Happy (ish) New Year!

SUMMARY

• A brief look back at the year and the blog

• Pandemics in a modern world

• What of 2021?

• Happy New Year to everyone 

Introduction.

What a year that was! I don’t know about you, but the celebrations of last New Years Eve seem like a very long time ago indeed. With all the new restrictions this years New Year celebrations for many will be quiet indeed! It is gloomy end to a difficult year. 

Not this time!

A year ago I had hopes that, urged on by Extinction Rebellion and COP21, and without Trump, the leaders of the world would make 2020 the year of real progress in tacking the huge threats to our collective future and made some world changing decisions, but sadly this will be remembered as the COVID19 year.

But last November Sars-Cov2-19 had already spilled over from its long association in bats. Early cases of severe viral pneumonia soon made us realise that something was amiss. All of a sudden, infections disease became the number one global issue, particularly with the dramatic early impact in Italy which caused genuine fear as to how we would cope with the pandemic.

 

SARS-COV2-19 – Yeuch!!

Since then we have fudged our way along, from the first lockdown applied with hesitancy by politicians not know for scientific nous, and certainly unused to having to follow advice from scientists. (Climate change, fisheries, ecosystems etc etc) Then the PPI scandals, the testing problems, the false dawns, the silly promises, and unachievable targets re-written as they were missed; the quieter complacent summer, and now the second and third waves mingled in together as new variant taking the blame for increase cases and pressure on hospitals. 

The new variant might be spreading infection more rapidly, though it might not – it could also just be what was bound to happen during the winter. Hopefully the hospital staff will be able to stick it out till the vaccine starts to take effect and the end of this phase of the pandemic will be over. 

2020 review

I cant help but look back at the year and review all those blog posts – Ive spent about two hours a day thinking and writing about this new age of inter-connectedness – for better and for worse. By that I mean that the whole pandemic thing describes our connectedness – to bats and their lives.

I first learned that the virus came from hungry bats and their shrinking habitats, hosting their myriad endemic coronaviruses – forced to spillover into human populations by our destructive food systems and rampant agribusiness. 

Don’t mess with us!

I also learnt more about the crucial evolutionary role of viruses – without viral genes having been integrated in our genome over the aeons we certainly would not be who we are. They even provide the genes which make placentas function – imagine that!

Early in the pandemic the dramatic effect of lifestyle on the severity of the infection became clear and I wrote on the means of getting ready for COVID, advice which remains relevant today. It is also important to know when to get to hospital – not leaving it too late in particular – for vulnerable people, oximetry helps.

It was and remains an excellent time to quit smoking and vaping. Good food, and eating well also has a positive impact. Vitamin D too is likely to be helpful, I have posted on how to enhance its effect, its benefits in terms of preventing infection and for people admitted to hospital. The need for supplements such as Zinc highlights the low quality of staple food for billions of people. Agribusiness again!

It was also clear that, as usual, the disadvantaged sections on society pay the heaviest price in terms of illness, hospital admissions, deaths as well as the impact of lockdowns and the economic impact of the pandemic.  COVID is a disease of society. 

Then our response; the spring lockdown, the care home crisis, and how discharging infectious patient back to care homes tragically spread the infection in the community. How too that our system of testing and tracing contacts failed at the time it was most needed to work – these were nettles our leaders could not grasp. The harsh effect of lockdown on our lives could not be ignored, though it turned up one surprising benefit – less premature births. 

Boris Johnson’s own infection, caused by his own ignorance of biological reality brought home the impact of the illness. His obesity became an issue, and outbreaks in meat processing plants further magnified the damage caused by Big Farmer.

I learned more about our immunity, with lessons on how long we are infectious for only recently put into action – a week.  My early hopes that T cell immunity would play a major role turned out to be true – that is why so few young people are hospitalised by the infection and why it is so serious for the elderly with (sorry folks!) our in-built in immunosenecense. 

T Cell

Early hopes that herd immunity would be galloping along soon proved over-optimistic.  It became clear that vaccination will play a big part in ending the pandemic.

Since them we have had emergence of the mRNA vaccines followed by Astra Zeneca vaccine in collaboration with Oxford University.  Vaccine development has been speeded up by some clever thinking. This wouldn’t have happened without much of the work that went into vaccine development after Sars1, which gave us a head start this time. Nor without running the different phases of the trials concurrently rather than consecutively. 

While vaccine development has not been without its cock-ups, its rapid development will help us next time around and mRNA vaccines has some real potential in other areas of health, like the treatment of certain cancers – that will be a new age of therapeutics! Beware the new virus of vaccine misinformation!

Our leaders continue to be keen on mass screening and even with some pretty poor results in Liverpool, have started to roll out this expensive nonsense to other unsuspecting areas. I assume its called Moonshot as it costs just about as much as sending the whole Cabinet to the Moon for Christmas. Perhaps back too.

So now sadly to the second winter wave, which back in the summer I had hoped would not happen or would not be so big, though there was never a good reason why it shouldn’t be. Right now there are more COVID patients in hospital that back at the peak of the first wave, though about half as many are being ventilated. To what extent this is due to better care is hard to call, though the NHS is a quick learner and there are more options before that trip to ITU. 

Second winter wave – admissions

Treatments have been a big disappointment. At least their use has been properly defined before leaping into expensive and/or ineffective treatments, unless that is of course, you are Donald Trump, at whom they threw the book. One of the hight points of the year is that he will soon be dragged out of the White House, though Im sure not from American politics.  

After Lockdown 2 and the tiers it looked, however briefly, that things were headed in the right direction. Hope can be fleeting and early Then all the numbers stated heading in the wrong direction, potentially due to a new variant, human behaviour, more likely both.

The new strain, pending definitive lab tests, is assumed to be behind increasing numbers testing positive and being admitted to hospital. For once I had some sympathy with a tired “Handsfree” Hancock as he announced the virus is one step ahead again. However, I do wonder if this is a cover up for the poor handling of the winter so far – the new variant might be more transmissible – we don’t know yet – it might be that we have just been spreading the virus at the time of the year viruses love the most. I will keep my eyes on this.

New COVID variant  – powerful enough to stop lorries!

Much gloom is coming from our tired hospital teams. It remains a long time till April, when the seasonality of the virus will quieten things down. In the meantime, more tiers, restrictions and complaints from the sceptics as the number of people in hospital with COVID19 exceeds the first wave and seem to be heading very much in the wrong direction. The prospect of being unable to give patients the treatment they need is never far away.

While there is much pontification on the overlapping priorities of the economy and health, sceptics need to bear in mind that notion of how many lives would have been lost without having modern hospital treatment. COVID19 was a novel experience for patients and staff alike, and high initial hospital mortality rates started to fall even during the first wave. 

Getting better all the time

Less people are now being ventilated due to better early and ongoing care, more therapeutic options and treatments, though sadly again, the overall numbers are rising.  Who knows what we will see when we will look back at the (final??) numbers at Easter?

Over 250,000 people have been through the hospital system with COVID19, with an average age of about 60 – that the average age of death is 80 shows how well the NHS has done. How many lives have been saved? It is not unreasonable to say hundreds of thousands! 

However that total NHS admissions are down generally shows how much the NHS has changed and that care of other illnesses has been hit – with an underfunded health sector, we cannot have everything. 

Pandemics in a modern age

Technology, with all its manifestations, has made this pandemic different from all others in the past. We have information at our fingertips allowing folk like me to be able to keep track of what is happening in ways I could never have dreamed of as a medical student, (no computers at all) or for most of my career as a doctor. I witnessed the first computer installed in a side room in neonatal intensive care in Plymouth in 1987. How things have been transformed!

Plymouth General hospital total computing system – 1987

The quality of care in modern ITU’s and HDU’s is impressive and it is reasonable to think the death rate would have been 2-3 times worse, and the average age of death much lower without the NHS and its staff – once again the health system picks up the tabs for industries and systems which pay little heed to health – the food corporations come to mind in particular.

COVID19 has demonstrated our how sick our society is. Without terrible food poisoning the metabolism, the pernicious effects of air pollution, the obesity epidemic, social inequality, immoral levels of poverty and undeserved wealth, the pandemic would have been so much more easy to deal with. Lockdowns may well have not been needed – if ever it needed demonstrating, poverty is unaffordable.

Yet, we are both in the age of information and the age of misinformation. I have been genuinely astonished at some of the inaccurate, misleading and often frankly absurd stuff we can find so easily on social media. This is genuine mind pollution and like choosing the food we eat, discernment and critical reading have never been more important. Good information is good for the mind.

I wish!

Im all for free speech, but his should not extend to falsehoods and some sort of editorial control of Facebook, Twitter and the others would be a good thing. Not saying ban them, just make sure there is a big fat health warning attached – rather like those on the side of fag packets – bad information can kill!

 Freedom comes with responsibility and this applies to internet content as well as in every other aspect of life. I really have seen some terrible stuff on-line this year – so have millions of others.

So, in the new year I will spend time looking at a couple of You Tube videos doing the rounds and analyse their content. It’s a chore, but is quite revealing. So far I have found plenty of misrepresentation and misinformation which plays on genuine fears and reasonable questions about vaccinations. If I were dishonest or daft enough as a doctor to advice anyone on the basis of such stuff, I would have been hauled up in from of the GMC for misbehaviour. Quite rightly too. 

What of 2021?

Well, more restrictions until vaccinations accelerate our drive to herd immunity, hospital admissions start falling, numbers of viruses in the world tumble as they fail to spread, and then we slowly get back to socialisation, work and play.

Yet perhaps there will be no new normal. These are abnormal times; this virus has magnified our ‘normal’ fault lines. We cannot carry on the way we were; too much poverty and far too much wealth; globalised food systems producing cheap low quality food; international trade

and travel, low investment in public services, poor public health systems, and poor public health. All must change and unsurprisingly, the changes needed to prevent the next pandemic are more of less those which are likely to address climate change and destruction of ecosystems and species. 

I would like to look in the eyes of my beautiful grandson, like all four year olds innocent to the realities set to dominate his life, and see a less difficult future than the one I see right now. 

COVID19 has shone a historic light on humanity, its lessons are clear. Out of respect to my former colleagues working so hard right now, all those who are ill as I write, those who have been ill and still suffer, those who have died, and those who have lost loved ones, we have to learn those lessons and do our best to change the world for the better. Before it, once again, changes us.

Happy New Year!

Happy New Year to anyone who reads this blog – thank you so much for taking the time and energy to plough though my perspectives – some of the feedback has been heartwarming and encouraging. I will return in the new year with posts on internet misinformation, non-hoaxes as well as the evolution of the pandemic as we hopefully move towards its conclusion.

Have a healthy 2021. By comparison to 2020, it might well be quite wonderful. Who knows, we might even move towards a more just, equitable and sustainable future. x