If we want our lives back, we have to prepare to live with COVID-19 forever.

By Martin Michaelis and Mark Wass. The Omicron variant has resulted in the introduction of new restrictions around the globe. Although we do not yet know what its impact will be, the arrival of Omicron is a stark reminder that COVID-19 is not over and that new devastating variants can emerge at any time. Until now, our measures to counter COVID-19 have always had a temporary nature, assuming that the COVID-19 pandemic will be over at some point in the not so distant future and that we will then return to ‘normal’. However, since COVID-19 may simply not go away, we need to find long-term solutions that are also viable, if the threat posed by COVID-19 does not disappear.

There is much speculation around the Omicron variant. The virus is heavily mutated in places that mean it may be highly transmissible, potentially more so than the Delta variant, and/ or better at infecting people, who have some level of immune protection due to vaccines and previous infections. Initial epidemiological and laboratory data confirm such fears, but the real-life impact remains to be seen, in particular on hospitalisations and deaths, which occur with a delay after the initial infection.

Independently of how harmful Omicron turns out to be, it has already taught us a lesson. SARS-CoV-2, the coronavirus that causes COVID-19, keeps evolving. Increasing levels of immunity in the population push it towards variants that are better at infecting vaccinated individuals and re-infecting COVID-19 survivors. Moreover, SARS-CoV-2 has been detected in wild animals including otters, mink, non-human primates, big cats, and deer, from which modified, dangerous variants may be re-introduced into the human population. Hence, COVID-19 may remain a substantial health threat for the foreseeable future, potentially forever.

Despite this potential long-term impact, we continue to handle COVID-19 as a temporary distraction and have repeatedly tried to return to ‘normal’, when we hoped the biggest threat might be over. Since we do not know whether COVID-19 might be over at some point, it would be a more prudent strategy to work out how we want to live with COVID-19 if it is here to stay and remain a substantial mortality threat in a ‘hoping for the best, expecting the worst’ approach.

The design of long-term strategies to live with COVID-19 raises many important societal questions that need to be answered. How do we want to live with COVID-19? Is the current level of COVID-19 deaths acceptable? We are reporting on average between 100 and 150 deaths each day, which means that COVID-19 is a leading cause of death in the UK, accounting for more than 10% of total deaths. COVID-19 has seen life expectancy reduce for the first time since records began. Do we accept that this is the price we have to pay? Would we accept more deaths? If yes, how many?

Our current approach has focussed on keeping our health care system and our hospitals functional, basically meaning that there have to be beds in hospitals and intensive care units for everyone, who is seriously ill or injured and that people do not die because they cannot access appropriate medical care. Is this good enough? Do we want to generate higher hospital capacities, so that we can handle larger numbers of severely ill COVID-19 patients without overwhelming our health care system?

Or do we want to reduce the level of COVID-19 spread so that fewer people become infected and die? Do we find a way to lead meaningful lives and to control COVID-19 spread at the same time?

Since we do not know whether there will ever be an end in sight regarding the threat provided by COVID-19, answering such questions and the set-up of a long-term strategy is the only approach that will give us back control of our lives in a sustainable manner.

Even if COVID-19 disappeared or turned into a very mild disease that does not cause significant disruption, the lessons that we would learn from working out a sustainable approach to deal with a serious infectious disease would increase our preparedness for further, potentially more severe pandemics that are inevitable in the future. After one pandemic is always before the next pandemic…