Notes from a pandemic

Back in 2009, I was working at the British Medical Journal as an editor on their (now-defunct) patient information site, Best Health. It was a job I loved, working with doctors and experts in evidence-based medicine to bring the best quality health information to the general public.

6a00d8341d417153ef011572077520970b-800wiDuring April, reports began to emerge of a new strain of flu, identified first in Mexico and swiftly dubbed swine flu (later known as H1N1). Cases started to be reported around the world and by the summer, the UK was part of a full-blown pandemic, with cases peaking in July.

My boss was on holiday when I was asked to research and write a swine flu topic for speedy publication on our website. As is the way of these things, I therefore became our default expert on the topic, appearing in BMJ podcasts and writing articles about the subject.

Mercifully, swine flu turned out to be far less virulent than the coronavirus pandemic we are currently living with. But I will never forget reading the government’s pandemic flu plan for the first time, and realising with startling clarity the sheer fragility of our way of life.

Our supply chains, with the ‘just in time’ deliveries to supermarkets, would be threatened by mass sickness among delivery drivers. Our technology was reliant on power supplies and technicians not getting sick. Our NHS, with its close-to-capacity wards and high vacancy rates, could easily become over-stretched. I learned why those in the know put pandemics at the top of the threats facing the UK.

Over the next 10 years, other threats seemed to loom larger. Austerity. Brexit. Terrorism, periodically. Antibiotic resistance.  I stopped worrying.

So here we are. It looks like I wasn’t the only one who had forgotten to be truly afraid of infectious disease. Despite my knowledge, it took me weeks to catch on to the fact that the new coronavirus outbreak was more serious than we were being led to believe.

The return of hand-washing advice and “catch it, kill it, bin it” made me imagine this would be a re-run of 2009. Yes, I realised the virus would reach the UK, and once it did, it would spread through the population. But at first I assumed this would be like seasonal flu – unpleasant, possibly dangerous for the elderly and frail, but no worse than we’d seen before.

The news from Italy was the first wake-up call. Why not China? Somehow, lock-down in China and deaths there seemed too far away, too unlikely. But Italy? I began to look at the early figures. The mortality rate was high. Way higher than seasonal flu, which is around 0.1%, 0.5% in a bad year (about the same as swine flu in 2009). Events I had planned to attend started getting cancelled. Even then, I was unprepared for the complete UK lock-down when it came.

Then my octogenarian parents got sick. Sixty miles away, over the phone, I heard my father coughing uncontrollably. I tried desperately to ensure they got the medical help they needed – which they did, after 90 minutes on the phone to 111. Mercifully they both recovered without needing hospitalisation. But the fear was personal now, not just theoretical.

Yesterday I stared in horror at a graph showing deaths from all causes in England and Wales, for the week ending April 3. There had been 16,387 deaths – up 5,246 from the previous week. The ‘additional’ deaths told a stark tale. All cause mortality is an unarguable measure. It doesn’t matter whether people were tested or not, whether they died with or of covid-19. They died. The figures showed that, compared to the five year average for this time of year, there were 6,082 additional deaths in one week. That is an extraordinary rise.

Not all of these people had covid-19, and only 21% had the virus mentioned on their death certificate. So why did they die? It is hugely important to know. If they died of covid-19, the real figures are way above those being reported daily via NHS hospitals.

If not, it’s almost more worrying. Did these people find it impossible to access treatment for emergency conditions such as heart attack and stroke? Perhaps the 90-minute wait my parents experienced put other people off calling for help. Did they not want to bother the doctor, or the hospital, because they’d been told to stay at home? Did people with pre-existing conditions die because they did not or could not get the care they needed?

After swine flu, some scoffed that the government had ‘cried wolf’ by raising the alarm about a virus that turned out to be much less lethal than feared. But we didn’t know that’s what would happen. We got lucky. We should have used the reprieve to prepare, to keep the plans under review, to stress-test and plan.

How much worse, this time, to have ignored the cries until the wolf was inside the house.

I’ve been writing about covid-19 for a range of publications, including the BMJ, Medscape and Covid-19 Facts. You can find links to my articles below.

Myth: red eyes mean you have coronavirus. Published in Covid-19 Facts, 14 April 2020.

Does air pollution increase deaths from Covid-19? Published in Covid-19 Facts, 9 April 2020

How do we decide who gets life-saving Covid-19 treatment? Published in Medscape, 6 April 2020

PHE upgrades PPE advice for all patient contacts with risk of infection. Published in BMJ, 3 April 2020.

Are doctors getting sufficient protective equipment against covid-19? Published in BMJ, 2 April 2020 (updated 3 April)

Does losing your sense of smell mean you have coronavirus? Published in Covid-19 Facts, 2 April 2020.

Myth: drinking hot water, or gargling, can prevent coronavirus infection. Published in Covid-19 Facts, 1 April 2020.

Myth: Taking a hot bath or sauna can kill coronavirus. Published in Covid-19 Facts, 31 March 2020.

Is primary care ready to switch to telemedicine? Published in Medscape, 27 March 2020.

Do people with blood type A have a higher risk of coronavirus infection? Published in Covid-19 Facts, 27 March 2020.

Myth: anti-malarial drugs can cure coronavirus. Published in Covid-19 Facts, 26 March 2020.

How UK doctors are coping with anxiety/distress during Covid-19. Published in Medscape, 26 March 2020.

Experts question analysis suggesting half UK population has been infected. Published in British Medical Journal, 25 March 2020.

Trials of 4 potential treatments to generate robust data of what works. Published in British Medical Journal, 24 March 2020.

Should pharmacies sell protective face masks to patients? Published in Chemist and Druggist, 23 March 2020.

Myth: pet cats and dogs are spreading coronavirus. Published in Covid-19 Facts, 19 March 2020


One comment

  1. Andrew Lukas · ·

    Yes – swine flu the forgotten outbreak. Andy Burnham was a Health Minister at the time and has commented recently about his past experience.
    I understand government departments have plans and practice scenarios for different contingencies. But I wonder whether the playbook is found or followed once the crisis occurs. And I fear vital nhs stocks of equipment were not kept or had been run down during austerity.

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