COVID-19 Past, Present and Future

A personal view
       By Stephen Isaacs, David Isaacs and Mark Isaacs

Past
   The world is currently in the grip of a Pandemic. Coronavirus represents bad news in a lipid coat, to paraphrase Sir Peter Medawar. Pandemics are rare, the most recent ones being HIV/AIDS (2005-12), Swine Flu (H1N1) {2008/9} and SARS (2003/4).
     Some countries appeared to learn from previous Pandemics such as SARS; others did not. Britain is looking increasingly unprepared. We looked askance at the early reports from Italy and China, but our fatality figures have overtaken those of China and are closing in on Italy’s. Worse, we have not had the PCR Tests ( PCR stands for Polymerase Chain Reaction ) to confirm whether deaths were due to Coronavirus or not, nor have we included those who died outside Hospital, especially in Care Homes. We have fulsomely praised our NHS, but our voices have been drowned out by those staff complaining of lack of safety equipment, masks, ventilators. Austerity was not just an economic move, our NHS has struggled to cope with a crisis.
     Australia acted faster, banning flights back from Wuhan and adopting the policy of social distancing much earlier. Like S.Korea, Australia made its own PCR Tests and tested everyone with a cough or cold. This meant that less people were removed from the Medical workforce and those who tested positive were isolated early. At the time of my writing, Australia have had 50 deaths, the U.K. has had 12,100 deaths, an underestimate as these figures refer just to deaths in Hospital.  Not for nothing did the WHO exhort countries to Test, Test, Test.
      Reports are that UK Tests are only 60% reliable. This is why two swabs are used. Due to the nature of the virus, the Test can turn from negative to positive in the course of the illness. There is a real danger in using unreliable Tests. Ventilators and safety equipment are more emotive. Those working at the front face appear to be at risk if someone infected coughs full in their face. The virus kills mostly those who are old and with a pre-existing medical condition, but the young and previously healthy are not immune.
      The present policy amongst all the countries in the world revolves around lockdown. The idea of reducing physical contact is to reduce the chance of transmitting the virus. This in turn should reduce the incidence of COVID-19 infections, slowing the spread and “flattening the curve”. The gradual approach should then buy time to develop or obtain extra equipment, and even build new hospitals.
       Different countries interpret lockdown differently. UK and USA have been accused of delaying the lockdown. In the case of UK, the Government slowed down lockdown as a deliberate policy, putting it to the public in piecemeal fashion. The implication was that the public would not accept immediate lockdown. S.Korea interpret lockdown very literally. People who develop the virus are given an APP which allows them to be tracked and their contacts traced. One woman returning from England was locked down and her front door nailed down.
      Another phrase that has been bandied about is “Herd Immunity ” which means that enough of the population are immune to offer added protection. One problem is that 60% of the population are required to attain Herd Immunity. We do not have an Antibody Test as yet to test whether someone has had a past Coronavirus infection. No one has the Antibody Test yet. The situation could also be improved if a vaccine were to be developed.
       This virus is a completely new one, thought to emanate from bats sold in the Wet Kitchen in China. It is the same kind of virus as SARS, but it behaves differently . As it is a new virus, then a new vaccine will have to be developed. A reliable, safe vaccine would normally take 18 months to produce. To avoid previous accidents, this vaccine would need to be extensively tested. The race to find a vaccine must be tempered by the need to test it thoroughly, the danger being that an unsafe vaccine could cause damage in its own right. Although this is currently controversial, in the past there have been examples of people contracting polio for example after vaccination.
    
Present
The world situation could be seen as an opportunity for cooperation. There is a common, if minuscule, enemy and shared aims. There could be exchange of information, of equipment, of Tests, of masks, of vaccines, of policies.
There could also be an opportunity for suspicion, espionage, sabotage and even paranoia.
    Within the U.K., it is an achievement that the Government has been prepared to accept expert advice, rather than bad-mouthing it. The viral Coronation of our Prime Minister was chastening. The public cooperation with the policy of physical isolation has been largely observed. The phrase Social Isolating is inaccurate; I prefer to say Physical Isolating.
      The burgeoning of social media devices means that a significant portion of each day is spent socialising. One can use the telephone, WhatsAPP audio or video calls, FaceTime, Skype , Teams or ZOOM to contact friends, relatives or to work remotely at home. Ten years ago, most of this technology had not been developed.
     The locked in are using their imaginations. Online quizzes, online bridge matches, chess, films, Family Meetings, work groups, gym classes….we can all add to this list. Meanwhile the roads outside are empty, pollution drops, noise pollution fades and the streets are less crowded.
    Psychotherapy or psychoanalysis can certainly use this technology. Practitioners have the added option of seeing their patients or just holding voice sessions. Teaching seminars and lectures can be held remotely. Many professionals can work from home. Firms have been refining their equipment for this purpose.
    Predictably small time crime has reemerged. The level of unemployment and food shortages provide fertile ground. Scams such as spraying old peoples’ drives to eradicate COVID-19 or speeding on empty motorways at night at 151 mph, these provide headlines, but crime has risen.
   There has been a huge effect on industry in many countries. Workers are laid off or furloughed. Small firms are unable to trade. Jobs are at risk and the self-employed are especially hard hit. How lasting this effect will be remains to be seen.
Many of the employed are able to work from home, and thus see more of their family.
Addendum: This can be seen as a cruel virus. Whereas in SARS, the symptoms appear late in the illness, in Coronavirus the symptoms are early or the patient is asymptomatic. This means that in the latter, the virus is more easily spread.
 Cruel in the physical isolation, not being able to be physically with one’s loved ones, not being able to accompany one’s loved ones to Hospital or to attend their funeral.
    To declare an interest, I have an identical twin brother who lives in Sydney, Australia. He is a Professor in Infectious Diseases in Children, and has recently written a book entitled “Defeating the Ministers of Death”, about immunization and vaccination.
     He gave an interview to his son Mark who is himself a journalist and an author, which explains in simple terms about Coronavirus. I will attach this interview which is also in the form of a transcript of a podcast, as it is informative.
       Podcast
As well as the podcast, one can see that information exchange about the U.K. and Australia situations has taken place, by means of social media, between two of the authors.
 
Future
    Many comment that the current situation seems unreal. In effect the Coronavirus has transformed our lives in a very short period. It may be a year or even more before our country is sufficiently safe for ordinary life to resume.
      The psychological effect of the virus is incalculable. There is the effect of being locked down for months, the fears of a novel agent that reminds one of The War of the Worlds, then the ear of losing one’s loved ones or one’s own life. The effects of being on Intensive Care and especially having CPAP ( Continuous Positive Airways Pressure ) or worse being ventilated are terrifying. There are various post Viral Syndromes recognized, for example following treatment for SARS there were high levels of anxiety and depression recorded. We are already hearing of high psychological morbidity after recovery from COVID-19, and there are frequent descriptions of patients feeling totally washed out.
      Could there be a grouping of countries to analyze what has happened with the Pandemic and agree ways of fighting it in the future? We would have to learn lessons….the countries that controlled the outbreak best were those that were best equipped and who tackled it earlier.  There is an opportunity for cooperation. Unfortunately past examples of attempts at world cooperation have not been spectacularly successful.
      Some of the poorer nations are desperately lacking in suitable medical equipment. Unfortunately some of the wealthier countries are lacking in vital equipment too. In an ideal world, the rich would supply the poor with much needed equipment. The spirit of Robin Hood still lives.
      What other lessons can be learnt? Might we emerge into a world where much more work was done from home? The environment would benefit, roads would be clearer, we would be able to see a lunar eclipse, asthma admissions would fall.
Employers will be making their own appraisals which will be largely financial. Smaller offices will be possible, fuel and mileage bills will fall. But face to face interaction might have to be via a computer screen.
     At home, we the people will have acquired new computer skills. It will be easier to contact one’s loved ones, whichever country they live in. We will be able to organize 4-way bridge matches or 2-way chess matches, and we can use ZOOM to scan our opponents’ expressions. We can visit our loved ones without crossing the front door, if we want to.
      So the message is that this next year may lead to a multitude of changes to our way of life. The speed at which new developments occur means that my personal view is a current one, and will inevitably change as well.
 
References:
      1) Defeating the Ministers of Death
   The Compelling Story of Vaccination, One of Medicine’s Greatest Triumphs
         by David Isaacs
 
     2) Online Psychotherapy: Trailblazing Digital Healthcare
BJPsych April 2020, Vol.44, Issue 2, pp60-66
McDonald A, Eccles JA,  Fallahkhair S, Critchley HD

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