15. What We Must Learn from the COVID-19 Pandemic

When the COVID-19 pandemic is behind us, we must take a clear and sober look at what happened and what we can learn from it. What went well and what could have been done better? It is clear that much could have been done better but I am reluctant to criticise as this was a new situation and there was no history to call on. Even the science was lacking in evidence on which to base advice.

This must not be a hunt to find a scapegoat or a blame-game, but an honest attempt to do better next time; and no one believes that it will be another 100 years before this happens again. It must not be a party political point-scoring session or a media frenzy but a chance for open admission of errors without fear of vilification or retribution. It is learning exercise.

This is really an addendum to the chapter COVID-19. What You Need to Know.

It will contain the following sections:

If you want to go directly to one of these sections, click on the title in blue.

Predicting Pandemics

The pandemic of Spanish Flu killed more people than the First World War, and many were young adults

As we have seen from the chapter COVID-19. What You Need to Know, there have been pandemics across the millennia. In the last 100 years there have been many epidemics that have caused many deaths, including AIDS, Ebola, Sars-1, MERS and several types of influenza. However, the last time that there was a massive pandemic on the scale of COVID-19, was the pandemic called Spanish Flu, just over 100 years ago. It spread rapidly as troops returned home after the First world War. Nowadays, the connectivity of the world, with flights connecting any two places within 24 hours, makes it easy for disease to spread and the carrier can reach the destination before developing any symptoms.

New diseases can appear when viruses jump from animal species to humans. If the spread is only animal-to-human, it is only those in contact with infected animal who are at risk. However, if this is followed by human-to-human transmission, spread can be rapid and as it is an unfamiliar disease, there is no pre-existing immunity.1eleven (sometimes) deadly diseases that hopped across species

Animals are kept in appalling conditions with cages on top of each other and this facilitates the spread of disease

Such diseases are most likely to occur when humans are in unusually close contact with animals that may be infected. The Chinese have a predilection for exotic animals as food or to use in Traditional Chinese Medicine. More information is available in the chapter Other Modalities of Complementary and Alternative Medicine. Go to the site and in the list of topics click on “Traditional Chinese Medicine” in blue. It shows that this often involves cruelty to animals and the use of endangered species. In addition, there is no evidence that it is of any benefit and so it should be banned, but the Chinese government sees it as part of their culture and heritage. In the last 100 years or so, AIDS came from Africa as did Ebola, and MERS came from Saudi Arabia, but most others, probably including the so-called Spanish flu, came from China or the Far East.

Many new diseases can appear over any year and so it is necessary to monitor these to predict which have a significant mortality rate, are highly infectious and represent a significant risk to the world. An agency such as the World Health Organisation (WHO) is ideally placed for such surveillance, but it must have access and honest data. Many countries have understated their death toll.

No one dares challenge the narrative in China

China now claims that the virus did not start in Wuhan, or anywhere else in China. No one believes their denial. The extent to which China denied knowledge to the world at a time of great danger is becoming clearer. When SARS-1 appeared in China in 2002, there was much denial from the Chinese Government and much important data was hidden. When SARS-2, better known as COVID-19 came along, many thought that the Chinese Communist Party had learned the lesson and would be honest this time. The evidence suggests that they were not. Whenever there is a problem, dictatorships are in denial and suppress the truth. It is what comes naturally to them.

Denial is only a short-term gain

Communication on a global scale is imperative. China was aware of human-to-human transmission of COVID-19 for three weeks before it informed the rest of the world. Such denial is typical of totalitarian regimes, but it is a short-term policy that will rebound when the truth comes out, as is inevitable. It was clear well before China admitted it, that this was a disease with human-to-human spread. It was like SARS, as the genome showed, but it was rather more infectious. SARS has a mortality rate around 10% but this was around 2%, which is very significant, especially for such a highly infectious disease.

By the time that the rest of the world realised that there was a highly infectious disease that was new and had a significant mortality, it was too late. Closing borders in March 2020 would probably have achieved little as the virus was already in many countries.

A number of countries have been dishonest about numbers, especially those that are not habitually truthful. Russia’s state statistics service in February 2021 reported 162,429 deaths related to COVID-19 in Russia in the last year. The figure is almost three times higher than the 57,555 deaths attributed to COVID-19 in 2020 by Russia’s coronavirus task force.2New Figures Suggest Russia Had Third Highest COVID-19 Death Toll in 2020

In 2021, a team from the WHO entered China to find the source of the outbreak, but the Government was very obstructive and unhelpful and would not give them access to some samples that they requested. They made life difficult for them. They did not want their shortcomings to be exposed. They even insisted that they should not be blamed for the outbreak, which seems unreasonable before any investigation has even begun.

The team has concluded that the disease did not leak from a secure laboratory in Wuhan, as Donald Trump had suggested, but probably from the wet market, but how is uncertain.3EXPLAINER: What the WHO coronavirus experts learned in Wuhan There is also a theory that the virus may have spread via frozen food. There does seem to have been some submission to Chinese pressure.4The WHO’s Theories About the Origins of COVID-19 After Wuhan Probe I think that the WHO should have been more forceful in its condemnation of wet markets and the Chinese management of animals including exotic species.

One thing that China appears to have done well, was to sequence the genome of the virus and to present it to the world. This permitted early work on vaccines and probably testing too. However, this release was unofficial and the authorities were displeased and took action against those responsible. The lesson is that we still cannot trust the Chinese to be open and honest. They denied human-to-human transmission long after it was clear. They made unreasonably strict criteria for diagnosis so that they grossly underestimated the number of deaths from the virus. They obstructed information getting to the country and the world. Open and honest exchange of information between countries is essential to protect the world. Some brave people in China tried to warn their colleagues and the world and the state prosecuted them for it.

Containing the Spread

Closing borders is “locking the stable door after the horse has bolted”

It may become clear that a new disease is spreading and countries will wish to keep it from reaching them. Closing borders is often seen as the obvious solution but by the time this is done, the new disease is probably in that country and it is too late to prevent it.

Counties of the Far East did very much better than western countries to prevent the spread of COVID-19 and the associated many deaths. They learned from SARS-1. In many places their official statistics must be greeted with scepticism but Taiwan seems to be a genuine success. They are said to have a death toll in single figures and they avoided lockdown, with its economic consequences. Singapore has also done well. Germany was quite successful with contact tracing easing lockdown.5The first wave: How Germany’s coronavirus contact tracers helped to ease its lockdown

Containment in the early stages is the key to preventing spread of the disease. This may require test and trace, with the ability to test those with symptoms and those without who have been in contact. It is important to remember that with COVID-19, as with many diseases, people with symptoms tend to isolate from others, and those who know that they are ill, are careful around them. The big problem is the significant number of people who are infected but have no symptoms and so they continue life as normal, spreading the disease wherever they go. A major error of British policy in the early stages was the failure to test those who were not symptomatic. This requires far more testing kits and probably more resources to use them and to process them.

It is also essential that the kits used in test and trace are reliable, without excessive number of false positives or false negatives.6Seven in ten testing positive for virus show no symptoms These are positive tests which should really be negative and negative tests which are really positive respectively.7What is the diagnostic accuracy of antibody tests for the detection of infection with the COVID-19 virus?

Old people were transferred to residential homes without testing

Another very serious problem was the transfer of patients from hospital to residential homes to free hospital beds but without testing people before transfer. This was one of he reasons for the disastrous toll from residential care. When the disease is established in a home, it is devastating.

Lockdown is seen as a last resort. Leaders in democracies are reluctant to introduce it, partly becuase of the curtailment of personal freedoms, but also because of the catastrophic effect on the economy. Nevertheless, if it is required, it is better to do it sooner rather than later. Sometimes announcements were made that restrictions would be tighter after the weekend. People responded by going wild over the weekend and spreading the disease more. If restrictions are announced, they should be implemented within 24 hours.

Evidence that lockdown works comes from as far back as the great epidemic of bubonic plague in 1666. The Great Plague lasted from early 1665 until September 1666. It was the last major epidemic of bubonic plague to occur in England and it killed an estimated 200,000 people or a quarter of the population of London. Fatalities soared in London where people moved freely.

A consignment of clothes was sent from a tailor in London to a tailor in Eyam, a small village in Derbyshire. The clothing is thought to have been infected with human flees or body lice and two days later the tailor died of the plague. There is good evidence that the black death was not spread by the fleas of black rats, as has been thought for so long, but by human fleas or body lice. By the end of the spring of 1666, 42 villagers had died, and many wanted to move out to save themselves.

The newly appointed village rector, William Mompesson, was determined to prevent the plague spreading to the nearby towns of Sheffield and Bakewell and foresaw that the village should be quarantined. This would mean his parishioners would effectively have to sacrifice their lives.8Eyam’s Ultimate Sacrifice

The Plague Window in Eyam church commemorates the selfless bravery of the village in 1666

He convinced them to stay and to put a one-mile guarded cordon around the town. Eventually they agreed. They also agreed to what we would now call social distancing and did not even attend church. One at a time they went to a boundary stone with six holes drilled in the top in which they placed coins to pay their neighbours and traders for essential supplies.

The original population of the village is uncertain with estimates from 350 to 800. What is certain is that they paid a high price with 260 deaths. Families had to bury their own dead to prevent cross-infection. One woman buried six children, two on the same day. However, the plague went no further than that small town. Their bravery had been successful.

The Cheltenham Festival was a “super-spreader” event

We were unduly slow to curtail public meetings and sporting events. An example was the Cheltenham Festival on 13th March 2020, when a quarter of a million people came together for a race meeting. Young people, in particular, did not seem to appreciate that the rules of not mixing applied to them too. When lockdown was eased in the Spring, many people flocked to beauty spots and tourist points where numbers were often in excess of what would have been seen in a normal year. People went to the seaside but when they saw how crowded it was, they did not turn around and go home. There were vast numbers at airports and stations. Much of this is personal irresponsibility.

Masks, gowns, etc are called personal protective equipment (PPE) and they deserve their own section.

Personal Protective Equipment (PPE)

Be Prepared is the Scouts’ motto

We must be prepared for occasions when there will be a great demand for protective equipment when people are dealing with infectious and potentially dangerous patients. The motto of the scout movement is “Be Prepared” but the home of Baden Powell and the scout movement was not prepared. Infectious disease may strike, and we need to be ready with a plentiful supply of such equipment to protect both patients and staff and to reduce spread. There should be stockpiles of personal protective equipment (PPE) ready for use. During the 20-teens, when national finances were stretched after the financial crisis of 2008, there were stockpiles of PPE that had not been used but they were nearing or past their “use by” dates and it seemed a poor use of resources to spend money replacing them. It is easy to see how such a decision was reached, but we paid the price later.

We are not the only country that was unprepared. Most of Europe and North America was in a similar position and we were all rather late in detecting the presence of the disease. Only countries in the Far East that had previously experienced SARS-1 were ready. We must be like them next time.

N95 face mask

We must think not only of NHS staff but those in residential homes who need such equipment to protect themselves and those in their care. The care sector, in residential homes or in people’s own homes, never receives the kudos and attention of acute medical care. There was a severe shortage of PPE in care homes and this, along with the discharge from hospital of infected but untested patients, produced a dire toll on care homes and also many of the care staff. Even in the NHS, some staff went to builders’ merchants to buy their own masks that met N95 specifications. We must have enough stockpiled for next time.

Tonnes of PPE from China and Turkey were substandard

We imported many tonnes of PPE from places including China and Turkey and much of it was below standard and had to be sent back. This was at the same time that clothing manufacturers were being furloughed. It would not be difficult for those who are skilled in making clothing or fashion to turn their skills to producing gowns and masks. There were also small engineering firms that could turn to manufacturing visors for PPE.

We were also supposed to move car production over to produce ventilators to help those in intensive care with breathing difficulties. However, I do not remember seeing any evidence of the happening and the new car market was in serious decline, so they were not too busy.

We imported a great many testing kits from such countries as China and Turkey and had to send much of it back because it was unsatisfactory. We are supposed to have a world class biosciences industry. Why were we not able to produce our own testing kits and in large numbers? Do we really have to turn to much less advanced countries to do it for us?

Droplet spread is the main way the disease is transmitted

In the early days, the value of masks outside the clinical setting was dubious. The WHO was not very supportive of their use as there was a surprising lack of evidence about their effectiveness. However, lack of evidence of effectiveness is not the same as evidence of lack of effectiveness, and later work showed that they were of value. It was known from an early stage that spread was by contact or small droplets. It was later than it became clear that droplet spread was far more important.

Masks are more important at protecting others that protecting the wearer, but they do offer some benefit both ways. There is no point in wearing masks outdoors, when the wearer is at least two metres from anyone else and there is a breeze to disperse the droplets, but they should be worn indoors in public places and outdoors where people are unable to keep their distance. Mask wearing should be enforced. They are of little use when not covering the nose and totally useless around the chin. People with heart or lung disease who would become distressed if they had to wear a mask were granted exemption as were people with psychiatric reasons for not wearing a mask. However, those with physical reasons are also much at risk of the disease and everyone who is unable to manage a mask should at least wear a visor. Too many people went into shops without masks and staff did not feel confident to challenge them. Even security staff at supermarket doors just let them pass.

The clinical style mask, above, is more effective than a fabric mask

The clinical style masks are more effective that fabric masks although the latter are easier to fold and put in a pocket. I have often seen masks around the countryside and I suspect, or hope, that they fell out of pockets and were lost accidently rather than thoughtlessly discarded. The clinical style masks contain polypropylene which is a plastic and so very poorly biodegradable. Fabric masks decay much more readily.

Indoors, droplets can hang in the air and even being 2 metres apart may not be enough. Masks should be worn, even in open areas such as shopping malls or railway stations. To wear a mask when cycling or jogging is probably unnecessary. However, it is wise to wear them outdoors in crowded places where it is impossible to keep at least 2 metres apart.

Why Was Our Mortality Rate So High?

A very sad milestone

In January 2021, the UK passed the figure of 100,000 deaths from COVID-19. We were the first European country to reach that figure and, taken as deaths per million population, we had the worst mortality rate in the world. Despite out greatly beloved NHS and serial restrictions and lockdowns, we were the worst in the world. How did we reach such a situation?

According to official statistics, China has about 25 times our population and about a twenty-fifth of our number of cases. However, their official figures are always dubious at best. Nevertheless, even by the standards of other European democracies, we did badly.

There are a number of factors that contributed to this unenviable record.9UK Covid deaths: Why the 100,000 toll is so bad

The UK, and especially London, is global hub

One of the reasons is that UK, and London in particular, is a global hub. Many people come here from all over the world and so the virus was able to take a hold and spread rapidly. Genetic analysis showed that by the end of March 2020, the virus was brought into the UK on at least 1,300 separate occasions, mainly from France, Spain and Italy. By the time that we realised that it was here, it was well established.

We also have a very dense population and it is much easier for it to spread in cities than in rural settings or the highlands of Scotland, for example. The UK is among the 10 most densely populated nations with a population in excess of 20 million. Our cities are well inter-connected. This enabled rapid dissemination of the virus. It started largely in London but soon spread. In Italy in the first wave, most cases were in the north of the country.

We have an ageing population. Adjustments for this, known as age-standardised mortality, show that deaths have risen, but not by as much as some of the headline figures suggest.

Processed junk food and fast food contribute to obesity

Another important factor is that we are now the most obese nation in Europe.10British women ‘the fattest in Europe’ With that goes a high incidence of diabetes. We are not as bad as the USA, but we still hold that unenviable position in Europe. As we have seen in COVID-19. What You Need to Know, obesity raises the risk of serious or fatal infection quite considerably and it also reduces the age at which people become significantly vulnerable, perhaps by 20 years.11The Perfect Storm: Coronavirus (Covid-19) Pandemic Meets Overfat Pandemic There is more about obesity and how to tackle it in Exercise, Obesity and Diets for Weight Loss.

When Prime Minister Boris Johnson was admitted to St Thomas’ Hospital with severe disease, it was said that his BMI was 35. He has done well, loosing much weight since then. We need a concerted policy to tackle obesity, starting in childhood.12Boris Johnson to launch war on fat after coronavirus scare. Much of this should probably be aimed at getting us to eat far less processed food and to replace it with proper, cooked food. The gut biome is very important. If more families sit around the table to eat a meal rather than sitting around the television eating “fast food”, it will improve not just our levels of obesity, but family cohesion and the quality of life in young people. This is also very low by international standards.

As well as substantially increasing the risk of the disease, there is evidence that obesity may impair the response to the vaccine. This applies not just to the COVID-19 vaccine but childhood immunisations and all vaccines.13The weight of obesity on the human immune response to vaccination. This applies to influenza vaccine, pneumococcus (a common cause of pneumonia) vaccine and hepatitis B vaccine. It also seems to apply to obese children when they receive their childhood vaccines. Tis paper does not refer to the COVID-19 vaccines as it was published back in 2015.

The Prime Minister was naturally reluctant to impose a lockdown and we were the last major European nation to do it. It has a disastrous effect on the economy, but if it is done, it is probably better done sooner rather than later. It is easy to be critical in retrospect, but easing restrictions too early or too fast and allowing even one day of limited mixing at Christmas, may have been a mistake.

The USA had more of a problem with a president who lived outside reality and was in denial. Advisors advise but politicians have to make the final decision. It is imperative that politics does not get in the way of the painful but necessary response.

Vaccines for Covid-19

The vaccine has been a great success

After so many negative comments about the management of the pandemic, it is time for a positive story. The vaccine story has been a great success. The much maligned pharmaceutical industry has really come through for us. There was unprecedented cooperation at both company and international levels. The pandemic is a problem for the whole world and vaccine nationalism is to be depreciated. It still happened. It is still happening. I regard the attempts by some European countries to cast doubt on the efficacy of the AstraZeneca vaccine in the over 65s as vaccine nationalism.

Both the m-RNA and the adenovirus vaccines are a new way of producing vaccines and they have both been a great success. The process of producing a vaccine from concept to marketing usually takes about 10 years. This was done in less than one year. No steps were omitted and the safety has not been compromised. Where there have been considerable risks, they are financial. Usually, the mass production of the vaccine does not start until the vaccine has a licence as if it fails to be approved, the whole production goes to waste. Time was of the essence and they have done really well in ramping up production to meet demand.

The army helps with vaccine administration

As well as getting vaccinations done through GP practices and pharmacies, as is done with the annual flu vaccines, the armed forces have been brought in to help out and many people with no previous experience in the field have been trained as vaccinators. Giving a vaccine is not difficult but they must be properly trained.

Governments need to order early so as not to be at the back of the queue

If governments want to get in early with a vaccine, and not to be at the back of the queue, they have to place their orders early and possibly make non-returnable financial commitment. This is what the British Government did, and it paid off. They were three months ahead of the EU in placing orders. They hedged their bets with multiple orders to different companies, not knowing which would be successful. This costs money, but not as much as lockdown.

The vaccines had been tested with a three or four weeks interval between the two injections but when the AstraZeneca vaccine was released, the Government decided to extend that to 12 weeks. This was a gamble but it paid off. It seems that the longer interval between vaccines is beneficial. It also allows more people to have their first vaccine before places are taken by people receiving their second and it is better for the community if 10 million people have had one vaccine than 5 million people have had two. A little later the data supported a better immune response of the AstraZeneca vaccine was given with a longer interval between the two injections.14COVID-19: UK ‘vindicated’ over ‘brave’ decision to delay second vaccine dose, WHO official says.

The success of the race to make a vaccine, to test it and produce it, has been far more successful than had been hoped. Hence, we may have more doses than we need. That is not a problem. We can let others have them. Being short of vaccines would be a problem.

There are stories of unused vaccines being discarded from vaccine centres at the end of the day. This is disgraceful. They are a precious commodity with many people in the country eager to have them and the whole world crying out for them. As the day draws to a close, centres should assess how many vaccines are left over and, in the early days, staff can call their family, friends, neighbours, etc to say, “If you can be here in the next half hour, you can have a vaccine.” There may be accusations of “queue jumping” but it is better to have a vaccine in an arm, any arm, than in the bin. In the meantime, collect names and phone numbers of local police officers, fire fighters, teachers, shop workers and anyone who works directly with the public and who has not been vaccinated, so that they can also be given a call to get in in the next half hour if possible. Vaccines are too precious to waste.

Coronaviruses are notorious for their ability to mutate, and this one is no different. Scientists have been monitoring mutations to see which are of concern. At the time of writing the three of concern originated in Kent, South Africa and Brazil. As well as being more infectious, they may possibly cause more fatalities and even cause serious disease in younger people. A major concern is that they will evade the current vaccines.

The vaccine aims at the spike on the virus

The vaccines aim at the spike on the virus which is how it gains access to the cell and the mutations of concern affect the spike. This might make them more infectious. It is a very large protein and so, even if the vaccine is less effective against the mutant virus, it is unlikely to be ineffective. Nevertheless, we shall need to have annual vaccines to counter the variants, rather as we do with flu vaccines. We also do not yet know how long the vaccine will be effective for, as it has been available for a limited time. We do not know if the annual vaccine will be for 5 years, 10 years or for ever, like the flu.

Uptake in ethnic minorities has been low

Another cause for concern is the low uptake of the vaccine among those of those minorities. White people are said to be twice as likely to have had a vaccine although, as we saw in COVID-19. What You Need to Know, people from ethnic minorities are more likely to die from the disease. There was a report of a vaccine centre in Newham, East London, closing early because of poor uptake. This is astounding. It requires a massive offensive to counter fake news that is aimed at ethnic minorities and this is addressed in the next section.

Fake News and Blatant Lies

With a new disease arriving and so many unknowns, it is unsurprising that this is fertile ground for conspiracy theorists and the purveyors of fake news.15For a coronavirus vaccine to work, first inoculate against lies. This should be foreseen and we should be ready to counter it. Most conspiracy theories are utterly absurd and it would seem that only the deranged could believe them, but believers fall into two groups. There are the hard-line believers who are totally impervious to logic and who stick with their own “alternative facts”. They may believe something along the lines of the Q-anon narrative. Then there are those who have been misled who can be convinced by reason. They are sometimes referred to as the sceptics. It is worth taking time to turn the sceptics before it becomes too ingrained but trying to turn the hard-liners is a waste of time. The anti-vaxx brigade is alive and well.16Even covid-19 can’t kill the anti-vaccination movement

There have been people who believe that the disease is really quite mild and we should not be concerned about it. There have been claims that 99.97% of those infected recover without complications. This would mean a death rate of no more than 0.03%. If this was true and every single one of the 65 million people in the country had been infected, the death toll would be 19,500. A much smaller number have been infected but the death toll is more than five times that figure. They also claim that the vaccine is more dangerous than the disease. At the time of writing, three times as many people have received the vaccine as have had the disease and the score for deaths is: disease- more than 100,000; vaccine- in round figures, a nice round 0.

Some of the lies have been aimed directly at ethnic and religious minorities. They include the claim that the vaccine contains pork or beef products or alcohol, making it unacceptable to Moslems, Hindus and Jews. There is no meat product of any kind in the vaccine. However, the ethnic group with the lowest uptake is black people and most of them, originally from the West Indies or Africa, are Christian.

The BBC and some other media outlets have been very good at exposing fake news. The BBC also examined 17The seven types of people who start and spread viral misinformation They included conspiracy theorists, politicians and celebrities. A study from Cornell University also found that Donald Trump was the most prolific purveyor of incorrect information about the vaccine in the world.18Trump ‘worst offender’ for spreading fake health news

These lies must not be ignored. They must be countered with facts but they should also be attacked by people with credibility in the target group.19Coronavirus: False and misleading claims about vaccines debunked This may be religious leaders. It may even be celebrities, if this gets the message across. Using mosques as vaccine centres reinforces that Islam is happy with them. We should be prepared for this barrage of false information and be ready to counter it. This may mean taking down posts on social media and YouTube.

Further Resources

References

  1. UK Covid deaths: Why the 100,000 toll is so bad. Nick Triggle, Christine Jeavans, Robert Cuffe. BBC News 27 January 2021
    https://www.bbc.co.uk/news/health-55757790
  2. New Figures Suggest Russia Had Third Highest COVID-19 Death Toll in 2020. Medscape 9 February 2021.
    https://www.medscape.com/viewarticle/945481
  3. EXPLAINER: What the WHO coronavirus experts learned in Wuhan. The Independent. 10 February 2021
    https://www.independent.co.uk/news/explainer-what-the-who-coronavirus-experts-learned-in-wuhan-china-who-coronavirus-pandemic-team-questions-b1800309.html
  4. The WHO’s Theories About the Origins of COVID-19 After Wuhan Probe – Medscape – Feb 10, 2021
    https://www.medscape.com/viewarticle/945601
  5. The first wave: How Germany’s coronavirus contact tracers helped to ease its lockdown. The Times 26 May 2020.
    https://www.thetimes.co.uk/edition/news/the-first-wave-how-germanys-coronavirus-contact-tracers-helped-to-ease-its-lockdown-w7tw5ddjs
  6. Seven in ten testing positive for virus show no symptoms. The Times 29 May 2020.
    https://www.thetimes.co.uk/edition/news/seven-in-ten-testing-positive-for-virus-show-no-symptoms-qms2vd9mx
  7. What is the diagnostic accuracy of antibody tests for the detection of infection with the COVID-19 virus? Cochrane Review 25 June 2020
    https://www.cochrane.org/CD013652/INFECTN_what-diagnostic-accuracy-antibody-tests-detection-infection-covid-19-virus
  8. Eyam’s Ultimate Sacrifice: Medieval Village Locked Down to Stop the Plague. Ancient Origins. 31st January 2021.
    https://www.ancient-origins.net/history-important-events/eyam-0014871
  9. UK Covid deaths: Why the 100,000 toll is so bad. By Nick Triggle, Christine Jeavans and Robert Cuffe
    BBC News 26 January 2021
    https://www.bbc.co.uk/news/health-55757790
  10. British Women ‘the Fattest in Europe’, The Times 26 November 2011
    https://www.thetimes.co.uk/article/british-women-the-fattest-in-europe-mk9wdnssvlr
  11. The Perfect Storm: Coronavirus (Covid-19) Pandemic Meets Overfat Pandemic. Maffetone PB, Laursen PB. Front Public Health. 2020; 8: 135.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190793/
  12. Boris Johnson to launch war on fat after coronavirus scare. The Times 15 May 2020.
    https://www.thetimes.co.uk/article/boris-johnson-to-launch-war-on-fat-after-coronavirus-scare-flgswhmvx
  13. The weight of obesity on the human immune response to vaccination. Painter SD, Ovsyannikova,IG, Poland GA. Vaccine. 2015 Aug 26; 33(36): 4422–4429.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547886/
  14. COVID-19: UK ‘vindicated’ over ‘brave’ decision to delay second vaccine dose, WHO official says. Sky News 7 February 2021
    https://news.sky.com/story/covid-19-uk-vindicated-over-brave-decision-to-delay-second-vaccine-dose-who-official-says-12211550
  15. For a coronavirus vaccine to work, first inoculate against lies. The Times 31 May 2020
    https://www.thetimes.co.uk/article/for-a-coronavirus-vaccine-to-work-first-inoculate-against-lies-2prn8dg9j
  16. Even covid-19 can’t kill the anti-vaccination movement Megget K. BMJ 4 June 2020
    https://www.bmj.com/content/369/bmj.m2184
  17. The seven types of people who start and spread viral misinformation. BBC trending 4 May 2020
    https://www.bbc.co.uk/news/blogs-trending-52474347
  18. Trump ‘worst offender’ for spreading fake health news. The Times. 2 October 2020
    https://www.thetimes.co.uk/article/trump-worst-offender-for-spreading-fake-health-news-f82vnkh9c
  19. Coronavirus: False and misleading claims about vaccines debunked. BBC Reality Check 25 July 2020
    https://www.bbc.co.uk/news/blogs-trending-52474347

Site Index

This website is under construction although nearing completion. The following list shows the sections that are planned but, so far, only the ones in blue have been completed. Just click on the topic in blue to go to that part of the site.

1 Introduction
2 A Very Brief History of Science And Medicine
Fundamentals of Medical Science
3 Finding Good Medical Advice and Evidence Based Medicine
4 Randomised Controlled Trials
5 Cohort or Longitudinal and Epidemiological Studies
6 Qualitative Research
7 Basic Maths in Medical Research and Decision Making
8 How Good is the Evidence?
9 Ethics in Practice and Research
Public Health Issues
10 Screening Programmes
11 Fake News and Vaccine Scares
12 Electronic Cigarettes (E-Cigarettes)
13 Motor Vehicle Emissions, Air Pollution and Health
14 COVID-19. What You Need to Know
15 What we Must Learn from the COVID-19 Pandemic
Nutrition
16 Basics of Nutrition
17 Exercise, Obesity and Diets for Weight Loss
18 Diets and Nutrition for Health and Fitness
19 Supplements
Complementary and Alternative Medicine
20 Introduction to Alternative Healthcare
21 Homeopathy
22 Acupuncture
23 Manipulation of the Spine
24 Reflexology
25 Herbal Remedies
26 Other Natural Products
27 Chelation Therapy
28 Hypnosis
29 Other Modalities of Complementary and Alternative Medicine
Some Controversial Diseases
30 Fibromyalgia
31 Chronic Fatigue Syndrome (CFS) or Myalgic Encephalitis (ME)
32 Systemic Candidiasis and Leaky Gut Syndrome
33 Mobile Phones, Masts, Wi-Fi and Electro-sensitivity
The Environment
34 Global Warming and Climate Change
35 Alternative Energy
Some Final Thoughts
36 Still Searching for the Age of Reason