Friday 23rd October 2020

Spoiler alert… there are no updates at the end of this message

 One of the issues with writing weekly on the impact of COVID-19 and the ways in which we are dealing with it is that I find myself skipping over the more difficult strategic epidemiological questions that arise…dealing with the urgent rather than the bigger picture “what ifs?” “what nows?” and “what do I really think?”.

For the most part, what you see is what you get. All of the decisions we have made have been with two major aims:  1) to keep everyone safe and 2) to ensure that livelihoods are protected and that careers progress. Of course, there are all manner of details embedded in the second point as it is only by addressing the lot of both student and staff populations that we can ensure the meeting of learning objectives and graduation, as we need a sustainable environment and complete staff cohort for that to happen.

That said, there are many FAQs or not-so-FAQs that play around in my head most days and a lot of these relate to the question “if one was making the national decisions, what would one do differently?” Here are a few of those….. it is a stream of consciousness and unreferenced.

Q1 Where did it all go wrong?

That’s an easy one. We knew it was coming. We didn’t do enough, early enough. Our preparedness and our logistics and our health system were not where they should have been. And we have also lost trust in those making decisions. We can blame it on Barnard Castle or on broken promises, but the real answer lies in the preparedness.  We just were not ready, and that lies with successive administrations and is regardless of political colour.

Q2. Did China and the WHO do everything they could in the early days?

Almost certainly not. We all have 20/20 vision through the ‘restrospectoscope’.

Q3. Why is China now in such good shape given that it started there?

In short, and not withstanding their communications with the rest of the world, they acted quickly, they locked down, they tested like there was no tomorrow and they had the ability to make their people do as required. Notably, we didn’t and we don’t.

Q4. Should we have locked down and was it a waste of time?

With what we knew then – a) yes and b) no. With what we know now – a) yes and b) I hope not…but that’s based on what has happened subsequently.

Q5. But it only really affects old people, right?

For sure, in this country, the average age at death associated with COVID-19 is 82; the average age at death for non COVID-19 related deaths is 81 and currently there are more people dying from influenza and pneumonia than COVID-19 related causes. And of course, the problem with mortality and humans, is that it is ultimately 100%. But this ignores several important issues and ones that we frankly do not fully understand. There are unexplained morbidities and deaths in much younger cohorts and we simply do not know what repeated cycles of this virus will cause in our population. Remember that the virus has the ability to attach to receptors in cells in lots of different body systems, so we are not just talking about a respiratory disease. We also know that viruses can change and an uncontrolled epidemic of SAR-CoV-2 (the virus behind all this) could well lead to new versions of the virus circulating.

And, citing average ages ignores that there can be significant distributions around those average figures.

Q6.  Is a second wave inevitable?

Yes. And no. So, the summer months and the impact of the national lockdown had us in a really good place. In my view, another short-term lockdown (or circuit breaker) at that point would have been a real opportunity to reduce what was a really low prevalence to something even lower. But, hey ho.

So, let’s look at every other infectious disease that has respiratory components. Guess what, they come and go and often associated with the season. So, yes, the natural undulation of infective waves was expected, but not perhaps the close to tsunami levels that might occur if we get it wrong.

Q7. What are the chances of vaccines coming to our rescue?

I was fortunate to hear Dr Anthony Fauci address an audience earlier this week and, without going into all the details, there are around 11 different vaccine trials ongoing using three different vaccine approaches. Given the incidence of the infection in the areas where the stage 3 clinical trials (the last stage before approval) are being conducted, the results should be known by mid-November this year, with the first real deployment early in 2021. So yes, there are grounds for optimism.

But - and it is a big “but”- v vaccines are not enough. We need a healthcare system that works, with good tests and with logistics that can deliver…. and probably most importantly, a population that will accept vaccination. There will also be a need to consider equity – who gets vaccinated first? A pragmatic view, and one supported by the modelling work, is that the vaccines should go first to those most vulnerable and second to those most responsible for spread. However, this ignores the international aspects of policy as many of the most vulnerable both to the health effects of COVID-19 and the economic impact of the pandemic are in low and middle income countries (LMICS) where healthcare systems are less able to support the infected. There is much thinking to be done.

Q8. Other options?

There have been lots of advances in our approach to treatment and there is a rather blurred line in the deployment of some of the antiviral drugs and the antibody therapies that can prevent infection as well as reduce the severity of infection. It is fair to assume that the longterm solution will require all the different approaches.

Q9. And what of One Health?

So here is where the real answer lies. Those of you who have heard me speak on One Health in a scientific context will know that rather than refer to the human/animal/environmental triumvirate manifestation of One Health, I prefer the FAO’s three levels of a One Health solution. This framework requires a technical level solution (like a good test or a good vaccine), a social level (like good behaviours, such as observing social distancing and lockdowns) and an institutional level (like laws and government policy and international funding) … and it is only when all these three come together that one has a full One Health solution.

Now if we refer back to some of the other questions and answers, one can perhaps understand why countries like China and Taiwan – who did large scale testing early, who required masks and lockdowns early and who made laws and invested massively – are in a better place than others, like us, who did not invoke any of these three levels early enough.

Q10. So, is it science or politics that has failed?

Of course, biological science is only one aspect of science and the social sciences are equally important in our considerations; science, in general, can provide answers but equally we must acknowledge that there is no single solution nor one absolute truth. If there has been a failure it has been the inability of the sciences to communicate their answers clearly and quickly in a way that politicians could understand and implement quickly; and an inability of politicians to listen and hear the important messages. There was also failure in our preparedness – those countries who had experienced recent epidemics and who had invested in healthcare systems and logistics were able to dust off policies and procedures quickly. We were not, and even a country like the USA, with its wealth and its plans, could not get its act together.

At the end of day, it doesn’t really matter who got it wrong - we all did. And it is now in our hands to get it right. We have made it harder than it needed to be, but we can still do it.

So, what is the answer?

Like many intractable problems, one might say, if one wanted to get to a societal free from COVID-19, one wouldn’t start from here…. But here we are. So, I take us back to things that we know work:

  1. Wear a mask
  2. Observe social distance
  3. Avoid crowded places
  4. Wash your hands
  5. Outdoors is better than indoors

If we ALL do this, when we can, it will make huge difference. And even if you don’t think it will make a difference to the global picture, it may well make a difference to your personal one.

Have a good one

Stuart

PS I reserve the right to change my opinion on any and all of the issues discussed in this posting…..

If you would like to read earlier messages see Previous messages from the Principal.

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