I was 14 years old when I first felt the impact of an epidemic. The word went round my school: polio. We learnt of this disease caused by a virus that suddenly paralysed you. People were put into what were called iron lungs, only their head protruding, being fed by a nurse, drinking through straws. One boy who had been a star of the rugby team and was then an undergraduate at Oxford became a victim, paralysed in his legs.
All sport was stopped, and the school term ended weeks early. I asked my father about it; what caused it, why did people call it infantile paralysis when it seemed to be affecting older people? He said it was because we had become too clean, children didn't eat enough dirt and the germs in it, and so didn't get a mild attack as infants and were no longer immune when they were older. It was my introduction to the concept of immunity. I felt I might be all right, since as a small child I was always being reprimanded by my mother for getting dirty. Do you remember the Hilaire Belloc cautionary verse? My children and grandchildren do, as I quoted it to them after encouraging them to play in mud.
His father came on Franklin Hyde, carousing in the dirt
He shook him hard from side to side, and hit him till it hurt,
Exclaiming with a final thud, take that abandoned boy
For playing with disgusting mud, as though it were a toy.
And then, laughing, I used to chase them with a stick.
It dawned on me that all those illnesses that we all had suffered, measles, mumps, chicken pops (as we called it) and German measles were epidemics, spread from person to person by coughing and contact; coughs and sneezes spread diseases. They were not much fun when you had them but when you recovered you were immune, unlikely to get them again. Unfortunately, a small number of children fell so ill with them that they died or suffered long-term damage to the lungs or other organs, and then the great medical miracle happened. My younger siblings got injections instead of the illnesses and even I, as an adolescent at university, got an injection of Dr Salk's vaccine that protected me from polio. My siblings were even luckier, as they didn't even need an injection but drops of Dr Sabin's vaccine on a sugar lump, and poliomyelitis, a viral infection of the spinal cord no longer occurs in Britain. We have vaccine-induced herd immunity.
The WHO, so derided by the foolish Trump, followed its success with smallpox vaccination to take up the battle against polio. Almost incredibly (sorry – that adverb has been so devalued by politicians like David Cameron), and with great courage in the face of threats to their workers by religious fundamentalists, WHO has succeeded in eliminating it worldwide, save in small parts of two politically benighted countries.
German measles! Why German? For the same reason that Trump wishes to call COVID-19 the Chinese virus, for the same reason that syphilis was called the French disease by us and la maladie Anglaise
by the French, and that what we might call a French letter, the French call une capotte Anglaise
. It's what we do, attribute something rather nasty to a foreigner. You may recall at the start of this series of articles I referred to the porter at Leeds Royal Infirmary telling my grandfather in 1919 that he had a touch of the Russian and the next day he was dead. He was, poor man, referring to his memory of the previous great pandemic in 1889 that was widely known as the Russian flu. Alas, he died of the Spanish flu, but neither could be blamed on any individual country; viruses have no nationality. Both pandemics travelled the world on railways and steamships. Now they fly as well.
Never mind the adjective. Why influenza? The 1745 epidemic in Italy was attributed to the influence of the heavenly bodies, not unreasonably for the times. The name stuck save in France where more prosaically they call it la grippe
to express their discomfort, a word from the same root as our expression griping in the guts or my griping at the Government. Whatever, flu is a nasty illness and has a habit of occurring in waves each winter. In most of my career as a doctor, it did exactly what COVID-19 has been doing, killing older and chronically ill people, giving younger people a week of misery, and leaving those who have had it before relatively untouched because a degree of herd immunity existed among us.
On one occasion, working in the late 1960s as a locum ship's surgeon I had the unexpected experience of bringing a flu epidemic across the Atlantic in a passenger liner. It made an interesting change from setting fractures of old ladies who had got out of bed in the night and found themselves falling from the top bunk, but on arrival in Liverpool we had to fly a yellow flag and be vetted by the port authorities before anyone could disembark. But as with all these other viral diseases there are now influenza vaccines and as each new flu germ mutates a vaccine is produced that usually gives the vulnerable a good measure of protection.
This brings me round again to COVID-19. How does mankind protect himself from these viruses? We have to understand how they spread and how they attack us. Most are spread either by contact or by air or by both. Our defences are personal, taking action to reduce risks, and general, public health and therapeutic measures. In terms of the personal, we all now know about repeated handwashing and avoidance of hand-shaking. If you have been to India and much of the Far East, you will know of namaste (a small bow with palms pressed together); they learnt not to shake hands millenia ago. That is a much more gracious way to greet someone than bumping elbows.
Airborne spread is reduced by avoiding crowds and any close conversation indoors, and I have explained the science behind this previously. There is nothing magic about two metres distance; the closer you are to the mouth of an infected person talking to you, the greater the risk, but in a room the danger is also greater the smaller the room, so good ventilation is important to dilute any virus exhaled. That is why your grandmother liked to have the house well aired.
I'm very glad that the Governments are now taking notice of the potential value of face covering. I personally am very wary of visiting a hospital at present because many of the staff have been exposed to COVID-19 and do not know whether they are carriers or not. This is the reason I have been urging regular testing of all staff. The risk of such people passing the virus is reduced by medical masks, and the risk of you unknowingly passing the virus to them is reduced likewise by your wearing one. Simple face coverings are not as effective but certainly better than nothing to stop you passing the virus to others. The more of us who wear these, the harder it is for the virus to find someone to live in. It is highly desirable that we should all wear face coverings when we go into places where people congregate such as shops, cinemas, pubs, churches and football matches, when such activities are allowed. Efficient and therefore expensive masks are essential for front line staff together with the more complete protection described as PPE.
Everyone knows by now that COVID-19 is not the same as flu, though many of its effects are similar. There is clearly some innate immunity in the population as some people seem not to catch it, and it is possible that the common cold, which may also be caused by a coronavirus, may have caused some immunity. But, in general, we are dependent on the discovery of a vaccine, a very complex process; even when one is discovered, it would be expected to take a year or two to produce one that is sure to be both effective and safe. It is likely that when they are found they will be used first to protect the most vulnerable. Likewise, a curative antiviral medicine can reasonably be anticipated within a year or two, but do not underestimate the ability of any micro-organism to develop resistance quite quickly; I would expect it will take a combination of antivirals to be sufficiently effective against this one.
I'm also pleased that our Governments have returned to tracing and quarantining contacts. This is the essential traditional and effective means of controlling an epidemic. In England, characteristically, much play has been made about an app such as the one that has been used successfully in the Far East. If it works well, it will be a help but is not a substitute for shoe leather tracing of contacts. There is an irony in Johnson pronouncing that he will soon have a world-beating method, as the numbers of deaths already show the UK to be among the most severely affected three nations in the world. Using something that has been successful in the Far East does not put us top of the league; we are fighting to avoid relegation.
We in Scotland are no better than England in terms of mortality, in fact probably a bit worse, but at least we now have a properly engaged public health system and there are signs that control of the virus is coming nearer. However, this depends critically on public compliance with the advice from our Government, even if you are rather tired of the man who keeps giving it to us on the television. I suppose no advertising person is old enough to recall the television doctor. Our main problem has been the appalling mortality in care homes, and this must be subject to an enquiry in due course.
One looming problem is the premature relaxation of lockdown in England. It is likely that there will be a second epidemic south of the border and I am afraid it is a porous border; how will our Government cope with that? We need to be prepared for it. Do we stop flights and trains from coming here, and keep a close watch on arriving visitors and cars? Public Health England is one of the failures of this epidemic and is still handling it badly despite the protests of regional directors of public health, who have been sidelined. Our Scottish Government needs to take a much more critical look at the UK Government's advice and especially their political responses.
And finally, the latest issue; quarantine. Another word from Italy, meaning 40 days of detention, first introduced in Venice in the late 15th century to protect the city against epidemics introduced by ships. Now the duration depends on the incubation period of the infection, so if you are exposed to someone with COVID-19 you are required to isolate yourself for two weeks. If you haven't developed symptoms in that period, it is very unlikely that you will infect anyone or develop the disease yourself subsequently.
Many of us have already been in this position and many more will, as the process of tracking and tracing contacts continues. It is critically important that we are strict about this and do isolate ourselves if asked to do so, as they did in Venice. Starve the virus of humans to feed on. As for quarantine of people visiting these shores, that is something that should have been done when other countries had a higher prevalence of the disease than we did, hardly when the reverse is the case. It just illustrates the muddled thinking of this UK Government.
So, from my early experience of fearing polio to continuing experience of sheltering from COVID-19, from my air-raid shelter in the Second World War to fearing the awful threat of climate change, I watch the cyclical change relating to mankind's role as the dominant organism on this planet and I wonder, where are we heading? And that, I'm afraid, is up to us and how we behave and vote.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own.