Image Credit: left Photo by cottonbro studio via Pexels; right Photo by CDC via Pexels
Table of Contents
COVID-19 Not Just The “Common Cold”
COVID-19 Complications
– Long COVID
– COVID-19 Increases Risk Of Health Problems
Cold Vs Flu Vs COVID-19 Summary
What Has COVID-19 Got To Do With The Gut?
Can COVID-19 Trigger New IBS?
Can COVID-19 Worsen Existing IBS?
Countermeasures
Reasons For Countermeasures
Countermeasures In Practice
When Will It End?
Nasal Vaccines – The Saviour?
Further Reading And References
COVID-19 Not Just The “Common Cold”
The strain of COVID-19 circulating in 2025 (Omicron) has milder symptoms than previous strains. In some people these symptoms may feel like the common cold or flu, which leads to many people thinking that COVID-19 is now just like the “common cold”, but this is not correct. With the lack of media focus and public information about COVID-19 (92) and for many people, life returning to normal, coming to this conclusion is understandable. This means that some people may be making choices in regards to their health based on a lack of information (92).
It is important to understand the differences between colds, flu and COVID-19. These differences are outlined in the tables below. This explanation is necessary for people to understand how COVID-19 may be linked with IBS.
Caused by
| Cold | Flu | COVID-19 |
|---|---|---|
| One of more than 200 viruses including: Rhinoviruses – 10%-40% of colds [Common cold] coronaviruses – 20% of colds RSV and parainfluenza – 20% of colds Unidentified – 20%-30% of colds (1) | One of 4 types of influenza viruses, A, B, C, and D. Influenza types: – A and B tend to cause human infection – C is less frequent and causes mild infection – D mainly infects cattle and is not known to infect people (2) (15) | SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus (26) |
Mode of transmission
| Cold | Flu | COVID-19 |
|---|---|---|
| – virus enters through the nose, mouth and eyes – from inhaling virus aerosols in the air from infected people coughing, sneezing, talking, or laughing – from direct contact e.g. hand shaking or handling contaminated objects such as door handles, then touching your nose, mouth or eyes afterwards (3) | Same (15) | Same – contact route regarded as secondary to respiratory transmission (27) (114) |
Mode of progression
| Cold | Flu | COVID-19 |
|---|---|---|
| – infection occurs in the upper respiratory tract – Pattern Recognition Receptors (PRR’s) detect the virus leading to the release of immune cells (cytokines) which circulate in the blood to cause symptoms such as headache, muscle aches and pains and tiredness – inflammatory substances are generated including bradykinin and prostaglandins leading to local symptoms such as sore throat, sneezing, runny nose and nasal congestion. (4) | – flu infection replicates inside the respiratory tract including the lungs – the immune system sensing the presence of the infection produces cytokines which orchestrate other parts of the immune system and chemokines which direct these to the location of infection – white blood cells (T lymphocytes) proliferate in the lymph nodes around the lungs and throat causing lymph node swelling and pain – after a few days these T cells move to the lungs to kill infected cells leading to a build up of mucus in the lungs inducing coughing – cytokines and chemokines enter the blood stream leading to wider symptoms such as headache, fever, appetite loss, fatigue and weakness – infection causes increase in the expression of muscle-degrading genes and a decrease in expression of muscle-building genes in skeletal muscles in the legs causing muscle aches – in some cases infection can spread to the gastrointestinal tract, but the route of this is unclear (24) (19) | – SARS-CoV-2 enters the upper respiratory tract and moves to the air sacs in the lungs (alveoli) where it binds with ACE 2 (angiotensin-converting enzyme 2) receptors using the spike protein on the virus cell. (28) (29) – ACE2 is present in many parts of the body including the brain, eyes, nasal cavity, oral cavity, thyroid, heart, blood vessels, lungs, liver, gallbladder, kidneys, bladder, stomach, pancreas, intestines, male and female reproductive systems and the skin (30). ACE2 is involved in critical regulating processes such as blood pressure, wound healing and inflammation and protecting against tissue injury. – When SARS-CoV-2 binds to ACE2, it prevents it from carrying out its normal protective functions. SARS-CoV-2 is not only capable of binding to ACE2 in the lungs, but also to ACE2 present in the long list of organs already mentioned, which can lead to damage of those organs. (31). This is why SARS-CoV-2 can be considered a body wide virus and not just a respiratory virus. – As with colds and flu the body employs Pattern Recognition Receptors (PRR’s) to detect the virus and releases cytokines and chemokines are part of the immune response. (28) (29) |
Parts of body that can be affected
| Cold | Flu | COVID-19 |
|---|---|---|
| Upper respiratory tract involving: – nostrils – nasal cavity – mouth – throat (pharynx) – voice box (larynx) (4) (16) | Upper respiratory tract involving: – nostrils – nasal cavity – mouth – throat (pharynx) – voice box (larynx) (16) and lower respiratory tract involving – windpipe (trachea) – lungs containing: – bronchi – bronchioles – alveoli (17) (18) occasionally involving gastrointestinal tract (24) | Many parts of the body have ACE2 receptors which SARS-CoV-2 can bind to and affect those organs including: – brain – eyes – nasal cavity – oral cavity – thyroid – heart – blood vessels – lungs – liver – gallbladder – kidneys – bladder – stomach – pancreas – intestines – male and female reproductive systems – skin (30) |
Complications
| Cold | Flu | COVID-19 |
|---|---|---|
| Can impact: – the chest: bronchitis – sinuses: sinusitis – ear: ear infection (13) | Can impact: – neurology – in 8.5% of children hospitalised with flu (20): febrile convulsions (mainly children), Reyes syndrome (mainly children), meningitis /encephalitis, transverse myelitis, Guillain–Barré syndrome – cardiac – those hospitalized with flu without prior cardiac issues 5% and 12% overall (21): pericarditis, myocarditis, exacerbation of cardiovascular disease – respiratory – leading to 12.7% of flu patients being hospitalised (22): otitis media (mainly children), croup (mainly children), sinusitis, bronchitis, pharyngitis, pneumonia (viral or secondary bacterial), exacerbation of chronic lung disease – pregnancy issues – musculoskeletal issues: myositis, rhabdomyolysis (23) Risk factors: here. | – See COVID-19 Complications |
Hospitalisation rate per 100,000 population
| Cold | Flu | COVID-19 |
|---|---|---|
| Equivalent statistic not reported by UK government (levels should be lower than flu or COVID-19) | 21/12/23: 3.46 25/01/24: 5.40 22/02/24: 4.27 21/03/24: 2.59 25/04/24: 0.42 16/05/24: 0.40 20/06/24: 0.00 18/07/24: 0.00 15/08/24: 0.00 | 21/12/23: 4.68 25/01/24: 4.80 22/02/24: 3.00 21/03/24: 1.85 25/04/24: 2.01 16/05/24: 3.13 20/06/24: 3.31 18/07/24: 4.35 15/08/24: 2.69 |
Hospitalisation Note: Hospitalisation risk due to COVID-19 for babies (0-1 years old) is disproportionately high, compared to other age groups, especially under 6 months, whose risk is even higher than for those over 90 years of age. Vaccination from 6 months old and during pregnancy can go some way to reducing these risks. In the UK the JCVI only recommends vaccination of vulnerable babies at 6 months and withdrew vaccination in pregnancy in November 2024. (113)
Deaths
Transmissibility
*Reproduction number – infections generated by one infected person
How long does it last on surfaces?
| Cold | Flu | COVID-19 |
|---|---|---|
| – cold viruses can survive outside the body for 2-3 hours (3), though there is evidence it that they can be infectious on surfaces for up to 24 hours (7). Specifically Rhinovirus lasts on the following surfaces: – Formica, stainless steel, varnished wood, nylon, wool, and silk for up to 3 hours – cotton, facial tissue, and paper towel for up to 1 hour (11) | – flu viruses can survive on hard surfaces and be infectious for 24 to 48 hours (7), and 8-12 hours on porous materials such as paper and cotton (8). | – A 2022 study found SARS-CoV-2 Omicron (B.1.1.529) had a survival time on: – plastics of 8 days (193.5 hours) – skin of 21.1 hours (9) – a 2022 review of studies reported the following times up to which SARS-CoV-2 survives on specific surfaces: – plastic – 7 days – stainless – 7 days – metal – 5 days – glass – 4 days – ceramic – 4 days – paper money – 2 days – unvarnished wood – 1 day – cloth – 1 day – cardboard – 1 day – paper – 30 mins – tissue paper – 30 mins (10) |
How long does it last in the air?
| Cold | Flu | COVID-19 |
|---|---|---|
| – how long virus aerosols from an infected person last in the air depends on the aerosol size. The time required for an aerosol of 100, 5, or 1 μm to fall to the ground (or surfaces) from a height of 1.5m is 5 seconds, 33 minutes, or 12.2 hours, respectively. These can travel beyond 1-2m from an infected person enabling short and long range infection. Droplets greater than 100μm cannot be inhaled and fall to the ground in under 5 seconds. (12) | Same | Same |
Time infectious before symptoms
| Cold | Flu | COVID-19 |
|---|---|---|
| 1 to 3 days (14) | 1 day (25) | 2 to 4 days for Omicron on average though can be 2 to 14 days after exposure for symptoms to appear. (37) Note that it can take 2 to 4 days from exposure to show up on tests, though specifically PCR tests can detect the virus before infectiousness. (38) |
Days infectious with symptoms
| Cold | Flu | COVID-19 |
|---|---|---|
| You are contagious as long as symptoms are present which can be 5 days to 2 weeks after symptoms starting, though some cold viruses can persist in the body for up to 4 weeks. (14) | 5-7 days after you start symptoms, but can be spread until symptoms disappear (25) | Many people will no longer be infectious after 5 days, but you can be infectious for up to 10 days (39), though testing can help identify infectiousness. It is also possible to have no symptoms (asymptomatic) and still spread the infection. A 2022 study demonstrated around 32% of Omicron sufferers were asymptomatic. (40) Due to the incubation period, the possibility of asymptomatic infection and some people experiencing symptoms similar to other respiratory diseases, it is not possible to tell whether someone has COVID-19 or not without accurate testing like using PCR tests. |
COVID-19 Complications
Long COVID
- Long COVID is related to 200 health effects across multiple body systems, for example, heart disease, neurological problems, stroke, dysautonomia (related to disruption of nerves that carry out vital bodily functions), severe fatigue, gastrointestinal disorders, kidney disease, diabetes and immune disfunction (33)
- Although the emergence of Omicron altered binding mechanisms in the upper respiratory tract making severe infections less likely (43), the existence of Long COVID means that even with Omicron, in some people, COVID-19 may not just be limited to the respiratory tract
- Long COVID can affect healthy people, not just those with risk factors (33), and those within any age group (34)
- A 2024 report states that the risk of Long COVID is 7.7% for unvaccinated and 3.5% for vaccinated people with the Omicron variant of COVID-19 identified late 2021 and circulating in 2024. (33) [Note vaccinations are now restricted and 7.7% is an average, so could be more based on personal risk factors]
- More than 90% with Long COVID had mild COVID-19 infection (33)
- There are estimated 2 million Long COVID sufferers in the England and Scotland (3.3% of the population) (34) and 65 million sufferers globally (33)
- Long COVID can impact ability to work and even day to day activities for months or years after infection (33)
- The risk of Long COVID increases with each COVID-19 infection. A 2023 Canadian study found that for those infected with COVID-19, 3 times or more, the risk of long term symptoms was 38% (35)
COVID-19 Increases Risk Of Health Problems
- Impacts to multiple bodily organs
- COVID-19 can impact internal organs even if you have mild symptoms (49), no symptoms or Long COVID. This may lead to health problems that may not have been experienced without prior COVID-19 infection either after the infection or lead to health problems in the future
- Serious complications from COVID-19 could lie dormant for years (36)
- Reinfection increases the chances of organ impacts (48)
- Below are just some examples of organ impacts and the list is long
- Impacts to cardiovascular system
- Organs being impacted by COVID-19 could lead to future health issues such as heart attacks and strokes. (32) For instance, a study confirmed that Omicron posed similar cardiovascular risks to previous variants (40) (54)
- With the Omicron JN.1 variant, blood vessel damage (including micro blood clotting) has been observed (44)
- Affects on the immune system
- Potential links with cancer
- Impacts to the brain and on mental health
- An October 2021 to January 2023 study found that COVID-19 contributed to cognitive decline (brain fog) and brain aging (41), which can occur even with a mild COVID-19 infection (97). Some of these issues may be due to the fact that a 2024 study has found the COVID-19 spike protein lingering in the brains of COVID-19 patients, which could have neurological impacts (119)
- In some young people, mild COVID-19 infection has been found to disrupt brain connectivity and reduce memory function (108)
- COVID-19 may cause depression. During infection, substances such as cytokines and chemokines are produced by the body which results in inflammation. Scientists have found higher levels of T-helper-2 cell-secreted cytokines, in people with COVID-19 and especially in those with more severe cases. If these cytokines are not controlled by the body this may lead to, for example, nerve inflammation, disruption to the blood/brain barrier, immune cell entry into the central nervous system, impaired nerve transmission, HPA (Hypothalamic-pituitary adrenal) dysfunction. All of these are associated with mental health disorders such as depression, which can occur after recovery from the virus (109) (111)
- A study by University of Oxford and the University of Leicester, found 2 to 3 years after infection, participants on the study on average suffered reductions in attention and memory tests equal to 10 IQ points. More than 1 in 4 changed occupation due to not being able to meet the cognitive demands of their jobs anymore. 1 in 5 suffered from depression, 1 in 8 anxiety, 1 in 4 fatigue and 1 in 4 reductions in perceived memory. All of these symptoms became worse over time (110)
- Impacts to kidneys
- Impacts may vary with each strain
- As the virus keeps evolving which cells get affected (and where symptoms are experienced) will keep changing – for example diarrhoea or a headache were dominant symptoms of the Omicron JN.1 variant. (44)
- The early 2024 Omicron KP.2 and KP.3 variants of concern had higher ACE2 binding capability compared to the previous Omicron strains and potential immune escape (42)
- The later XEC variant was associated with a slight increase in hospitalisations and 163 deaths during the week ending October 4 2024, which was an increase of 27.3% from the previous week (112)
- Impacts to the NHS
- Considering that COVID-19 increases risk factors for other illnesses, it stands to reason that this will place extra burden on the NHS, not only in the years since the start of the pandemic, but also in future years to come
- Impact to business & GDP
- A survey reported by the Chartered Institute of Personnel and Development (CIPD) and Simplyhealth in September 2023 found that 37% of organisations reported Covid-19 as still being a significant cause of short-term absence (90)
- Add this to the increased burden of spin-off illnesses that may not otherwise have occurred without COVID-19, associated impacts on sickness absence and subsequently the bottom line, these effects may still be felt for many years potentially resulting in a overall drag on GDP
Cold Vs Flu Vs COVID-19 Summary
- Colds, flu and COVID-19 are caused by different viruses
- Colds impact the upper respiratory tract and flu, the upper and lower respiratory tracts. Although the latest variant of COVID-19, Omicron, is more likely to target the upper respiratory tract* and you are far less likely to be hospitalised with or die from Omicron, it still has the potential to impact many different parts of the body even with a mild infection or an infection without symptoms (94). These impacts may not be felt for years and the exact risks of these are unknown. For example, survivors of the 1918 Spanish Flu pandemic were two or three times more likely to develop Parkinson’s disease in their life time – this finding has also been correlated with other virus outbreaks with the theory that these viruses cross into the brain leading to degeneration that increases the risk of the disease. There have been abnormal spikes in Type 1 diabetes since the start of the pandemic with the theory that this may be related to inflammation of the pancreas from the virus. (46) *There is anecdotal evidence that the FLiRT variants of Omicron circulating in 2024 were giving worse symptoms than previous Omicron strains (47). COVID-19 can cause more-serious illnesses in some people than can the flu and quite different complications to the flu such as blood clots (55)
- COVID-19 is far more transmissible than colds or flu, which means the chances of catching it are relatively high. Each newer strain of COVID-19 seems to have increased levels of transmissibility compared to older strains (45). Buckinghamshire Disability Service provides a weekly risk assessment of the likelihood of coming across someone with COVID-19 in England, here. A different map also shows the percentage of positive PCR tests taken, usually in hospitals, in an area
- Flu is very much a seasonal disorder, peaking in the winter months and then dropping off, whilst COVID-19 is non-seasonal, with cases peaking at other times of the year including the summer. Again this increases the likelihood of catching it
- Chances of reinfection with Omicron are 5.5 times higher than with the earlier strain (Delta). One early study shows that previous infection only gives a 19% protection rate (50)
- Some COVID-19 sufferers can harbour infection for long periods of time, known as persistent infections. Researchers estimate that between one in a thousand to one in 200 (0.1-0.5%) of all infections may become persistent, and last for at least 60 days (51) (52)
- The risks of developing Long COVID after being infected even with a mild infection are not insignificant, particularly if not recently vaccinated which is true for the majority of the population in the UK. This can lead to inability to work and/or a reduction in the ability to carry out normal day to day activities including exercising. These risks increase with each additional infection. A report, based on General Practice Patient Survey data from 2022 (56), discussed in the media on 23rd August 2024 showed that in North West England just over 1 in 20 (5.5%) of the population were suffering with Long COVID, with North East England and Yorkshire at 5.1%, South West England 3.4%, South East England 3.6%, with an overall average across England at 4.4% (53) (which is higher than the 3.3% ONS report of November 2023 to March 2024 based on a questionnaire issued to a specific group of participants and mentioned above (34))
What Has COVID-19 Got To Do With The Gut?
From the above table, it is clear that COVID-19 can infect many different parts of the body due to the presence of ACE2 receptors, which COVID-19 binds to, throughout the body, the gut being no exception. Hence it should not be a surprise that 50% of people experience gut symptoms after COVID-19 infection. Gastrointestinal symptoms may be the first sign of COVID-19 in some people, but many people will not correlate this with COVID-19. ACE2 receptors can be found widely in the blood vessels of the gut and the gut lining. COVID-19 infection of ACE2 in the gut leads to the release of inflammatory cytokines and damage to the gut lining (its mucous membrane barrier) leading to symptoms such as nausea, vomiting, abdominal discomfort, and diarrhoea. The gut lining damage can impact its integrity allowing bacteria to enter the blood stream and cause infections. As with elsewhere in the body COVID-19 can cause microclots in the blood vessels including those in the bowel. (57)
COVID-19 infection can cause a disruption to the gut microbiome including reduction in numbers of Bifidobacterium adolescentis, Faecalibacterium prausnitzii, and Eubacterium rectale, which influence immune responses. Such adverse changes in the gut microbiota can also lead to gut dysbiosis (a dominance of bad gut bugs over good) (58) and an increase in inflammatory cytokines and blood markers of tissue damage. The production of butyrate by good gut bacteria suppresses inflammation in the gut, but the bacteria that produce this such as Faecalibacterium prausnitzii is reduced by the infection. Reduced levels of Faecalibacterium prausnitzii have been found in those with COVID-19 and Long COVID. All of these changes can explain the ongoing gut symptoms experienced by Long COVID sufferers. (57)
Can COVID-19 Trigger New IBS?
Yes. Post-infectious IBS relates to IBS that is triggered within 2-3 years of a bacterial, parasitic or viral infection. Researchers believe around half of IBS cases relate to post-infectious IBS and that COVID-19 can be a trigger for it. (59) (60) (61) (63) This is hardly surprising considering the impact COVID-19 can have on the gut and the microbiome and that IBS can be related to gut ‘injury’ from infection and from dysbiosis of the microbiome.
Can COVID-19 Worsen Existing IBS?
Yes. In a study, those infected with COVID-19 and pre-existing IBS experienced an increase in severity of their IBS symptoms. (64) This is also evidenced anecdotally on IBS forums, with IBS sufferers complaining of worsening IBS after COVID-19 infection and even triggering IBS flares after some time of stability and careful management (examples here, here, and here). Again, the potential impact on the gut by COVID-19 provides a clear explanation for this, effectively adding more ‘injury’ to an already out of balance and/or compromised gastrointestinal system.
Countermeasures
The risk of COVID-19 infection and potential ramifications from this, can be reduced in the following ways:
- Vaccination – as already mentioned vaccines can halve the risk of Long COVID. They have also reduced the risk of hospitalisation and death from COVID-19. Vaccines significantly lower the risk of developing more severe cardiovascular conditions linked to COVID-19 infection (107). However, a fraction of the UK population is entitled to vaccination in 2024 due to specific eligibility criteria. These edibility criteria have been weakened over time with the eligibility for Covid vaccinations in 2025 being changed by the Joint Committee on Vaccination and Immunisation (JCVI) to exclude the 65 to 74 years age group from the Autumn 2025 booster campaign only allowing adults aged 75 years and over whilst keeping other eligibility criteria (115). This decision was based on the costs of hospitalisations and deaths, without considering the impact of Long Covid (115) and health issues that could arise and would not otherwise have otherwise arisen without Covid-19 infection, including the burdens placed on the individual, businesses, GDP and society in general.
- Fresh air – ventilation in the home and other buildings can help bring in fresh air and remove stale air that may contain virus particles. Opening windows and doors, especially at opposite sides of the room or your home/workplace improves air flow (cross ventilation). Windows can also be opened periodically, especially in the Winter. (65) There is a suggestion that opening a window for 10 minutes every hour might help. Although some rely on air purifiers to remove viruses from the air, they cannot be relied on in isolation for protection against COVID-19 (66) (67). There are groups such as the World Health Network who are campaigning for improvements in indoor air quality in public settings.
- Masks – wearing a face covering when it is hard to stay away from people is helpful (70). Masks with filters/respirators offer better protection against COVID-19 than cloth and surgical masks. N95/FFP2 masks give 95% filtration of airborne particles that can carry the COVID-19 virus and FFP3 masks filter out 99% or more of airborne particles. (71) (74)
- Good hygiene – although infection with COVID-19 by touching contaminated surfaces is less likely than when you breathe in the virus, it cannot be ruled out (69). Avoiding touching your eyes, nose or mouth if your hands are not clean and washing hands with soap and water or use hand sanitiser regularly throughout the day can reduce this risk (70). Surfaces you touch often (such as door handles and remote controls) can be regularly cleaned (70).
- Testing – some people test others before they enter their home. PCR tests can accurately detect COVID-19 infection before infectiousness (38). Antigen tests may not pick up on the virus straight away and may need to be repeated (68). PCR tests used to have to be sent off to a laboratory, which caused a delay in getting the result. There are now PCR tests that can give a result at home in less than 45 minutes such as Pluslife, which requires the purchase of a device and tests.
- It is suggested that looking after your microbiome can help prevent severe COVID-19. A study found that a diet rich in healthy plant based foods was associated with lower risk and severity of COVID-19 (72) (73). It has recently been discovered that lungs have a microbiome in addition to the gut, which promote respiratory health and guard against pathogens. It has been found that the microbiome in the gut and the lungs communicate with and influence one another known as the “gut-lung axis”. This is another explanation for how viral infections of the lung can cause gastrointestinal symptoms. Conversely having a healthy gut microbiome can help immune cells in the lungs to work well to keep respiratory infections at bay. Gut microbiome imbalances can lead to a reduction in the integrity of the gut lining allowing pathogens from the gut into the blood stream adversely affecting immune response in distant parts of the body including the lungs. (82)
Reasons For Countermeasures
The reasons for considering mitigating measures against COVID-19 might be as follows:
- those who have risk factors for COVID-19
- those who have conditions not in the ‘at risk’ list that could be exacerbated by COVID-19 due to COVID-19’s ability to infect different parts of the body and not wanting to potentially experience a worsening of those symptoms
- those who practice a healthy lifestyle such as exercising and eating a healthy diet for their wellbeing and to reduce the risk of health issues in future. Practising COVID-19 countermeasures could be considered part of this healthy lifestyle, providing protections against the potential of future complications from the infection, the risk of which is unknown and therefore not impossible
- those simply wanting to avoid the potential of complications from COVID-19
- those wishing to protect others for one of the reasons above
Countermeasures In Practice
It seems that Public Health bodies have been more concerned about hospitalisations and deaths from COVID-19, rather than potential long term consequences. As soon as hospitalisations and death numbers decreased with the arrival Omicron, mask mandates stopped and so did up to date public information about COVID-19 (92). This gave many the misconception that we are out of the woods and COVID-19 is much like a cold, since it is hardly mentioned anymore using words like “post-pandemic”.
Whether someone takes precautions against COVID-19 may be down to their approach to taking risks regarding their own potential health outcomes, whether Long COVID or possible dormant health problems that might occur in future that wouldn’t have happened otherwise without infection. Some, if not many, are happy to live with these risks or would rather not think about them.
There is emerging evidence that a person’s tolerance for risk may be genetic (75). Additionally, a gene has been found that makes someone a Highly Sensitive Person (HSP). Elaine Aron, a HSP researcher says that 15%-20% of the population have this gene. (76) The Journal of Clinical Medicine says that this affects as much as 20%-30% of the population (78) The traits can also emerge in adulthood based on adverse childhood experiences. (77) These traits may have evolved through our ancestors to include members of the tribe who are more sensitive to their surroundings to alert the less risk averse to dangers. This combination of risk-takers and HSPs, who have careful sensory processing skills, has aided the survival of the human species. (79) People who are HSPs have a lower tolerance to risk and have higher rates of survival since they are hardwired to look out for dangerous situations and, in the process, help to protect others from danger. (77)
Theoretically, this could in part explain why many people were happy to drop COVID-19 safe measures due to a greater proportion of the population having a higher tolerance for risk. It has been found that those with a high optimism bias showed lower engagement with COVID-19 mitigations (83). Once measures are ended by the many, even those who are risk averse may drop those measures as well in order to fit in and not stand out from the crowd. Psychological research shows that people often ignore what is in front of them in order to conform to popular pressure (83). In an experiment called the “Asch Paradigm”, groups of participants were asked to match the length of one line with other lines on cards and the correct answer was obvious. Each group only had one real participant, with the rest initially instructed to give correct answers, then progressively incorrect answers with the real participant giving their answer last. Over 12 trials 75% of the real participants conformed to the incorrect answer at least once, proving the extent to which social pressure from a majority group could affect a person to conform. (91) It’s interesting that this percentage split between 75% conforming and 25% not is the rough split between HSP’s and non-HSPs, though there, is as yet, no evidence of a correlation.
Additionally, avoidance or not thinking about the pandemic, is a method some people use to deal with the trauma of COVID-19 (83). There is also the belief that you can’t protect health and the economy at the same time, but Long COVID comes with a huge cost to the economy (83). As already mentioned, The Chartered Institute of Personnel and Development (CIPD) and Simplyhealth reported in September 2023 that over a third (37%) of organisations reported COVID-19 as still being a significant cause of short-term absence (90), which would have a significant effect on the GDP per capita (at population level).
Western populations have a different mind set to mask wearing than those in East Asia. East Asian countries have seen other outbreaks like SARS or MERS and have been primed to respond to pandemics. These countries have brought in laws that have allowed the state to have certain rights over individual liberty. These countries also have a greater sense of community mindedness, where actions are taken by the individual for the greater good. Many Western countries lack this collective mindset with more importance given to freedom of choice and individuality, so people are less likely to do something that they don’t want to do for the common good. This may add to the reasons why people in the UK were ready to ditch the mask as soon as they were able to. (80)
With the emergence of Omicron, with its symptoms in some people more closely resembling the common cold, this may also lead to people taking it less seriously. This is quite a clever tactic by COVID-19, known as symptom mimicry – make the virus appear like something people have seen before to affect behaviour so that people drop their guard, cleverly allowing the virus to spread. (81)
The vast majority of people in the UK do not continue to take COVID-19 precautions when not legally obliged to do so and there can be many reasons for this. For some people, they’d happily like to forget that COVID-19 ever existed, which is their choice. However, if they do come across someone who is taking precautions, they need to remember that:
- they may still be COVID-19 cautious due to one of the reasons above
- the person does not have a mental illness – they are just making a personal choice based on the information at hand and measured against their own tolerance for risk
- telling a person to not be so sensitive or to increase their exposure to risks, won’t do any good, since their decision making is part of their temperament, which is likely to be hardwired into their personality due to evolution and is highly unlikely to change
- it is possible for some to manage to live their lives whilst still being COVID-19 cautious
- different personality traits need to be expected, and people shouldn’t expect everyone to be like themselves, since these differences are part of human evolution
- if every person was the same, the world would be a boring place
- remember the risk averse have helped the survival of the human species, in addition to the risk takers
Having said all of this, most people are not masking but may be taking measures more covertly such as going out less. A 2024 reported study by the Wellbeing and Space Society found that nearly 60% of study participants stayed at home more often since the start of the COVID-19 pandemic. This included reduced visits to places of leisure such as arts and cultural sites (62.5 %) and dining establishments (74.6 %). More than half exercised in indoor facilities less often, whilst under one quarter exercised in outdoor facilities less often. Interestingly, time spent in outdoor exercise facilities increased by 11%, indicating a slight shift from indoor to outdoor exercising for those still participating. Overall, the attendance at outdoor facilities changed the least. (116)
It seems government authorities are minimising COVID-19, including no longer providing the public with information regarding the virus (92) and reducing vaccination levels across the population (115). This could be for a variety of reasons such placing much less importance on potential increases in long term illnesses compared to hospitalisations and deaths. However, even though the 2024 UK Labour government are trying to get the long term sick back to work where they can and the numbers of those with long term sickness are very high, it seems the potential ongoing impact of COVID-19 is not being considered, which is short sighted. There is also the belief in cost to the economy from people being more cautious. The UK makes very little, with the manufacturing industry only 16.68 percent of GDP and 72.17 percent of GDP coming from the services sector (117) including the retail sector, the financial sector, the public sector, business administration, leisure and cultural activities (118). There is a huge reliance on the public engaging in leisure activities to contribute to the bottom line. However, from the study above, keeping COVID-19 hush hush and not reassuring the public that the government has policies in place to keep people safe from any long term effects of COVID-19, seems to be backfiring and people are quietly quitting from the activities that drive the economy.
When Will It End?
There is no modern record of a coronavirus pandemic. This is the first recorded pandemic of a SARS coronavirus. There is a suspicion that the 1889 “Russian flu” might have been caused by a coronavirus, but this is only a theory. This means there is no record of how long it took for a coronavirus pandemic to settle into an endemic state. All pandemics in modern history have been the flu virus, so it is hard to see how a coronavirus pandemic will play through. It is difficult to make the comparison with a flu pandemic since with coronaviruses, the incubation period, the time of infectivity and the time sick is longer than flu. (86)
SARS-CoV2 has shown a high number of mutational changes over long periods of time and a high level of infectivity. This means that even if you’ve had COVID-19 before, your body sees it as something different. Due to these mutations, sterilising immunity, where the immune system is able to completely prevent a virus from replicating in your body, which has been built up from prior infection, is not yet achievable. Although you may still get a level of protection from prior infection or vaccination. (84) A scientific paper describes the fact that infection with Omicron without vaccination, does not give broad protection across Omicron variants. However, breakthrough infections with Omicron after vaccination give higher levels of immunity from all variants of concern. (85) However, the vast majority of the UK population have not been offered COVID-19 vaccination recently. Additionally, coronaviruses don’t trigger enough long lasting immune protection for herd immunity, where a virus finds it hard to spread due to immunity in the population (86).
Nasal Vaccines – The Saviour?
The above assessment of the future of the COVID-19 pandemic paints a bleak picture with many unknowns. Many people already argue that COVID-19 is not going to go away – continuing with counter measures is a waste of time and can’t go on for ever, which is another argument for people returning prior pandemic behaviours. We all have to learn “to live with it”. However, there may be light at the end of the COVID-19 tunnel.
Vaccines have been imperative in the fight against hospitalisations and deaths from COVID-19. They have also been good at reducing risks associated with COVID-19 such as Long COVID.
A study of mainly Omicron XBB.1.5 vaccines, during the 2023 autumnal vaccine campaigns in Europe, found that these vaccines were 40% effective against laboratory confirmed, medically attended symptomatic SARS-CoV-2 infection in the 3 months following vaccination. The effectiveness was lower among older adults at 36% than among younger patients at 59%. (87)
These vaccines are variably effective at preventing symptomatic infection and transmission and do not provide full protection from the risks associated with catching COVID-19.
The good news is that scientists are working on a variety of next generation COVID-19 vaccines that hope to significantly improve the effectiveness of COVID-19 vaccination. Nasal vaccines as opposed to an injection in the arm are showing greater efficacy against infection and may have fewer side effects. Nasal vaccines can stimulate the immune system at the point of entry of the virus, the nose. This means that they should halt viral replication at the point of infection, making them much more effective. They also stimulate a whole-body immune response to aid long-lasting protection (93).
In a 2024 study, hamsters were administered, a chimpanzee adenoviral-vectored vaccine (one that has been altered so that it cannot make you sick) nasally or the BioNTech and Pfizer COVID-19 vaccine via muscular injection and then exposed to hamsters infected with COVID-19. The amount of virus found in the upper and lower airways of the hamsters was measured to determine transmission of the virus. The nasal vaccine prevented primary SARS-CoV-2 transmission and infection of the lungs and blocked onward transmission to both vaccinated and unvaccinated hamsters. The BioNTech and Pfizer COVID-19 mRNA vaccine did not block virus replication in the lungs or onward SARS-CoV-2 transmission. This has the potential to reduce the community spread of SARS-CoV-2, which is extremely promising (93). (88)
In a trial, 2 doses of a nasal spray, NB2155, led to a greater than 50 fold increase in specific antibodies against 10 strains of COVID-19 among health care workers, who also showed evidence of having blocked infections. (102) (103)
Researchers at the University of Texas at Austin have isolated an antibody from one person which identifies the spike protein of many different COVID variants. The researchers are working towards a universal vaccine that will give protection against current and future mutated versions of COVID-19. (95) (96)
Imperial College London, are working on the development of nasal vaccines that aim to stop people from catching a virus. This should reduce the circulation of the virus and its ability to mutate into new variants. They aim to have human trials that intentionally infect young, healthy volunteers to test the potential of several nasal spray vaccines against betacoronaviruses which relate to Sars-Cov-2, Mers and several seasonal common cold viruses. (89)
The above are just some of the numerous examples of the next generation of COVID-19 vaccination research.
There is a vaccine tracker which tracks currently approved vaccines and vaccine clinical trials globally and in the UK. One of the vaccines under trial in the UK, CoviLiv (previously called Covi-Vac) by Codagenix, is a nasal vaccine which was undergoing Phase 3 clinical trials during the latter part of 2024.
Scientist, Hilda Bastian writes highly comprehensive monthly blogs regarding all the latest developments regarding COVID-19 vaccine trials here. There are many new vaccines that are already under human clinical trials.
Further, a drug free nasal spray called Pathogen Capture and Neutralizing Spray (PCANS) and sold commercially as Profi™, which contains FDA approved ingredients, forms a gel that lines the inside of the nose, trapping, neutralising and immobilising SARS-CoV-2, influenza, RSV, Adeno and many other viruses and bacteria until they die. The makers claim greater than 99.9% effectiveness and that it doesn’t effect breathing. In a mouse study, it blocked 25 times the lethal dose of influenza virus, reduced the virus in the lungs by more than 99.9% compared to untreated mice, retained in their noses for up to 8 hours and blocked infection for at least four hours. The product is still to be tested on humans, but has been tested on a 3D printed model of a human nose where it trapped twice as many virus droplets as mucus alone. The makers say it could also be useful for allergens. (98) (100) (101) (104) (105) However, it is to be noted that people simultaneously breathe in through the nose and mouth when they speak (99). This suggests that COVID-19 could be inhaled into the respiratory tract, by-passing the nose whilst mouth breathing during talking, which means that not all entry routes will be protected if just a nasal gel is used. Though there will be an element of protection from the nasal gel, nasal vaccines will provide further protections to other parts of the body through the development of antibodies. Additionally, the results are from an animal study only and human trial results are needed. Further the product’s ingredients are: Pectin, Gellan, Purified Water, Phenethyl Alcohol, Polysorbate 80, and Benzalkonium Chloride. The ingredients have good safety apart from Benzalkonium Chloride, which the Environmental Working Group (EWG) says is: a preservative and surfactant associated with severe skin, eye, and respiratory irritation and allergies and is especially dangerous for people with asthma or skin conditions such as eczema.
In summary, it is not all doom and gloom. There is very encouraging work among the scientific community which provides hope for the future. Knowing this, some may decide to continue with mitigating actions until these new vaccines come to fruition, akin to delayed gratification, such as studying for an exam, investing time and energy now, to reap rewards in the future. However, so many are used to going back to normal, it is unlikely that this will shift. It also remains to be seen, when these vaccines do become available, whether they will be available to all or just eligible at risk groups, leaving the rest to deal with the potential consequences of COVID-19. Alternatively, nasal vaccines may only be available at a cost to those not meeting risk criteria resulting in huge health inequalities. The fact that nasal vaccines may prevent onwards transmission, it makes far more sense to get as many people vaccinated as possible assuming the new vaccines are safe. This is to reduce or eliminate the burden of new Long COVID diagnoses and the potential uptick in other diseases down the line as a result of COVID-19. There is the individual burden, the impact on productivity, the economy and cost to the health care system. All of this remains to be seen.
Further Reading And References
(15) World Health Organisation: Influenza (Seasonal), 3 October 2023
(39) NHS: How to avoid catching and spreading COVID-19 infection, Page last reviewed: 21 March 2023
(68) Mayo Clinic Staff: COVID-19 diagnostic testing, Mayo Clinic, July 18, 2024
(70) NHS: How to avoid catching and spreading COVID-19 infection, Page last reviewed: 21 March 2023
(71) Scott Weaver: FFP2 (N95) vs FFP3 (N99) vs Surgical Masks, UK Meds, Updated at: October 13, 2023
(72) Merino J, Joshi AD, Nguyen LH, et al: Diet quality and risk and severity of COVID-19: a prospective cohort study, Gut 2021;70:2096-2104.
(73) Lang K. What do we know about covid-19’s effects on the gut? BMJ 2024; 385 :q842 doi:10.1136/bmj.q842
(76) Elaine N. Aron, Ph.D.: The Highly Sensitive Person
(84) Steve Griffin: When will the COVID race be run?, Independent SAGE, Mar 21, 2024
(92) Juliet Green: Covid-19: is there a gagging order?, CENTRAL BYLINES, 13-09-2024
(112) Ben Hurst: Covid deaths rise by 25 per cent as XEC variant spreads, Surrey Live, 18 OCT 2024
IBS Researcher 