I remain a second wave sceptic. Yes, cases have taken off, but we never left the first.
The appellation gives the strong impression that the current increase was an Act of God and was bound to happen because it is an inherent property of the virus, just as waves happen with influenza (for reasons we don’t yet understand). Not so. It is an indictment of the Test and Protect system.
In midsummer new daily cases in Scotland were in penny numbers, ideal circumstances for Test and Protect to show its mettle and stop virus transmission. But the virus continued to circulate, leading us to the position we are in today. It is likely that the Test and Protect system failed in several ways, but guesswork points to self-isolation breaches being by far the most important. It is guesswork because useful information about adherence to self-isolation advice has not been published, though surveys have shown that although a majority would isolate if asked, only a minority do so in practice.
The biggest difference between the countries that have stopped community transmission of the virus – e.g. China and New Zealand versus ourselves – is their use of quarantine facilities for self-isolators: 16 new temporary Fangcang hospitals in Wuhan with 20,000 beds and managed facilities in New Zealand. China had already used Fangcang hospitals in earthquakes. It could be said that experience in coping with big natural disasters gave them an experiential advantage.
We have been lucky in that regard and don’t have ones of seismological proportions, and our memories have dimmed regarding the last one that stressed hospitals, when they were full not only with the wounded but also with soldiers with PTSD, and that was WW1.At that time medicine could do virtually nothing for patients during the high mortality second wave of influenza, except to suggest the last rites after the onset of the dreaded heliotrope cyanosis.
Truly novel virus
COVID-19 is novel not only as a virus but because it disproportionally affects the very old, whose numbers have significantly increased in recent years, and because the intensive care units needed to successfully treat its victims are also a relatively recent development. London smogs used to kill many thousands. I am old enough to remember the last one as a junior doctor. Extra beds were put down the middle of the ward. But we could do little for their inhabitants. Dr Ron Bradley came round occasionally, wheeling a big trolley for measuring vital signs. It was the nearest thing to the apparatus that today surrounds a patient in an ICU, which he was instrumental in pioneering years later. He and his assistant were called the ‘death watch beetles’.
The COVID-19 pandemic is particularly hard to control because those with it are infectious before they develop symptoms. Some never do. In Scotland we were slow to understand this, and for quite a long time confident but erroneous statements were being made at press conferences that testing asymptomatic individuals was unreliable. This view probably played quite an important role in the failure to prevent the virus getting into and circulating in care homes, with lethal consequences.
Protecting the population during other past pandemics has been easier, not so much because of public health measures, but because of other changes. Glasgow escaped the ravages of the fourth cholera pandemic in 1866, because after taking advice from Robert Stephenson and Isambard Kingdom Brunel, it had built the 34 mile aqueduct from Loch Katrine; its purpose was to supply water to a rapidly increasing population, help trade, and supply the rapidly increasing number of fire hydrants. Another big benefit it brought was the introduction of the municipal steamies, which allowed residents to wash and change their clothes regularly, leading to the virtual extinction of the body louse, the vector of typhus fever. Deaths from it fell from 3,607 in 1865-9 to just ten in 1906-10.
As a microbiologist whose job it has been to speed up the eradication and extinction of the inhabitants of that part of the biodiversity sphere occupied by pathogenic bacteria and viruses, it is not to be expected that I would have much sympathy with syndemic theory: that non-communicable diseases and socio-economic inequality are as important as the virus in a pandemic. I don’t.
By far the most important risk factor for getting hospitalised, being admitted to an ICU, and dying from the disease is old age, particularly being over 80. Not many housing scheme residents get that far…
Image of Fangcang hospital in Hongshan Stadium, Wuhan, via Xinhua