The Times News Review by Ben Spencer

 

Doctors and nurses were among the first to be struck down by the virus. The prime minister was incapacitated for weeks, parliament was closed, education was disrupted. In the darkest days of the crisis, Norwood Cemetery in south London held 200 funerals a day.

This was Britain during a pandemic. The year was not 2020, though, but 1890, and the disease was not Covid-19 but Russian flu. It tore around the world, killing 125,000 people in the UK and one million globally.

The similarities between that pandemic and today’s are uncanny. Symptoms reported by doctors 130 years ago included dry coughing, a sudden fever and, for many, a lost sense of smell. Some survivors were struck by a lingering depression and lack of energy that left them debilitated for months. The saving grace of the virus was that children were affected much less than adults.

The Pryzm nightclub in Brighton made the most of ’freedom day’ by reopening its doors — but cases of Covid-19 are rapidly rising
The Pryzm nightclub in Brighton made the most of ’freedom day’ by reopening its doors — but cases of Covid-19 are rapidly rising CHRIS EADES/GETTY IMAGES
 

Many virologists now believe that the 1890 outbreak was caused not by flu at all, but rather by a coronavirus that jumped from cows to humans, in much the same way that Sars-Cov-2 is believed to have leapt from bats to humans.

So what can we learn from that crisis? When was the so-called Russian “flu” eradicated? And above all, what does it tell us about when the current pandemic will end?

Nearly a week after the July 19 “freedom day” marked the end of lockdown, the Covid crisis feels far from over. Nearly 50,000 coronavirus cases are being recorded each day and daily hospital admissions are up to 800. The threat of the NHS becoming overwhelmed and restrictions being reimposed hangs over us like a cloud. The “pingdemic” continues to wreak havoc, with many families keeping their children at home for the last week of term, afraid not of infection but of having to spend the first days of the school holidays in isolation. We are deep into the third wave of the crisis.

The virus that first struck Britain in 1890 also hit the country in waves. Four big surges swept across the nation until 1894, with further sporadic outbreaks until 1900, when the pandemic fizzled out.

But the virus never disappeared. In fact, there is some evidence it may still be among us, passed from person to person as a key cause of winter sniffles. A Belgian study published in 2005 suggested the Russian outbreak may have been caused by what is now known as OC43, one of four coronaviruses that between them cause 20 per cent of common colds in the UK.

Paul Hunter, professor of health protection at the University of East Anglia, believes Sars-Cov-2 will follow a similar trajectory and eventually become endemic, a seasonal virus that circulates every winter but does not cause serious problems. “The virus is here for the long term,” he said. “Our grandchildren’s grandchildren are going to get Covid. But for them it won’t be a big deal.”

The question, of course, is how long will that process take? That our distant descendants will no longer be affected by the pandemic is faintly reassuring, but how much more of this upheaval will we have to endure ourselves?

Few experts are willing to gaze into the crystal ball and give a definitive answer — Covid-19 has surprised us too many times — but Hunter believes the process is already under way, driven by the vaccines. “The symptom profile of cases is now changing, resembling less the Covid disease of last year and looking more like a common cold,” he said.

Some virologists believe that the influenza outbreak of 1890 may have actually been caused by a coronavirus that jumped from cows to humans
Some virologists believe that the influenza outbreak of 1890 may have actually been caused by a coronavirus that jumped from cows to humans ALAMY
 

Dr Julian Tang, clinical virologist at the University of Leicester, guesses that it will take three to five years for Covid-19 to become fully endemic in the UK, but stresses we will not be truly safe for the five to ten years it takes to complete global vaccination. David Matthews, professor of virology at Bristol, is slightly more optimistic. “It will take several years to reach an endemic state, but I would say that once this wave is done, that’s probably the worst of it.”

Francois Balloux, director of the University College London Genetics Institute, has an even more hopeful outlook. “If you were extremely optimistic, and not afraid of hurting people’s feelings, you could say the pandemic is already borderline over. If we use a criteria that says if it is not causing more morbidity and mortality than any other virus in circulation, then I will be surprised if it were still the most deadly virus in circulation by next spring.”

That, as Balloux admits, is a controversial view. Many doctors have raised the alarm about the danger of Britain’s “great gamble”. But the key to virologists’ optimism is the idea of immunity. The coronavirus that sprang out of Wuhan last year was so dangerous because it was new. The human immune system had no way to fight it off.

For the majority of the British population, however, that is no longer the case. In the 1890s it took four years for enough people in the UK to become infected for immunity to reach significant levels, and then another five years of sporadic outbreaks until the virus settled into an endemic pattern. This time that process has been artificially accelerated by vaccines. About 88 per cent of adults in the UK have now received a vaccine and 69 per cent have had two doses. Add to that the many young people who have been exposed via natural infection and there is a very high level of immunity in the UK.

Nadhim Zahawi, the vaccines minister, describes this as a “wall” of protection. In reality it is more like a net. Immunity wanes and the virus mutates. The jabs are better than anyone ever dared to hope, but they do not stop all infections.

Nearly 29,000 people in England have tested positive after receiving two vaccines but the vast majority suffered only mild symptoms: just 1,656 of those who have been double-jabbed required a hospital visit, of whom only 843 required an overnight stay.

The vaccine net is doing its job — some cases are slipping through but most severe cases are prevented. The number who have died after receiving both vaccines is extremely low: 224 in England, of whom only four have been aged under 50.

Parents have taken their children out of the last week of school, fearful that a notification to self-isolate could scupper holiday plans
Parents have taken their children out of the last week of school, fearful that a notification to self-isolate could scupper holiday plans ALAMY
 

So if the vaccines are working and deaths are down, are we approaching herd immunity? In a sense, we are. But this is not the herd immunity that became so toxic last year when the government considered letting the virus rip through the UK population, putting millions at risk of death. The herd immunity we are approaching has been achieved in a much safer way, using vaccination rather than mass exposure.

The consequence of herd immunity is also different to that envisaged last year. “It’s not a case of, ‘We reach herd immunity and the virus will just go away’,” Matthews said. “There is no avoiding this virus now.” The aim, he said, is “a kind of truce. We will all catch it, several times. But because you’ve been vaccinated or you’ve had it before, you won’t die.”

Even if that is the long-term prospect, the coming winter poses a major hurdle. A group of British virologists last week wrote to the Financial Times warning that the relaxation of lockdown measures was “potentially a recipe for disaster”, placing pressure on the NHS and providing the “ideal setting” for the evolution of new Covid variants.

Tang, who signed the letter, said two or three more months of restrictions, to keep case rates suppressed and push vaccination levels higher, would help the NHS survive the winter. As schools reopen in the autumn, cold weather sets in and we start socialising indoors without masks or restrictions, the cases that break through the vaccination net are likely to rise. “What we need is an Indian summer that lasts until October,” Tang said. “That might stop everyone socialising indoors.”

Jonathan Ball, professor of molecular virology at the University of Nottingham, believes the risk is overstated. He thinks many of the hospitalisations being reported as Covid-related are incidental. Patients are brought in for other reasons but happen to have asymptomatic coronavirus. “There are two types of hospital admission,” he said. “There’s one with Covid and one because of Covid. As you see community cases rise, both types are going to inflate.”

Ball believes the government was right to lift restrictions. “The vaccines are doing what we asked them to do, the vulnerable have all been given two doses.” But vaccine uptake has now slowed to a trickle, with three million young adults yet to take up their offer. “There’s some messaging to be done there, but are we going to hold off while we try to persuade them?” Ball said.

In many ways, the country has reached the limits of what it can do to control the virus. Unless the government decides to inoculate under-18s — which its scientific advisers last week cautioned against — vaccination levels are very close to reaching their maximum.

Hunter also backs the lifting of restrictions and believes continuing to lock down could do more harm than good. He also believes the time has come to end the “pingdemic”, by bringing forward the date at which vaccinated Covid contacts are spared from self-isolating (currently August 16). “The requirement to quarantine after being pinged because you are a casual contact has little if any value in controlling the epidemic,” he said.

Ball puts it differently. “Perhaps August 16 is when the pandemic ends in the UK,” he said. Now vaccination has ended the risk of severe disease for most, the biggest fear for many is having to spend ten days in isolation.

Once again, the parallels with 1890 are apt. According to a 1995 history of Britain’s Russian flu outbreak, published in the Social History of Medicine journal, the crisis “touched most sufferers lightly, but it nonetheless cast thousands into an indeterminate, threatening situation”.

The Covid pandemic has undoubtedly been tragic. Yet for those who have not been struck down or bereaved, the biggest impact has been the chaos, the uncertainty, the indeterminate threat.

Perhaps August 16 will end up being our true freedom day.

 

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