Ignorance or the lack of knowledge is something we all struggle with from our earliest days. As children, we ask questions and believe the answers. As we develop, we may feel ashamed and conceal our ignorance while we try to find answers for ourselves, and in doing this we may develop scepticism. We discover that our own ignorance is shared with others and may indeed be universal; nobody knows the answer to some questions and sometimes we don't want to know. The future may be too frightening. As Thomas Gray put it in his sombre Ode on a Distant Prospect of Eton College
, '…when ignorance is bliss, 'tis folly to be wise
These two manifestations of ignorance, personal and general, have been very apparent during this pandemic, and they have afforded us all a lesson in both the advantages and the dangers of not understanding things. Pope's couplet is apt: 'Nature and nature's laws lay hid in night; God said "Let Newton be!" and all was light
'. General ignorance can become general knowledge as a consequence of scientific insight but for all of us there comes a point, usually about the age of 14, when we realise that we cannot comprehend everything and must concentrate our minds on what we can grasp.
For me, J C Squire's 20th-century rejoinder to Pope: 'It could not last. The Devil howling "Ho! Let Einstein be!" restored the status quo,
' illustrated the point at which understanding of physics started to pass beyond my comprehension. Fortunately, others had no such trouble, perhaps until Professor Higgs introduced us to his boson.
Some knowledge is so esoteric that only very few gifted people can understand it; a senior Treasury civil servant some decades ago told me that neither he nor any of his colleagues could understand the nuclear physicists when they were arguing for their part of the science budget. On the contrary, some knowledge that was once a complete mystery is now almost universal; few doubt that the heart pumps blood rather than accommodates the emotions. The challenge of ignorance to scientists and philosophers is to replace it with understanding, and this is what drives them.
As we have watched the evolution of the pandemic, general ignorance of the biology of viruses has slowly become general knowledge; they divide rapidly in cells and mutations allow them to adapt to new hosts for the species to survive. We have seen the UK variant appear in Kent and spread to cause a third wave of infections both here (where it was superimposed on the second wave) and in Europe. Fortunately, though now recognised to be more virulent in its effects, it is still susceptible to the antibodies produced in response to the current vaccines. However, this is not true of the South African, Brazilian and probably the Indian variants, and vaccines will need to be modified to prevent them getting hold where they are not already prevalent.
We knew this pandemic was likely as soon as the original SARS-CoV-2 virus was identified in China. We also knew how to modify or even prevent such an outcome from previous experience with other viruses. We very quickly found out how infective the virus was, the infamous R number. But our ignorance lay in understanding the interaction between the virus and human populations, since none had been exposed to it before. This ignorance was the opportunity for the modellers, of whom we have heard so much subsequently and who proved to be the dominant force in advising governments.
The modellers had the advantage of seeing how the virus had spread among and affected other populations before it reached us, and their predictions proved quite accurate. They had to take account not only of the infectivity but also of likely political and societal responses, and here lies the greatest difficulty. Predicting the future of biological interactions depends on guessing at things of which we are all ignorant – think, for example, of advice to observe hygiene measures combined with financial incentives to go to pubs and restaurants! How would people respond to such conflicting messages? While one thing could be predicted easily from experimental science – that vaccines would produce immunity in those who accepted the jag – how many would and how long would immunity last? And what about side effects? Now we have some answers, some more knowledge, but still plenty of ignorance.
Both the Pfizer and AstraZeneca vaccines (and almost certainly the Johnson & Johnson and Moderna ones) give excellent immunity to both common UK variants and enough people (approximately 70%) now have antibodies for us to be approaching herd immunity. That is the good news, as this makes it more difficult for the virus to cause another severe outbreak or for further variants to evolve. However, smaller local outbreaks are still very likely.
For population protection to be maintained, two things are necessary. First, we must continue to observe the same cautious hygiene measures, perhaps indefinitely but certainly for the rest of this year. This obviously includes foreign travel while the epidemic rages elsewhere. Second, our governments must ensure that contact tracing and isolation is highly efficient. The so-called surge testing to find contacts is part of this, but only part. Isolation with support for contacts is equally important, and we must be told how close public health measures are to achieving high compliance. Many breadwinners may find it difficult without support and government silence on this is worrying.
Another problem for the modellers is the spread of new variants. The serious effect of the UK variant was not predicted by the models because its virulence was unknown at the time. However, the UK is doing very well at identifying these variants, of which there are very many. Most are likely to respond to the current vaccines, but some do not. The scientists can be relied upon to modify the vaccines to deal with the most dangerous, and I expect that many of us will be invited for booster jags before the year is out to take account of possible spread of the South African and Brazilian variants. These, with the Indian one, now present the greatest risk of a fourth wave of infection, probably affecting younger people more severely and again disrupting the nations' health services. For the sake of our medical and caring staff, I would urge everyone to continue to behave sensibly.
I wish the television media would stop showing pictures of jolly, overweight people congregating, laughing and shouting at each other in pubs, implying that this is essential to normal life. It is not the way to encourage us; most people are more sensible than this.
Finally, a word on another area of ignorance, vaccine side effects. The evidence is now very suggestive that the very rare blood clotting episodes reported after some inoculations with the AstraZeneca and Johnson & Johnson vaccines (which are very similar in that they rely on adenoviral vectors – see SR 18 November 2020
and 3 February 2021
) are true but very rare side effects. The severe manifestation of some of these unusual abnormalities of the blood clotting system, causing thrombosis of a vein in the brain, are so rare that there must be an important susceptibility factor in some individuals and there are well-developed means of investigating this in small groups of individuals. A hint, no more than that, comes from the probability that younger people, especially females, are most at risk, but susceptibility may be environmental as well as genetic.
To achieve herd immunity and suppression of viral transmission, young people need to be vaccinated even though they are much less likely to suffer severe illness if they catch COVID-19. This alters the balance of individual risks in them, so it was sensible and prudent to change policy and give younger people the Pfizer or Moderna vaccines which are different in concept, being spike mRNA in a nanoparticle, and have not to date been associated with this reaction. How fortunate we and our politicians are to have available both this range of vaccines and the science that can alter them subtly to take account of dangerous mutations.
We have been known as Homo sapiens
, wise mankind, since Linnaeus gave us the name in the mid-18th century, within a few years of Gray's poem about loss of the innocence of youth with which I began. Our ability to reason, to ask questions and seek the answer, has justified the appellation but it would be wrong to think that we are all wise. There has been plenty of scope for both an optimistic scientist and a rather gloomy poet over the last year. The response of science and medicine to the pandemic has been remarkably wise, that of society collectively has been generally sensible and altruistic, and that of most politicians has been confused. We have witnessed folly and, in Trump and Bolsonaro particularly, the unjustified arrogance of power. But over this past year we have all become much less ignorant of the implications of a pandemic and of what we need to do to get out of this one and to prepare for the next.
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