Masks, ventilation, vaccines: Why have we given up on Covid?

"I was trying to come to terms with what looked like me never being able to leave the house safely again.

"That's a big thing to get your head around."

Dr Witcher - who was awarded an OBE in 2006 for her work on disabled rights and equality - had been on the shielding list due to her high clinical risk.

But as restrictions were rolled back, and Covid rates soared, she found herself ineligible for the additional boosters or antiviral treatments which had been hailed as the cornerstone of a world where Covid was to be tolerated rather than controlled.

She felt left with no option but to stay home.

Covid rates were much higher during 2022 than they had been at any previous point in the pandemic and remained so into 2023 (Image: PHS/ONS)

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In June last year, she resigned from her role as chair of the Scottish Commission on Social Security in order to rail against the Scottish Government's handling of this phase of the pandemic, which she complained had positioned clinically vulnerable people "like modern day lepers".

Amidst her anger, however, Dr Witcher began to wonder what a better "new normal" might look like?

"I stopped myself and I asked 'well, what would it look like if you had a strategy that was actually about making society as safe as possible for as many people as possible while maximising everybody's freedoms?

"That was a question I thought was worth trying to solve."

Dr Sally Witcher has criticised the Scottish Government's handling of Covid as restrictions were lifted (Image: Gordon Terris/Herald&Times)

The result is Inclusive New Normal, a manifesto which advocates - among other things - for cleaner indoor air and masking in healthcare.

Dr Witcher describes the decision in May to drop guidance on masks for staff and visitors to hospitals and care homes as "inexcusable and unforgivable", and is frustrated that public messaging has failed to make clear to people how much more effective FFP2/3 masks are against Omicron spread compared to cloth or surgical face coverings.

She would also like to see the "huge amount of learning" on ventilation and Hepa air filtration put into widespread use.

Heated debates have raged on social media, and among scientists, on the spread of Covid through air.

There is a consensus that it does, but ongoing disagreement about how big a part airborne transmission plays in infections compared to close-contact or surface-touch transmission.

Nonetheless, there are potentially huge health gains to be had from protecting indoor air from respiratory pathogens, allergens, and pollutants.

READ MORE: Is it time to treat indoor air like we do clean water? 

A paper published in the journal Nature on July 10 revealed that a prototype air monitor can detect the presence of an infected person in as little as five minutes, potentially offering a way to make public spaces such as schools, offices, care home, hospitals, and shops much safer.

"We know that Covis is airborne," said Dr Witcher.

"That means you have to have clean air and you have to have a respiratory mask for protection.

"Yet we've got places where people at high clinical risk have to go and we have no rules for keeping ourselves safe in that environment.

"People are being actively encouraged to take their masks off, even by consultants who know about their risk.

"What is going on?"

There have been calls for guidance on masking in health and care settings to be reinstated immediately, and FFP2/3 facemasks provided to staff 'as a minimum' (Image: PA)

Dr Witcher said the past year has been "incredibly tough" and she and others who continue to restrict their lives to avoid Covid find themselves "pushing against this tide of public indifference".

She stresss that her aim is not a return to lockdown but to maximise environmental safety for everyone.

She said: "This isn't just about people who are clinically vulnerable; it's about really solid research showing that the more times you get infected, the more damage is going to be done to you.

"And it's about your exposure risk as well.

"You look at the statistics for people who've got long Covid and guess what? - the people who are most likely to have it are social workers, healthcare workers, teachers, people who are regularly exposed to Covid in environments that are not safe because the air isn't clean and basic protections have gone.

"Look at excess deaths - nobody wants to join the dots, governments least of all.

"You're seeing upsurges in young people getting heart attacks and strokes, links to cancer, links to early onset dementia, or aggravation of dementia where it's already there.

"The WHO warned governments that there's a huge public health disaster coming our way, but governments persist in only looking at acute infections.

"They only want to look at it in terms of the vaccine."

READ MORE: Campaigners call for 'immediate' return of facemasks in hospitals and care homes 

Dr Witcher's campaign has the backing of Lara Wong, who founded the Covid Vulnerable Families support group back in 2020 amid concerns that the spread of the virus in schools was putting clinically vulnerable children and parents at unacceptable risk.

It now has 2,500 member households on Facebook and 11,600 on Twitter, and has broadened in scope to lobby for stronger public health measures against Covid.

Ms Wong says the "single biggest issue" for her members is safe access to healthcare.

"We would like to see masks back in healthcare - we wouldn't reasonably expect them to be anywhere else.

"But given that people who attend healthcare may be actively infectious and that's whey they're there - it's a high risk setting with high risk people - it seems like it should be treated differently."

Vaccines and antivirals have been the main line of defence in the 'living with Covid' strategy over the past 18 months (Image: PA)

She would also like much more done on ventilation and air filtration in public buildings, and more flexibility from employers.

"Over time people have been losing jobs because workplaces aren't necessarily willing to put mitigations in place and people are struggling to continue working from home.

"Not everyone who's immunosuppressed will qualify as disabled, so they don't necessarily qualify for reasonable adjustments under the law.

"That can put them in a really difficult position."

Use of facemasks in Scotland declined sharply when it shifted from a legal requirement to guidance (Image: ScotGovt)

Ms Wong agrees that vaccines and antivirals mean we are "not in the same situation as before", but stresses that comes with caveats.

"Not everyone who's clinically vulnerable is being offered vaccines repeatedly, and for antivirals it's not straightforward.

"Even for the people who qualify - and that's a really small cohort - they can really struggle to get them within five days.

"And over time the number of antivirals that actually work has been decreasing.

"The main one that's working at the moment is Paxlovid, but the virus will evolve and it's going to evolve away from any of the treatments that we have over time.

"It should not be down to the individual to try to protect themselves in impossible circumstances.

"It's quite shocking that this is the situation we're in right now."

READ MORE: Devi Sridhar - 'Yes, there are lockdown lessons from Sweden - but not the ones you think'

While the focus of campaigners goes beyond acute illness, a major study led by Glasgow University recently repoorted that two Covid vaccine doses appear to protect the majority of immunocompromised people from hospitalisation and death.

The Octave trial found that while only half of these patients generated antibodies - a barrier against infection - 88% had a T cell response, suggesting that they would have good defences against severe disease.

Professor Iain McInnes led the Octave trial. He is head of the College of Medical, Veterinary, and Life Sciences at Glasgow University (Image: Newsquest)

This is borne out by data showing that for 90% of the participants who did test positive for Covid between 2021 and mid-2022, their infections were either asymptomatic or mild (meaning they did not require hospital care).

Of the 10% which were severe, this was most common among patients with renal failure and ANCA-associated vasculitis or who had undergone stem cell transplants or CAR-T therapy for cancer.

READ MORE: Covid vaccine study - a new normal for immuno-compromised? 

There was also evidence of changing trends over time: of the 107 cases identified among study participants during the Delta wave, there were eight deaths and 23 severe infections, whereas Omicron resulted in 327 cases but only 17 were severe and two fatal.

The researchers stress that it is "not possible to disentangle" how much of this is because the Omicron era coincided with the rollout of vaccine boosters and Covid antivirals, as opposed to the strain being less pathogenic than Delta.

Work is ongoing to evaluate the impact of third and fourth doses but the study's lead researcher, Professor Iain McInnes, said that "on the whole patients should find this reassuring".

He said: "The study has given us vital insights into the effectiveness of vaccines in some of our most vulnerable patient groups, and while we have identified a small number of patients who may not respond to the vaccines, the results should increase the confidence in our vaccines for the majority of our most vulnerable patient groups.”

Tomorrow in the Herald on Sunday: New normal? The Scots 'still shielding' from Covid