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

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.