Delta variant danger is an unknown unknown

We have former US Defence Secretary Donald Rumsfeld to thank for the concept of ‘unknown unknowns’ and though his analysis generally elicits laughter and derision from analysts, that has probably more to do with the general reaction of the world to the US’s on-going and constant wars.

But we are in a situation now where we have to make policy decisions based on the ‘unknown unknowns’, though most politicians would prefer not to acknowledge that fact. Let’s start with Rumsfeld’s parameters – ‘known knowns, known unknowns and unknown unknowns’.

It all looks and sounds a bit silly, but actually it’s a straightforward way of processing information when it comes to using that information to make decisions.

We know about viruses and vaccines. We know how they work. Despite the white noise of the anti-vaxxers, we know how the science works. There’s no argument there among sane people.

But there are many factors out there about which we don’t know. We know the virus has mutated, and the danger has increased, but we’re not really sure by how much.

It looks as if the Delta Plus variant will put all our plans on hold for the Summer – but it’s too early to tell.

And then there are the ‘unknown unknowns’ – will the Delta Plus variant spread so fast as to kill millions of un-vaccinated people in poorer countries? Will a mutation form that is resistant to current vaccinations? We could easily add to Rumsfeld’s doctrine that there are unknown ‘unknown unknowns’. We simply don’t know what will happen and commentators – no matter how intelligent or well-informed – are foolish to pretend otherwise.

Doctors have always worked within an overall system and trusted the science and that system to take the best care possible. It doesn’t always happen, but at least there’s a plan. There is even a plan when things go wrong – bad doctors are struck off. The system (mostly) works.

Therefore it’s hard to deal with a disease that dodges and weaves and doesn’t fit that system. Not alone can it be frustrating to have a huge increase in workload – at the same time that many more people are getting sick – but there is the danger of contracting the disease itself.

Ironically, that danger – and the heroic role played by many healthcare professionals (not just doctors) has attracted more people into medicine.
Medicine is a job where you get the sense of satisfaction that comes with helping people and making a difference in their lives. Oh yes, the person driving the Bentley will tell you that it’s very satisfying to sell people beans or butter, but the reality is that they’re bored and beaten down every day knowing they are making money, maybe lots of it, but their lives are as vacant and empty as the former US President’s brain.

It is sometimes suggested that some specialties in medicine are particularly taxing – oncology being one – but often that is not the case. It depends on the individual, and their ability to deal with the particular pressures that it brings. Often, these oncologists are a beacon – a ray of light in an otherwise dark world for patients, and the returns from oncology can also be rewarding, if problems are diagnosed in time. It is just as rewarding as other areas of medicine if time is on the oncologist’s side. It’s all about timing.

Time is not on our side in relation to the latest threat. The Covid-19 variant that devastated India has now spread to 80 countries. The Delta variant – B.1.617.2 is now the dominant strain in the UK accounting for 90% of cases there and in the US, it’s gone from 10% of cases to 20% in a week.

Dr Tony Fauci – now finally freed of the weak and slow-witted Trump – has called it the ‘greatest threat’ to the country’s attempts to eradicate the virus, but America and the UK – though closest to us culturally – already have pretty good vaccination rates. They may well survive a highly infectious variant with minimal (considering the circumstances) loss of life. What of those countries with little or no protection?

The mutation cause by the Delta variant is the ‘fastest and fittest’ yet, according to the World Health Organisation. The mutations of the ‘spikes’ make it easier to attach to human cells, and those with the Delta variant might exhibit different symptoms such as headaches, sore throat and a runny nose – replacing cough and loss of taste and smell.

Research from around the world indicates that Delta is 50% more transmissible than the Alpha variant, and Alpha was 50% more transmissible than the original strain. This implies an increase in the R number from around 2 for the original strain, to roughly 4 for the Alpha strain, and now 7 with the Delta strain.

It would be very difficult – if not impossible – to halt a disease spreading at that rate through a population. One person infecting seven more is a R rate that moves too fast to track, trace or stop.

However, it would seem that vaccines are effective against the Delta strain. Data from the UK Public Health bodies show that the Pfizer vaccine is 96% effective, and the Astra Zeneca vaccine is 92% effective against hospitalisation after two doses. That’s comparable in terms of efficacy to the Alpha strain.

So here we are again. It’s all about the vaccine. It always has been, but even more so now. It’s all about getting it into arms and surviving this thing. And, as usual, when the First World is safe and secure, and we get back to worrying about our First World problems – such as going to gigs and pubs – then we’ll have a long think about how many millions could die of this disease in the Third World.

It could be many, many millions.

I just wonder how Andrew Wakefield sleeps at night.


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