Thoughts on our Healthcare

“It is forecast that by 2030, the global consumption of antibiotics will rise by more than 30% (200% if it continues at current growth levels). By 2050, the annual death rate will have risen from 700,000 to 10 million with no action.”

 

It is a humbling situation when one realises how fragile we are in the face of nature and how little we really know in the battle to protect ourselves.

My generation have the unique honour of having grown up at a zenith of medical know-how. As a child, I often reassured myself that, if I or anyone I knew ever became unwell, everything would be fine. I always comforted myself that, should it be needed, there would be the medical expertise somewhere to cure anything. I was confident that the medical care and consensus behind every treatment was solid and complete; its efficiency spotless. Now I realise that this was simply a form of therapeutic self-delusion.

The truth is that, although our capabilities far exceed the wildest dreams of Hippocrates and Aristotle, we are far from perfect. What we don’t know far outweighs what we do. Treatments remain speculative, their quality reliant upon where we fall at any one time on the curves of demand and supply. Despite officious regulation, treatment remains highly subjective according to who treats you (bearing in mind this may be an exhausted doctor or nurse running on empty), and could still be based on faulty or unreliable evidence. We can’t guarantee a cure for your cancer and we can’t always tell for sure why you’re feeling so tired and achy, so sometimes we have to guess a bit.

Our exaggerated opinion of our own ability as a species extends beyond just medicine of course. While that can be catastrophic in other fields, it does at least provide some benefit in a healthcare setting. Confidence in physicians can be a therapy in itself. Despite what I have said, this trust is important and well placed. Though not perfect, we are better than nothing! And yet, when something like the Covid-19 pandemic hits – something so undeniably out of our control – it highlights those cracks that we’ve otherwise consciously chosen to ignore. 

What has struck me most about the Covid-19 pandemic is our reaction to it. While in some places it has highlighted tremendous courageous and community spirit, in others it has merely brought out human attributes that are the polar opposites of the aforementioned. For me, it has emphasised the prospect (and quite possibly the need) for fundamental change in how we utilise the medical expertise and the knowledge we have accumulated.

The meaning of ‘our NHS’ has become a bit warped in recent times. When someone has been treated with kindness and care, it is the NHS that gets the thanks. In reality, it is the people that work for the NHS who should be thanked as well as the organisation as a whole; a distinction that I feel too often gets overlooked. Obviously this is semantics and very often that is what people will mean when they praise the NHS. But in merging the two, a powerful message is being lost.

The people that work in healthcare, whether it be within or without an NHS, deserve all the praise they are getting. Likewise, the idea of a National Health Service that provides universal, comprehensive and free healthcare should also be praised. The problem is, at its inception in 1948, the idea of comprehensive healthcare is very different from what it is now.

In 1948, paracetamol was yet to become readily available, open heart surgery was 4 years old, statins had not yet been invented and antibiotics were in their infancy. Fast forward to the present day and we are seeing around 200 heart transplants a year in the UK, an entire pharmacy of medications available to us at our beck and call, lifesaving emergency services 24/7 and access to state of the art intensive monitoring equipment. Around half of the UK population takes at least one regular prescription medication. If your hips or knees go, you are entitled to have metal replacements inserted for no extra charge. If you have a rash, you can have it seen to or if you want your ingrowing toenail sorted, you can have it clipped or lopped off. If your ears are blocked, someone will clear that for you too.

With our population increasing and growing older, it is little wonder that the whole thing is beginning to creak. The outcome…? You have to wait a long time for your hip replacement, you might be denied the chance to have your bunions sorted out because it is a low funding priority. Your GP is running late by 20 minutes or even a bit longer. That may seem a bit insensitive or flippant (or both) but believe me, I’m not happy about it, certainly if it means people are waiting for treatments in agony. While some have a rational grip on such situations, others will not. Those are the ones that abuse the staff who are only trying their best in impossible circumstances.

Demand has far outstripped supply already. At current levels of funding, the promise of delivering a comprehensive service is no longer accurate. But that is only if we all agree on what counts as comprehensive.

We have been rather spoilt with the NHS, rather like a child who is given one sweet and then pleads for several more, never content with what they are given. The level at which our baselines have shifted (there is an actual concept know as shifting baselines syndrome that one could probably apply to much that is wrong with the world) is significant. Consider 100 years ago, antibiotics were non-existent, surgery was more dangerous than beneficial and not long before that there wasn’t even the luxury of an anaesthetic. Just read the 1810 diary account of Fanny Burney, the English novelist, who developed Breast cancer and underwent a mastectomy without anaesthetic to see what I mean.

Antibiotics and our use of them serve as a perfect microcosm to demonstrate my point. For all they have given us, they have also contributed to levels of antibiotic resistant infections that kill 700,000 people a year globally. Don’t get me wrong, antibiotics are great; a lifesaver in fact. Prior to their widespread utilisation, a cut or scratch could become infected to life threatening degrees and as such they have arguably become the single most important tool in our therapeutic arsenal (vaccination is arguably more important). And yet they have suffered a severe case of mission creep. They lend a hand in all sorts of unexpected ways. Caesarean-sections and routine hip replacements would be rather more hit and miss in terms of survival without them. Not content with saving lives, in fact they have become somewhat of a luxury, whether it be to shorten a cough or a bout of diarrhoea or to fatten up our animals so their meat is better.

In the UK, at least 20% of antibiotics prescribed in primary care are inappropriate (I would probably argue that figure is higher depending on your definition of inappropriate). At any one time, a third of patients in hospital are on an antibiotic. 

Resistant organisms transfer at will from one person to another, or to food and animals. As they do, we edge ever closer to a circumstance in which we are unable to treat them at all. There are already strains of TB and gonorrhoea that cannot be treated even by the antibiotics reserved as last resort.

The WHO cites antibiotic resistance as the biggest threat from global pandemic. Considering what is going on at the moment that should prick some ears.  Just as there are warnings about antibiotics, so there were for coronavirus. A pandemic such as the one we find ourselves in isn’t exactly a surprise and yet to a large extent, we have all been caught napping.  I liken it to sitting on a beach with a bag of popcorn, admiring the spectacle of a tsunami rolling in. Suffice to say, a tsunami of antibiotic resistance is far less palatable than the comparative swell of coronavirus we are seeing now.

It may therefore be time for some realism and some hard choices. This includes both those at the very highest levels but also, I’m afraid, for us all. Who knows in what shape we’ll emerge from the current saga.

In an ideal world, the government would pledge a suitable amount of money for the NHS to cater perfectly for everything from the largest and most severe of our medical needs down to the smallest and most trivial. Failing that, management of the entire system must get realistic and we must allow it to do so. No one wants to see a privatised NHS, (including the government if what they say is to be believed). Clarity of mission alongside acknowledgement of the problems– not spin – is what we need. Without this, whispers and rumours of privatisation will continue. If measures are to be painful, in my opinion telling people that is far better than trying to sneak it under their noses. Better still, a cross party approach in order to depoliticise proceedings is preferable so election success no longer rides on it. What we don’t want to see are more layers of management. Time and time again, we experience instructions from those at the top, far removed from the realities and often the progress we make is in spite of these targets instead of because of them. In any situation, the more layers you add, the more complex it becomes and the easier it is to trip over yourself. A bit like the game Tetris – a certain amount of blocks at the right speed will build something solid but as soon as the rate and number of bricks increases, it all runs away from you.

Just as importantly, perhaps even more so, is our individual role in all of this. As we clap our health workers every Thursday evening while in lockdown, perhaps take a moment to consider what we ask of them under normal circumstances. A large proportion of GP consultations are unnecessary and could be dealt with either by a pharmacist, or by the patient themselves. The NHS website has the information available if people were only to access it.

Between February and March, there has been a 22% fall in A&E attendances, many of would have been unnecessary anyway and would have taken up valuable resources and time.  General practice and outpatient secondary care has also seen a sharp drop in demand for routine enquiries. Many issues will have gone away on their own, or have been dealt with using online advice. Still more infections will have settled without antibiotics. We must harness this new way of using the health service.

This current situation may therefore serve as a not so gentle reminder of what are reasonable expectations in terms of our healthcare. That said, between early and late March, there has been a fall of 150 patients per day presenting with symptoms of heart attack. Now, it is unlikely that the Covid-19 pandemic has somehow cured heart disease altogether and though many people with chest pain turn out to be fine, there will be some within that cohort of 150 who have had real heart attacks; heart attacks that are currently going untreated.

Lack of presentation for this sort of thing, or indeed other worrying symptoms of things like cancer (loss of weight and appetite or a change in bowel habit to name just three), means the health impact of this pandemic will not be just related to Covid-19. For anyone with worrying symptoms like this, you absolutely must not ignore them just because of the outbreak.

We need to use the NHS sensibly. Not too much, but not too little. We have swung from one extreme to the other in the last few months. Once we emerge from this, we must all consider how best to use it going forwards, and focus on the bigger issues at hand, no doubt at a time of great change. Self-care is a big part of that, not just in how we deal with an acute medical situation but also in how we look after ourselves in general. Smoking alcohol, diet and exercise are the key areas that cost nothing to improve.

As a nation, our perspective in terms of the scope of our healthcare has run away from us. Some expect miracles – you don’t need to go to your GP if you have a cold. Nor do you need to go to A&E with a broken fingernail or a year old rash. Meanwhile, the threshold for others is far too high and there is a proportion of people that will hold off in coming to a doctor when they actually need to be seen.

As doctors we want to ensure that everyone who needs to be seen, and who we can help, presents to us appropriately. At the same time, we would request that others, who might reasonably be able to manage their own minor issues, do so. It is a fine balance and even writing this makes me uneasy that some may stay away for fear of overusing the service. The level of disparity in comprehension of how best to use the NHS is, in my experience, remarkable.

Nevertheless, I think we all could perhaps do with shifting our baselines back a hundred years or so. As doctors, we need to look at how we are using our resources and considering whether far more significant changes are necessary. Antibiotics use is just one example. Fundamental change at the top is needed to streamline the provision of healthcare and cut out the obfuscating bureaucracy. Difficult lines must be drawn. Leaders must consider taking more than half a glance at the deeper issues facing us – after-all from our current position, an antimicrobial resistant pandemic suddenly doesn’t sound as far-fetched as it did a few months ago. If that change is severe then so be it. Sometimes you have to go backwards to go forwards. In that case, we all have a responsibility to understand it and adapt, though politicians must realise that we cannot be expected to do that if left in the dark.

Urgent care must remain a priority for the service as a whole, but how we look after an ageing population effectively is just as vital. Prevention of health problems is key. One of the best ways to help therefore is to look after yourselves properly (we can only do so much in that respect) but also to seek help when appropriate in order to avert bigger health issues down the line. Staying away isn’t always the answer (particularly at the moment) although granted, there is a fine balance. That balance has always been upset one way or another and we all need to contribute in order to redress it. Now might be the time to set it straight.

 

 

 

 

 

 

Healthcare After Covid-19

“Just as important as the government’s role in the NHS as it emerges from Covid-19 is the responsibility all of us have. We must shift our baselines back a hundred years – maybe more”


As a civilisation, humanity knows so much. To have in our arsenal an understanding of physics that includes relativity and all of its applications alongside our almost infinite artistic creativity is testament to our intelligence. These examples only scratch the surface of what we can do. So it is hugely humbling when we experience something like the Cvoid-19 pandemic.


As powerful as we are, we are still painfully fragile in the wider context – something we have a tendency to forget. It was not so long ago that we had to undergo operations without the luxury of anaesthetic and before antibiotics, we were faced with the rather uncivilised prospect of fighting infections using just our own immune systems.


Indeed, so uncivilised has the idea of being even slightly unwell become, that people now will seek medical help for a few days of cough and sore throat. The expectation for these worried well is that it is their right to expect an immediate cure. “Surely if we can do all of these marvellous things with technology, there is no disease we cannot sort out if we put our minds to it,” these people think. But these people are living in a different world, one of their own imagination. Others more prudent, sensible or experienced will realise that what we can do falls far short of this idealistic expectation.


We as a species go further. We harm ourselves willingly and then expect our medical professionals to pick up the pieces – even become angry when they can’t. Smoking, lack of exercise, poor diets – take your pick. That these things are bad for us there can be no question.


Of course one cannot wholly blame individuals for this. Capitalistic society is to blame here as much as anything. Profit and competition introduce temptation at the expense of welfare. I am not preaching socialism here – far from it. I simply point out that the drive for business to gain custom at any cost is a huge flaw in the system and in our health.


Whichever way one looks at it, we have become spoilt. Our perspectives on what we might expect from our healthcare have been shifted gradually but significantly over the last century. Only now are we being brought down to earth with a more humbling realisation; the thin facade of our supposedly advanced age has been withdrawn. There is even a name for this sort of thing – shifting baselines syndrome. It could be applied to many things. We have come to accept the nonsense and bile that comes from Donald Trump’s horrible little mouth as just the way it is these days. The baseline has shifted.


Just in the same way, many have been spoilt by the healthcare provision that they expect as a given. What we expect as a free benefit from our NHS nowadays (toe nail surgery, access to a GP to tell them about your cough, state of the art surgical procedures, cures for cancer and lifesaving emergency response within minutes) would have been the stuff of dreams for our ancestors. That the ever-expanding achievements of the last 50 years of medicine has caused the entire system to creek under its own weight is not surprising.


When I was younger, I reassured myself that if I or anyone I knew ever became unwell, it would be fine because there would always be someone somewhere that could cure whatever ailment had befallen them. My impression of medicine was that it was water-tight and so much more precise than the reality. A reality that slowly dawned on me during medical school. Much of it is guess work. Barely any treatment is 100% effective. What we don’t know far outweighs what we do know. The assumption is that there will always be a medicine to solve all problems. In a profession that revolves around trust in the doctor or nurse (a reassurance that can be therapeutic in itself) it is difficult sometimes for us to admit that we don’t have all the answers and can only do so much. Perhaps it is time we were more open with its limitations or else we make a rod for our own backs.
One might argue that what we now provide under its umbrella has gone far beyond the boundaries of what is sensible. To argue that we can effectively achieve 100% of what we aspire to medically is not possible. The issue is, the more superfluous and luxurious perks we add in, it edges out or at best blunts the core services that are most important.


At a time in which we are faced with something as dangerous and universal as Covid-19, we must heed a wake up call. The work the NHS is doing at the moment is what it is there for. Add to that health prevention, basic surgical treatments, mental health support, serious disease detection and treatment (including cancer), dignified end of life care, and social care.


Beyond the essentials, it is time for government to look at what the NHS really stands for and what it can really achieve. (Or preferably a cross party response to side step the political distractions). In an ideal world it would do everything to maximum efficiency. If a government wants to invest enough to make this possible, then great. The reality though means that the healthier a population is, the older it gets. Add to that the ever increasing scope of potential therapeutic options and one may argue that we could reach a point where a line must be drawn in how far we go in prolonging life. Should we become reliant of a system of health to such an extent (and perhaps we have already reached that point), the consequences of that system and it’s resources failing do not bear thinking about.


Governments need to look at this, decide where the line is drawn in what the NHS does and is expected to do. More importantly, they must be open about this. To back the NHS in a blind head long rush into the future, pledging vague sums of money that don’t make any sense to those in the know – none of this is helpful in any other way than to win elections. To acknowledge the need to be sensible about what is achievable and what is not seems difficult for politicians. Hence back room deals, rumours of privatisation etc. No one wants to see a privatised NHS. If the politicians are to be believed then they are included in this group, so why the cloak and daggers? The public deserve transparency and straight forward answers. Most understand that there is no definite right answer to a problem, even more so if it is explained to them. Without this, conspiracy and disquiet will breed.


Just as important as the government’s role in the NHS as it emerges from Covid-19 is the responsibility all of us have. We must shift our baselines back a hundred years – maybe more. This is urgent. Everyone must consider how we use our health service. That cough or rash that you might normally have seen your GP about – seems to have gone now doesn’t it?! That lack of exercise, my poor diet, that smoking habit – I can do something about that myself. No one else can help and we shouldn’t have to hold your hand. (Of course we do this and will continue to do so). Self care has been important during this lockdown. And yet, it shouldn’t be any more so now than any other time.


The problems with the health care system are clear. We all know about them. Covid-19 has affected us all and is scary. But perhaps it is the wakeup call that we all need.

The birth of a new viral lexicon

All of this inevitably got me thinking about other words that, quite frankly, we should all be trying to create as a result of this crisis – or corisis

By now we are accustomed to hearing new words and phrases hitherto unheard of even a short while before. Of course the youth have almost an entire language to themselves. (This is quite a painful admission as I consider myself to be youthful still).

But in the age of Brexit, we as a species have begun to tinker with the English language in ever more ingenius ways. At present, there are 171,476 words in the Oxford Enlgish dictionary. There are many more unofficial ones in circulation, should you be streetwise enough to be using them. 

In 2019 there were 650 new words added to that number including whatevs, chillax, Jedi (which I think is cool and I’m surprsied it took this long) and sumfin (which is think is kind of mental).

Flashforward to now and we are in the midst of a global pandemic. It is bad and is only going to get worse so I wanted to focus on something positive. To that end, the fact that ‘covidiot‘ is now trending on twitter has brought a refreshing twist on humanity’s inherent stupidity. 

The word refers to those special individuals who rush out to panic buy toilet roll and pasta or those who think social distancing just isn’t for them. 

It’s not the only new word I’ve heard. Caremongering, the act of caring for those most vulnerable and encouraging others to do so, seems to be taking hold across the pond. It seems to have emerged from Canada which makes sense because – well, Canada. 

Presenteesim is the word for NHS workers who will lean towards going to work even if they are unwell which, in the current situation is not good. Under normal circumstances, I too have experienced this phenomenon, having crawled into work more than once feeling like the inside of John Mccririck’s underpants, only to be met by a smiling patient telling me they have had a cough for a few days. 

One of my favourites is the word for the cohort of babies born as a result of everyone being cooped up in isolation over the next few months. Coronials.

All of this inevitably got me thinking about other words that, quite frankly, we should all be trying to create as a result of this crisis – or corisis. Here are some of the best ones so far…

Quaranteens – The teenagers who are now home for the forseeable future since the schools closed, for which their parents are – I’m sure – ecstatic. 

Coronference call – As more and more of us begin to work from home, these are the ideal way to observe the social distancing measures while maintaining business efficiency. 

Whatsapp Thumb –  With friendship groups torn apart by the isolation, Whatsapp groups have gone wild. The chat within previously dormant groups has been going through the roof. Make sure you take precautions and limit your use lest you experience this painful condition. 

Covexit – The much sought after and mythical end to this epidemic. Who knows when we can reach it?

Recovid – My personal favourite here. With many people having already recovid from the disease, here’s hoping that many more will do the same. 

So there you have it. I’m sure there are plenty more of these so your suggestions are most welcome. Perhaps, by the time the next pandemic comes around (my money is on peronivirus) we may have a completely new set of vocabularly at the ready. 

WJ

 

Covid-19

There are elderly people who are vulnerable and rely on certain supplies alongside others with genuine medical conditions or who are in pain who need things like paracetamol to control pain. It does no good at all if it’s stored up in Steve Jobsworth’s bomb shelter.

When I googled how many films Hollywood actor Kevin Bacon has been in, the answer “at least 61” popped up. The figure is as high as it is vague, and is the basis of the parlour game “six degrees of Kevin Bacon”. For those that don’t know, the game involves challenging yourself to find the shortest path between a chosen actor and Kevin Bacon based on who they have acted alongside. It is built on the idea that, in this day and age, two people on Earth are six or fewer acquaintance links apart – the concept of “six degrees of separation”.

The world is interconnected to a degree never previously seen, allowing local crazes to spread quickly across the globe. The South Korean pop song Gangnam Style reached 3 billion views on Youtube in 2017 – just one example amongst others that include the ice bucket challenge, Furbies and David Beckham hairstyles.

That’s all well and good when what spreads is (arguably) something positive. When it comes to disease, our global closeness becomes more of an issue. By now, the novel coronavirus first isolated in the city of Wuhan in China has become international news and, as of last week, a full blown pandemic. Pandemic originates from the Greek words “Pan” meaning “all” and “Demos” meaning “people”. According to the World Health Organisation, a pandemic occurs when there is a worldwide spread of a new disease.

At the time of writing, there are 596 official cases reported in the UK.

Globally, that figure is currently at 132,500, the majority of which are still from China. In all, around 10 deaths so far have been reported in the UK and 5,000 deaths globally. Although there is a lot of emerging information still being analysed amidst a lot of conjecture and misinformation, this outbreak is turning out to be quite a shock to us all. One positive to emerge amongst the chaos is the high level of international communication and co-operation means that something like this has far less impact than it might have done in the past. There are obvious exceptions here (Trump) but nothing’s perfect.

Historically, true pandemics were far more devastating. The most recent example, the Spanish flu of 1918 is estimated to have killed around 100 million people and is thought to have infected around 27% of the world’s population. Perhaps the most famous of them all is the bubonic plague or “Black Death”. The most widely known outbreak of this decimated the populations of Europe throughout the 14th Century, killing around 75 million people. The culprit, a bacteria known as Yersinia pestis, is still around today and between 2010 and 2015, accounted for 3,248 cases of plague worldwide. Nowadays, it can be treated with antibiotics, but in the 14th Century, people still believed in such things as the four humours, conceived in part by the Roman physician Galen, who also apparently coined the term ‘plague’. In the belief that the plague was a punishment from God, some practised self-flagellation to repent for their sins. It didn’t do much good.

A similar outbreak, known as the plague of Justinian, broke out across the Byzantine Empire in AD 541 and it is thought that this was also due to a form of Yersinia pestis. This affected between 13 and 26% of the world’s population at the time. Both forms of plague were so transmissible and virulent in large part because of the fleas on the back of rats that were transported along the Silk Road and across the oceans on ships.

The association with animals is quite a common feature in disease outbreaks and epidemics. There are many viruses for example, carried by animals that do not infect humans. However, all it takes is a genetic mutation in this virus to enable it to cross the species barrier. The resulting pathogen is one to which populations have no innate immunity, hence the tendency for them to spread more rapidly. That is what is thought to have happened in the case of this novel coronavirus. Coronaviruses are widespread in our population already, many of which are responsible for a simple cold. However, various forms can cause more severe illnesses – for example the Severe Acute Respiratory Syndrome (SARS) from 2003. This was a coronavirus. The current outbreak was thought to have originated from a seafood market in Wuhan and the transfer from animal to human is known as zoonotic. SARS was thought to have been caught from civet cats and the coronavirus that caused the MERS (Middle Eastern Respiratory Syndrome) in 2012 originated from dromedary camels. It should be easy to guess where the H1N1 influenza virus that caused the swine flu outbreak in 2009 came from.

With so many different names, things can get a bit confusing. The WHO takes responsibility for naming the disease itself (now christened as COVID-19) but the International Committee on Taxonomy of Viruses is responsible for naming the virus based on its genetic makeup. They have labelled it as SARS – CoV – 2. In an attempt to prevent unnecessary fear in the regions that suffered most from the SARS outbreak in 2003, and perhaps taking a leaf out of Prince’s notebook, the WHO are referring to it as “the virus responsible for COVID-19”.

In the modern age, notwithstanding the risk to human life, there is potential for huge economic impact during outbreaks such as this through restriction of human movement so vital to industries such as tourism and shipping. This aspect is beginning to emerge in levels the current infrastructure has never experienced before and how it affects us all is perhaps an even bigger uncertainty than the virus itself. Some estimates of a 25% reduction in the global tourism industry have even been suggested. With markets and livelihoods at risk, tremendous efforts to look for solutions are underway. Much of this builds on successful work carried out in the past.

Smallpox is the flagship example of the success of vaccination. Caused by the variola virus, smallpox was responsible for around 300-500 million deaths throughout the 20th Century but was officially eradicated through vaccination in 1979. Only one other disease has been wiped out in the same way, though it is less well known. Rinderpest was a virus that affected cattle and buffalo and, again through vaccination, was declared formally eradicated in 2011. Interestingly it is thought that the modern measles virus may have branched off from the rinderpest virus (making it zoonotic) around the 11th Century.

The Ebola virus that affected West Africa between 2012 and 2016 did not reach pandemic proportions although it caused 11,310 deaths in the affected regions. (Ebola was also zoonotic, coming from apes, bats and deer). Following the development of a vaccine, the outbreak was halted. This was largely due to the rapid co-operation between drug regulators, pharmaceutical firms, and charities across the world who, along with the WHO, collaborated more closely than they normally would have done. 

The Coalition for Epidemic Preparedness Innovation (CEPI) was set up following the Ebola outbreak and aims to forearm experts all around the world against future outbreaks of disease. As a result, techniques and templates for faster vaccination development have been outlined and experts are using new technology in gene sequencing more and more. The genetic sequence of SARs-CoV-2 was published by Chinese scientists in January and work is underway already to find a vaccine.

Seasonal flu jabs are an important part of our disease prevention techniques already. In the USA between 2017 and 2018 around 60,000 people died from influenza and so this is no time to become complacent considering that early mortality rates (and one must be cautious considering there may be mild cases that are not making their way into the stats) seem to indicate a higher percentage for Covid-19. Neither though is it time for panic as around 81% of COVID-19 is mild and self-limiting. It may be difficult not to do just that in light of the unprecedented measures the government are now advising.

The latest update is that, if you are in the UK, one should self-isolate if one has a new cough and fever. I will admit, some of the projected figures look alarming and it may be that this goes on for some time, eventually inducting this current coronavirus into the seasonal epidemics in the coming years alongside flu. Had this happened in 1918, who knows how bad it would have been? Then again, we didn’t have the force (destructive or not depending on how you look at it) that is social media back then. It would seem this is becoming more of a social experiment of how well we can all pull together and co-operate as much as anything else. Hopefully we don’t embarrass ourselves.

Common sense is our biggest ally here. If you think you might have it, take the necessary precautions but don’t panic. Don’t call your GP if you just have the sniffles (most likely a normal cold anyway) but do contact help if you are struggling with your breathing or concerned that you are deteriorating. Look at the NHS and government websites for the latest guidance, not Twitter or Facebook. Don’t panic buy. There are elderly people who are vulnerable and rely on certain supplies alongside others with genuine medical conditions or who are in pain who need things like paracetamol to control pain. It does no good at all if it’s stored up in Steve Jobsworth’s bomb shelter.

As far as I know, there is no current advice on what to do if you come into contact with Kevin Bacon.