Responding to the Covid-19 (coronavirus) outbreak: the dark side and the brighter

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It is a plain and simple fact that we have not been anywhere like this before within living memory. Not even in the memory of my 98-year-old mother, currently cooped up in an excellent care home which has, quite rightly, banned all visits including from immediate family. She was born in 1921, not that long after the eventual end of the 1918 Spanish flu. Even those who have their centenary (unless they are 107 or so) will not have even childhood memories of that pandemic which, depending on the estimate that you go for, killed somewhere between 20 and 100 million people worldwide.

And it is clear that this lack of memory is one of the reasons behind the dark side of the Covid-19 outbreak. Its absence has made it remarkably hard to get some people (far too many people) to take seriously the life-saving warnings about ‘social distancing’ – physical distancing might have been a better phrase.

The UK has not had a proper epidemic of influenza since the so-called Hong Kong flu of 1968, some 50 years ago. The ‘swine flu’ outbreak in 2009, which initially looked terrifying and led to the NHS stockpiling hundreds of millions of pounds worth of flu treatments, did indeed cause fatalities. But in relative terms it barely touched the UK.

So long ago are the late 1960s, so much are they outside many people’s memories, that for many years people have tended to say ‘I’ve been off with the flu’, or ‘a touch of the flu’ when in reality what they’ve usually had is a decidedly nasty cold. Get a decent dose of influenza – and I’m old enough to remember having it, while being protected by the vaccine in more recent years – and you know it. Bed ridden, aches and pains and knocked out for days. And that is just flu, not Covid-19.

But I do remember the Hong Kong flu epidemic, which hit the UK in two waves in 1969 and 1970. That was sufficiently bad that, for a briefish period, everything stopped for tea, so to speak. There was no email in those days, and much of the post stopped being delivered, or was very late. The milk – almost all of it delivered to the door in glass bottles – stopped arriving. Trains and buses ran to heavily reduced timetables: not because of the sorts of decisions being taken now, but because drivers had the flu. Clinical staff, of course, also caught it, and for a period the NHS was overwhelmed. But it was for a relatively small number of weeks. And while this flu was highly contagious, it had a relatively low mortality rate – perhaps 30,000 to 40,000 excess deaths in the UK in each wave against, in recent times, an average of around 17,000 a year from influenza, although that figure varies widely even in non-epidemic years.

Covid-19 is, of course, something entirely different. On the evidence so far it is far more transmissible than influenza – the infection rate per person without physical distancing appears to be closer to 3 people for each person infected than the 1.5 for influenza. If people do not keep their two metres distance, that seemingly small difference compounds very quickly to produce the pandemic we are witnessing. It also has very severe respiratory symptoms in a significant proportion of cases, and at a higher rate than flu.

What of the government’s response so far? Only time and the outcome will allow a proper verdict. What is clear is that, from day one, both the government and its advisers have had to make judgements, and they have had to do so on fast changing evidence. How far was it realistic to seek to suppress and then mitigate it? How much collateral damage would be done to the economy, to the treatment of patients with other life-threatening conditions, and to social cohesion, by what decisions? The answers will look much more obvious in hindsight. They were clearly less so when they had to be taken.

But as the country goes into increasingly stringent forms of lock down, there is a bright side. Namely that we are so much better equipped to tackle this than in the past.

Back in 1968, and when I started out as a health reporter in the 1970s, we were still in the days of paper, pencil, typewriters and landlines. The best way to get a clue as to what was going on during winter pressures (yes, they have always existed) and in the flu outbreaks that stopped short of a full-blown epidemic, was to ring the London Emergency Bed Service. Founded in 1938 to help GPs find hospital beds for their patients, it was this service that hospitals reported to when they were full, so that ambulances could be diverted elsewhere. One could track how bad things were by its reports of how many hospitals were closed to new admissions. Its daily bulletins, compiled with paper and pen were about the only real time data available.

Technology has changed all that. Epidemiologists, scientists, clinicians, planners and ministers can track day-by-day what is happening around the world, not just within the UK, as a global effort is made to tackle Covid-19. And the science is in a totally different place, way ahead of where it was in 2009 with swine flu, let alone in 1968. Far faster, more effective.

The closure of retail shops has been made more manageable by the existence of online retail, which at the time of writing is still permissible, even if the supply chain will struggle and will doubtless be hit by drivers getting Covid-19 or having to self-isolate. Social media in its many forms is keeping families and friends in contact while allowing lessons and lectures to take place. It is also helping rapidly create the many community groups now springing up to support not just the vulnerable locally, but also the staff of the NHS itself. This now happens without that requiring face-to-face contact, or a well-stocked phone book (and I mean phone book) to get them established. And for course, for those for whom it is possible, it allows remote working. All this for as long as the internet can take the strain, which it seems to be doing.

This piece may or may not be worth reading. But in 1968, I’d have had to write it on a typewriter, post it or find a courier, and The King’s Fund would have had no way of publishing it other than in some form of newsletter. It would have had to be sent off to the printers, or re-typed to be cyclostyled (younger readers can look that up), before it was posted out, physically. And then only to those that the Fund had on its mailing list (a proper old- fashioned mailing list, that is, not an electronic one). The internet has undoubtedly brought its problems – misinformation, fake news, conspiracy theories, on-line abuse and bullying. But right now it is a crucial part of the answer, both scientifically and socially. Just take the drive to get non-ventilator manufacturers to manufacture ventilators. Not enough will arrive fast enough. But they will still arrive far faster than they would have done without the internet and video conferencing.

So while times are hard and are clearly going to get much harder, there is a bright side. Pandemics have occurred before. Globalisation has increased their speed of spread, but by definition, they always got around the world. And it will be easier (if far from easy) to tackle this than it was in the past, even 20 years ago, let alone 50. That is, of course, provided that the loss of memory (and a false sense of invincibility) does not see far too many people not follow what is now not so much guidance but instructions on how to keep themselves and others safe.


Raoul Pinnell

Bromley Healthcare
Comment date
07 April 2020

On the bright side - I have observed something of the human response of staff (and I don't know if this is learnt or just an instinctive response to crisis) - how many of our staff have been prepared to 'throw away their job descriptions' and respond 'in the moment' to what needs to be done e.g office based staff delivering PPE to their front line colleagues.

Judith Gunn

Self employed
Comment date
10 April 2020

I remember Hong Kong flu, whole family had it in Northern Australia in 1970. I am therefore unaware of the lack of post or the restrictions to rail services, isolated up north we got through, but it as ill as I have ever been apart from Scarlet Fever which I managed to get in the 80s - which only demonstrates that these things don't really go away.

Marlene cornforth

Comment date
06 May 2020

I had hong Kong flue, I was 20ish, I was really ill, my gran didn't get it, I was of work for 3 weeks, went back to work and was of again for 2 weeks I was so weak. I've never forgot it and never will. Now I'm 72. Up until now get the odd cold, never have the flu jab, I've to think I could, yes I could be emu be from a lot of viruses, but one never knows

Richard Excell

Retired Company Director past Chairman SetSquared University Partnership,
Comment date
14 May 2020

Congratulations on reminding of us of something Just 50 years ago that was responsible for 80k deaths in the UK. No paranoia, no lockdown, no trashing the economy for our children? As you say these events are not unique but our response to each has been - Now driven by a hungry media who somehow rarely refer to this Pandemic - yet likely to be a bigger killer than this one. The post Morten will be whether the world overreacted to an occurrence that is part of the unstoppable life cycle of the world. Are we powerless to stop it? Almost certainly yes. Can we minimise its impact? Directly by policies such as lockdowns probably only delay the impact but with certain indirect suffering over a long period of time for The majority of the population with low risk to the virus and the deaths of younger people denied treatment for other Treatable medical conditions because of the refocus of the medical services.

Will the 'lucky' post war generation have looked after themselves again to the detriment of the next one? Not deliberately but sadly until we realise that science has not created immortality - yet - it looks that way! Dying is part of the life cycle! Most of the fatalities will be at an age when insurance life premiums are unattractive! The lack of 24 hour media coverage in 68/70 meant the virus did its worst almost unnoticed causing huge distress but GDP rose, a minor short recession followed - and for most like me as a twenty year old it was a non event.

I am saddened to see the media role played by some of the Science Advisors. What was their advice in 68/70? Despite so much progress being made over the past twenty years of joining up our primary research with good private sector innovation to benefit sound national policy making, we have been faced with watching little short of a shambles compared with the German focus driven off the back of their effective Fraunhofer Institutes. A mix of over sized science egos, paranoia of letting the private sector be coupled with the NHS over our national public/private testing capability have all been on show. To then hear our no 1 Science Advisor at an early stage indicate that the benefit of testing might be overrated left me speechless but surmising he did not know the National capacity!

Probably through ignorance I suspect the lack of interference in the life/death cycle in 68/70, history will reflect that this has been badly handled by our policy makers.

Michael Collins

Comment date
15 May 2020

I had Hong Kong flu in December 1968, it was brutal. My family had it at the same time, I remember us laying around suffering. Thankfully within a few days I was better.

The idea of closing society down never seemed to be considered. I seem to remember TV news reporting very high death rates. last week I was checking some newspaper headlines from the period and one read "15 million Italians confined to bed with flu." Also I don't remember being told to social distance, infact I think that it was taken that every winter flu came around and this just happened to be a nasty strain.

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