COVID-19: Three years on


As we begin 2023, the current COVID-19 picture is dominated by the explosive growth in new cases in China.

This is due to the central government abruptly and unexpectedly making a U-turn on their “zero COVID” policies. Subsequently, there has been a rapid surge of COVID-19 cases amongst a population with low levels of immunity and poor vaccine coverage in elderly and vulnerable groups. However, despite the rapid rise, the central government hasn’t been forthcoming with details of new cases and numbers of deaths.

Due to the extremely high volume of circulating virus in a less immune population, there is an increased medical risk that a new COVID variant could emerge. The characteristics of this variant could be more detrimental on a global level, transmitting faster and with more virulence.

Alternatively, the theoretical variant could have positive characteristics, transmitting faster, thereby outcompeting other variants. It could be less virulent, leading to less illness and death. One of the difficult aspects of the Chinese outbreak is that we are not able to access accurate and timely data about case numbers and genomic sequencing, which we have been able to do with past regional outbreaks.

Expect the current surge in China to ease during Q1 of 2023 as Omicron spreads through the population. Significant disruption to the healthcare system in China is also expected as well as significant morbidity and mortality levels.

European and North American healthcare systems are also under pressure from a combined threat of multiple respiratory viruses and backlogs of patients. With hospital care paused during the past lockdowns, waiting lists have been growing.

The return of other respiratory viruses

Relatively high levels of circulating COVID-19 variants have, for the first time in the pandemic, occurred simultaneously alongside influenza, respiratory syncytial virus (which can be severe in babies and children) and the common cold.

As social distancing and other pandemic mitigation strategies have eased, respiratory viruses have returned with a vengeance as after years of low circulation, people’s immune systems fail to recognise common viruses. Businesses may experience operational disruption due to high levels of sickness amongst staff. Staff absence could also occur due to childcare issues as children become sick and stay off school and nursery. There is a heightened medical risk associated with excessive demand on primary and emergency care.

The impact of medical risk on the travel landscape

Despite the above concerns, both leisure and corporate travel are continuing their upward trajectory from mid-pandemic lows. Surveys of corporate travel managers suggest that travel expenditure is now at or exceeding pre-pandemic levels. It seems that for the majority of companies, an element of hybrid working and virtual meetings is here to stay alongside business travel and face-to-face meetings where impact will be greatest. High levels of vaccination and natural immunity from continually circulating COVID-19 means that most staff are well protected against severe illness.

COVID-19 has re-emphasised the importance of pandemic risk planning. Pandemics are a natural part of human history and without a doubt we can expect more in our lifetime. In 2022, mpox (previously known as monkeypox) spread rapidly around the world in specific groups. This was the first time it has spread outside of west and central Africa. The WHO and regional governments mounted a rapid response and targeted vaccination of gay men and healthcare workers at risk with the smallpox vaccine. This led to a dramatic drop in cases by the end of the year. While the threat from mpox recedes, expect future pandemics to arise with the potential to disrupt business, travel and our daily lives. For this reason, organisational pandemic risk mitigation policies need to be up-to-date and adapted to emerging threats.

What lessons can be learnt from the pandemic that will help shape your organisation moving forward?

  • Prepare policies for workplace health and safety. That can include providing adequate hand hygiene facilities, arranging effective workplace cleaning, or re-structuring the workplace environment to reduce transmission areas. Ventilation, air circulation and filtration are key to mitigating medical risk.
  • Maintain strong communication lines with the workforce in order to coordinate business plans. Facilitate confidential employee feedback regarding health and safety concerns or unsafe health practices, and consider ‘whistle-blower’ protection policies. Establish policies for sick leave absences.
  • Continue to evolve the virtual workspace. This could be through embracing technology and ensuring there are provisions in place in case the workplace is inaccessible.
  • Encourage and facilitate the opportunity for routine annual vaccinations, for example influenza.
  • Review or establish insurance coverage.
  • Plan and be prepared for a future pandemic. Use business networks or other business organisations to share best practice, to learn from each other and to engage in joint exercises. You should revisit and retest continuity plans periodically to ensure that it remains current. Check that preparations that could go out of date, such as phone lists or arrangements for alternative chains of command, are up to date.

Luke Kane
Medical Officer
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