Are we on the brink of a third wave of COVID?
If countries relax COVID restrictions too soon, a third wave is likely. Here in the UK, we are waiting patiently for the government to lift all COVID-19 restrictions on June 21, as it has promised to do. UK businesses are urging the government to stick to its promise. The thought of ongoing restrictions is difficult for all of us  every doctor knows the harms that lockdowns bring to their patients. People are clearly feeling increasingly angry about the prospect of a lingering lockdown; there have been large protests against lockdowns in many countries, with fringe groups continuing to claim the virus itself does not exist. When healthcare professionals see these protests and false claims, though, it rubs salt into very recent wounds. We have been working tirelessly and risking our own lives caring for our patients with the virus. Each protest feels like a slap in the face for all the work we have done so far. So, despite the fact that the numbers of hospitalisations from COVID are at a low in the UK and our vaccine programme has been a runaway success, scientists and doctors would prefer that the government wait another month to lift restrictions until more people have received both doses of the vaccine, which has been shown to offer a good level of protection against the delta variant. The cause for their concern is a rise in the number of new cases of the B1.617.2  or the variant first identified in India, now being called the delta variant, which can increase the risk of hospitalisation by 2.7 times, according to Public Health England. The UK government has already come under fire for not acting quickly enough to restrict flights from India and it is dithering about what to do next. As a doctor, it is painful to watch. The one thing we should have learned since this pandemic began is that any delay in responding to this virus results in more deaths and longer and harder lockdowns. Over-reacting, earlier, saves time and lives in the long term; we only need to look at New Zealand for the evidence. Under-reacting, and taking too long to make a decision, risks another serious outbreak of the virus. Evidence that we are on the verge of a third wave, not just in the UK but globally, is mounting. Since March, large parts of Europe have been racing to vaccinate their populations against rising numbers of infections, mainly thought to be due to the variant first discovered in the UK, B1.117, now known as the alpha variant. Hampered by delays to the delivery of vaccines, Germany and Italy have seen cases surge and lockdown rules extended. These countries are now worried about rising numbers of cases of the delta variant in the UK, with Germany banning all but essential travel to and from the UK as of May 23 as it brands the UK an area of variant concern. This comes after 189 people were quarantined in an apartment block in the German town of Velbert on May 18 after one of its residents tested positive for the delta variant. People were unable to leave the building until all residents had been tested and contact tracing was complete. Aside from Germany and the UK, the delta strain has been detected in other European nations including Denmark, Ireland, Italy, Belgium, Switzerland, France, the Netherlands and Spain  albeit at low levels. Elsewhere, Nepal continues to struggle against a rising wave of infections, with hospitals finding it difficult to meet the demand from increasing numbers of patients. Nepals prime minister, KP Sharma Oli, has made an urgent plea for vaccines to his UK counterpart Boris Johnson. Speaking to the BBC, he said the UK should acknowledge the sacrifices of Nepals Gurkha soldiers who served the UK and make Nepal a priority for UK COVID aid. There have also been reports of a new variant being discovered in Nepal, although the World Health Organisation (WHO) tweeted: WHO is not aware of any new variant of SARS-CoV-2 being detected in Nepal. If there is a new variant, it is likely to be a mutated version of the delta variant. Scientists are still studying this potential variant, but it is thought to harbour the K417N mutation which could make it more evasive to the immune response triggered by the vaccines. If that is the case, it could be potentially problematic as it has been identified in Vietnam, Japan, the UK and Portugal as well as other countries. South Africa is already taking action to prevent a third wave. President Cyril Ramaphosa has imposed tighter restrictions across four of the countrys nine provinces. With almost 1.65 million cases and 56,363 fatalities, South Africa is officially the worst-affected country on the continent. Ramaphosa has repeatedly criticised richer countries for hoarding vaccines by buying them up too quickly, leaving the African continent with less than 2 percent of its population vaccinated so far. South Africa is also calling for an end to patent rights on the coronavirus vaccines so it can manufacture its own supplies and administer them. It is a worrying time for many people involved in the fight to contain the COVID-19 pandemic, particularly in preventing the spread of new variants and racing to get as many people fully vaccinated as possible. But while countries continue to look inwards and protect only their own populations, this virus is likely to find fertile breeding grounds in countries that are unable to vaccinate their people at the same rates, resulting in further variants arising. We need to break the chain between infections and hospital admissions, and the only way to do this is to vaccinate the worlds population. If people are protected against serious disease by vaccines then we can suppress and then live alongside the virus with regular booster shots for future variants. If countries continue to be nationalistic about vaccines, a third wave is looking more and more likely. We live in a world where people can move relatively easily from continent to continent, so while vaccinating your own country might buy time, we need to vaccinate globally to solve this pandemic. The theory  until now widely dismissed as a conspiracy theory  that the coronavirus was man-made in a laboratory in Wuhan has recently started to circulate again. The Wall Street Journal reported on May 23 that three researchers in Chinas Wuhan Institute of Virology became sick enough to warrant hospital treatment in November 2019, before the outbreak in Wuhan officially began. The Wuhan Institute leads studies into coronaviruses as well as other pathogens, and the researchers allegedly showed symptoms that may have been consistent with COVID-19. The question as to whether the symptoms were COVID remains unanswered. Four days after this report appeared, however, the Office of the Director of National Intelligence (ODNI) in the US released a press statement saying: The US Intelligence Community does not know exactly where, when, or how the COVID-19 virus was transmitted initially but has coalesced around two likely scenarios: either it emerged naturally from human contact with infected animals or it was a laboratory accident.  The ONDI said it is divided over which one of these cases is more likely, and it will continue to examine all available evidence. President Joe Biden ordered his intelligence committees to investigate the possibility of a laboratory leak, something China has firmly rejected. Well, yes, it does. It is vital that we understand the origins of this virus so we can prevent similar pandemics from occurring in the future. An investigation team sent in January this year by the WHO to examine the possible causes of the outbreak of the coronavirus in Wuhan concluded it was extremely unlikely the virus had escaped from a nearby laboratory. The US has asked the WHO for more data and transparency as it moves into Phase Two of its COVID origins study. The widely accepted theory about the origins of the coronavirus is that it was zoonotic, meaning it jumped from animals to humans; the most likely animal coming into contact with a human being either a bat or a pangolin. The theory that it was man-made in a laboratory in China has always been dismissed by many scientists as a conspiracy theory but, since President Bidens announcement, it has now gathered mainstream interest. Canadian Prime Minister Justin Trudeau told a Canadian press conference on May 27 that he supports Bidens efforts to investigate the origins of the coronavirus. In a paper that has not yet been peer-reviewed but is due to be published in the scientific journal, Quarterly Review of Biophysics Discovery, two scientists have concluded that SARS-Coronavirus-2 has no credible natural ancestor and that it is beyond reasonable doubt that the virus was created through laboratory manipulation. Two of the papers authors, British Professor Angus Dalgleish and Norwegian scientist Dr Birger Srensen, told the Daily Mail in the UK that the virus has unique fingerprints that could only have been manipulated in a laboratory and could not have occurred naturally. They say they believe that, in a bid to study viral effects in humans, Chinese scientists modified naturally occurring coronaviruses and made them more infectious by inserting chains of amino acids into the spike protein of the virus. This process of altering a viruss makeup so it becomes more transmissible and studying its effects on human cells in a lab is known as Gain of Function  and is banned in many countries. The two authors also claimed that after the pandemic began, Chinese scientists took samples of the COVID-19 virus and retro-engineered it, making it appear as if it had evolved naturally. This may sound fantastical, but it is, in fact, entirely possible to do. China has always denied that the virus was man-made. Whatever the origins, it is clear we need further investigation, Chinese cooperation and full transparency so the international scientific community can fully scrutinise the data in an effort to reduce the risk of further pandemics originating in the same way. In the doctors surgery: Patients returning to my clinic  It has been a busy week at the surgery. Patients are facing long delays to routine surgical procedures such as hip or knee replacements, as well as other more minor hospital treatments for their ailments and are returning to their family doctor to help manage symptoms while they wait. During the pandemic, I had many vulnerable groups of patients who were shielding due to underlying health conditions and an increased risk of them becoming seriously ill should they contract COVID-19. This meant they could not visit my surgery and I could not go to them because of the risk of me unwittingly taking the virus into their homes. Most of our consultations were, therefore, conducted remotely over the phone or through video calls. But these people have now had both doses of their vaccine and no longer have to shield. This week, I saw one such patient at the surgery, an elderly man who I have been looking after for many years. I hadnt realised how much I had missed seeing my patients face to face  it was a real pleasure to have him back in my consulting room. As well as talking about his illnesses, we talked about a shared passion of ours; gardening. He told me his tomatoes were coming along nicely and that his onions were doing well; I told him about the hedgehogs that have been frequenting my garden. It might sound like an odd conversation for a doctor and patient to have, but these moments are what make the relationship between a family doctor and their patients special. My elderly patient had been alone for the best part of a year and human contact had been sorely missed. And, if I am being honest, I missed this part of my job too. The COVID pandemic has made these little conversations harder to have as we have been so focused on managing acutely unwell patients, but as things open back up, I am looking forward to catching up with my patients on all the small things too! And now, some good news: Cancer patients respond well to vaccines  A study published this week shows that cancer patients are having a good immune response to the COVID-19 vaccines. People living with cancer have had a tough pandemic. As well as enduring delays to treatments, they have had to isolate or even shield due to being at increased risk of severe illness if they catch the virus. Because these people are on treatments that can dampen their immune systems  putting them at risk of serious illness from even minor infections  having an effective vaccine response may help alleviate their fears about going to hospital and feeling safe. The Israeli study compared blood tests of patients undergoing cancer treatment for solid tumours with healthy adults 12 days after they had their second dose of the Pfizer vaccine. The study showed that 90 percent of the cancer patients had adequate coronavirus antibodies, compared with 100 percent of the control group. This good news was caveated with findings showing the overall concentration of antibodies to coronavirus was lower in those receiving treatment for cancer compared with those without cancer. This is most likely due to the chemotherapy or immunotherapy they were receiving as part of their cancer treatment which can affect their immune response. The duration for which the antibodies last in people receiving treatment for cancer remains undetermined, but there may be a call in the future for booster vaccines to ensure this vulnerable group remain adequately protected. Since the pandemic began, many people have looked for natural ways to help maintain a healthy immune system. Getting a regular, good nights sleep is actually beneficial to the immune system. Sleeping for seven to nine hours each night gives the body a chance to rest and recover. When we sleep, our bodies produce more T-cells, which are immune cells that play a critical role in fighting off infections. We also produce proteins called cytokines while we sleep; these target areas of infections and inflammation, aiding the healing process. Combined with a balanced diet rich in fruit and vegetables and regular exercise, getting a good nights sleep is a natural way to boost your immune system.