Covid-19 and the Queen: What the virus looks like for the over 70s

At first glance, the timing of this week's announcement by the British Prime Minister that the Government is ending most Covid restrictions could not be worse. For just as Boris Johnson prepares to unveil plans that the legal requirement to self-isolate after testing positive for Covid is being scrapped and lockdown laws are being repealed – it emerged on Sunday that the Queen has tested positive for Covid-19.

But from another perspective, the confirmation of a positive test result for the nation's figurehead, and subsequent reassurances from Buckingham Palace that the 95-year-old is only suffering mild symptoms and continuing with her work, could not have come at a better time for the many, particularly elderly, people who are concerned about the imminent lifting of restrictions and whether they, too, will soon be exposed.

Indeed the Queen's robust response to the virus (just Sunday morning she was reportedly well enough to sign a message of congratulations to Britain's curling teams at the Winter Olympics) seems to confirm the extent to which the vaccine programme, scientific breakthroughs and an increased epidemiological understanding have reshaped the way we view Covid-19 in the elderly.

The calm sense of practicality emanating from Windsor Castle, where the Queen will continue with "light duties" while her health is monitored, is what living with the virus will in practice look like for many of the older generations who throughout the pandemic have been deemed most at threat (albeit in rather less rarefied surroundings).

The Queen's robust response to the virus seems to confirm the extent to which the vaccine programme, scientific breakthroughs and an increased epidemiological understanding have reshaped the way we view Covid-19 in the elderly. Photo / Getty Images

For the over-80s, a person is 60 per cent less likely to be hospitalised with Omicron than if they caught Delta, the previously dominant strain, research from Cambridge's MRC and the UK Health Security Agency (UKHSA) shows. Above all, says Chris Smith, a British consultant virologist and lecturer at Cambridge University, this is down to the impact of the vaccines.

"They are really very effective in this age group, returning 90 per cent protection in a fully vaccinated individual," he says. This, combined with the lower virulence of Omicron despite its enhanced transmissibility, has created a situation that, he says, is safer than at any point since the pandemic began.

He also stresses that the dropping of legal restrictions does not mean people will stop suddenly following their common sense (as was shown in the voluntary isolation many undertook over Christmas). "Am I worried for my mum who is in her 70s?", he asks. "No. I'm less worried about her now than I have been for the last few years."

The UK vaccine rollout has been especially successful at covering the elderly and most vulnerable. More than 90 per cent of those in the 80-plus age cohort have received at least one jab and the vast majority of those have also received second and third doses.

"Overall, more than nine in 10 individuals aged 18 and over who have received at least one dose have also received a second dose (96 per cent)," says the latest official report.

The Queen will be eligible for The UK Government's plan to offer a fourth jab to the over-75s and clinically vulnerable within weeks. Photo / Getty Images

"This proportion is slightly higher for females than males (96.4 per cent compared with 95.9 per cent)."

The UK started rolling out boosters in mid-September, with the oldest and most vulnerable again being prioritised. While it has not been publicly revealed when the Queen received her third vaccine, by virtue of her age it is thought this would have been in late September or early October.

While extraordinarily effective, even boosters wane. The UKHSA says antibodies induced by a third dose start to fade after about 10 weeks, reducing protection.

This has been most visible in Israel, which boosted its population in August. The country witnessed hospitalisations rise sharply during the early part of the Omicron wave, partly because the protection provided by third doses had lessened. It has been urging citizens above 60 to get a fourth jab as a result. The UK Government, too, is expected to offer a fourth jab to the over-75s and clinically vulnerable within weeks.

Figures from the Office for National Statistics (ONS) show that for every 100,000 people over-90 who have been boosted, there would be 343 expected deaths or a 0.34 per cent risk of death.

This metric, known as the age-standardised mortality rate, is 10 times higher for an unvaccinated person, with 3237 deaths expected per 100,000, or 3.2 per cent.

It was around a month ago, when case rates were soaring, that Sage's SPI-M modelling sub-committee, which advises the Government, confirmed this dramatic improvement in the prognosis for older people with the Omicron variant.

This is due not just to the high take-up of boosters, but also the increased use of community treatments for Covid-19: in particular, at-home oxygen monitors which can detect deteriorating lung function earlier and lead to shorter hospital stays, and the use of powerful antiviral medications which the NHS now has at its disposal.

'Game-changing' antiviral drugs

Dr Fergus Hamilton, a Wellcome doctoral fellow and specialist in infectious diseases based at North Bristol NHS Trust, says this has been apparent in the reduced age profile of Covid patients on the hospital wards where younger, unvaccinated people are now dominating.

He says when older patients have a positive test confirmed at home, they are sent the new antiviral drug Paxlovid, manufactured by Pfizer, which was approved late last year by the Medicines and Healthcare products Regulatory Agency (MHRA) for adults who could be vulnerable to coronavirus due to age, weight or a prior chronic illness.

In a clinical trial in high-risk adults with symptomatic coronavirus infection, the drug (which is taken as a pill) was found to reduce the risk of being admitted to hospital and of death by almost 90 per cent. Another antiviral offered to NHS patients is the "game-changing" pill Molnupiravir, which the UK became the first country in the world to license in November.

While it is not known whether the Queen will be offered one of these at-home treatments, given her age it seems likely.

In cases of more serious illness, high-risk patients are increasingly given the same monoclonal antibody treatments which were administered to former US president Donald Trump and have been shown to reduce hospitalisation and death by around 60 per cent. Fergus Hamilton hails such treatments as "huge defences in the armour available to older folk".

While he broadly supports the Government indicating that it will press ahead with ending the availability of mass tests as part of its "living with Covid" plans, he stresses the need to maintain targeted testing of older and vulnerable patients because of the effectiveness of the available drugs.

"We shouldn't reduce targeted testing in the older population because there are such good benefits," he says.

But even given such positive trends, there remains an underlying fear of the virus, which for some will be difficult to overcome in the weeks to follow.

'It is important not to be too fearful'

Professor Tom Kirkwood, emeritus professor at Newcastle University, who has researched the field of ageing and health for nearly 50 years, says there are steps all elderly people can take to boost their immunity and improve their confidence about facing the virus.

These are, he says, nothing more complicated than eating moderately and well, ensuring plentiful supplies of vitamin C due to its immune-boosting properties, maintaining regular exercise to boost cardiovascular function pumping oxygen around the body and, above all, to remain positive.

"It is important not to be too fearful," he says.

"There is evidence that having an optimistic outlook on life is also good for bodily function."

And as he points out, there is no greater embodiment of that stoic approach, than the Queen herself.