The problem with wars is that pragmatism is often denounced as defeatism. So it is coming to pass with the common sense view that, once the vulnerable are vaccinated, we should cope with coronavirus as we do with influenza. It was always going to be difficult for the Tories to shift from valiant vows to “defeat” Covid to that gloomy gallop of the phrase “learning to live with it”. Such a pivot demands not just a level of political humility, but a drastic shift in the diagnosis.
Over the last generation, society has been hard-wired to feel terror at the silent self-replication of lethal disease, particularly cancer. In time historians may well opine that, during this pandemic, our revulsion towards the original – and now overshadowed – Big C ironically informed our view of Covid. Until now we have treated coronavirus like a malignant rather than a chronic affliction – something society must defeat or die trying, enduring chemotherapeutic lockdowns and zapping new mutations.
This creates a complication for those hoping the world will come to see Covid like flu. Coronavirus may be a medical milestone rather than simply a scientific event, changing society’s attitude to endemic viruses permanently, as threats that must be eliminated. If anything, rather than seeing Covid like flu, society is more likely to start seeing flu like Covid.
This might seem outlandish. After all, the flu mortality rate is lower than that of Covid, and the NHS copes with flu patients every year without disruption to wider society. It’s also tempting to believe that society is perfectly capable of regarding an illness as both a serious killer and something to be tolerated. As a virus that most recover from and that tends not to leave visible scars, flu has never got under our skin, unlike smallpox or the Black Death. Despite killing 50 million, the Spanish flu inspired little poetry or literature. The linguistic history of influenza also betrays our lack of fear. “Flu” derives from the Sanskrit “plu”, and alludes to flowing snot. Nicknames range from the “old man’s friend” – which, in the ecstacy of fever, helped people up to the arms of the Lord – to the Anglo-Saxon “Wolf”, a noble beast of death.
The hitch is that modern indifference to flu is down to pig ignorance rather than rugged stoicism. Only a minority of informed citizens know that it is a deadly and costly disease, claiming tens of thousands of lives a year, and increasing the mortality rate of several other illnesses. The institutionalisation of death in hospitals and care homes has pushed lethal flu into the shadows. Misdiagnosing sore throats and stomach bugs as influenza has also reinforced misunderstanding of the virus.
Nor has popular science corrected our confusion – for the simple reason that, thanks to a number of historic embarrassments, flu scholarship only recently went mainstream. Medical elite failings during the Spanish Flu led to an “institutional forgetting”, which condemned research into the virus to the academic backwaters. Mortifying false pandemic predictions in the 1970s (partly inspired by the curious idea they came in 11-year cycles) caused public health bodies to scrap preparedness programmes. Only with the recent spate of bird and swine flu outbreaks have these returned to fashion.
In other words, modern tolerance of flu is built on shaky ground, which may finally buckle in the era of Covid. The public will likely lump together flu with coronavirus, as an enemy to be controlled through mask wearing and social distancing. This autumn we may well find ourselves tracking daily flu cases on our phones, as experts speculate about variants. Not least because the collapse in flu cases this winter makes it trickier for vaccine developers to predict how it might mutate next year, and young children to build immunity. All this before you even consider that scientists widely view Covid as a dry run for an “inevitable” flu pandemic; perhaps the best we can hope for is a future of false alarms and foiled outbreaks .
On the plus side, a Zero Flu world is just about starting to look credible. The 2009 swine flu pandemic scare spurred research into a universal vaccine that would work on all future flu mutations. While this may have seemed far-fetched a few years ago, efforts to neutralise a flu virus protein crucial to its infectivity called hemagglutinin may soon yield a breakthrough. At the very least, the WHO thinks a universal vaccine that protects against severe disease due to Flu A is doable by 2027.
In other words, viruses are the new cancer. While they may exist on a spectrum, with flu benign and Covid more malignant, perhaps we have tipped into a new era in which infectious disease is both socially unacceptable and scientifically beatable
So if the argument that we tolerate Covid like flu is doomed, what is the alternative to locking down until we reach Zero Covid? The trick could be to find inspiration in the scientists who are hoping to eradicate flu, and redefine the quest for Zero Covid, rather than reject it. Perhaps the UK should announce a target to reach Covid Zero by 2027 (or some other reasonable date) tied specifically to a universal vaccine. This could help gently adjust the public’s short-term expectations, and shift the emphasis from lockdowns to scientific innovation, as the answer. It might even prove a gift to the politicians. What better way out of the current wartime narrative than a full-throttle Johnsonian national scientific effort?