you can learn from it. Hence, now would be a good time to make the most of the disruption that the pandemic has caused and to rethink our continued and hardened perceptions towards health and disease, including our healthcare system. We should make sure that as much good comes out of the bad as possible and not prevent progress out of nostalgia and because we do not like change.