Part 1: Background
September 1st 2021

COVID-19 (SARS-CoV-2) — A 21st Century Global Disaster
The COVID-19 pandemic is an ongoing global infection of a novel Coronavirus that was first identified in December 2019 in China's Wuhan, Hubei Province. As of August 31 2021, there have been 219 million confirmed cases and around 4.5 million people have died from COVID-19 worldwide. These figures are possibly understated because in some countries the ability to test for the virus is limited and records of deaths are not as accurate.

Corona viruses are RNA viruses (a virus in which the genetic information is stored in the form of RNA, as opposed to DNA) that cause respiratory and intestinal infections in animals and humans. This new virus was originally named 2019-novel coronavirus but on February 11 2020, the virus was scientifically designated as SARS-CoV-2, however, the popular name "COVID-19" is most commonly used to describe the virus.

Health officials initially thought they were facing a new strain of the influenza virus but it rapidly become obvious that COVID-19 was something more deadly than influenza. COVID-19 proved to be a highly contagious disease to which the human immune system had no response. People infected with COVID-19 reported a wide range of symptoms ranging from mild symptoms to severe illness 2-14 days after exposure to the virus. Around 5% of patients became critically ill and many died within 18 days of becoming infected. Dispelling the original influenza variant theory, the virus acted like no pathogen the world had ever seen, doing immense damage throughout the body. Starting in the lungs, it was discovered the virus quickly attacked other vital organs, including the heart and blood vessels, the kidneys, gut, and brain.

Where did the novel coronavirus come from?
At the time of writing no one knows the answer to this question for certain. The official Chinese explanation remains to this day that coronavirus passed from bats to humans, possibly in the Wuhan market where food became contaminated by bat droppings. The Chinese also made the claim that the virus may have originated outside China, being introduced into the country on contaminated frozen food packaging. In retaliation to American suggestions that the Chinese had created the virus in a laboratory in Wuhan, they countered by accusing the USA of being behind the virus. Investigation by the WHO, following a visit to Wuhan, was inconclusive and scientists around the world continue to seek the possible source of the virus. The British Professor Angus Dalgleish, a professor of oncology at St George's University, London, together with Dr. Birger Sørensen, a Norwegian virologist, and chair of the pharmaceutical company, Immunor, produced a 22–page paper describing their forensic analysis looking at experiments done at the Wuhan laboratory in China between 2002 and 2019.

Dalgleish and Sørensen claim Chinese scientist took a natural coronavirus found in Chinese cave bats and spliced onto it a new "spike", turning it into the deadly and highly transmissible COVID-19. Professor Sorensen said that four amino acids on the spike have a positive charge, which causes the virus to tightly cling to the negatively charged parts of a human, becoming more infectious. Because these positively charged amino acids also repeal each other, it was rare to find even three in a row in naturally occurring organisms, while four in a row is extremely unlikely. Professor Dalgleish is reported as saying that: "The laws of physics mean that you cannot have four positively charged amino acids in a row. The only way you can get this is if you artificially manufacture it." So, they claim that coronavirus was genetically modified adding sequences and inserts near receptor bindings, which allowed coronavirus to bite into human cells and thus infect humans.

Dalgleish and Sørensen dismissed claims that the virus passed naturally from bats to humans, as this would take many transmissions from bats to humans and back to bats and then back to humans again before the bat corona virus could mutate to a variant of the virus that could infect humans. The professors made their ideas known early in 2020 but their research findings were largely dismissed by the scientific community. It was only after US President Biden expressed an interest in finding the source of the novel coronavirus that the work done by Professor Dalgleish and Dr. Sørensen began to gain a credible following in the world of science and medicine.

Early Treatment of COVID-19
Victims of COVID-19 were admitted to hospital intensive care units (ICU's) in large numbers when the severity of the COVID-19 disease was first realised, but there was no known treatment at the start of the pandemic and the death rate globally began to rise rapidly. People in most countries began following published daily death rates with alarm and despondency and hospital ICU's reached saturation point becoming overwhelmed with sick patients requiring mechanical ventilation and oxygen. Twenty percent of ICU patients progressed to a severe or critical stage of the disease developing pneumonia, acute respiratory distress syndrome, multiorgan system dysfunction, hypercoagulation, and hyperinflammatory manifestations, in some cases leading to death.

It was recognised early in the pandemic that giving oxygen was one of the essential treatments for Covid-19 patients. Because the COVID-19 virus attacks the lungs and can cause pneumonia and hypoxaemia (a lack of oxygen in the blood), oxygen therapy proved to be lifesaving. In poorer countries, a shortage of supplies of oxygen and the logistics of maintaining supplies of oxygen in hospitals started to prove a critical factor. India, for example, quickly suffered a shortage of oxygen in the country's hospitals and relatives of patients often had to source and supply cylinders of oxygen themselves. Correspondingly, the death toll in India quickly mounted.

During the first wave of the COVID-19 pandemic, almost three quarters of patients who were admitted to critical care received invasive ventilation, and one in two received it within 24 hours of admission.

Use of anti inflammatory drugs
Every virus is different and attacks cells in specific ways and the antiviral drugs that fight them off are specific too. Very rarely does an antiviral built for one virus also work for another but the severity of the pandemic led to a frantic trialling of existing antiviral drugs in the hope of finding one that would be effective on COVID-19. There was no treatment available for patients with initial to mild symptoms but for those with moderate to severe symptoms some success was reported in the use of the antiviral drug dexamethasone. Dexamethasone (trialled in March 2020 and introduced in the UK in June 2020) reduced mortality by a third in hospitalized patients requiring mechanical ventilation or for patients on high-flow oxygen.

On May 1 2020, Remdesivir (an adenosine nucleotide prodrug) was approved in the US as a treatment for COVID-19, reportedly reducing hospital recovery time from 15 to 11 days. In June 2020 the NHS recommended Remdesivir be used as a treatment option for COVID-19 patients in the UK. The drug was believed to reduce supportive treatment measures (including mechanical ventilation) and to aid the recovery of patients on supplemental oxygen treatment benefiting patients with mild, moderate or severe COVID-19 disease. Remdesivir was expensive and had to be given intravenously, once daily after an initial loading dose. Reported adverse effects included elevated levels of a family of enzymes called transaminases, drug hypersensitivity and infusion related reactions (hypotension, nausea, vomiting and diaphoresis).

By November 2020, the World Health Organization’s Solidarity trial (a huge international study involving thousands of patients) published interim results showing that Remdesivir had no significant impact on mortality, length of hospital stay, or that it reduced the need for ventilation among hospitalised patients. Considering the drug's high price, the limited stock, and seemingly limited benefits, it became evident that Remdesivir was not going to be the lifesaving drug everyone had hoped for.

Other antiviral drugs evaluated and rejected as treatments for COVID-19 were: Ivermectin, Nitazoxanide, Hydroxychloroquine or Chloroquine and/or Azithromycin, Lopinavir/Ritonavir and other HIV Protease Inhibitors.

By the end of 2020, it was becoming obvious that existing antiviral drugs were mostly ineffective and research stepped up to find a new antiviral drug or a vaccine.

Use of Antibody-filled Plasma
Early on in the pandemic, researchers began studies to see if using antibody-filled plasma from people who had recovered from COVID-19 could lessen the severity of the illness or protect those not yet infected, or both. On August 23 2020, the Food and Drug Administration in the US granted an EUA (Emergency Use Authorization) for plasma antibodies, stating they were likely to be both beneficial and safe for patients. Plasma antibodies were found to reduce the chance of dying by 50% when given to patients with COVID-19 early enough in the course of their illness. (However, in January 2021, the UK Department of Health and Social Care decided to stop collecting convalescent plasma donations following the completed analysis of trial results, which showed no overall benefit for people in hospital with coronavirus and a decision was taken not to proceed with a third trial into plasma use early in the disease.)

Transmission of the Virus
On February 28 2020, the British Prime Minister famously said: "The most valuable thing we can all do to prevent the spread of the coronavirus is to wash our hands for 20 seconds or more with hot water and soap." It was a widely held presumption in the early days of the pandemic that coronavirus was a form of influenza virus and nothing too serious, probably based on the UK's pandemic preparations being based on the assumption that the most likely threat to the UK would come from a flu variant. This view rapidly changed as more people fell seriously ill from COVID-19 and the virus spread across the UK.

It was fairly quickly established that COVID-19 transmitted when people breathed in air contaminated by droplets and small airborne particles of the virus from coughs and sneezes but it took until mid–May before government advised on wearing masks in an attempt to reduce transmission. (Later variants, like the Alpha, Delta and Beta variants were found to spread more rapidly than the original Wuhan virus strain, the most virulent being the Delta variant, which spread by aerosol droplets, such as, during normal respiration.) The risk of breathing in these contaminated droplets was deemed to be at its highest when people were within close proximity of each other (0 - 9 metres), but some experts warned it was possible that the virus could be inhaled over longer distances, particularly indoors. (This was found to be especially true of the later Delta variant when it was advised to increase ventilation in closed spaces.)

Early on in the pandemic it was recognised that transmission also occurred if a person was splashed or sprayed with contaminated fluids in the eyes, nose or mouth and the general public were introduced to the idea of wearing face guards (a plastic sheet that protected the eyes, nose and mouth), although these were not widely adopted. Contact with contaminated surfaces was a concern, especially if a victim then touched their eyes, inside of nostrils or mouth.

Infected people were found to remained contagious for up to 20 days and could spread the virus even if they did not develop any symptoms (asymptomatic) or during the disease's incubation pre–period. There was no real evidence the virus could contaminate drinking water but transmission by handling food or food packaging was thought possible with the virus reportedly lasting up to 72 hours on metal and plastic and 24 hours on cardboard and paper. Information on how long COVID-19 could survive on different materials however was vague.

The virus appeared to be stable at low and freezing temperatures for a certain period and at normal air temperatures. Scientists thought it unlikely that coronavirus could be caught from fresh food and that normal cooking (temperatures 70°C and over) could kill off any virus on contaminated products. It was recommended that alcohol, household bleach, normal household detergents and cleaning products containing an anti–viral agent (like Dettol) should be used to decontaminate surfaces in the home and at work.

Government guidelines recommended washing hands regularly in household soap for more than 20 seconds or the use an alcohol hand gel. It was recommended that people should keep up to 2 metres apart to limit transmission of the virus and to avoid contact with others as much as possible. The "2–meter rule" quickly became unpopular in the hospitality industry as this limited the number of customers in any given area.

People in the 20% most deprived parts of England were twice as likely to contract and die from COVID-19 as those in the least deprived areas. They also died at younger ages, although in the most deprived areas people may have had lower life expectancy because of existing health inequalities.

Personal Protective Equipment (PPE)
The use of PPE is vital in the fight against an airborne virus. In March 2020, the World Health Organization warned that severe and mounting disruption to the global supply of personal protective equipment (PPE) caused by rising demand, panic buying, hoarding and misuse put lives at risk from the new coronavirus and other infectious diseases. Hospitals in the UK ran dangerously short of essential PPE and many had to improvise using PPE that was not "fit for purpose". Limited access to supplies of gloves, medical masks, respirators, goggles, face shields, gowns, and aprons became a serious issue. This was a contributing factor which led to the death of front–line hospital doctors and nursing staff in Covid wards. (In the UK, 44 doctors and consultants, 47 male nurses and 110 female nurses died of COVID-19 between 9 March and 28 December 2020.)

The general public were instructed on how to make their own face masks but such masks did not offer much protection against the virus. There was disagreement between experts on just how effective masks were in the fight against transmission but the consensus was that wearing masks did reduce transmission of the virus if a person was infected, reducing the amount of virus the mask wearer could spread, but masks did little to prevent breathing in the virus unless the mask was a top level surgical mask and these were expensive and hard to come by. The general public reluctantly learned to adapt to the use of PPE (gloves, masks and face shields) on public transport and in crowded places. Often contradictory statements by government spokespersons, academics and medical experts on the effectiveness of face mask as a way of reducing the transmission of the virus led to confusion among the public and opinion on mask wearing became polarized.

Restriction of Movement and other Methods
In the UK laws were passed to give police legal powers to restrict non–essential travel, to enforce social distancing, to prevent gatherings of people and to enforce the wearing of face masks in shops and on public transport. In the first wave of the pandemic people in the UK were told to stay indoors (lockdown) and if possible to work from home.

Authorities worldwide responded by implementing travel restrictions, lockdowns and quarantines, workplace hazard controls, and business closures. There were also efforts to increase testing capacity and tracing contacts of the infected making self–isolation mandatory.

Lockdowns in an attempt to reduce transmission
England was in national lockdown between late March and June 2020. Initially, all non-essential high street businesses were closed and people were ordered to stay at home, being permitted to leave home for essential purposes only.

Most lockdown restrictions were lifted on 4th. July 2020. Hospitality businesses were permitted to reopen.

On 14th. September 2020, England’s gathering restriction was tightened and people were once again prohibited from meeting more than six people socially.

On 5th. November 2020, national restrictions were reintroduced in England. During the second national lockdown non-essential high street businesses were closed and people were prohibited from meeting those not in their support bubbles. People could leave home to meet one person from outside their support bubble (outdoors only).

On 2nd. December 2020, the tier system (different rules for different areas according to local rate of infection) was reintroduced (with modifications). Restrictions on hospitality businesses were stricter and most locations were initially placed in tiers two and three. On 19th. December, the Prime Minister announced that a new ‘tier four’ would be introduced following concerns about a rising number of coronavirus cases attributed to a new variant of the virus.

On 6th. January 2020 national restrictions were reintroduced for a third time. The rules during the third lockdown were more like the rules in the first lockdown.

On 8th. March 2021, England began a phased exit out of lockdown.

Contact Tracing and Quarantine
In May 2020, NHS Test and Trace (NHST&T) was set up with a budget of £37 billion over two years. Between May 2020 and January 2021, daily UK testing capacity for COVID-19 increased from around 100,000 to over 800,000 tests. NHST&T had also contacted over 2.5 million people testing positive for COVID-19 in England and advised more than 4.5 million of their associated contacts to self-isolate.

Contact tracing is a tried and tested method for controlling transmissible diseases. The process involves an infected person recounting their movements and activities to establish with whom they have been in contact, so these persons and their contacts can be tested and infected persons put in quarantine. Contact tracing was regarded as crucial to limit the spread of COVID-19 as symptoms could take several days to appear, during which time the person could pass on the disease. There was also the risk of infected people being asymptomatic, thus passing the virus on without knowing they were contagious.

At the start of the pandemic, contact tracing involved an interviewer asking an infected person where they had been and with whom they may have been in contact. Any potentially infected persons were then asked to self-isolate and take a test. In England, people testing positive for coronavirus were contacted by the NHS Test and Trace service by text message, email or phone. A person thus contacted was sent a link to the NHS Test and Trace website where they entered details of recent contacts. Contact tracers then contacted these people asking for the contact details, email addresses, home address and phone numbers of anyone they may have been in contact with, anyone at risk of contracting the virus was told they must isolate for 14 days, whether they were ill or not. From September 28 2020, it was illegal for people not to self-isolate once they were contacted by Test and Trace; the government having the power to issue £10,000 fines to people caught breaking the rules.

The NHS later developed a contact tracing app which used a form of low energy Bluetooth to identify phones nearby. Bluetooth signal strength between different devices was used to estimate the distance between people, so if someone tested positive for Covid-19 the system sent out alerts to anyone they had been in close proximity to, telling these people to self-isolate. This approached cause what became known as the "pingdemic" because thousands of people were "pinged" telling them to self–isolate. (The phrase pingdemic was a play on words made up of the terms “pandemic” and “ping” referring to being "pinged" by the NHS Covid-19 app on a person's phone telling them to self–isolate.) More than half a million people were “pinged” by the app in the week up to 7th. July 2021, even though there were only 48,000 confirmed cases of COVID-19. This resulted in staff shortages and disruption in industries where people could not easily work from home, for example, in supermarkets and on transport networks.

In spite of the huge resources thrown at the Test and Trace project, it made no measurable difference to the slowing of transmission and the UK still suffered two more lockdowns.

Government Emergency Planning
Between March and April 2020, seven temporary Nightingales Hospitals were built by a consortia of NHS, the Military and private investors. The hospitals were located in the North East of England, Yorkshire & Humberside, the North West of England, Birmingham, London, Bristol and Exeter and were built at a cost of over £530 million. The purpose of the new hospitals was to deliver oxygen to patients, support infection control, deliver complex critical care and process the dead. Apart from the hospitals, the largest of which were planned to have 4,000 beds needing 16,000 staff (at a time when the NHS already had 100,000 job vacancies), a behind–the–scenes infrastructure was required, such as, finance, clinical governance, food and drink, etc., making the Nightingale hospital project a massively expensive and complex undertaking.

That the UK Government undertook this massive project and delivered it in record time underlines the fear and uncertainty surrounding the COVID-19 pandemic. In fact, the hospitals were never used, and by the time of writing (September 2021) most have been decommissioned. The Nightingale hospitals were never going to become operational because the NHS did not have the staff to run them but at best the Nightingales could be regarded as an insurance policy if current hospital ICU's were overloaded, at the worst, a disastrously expensive PR stunt by the Government who were trying to allay the fears of the public and demonstrate they were in control of the pandemic situation.

The disposal of the dead is not a statutory service for local authorities, neither has central government any control of burial and cremation facilities. To deal with the expected overwhelming number of dead in the pandemic, the Government made provision for this in the Coronavirus Act 2020. Section 58 of and Schedule 28 of the Act introduced new powers relating to the transportation, storage and disposal of dead bodies and other human remains. These powers were included in the Act to ensure the UK was prepared for a reasonable worst case of deaths caused by COVID-19. Under the Act, Local Authorities were given powers to transport and dispose of corpses locally and in other areas if they ran out of local capacity. The government began coordinating plans for the creation of a network of temporary mortuaries nationwide to cope with the projected death toll from coronavirus. The Government made plans for collective and mass burials.

(The term collective burial is used where burials occur in a trench in rapid succession, each burial separate and identified. It can be provided by relatively unskilled staff and does not rely on technology or external help. It is not “mass” burial where the bodies are placed together and one on top of another.)

Emergence of COVID-19 Variants
The World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern on 30 January 2020, and a pandemic on 11 March 2020. Since the start of the pandemic in 2020, other variants of the virus have resulted in further waves of infection in several countries, with new variants of concern being named Alpha, Beta, Delta and Gamma. The Delta variant of COVID-19, which appears to have originated in India, has proved to be the most virulent strain so far, having spread worldwide at lightning speed, accounting for over 90% of cases in countries like the UK. The Delta variant is thought to be up to 55% more transmissible than the Alpha variant (which originated in Kent. UK), which itself was 50% more transmissible than the original Wuhan virus. A UK study found that the risk of dying after being infected with the Delta variant was 64% higher than for previous strains. In 20 to 29-year-olds, the risk of dying from the Delta variant tripled compared with previous strains.

The Beta variant was first detected in the Nelson Mandela Bay metropolitan area of the Eastern Cape province of South Africa in October 2020. The Beta variant carries a mutation, called N501Y, which appears to make it more contagious or easy to spread. Another mutation, called E484K, could help the virus dodge a person's immune system reducing the effectiveness of potential vaccines. Currently, there are 1,073 reported cases of the Beta Variant in the UK.

In Brazil, the Gamma variant is causing a spike in COVID-19 deaths in young and middle-aged people, who had previously been less at risk than older people.

There are 6 more variants of concern being studied that could imply a significant impact on transmissibility, severity and/or immunity and a further 22 variants that are being monitored worldwide that give some indication that they could have properties similar to those of "a variant of concern".

Race for a Vaccine
On 2nd. December 2020, Britain gave emergency authorization to Pfizer’s coronavirus vaccine. The Oxford-AstraZeneca vaccine was approved for use in the UK on December 30th. 2020 with first vaccines being given on Monday 4th. January 2021. The COVID-19 vaccine developed by Moderna was given regulatory approval in the UK on 8th. January 2021. Johnson & Johnson’s single-dose COVID-19 vaccine was given regulatory approval in the UK on 1st. June 2021. Russia's Sputnik V coronavirus vaccine was approved in Europe on 4th. March 2021.

The vaccines used in the UK have different effective rates with AstraZeneca being the lowest, giving 76% protection against severe disease, ranging to the Pfizer and Moderna vaccines giving up to 95% protection against severe disease. Effectiveness of the vaccines against the Delta variant is currently being evaluated. In the UK people were not given a choice of vaccine and the Government have not published statistics on how many people received which vaccine.

Global Vaccine Concept
Scientists around the world agreed that in order to deal effectively with the pandemic it was necessary to vaccinate at least 80% of the world's population and combine this effort with effective tracking, tracing and isolating those infected. This initiative to be led by the WHO would limit the spread of the virus and in the process reduce the emergence of more deadly COVID-19 variants.

The World Health Organization (WHO) announced on September 21st. 2020 that countries representing close to two-thirds of the world’s population had joined COVAX (its plan to buy and fairly distribute COVID-19 vaccines around the globe). It also unveiled the mechanism through which it planed to allocate the vaccine as it become available, aiming “to end the acute phase of the pandemic by the end of 2021.” However, this plan by the WHO unravelled because countries with surplus stocks of vaccines (for example, UK and USA) were reluctant to part with stocks of vaccines and many countries pledged financial help rather than shipping out vaccines to poorer countries. This financial help was to provide funding to health systems enabling countries to protect health care workers, perform vital surveillance and training, and purchase diagnostic tests rather than freeing up intellectual property rights protecting the production of vaccines allowing vaccines to be manufactured and delivered in poorer countries.

"Vaccine nationalism" became a new phenomena arising from the tardiness of many EU countries that had failed to secure vaccine stocks and develop effective vaccination programmes. Partially, this was due to an initiative by the EU to centrally purchase and supply vaccines to member states, an initiative that failed, leading to different member states going their own way in procurement.

On March 24th. 2021, the European Commission (driven by mounting frustration in the EU about the bloc's sluggish vaccine rollout, as well as vaccine delivery delays from pharmaceutical companies like AstraZeneca and Johnson & Johnson) proposed controversial new rules that would let the EU slash vaccine exports for six weeks to places like the UK and US. — countries that were either receiving EU-made vaccines but not sending vaccines back, or that had vaccinated more of their population than the EU. World Health Organization officials voiced concerns about “vaccine nationalism” warning this could increase the risk of the coronavirus mutating further because of the lack of vaccines in poorer countries. The conclusion of a WHO evaluation in 2021 was that it had failed to make progress in addressing inequity in the supply of vaccines and had been only partly successful in influencing national actions as a top–down approach. While more poor countries will see the arrival of doses from the World Health Organisation’s COVAX facility, the amounts available mean only three per cent of people in those countries can hope to be vaccinated by mid-year, and only one fifth at best by the end of 2021. Meanwhile, in richer countries vaccines are being given at the rate of one vaccine per second.

Editorial update:
(On Thursday 23rd. September 2021 in the UK, 48.6 million people had received the first dose of the vaccine and 44.5 million people had received the second dose of the vaccine, 82% of the population being fully vaccinated. Worldwide 6.03 billion vaccines have been given with 2.53 billion people being fully vaccinated accounting for 32.4% of the world's population.) In the UK, the plan is to provide booster vaccines from September 2021 in order to prolong the protection that vaccines provide in those who are most vulnerable to serious COVID-19 ahead of the winter months. The 2-stage programme would take place alongside the annual flu vaccination programme.

Deaths occurring between 2nd. January and 2nd. July 2021 involving COVID-19:

• Unvaccinated: 38,964 deaths.
  
• Vaccinated with one dose: 7,287 deaths.
  
• Vaccinated with two doses: 458 deaths.

(Source: Office for National Statistics – National Immunisation Management Service, NHS Test and Trace.)

The above figures suggests that two doses of a COVID-19 vaccine gives good protection against serious illness and death.

Social Impact of the Disease.
Initial panic buying and agricultural disruption led to widespread supply shortages and food shortages (although that situation has now stabilized to a degree). The enforced lockdowns (people being told to stay at home, work from home and only make necessary journeys) were forecast to create temporary decreases in emissions of pollutants and greenhouse gases on the positive side but the lockdowns led to economic uncertainty and mental health issues on the other. (It subsequently proved lockdowns had little or no effect on the environment globally and greenhouse gasses during 2020 were at their highest levels on record.) Numerous educational institutions and public areas were partially or fully closed, and many events were cancelled or postponed.

Fear of contagion led people to avoid hospitals and dental surgeries and it is suspected that the death rate from preventable cancer and heart diseases have probably led to more deaths than from the virus itself. The pandemic also raised issues of racial and geographic discrimination, health equity (defined as removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care), wealth inequality and the balance between public health imperatives and individual rights.

Economic Impact of Lockdowns in the UK
The pandemic has resulted in serious global, social and economic disruption, including the largest global recession since the Great Depression of the 1930s.

Almost 190,000 UK retail jobs were lost since the first lockdown in the UK. Shops that collapsed into administration in 2020 because of lockdowns included: Bonmarché, Arcadia Group (Topshop, Dorothy Perkins, Burton and Miss Selfridge), Peacocks and Jaeger (part of the Edinburgh Woollen Mill (EWM) Group), The EWM Group, M&Co, DW Sports, Oliver Sweeney Group, Peter Jones (China), Norville Group, Bensons for Beds, Harveys Furniture, TM Lewin, Bertram Books, Go Outdoors, Lee Longlands, Oak Furnitureland, Le Pain Quotidien, Monsoon, Quiz, Victoria's Secret, Aldo, Johnsons Shoes, Antler, Oasis and Warehouse Group, Debenhams, Cath Kidston, Autonomy Clothing, Lombok, BrightHouse, Laura Ashley, Soak.com, TJ Hughes' outlet division, Hawkin's Bazaar, Ashbury Furniture, Beales, Hearing Health and Mobility and Houseology.

(More than 8,700 chain stores closed in British High Streets, shopping centres and retail parks in the first six months of 2021 averaging nearly 50 outlets a day as the impact of the pandemic and buyers changing to online shopping affected many towns and city centres.)

In the first year of the pandemic, from April 2020 to 2021, the UK Government borrowed £299bn, the highest figure since records began in 1946 to fight coronavirus and protect the economy. The lockdown reduced the amount of money the government was able to raise in taxes and there was a loss of revenue from travel and fuel taxes etc. Expected borrowing April 2021 to April 2022 is expected be more than £200bn. Before it was elected in 2019, the Government promised not to raise the rates of income tax, National Insurance or value added tax, however, in March 2021 the chancellor announced measures which will increase most people's tax bills in 2022. By May 2021, the Government expects to spend £372 billion on COVID-19 measures, comprising of: £150.8 billion for support for businesses, £97.4 billion for health and social care, £54.9 billion for support for individuals, £65 billion for public services and emergency responses, £3.5 billion for operational costs (source: National Audit Office).

Spreading of Alarm and Despondency
Misinformation was circulated through social media and mass media, and political tensions were exacerbated. So called anti–vaxxers, (people who believe that vaccines are unsafe and infringe on their human rights), influenced the young in particular, also certain ethnic minority groups, resulting in many from these groups refusing vaccination. Fear and alarm spread on social media channels with various conspiracy theories hyping up fear that the Coronavirus vaccine is harmful to health.

In fact, the coronavirus pandemic proved to be a perfect storm for conspiracy theories. During the lockdowns, (when some people had a lot of time on their hands and little social contact) and because of a growing mistrust of traditional news channels, the confusing messages spread by Government and growing uncertainty, many (especially the young) turned to social media as a source of information. Social media, being an unregulated source, meant misinformation spread quickly and widely and conspiracy theories blossomed.

Conspiracy theories ranged from the idea that the pharmaceutical industry was involved in the spread of coronavirus, the pharmaceutical industry was using the population on–mass to test new drugs that no one knew about, that vaccines contained mind–altering drugs so governments could control their people, that coronavirus was an escaped (or deliberately introduced) bio–weapon and that the virus originated from the Wuhan Institute of Virology in China. The WHO attempted to pinpoint the origin of coronavirus but failed to come up with anything conclusive and this further fuelled the conspiracy theorists.

Facebook banned postings claiming the virus was made in a lab in China in February 2021 then reversed its ruling in August 2021 after US president Joe Biden ordering his intelligence experts to examine the possibility the virus had escaped from the Wuhan Institute of Virology. The Chinese said the CIA was responsible and so it went on...

Using the Law to Control the Population
The UK Government became more authoritarian and passed the Coronavirus Act 2020. Under this Act:

• Police forces were granted sweeping and unworkable powers to detain anyone who could be infectious;
  
• the power to forcibly test, question and isolate people indefinitely – with criminal sanctions if they failed to comply;
  
• safeguards for disabled people, people with mental health issues and those relying on social care were removed;
  
• there were restrictions on the right to protest and
  
• the power to close borders and suspend some elections.

The police were also given rather vague guidelines allowing them to restrict people travelling outside their own area and it was only legal to take exercise locally. Local police forces interpreted rules on travel and assembly differently. The police were able to fine people breaking the rules or ignoring government guidelines and these fines varied in England, Scotland, Northern Ireland and Wales. In England People aged 18 or over could be fined £200 for the first offence, lowered to £100 if paid within 14 days, £400 for the second offence, doubling for each further offence up to a maximum of £6,400.

Travelling abroad on holiday was illegal. These new legal powers passed by government were also backed by advertising campaigns supposed to protect the Health Service. These advertising campaigns were carefully orchestrated with a strong behavioural psychology element designed to make people fear ending up in ICU and dying in hospital as a way of getting people to comply with the new law and accept restriction of civil liberties.

Regular Government Briefings and Other Confusion
Despite regular televised government information briefings, people ended up confused by contradictory statements, government U–turns on policy and lack of reliable information (on, for example, the effectiveness of the different vaccines). This, coupled with scant information on the location of infection hot–spots, down to more practical personal issues on whether wearing masks prevented transmission, just how easy or not it was to catch the virus from surfaces, the effectiveness of social distancing (the UK Government claimed people were safe if 2 meters apart), whether asymptomatic people could spread the virus and a host of other unanswered questions, led to considerable confusion amongst the general public. The UK Government did accomplish its aim of frightening a lot of people in its efforts to control the spread of the virus and deflect public attention away from the fact that the government were unprepared for such a pandemic and clearly were often struggling to handle the situation. To the government's credit, they did back the development and roll out of the vaccines, despite no one knowing for certain if the vaccines available would halt the virus and limit severe disease and certain death.

Situation: August 31 2021
British Prime Minister Boris Johnson confirmed that all legal COVID-19 lockdown restrictions, including the mandatory wearing of face masks, would end on July 19 2021. (Rules varied in Wales, Northern Ireland and Scotland but were basically following the same guidelines as laid down by the Government in Westminster.)

Since the end of the restrictions and despite the fact that 78% of the population in England (77% in Northern Ireland, 80% in Scotland and 83% in Wales) had received two doses of a Coronavirus vaccine, the virus has continued to spread and deaths averaged over 120 per day.

Protection from serious illness after two shots of the Pfizer vaccine decreased from 88% at one month to 74% at five to six months. For the AstraZeneca vaccine, the fall was from 77% to 67% at four to five months.

More vaccinated people are currently dying of COVID than unvaccinated people, according to a recent report from Public Health England (PHE). The report shows that 163 of the 257 people (63.4%) who died of the Delta variant within 28 days of a positive COVID test between February 1st. and June 21st. had received at least one dose of the vaccine. At first glance, this may seem alarming, but it is exactly as would be expected according to health experts.

There is ongoing debate about vaccinating younger children and giving a third "booster" vaccine to elderly and vulnerable people in the Autumn of 2021.

Long Covid
In conclusion, it is necessary to mention a long term illness experienced by between 2.3% and 10% of people who tested positive for Covid-19, patients experience some symptoms for 12 weeks or longer.

The National Institute for Health and Care Excellence (NICE) defined COVID-19 as an illness lasting up to four weeks. Persistent symptoms lasting 4-12 weeks were described as 'ongoing symptomatic Covid-19'. Symptoms that persisted 12 weeks or more were classed as 'post-Covid-19 syndrome' known popularly as Long Covid. According to the NHS, Long Covid symptoms include:

• Extreme tiredness;
  
• shortness of breath, heart palpitations, chest pain or tightness;
  
• problems with memory and concentration ("brain fog");
  
• changes to taste and smell and, or
  
• joint pain.

Surveys have identified many other complaints. A large study by University College London (UCL), identified 200 symptoms affecting 10 organ systems. These include hallucinations, insomnia, hearing and vision changes, short-term memory loss and speech and language issues. Others have reported gastro-intestinal and bladder problems, changes to periods and skin conditions.

The severity of symptoms varies, but many have been left unable to perform tasks like showering, grocery shopping and remembering words. Research is ongoing into exactly what causes Long Covid. Possible explanations have been mooted: The virus itself could be hiding in the body in a latent state before reactivating. Alternatively, Long Covid could be the result of a persistent immune response triggered by the virus that then causes inflammation and damage to other parts of the body. It is possible that tissue damage done during the acute phase of the illness could be the cause.

It is known that other viral infections lead to chronic fatigue syndrome and this syndrome may follow infection by COVID-19. At this point in time the exact cause of Long Covid is not known, nor is it know how for how long patients with Long Covid are likely to suffer. A parallel may be drawn with the SARS outbreaks between 2002-2004 which showed signs of causing similar long term problems that left some people unable to work for up to 36 months after infection and 40% of those who recovered from SARS still suffered chronic fatigue four years later. Long Covid is a serious issue. There could be hundreds of thousands of patients in the UK who will endure symptoms for many months, putting further pressure on an overburdened healthcare service. This will not only impact the lives of those who are suffering, but may also create an ongoing economic burden if Long Covid patients find themselves unable to work.

Data from more than 1.2 million adults in the United Kingdom who participated in the national COVID Symptom Study indicates that the risk of contracting Long Covid is 49% lower for adult who have been vaccinated with a least one dose of Pfizer-BioNTech, Moderna, or AstraZeneca mRNA COVID-19 vaccine.

At the moment, Long Covid remains a mysterious syndrome and we are left with the unanswered question – where did COVID-19 originate from? Did it really pass from animals to humans or was the virus man made? We may never know for certain but the fact remains, COVID-19 and the aftermath of Long Covid are here for the long haul and we have to learn to live with this new disease. In part 2 of this article I will look at just that, drawing from my own knowledge of pandemics and my personal experiences during the COVID-19 pandemic.