Friday 1 May 2020
The Government thinks it is the bee’s knees with 100,000 daily tests (Pavel Hájek)
Each evening, at 1700hrs on weekdays, 1600hrs at weekends, the government gives the nation its daily Covid-19 briefing. All sorts of spokesman have given it over the past five weeks, some good, some not-so-good, some more than hopeless. But yesterday, Boris was back, and the nation examined him closely. Our Prime Minister has had all of life’s stresses thrown at him within a few months, yet somehow still remains smiling. Divorce settlement, disease, a new baby, election, and moving to a new house. For all I know he might also have had debt. Any one of those would level the strongest. Boris Johnson, who seems to have blotted every copy book it is possible to blot, still has something about him. It was good to see him at the briefing as our country has been missing a leader.
The Prime Minister has lost weight, that much is clear. Covid-19 is clearly a fearsome way of dieting, and he is still out of breath. I could hear the rasp to his words as he gave his speech. But behind it all, he was still Boris. Love him or hate him, I am guessing that most of the nation was pleased to see him in one piece.
Government language has changed in recent days. One of the five factors that the bigwigs say must be satisfied is for the UK to avoid a second wave. This has been expanded slightly, at least by Boris, to include a second wave “that will not overwhelm the NHS.” This additional phrase is crucial because, at the moment, the NHS has plenty of spare capacity. The onslaught that it feared has not yet happened. Critical care beds are also underused, and the new Nightingale Hospitals, those that have been completed, have only just been blooded and are way below maximum potential. The additional phrase is significant, as history shows that further waves of infection are likely. History also shows that subsequent waves can be worse than the first.
There is another phrasing too, which is beginning to worry me. It is the statement made by the Prime Minster, “We are past the peak.” We may be past a peak, that I accept. We will not be past the peak, as there are others yet to come. I sense it is wrong for the nation to relax at the moment.
The situation this morning – 1 May 2020 (courtesy Center for Systems Science and Engineering at Johns Hopkins University)
Scotland, meanwhile, has now advised the public wearing of facemasks, although the country’s First Minister has also said that a mask is no substitute for social distancing, staying at home, and other measures. The problem with a mask is that it delivers an, “I’m alright, Jack,” feeling to wearers and makes them feel invulnerable. On the streets of London, the use of facemasks is increasing, despite there being no government directive. I see that around me daily.
In the USA, the drug remdesevir has become what they are calling the “standard of care” for Covid-19. A trial has been undertaken comparing patients with advanced Covid-19 and lung involvement who received remdesevir, with similar patients who received a placebo. A placebo is basically something that looks like the trial drug but actually contains nothing of consequence. The trial began approximately two months ago at the University of Nebraska Medical Center. The first patient was an American who had been repatriated after being quarantined on the Diamond Princess cruise ship. Remdesevir had shown earlier promise when treating experimental animals for Middle East Respiratory Virus (MERS). Poor little macaque monkeys. The drug actsby incorporating itself into the viral RNA, SARS-CoV2 is an RNA virus, interferes with what is called viral replication, and causes their premature termination. I am all for prematurely terminating this virus. Remdesevir was initially developed for the treatment of Ebola, and other viral illnesses as well. The mortality rate for the group that received remdesevir was 8.0%, and for that receiving placebo was 11.6%. This does not strike me as a huge difference. I was interested to see that a Chinese study looking at the same thing turned out to be inconclusive.
The government appears to think it is the bee’s knees today, as it has reached its self-imposed testing target of 100,000 tests daily. It escapes me why they bothered to inflict such a pressure on themselves when there is so much else to do. Testing is incredibly important, but it is only part of the overall management. A home-testing programme has also been developed, with 100,000 households being sent testing kits. The aim is to see how many people are currently infected with the virus and how many have been infected and recovered since the outbreak began. They are calling it the Real-time Assessment of Community Transmission (REACT-1) programme.
Letter from Jesse Lazear to his wife in September 1900 – “I rather think I am on the track of the real germ.” (Philip S Hench Walter Reed Yellow Fever Collection, University of Virginia Library)
A short while ago, someone circulated a sad collage of the healthcare staff who had died of Covid-19 in UK. Someone on social media had spotted that many of them were Black, Asian and Minority Ethnic (BAME) and highlighted the fact, as well as wondering why such a high percentage had died. The next thing was a tirade of abuse claiming that the statements were racist, which was manifestly wrong. No one on the social media channel was able to understand why a reader thought the comments were racist, and the discussion died a death.
I am glad the matter has now been reawakened as it seems that British BAME Covid-19 death rates are more than twice those of whites. The Somerset NHS Foundation Trust has taken this seriously and updated its risk assessments to take BAME into account. Regardless of what anyone thinks of this issue, the figures are clear. It appears that 63% of healthcare workers who have died from Covid-19 were BAME individuals, and more than half of them were not born in the UK. I would imagine that is a frightening statistic if you are BAME. For what it is worth, Boris Johnson’s paternal great-grandfather was a Circassian-Turkish journalist called Ali Kemal. One wonders if this had anything to do with our Prime Minister’s rough ride when he was a Covid in-patient on the St Thomas’ Hospital Intensive Care Unit?
My work at the London teaching hospital continues, although it is taking slightly longer to sort out than my previous supermarket experience, roughly three weeks ago. Yet each time I walk around the hospital area, I bump into signs for vaccine participants. “Polite Notice,” they declare, “Reserved for Covid-19 vaccine trial participants.” It is truly exciting to be in a location that is right next to possible history being made, and I keep my fingers crossed that this hospital, which for the moment is my hospital, actually does it. Medics are habitual experimenters. It is perhaps why doctors are said to practise, rather than do. Medics frequently experiment on themselves, which cannot be recommended but is frighteningly common.
I spent my very early years, before I trained as a medic, being fascinated by epidemics, vaccinations, and the heroism of my medical forefathers who did all sorts of things to themselves in order to treat their patients. Many died as a consequence. There was Jesse William Lazear, who gave himself yellow fever. He wrote to his wife in September 1900, after allowing an infected mosquito to bite him. “I rather think I am on the track of the real germ, but nothing must be said as yet,” he recorded. He died, aged 34 years, 17 days later. There was Max Joseph von Pettenkofer who, in 1892, obtained a soup laced with cholera, glugged it back and claimed that the mild symptoms that followed had nothing to do with the disease. The modern view is that he did indeed have cholera. There was Daniel Zagury with AIDS, Tim Friede with snakebite, and plenty of others, too. It was stories like these that encouraged me to become a doctor and here I am now, in the middle of our own pandemic. It is awful, yet exciting, as each day turns up something new.
Jesse Lazear’s fever chart – sadly he did not make it (Philip S Hench Walter Reed Yellow Fever Collection. University of Virginia Library)
The trend towards self-experimentation lives on to this day, even with Covid-19, at least according to the Global Times. Tianjin University in China is said to have successfully developed an oral vaccine against the disease. The professor who led the project took four doses himself and did not experience any side effects. I can wager, whatever the media will report on the day, that when a vaccine for Covid-19 has been developed in UK, there will be those involved in its creation that will have already tried the vaccine on themselves. Self-experimentation survives.
