Coronavirus: conceptual failures

22/04/2020

I remember once, in our first house, we had a cat flap in the back door which led into the kitchen. One night, our own cat decided to invite a dozen or so of his friends in for a party. But, when I blundered in to get a drink in the early morning, they all took fright.

With there being only being one exit, they scattered in all directions, skidding around the kitchen, bumping into fittings and scrabbling for a way out until, eventually, they all secured their escapes.

This scene very much reminds me of the way the media are behaving at the moment – mirrored entirely by the microcosm of Twitter – where they are all over the place, scrabbling in every direction. Not yet have they come to the point where they can define a single direction and escape. I doubt they ever will.

The problem, as I begin to see it, is that they are very good at collecting information – which is unsurprising: that is what they do. But they are very, very bad at analysing what they get, or understanding the implications. And that, unfortunately, means that much of their output is simply noise.

One good example is a story run by the Guardian on the under-use of the Nightingale Hospital in London, attributed to the shortage of critical care nurses.

Quick off the mark, the Telegraph has copied out the story but, reinforcing the Leveson assertion that journalists have "a powerful reputation for accuracy", has illustrated its version with a picture captioned, "The Nightingale hospital in London". It shows the conference centre in Harrogate, conveniently signed as the "Yorkshire and the Humber" Nightingale.

What is important about the Guardian story though - beyond the basic facts that tell us that dozens of patients with Covid-19 have been turned away from the London facility because it has too few nurses to treat them – is the response of an NHS London spokesman.

He says that, "There remains spare capacity in the critical care network across the capital to look after all coronavirus patients and others who need our care, and while it is incredibly reassuring for both staff and patients to have backup capacity at the Nightingale to alleviate pressure on ICU departments where needed, patients can be transferred to other hospitals in the city if they are better placed to receive them at that time – as is always the case".

Although this confirms what we already knew, it is useful to have the affirmation that this and presumably the other Nightingales are being used as overspill facilities rather than as the front line in the care of Covid-19 victims.

This comes at a time when we see a report from a Welsh newspaper recounting how two elderly women had been admitted to hospital after suffering falls where both had contracted the virus and died. This is an issue about which I have written earlier, remarking that the few reports we had seen of nosocomial infection were most likely the tip of an iceberg.

Interestingly, I have found a paper recording Chinese experience, where the proportion of nosocomial infection in patients with Covid-19 was 44 percent, affecting not only patients but staff, mainly doctors and nurses.

With a lifetime of experience in this subject, I have long been an advocate of hygiene by design, rather than relying solely on the slender thread of operational procedures. And while precautions are being taken in NHS units, it is almost impossible to prevent transmission in a typical (or any) district general hospital.

Typically, without the pressure of the Covid-19 epidemic, NHS district hospitals generate nosocomial infection rates of around ten percent, rendering them the largest single sources of infection within the communities they serve. And although many infections are minor, and suppressed with doses of antibiotics, many are not, leading to ward closures and sometimes the closure of whole hospitals.

With that as the normal background, the idea that the highly infectious SARS-Cov-2 virus can be contained in a district general hospital is absurd – and demonstrably so. In my earlier piece I recorded that the Chinese had abandoned the practice of treating victims in general hospitals. Instead, they had built so-called shelter hospitals in open areas such as stadiums or exhibition centres – with spectacularly successful results.

But not only is the NHS apparently failing to learn from this experience, we also have the double whammy of patients who urgently need treatment for issues unrelated to Covid-19 being unable to get care, either because it is unsafe for them to do so, or because the facilities have been diverted to the treatment of Covid-19 patients.

Yet, as the media reports more evidence of the misuse of the Nightingale hospitals, and the Mail headlines that 2,700 cancers are being missed each week because the NHS has been turned into the National Covid Service, it fails to join the dots and remark on the conceptual failures that are dominating the UK response to Covid-19.

Both patients and staff, I wrote earlier, are paying the price for what is an episode of monumental stupidity that almost beggars description. This stupidity continues, but the media hasn't even noticed. Instead, we see the scattergun approach, with a wide range of stories being followed with the lack of any unifying theme.

What seriously pisses me off, though, is the response of the Twitter "community". My earlier piece on nosocomial infection attracted 14 "retweets" and 17 "likes". In terms of "likes", a picture of my garden did far better, recording a grand total of 32.

While this blog readership remains healthy, with yesterday's post reaching a new record of 110,198 hits, both Pete and I are considering abandoning Twitter as a complete waste of time.

That said, the Guardian is at least picking up the pace on contact tracing, remarking in an editorial that the government needs to "get the basics right". Other democracies, it says, have kept death tolls low by using a combination of social distancing, tight travel restrictions, mass testing and contact tracing. Why can't the UK?

Specifically, when it comes to contact tracing, the paper opines that, "the longer we take to get mass testing and contact tracing going, the longer Britain is stuck in lockdown".

We then get a reference to Simon Clarke, local government minister, who was interviewed on the BBC Radio 4 Today programme yesterday. Says the Guardian, he did little for public confidence when he said it was not his job – despite being the local government minister – to press council health workers into a contact tracing programme.

Herein lies another conceptual failure. Whether pandemic or epidemic, this illness comprises multiple outbreaks, some large and some small. Each are locally focused and must be dealt with locally, even if the aggregate effort has to be directed centrally.

This is illustrated in a remarkable piece from Reuters which reports on the attention to detail that is required in the prevention of infectious disease on the ground.

This epidemic simply cannot be resolved by ministers sitting in their Whitehall offices, trying to orchestrate the response – still less by ivory tower academics crunching numbers on their computers in the manner of juju doctors with their rattles of bone.

Nor even can we rely on the self-appointed experts and the "leading scientists" whom the media so love to quote. If we are ever to return to normal, it will be shoe-leather epidemiology which does the job, tracking down real-life infected humans and taking them out of circulation.

With no sign of the government understanding this, only the media has the power to push them in the right direction. But the chances of that happening seem remote, as they skate around the subject like startled cats.