Health Matters – We are not the enemy

We are not the enemy

I’m not usually known for having a bit if a rant, but if truth be told right now that’s how I feel. It seems as if everyone has suddenly become an expert on viruses overnight, not surprising really when you consider the relentless coverage that COVID is getting, but even so there is a bit more to it than the media would have you think. Some years ago I was privileged to lead the British Society for Immunology which is the UK’s foremost organisation for academic and clinical immunologists. Right now it is playing a key role in helping the international response. So I think I can say I know a thing or two about viruses. It’s true we never really saw COVID coming, and I’m sure there will be a huge investigation once the dust has settled but what has intrigued me, and at times made me really quite wild, is the way science is being used to prop up and support any half-brained idea that happens to be flavour of the moment.

The UK, just like most advanced countries, has a plan for dealing with just about anything you care to mention. In the case of the UK many of these plans form the National Risk Register and whilst some of the planning is classified for obscure reasons, I can tell you that pandemic ‘flu rated top of the list on the basis of the likelihood of it happening and the consequential impact if it happened. Taken together the picture was a grim one and that is what the planning was all supposed to deal with.

There is absolutely no question that a priority must be to keep a functioning health system, indeed it’s a prime function of government to keep its citizens safe. But in order to protect a health system, wherever it is, that means a degree of rationing or at least a change in what people can expect it to deliver. That’s a tall order in anyone’s book, but you can explain it and carry people with you if you treat people like adults. That’s where the use, or mis-use, of the science comes in.

COVID was frightening when it first emerged. We didn’t know much about it, we struggled to understand how to manage it, and in the early days it took many lives. It destroyed families and communities, and yes it hit Spain in a cruel and very hard way indeed. At times like these people will turn to those in the white coats and expect answers, or at least sound advice. We’ve not done a very good job in my view.

We’ve confused people. A virus is not the same thing as a ‘bug’ or a ‘germ’. It’s not alive for a start, it certainly can’t think or decide what to do, and because it’s not alive you can’t kill it. But our language has got muddled and we’ve made a mess of explaining things.  Overly complicated graphs, mixing forecasts with predictions; ‘R’ numbers and ‘excess deaths’  all of this has meant that some of the restrictions we have ended up with are plain stupid, some are hard to understand, and even harder to explain. And this leads me to my rant.

But let me clear up one thing, don’t for a second think I’m not taking this seriously, I am very serious. We do need to contain this, and yes we also need a vaccine, and fast. In the meantime we are paying a huge and horrible price; in lives lost, and an economy in free fall. The impact on our mental health, all very fashionable right now, but to put it plainly the stress from feeling, and being, locked up is cumulative and very significant.

So back to the ‘flu. We’ve all had it from time to time and we know how it is spread. Take it from me, but ‘flu and COVID are very similar. They both cause respiratory disease and they are both spread by direct contact, droplets in the air and to a degree by ‘fomites’. A fomite is just a fancy way to describe something like a door handle that might be contaminated with some mucus which you then pick up on your hand which then conveniently finds its way into your mouth. We all know if you enclose a load of people in a bus with no ventilation if someone is infected and they are coughing and spluttering all over the place and not using a tissue, then the chances are others will get infected too. So is a face mask useful in a situation like this, answer is probably yes. (But you have to wear it properly)

If you are walking along the open road, minding your own business, and there isn’t anyone close to you and there is lots of fresh air is a face mask necessary? The answer is a resounding no, it’s absolutely pointless, but of course you are breaking the law now if you don’t wear one. So we have got ourselves into a position where behaviour designed to restrict the spread of the virus is now enshrined in law, and you’ll be fined or possibly arrested for doing something that is illegal, but utterly pointless and totally harmless. Confused? You should be.

We’ve seen everything from 50% capacity to 75% capacity, to curfews, one way systems, towns and cities locked down. Borders closed, then opened, then closed again. You isolate for fourteen days, no maybe seven, but if you are a truck driver you are somehow immune and don’t need to do any of this. But don’t worry; you don’t need to understand because it’s all backed up by the science. If only.

I wouldn’t want to be a politician right now. The decisions we are asking our leaders to take are enormous, have far reaching consequences, and are unlikely to be popular. Our leaders are being given sound scientific advice; I know that because I used to be involved. But mix politics and public health and it is always going to be a very difficult marriage.

We are reaching a point that my former colleagues would call ‘COVID fatigue’, we are all fed up hearing about it. Usually that means that compliance tends to drop, but of course here in Spain an armed police force generally means you do as you are told, but that all adds to the fatigue factor. Secondly, the seemingly desperate measures such as night time curfews, which are very hard to explain from a scientific point of view, and mix in a potential criminal aspect for not complying, together don’t suggest there is light at the end of the tunnel anytime soon. And then we have a growing number of people who have lost their jobs, Spain’s important tourist industry in ruins, and an economy in freefall. All because of a little virus?

Treat citizens like adults, yes some will behave in a selfish and thoughtless way, but the vast majority won’t. Tell people in a straight forward way how this thing spreads; don’t confuse people by sterilizing sun beds, or making people swim in an allocated section of a swimming pool, or wear a mask in between mouthfuls of food. And if you do decide to press the nuclear button and go for a lockdown, and yes real lockdowns do work, but make sure you listen to the scientists and don’t re-open things too quickly.

Hindsight is a wonderful tool, however I and others did say at the time that we were rushing to re-open too soon, ignoring the science. So should we do things differently? Well that depends, but we have a few examples from around the world to look at. Not so far away Sweden adopted a very different approach and treated their citizens like grown-ups, very few rules and restrictions and people behaved responsibly. What worries me now is that the messages have become very mixed up, and on top of that people are fed up with the whole thing. Can we go to midnight mass? Can I have a close friend to stay the night? Midnight mass could certainly happen with some sensible precautions and that close friend- well I really can’t see the problem. It’s really important right now that people, citizens, don’t feel like they are being punished.

The latest idea, and one I think is a really good one, is the idea of a ‘Contacts Budget’. Just like you budget to do your weekly shopping; you set a budget and once it is spent that’s it until the next time. So with COVID you could decide to limit the number of people you see in a week, your contacts. Once you reach your limit you stay in. You could decide the limit based on the level of COVID in your area. It is something people would understand and it makes sense.

We’ve made it a crime for someone to spend the night. We’ve also seen some truly incredible examples of humanity in action, strangers reaching out to help one another. It’s what makes us human. We need human contact, we need love and affection. Let’s not forget we are not the enemy, the virus is. We need to keep this thing in perspective, the risk is that it wins and we all lose.

Should I think about getting that ‘flu jab?

It can seem a bit incongruous, sitting on the Paseo Maritimo sipping something cool and watching the world go by ‘flu is probably the last thing on your mind.  Well, of course, the Costa del Sol certainly isn’t the frozen north, but ‘flu doesn’t care about that, and yes it is here big time in the sunshine.

The ‘flu vaccine does work, so if you are in an ‘at risk’ group get vaccinated. This year it really is important because with COVID hanging around catching ‘flu can leave you with your defences weakened so don’t risk it.

*DISCLAIMER*

Dr Marcus Stephan

My views are entirely personal and do not reflect the view or position of any organisation. You should always consult your own medical practitioner regarding any concerns that you may have.

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