It is still very early days of this new life for all of us. There are such a lot of changes – home working, loads of leisure time to fill, catching up with friends we have neglected due to busy schedules. There really are lots of positives for those of us wealthy enough not to have to worry about finances, feeding ourselves or looking after other family members., Quieter shopping, more outdoor exercise rather than the gym, and perhaps a re-evaluation of life in general. Pollution of the envirnoment is plummeting all over the world. In the end it could lead to real benefits for many people.

But for those who are not fit, reasonableIy well off or have difficult family problems, it is a different matter. People who lose their jobs suddenly are being helped by the government’s schemes but some are not covered and those already in debt are in an even worse predicament. Economies seem to be at a loss – what will be the result of an almost complete shut down of the economy and the sudden appearance of a magic money tree, being shaken now very vigorously to all sections of the population. I have even heard talk of a Debt Jubilee, which is a grand out-of-court settlement between bond investors, banks and consumer groups – “great haircut” – to fix the underlying problem of excessive debt ,and jump-start the economy. Apparently this is what was done in 2,400 BC, when the Sumerian king Enmetena declared a general debt cancellation in his kingdom. A debt jubilee is a recognition that economic life must be socially rooted if it is to be sustainable. If debts can’t be paid off, they won’t be – and it might be better for everyone if that can be addressed peacefully. Compare and contrast the treatment of Germany by the victors in the two world wars. After WW1 Germany was punished and its economy ruined, with dreadful inflation, leading to the rise of fascism; after WW2 in 1948, the Allied Powers replaced the reichsmark with the Deutsche mark, wiped out 90% of government and private debt and paved the way for West Germany’s economic miracle. In the present day case, without debt relief, especially for households at the lower end of the income and wealth spectrum, the world faces a prolonged spiral of depression driven by corporate collapses and rapidly falling demand for goods and service. Which way shall we go? A great levelling off, or a slump lasting for years which would kill far more people than co-vid 19? We shall soon see.

It is important to recognise that the present push for lockdown of populations in most countries worldwide, is to prevent health services becoming overloaded and so to enable as many people to be treated as possible. Most people with the virus have a mild illness or no symptoms at all. Only a small proportion need hospital admission., and even fewer intensive care. Yet so far the mortality in those who have been ill enough to need ventilation is about 50%, and in some cases even lockdown down does not prevent the epidemic becoming so huge that many people cannot be treated because of lack of staff and equipment. The virus will run its course, and those people who are going to die will do so when the restrictions are finally lifted, as they would have to be in the end. It will be important to discover in more detail exactly which patients are more likely to die.

While we know that age and underlying chronic illnesses predispose to an increased incidence of severe illness needing treatment, it seems that many younger people without previous illnesses are now dying. A report from the Intensive Care National Audit and Research Centre found that of the 196 patients admitted to participating hospitals (England Wales and Northern Ireland) up to 19th  March, 16 died, 17 were discharged and 163 remained in critical care. This shows how long people stay in critical care and why so many staff and so much equipment is required. Almost three quarters (139) were male and the median age of those included in the audit, which is the first to outline in detail the case mix of UK patients in intensive care, was 64 years. This means that a lot of the patients were much younger than those reported in China. But something new was also noted. Only 20% of those patients had a BMI under 25 ie. were of normal weight. 33% had a BMI of between 25 and 30 (mild obesity, 33% between 30-40 and 13% were severely obese. (BMI >40). While the `British population is getting more obese, this is definitely skewed towards obese people needing intensive care more often.

So is the virus mutating? In Wuhan in China nearly all the people who died had either an underlying problem, were over 65 or both. It doesn’t seem like that now.

The only good way out of this situation is more research, with the ultimate aim a specific vaccine, or a new treatment. Once we have that we may be able to prevent so many people getting so ill. The work is already well under way, usuing a new technology – a “recombinant” vaccine*. About 35 companies and academic institutions are racing to create such a vaccine, at least four of which already have candidates they have been testing in animals. The first of these – produced by Boston-based biotech firm Moderna – will enter human trials imminently. This has been facilitated by the fact that many firms were already working on flu vaccines, because of the SARS and MERS epidemics, and because Chinese scientists were very quick to sequence the DNA of Sars-CoV-2, which shares between 80% and 90% of its genetic material with the virus that caused Sars – hence its name. A series of clinical and human trials are about to get underway, with the first, involving a few dozen healthy volunteers, testing the vaccine for safety and monitoring for adverse effects. The second, involving several hundred people, usually in a part of the world affected by the disease, looks at how effective the vaccine is, and the third does the same in several thousand people. But many vaccines fall by the wayside because they are unsafe, or they’re ineffective, or both, and the process must be safe and can’t be hurried. That’s why they say an effective vaccine may be many months away.

However, we must hope that science will win this battle. We must also hope that politicians now realise that it is vitally important to plan for epidemics and pandemics, and embrace policies that put the health of the population very high on their lists of priorities. Now that some countries, notably USA, UK and Australia have now realised that free market dogmas only work when times are good, let’s hope that there is a sea change in recognition of the importance of scientific rigour in future decisions. This might even lead to an understanding that climate change too needs to be treated very seriously before we all succumb to even more threats.