Blue Giraffes and Horse Serum
Student halls of residence have now joined cruise liners, care homes, meat plants, giant evangelical church gatherings and migrant worker dormitories as Covid-19 transmission hot spots. The US is top of the league table so far. A New York Times survey found that by 25 September, 1300 colleges had been affected and 130,000 students had tested positive. Universities in Scotland start teaching earlier than in the rest of the UK, so here they have led the way, with cases and outbreaks at St Andrews, Aberdeen, Glasgow and Edinburgh. Many other universities in England, Wales and Northern Ireland have followed since.
Historically, campuses have tended to be safer from the lethal effects of infection than the communities surrounding them. Oxford and Cambridge have been studied intensively. In 1348-9 during the Black Death, students and masters in the theology faculty at Oxford had a mortality rate of 25 to 27 per cent. For the rural poor it was 40 per cent. During the 1918-19 influenza pandemic, three students at Cambridge died, two in the second wave in November and one in the third wave in February. During this period influenza killed 117 town residents, including five labourers, ten domestic servants, three shop assistants and four munitions workers.
Outbreaks of infection caused by other pathogens in universities have been small, such as the occasional recent clusters of cases of meningococcal meningitis, or the forty cases of septicaemia at the University of Jena in 1882 caused by contaminated duelling Schläger. A very recent upsurge in cases of mumps was driven by outbreaks in universities. It terminated abruptly after the UK-wide lockdown. Students had become susceptible to infection because their vaccine-induced immunity had waned, and some had missed out because of Andrew Wakefield. If mumps resumes it is remediable. There is a vaccine.
As transmission hot spots, university halls of residence are close epidemiologically to migrant worker dormitories, even though hot bunking is not the norm, they are not usually infested with bed bugs and students pay fat fees to stay in them. The good news is that testing positive is not the same as being ill; a study of 670 positive students at a North Carolina university in August found that none had been hospitalised.
Big outbreaks of respiratory infections in migrant workers are not new. Early in the 20th century, pneumonia mortality rates among gold miners in South Africa were extraordinarily high. In early 1904, 206 men arrived at a Rand mine from Mozambique. Within four months, 116 were dead. The cause was Streptococcus pneumoniae, a bacterium carried harmlessly by a minority of adults in the nose and throat. Like Covid-19 it can cause pneumonia and spread to other organs, and is particularly harmful to the elderly. In early editions of his landmark medical textbook William Osler called it ‘the special enemy of old age’; in the final edition, published posthumously, it was termed ‘the friend of the aged’ because it killed quickly.
In the pre-antibiotic era, S. pneumoniae, like Covid-19 today, was more lethal for black people and individuals living in poor quality housing, and it still kills more men than women. Unlike Covid-19, the risk of a pneumococcal infection is highest in infants, and alcoholics are more susceptible. When I was a casualty officer I once saw a very sick and agitated ticket collector from Waterloo Station. One side of his chest was completely solid. I asked if he was seeing pink elephants. No, he said, blue giraffes; pneumonia had stopped him drinking, causing alcohol withdrawal delirium tremens.
Research on a pneumococcal vaccine in South Africa started in 1911, funded by the Witwatersrand Native Labour Association, a mine recruitment organisation. Progress was slow. Real success didn’t come until 1976, when a trial at the East Rand Preparatory Mine near Johannesburg showed that the latest vaccine gave 80 per cent protection. Just as well, because antibiotic-resistant strains were becoming common.
Before antibiotics, if you got pneumococcal pneumonia and were in a specialist hospital there was a strong possibility that you’d be given blood serum from immunised horses. You would be told that, with the serum, you had about a 20 per cent chance of dying from the pneumonia, possibly doubling your survival prospects, and a 10 per cent chance of an allergic reaction, though the likelihood of being killed by anaphylaxis was very low. Serum treatment was abandoned as soon as sulphonamides and penicillin appeared. Whether human plasma from convalescent patients will work as a treatment for Covid-19, time will tell. In August Donald Trump hailed it as a miracle cure. I wonder if he feels differently now that he’s tested positive for Sars-CoV-2 himself.