Since I last wrote on COVID-19, most people have returned to some semblance of normal behaviour, attending football matches, going to pubs and even to those most dangerous of places, nightclubs. More recently, children in Scotland have returned to school.
I have been on several cautious walks with other retired old folk in local hills and woods and have spoken to some of my grandchildren in my garden, though well separated. Two of the five have recovered from COVID-19 as have some other family members working in the NHS. And I have read Spike, the Virus vs the People
, Sir Jeremy Farrar and Dr Anjana Ahuja's inside account of the pandemic and its management in the UK, which I strongly recommend to anyone interested to know what went on behind the scenes.
My expectation was that the pandemic was becoming endemic and that future waves would be more like ripples as a higher proportion of our population was vaccinated against the prevalent viral types. However, I did note that widespread association in circumstances favourable to transmission increases the likelihood of new and more dangerous variants emerging. I noted that there had been four waves. The devastating first one that overwhelmed the NHS from the original virus was a consequence of failure of traditional public health measures and literally fatal delays in implementing those we could have used.
The UK's lack of preparedness, that came largely from the run-down of public health over decades and from political exceptionalism, was shocking; testing was virtually unavailable and most cases of disease were never recorded, but mortality among the elderly was severe.
As this wave slowly and at great economic and health costs came under control, the ignorant governmental belief that encouraging us all to return to normal – 'Eat out to help out' – was the right approach led to a second wave. This was accompanied by a useless system of test and tracing of contacts over which an amateur, Baroness Harding, a friend of the Health Secretary, presided. Again, there was political delay in locking us down. This renewed circulation of the virus led to development of the Kent or alpha variant which swept through the population and became the dominant organism, causing a third wave which we exported to Europe and then the rest of the world.
By this time, some partially effective treatments and very effective vaccines had been developed: the two great successes to date of both international science and the NHS. Also, better supplies of protective equipment became available and, as case numbers fell, test and trace slowly passed to more local control where it should have been from the beginning and the much-hyped app began to work better. However, already several other viral variants had developed in South Africa (beta) and Brazil (gamma) and the alpha variant was sweeping round India where, unsurprisingly, another variant developed, delta.
By May, the infection rate had declined and again there was encouragement from government to get back to normal behaviour, just as the first case of infection from the delta variant was discovered in the UK. The G7 meeting, international football matches and then pop concerts and nightclub parties became spreader events and case numbers rose in a fourth wave that was partly controlled by improved case-finding measures. However, by the time that Scottish schools reopened, the delta variant had become the dominant cause of infection, and the evidence now shows that it is both more infective and more likely to cause complications in younger people.
As in the previous second/third wave, the infections with delta have caused an upsurge and what is now clearly a fifth wave, as the graph shows. Fortunately, so far, the mortality rate has been controlled though it is starting to rise again, and the NHS is under double jeopardy, from increasing numbers of serious cases and loss of staff to isolation and infection. Do not underestimate the stress now on the front line and the risk of hospitals again becoming places where infection will spread.
The diagram above illustrates COVID-19 cases per 100,000 in the Scottish population – showing the five waves. The first one underestimates the numbers because of extremely low detection rates. The two lines show that rates in males and females were the same.
In contrast to the numbers of infections, the weekly death rates so far show only a ripple. Undoubtedly lives have been saved by better treatment, but this 'ripple' means around 1,400 deaths a week in the UK including around 55 a week in Scotland. Those who end up in hospital are almost all either not fully vaccinated or have other serious illness. Few, I suspect, read Scottish Review
. At present, 80% of the eligible population in the UK have been double vaccinated. This sounds good, but the 20% represent some 8.6 million people of whom at present rates some 8,000-9,000 will die and 40 times that find themselves in hospital. English schools have only recently returned, and their fifth wave is to be expected shortly. The current pandemic death toll in the UK is 157,000, with 10,600 of them in Scotland.
This emphasises the need for all over-16-year-olds to get fully vaccinated and the desirability of a vaccine passport to be compulsory for access to places where people meet. While there are a few people with genuine allergy to vaccines or with illnesses or medication that preclude their use, most who refuse vaccination should understand that their obstinacy makes them a serious threat to others and their exclusion from pubs, theatres, football matches and so on is the price they must pay. Some of them are now paying with their lives or with the prolonged misery of intensive care. The delta variant does not spare the previously healthy unvaccinated under 50s from death.
Through this pandemic we have been fortunate in our NHS and scientists, foolish in our having allowed public health services to deteriorate, and unlucky in having a UK Government which was obstinate and slow to appreciate the problem, wedded to gimmicky solutions and involvement of their cronies, and responsible for us suffering among the highest infection rates in the world.
We still have the same government, sitting on a pile of vaccines for which the world is crying out. They know that if the whole world is not vaccinated, new variants will evolve and find their way here. They know that we are not yet fully protected at home and that the immunity starts to reduce from six months after the second jab. It is far from easy for them but the problem is of their own making. Meanwhile, we must look after ourselves and our families and act in the knowledge that the virus is still there, searching us out.
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