We will overcome - strength in togetherness
LIKE no other topic in recent memory, the COVID-19 pandemic has captured our attention, writes Dr Con Kelleher. This is so because it is a threat to our lives and our health, to our social activities and to our jobs and the economy. It seems unfair that when people were putting the woes of the latest recession to the back of their minds, the corona virus strikes. Further, we saw and heard of the damage in China and know what is happening in Italy.
I would like to express sympathy to the families who have lost loved ones and not being able to comfort them in their final moments and to those affected. The treatment by medical staff is heroic. Dr Tony Holohan and his team, and indeed the government and politicians, are managing the situation as well as they can. It is tragic that people have lost their jobs overnight and this has generated understandably high levels of stress. To balance this, most people are behaving impeccably and should be applauded. Those keeping shops and essential services are playing starring roles. Of course, we do have the irresponsible few not complying with advice.
A young man well known to me, when he was young, had a sign on his bedroom door and another on his wall. The one outside went ‘No Girls Aloud’ (sic) and ‘Nasty Things Happen’, the latter expressed more earthily and bodily. It was quite philosophical for a 10-year-old. But it is true and now both our country and the world have ‘ nasty things’ happening.
The Black Death or Bubonic Plague (1340s-1350s) was caused by Yersia pestis and resulted in an estimated 75-200 million deaths in Europe and Asia, and killed 30-60 per cent of Europe’s then much smaller population. One effect was a boost to the English language in Britain because ‘clever’ lay people, without Latin, were quickly ordained. Before that, Latin and French were the languages of religion and government and the elite.
During the Great Irish Famine 184552, of eight million, about one million extra people died and another 1.5 to 2 million quit the island between 1846 and 1856. Most of the famine deaths were caused by infections and not starvation. There was another famine in the 18th Century and may have killed proportionately more Irish people. Hunger and starvation struck again in the west of Ireland in the 1880s.
In the 20th Century we had two World Wars, the Spanish Flu, the first and second uses of atomic bombs and many other catastrophes. In this country we had the War of Independence and the civil and economic wars. From 1939-1946 the country experienced the ‘Emergency’, and in the fifties about 400,000 Irish people were forced to emigrate. Between 1800 and 1921 about eight million Irish people were mostly forced to leave the country and the 1980s saw another upsurge in emigration. Tuberculosis (TB) was a big ‘ killer’ in Ireland until the 1960s. For example, in 1916, 9,323 succumbed to TB (the Irish population in 1911 was c. 4.39 million). Global warming is the issue of our time and threatens civilization.
The Spanish Flu killed about 17 million 1918-20 worldwide (some think the figure may be even as high as 100 million) and about 23,000 in Ireland, more than the combined Irish deaths in the War of Independence and the Civil War.
Despite the limited travel at the time, the pandemic reached almost every part of the world. A feature was that the flu struck quickly and affected many young adults, and it left many orphans. About 35,000 Irish people lost their lives in WWI (1914-18) or an average of 7,000 per year.
The above is not to depress but to give perspective. While the numbers which came out of China were big, we must recall that it has a population of about 1,437.7 million (300 times the size of Ireland) and Italy’s is about 60 million, or 12.5 times as big as ours. For proper comparison we can divide the Italian numbers by 12.5.
As I write today, Saturday, March 21, the numbers in Ireland (R.o.I) are 683 cases, three deaths, with 12 patients admitted to intensive care. These numbers are bound to rise. Compared to the huge numbers who died in the Famine and the Spanish Flu the numbers are still thankfully small.
Although so far there is no cure for COVID-19, many drugs are being tested and some such as chloroquine (Plaquenil) have promise. Plaquenil is an anti-malarial medicine, is cheap and available, and has a good safety profile.
All new drugs and new uses of existing older drugs must be assessed for effectiveness and safety. Remdesivir, an antiviral, is also showing promise in trials. The Japanese anti-flu drug, made by a subsidiary of Fujifilm, favipiravir also has potential. The development of a vaccine is probably the best option but that takes time, and then it must be tested for effectiveness and safety. Mercifully, for about 80 per cent, the illness is mild, but 14 per cent become quite ill and about six per cent become very ill. In China, emergency teams sent to Wuhan have been sent home or are going abroad to help other countries in the fight While it is a cliché to say that prevention is always better than cure, it is absolutely true of Covid. The virus is spread by contact – droplets, shared surfaces and clothing, and faecal-oral contamination. Like other infections, coronavirus grows exponentially. This is because, like a chain reaction, the number of new infections tomorrow depends on the number of infected people today. Exponentially growing infections have a ‘doubling time’ that measures how quickly the infection is spreading through a population. For example, in most European countries at the moment, the doubling time of coronavirus is about three days. If one infected person enters the country three days later two people will be infected.
On day six, four people will be infected; on day nine, eight people will have gotten it. The numbers get large quickly, and become overwhelming. Without interventions like social distancing, the virus will take the same amount of time to get from one thousand to one million as it has taken to get from one to one thousand.
However, the doubling time depends not only on the virus itself but also on our behaviour. So the ‘trick’ is to take as many steps as possible to prevent new infections. For example, if the doubling time stays around three days, the virus will take about two months to infect a million people: enough to totally overwhelm emergency rooms. If we increase the doubling time to 10 days, it will take almost seven months to reach this figure: still not great, but it gives us a much better chance to build up capacity and prevent unnecessary deaths. And, hopefully, in these extra months, better treatment options will have arrived.
So how do we prevent the infection spreading? Basically, we do it by following the rules:
1. Scrupulous hand-washing.
2. Scrupulous coughing and sneezing etiquette.
3. Do not shake hands or hug.
4. Clean surfaces particularly, but clean everything.
5. Keep your distance – at least 2 metres or six feet is recommended.
6. Social isolation. Keep contact with others to a minimum. Avoid social gatherings, including extended family occasions. (Bushing in the Castle Grounds, Macroom, or anywhere else flies directly in the face of safe practice.)
7. Social cocooning for the vulnerable.
8. Keep active physically and mentally.
9. Being outside in the fresh air is healthy and safe
10. Watch out for your neighbours, and help where and when you can.
The message is that the COVID-19 pandemic is temporary and no or very few new cases are being recorded in China. The better we behave, the less severe will be its impact and the shorter the pandemic will last. The illness is mild in 80 per cent of cases and there are some promising treatment options being researched. More than 80,000 have recovered from the illness.
Finally, I would like to thank all our health and HSE officials for their wonderful efforts so far. The mind boggles at what this society could achieve if the same efforts could be applied to housing and other problems. The medical community has been fantastic, especially the nurses, lab technicians and ambulance people as have been shop owners and assistants and many more.
The reaction of people in acts of kindness has been heart-warming. We must keep up the good work and continue to help each other. Take one day at a time. Take care of yourself and help others.
Remember ‘We Will 0vercome’ through practising ‘Ní neart go cur le chéile’ - strength in togetherness. I thank my son Colm with the ‘maths’ and proof reading. (Dr) Con Kelleher.