It's not over until it's all over

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.