how much risk does Covid pose to the Queen?

 The image of the Queen sitting alone while mourning the death of Prince Philip has become a symbol of public sacrifice during the pandemic. And the 95-year-old monarch appears to have been fastidious in abiding by public health guidance, routinely wearing a face mask, scaling-back Christmas celebrations and publicly confirming her vaccination status. However, with continuing very high levels of Covid-19 in the community, even the most cautious are at risk of infection.

© Provided by The Guardian Photograph: Jonathan Brady/PA

Throughout the pandemic, older people have been disproportionately at risk from Covid-19. During the first wave, about 10% of those aged 80 years and over who were infected died. And since March 2020, more than 5% of England’s population of those over 90 years old have died within 28 days of a positive Covid test. But during the past year, things have improved dramatically for the oldest people in society.

Vaccination has offered a crucial wall of defence. The Queen had her first vaccine in January 2021 and is thought to have had all her follow-up doses. Early on, there was concern that vaccines would be less effective in older age groups due to the immune system being less responsive. And it does seem likely that older people are more susceptible to infection, even when vaccinated.

A study of more than 200,000 people published this week, found that older people have significantly lower concentrations of antibodies in their blood after vaccination than younger people and their levels of antibodies wane more quickly. But lower rates of infection suggest that older age groups more than compensate for this higher susceptibility by behaving more cautiously and having fewer social contacts.

Protection against severe disease in older age groups appears to be holding up well. Research by the UK Health Security Agency shows that around three months after they received the third jab, protection against mild infection among those aged 65 and over dropped to about 30%. But protection against hospitalisation remains at about 90%. Omicron has also turned out to be a milder variant, with the chance of hospital attendance in those over 70 years being reduced by more than one-third.

In January, the prevalence of Covid infections in the over-70 category rose above 3% – the highest at any time during the pandemic – and remain hovering above 2%. But there has not been a huge surge in deaths.

Buckingham Palace indicates that the Queen’s symptoms are mild. Even so, there are other protections that the Queen’s doctors may be considering. In a recent trial, the Pfizer antiviral pill, Paxlovid, reduced the risk of hospitalisation or death by 88% when given within five days of symptoms. The pill, along with another antiviral made by Merck, is automatically available to clinically extremely vulnerable people who test positive on a PCR test.

Outside this high-risk category, the drugs can also be accessed by those aged over 50 who have a health condition, such as heart disease or asthma, or who are considered by their doctor to be vulnerable, through the Panoramic trial. Doctors also sometimes recommend monitoring for more vulnerable patients using an oximetry device to keep track of blood oxygenation at home.

Prof Paul Hunter, an infectious disease expert at the University of East Anglia, said someone in their 90s would be at increased risk of severe disease compared with younger people, even if they had been triple vaccinated.

Nearly all severe Covid infections begin with mild symptoms, he explained. Prof Hunter told the PA news agency: “With somebody in their mid-90s, even if they’re triple vaccinated you are concerned that they could gradually deteriorate over coming days and so you would need to keep a very careful eye on them.

“You would, I think, almost certainly be considering giving antiviral drugs, of which there are a number around at the moment.”

He added: “If you do get them early enough it does reduce the risk of severe disease developing so I would imagine any doctor for a patient in their 90s would be considering giving these antivirals out.”

The Queen’s diagnosis comes as the government plans to lift all remaining Covid restrictions, including the legal requirement for people who test positive for Covid to self-isolate, in the coming days.