Okay, okay, I probably should have written this blog a year ago, but I couldn’t work out how to do it and besides statistics make my head hurt! And anyway, better late than never….
 
Throughout the Covid-19 pandemic we have been repeatedly bombarded with a statistic called R0 (often referred to as the “basic reproductive rate”), whether from the Government or the news channels, as a way of describing how SARS CoV2 is spreading in the community. By now most of know what it is; it’s the number of people that a person with an infection will infect. If R0 >1 then the initial “outbreak” is expanding, if R0 <1 it is shrinking.
 
But, the Government and the news have been using it incorrectly… and as a result so have a lot of us. Let me explain….

Why do I watch the news? It only winds me up…
 
Watching loads of people queue (not socially distanced!) to come home from their beach holidays in Portugal because the rules about quarantine have changed really irritates me. Has everyone forgotten there’s a pandemic going on????? 

I love this quote from Winston Churchill, and often try and slip it into teaching sessions, and any conversation actually! But over that past year or so I have been wondering whether we might be able to use history to help us better understand the Covid-19 pandemic. My reason for this curiosity is that we have 4 common cold coronaviruses that infect humans, but it is likely that they didn’t originally start in humans but rather crossed from an animal into us in the past, and therefore we may have had a coronavirus pandemic before… we just didn’t know it or maybe we have forgotten it. Therefore, is there any evidence in the historical medical literature that would help us understand what might happen as the Covid-19 pandemic progresses? I do love dusty old medical “history” books…
 
Firstly, has there been any likely pandemic for other possible coronaviruses… I was wondering if the so called “Russian Flu” of 1889-90 might be just the thing I’m looking for…

Malaria is a common parasitic infection spread by mosquitos. WHO estimate that there were 229 million cases occurring during 2019, with 409,000 deaths of which 274,000 were children under 5 years old. This is both staggering and depressing because malaria is both preventable and treatable… and yet every year over 400,000 people die who shouldn’t. That means more people have died in the last 8 years from malaria than have died in the Covid-19 pandemic.
 
Trillions of pounds have been spent during the Covid-19 pandemic supporting the economies of developed countries and yet only about 3 billion pounds has been spent in total trying to fight malaria. Why the difference? It could be that Covid-19 had the potential to cause more death and disease than malaria, but then why not spend the trillions on the health response rather than the economy? Could it have anything to do with the fact that 94% of cases and deaths from malaria occur in Africa rather than Europe and the USA?
 
Now we all know we should go and get our Covid-19 vaccine but wouldn’t it be great if there was an effective vaccine against malaria too? The WHO want a malaria vaccine that is at least 75% effective by the year 2030. Surely if there was something like that it would be all over the news; all that death and disease prevented. Well there is a promising vaccine… it just seems to have got a bit lost in all the Covid-19 noise… it is being trialled by those clever scientists from Oxford again, but it does have a rubbish name…!

Okay, I’ve been trying to avoid it but maybe it’s time to catch up with the news. No, not local elections, Jersey-France fishing disputes or what colour wallpaper did Boris Johnson use in the Downing Street toilet (or something like that). Let’s have a quick catch up with Covid-19 and try and answer a few questions I have been asked recently.
 
Let’s get to it…

The Microbiologist gave a big sigh. It was a beautiful spring day outside, perfect for hitting the forest trails, and here he was sat at the duty desk advising on how to treat athletes foot… he sighed again…
 
The phone rang and with a heavy heart the Microbiologist answered.
 
“I have a patient who I think has a fungal infection” said the voice on the other end of the line.
 
“Here we go again” thought the Microbiologist.
 
“What kind of fungal infection?”
 
“I’m not really sure. He has a lump on his foot which has been getting worse since he came back from Africa a few months ago” said the voice.
 
The Microbiologist sat up straight. This was more like it, something weird and wonderful.
 
“Who am I speaking to? What was your patient doing in Africa? Did he hurt himself, cuts to his feet, anything like that?”
 
“Oh sorry, it’s the Dermatologist here, busy clinic and forgot my manners. The patient was volunteering, helping to build a school in a rural village, he was there for a long time and I suspect as he was wearing flip-flops a lot, he had many scratches and cuts to his feet during that time. I thought it might be another case of sporotrichosis, but there is no sporotrichoid spread and the lump is completely painless. There does look to be a sinus forming as well. What do you think?”
 
“It does sound like eumycetoma. Here’s what I think we should do…”

Viruses are boring! I mean, what’s the point to viruses? All they do is make us sick, right? You just have to look at the past year to know that, and you can’t turn on the TV without seeing some product that “kills all known germs… including the coronavirus… dead!” Shouldn’t we be trying to eliminate all viruses, wouldn’t the World be better if there were no viruses?
 
But some say not all viruses are bad for us!? More importantly, some say there would be no humans if there were no viruses!! How stupid is that?!
 
Well to look at this question, let’s first consider what we are, mammals.

One thing lockdown has taught me is that being outdoors in whatever weather the UK can throw at me is something to be embraced as much as possible. I’ve been fortunate. By being a healthcare worker, I’ve been able to leave the house and get a change of scenery even if it’s just a hospital building. On top of that the ECIC and I have a nice garden we can use at home to relax in the fresh air (sometimes more fresh than is comfortable!).
 
The ECIC and I are now even more lucky. We have recently been able to buy a bit of land to turn into our own little growing space for fruit and vegetables… okay, this may not be your idea of fun, but we like it…. Whilst we’re busy digging out the brambles and nettles we have been chewing over ideas about how to look after our crops, and one of our problems to solve is water.
 
The land we have has no mains water. We can collect a lot of water from the roof of our shed and greenhouses (planning permission pending!), but if we need more then we’ll have to look somewhere else. One option is the small stream nearby, so we wandered over to have a look at what it’s like… and it’s ORANGE!

The patient was in his 50s and had been previously fit and well, but had become unwell a few months earlier after working in his garden on a hot sunny day. After putting his shirt back on and coming inside his arm had started to itch. This had rapidly spread to his chest and then all over his body. It felt to the patient like he had insects crawling under and over his skin. Nothing helped. He bathed, got changed, took an antihistamine, all to no avail.
 
The following morning, after a terrible night’s sleep, the patient was covered in a scab like rash and the itching continued. He saw his GP who thought this was a probable contact dermatitis and gave advice accordingly.
 
Over the next couple of months things went from bad to worse. The itching continued, he couldn’t sleep, the rash and scabs spread, and he became convinced he was infested with bugs. In fact, the patient was able to squeeze “bug stuff” out of the scabs for his GP to see! The GP took skin samples and sent them off to the microbiology lab, but no parasites were seen and nothing infectious grew.

What is long Covid?
It might surprise you to know that there is still no formal definition of long Covid, even though the term has been used a lot in both the media and scientific literature over the past 6 months or more. Long Covid is the term commonly used to describe the persistence of symptoms in a person who has had Covid-19 infection and “should have got better”, but in whom symptoms persist. However, there is no consensus on what these symptoms are or how long they must be present before they constitute long Covid. Channel 4’s Dispatches, aired on 16th March, reported from Bradford one of the country’s worst hit Covid-19 regions and gave a glimpse into the lives of some people suffering the after effects of Covid-19.  
 
In the National Institute for Health and Care Excellence (NICE) guideline for managing the long-term effects of Covid-19 they refer to long Covid as “the persistence of symptoms or signs of Covid-19 more than 4 weeks after the initial illness”, with the caveat that there isn’t another explanation for the patients symptoms or signs. However other groups, such as the Office for National Statistics (ONS) use 5 weeks as the lower limit of time.
 
Well, we can’t agree on a time scale, surely we can agree what the symptoms are… can’t we?