COVID – LEARNING TO LIVE WITH IT

by Sherbhert Editor

LIVING WITH COVID

“Covid, what have you done to us?” was the headline question in a feature in the Daily Telegraph of 30 July about the changes taking place due to Covid-19(CV). The question itself illustrates a state of mind which is holding back the fight to live full lives and to inspire the young to take up a challenge in the face of CV. It shows helplessness and lack of control as if, apart from making some people (a small minority of older people normally) very ill, CV is actually changing behaviour and doing things to people. Whereas in fact it is people themselves who decide their behaviour, and it is the reaction to CV which is causing change. Would a better question be “Covid, what are we doing to ourselves in reaction to you?” Then people cease to be victims and can take charge.

Recent commentaries have been making the more positive point that, rather than lying down passively staying at home, “We have to learn to live with CV”, adjusting, but minimising the negative impact, working around CV, and accepting it exists as life goes on. Just as is done with other diseases, with the most vulnerable taking special precautions if they choose to.

TIME TO PUT THE YOUNG FIRST?

Another theme running through the news is that the younger generations are unfairly paying the highest price. Headlines include “We have burdened the young for too long” and “ How dare politicians scapegoat the young?” Despite this chorus, extraordinarily, various factions still want to stop children going to school in September. The original published A level results based on prediction and moderation of them  disappointed many. Reaction was knee-jerk, politicised and dramatized. However, the algorithmic approach which ignored individualism produced outrage. The resultant remedy to decide grades for A level and GCSE using teachers’ predictions was pragmatic, even if it will produce some anomalies and unfairness, with grade inflation and overgenerous gradings arising.

 Before the algorithm was abandoned, the outrage generated extreme language “ Lockdown’s betrayal of the young”,” Lives ruined”, “ A generation lost”. This is more of the same attitude as “Covid, what have you done to us?”. Of course, the system was flawed, as all systems are, and individual injustice happens even when there are exams. But a lower than hoped for grade  and even missing the University of choice are not life-determining events and should not be presented as such. The challenge for the individual adversely affected was to overcome the disappointment, and find another way to maximise potential and succeed where they aspire too. Talented people, poor or wealthy, if resilient, usually find a way: it is time too that the mythology that University is a right of passage for all students, and will benefit them all, was laid to rest. Perhaps the job of adults, such as teachers, politicians, parents, and others is to help the younger generations keep a perspective; explain there are no entitlements and that failure is a learning not a disgraceful event; demonstrate that life does not end with a setback and help maximise opportunity. Time again for can-do, and self-belief. CV is not damaging children, but the reaction of some adults and the media is.

It is necessary to put the young first, many will agree. If so, any talk of schools not opening in September needs to be squashed by media as well as Government, and by all with influence, accepting risks and doing the best to minimise them. To fail to let a child go to school in current circumstances will be a disgrace – for the parent, teacher, union or authority responsible.

WAVES AND SURGES

The idea of a possible second wave is repeated daily. Naming CV behaviour in this way is perhaps not helpful, as it projects a feeling of fear and defensiveness. Rather than thinking about second waves, would it be better to accept CV is here, and that in some regions from time to time it may erupt in a surge more virulently than elsewhere, and that those events must be dealt with, as is in fact happening. National lockdown would evidently destroy the economy and so is not an option. But UKGOV communication remains confusing as it still obsesses with infection rates not rising excessively, but expects, rightly, everyone to get back to work observing  precautions where possible. Infection rates in the UK remain low, with hospital occupancy and ICU occupancy, and deaths in hospital minimal generally. Perhaps rates of infection are not the big point- perhaps hospital occupancy, ICU deaths and protecting the most vulnerable is. And there are positives. Not only is the state of knowledge about CV about CV many times what it was in the first 3 months of this year, but there are already established tools to mitigate its effect and so the ability to combat serious upsurges is considerably enhanced. 

THE UK AS A LEADER IN RESEARCH

Here is a positive CV story. “The Brits are on course to save the world” Tyler Cowan, a leading U.S. economist, is quoted from Bloomberg Opinion. Generally, British scientists researching into drugs  to combat CV are receiving considerable praise. There is the work of the UK Recovery unit led by Martin Landry of Oxford University; and the vaccine development work led by Sarah Gilbert of the Oxford Jenner Institute. It is Recovery (Randomised Evaluation of Covid-19 Therapy) which discovered that dexamethasone, a steroid therapy for inflammation and arthritis, cheap at £5 a course, reduces deaths among CV patients who are seriously ill: it is now used around the world. Recovery has also discovered that the anti-malaria drug, hydroxychloroquine, had no benefits for CV patients. Despite certain national leaders such as Donald Trump and Emmanuel Macron vaunting its efficacy, it is no longer approved as a CV therapy.

Sarah Gilbert and team are optimistic about their potential vaccine. It is in Phase 3 trials, that is final trials, in Brazil, South Africa and the UK (the UK itself having too few CV cases to meet the numbers required to satisfy the trials). And it is said to be months ahead of the competition. Getting to this stage would apparently normally take about 5 years – it has occurred in 4 months. (One wonders perhaps whether the 5- year norm indicates some flaws in efficient process generally for vaccine development). Initial funding was provided by UKGOV. Astra Zeneca of the UK is geared up itself and with sub-contractors to produce 2 billion doses if the vaccine proves effective apparently. Astra Zeneca promises to sell the vaccine during the pandemic crisis on a not-for-profit basis. UKGOV is ordering 10s of millions of doses of this and other vaccines being developed, in order to be ready at the earliest opportunity, a substantial investment well worth the risk given the enormity of the impact of a vaccine. Perhaps this indicates that UKGOV has learnt a lesson that it can be worth investing in a contingency where the implications of not doing that are so significant: compare the failure of earlier governments to invest in PPE stocks and manufacturing.

Of course the Oxford vaccine may fail at any hurdle. However, progress to date is perhaps a brilliant example of British research excellence, and collaboration between that excellence, UKGOV and the corporate pharmaceutical world. That at least can be celebrated now. If an effective vaccine results then the UK, with any other successful vaccines developed, perhaps will be saving the world, or at least helping to. Sarah Gilbert says she hopes to know the answer on efficacy in Autumn 2020. Perhaps also Moderna in the U.S, will prove its vaccine works. Or perhaps Vladimir Putin’s claim that Russia has the vaccine will be found true, if it passes trials yet to take place. Maybe the first one will come from China. Will the world perhaps trust a vaccine developed in Oxford more?

TRAVEL, TESTING AND TOUMAZOU

A further UK discovery is the development of rapid test kits. One criticism of the UK test and trace system has been the inconsistent time to deliver test results: sometimes there is a delay of days which considerably reduces the effectiveness of the test. The Daily Telegraph of 4 August reports on the breakthrough in rapid testing made by a bioengineer, Professor Toumazou, of Imperial College, London. UKGOV has ordered 5.8 million rapid CV test kits which reportedly give results in 90 minutes, when the current “gold standard” is 24 hours. It costs about £20 per test, and apparently it also tests for flu. It is said to be considerably more accurate than laboratory testing. If it works, it could revolutionize reaction times to local CV infection surges, enabling testing of large numbers quickly. Then there is travel.

The UK tourist and aviation and travel sectors generally, as well as in other countries, is being decimated by fear of CV infection and the remedies to combat it. The most controversial and damaging is the requirement for all entrants to the UK (other than certain categories of workers) to self-isolate, or quarantine, for 14 days. UKGOV however publishes a list of countries deemed reasonably secure and so travellers from which are exempted from the requirement. That list is regularly reviewed and countries are added or deleted depending on the assessment of CV infection there at the time. The approach is not universally shared. France and Germany for example operate a testing regime for people coming from countries regarded as high risk. Singapore operates quarantine, but has announced it is considering a rigorous testing alternative. Perhaps the UK should do the same, although the current time to get results does not make that choice easier. Though testing will miss some people particularly with early stage CV, in the UK, given the monitoring of compliance with self-isolation is necessarily sporadic and detection of breach unlikely, it is reasonable to assume a number of people risk the fine and break the quarantine: if so, quarantine too has holes. And quarantine deters travel and harms economies, while testing facilitates travel and helps economies.

More cynically, could it be the case that UKGOV is, from an economic perspective, content with a system which discourages UK citizens from travelling abroad – especially on Summer holidays – and actually encourages them to spend the holiday budget in the UK. This helps compensate for the lack of foreign tourists, such as from the U.S. and China, normally big spenders.

However, a new rapid test kit, such as that found by Professor Toumazou, could be a saviour for the leisure and aviation industries as well as assisting a host of other sectors. Its benefit in airports for arrivals to the UK is evident. Removing the quarantine requirement could be life-saving for certain businesses.

LEARNING FROM OTHERS

Is it a fair question to ask whether our scientists and practitioners are really willing to learn from others? Does intellectual arrogance get in the way? The volte face on mask wearing is but one example. Scientists stubbornly asserted its irrelevance, yet it is now a core policy to fight against virus spread. Second, an article in the Daily Mail on 25 July highlighted the use of hydrochlorous acid (HCA) as another key weapon in certain Asian countries – Japan, Hong Kong, China and South Korea – to prevent spreading of CV. Yet it has barely been mentioned in UK discussions. In many countries HCA plays a major disinfectant role in healthcare and certain treatments. HCA is apparently 100 times more deadly to germs than bleach; is non-toxic; is cheap to make; easy to use; and completely safe to humans.

Yet it is used relatively sparingly in the UK. In the CV fight, the mentioned countries use it to spray people en masse – to disinfectant them. Fogging tunnels are used, where on walking through people are showered with HCA. Presumably they could be used in airports, schools, hospitals, stadiums, and anywhere where people congregate. Most obviously to get people “cleansed” on trains and on entering offices. Yet there appears to be not even any discussion of it. It has been presented to the NHS as a useful tool. But why has there been no public discussion about it? Why are scientists not promoting it in the UK? Maybe there is an imperfection with HCA, but Asian countries controlling CV seem to trust it.

NOW WHAT?

The UK infection rate has been coming down and is low  but perhaps flattening. It is not surprising if the number rises as more testing occurs and people go about normal living; nor is it that worrying if numbers in hospital and ICU are easily manageable as now: perhaps those catching Covid are no longer the oldest or most vulnerable, but rather younger people out and about – and it generally does not badly affect them. Hospitals as of now are not kept busy by CV. Numbers are skewed by local outbreaks, particularly in Northern cities, and notably Asian communities. Analysis by the Science Editor of the Daily Telegraph on 15 August demonstrates the point: on 9 August, in North West England (the hottest CV spot) there were ZERO admissions to hospital of people under 65 and 4 people over 65; and for England as a whole 5 people under 65 and 6 over 65 were admitted to hospital with CV and on that day only 599 people were in hospital for CV.The move towards more local testing and tracing may prove more effective than the centralised system: decentralising generally seems to be better when it comes to fighting CV. Vast areas of the UK are experiencing barely any cases and very few deaths. Recently the average death rate in the UK is lower than in a normal year, and flu and pneumonia are proving a much( reportedly 5 times) bigger killers than CV. There is a small CV problem in the UK, and the challenge is to keep it that way, stopping scaremongering and maximising productive economic activity.

The justification for national lockdown was to save the NHS from being overwhelmed. That is not today a likely possibility. Indeed, the priority is turning more to other risks such as delayed cancer diagnosis and the backlog of neglected people with serious conditions, not treated due to the obsession with CV. That emphasis perhaps needs acceleration: for a couple of months during the height of the CV crisis the NHS showed a real sense of urgency in some areas and  some ability to adapt and innovate, to change its embedded sluggish ways: that spirit needs to be drawn upon in clearing the backlog of non-CV serious cases and planning for the Winter and beyond.

Are people not tired of hearing the “glass half empty” commentators bemoaning what has gone wrong with the handling of CV and of coming depression economically? The past is irrelevant and unavoidable, except as a learning experience to improve future reactions. The future of the country and of individuals within it is relevant, and will to the major extent be dictated by the decisions of individuals to advance or to stagnate and wait for someone else to provide, and by businesses to adapt and manage  and thrive or go under. And if they go under, to see if they can rise again like a phoenix, but changed. There can be no expectation that somebody else will deliver success except oneself, which will be all the easier if people encourage and assist each other rather than focus on complaint and conflict.

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