3. On Escaping Epidemics and Endemics

Dearly Beloved

In late 1976 I was in Oman with a group of local wildlife wardens searching for populations of a rare goat antelope known as the Arabian Tahr. We had to first visit the local Walie, the Sultan's representative in the area, for permission to go into the local mountains. We arrived at one village to find it totally deserted; not a soul could be found. At last, after half an hour, a man emerged clutching his head. There was, he said, no-one who was not suffering from malaria; so the Walie's office was closed.

Thus it was another village we visited that week.This was not so much an epidemic as a seasonal endemic illness; every winter people were re-infected through mosquito bites, or they suffered spontaneous eruption of the plasmodium parasite into the blood stream from the liver in which it had lain dormant since the last infection. It has proved very difficult to counter because the plasmodium is a single celled organism, too similar to human cells to be able to counter them with drugs or vaccines without risking damage to human tissue too.

Almost exactly forty-four years later my anaesthetist son was having a tea break between administering epidurals and anaesthetics for C-sections in the maternity unit at his hospital in the north of England, when his pager rang and a message told him of a resuscitation emergency close by. He was surprised because the site was nowhere near the main hospital. He set off, still in his scrubs and clogs, running through the rain across a car park, around a duck pond to a building used for education.

There he found a dummy and two senior medics who were managing a mock-up emergency resuscitation; it was part of the preparation for the rolling out of the Covid-19 vaccine. This was a test to find out how long it would take for a resuscitation team to get to the vaccination site should anyone being vaccinated suffer anaphylaxis, a powerful allergic reaction. He joined in with the rest of the doctors and nurses who had answered the resuscitation call compressing the dummy. And afterwards they had a discussion of potential problems and solutions.

Last Sunday I attended my local vaccination site in Cambridge. It was Sunday evening,snowing and the temperature was below zero. Standing outside was a man stamping his feet to keep warm whilst he directed the arrivals, a second figure managed the car park, whilst a third sat outside under a dome shaped awning recording names of arrivals and checking appointment times. On the threshold was a nurse directing those in the queue to one of five rooms where the vaccinations actually took place. There were two people in each room, one of whom did the paperwork and the other administered the vaccine. Another group was taking a tea break. After vaccination two more staff directed us down the corridor to a room where up to ten socially-distanced individuals waited fifteen minutes, under the watchful eye of another nurse, who checked that no one suffered the symptoms of anaphylaxis in response to the vaccination -- the preparations for which my son had encountered in his hospital in the north. Finally, I was told I could leave; and on the way out, I once again met the man standing in the freezing cold whom I had met on entry. It was six o'clock on a Sunday evening. All of these doctors, nurses and volunteers were oblivious to unsocial hours, and were just ensuring vaccination was carried out as rapidly and efficiently as possible. Vaccination centres are manifestations of the huge amount of work that has gone into the provision of the vaccine. Years of scientific and medical research have been utilized to produce effective vaccines, tested on some of 400,000 registered volunteers, and which have then been mass produced by a totally different set of technologists, put in vials, refrigerated, transported by pilots and lorry drivers, divided again and routed to the vaccination sites. At each stage administrators would be crucial to coordinating everyone's efforts.

What a contrast all that is to the deserted sick villages which I had witnessed in Oman. There people could rely only on their families for help through the crisis of the dreadful disease of malaria. At that time people had no cure for malaria and they were largely isolated from any medical help, which was only just starting to be rolled out in the form of local clinics. The extraordinary vaccination programme taking place in the UK is, above all, the result of a huge network of people willing to put great efforts into solving a problem which is common to us all. Each person plays a small part according to their skills, expertise and ability; but the result, so far, is a phenomenally successful operation. That success is also due to a mixture of compassion and self-interest, and cuts across the political divisions between those who promote lock down to slow the virus and those who disparage it. When we humans agree that something must be done, it gets done.

I'm glad to say that today malaria is largely under control in Oman after decades of effort and a variety of strategies. Nevertheless, malaria remains endemic worldwide and, according to WHO, 400,000 still die annually from the disease, which has shown a capacity to produce new strains resistant to new drugs. Doubtless if it was still endemic in developed countries such as ours, modern medicine would have defeated it by now, but that has yet to happen. That is our human failure: most of us cannot quite extend our compassion to those in far off countries, of whom we know little, who have to fight malaria and other endemic diseases each year as they return in their season.

Peace, 

Paul

First published 04 February 2021.

Plague Doctor 

By I. Columbina, ad vivum delineavit. Paulus Fürst Excud〈i〉t. - 1. Johannes Ebert and others, Europas Sprung in die Neuzeit, Die große Chronik-Weltgeschichte, 10 (Gütersloh: Wissen Media, 2008), p. 197.