The failure to recognise the ongoing severity of COVID-19 is creating a reality gap that is being filled by groups peddling misinformation.
On 30 November 2022, a UK scientific team published a pre-print on the correlates of protection against the SARS-CoV-2 Omicron variant1. In it they said:
“Although there are societal impacts and risks to some individuals associated with ongoing transmission, breakthrough infection could be an efficient immune-boosting mechanism for subgroups of the population, including younger healthy adults, who have low risks of adverse consequences from infection.”
This is dangerously misleading.
It is in fact difficult to know which subgroups of the population have low risks of adverse consequences from breakthrough infection or reinfection, nor is it established that such subgroups exist, to begin with. People of all ages can develop debilitating Long COVID following SARS-CoV-2 infection, even after vaccination2-4. Current evidence suggests infected adults and children are at greater risk of new onset diabetes5-7, adults are at increased risk of cardiac problems8,9 and the long-term impact on children’s cardio-vascular health is uncertain10. In addition, people can experience kidney injury11,12, liver damage13, erectile dysfunction14,15, hearing loss16-19, immune dysfunction20-23, brain and memory dysfunction24, ocular damage25,26 and dermatological complications27,28. In fact there are few organs that SARS-CoV-2 can’t harm, largely because COVID-19 is a vascular disease29-31 with immune-mediated severity impacting multiple organs32,33. SARS-CoV-2 is an airborne virus that is transmitted via the respiratory system34, but the disease it causes is not localized to the respiratory tract35 with its multi-organ, multi-system impacts stemming from its vascular nature, the associated immune perturbation, and other systemic effects.
Children, the subgroup that is widely believed to be least at risk from SARS-CoV-2 infections, also experiences harm. A large Danish study of children showed the highest risk of Long COVID is in those aged <5 years, who are not eligible for vaccination in that country36. Other countries like the UK and Australia also deny vaccination for children <5 years unless severely immunocompromised.
Politicians and some influential commentators would have people believe COVID-19 is now no worse than a common cold or influenza37, but with high levels of excess mortality in countries that have allowed widespread transmission38-41, overwhelmed healthcare systems42-44, and an observable increase in community illness and chronic ill health45-47, it seems clear COVID-19 continues to have a serious impact on population health. In fact, health authorities continue to shift the focus on acute outcomes of infection, such as hospital admissions and death.
Those who suggest infection may be beneficial are ignoring the reality many of us are now experiencing in our day-to-day lives. Nearly all of us have either had COVID-19 or know people who have, and many of us know people living with the long-term consequences of infection. The friend with a persistent cough, shortness of breath or fatigue, the family member with cardiac or gastric complications48,49, the colleague with sudden hearing loss, cardiac damage or brain fog.
It should also be remembered that the suggestion that ongoing infection is “beneficial” is in fact rather new in the history of the pandemic. It follows the claims from early on in its course that once everyone is no longer immunologically naive, the pandemic will end. The reality is that virtually nobody is immunologically naive any more yet we are still observing rampant transmission and continued markedly elevated levels of excess deaths. The pivot towards extolling the virtues of reinfections and breakthrough infections thus seems to be an attempt to rationalize the mismatch between those early claims and the objective reality around us.
Worse, the failure to recognise the ongoing severity of COVID-19 is creating a reality gap that is being filled by groups peddling misinformation. A recent film viewed by millions of people around the world falsely claims vaccines are causing the excess mortality and sudden deaths. Rather than recognising and educating the population about the well documented role of COVID-19 in cardiac and neurological damage50-53 as a consequence of vascular damage or auto-immune dysregulation, governments and policymakers have remained silent, thus allowing misinformation and disinformation to flourish. The end result, predictable and indeed predicted since almost the start of the pandemic, is that trust in vaccination as a whole is eroding, undermining the foundation of public health, beyond the COVID-19 pandemic.
The reality gap and attempts to deflect attention away from the pandemic and its consequences have further repercussions. Earlier in 2022, acute hepatitis cases in children were seen around the world, and despite extensive evidence of SARS-CoV-2 causing liver injury, the UK Health Security Agency flagged adenovirus, a common virus not previously associated with hepatic injury, as the most likely cause54. This had clinical implications, with frontline healthcare workers encountering the condition opting to treat with antivirals. In fact, it seems the hepatic injury was immune mediated55, which might explain why children with the condition responded to immune suppression in the form of steroid treatment. The knock-on effects of mischaracterizing the root of the problem are serious: if an infection is the source of the hepatic issues, then immune suppression is not the proper treatment. Scapegoating adenovirus and ignoring the immune-mediated cause of liver issues in children meant that many of these pediatric patients did not receive appropriate treatment.
In a similar vein, it seems plausible COVID-induced immune dysregulation is contributing to the recent significant increase in hospitalizations for RSV as compared with pre-pandemic RSV admissions, with both children56 and adults57 affected. For example, SARS-CoV-2 depletes dendritic cells58 which are known to play a key role in fighting RSV infection59.
SARS-CoV-2 infection is also known to impair the immune response to certain fungal infections60,61, and the rise in bacterial and fungal infections being seen around the world62-64, may have its roots in the complex interplay between SARS-CoV-2 and the immune system.
Despite attempts to blame the outbreak on reduced mixing65 in a country in which children have been mixing normally at school since March 202166, the recent uptick in the frequency and severity of Group A Streptococcus infection seen in the UK67,68 might be caused by post-COVID-19 induced changes to the specific immune response needed to clear Strep A infection69,70. In fact, SARS-CoV-2 has been shown to cause persistent infection of children’s tonsils and immune cells71 in a way that has been shown to increase susceptibility to Strep A infection72. SARS-CoV-2 is known to activate platelets73,74 and adherence of streptococci to platelets is crucial for colonization75, so it is plausible prior, recent infection with SARS-CoV-2 might lead to worse outcomes with Strep A.
SARS-CoV-2 has been with us for three years. We are still learning how the virus affects human health, but there is already overwhelming and clear evidence it can have lasting impacts on almost every organ as well as the immune system. In fact, the US CDC recently issued an advisory76 to clinicians, saying:
“Emerging evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, can have lasting effects on nearly every organ and organ system of the body weeks, months, and potentially years after infection. Documented serious post-COVID-19 conditions include cardiovascular, pulmonary, neurological, renal, endocrine, hematological, and gastrointestinal complications, as well as death.”
Conversely, there is no evidence that repeated reinfections are always harmless and do not result in accumulated and compounded damage on the body’s internal systems, as is often suggested. In fact, available evidence points to the exact opposite77.
It is too early to say how the virus and post-infection changes to the immune system affect our ability to handle other pathogens. Governments around the world have said it is time for individuals to assess their own risk when making decisions about SARS-CoV-2 exposure. This is not the same as saying it is safe, or that people can return to their pre-2020 behaviors without additional precautions. However, all over the world, the majority of the general public has done exactly this and simply resumed pre-pandemic behaviors.
Specifically on the issue of children, who congregate daily in schools which for the most part have not seen any improvements in ventilation or air filtration, the public has been told there is no long-term risk to children of repeat SARS-CoV-2 infection and that they face no more danger than they do from influenza. The statement is factually incorrect and downplays the risk the virus poses to children78. The policymakers and commentators who’ve made such statements have a vested interest in downplaying potential complications of SARS-CoV-2 infection. They have staked their reputations on the most significant public health policy in recent history: allowing widespread transmission of SARS-CoV-2 free of meaningful airborne precautions. This will inevitably lead to repeat infection. These same people are now advocating the benefits of so-called hybrid-immunity without recognizing the many risks inherent in infection.
Germany’s Health Minister, Karl Lauterbach, has a different view. He says:
“Infecting an entire generation is irresponsible. We don’t yet know what this infection does to children’s immune systems when it occurs repeatedly.”79
We support Dr Lauterbach’s cautious outlook, and that of Dr Mike Ryan, Executive Director of the World Health Organization's Health Emergencies Programme, who said:
“You don’t want to get this disease once if you can avoid it, and you don’t want to get it four times for sure.”80
While it is natural to focus on the impact COVID-19 has on our health, there is also growing concern about the effect it is having on society and the global economy. There are ongoing staffing issues in all industries, in all parts of the world, impacting all aspects of our lives from health care81 to travel82 to hospitality83 and more. Major organizations like the Bank of England84 and the Brookings Institution85 suggest recurrent acute COVID-19 and Long Covid as significant factors in the staffing crisis, which in turn is exacerbating the rise in inflation86.
In these circumstances it is difficult to see how there will be a return to pre-pandemic standards of health and economic productivity without first acknowledging the harm caused by COVID-19 and then taking the steps needed to reduce transmission of the SARS-CoV-2 virus.