The glorious sunny weather in July must have moved many of us into a mood of optimism, easier to achieve by concentrating on sport or music and trying to ignore the international and national news. But the bad news has a habit of intruding and, with floods, wildfires, refugees, drug deaths, and tragic holiday losses of life, those of us with an apocalyptic mindset are finding equanimity hard to maintain.
I wrote (30 June
) that by 19 July, Mr Johnson's 'Freedom Day', we could see 60,000 new cases of COVID-19 each day and some 3,000 in hospital, threatening to overwhelm the NHS and encourage the development of new viral variants. As it transpired, by that date daily cases had peaked (perhaps temporarily) at 54,674 and over 5,000 people were in hospital with COVID-19 in the UK. Scottish numbers, which I thought might be one tenth of these, were over 7,800 cases daily with 530 in hospital.
King Canute once demonstrated to his courtiers that he was unable to control nature. Nevertheless, even today politicians may claim special insight and Mr Johnson has throughout this pandemic assumed magical predictive powers, but like you and me he is only human and will for sure know where hubris leads. To reduce the error in predictions, epidemiologists look backwards and think forwards, and calculations suggested that things would be unlikely to go smoothly. How far the numbers would continue to double beyond 19 July were largely speculative as they depend on human more than viral behaviour and the worst predictions proved over-pessimistic.
What is happening now?
It now appears that the measures we had all taken up to 19 July in the UK and are still taking in Scotland have apparently had an effect, as numbers of new cases have stabilised UK-wide. This started in Scotland in the first week of July and was delayed a week or two in the other nations, suggesting that school holidays and European football matches played a role here and that Scotland's earlier exit may have had a beneficial effect. With high vaccination rates and undoubtedly some immunity from undetected infections among the unvaccinated, herd immunity may be beginning to show its effects although these coronaviruses are notoriously able to escape such defences, rather in the way defender Andy Robertson repeatedly appears at the opposition's end of the football field to make a devastating pass into the goal area.
Fine weather must also have been beneficial, ensuring that most mixing has been outdoors and, importantly, people in general have been compliant with the advice from our public health leaders. However, rates of hospitalisation and the need for respiratory support have not yet declined, so the threat to the NHS persists. Remember that there are still about a full Murrayfield, up to 50,000 people, catching the virus each day and one in 80-100 people at any one time is a source of infection.
Fear of vaccines
We didn't have immunisation in childhood in my day save against smallpox and suffered accordingly. Measles was memorable, the most unpleasant experience of my childhood, followed by influenza and mumps. Luckily, I didn't get whooping cough and, when polio and TB vaccines became available, I was glad to receive them. This universal experience of my generation makes it difficult to understand people who refuse vaccines. I know some people have a fear of needles – once this was often justified as needles were sterilised and re-used and could be quite blunt, but now they are so sharp you barely feel them. Other people may have suffered an allergic reaction to some component of a vaccine and, together with the immunosuppressed, may need to avoid certain ones. But the issue of fear of vaccines goes deeper and has a long history, back to the first use of cowpox by Jenner in the 18th century. This is now amplified by nonsense in so-called social media.
Rational people will look at the balance between risk and benefit, as the medical profession does in its assessment of all new treatments. In the case of vaccines, the benefit side of the equation includes benefits to others than the person vaccinated, by preventing transmission of infection. This is illustrated most clearly by the effects of campaigns by anti-vaxxers against whooping cough in the 1960s which led to three epidemics of the disease in 1979-81 affecting over 100,000 children, some of whom died (my wife, then a school nurse, suffered a bad attack).
More recently, the campaign against the combined MMR vaccine following a discredited and fraudulent 1998 paper in The Lancet
led to the resurgence of measles across Europe, the disease acquiring endemic status again in the UK by 2008. The current popular but irrational movement against COVID-19 vaccination is dangerous to the health of all of us, and the media should stop giving publicity to its false prophets.
Ending the fourth wave
For us to get out of the pandemic requires very high uptake of the available vaccines and readiness to introduce updated vaccines if more dangerous variants emerge because of incomplete control/vaccine programmes elsewhere. The vaccines have undoubtedly reduced the numbers of deaths and serious illnesses, so now the majority of these are in the unvaccinated or the very vulnerable, although there will be a serious toll in longer-term complications even after milder illness, and the need for hospital care and death are still with us.
The next few weeks will be critical. In Scotland, return to school and colder weather poses a serious risk of a rise in cases, but this can be controlled by increasingly effective case and contact testing as numbers become low enough to make this more efficient, and by us all taking care to avoid crowds, wear masks in confined spaces including transport, and generally not breathing in each other's expired air. And this latter point is something that we shall need to remember beyond this pandemic.
Is this a turning point?
Coronaviruses are well-known to virologists as one of the many common cold viruses, particularly liable to mutate and thus making effective vaccines unlikely to produce long-term immunity. They were described in the 1960s by a pioneering Glasgow-born electron microscopist, June Almeida, who started as a technician in Glasgow Royal Infirmary, obtained a Doctor of Science degree in Canada, and then joined David Tyrrell in England in common cold virus research. Tyrrell went on to show, with James Lovelock (of Gaia
fame), how such minute organisms could spread very easily on breath, an experiment strangely ignored early in the current pandemic leading to inadequate initial advice on PPE. These two lessons from over 50 years ago – rapid mutation and easy spread on breath – are important in now predicting what will happen in this pandemic.
The causes of the current apparent fall in incidence of COVID-19 is unclear. However, it is very unlikely to mark the end of the pandemic's effects in the UK and relaxation of restrictions are likely to increase spread especially among the incompletely vaccinated and lead to more hospitalisations. We are probably approaching an endemic situation wherein we shall have to learn to live with the virus, expecting seasonal and local outbreaks requiring good public health and regular vaccination at least of the over 50s – a sea with ripples rather than giant waves. However, much depends now not only on how we behave personally but also on how well the pandemic is controlled by vaccination worldwide. This is why sharing of vaccines and delivery facilities with the poorer world is so important.
I think we are indeed at a turning point but perhaps not the road to freedom that many hoped for. Rather, we have reached the point at which we must accept the need to adapt our behaviour to enable us to live with this virus as we live with many others. In doing this, we shall also need to take account of the other even more important threat to humanity: climate change. Not surprisingly to me, our adaptation to one is very similar to that to the other; both will require us to lead rather simpler and more sustainable lives. Now is the time to change and I shall, I hope, return to this subject in my next essay.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own