In my last essay , I urged a stoical attitude to this pandemic, characterising most of us as phlegmatic. This adjective describes one of the four classical humours of mankind, choleric, sanguine, and melancholic being the others. I noted that other people understandably react to such adverse environmental disasters in different ways according to their personalities and personal circumstances; it is obvious that as our circumstances change, so our reactions will be modified. At times, I admit to erring towards a choleric reaction, and one thing that provokes this is governmental failure to learn from experience.
You will have noticed that many observers are calling the current outbreak a third wave; could this be to disguise the number of basic errors made so far? The severity of the first wave was strongly influenced by delays in instituting lockdown. The second wave was evidence of a failure of standard public health measures including control of the borders, when the number of infections had been reduced to manageable levels by the first lockdown. The third wave was then driven by the more transmissible Kent, now alpha, variant that was allowed to spread during that period of failed control, and this mutant then spread round the world including to India, where similar public health failure (more forgivable in their case) led to evolution of the delta variant.
And now the fourth failure in the UK, by allowing uncontrolled return from India, is giving us the current wave, fortunately modified in severity if not in numbers by the excellent vaccine programme.
It appears to me that an air of complacency is being encouraged, with talk of opening up nightclubs, foreign holidays, a return to ‘normality’. Could diversionary tactics, such as sending a warship with BBC and Daily Mail reporters on board into Ukrainian waters to annoy the Russians, be intended to distract us from some awkward facts? What is this fourth wave going to bring? How is it likely to affect us?
You will have seen the numbers. More people are now being infected in the UK than in the previous waves (although the numbers in the first wave were greatly underestimated, as reliable tests were then little used or unavailable). Hospitalisations and deaths are happily much reduced so far but are rising. Superspreading events are occurring – the G7 conference in Carbis Bay, a sleepy corner of Cornwall, has been followed by a significant number of new cases in the local population and I note that Andrew Marr who reported from there has told us that he missed his Sunday programme a week later because he had an unpleasant attack of COVID-19, though fully vaccinated. I anticipate that European football matches and eventually perhaps the COP26 conference will have similar effects.
Wherever people get together and speak loudly to each other, especially indoors, the virus spreads. You may think that this is only affecting the young in whom it is a minor illness at worst; this is not so. There are many unvaccinated or partly vaccinated people of all ages, many poorer, chronically unwell, or obese people at risk of infection by the delta variant; they are the ones who are now requiring admission to hospitals. And even the young may suffer serious symptoms or develop long Covid. A recent study in Norway has shown half of under-40s with symptomatic COVID-19 still have symptoms such as fatigue, loss of taste or cognitive change six months after recovery.
As I write (June 27) new cases are doubling each week and severe cases requiring ventilation have doubled in about a month. At this rate, there could be over 60,000 new COVID-19 cases daily and some 3,000 in hospital in the UK by 19 July. Divide by 10 to get the approximate Scottish numbers; tracking of contacts would again become very difficult. Two consequences are to be feared; new variants will evolve, and our hospitals could again be unable to cope other than with COVID-19 patients. The most vulnerable of all ages will die.
It is important to point out that now, in midsummer and what is usually a medically quiet season, our hospitals are extremely busy with the backlog of patients whose treatment has been delayed and with a mass of patients attending as emergencies who seem unable to access their usual general practice services. Hospitals are also suffering from loss of staff who are recovering themselves or self-isolating having been in contact with children who had COVID-19. In Scotland, currently some 1,700 or 1% of the NHS workforce are absent for COVID-19 related reasons.
I am being blunt because some newspapers and politicians are crowing for us to be allowed to get back to normal, and their advisors seem reluctant to point to the stark realities. Mutations occur when the virus is allowed to circulate widely, and these are then transferred by travel and congregation. Far from removing restrictions, we should be tightening them, especially with respect to international travel. King Canute showed that leaders do not have magical influence over nature. Until we are all vaccinated, we remain at serious risk.
The great danger is development of a new resistant mutant, so we all must continue to take reasonable steps to protect ourselves, making our own risk assessments. Mine stem from recognition of where the danger lies – close contact with other people, especially the young. It is very likely that the risk relates to dose of virus inhaled and this increases with duration of contact and amount of virus spread by our contacts. The latter is increased by shouting, singing and numbers of people in the area – exactly the behaviour encouraged in football supporters by television interviewers – though outdoors is much safer than indoors. Andrew Marr, by his own admission, was complacent and believed that vaccination guaranteed immunity. It does not, even though it reduces risks considerably.
Sixteen months have now passed since the first UK death from COVID-19, the first of 152,500 (10,160 in Scotland) to date. We have endured three waves with great fortitude, despite personal losses and considerable privation. The world of science partnered by the NHS has had extraordinary success in developing both treatments and vaccines. Our distribution of vaccines has also been a success in UK, but we have not succeeded as partners in the international role in vaccination that is necessary. It is on the success of this latter campaign that control of the future course of the pandemic depends, and this will take time. That is why we need to be patient, to avoid becoming patients, and to avoid exporting our virus and importing others’ variants.
Now, I shall revert to my more phlegmatic personality and hope you will join me.
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 | 30 June 2021