Richard North, 28/04/2020  
 


Well, it seems that prime minister Johnson is back at work after his enforced absence and, in typical style has delivered a semi-literate collection of sound-bites, for want of a speech, presumably in an effort to re-energise the nation.

Frankly, though, his talk of "sheer grit and guts", with his gritted teeth and clenched fist, leaves me stone cold. This is not so much "true grit" as false grit. And I am left unmoved by his thanks for our "forbearance", our "good sense", "altruism" and "spirit of community". This is from a government which has sought (and failed) to manage this epidemic centrally, quite deliberately excluding a community response.

And, as always, we have to listen to the man's turgid propaganda as he goes through his "tractor production statistics" in the manner of a Communist despot, while he tells us that there have been fewer hospital admissions and Covid patients in ICUs. This, the man believes, constitutes "real signs now that we are passing through the peak".

With that, he couldn't resist one of his mind-numbing conflict homilies, telling us that, "If this virus were a physical assailant, an unexpected and invisible mugger … this is the moment when we have begun together to wrestle it to the floor".

Not only is this really naff, it signifies the distorted picture that must inhabit what passes for the prime minister's mind, in his attempt to visualise the threat that confronts us all. If he sees our collective role as one of wrestling the virus to the floor, there isn't a lot of hope for us.

But there are other clues that this man hasn't really managed to craft a valid mental construct to define this epidemic, signifying that he has no real understanding of what he is dealing with.

Ruminating on whether "is the time to go easy on those social distancing measures", he warns us of the risk of "a second spike" and of the "risk of losing control" of the virus, "letting the reproduction rate go back over one". This, he says, "would mean not only a new wave of death and disease but also an economic disaster".

There are several points here. His earlier reference to "passing through the peak", and of the "second spike", suggests that he still labours under the false premise that we are dealing with a single outbreak, conflating the term "epidemic" with "outbreak", as if they are synonyms – which they are not.

We have one epidemic but multiple outbreaks which means that his "peak" and any "spike" represent a composite of multiple events expressed in one curve which, for epidemiological purposes, is worthless.

The error is compounded when he tells us that he refuses "to throw away all the effort and the sacrifice of the British people" and "to risk a second major outbreak and huge loss of life and the overwhelming of the NHS". There will be no "second outbreak". Rather we will see the recrudescence of multiple outbreaks which have been temporarily suppressed by the lockdown.

More "tractor production" data follow as the man tells us that "we defied so many predictions: we did not run out of ventilators or ICU beds; we did not allow our NHS to collapse; and on the contrary we have so far collectively shielded our NHS so that our incredible doctors and nurses and healthcare staff have been able to shield all of us".

Needless to say, this is something of a partisan view. As we remarked yesterday, this has been achieved largely at the expense of the old and frail, turfed out in their thousands to make way for Covid-19 patients, the cancelling of routine operations and such trivial things as cancer treatment, and the very sensible aversion of the British public to be treated in the Covid infection centres which our hospitals have now become.

For this man, though, tractor production is all that matters, even if the tractors have no wheels. But wasn't this the man who didn't know the words of "The wheels of the bus …". Perhaps he really doesn't know that tractors need wheels.

Worst of all, Johnson has obviously bought into the "five tests" charade, set by Hancock for relaxing the lockdown. Never mind that the WHO set six tests, which included the minimisation of hotspot risks in vulnerable places such as nursing homes and, of course, hospitals. This, the man doesn't mention, presumably unwilling to cast aspersions on the holy NHS shrines.

And here the failure of Johnson to understand the dynamics of an epidemic really does show. We started off with the primary cases, where people picked up infection from abroad and brought it into this country. We then moved to the next stage where these people passed on their infection to people already in the UK, creating secondary cases.

But now, the disease has become established in hospitals and other institutions to become foci of infection, continually re-seeding their communities with the risk of the infectious staff and recovering patients feeding multiple outbreaks once the lockdown is relaxed. Thus, when Johnson talks of the "risk of losing control" of the virus, he is deluding himself – and us. We are not in control. And the moment the lockdown is relaxed, we will see a recrudescence of disease.

In one small glimmer of hope, though, we see an article in The Times which indicates that Nightingale hospitals are being lined up to become the primary centres for treating Covid-19 patients. The ten new hospitals would aim to care for as many coronavirus patients as possible allowing hospitals to be "Covid-free zones". If this is true, all we can say is, "about bloody time".

That aside, the rest of today's media is just as crass as the prime minister. The Times headlines Johnson's claim that "We're moving into the second phase of the battle", emphasising the martial tone of the prime minister. The Daily Mirror deludes itself with a headline declaring "Not much longer", telling us that Johnson is set to announce his lockdown exit strategy next week, and The Sun picks up on Johnson's delusion, with the headline: "Turning the tide", while the Telegraph picks Johnson telling us that it's "Time to fire up the engines".

If you can help protect our NHS, to save lives, says Johnson in his peroration, then he has no doubt that, when it comes to this epidemic, "we will beat it together". We will, he says, "come through this all the faster and the United Kingdom will emerge stronger than ever before".

But, rather than dribble out his faux optimism, Johnson would be better off reading the words of his own government spokesperson in response to the BBC Panorama programme last night on the failures to stockpile PPE for the holy NHS. Said the spokesperson, "the stockpile was designed for a flu pandemic" and "Covid-19 is a different disease with a higher hospitalisation rate".

There is as open an admission as you can get of my thesis that the government was preparing for the wrong disease. Planners were obsessed with pandemic flu, and nature sent us SARS.

Worryingly, just as the epidemic was beginning to take a hold, on 19 March, the government downgraded the status of Covid-19, removing it from the "High consequence infectious diseases" (HCID) category. This automatically reduced the level of PPE protection required, a decision that has cost multiple lives and which prevents hospital staff from being properly decontaminated when they leave infected areas.

To this, we can add the charge that the government's secret science group has "a shocking lack of expertise". The group, according to the Guardian, includes seven clinical academics, three microbiologists, seven modellers, two behavioural scientists with backgrounds in disasters and terrorism, one geneticist, one civil servant and two political advisers.

It lacks molecular virologists who could explain detailed pathogenic differences between Covid-19 and influenza. There is no intensive care expert or nursing leader, and no immunologist to examine whether this virus produces lasting and protective immunity.

Furthermore, there are no social scientists who could work on community engagement, nor a logistician, who would have expertise in planning for the delivery of supplies and resources during a pandemic. Neither are there any experts working at the frontline of the pandemic, such as those in public health, primary care and intensive care.

With the committee dominated by academics and modellers, lacking shoe-leather input, the prime minister is extremely badly advised. It is no wonder that he lacks any grasp of the basics. His advisors are so far detached from the "boots on the ground" realities of outbreak control that they must simply be feeding Johnson's fantasies about being in control.

But then, even in the realms of high science, there is potentially bad news. One research team is suggesting that antibody-dependent enhancement (ADE) could be playing a part in Covid-19 pathogenesis, an alarming process by which the virus uses antibodies to help it invade human cells, paradoxically increasing disease severity in an immunised population.

Perhaps this is why Vallance was so downbeat last week about the prospects for a vaccine, and it would serve to underline the faux optimism of the prime minister and his belief that we have things under control.

From the look of it, even in the Churchillian terms that The Dear Leader so loves, we haven't even reached the end of the beginning. As the Observer pointed out yesterday, we need local public health teams to take back control.






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