In 1802, in his sonnet, The world is too much with us , William Wordsworth lamented the way modern habits and industrialisation were opposing nature, and hoped for a glimpse of something better:
So might I, standing on this pleasant lea,
Have glimpses that would make me less forlorn;
Earlier this month ( 13 January ), I quoted John Milton in writing what I called ‘A Glimpse of Hell’, in relation to the Trump-inspired fascist storming of the Capitol building in Washington DC. But now it is possible to take some comfort from the inauguration of President Biden and the extraordinary performance of a 22-year old black woman, Amanda Gorman, who movingly read her poem at the ceremony, starting:
When day comes we ask ourselves,
where can we find light in this never-ending shade?
and concluding:
The new dawn blooms as we free it
For there is always light,
if only we’re brave enough to see it
If only we’re brave enough to be it
So, some more positive thoughts.
Isolation
My wife and I, like many of you, went into isolation in early March last year and have not yet escaped. We took comfort from each other’s company, meeting others electronically and speaking to our children and grandchildren on the phone, even seeing them on Zoom for Christmas. Our view of the world outside has necessarily been in glimpses; glimpses while venturing out briefly for shopping or for walks, glimpses from episodes shown or discussed in the media. I know we are among the fortunate, our home encompassing our life, but the world outside had become an alien place. However, good things are happening, and it is important not to forget the positives despite the relentless images of death and misery presented to us daily in the media. Here are some glimpses.
The virus
Coronaviruses are famous for mutating and the general outcome is to become less virulent but more readily transmissible. The current ones seem to be more easily spread and the most common one in UK may be slightly more fatal, but this is not a cause for panic. All variants infect us in the same way and all respond to the same preventive measures. As far as can be seen, they do not affect younger people more severely, but they are infecting more people and thus more younger people.
The stated increase in virulence of between 10 and 30% needs to be understood in terms of individual risk. If your risk is very low, a 50% increase still leaves a very low risk, say from 1 and 1000 to 1.5 in 1000. If it is high, say from 1 in 10 to 1.5 in 10, it matters to you much more. This means that the effect is still considerably greater in the elderly than the young. Of course, any increase in virulence matters to the NHS as it implies more seriously ill patients, but the implication for all is that we need to continue to take the same careful protective measures.
In protecting ourselves, we are protecting others and thus the NHS. Our behaviour during the current lockdown is reducing the numbers of infections and thus the risks to each of us. We need to continue to observe the rules strictly and, if so, this outbreak will settle to the point that it will be controllable by an efficient test and trace system. The light ahead is a rather flickering one and depends on our governments having test and trace locally based and properly staffed. Clever apps are perhaps a help but not a solution; skilled people are.
The vaccines
The COVID-19 vaccines are as close to a medical miracle as anything in my lifetime, the result of decades of brilliant science on the genome dating back to my undergraduate years. I have said almost enough about them previously, but I need to add a bit. So far, the evidence is that they will reduce risks of infection by the current strains of SARS-CoV-2 in the UK and are likely to be at least partially effective against other variants. It is also certain that as new ones evolve, scientists will be working on newer vaccines. If we comply with lockdown instructions, these vaccines will control the rates of infection in the UK to a point at which an effective test and trace system can be set up to deal with outbreaks and life will be able to resume here at a controlled and cautious pace. But getting beyond this means a worldwide programme. Thank goodness the USA has re-joined WHO.
The vaccination programme is proceeding well in England and all my elderly friends there have been vaccinated at least once. Like me, other octogenarian readers will be wondering what has happened in Scotland. Distribution of vaccine was one of the pinches of salt I warned about last year. Fortunately for our government, we are a patient age group and not inclined to public display, but on your and my behalf I’d like to urge them to pull their socks up and get all over-70s vaccinated quickly. This plus the lockdown will make life more bearable for our NHS friends, and incidentally could allow many of us with appropriate experience to become vaccinators and contact tracers ourselves.
The treatments
Some viruses, such as the one that causes cold sores, respond to antiviral drugs but SARS-CoV-2 does not. Curiously, however, most of the serious effects of infection relate to secondary complications from the immune reaction and this led investigators to test many other drugs, some in common use. Dexamethasone was the first to prove life-saving in a proportion of seriously ill patients and two other drugs used in rheumatoid arthritis followed. More recently, a synthetic viral antibody has been shown to prevent progression of disease in some earlier cases and this may prove a useful drug when the investigation has been completed.
Many other drugs are under active investigation, and there is reason to be optimistic that useful ones will be found. This is a field in which the UK really is a world leader. Nevertheless, the drugs in use and the corresponding advances in oxygen therapy and management of sick patients have made a very significant difference to the chances of seriously ill patients surviving.
The NHS
The pressure on the NHS remains enormous, but there are now signs that the infection rate has peaked and is likely to reduce over the next month. The problem is capacity, of beds and staff; both are being dealt with by expanding COVID-19 areas within hospitals and by re-deployment of people, but capacity is finite, and this means that more routine work suffers and hospitals have to concentrate on emergencies while out-patient visits and operations have to be deferred. This cannot easily be solved in the short term, but better planning of using Nightingale-type and private hospitals could have reduced much of it.
Amazingly, in spite of all the pressures, the emergency side is working well. Two weeks ago, on a Sunday evening, my wife fell and seriously injured her arm, bleeding badly. Having wrapped it up, we drove to the local hospital A&E, arriving at nearly midnight. I was rightly sent away to sit in my car clutching my mobile as she was seen within minutes by a doctor. By 1.30am, I received a call from a surgeon that he had cleaned and dressed the eight-inch wound and had arranged an appointment to see a plastic surgeon the next morning.
A few hours later, we drove back and were seen by a very efficient and sympathetic young female consultant who spent 40 minutes re-placing the skin flap, dressed it up and expressed the view that it was likely to heal. Everywhere, we saw COVID-19 precautions being taken. And so far all is well. Yes, the NHS is still working, and its patients are more grateful than they can say.
One thing is clear to me. The stresses on us and the NHS have been increased by years of government complacency about public services and overdue emphasis on the benefits of private involvement and central control. This chronic problem has been made acutely worse in the pandemic by the same ideology, leading to reliance on the private sector for contact tracing and ignoring the role of rundown local public health. The waste of money is on private fees that could have been devoted to the service. My ray of light is that we have all learnt to appreciate the NHS and those who work in it, and thus those who can afford it will not begrudge their taxes being spent on it. And the same is true of social services. Perhaps our politicians will realise that we are no longer a selfish society.
The people
Despite the inevitable concentration of the media on the dramatic and shocking, the great majority of our people have been law-abiding and helpful to the common cause. Very many are losing work and money, and even more are suffering from loneliness and depression. Yet so many are rising above their problems and helping. Our posties and the men and women who collect our household waste, the ones who deliver groceries and essentials, those who work in food banks and places of worship, our school and college teachers, builders, shop assistants; all glimpses of people who are keeping going, often cheerfully, to help us through even though they may well be struggling themselves.
We have become too used to such services and often forget to appreciate those who provide them. I hope that this will change and, again, that we will not begrudge paying our taxes. They support our supporters.
Young people and their teachers
Although least likely to suffer symptoms from the virus, young people in general are paradoxically most likely to suffer the consequences of the pandemic, since almost all are affected by loss of schooling, lack of work opportunities or loss of jobs. They will recover, as resilience goes with youth, but we must not underestimate the difficulties they face. The efforts made by teachers and lecturers to continue their education have been heroic, both in facing infection themselves and in providing all the online support necessary, and they deserve our collective gratitude, as do all the home-educating parents.
I sense among today’s children a generational change. They care about the world and its climate, they want to make a difference; like Amanda Gorman they look for a better, fairer world. They see the light ahead – if only they are brave enough to be it. But they need our support.
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
By Anthony Seaton | 27 January 2021
