Over 36 million people in the UK are now fully vaccinated and also have received booster dose. England's remaining coronavirus regulations are now lifted, and the British government is moving away from treating the disease as separate from other broader respiratory illnesses. Confirming this shift, and to the dismay of the WHO, UK Health Secretary Sajid Javid has suggested the virus should now be treated like the flu. The WHO called this stand rather premature and believes coronavirus must be seen as a separate entity.

So who's right: the UK government or the WHO? Should flu be treated more like Covid-19?

“I think people use the term depending on whether they want to call [Covid-19] mild or severe, we don't have any real benchmarks because there can be very severe forms and mild forms,” Prof Tim Spector of King's College London told The National. The acclaimed genetic epidemiologist and founder of the Covid-19 symptom-tracking ZOE app has urged a revision in how flu is defined to prevent its politicisation.

Latest data shows that in UK for the first time since the pandemic struck, the incidence of Covid-19 with respiratory symptoms has reduced with the incidence of cold and flu-like respiratory symptoms not being related to Covid-19. This means, in the UK if you have a respiratory illness, the chances of it being Covid-19 is same as any other respiratory illnesses currently circulating.

Unlike the UK government, Prof Spector believes this convergence is not the green light to return to old lifestyles before the pandemic, but instead an opportunity to modify our approach to public health. “I think we have got to realise this pandemic is just going to be one of many that are inevitable due to the population size and our interactions with animals — and seeing how [Covid-19] has now gone into many animals, it's likely to come back at us in different forms”, he said.

In the context that pandemic is “no worse than flu”, flu is used as a proxy for mild illness, not a virus which requires public health measures and the limitation of personal freedoms.

UK Office for National Statistics mortality data between 2013 and 2015 shows that flu and its associated complications, like pneumonia, are far from benign. During the time period monitored, average of more than 26,625 people a year died from influenza or pneumonia — a number reduced by the 73,512 people who died from Covid-19 in 2020, according to Public Health England data.

Francois Balloux, professor of computational biology at University College London, said how it was ironic that Covid-19's comparison with flu had become a figure of speech for those seeking to minimize its severity. “The most dramatic pandemics, with the exception of HIV, were influenza pandemics,” he said. “1957 and 68 were not particularly mild, and 1918 the same!”

Influenza, also known as the Spanish Flu, has approximately killed between 17 and 50 million people globally. Even if taking the lowest parameter as accurate, it is still over three times the Covid-19 casualties globally to date.

Prof Balloux said the US Centre for Disease Control (CDC) has produced “the best estimates”, but even these are “pretty rough".

The fact that flu means different to different people is rather concerning. The lack of logic showcased by UK government’s decision concerns Prof Balloux. “We have such bad numbers and people underestimated the burden of the flu before, including academics. They saw it as something trivial, which it isn't.”

Treating Covid-19 like flu would be a risk for any country, even like UK that has a largely vaccinated population. Deaths as a percentage of overall cases have reduced drastically as well as the relative mildness of the Omicron variant due to large scale vaccination. But still the number of cases and deaths is hard to ignore.

“I think we have to realise that things have changed and [Covid-19] is acting more similarly to most respiratory viruses in the current environment of previous exposure and vaccinations,” said Prof Tim Spector.

 “So calling it a cold or flu-like illness, or cold or flu-like virus, is probably becoming more appropriate now than it was. You can't separate them symptomatically in vaccinated populations.”

This is supported by data mined from Prof Spector's ZOE Covid-19 symptom tracker, which during the entire pandemic has invited users to log their daily symptoms, Covid-19 infection or not. This has helped the researchers at ZOE to have early insights on the changing nature of the virus and its symptomatic presentation. During early stages of the pandemic, the app was instrumental in alerting policymakers to the emergence of symptoms such as loss of smell and taste as indicators of an infection.

“I do think we need a more global monitoring not only of the genetics … but also like the ZOE app of symptoms, so people can see when something funny is happening and investigate,” said Prof Spector. “I think we just haven't devoted really any money to this kind of stuff in the past.”

“An early warning system I think is needed by every country that can afford it,” he said underlining how amused he is that other countries do not have such a system. “And I think the other thing we missed out on is realising that most of these waves have started in kids, which we cottoned on to rather late, even in our [ZOE] data. Because of the complicated ethical ways of getting at kids, we had to get to them from their parents and get them to do these tests.”

Prof Spector does see cause for hope: “I think there are some good things that come out of it. We have incredibly compliant populations who are doing lateral flow tests and reporting their symptoms. And we've managed all this without any real government support or publicity.”

“So if any government wants to get behind a national programme that gets populations to test for viruses once a week and log their symptoms, and particularly get kids in schools involved, it would be pretty easy.”

These tests must be the quick lateral flow tests, said Prof Spector, who suggested such test which tested combination of Covid-19 and other circulating respiratory illnesses to be a useful tool for coming few years “until Covid fades into the distance".

“Lateral flow is definitely the way to go; PCR is too expensive and too slow,” he said. “Naturally these viruses get quicker so everything's got to be done faster. And generally done at home, at the airport, at the office, to get a real result immediately, not waiting 72 hours. That's nonsense.”

Prof Spector thinks measures like masks wearing — state funded and high grade — and social restrictions can be lifted in future, but shouldn’t be taken for granted.

Prof Balloux is doubtful that they should be used at all. “I think we cannot just stay in a pandemic mood for ever,” he said. “I'm really in favour of people feeling free and encouraged to do anything they're happy to do.

“And on the mask debate, I think we've got that very wrong because now I think it's clear to everyone that it's only high-grade masks that really have an effect.”

Instead of focusing on masks and social restrictions, which he called “mission creep”, Prof Balloux hopes to see a more holistic approach to health.

“While producing better ventilated buildings and controlling transmission in hospitals can help, we have to face it that the main problem is the poor health of populations,” he said. He believes a focus must be on education and young people, and better school meals and more exercise, things he says require “less political will”.

He says that in long term it is not feasible or reasonable to ask people to think how they can protect others. He wants the approach to shift to “how individuals can better protect themselves.”

Prof Spector says, “We need to learn from the Japanese who for the last 10 years have been wearing masks every winter, and travelling to work in them even if they don't have a cold.”

“They realise it's a sign of respect and, and they wouldn't sneeze on people. So I think we need to change our cultural habits.”

Though Prof Spector and Prof Balloux diverge in their public-health visions and how to move with Covid-19 in the future, they agree that it is reasonable in fully vaccinated populations for Covid-19 to be treated in equivalence with other respiratory illnesses.