Dr Waqar Rashid

Can the mad cow disease outbreak teach us anything about Covid-19?

Can the mad cow disease outbreak teach us anything about Covid-19?
A deserted Smithfield meat market at the time of the BSE outbreak (Getty images)
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When so-called ‘mad cow disease’ hit the headlines in 1996, I was in the final stages of finishing my medical degree. Understandably, I was already fascinated by the brain and its workings so I wanted to know more about this deadly malady which could be transmitted from animals to humans. Information back then was harder to come by without social media, but it was probably more accurate and varied without the echo chambers that are now created. Even so, relative panic ensued and there are parallels to be drawn with the current Covid-19 crisis.

The thought of a terrifying illness which we would have no protection against has always been lurking in the recesses of the human condition as one of our greatest fears. Children are taught about the bubonic plague; the ‘black death’ no less. Smallpox and tuberculosis epidemics were not that long ago. As time has gone on though we have been protected by improved hygiene and diet, antibiotics and vaccination. In the western world especially, we felt very safe and had become complacent. Even TB, which will almost certainly kill far more people this year than Covid-19, is thought by many people in Britain to have been consigned to the past not so long ago.

This isn’t, of course, to discount the threat from Covid-19. Tens of thousands have died and each of these deaths brings with it grieving relatives mourning a life cut short. But it is vital that we see this illness in a wider context. And remembering how we reacted to Bovine Spongiform Encephalopathy (BSE) helps in some way towards doing that.

BSE is a disease that could be contracted from cattle who had been fed infected offal. The human variant kills you by destroying your brain. There was no cure. It is no surprise that widespread terror greeted this disease. How couldn’t anyone possibly be afraid? If you had ever eaten beef, you were potentially at risk. Even vegetarians couldn’t be totally smug because it was possible even small exposure in childhood may still be a risk.

And yet there still remained a healthy scepticism among many about the impact this disease would have. Professor Neil Ferguson in 2002 modelled a worst-case scenario of up to 150,000 deaths resulting from BSE depending on other factors. (He did, however, have a confidence interval which calculated a lowest figure of 50). So far, almost 20 years on, the figure is barely above 200 and the rate of new cases continues to fall to almost zero. I don’t say this as a personal jibe to Professor Ferguson; the wide range shows just how difficult it is to model a new disease (something SAGE as a whole should really have realised) and in the end the low incidence of BSE was due, in part, to people requiring a specific genetic profile before they could be vulnerable (something which is true for many diseases and again seems to have been forgotten by current day SAGE). But if in the future we are to remember lessons from the Covid-19 pandemic, then it’s vital that we learn lessons from the outbreak of BSE. Doing so, gives grounds for optimism.

BSE and Covid-19 are different in several important ways, of course, not least in the mode of transmission and its contagiousness, which presumably is the driving factor of many of the restrictions placed upon us now. However, we have been exposed to many deadly respiratory viral infections over the years and never reacted in the way in which we have done this time. Yes, this is a new disease. But are we now different in the way in which he perceive such threats?

In the generation since the BSE outbreak, it seems plausible that some of our natural scepticism has also disappeared. We seem as a population to be more credulous and more willing to adopt measures of restriction in the name of prevention of disease. The reasons are complex and deserving of a longer analysis but I believe at the risk of generalisation we have become less confident in our health and wellbeing. This is certainly the impression I have from seeing thousands of people over the years during my time as a clinician.

Even though the figures do not in any way support Covid-19 as being a significant risk to people who are otherwise well, especially under the age of 65, the fear of this infection remains huge amongst the whole population, not just those who are vulnerable.

Broadcast media and government have amplified this. In days gone by, the medical profession would have tried to reassure people. Now the great and good are emphasising the danger nightly on our screens. And even as the disease is now no longer out of control in Britain, it seems that fear of a second wave means we cannot relax. 

In the months after the BSE outbreak, there were plenty of reasons to still be scared. We didn’t know really how deadly this illness was, or how widely it might spread. Yet for the most part we carried on with our lives. Was the risk and benefit balance which governs everything we do in our daily lives at a different setting and able to withstand a greater degree of uncertainty at the time of that outbreak? I’d say so.

Written byDr Waqar Rashid

Dr Waqar Rashid is a consultant neurologist at St George's University Foundation Hospital NHS Trust, London. This article is a personal view and does not necessarily represent the views of the Trust.

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