Paranoia, fear and uncertainty can sell a product or an idea, to millions of people. It is used by commerce, influencers and would-be dictators all around the world since civilisations began to flourish 12,000 years ago.
Thankfully, paranoid delusion, which is associated with mental illness, is not too common but every living person has to deal with fear, at many points in their life. That can be separation from a parent as a child, worries about money, or the health of our loved ones. As a doctor, I have spent my career dealing with uncertainty, which feeds into my patients’ fears.
Uncertainty is at the root of our worries about coronavirus. We have been living with other coronavirus organisms for generations and they have only given us symptoms of a common cold. The arrival of the CoViD-19 variant was not entirely unexpected, as we had seen similar severe respiratory illnesses arising from other new coronaviruses, in the middle east and China within the last 15 years.
The new virus had found a way to enter our lung cells and brutally damage them. What is more, it was able to stimulate our immune systems in such a way as it caused damage to many other organs in our bodies, leading to death.
Very soon it was noticed that in stark contrast to other respiratory viruses, severe disease and death due to COVID-19 was relatively rare in children. Differences in the immune systems and better blood vessel health were among the factors protecting them.
Earlier in the course of the epidemic it had also been noted that patients from BAME groups seemed to be experiencing higher infection rates and worse outcomes, including death. This was puzzling, since genetic research has revealed two deep truths about people. The first is that all humans are closely related. Secondly, in a very real sense, all people alive today are Africans.
Despite this knowledge, some racial and ethnic groups suffer relatively more often, and fare worse, from common ailments compared to others. Prostate cancer is one disease where such health disparities occur: Risk for the disease is about 75% higher, and prostate cancer is more than twice as deadly, in Blacks compared with whites.
There is now clear evidence that COVID-19 does not affect all population groups equally. Many analyses have shown that older age, ethnicity, male sex and geographical area, for example, are associated with the risk of getting the infection, experiencing more severe symptoms and higher rates of death.
Death rates from COVID-19 were higher for Black and Asian ethnic groups when compared to White ethnic groups. However, scientists in Japan and the US found no differences in seven genes associated with viral entry. Pre-existing medical conditions, environmental and socio-economic factors are more likely to blame for people of ethnic minorities being disproportionately impacted.
This was confirmed by a report published by Public Health England in the middle of 2020. The University of Leicester told the committee which produced the report, that people with heart disease, diabetes and high blood pressure, were at higher risk of having more severe CoViD-19 symptoms. High blood pressure is considerably more common among black African and Caribbean people than in the white population, and Asian and black ethnic groups develop diabetes at a younger age compared to white individuals.
All around the world researchers began to find out more about the virus and how some people were at more risk. A Spanish study in October last year found that 80% of hospitalised coronavirus patients had lower levels of vitamin D and increased signs of inflammatory reaction. Vitamin D is essential for regulation of immune function and has been shown to reduce inflammatory reactions.
Vitamin D is synthesised under the skin following exposure to UVB radiation from sunlight, so individuals who get insufficient sunlight are at risk of vitamin D deficiency. This is a particular issue during winter in countries further from the equator, when sunlight has insufficient UVB for vitamin D synthesis. People with darker skin colour who live in these countries, which includes many BAME communities, are at even greater risk, as are those who rarely go outside or expose very little skin to the sun.
None of the research to date, has been sufficiently analysed and reviewed to be certain about the cause of the differences. What is clear though, is that herd immunity is not developing quickly enough to suppress the epidemic, without the help of an effective vaccine. For measles, it’s a 95 percent immunisation rate whereas for polio it’s around 80 percent. It is estimated that 70% would have sufficient impact to halt the epidemic.
The most comprehensive study of COVID-19 vaccine hesitancy in the UK to date, shows a majority willing to be vaccinated but a substantial minority remain concerned. Analysis of the survey in the December 2020 Journal Psychological Medicine, indicated that 72% are willing to be vaccinated, 16% are very unsure, and 12% are strongly hesitant.
Additionally, approximately a quarter of the population are entertaining the idea that the virus is a hoax, with around one in five people thinking that vaccine data may be fabricated, and another one in four people unsure whether such data are made-up. Similar proportions of the population still think that there is a cover-up of a link between autism and vaccines, despite years of evidence to the contrary.
These fears and uncertainties are rooted in longer-standing issues of mistrust. Higher levels of hesitancy are associated with negative views of doctors, poorer NHS experiences, concerns about the financial motivations of vaccine developers, discontent with institutions, coronavirus conspiracy concerns, and vaccination conspiracy ideas.
All of this is about trust. Trust in our institutions, our professionals and our politicians. Paranoia, fear and uncertainty is the life blood of the fringe conspiracy theorist, the criminal confidence trickster and the autocrat manipulator. Our population, both white and BAME, have greater access to more information that ever before, thanks to the internet, mainstream and social media.
Whatever our background or privileges, as we grow up, we all have to learn to make balanced decisions that affect our lives and survival. Being able to distinguish informed advice from deceitful misinformation takes time and experience. No one can be forced to have a vaccination or see a collective benefit, when they do not see themselves at risk.
I see the pandemic through the lens of research that is reviewed and challenged by people who have nothing to gain except knowledge. The speed of development of the vaccines are a testament to the dedication and skill of those who have made them. Safety has not been compromised and the effectiveness is uncertain but probably going to be high. When my turn comes, you will find my sleeve rolled up.
Dr Peter Smith M.B.,B.S. D.R.C.O.G. D.Occ. Med. AFHEA