By Dr Naomi Forrester-Soto, virologist at Keele University. This article first appeared as a Personally Speaking column in the Stoke Sentinel on 27th October, 2022.

COVID - the large viral elephant in the room that no-one wants to talk about. It is said that Pandemics don't end when the virus goes asway, but when it no longer becomes the thing that society focuses on. This is the stage of the pandemic that we are living through now, where the virus is still very much present and causing infections, but we are no longer living as if it were important.

Why is this problematic I hear you say? This means no more lockdowns and no more masks, and half the time no-one has access to the tests so no-one tests anyway. You would be right in many ways, but the virus is still with us. The risks are still present – people who are unvaccinated are still more likely to die from COVID than those that are vaccinated and there is ample evidence from the US to demonstrate this.

The continued circulation of the virus is not going away no matter how much we might wish it to, and there is the increasing likelihood that we will have a higher influenza pandemic this year as well. Initial reports are also indicating that people infected with the flu are having more severe disease. This is most likely due to a lack of exposure to the virus for the past two years where we didn’t really have flu circulating within the populations.

This is problematic for several reasons, not least because respiratory infections such as flu or coronavirus are more prevalent in the winter. We all now know the reason for this, we spend more time indoors, we shut the windows and doors to seal out the cold air and this reduces any air movement that might reduce virus exposure. There is also some evidence that for some viruses a colder nose increases the likelihood of the virus replicating within the nose - that the reduction in temperature makes the nose a more beneficial environment to some respiratory pathogens. Either way, as we approach the winter with the usual round of Christmas parties and family gatherings, we are more likely to find ourselves in a place of increased virus circulation, with all the problems that causes. For some the potential for severe disease, but for many of us the significant disruption that COVID has to our lives. I am sure I am not alone in hoping that it isn't COVID when my kids are sick as the house of cards I have built comes crumbling down.

So what do we do? In a time where masking is now considered unusual, or testing is not as readily available as it has been, there are still ways to make sure that severe disease is not in our future.

The most obvious is vaccination. Vaccines are always our first line of defence against viruses. Although vaccination has become somewhat of a controversial topic in the past 20 years, when the first vaccines against polio were developed, parents were lining their children up to get it, to try and prevent children being paralysed due to infection with poliovirus. Vaccines have differing levels of efficacy. Some are very good for preventing both infection and transmission, but others are able to prevent severe disease, but not the ability to transmit.

COVID vaccines fall squarely in the latter category, they will protect against severe disease but not against transmission. It is complicated but basically, the antibodies that are present in your body are able to reduce the severity of the disease but cannot get to the virus quickly enough to prevent the virus being able to replicate. So by keeping up to date with the boosters, it enhances the immune response and prevents severe disease. Regardless of the lack of protection against infection, they remain the best option for preventing hospitalisation.

Respiratory viruses transmit easily through the air and we do not have the technology to purify the air and reduce transmission. In the absence of these magic bullets, the usual suspects are still the best solutions. Have doors and windows open, reduce the number of people in a room and wear masks if people are particularly vulnerable. However, over and above this, get vaccinated. Without vaccines, everything else becomes that much less effective. It is thanks to the vaccines that we can face this winter without masks and lockdowns, and so flu and covid vaccines should be our top priority this winter.