Pandemics and Epidemics – I have been locked-down for 100 days

By the time you read this, I will have been locked-down for 100 days, from March 9th in fact.

This is not the first epidemic or pandemic I have experienced. The first, in 1961, amounted to nothing very much but, without prompt action, it could have been even more serious than the present one.

I returned home to my student flat late one night to find the door locked and bolted. I rang and banged and shouted and eventually my flat-mate, Taffy, appeared on the balcony.

‘You can’t come in, mate.’

‘Stop messing around, Taffy and let me in.’

‘Can’t, it’s smallpox.’

‘There’s no smallpox here. Let me in.’

‘But there is in South Wales and in Bradford. We are possible contacts because we spent the weekend in South Wales. We are in quarantine for 10 days and must have no contact with anyone. Public Health sends someone around with food which they leave at the door.’

‘We? What do you mean, we?’

‘Me and Hazel.’ Hazel was his new girlfriend.

‘You mean you are both holed up in there for 10 days with nothing to do? You won’t be bored then. Have you two er…?’

‘No.’

‘Well, you had better get on with it, Taffy, you could both be dead next week.’ They ‘got on with it’ for the next 55 years until one of them died.

We students were put to work after attending lectures on smallpox. A retired doctor from the Indian Medical Service, the only person who had dealt with the disease told us about it and showed his horrendous photographs. The death rate of smallpox was about 30%.

We had our vaccination status checked, and some were re-vaccinated. Then we were taught how to vaccinate and sent out around Bristol to do vaccination clinics. A year earlier, we had been taught about epidemics. The principles are to act quickly, not today, not after lunch, but now. Isolate the index case or cases, quarantine their contacts and check for any other cases. Then use the diagnostic tests available and do not mind false positives, it is far better than missing one.

Smallpox vaccine was available for us and with that, and prompt action, especially in South Wales and Bradford, the total deaths amounted to only 40.

This time, with COVID-19, I am in the shielded group. I remain at home waiting for the lessons I learned the 1950s to be put into action. Now, one-third of a year has passed since the World Health Organisation (WHO) warning of a pandemic, and we are told we will have a ‘world-beating’ track and trace system next month. It would be nice to have had one that worked back in March.

The nature of this new virus, called SARS-CoV-2, is known. It is one of a large family of Coronaviruses and causes a disease known as COVID-19. The clinical description of COVID-19 was detailed in the world medical literature by January 31st by Chinese doctors. The World Health Organisation warned of its ability to spread, the death rate was 1% but 15% in the elderly.

The WHO issued a warning on January 4th of a possible pandemic. On January 30th, immediately after Dr Tedros, director-general of WHO, had visited President Xi Jinping of China, a PHEIC notice (Public Health Emergency of International Concern) was issued. On the next day, we enacted Brexit but did nothing about the PHEIC.

Herd immunity was proposed as the strategy to deal with it. But with a death rate of 1%, one does not even need GCSE maths to work out that the UK, with a population of 67 million, could expect over half a million deaths.

What was my profession of medicine doing? Why did they not act? Not long previously, they had run a simulated pandemic exercise. What they learned from this about supplies of PPE, bed availability and ventilators was ignored.

China knew what to do, so did Hong Kong, Malaysia, Singapore, Taiwan, New Zealand, Germany. Italy warned us, the advice from the WHO on January 30th was sound but ignored. There was a vacuum where we needed leadership. I suppose that we should be thankful that we are not like the USA where COVID-19 was put down as a touch of ‘flu, something you could put right with a little disinfectant. After the PHEIC the US cut the funding of the WHO.

What should I, and people like me, do now? People are fed-up with lockdown and are making their own decisions to abandon it and social distancing. Can I rely on government advice? They have been less than truthful with us, deceitful might be more accurate.

By March 23rd, the day of lockdown, there were about 1500 confirmed cases per day and 200 daily deaths in the UK. That was the reason for lockdown. Lockdown limited deaths to about 1000 per day and new cases to 4000 at maximum in April. Now the figures have declined. Will there be a second wave? Almost certainly. Are we planning for one?

Today, June 14th, there are about 1500 new cases and 200 deaths, the same as on March 23rd. And the virus has not changed. We have no vaccine and no specific treatment. The decline in cases and deaths seems to be flattening out around this level. Is this a good enough reason to suspend lockdown, to reduce social distancing? WHO does not think so.

I’m going to follow the science and stay in lockdown and maybe live a little longer.

The rates of COVID-19 per 100,000 population are: Eastleigh, 204; Southampton, 239; Winchester, 296. The highest rate is in Barrow in Furness, 843; and the lowest is Torridge, 53. Barrow is nearly twice as high as the next highest; there may be some anomaly there.

A stage 1 trial of a vaccine from Imperial College should start today with 120 subjects.