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It ain't over until the fat lady sings1
Many readers will have heard, or read, this quotation. Its origin is disputed, one source claiming that it refers to opera, namely, the stereotypical operatic ‘fat lady’ singing to close out operas. Another source credits it to Ralph Carpenter, reporting in The Dallas Morning News in March 1976 on a 72–72 tie late in the Southwest Conference tournament finals. ‘Hey, Ralph,’ said Bill Morgan (information director), ‘this… is going to be a tight one after all.’ ‘Right’, said Ralph, ‘the opera ain't over until the fat lady sings.’ Another source credits the saying to Dan Cook, a sports broadcaster from San Antonio, Texas. No matter who first said it, the simple meaning is – do not assume the outcome of a situation until it reaches its end.
Where is this going, you ask! I started writing this in late July, shortly after the announcement of the 200,000th UK death due to COVID-19, this having been described by doctors and the bereaved as a tragic milestone. The continuing arrival of new variants, the latest being the much more transmissible BA.4 and BA.5 variants, remains a salutary lesson to all. Let alone the arrival of monkeypox, the subject of the latest Commentary by Professor Samaranayake in this issue. It is interesting to note that, while 15% of people in the UK have never had COVID, in the latest wave this minority group accounted for 55% of infections.2 At the time of writing, I know of eight friends/colleagues who have been smitten by the new wave caused by variants, a number that greatly exceeds my previous experience. Readers will rightly say that this is not a scientific statement, but, in that regard, a total of 3.1 million, or roughly one in 17, people in England had coronavirus in the week to 13 July, this figure probably being an underestimate because of the current lack of testing. A month on, in the week up to 12 August, new infection rates had dropped, but, in the UK, there were still 7486 patients in hospital with COVID and there were 744 COVID-related deaths. This is not the full story, because long COVID appears to be affecting increasing numbers of the population, with 1.8 million people self-reporting this as of 2 July 2022. Of those, 81% reported experiencing long COVID symptoms 12 weeks after first having COVID, 43% after 1 year, and 21% after 2 years.3 The most common long COVID symptoms were fatigue (54%) and shortness of breath (31%), with a total of 23 symptoms being listed and with symptoms adversely affecting the daily activities of 1.3 million people. This is a substantial body of illness that cannot be ignored and which is taking people out of the workforce, and costing the already cash-strapped NHS.
It is, therefore, my view that it is time to recommence basic precautionary measures, such as mask wearing and social distancing in public places. Getting a supply of effective masks, such as FFP2, to the general public might be a good starting point. This is especially relevant as we head into autumn and winter, when infections such as ‘flu become more prevalent, and we should expect further waves of COVID. If we can have a new wave in summer conditions when the population is spending more time outdoors, then worse can happen in the colder, darker days and nights.
This Comment hopefully provides a useful introduction to a Guest Editorial by Grant McIntyre, a well-known Consultant Orthodontist based in Scotland, and should remind us of the potentially catastrophic sequelae that a COVID infection can bring, especially to the unvaccinated. I am sure that all readers will be delighted, as I am, to read of his recovery. Thanks for writing this for us, Grant. And a final reminder on the COVID pandemic, don't forget that ‘It's not over until it is all over.’