The New Normal
Playing Russian Roulette?
13th July 2020:
Last week, I discussed how Covid-19 is causing illness through damage to blood vessels, thrombosis and widespread inflammation of major organs other than the lungs, including the brain. I mentioned the need for rigorous long-term studies, so it was good to learn a few days ago about the launch of a £8.4 million study funded by the UK National Institute for Health Research1. This investigation aims to recruit around 10,000 people that will ‘track the long-term effects of the virus after hospital treatment, recognising that for many people, survival may be just the start of a long road to recovery’.
Meantime, most people are anxiously awaiting what will happen as the four countries of the UK, each with somewhat different policies, take steps to relax lockdown with the hope that the epidemic has been controlled sufficiently to allow cautious but incremental changes that will adjust the stringency of social distancing, permit restoration of work patterns, education, leisure activities and the opening of public amenities especially schools and other educational activities. It is early days; after all, it is only since June 18 that the reported number2 of new cases of Covid-19 infection in England fell below 1000 per day. There is substantial on-going transmission of the virus and many new cases occur each day even if the trend is heading in the right direction. Clusters of new infections, such as happened recently in a garment factory in the city of Leicester, indicate the fragility of the current status. The ability of national and regional public health teams to contain these outbreaks will be strenuously tested, not just in the immediate future, but in the longer term. Plenty to think about and discuss in a future blog as the trajectory of our epidemic evolves.
This blog is about all germs, immunity and vaccines, but the immediacy of the Covid-19 pandemic has resulted in other topics being given short shrift. It’s important to keep in mind that infections of all kinds account for more than half of all deaths on our planet each year. For example, the deadly malaria parasite causes 200-million infections annually resulting in 400,000 deaths each year. Because there is no vaccine and resistance to the main drugs is increasing, this disease is not going away in the foreseeable future. Although Covid-19 has already caused more than half a million deaths in just a few months, unlike malaria and many other infections (e.g. measles, TB, HIV, cholera, typhoid), this pandemic will decline dramatically with time. But, the Covid-19 pandemic has had a devastating effect on the global immunisation programme. Interruption of routine immunisation (e.g. polio, measles) has affected 80 million children under the age of 1. By cancelling immunisation visits to avoid exposure to Covid-19, the failure to deliver the Extended Programme in Immunisation (EPI) will have a lasting and dramatic impact on childhood mortality from vaccine preventable diseases3. So, I do worry that our current, arguably obsessive, focus on Covid-19 is distorting priorities.
My own major research interest is in meningitis about which I am currently writing a book. It’s the most feared and devastating illness that I encountered during my years as a medical student, trainee and ultimately a professor specialising in infections of childhood. What’s so terrifying is how rapidly this disease progresses. Within hours, a completely healthy person is overwhelmed by an illness that often requires intensive care. Meningitis is an infection of the linings of the brain, the most serious forms of which are caused by bacteria. It’s especially common in very young children at a time when their nervous system is developing making them highly susceptible to long-term brain damage. Although antibiotic treatment can usually prevent deaths from meningitis, many of those who survive suffer from long-term disabilities that include epilepsy, hearing loss and diminished mental capacity. Worldwide, meningitis affects more than 2.8 million people each year. So, a case of bacterial meningitis occurs every few minutes resulting in one in a hundred of all child deaths, although it’s not just children who get meningitis. The good news is that there are now safe and effective vaccines to prevent all forms of the disease.
In my book, called Brain Fever, I write about why I think that immunisation is one of the most important achievements in the history of medicine. I was appalled to read in a recent poll4 that if one or more Covid-19 vaccines become available, one in six people would refuse immunisation. A great deal of this “anti-vaxxer” sentiment is the result of messaging through social media in which misinformation is not challenged even though it is not supported by credible evidence. Scientists need to participate in these discussions and address the serious concerns of those who doubt that vaccines are beneficial. As an ‘insider’ who was personally involved in the research to defeat the dreaded bacterial assassins that are the cause of meningitis, my personal experience aims to share a compelling example of why vaccines are important and what is involved in making them.
Incidentally, the title of my book, Brain Fever, is the old (now obsolete) name for meningitis. There are few descriptions of the disease until the 19th century, when the disease became as well-recognised to doctors and lay contemporaries as measles, smallpox or consumption (TB). The term was used in Victorian literature to describe a quite different malady in which fictitious characters, often following traumatic life experiences, contracted and sometimes died from a lengthy illness. Madame Bovary became ill with Brain Fever after breaking up with her lover Rodolphe. In Great Expectations, Pip becomes seriously ill after his father figure Magwitch dies and in Emily Bronte’s Wuthering Heights, Heathcliff’s lover also succumbs to it. So, Brain Fever is also a metaphor that captures the profound emotions and despair experienced by family, friends and communities who suddenly and inexplicably lose a loved one from meningitis.
- The data on numbers of new Covid-19 infections per day are subject to many technical problems that compromise their accuracy.
- http://immunizationeconomics.org/recent-activity/2020/4/29/benefit-of -routine-immunisation-outweighs-covid-19-risks
- www.theguardian.com>media>jul>almost-one-in si….
Copyright Richard Moxon 13.07.20
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