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J. Meirion Thomas is a consultant surgical oncologist.

The world is pinning its hopes on a vaccine to bring the Covid-19 epidemic to an end.

But nothing is guaranteed.

Even if a vaccine is found, how effective will it be and how long will the immunity last?

The results of clinical trials of potential drug treatments are also unlikely to be transformative.

Interim analyses by now would have identified an obvious winner to be introduced urgently for treatment.

One of the contestant drugs may provide some small benefit but will that be sufficient to reduce the death rate?

So, if there is no magic vaccine bullet, Covid-19 will become a chronic threat.

How will it be managed if there are, say, 50 deaths per day for the foreseeable future?

Due to huge backlogs, the Government will hasten the return of NHS hospitals to previous duties.

Although individual family bereavements are inevitable, the general population will become accustomed to, and therefore insensitive to, a low “necessary” daily death rate as happens in time of war.

The way we live will shift to reduce transmission of the virus while allowing the economy to reopen.

The daily pandemic news briefings would end and we would be spared the noise of ambitious journalists competing to ask impossible questions to which they know there is no answer.

Moral Maze could discuss the ethics of sacrificing the baby-boomers, like myself, in order to allow the younger generations to prosper.

Indeed, dispensing with the idea that some miraculous new cure is around the corner will finally force us to have a grown-up discussion about this virus – particularly about those who are at greatest risk.

The facts on that count are clear.

The death rate for patients admitted to intensive care is 51 per cent, increasing further with age and comorbidities, including obesity.

Elderly patients usually need ventilation for longer and if they survive, recovery and rehabilitation is prolonged.

Younger people with no underlying health conditions appear to have little to fear from Covid-19.

Most patients over 70 years of age, however, are capable of taking pragmatic decisions about their own lives.

Currently, they will be the last to be released from lockdown.

They may prefer to be released earlier on the understanding that, if necessary, they will not be a priority or indeed eligible for intensive care.

Elderly people should have the choice. Some might prefer to avoid intensive care and be made comfortable with oxygen alone.

This pandemic has also highlighted obesity as a major risk factor for admission to hospital, the need for ventilation and death from Covid-19.

If this disease becomes chronic, surely that is an overwhelming inducement for obese people to lose weight.

Covid-19 aside, obesity alone risks death especially from cardiovascular disease (heart and stroke), the complications of diabetes and cancer.

A recent survey showed that 29 per cent of adults in UK were obese (Body Mass Index greater than 30) and a further 36 per cent were overweight (BMI 25 – 29.9).

One in eight obese people were morbidly obese with a BMI greater than 40.

According to a recent study, being over 65 and obese was the biggest risk factor for becoming critically unwell from Covid-19. Similarly, for obese people under 60.

The reasons for obesity exacerbating Covid-19 are not fully understood but it is thought that the immune system goes into overdrive in obese people, a phenomenon known as “cytokine storm”.

After that, there is the mechanical difficulty of breathing due to excess abdominal fat restricting movement of the diaphragm.

Could the pandemic tragedy result in life-style changes and a move towards healthy eating, improved fitness and weight loss?

Could it even change the attitude of the MMR vaccine-deniers who have now seen the ravages of a viral illness without a vaccine?

Could we even come to believe that mathematical modellers of infectious diseases are no better than soothsayers?

What about a more compassionate society? Could essential healthcare staff, such as nurses and those working in care homes be better rewarded? Will we invest more in social care?

Will the authorities bestow Captain Tom a knighthood and other healthcare workers with awards in place of civil servants who are regularly gonged for simply doing their job?

These consequences of the pandemic are worth a thought if only to distract our attention away from the possible criminality of the Chinese Communist Party and the failure of our Government to stockpile testing kits and PPE.

57 comments for: J. Meirion Thomas: If Covid-19 becomes permanent, how will we adapt?

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