I think what alarmed or resonated with me the most in writing this report, are two key points in the narrative: the fact that we still don’t know what the origins of Covid-19 are; and the fact that for whatever reason, we still do not have adequate oxygen supply to all those that need it in remote or crisis-stricken regions.

Amidst all of the evidence, all of the theories and data and learnings, it is those two facts that I began this series with and ultimately end it with too. 

Today, in this world of incredible state-of-the-art science and technologies, with all of our learnings from previous pandemics and genomes and epidemic sequencing, how do we still not know where this virus originated from?

Is it a big dirty secret from the pristine confines of a well-funded lab, as many would have us believe? Is it a quite literal freak of nature, reminding us of the inherent fragilities within our human ecosystem today? I had always been led to believe – perhaps by fiction – that nature did always leave a trail, a clue, as to the origin of its brilliance, but on this occasion perhaps not. Or have we not allowed ourselves to find it yet? 

Either way, the answer ‘remains elusive’. And it is clear to me that as long as that is the case, as long as we cannot nail that argument down with hard, incontrovertible evidence, not only will this pandemic be wide open to suspicion and expanding arguments over natural versus synthetic emergence, we also will not have learned those important lessons from it. 

At times, it hardly seems as though we have learned lessons from previous pandemics; we have of course, yet the response to this Covid-19 virus outbreak appeared to lack clarity, cohesion and in the very early days, the appropriate seriousness from those responsible for governing us. How could I be sat at my desk in late February and early March for example, across various news feeds and media outlets, and see the trend emerging with this novel virus and how it was moving so rapidly from east to west, and yet various countries – and certainly here in the UK – appear to be so sluggish in similarly joining the dots and responding? Of course, it is easier to level that with the benefit of hindsight, but it was something I had said to colleagues at the time and it didn’t seem so difficult to grasp. It felt like watching the dominoes fall across the map, country by country, until it was in fact your own nation in the thick of it.

”At times, it hardly seems as though we have learned lessons from previous pandemics…”

Were we really so well and truly blindsided by the political war games and apparent mistrust and paranoia we were so entrenched in at that time? Could we not see the wood for the trees? Were our leaders simply ignorant, arrogant even, that they could not grasp the gravitas of this pandemic emerging before them? Were economic arguments against the closing of borders and trade too strong to ignore? Could we really have stopped this virus at all? 

After taking a step back and attempting to do exactly that – see the wood for the trees in the chronicles of this disaster – these all seem to qualify as valid questions. And yet, I still do not have the answers I may be searching for. Who does? Will we ever? Perhaps no-one, and perhaps not. The point is, there are too many questions surrounding not only our Covid response in early 2020, particularly against the backdrop of instant global communications like never before, but also our continuing response even today. 

Likewise, how do we find ourselves in this position of lacking adequate (medical) oxygen supply in many hotspots where it is needed the most? We may reasonably be able to attribute the origins of Covid-19 to nature and acts beyond our control, but we cannot say the same for a product that we make. A critical product that we have been making for over a century. A product crucial to the frontline of the fight against coronavirus since January 2020 and yet, that has still been proven to be in short supply over 12 months later, in April and August 2021. 

Did we really roll with just the one-legged stool of vaccine, vaccine, vaccine? Yes, it’s true – you cannot plan for a pandemic, granted. But once you’re in one, you do know the rules of engagement. You generally know how it plays out; you know what you need. Or at least, you should do, and you should be mobilising around those treatments before you even need them. 

It was during the writing of this series that the groundbreaking new medical oxygen agreements were confirmed and announced. This story genuinely shocked me and, call me naive, I’m not afraid to admit that. Why? Because when you understand the mechanics behind those agreements and how they came to be, it’s shocking that medical oxygen had not been recognised as so fundamental from the very beginning. Because there are still only two major industrial gas companies signed up to these agreements, even as I write this. And because it seems implausible to me that only two could have engaged and committed to them, but after taking that as logical when breaking such new ground, there are still only two as I write this now.

The business case, not to mention the inescapable human case, is all laid out. It has been so very viscerally laid out before us since January 2020. Indeed, I have been at pains to throw the spotlight on this cause myself in recent months, to a chastening little effect I have to say. Yet still, with every week that passes by, we do not have the full quotas of oxygen required for those who need it in so many countries around the world. With every week that passes, lives are being lost that could well have been preserved. That underscores a pretty big question of both our healthcare systems and yes, our industry too.


How prepared are we? 

So why this series and why now, you may ask. The fight against Covid-19 is still not over, particularly in so many low and middle-income countries (LMICs) of the southern hemisphere, but even in the highly vaccinated advanced economies. New variants evolve, new challenges continue to emerge; this virus is resilient in finding a path into our lives. 

Yet more than 18 months since this same virus began to spill out into society in China and ultimately the rest of the world, it is timely to ask questions of our response. It’s also appropriate to ask questions of the (medical) oxygen supply chain and how it came to be so visibly crunched so many times over the last 18 months, particularly given the escalating crises in India in the last few months and more recently, with the advent of those new agreements that promise oxygen access for all. And as described above, there is still plenty to be desired in the oxygen supply chain in many regions, reinforcing the need for appraisal. 

Yet the pressing motivation for this series lies within a final question that underpins it and is wrapped up in our concluding chapters. How pandemic prepared are we now? 

Generations before us likely thought we were better prepared after the Spanish flu pandemic of circa 1918-1921 had been overcome. The same could probably be said of the Asian flu pandemic in the late 1950s. 

The 2009 influenza pandemic seemed a shock to the system for global health leaders and revised guidance was implemented internationally in an effort to ensure those learnings were carried forward and informed our future virus responses. We might well have thought that was the case. Zika and Ebola aside, we’d had a pretty good run for a decade, considering the ever-increasing effects of globalisation and international travel, and the vulnerabilities we open ourselves up to every day. We avoided various potential pandemics with MERS in that timeframe too. 

And yet, great writers of fiction and box office screenplays are clearly not sold on the theory that we would not succumb to the next viral threat. If they were, we wouldn’t find ourselves binge-watching such gripping dramas on both the big and small screen. So who’s the better informed really? And are we heeding these warnings in both history and yes let’s say it, fiction too? 

Scientists apparently say, Covid-19 may not be the last or worst respiratory pandemic. Given that we still don’t know how it started, we still don’t have all the treatments available to all, we’ve not yet defeated it and there may be more to come in the future, the question stands: how pandemic-prepared are we really?