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Coronavirus: a question of responsibility

2020-03-11 06:43:28

There were several pieces I could have written for today's post, and I was sorely tempted to deal with this thoroughly dishonest article in the fanboy gazette about deregulation. I may yet return to it, as it typifies much of what I hate about Toryboy zealots.

What tilted the balance in favour of yet another coronavirus piece, though, was this clip from the Victoria Derbyshire show yesterday, which – albeit unwittingly – makes the point that I raised in Monday's post about dealing with the need to expand our ICU (critical care) provision.

There, I referred to wartime Henry Ford who was asked to build mass-production factories in order to increase the number of aircraft coming on-stream. Interestingly, here is the film, made at the time, explaining how he did it (outtake illustrated above). By 1944, he was producing B-24 Liberator bombers at a rate of one every 100 minutes, seven days a week, eventually producing them faster than the USAAF could use them. Over 400 ended up being scrapped without ever having seen service.

Compare and contrast with the Victoria Derbyshire clip which features Ron Daniels, a consultant in intensive care, telling us that the UK cannot increase its ICU capacity "rapidly enough" to deal with levels of coronavirus patients. Apart from anything else, he says, "We're not going to suddenly find 10,000 extra intensive care nurses".

"We cannot escalate our capacity rapidly enough" to accommodate the patients in this epidemic, he says. And when asked by Derbyshire whether the NHS was ready for the epidemic, Daniels answered, "We're doing what we can with the resources available to be ready" but if the case predictions are accurate, he says, "then we're never going to be ready".

The point that emerges is that, when the USAAF wanted to ramp up bomber production, it took the job away from the aircraft manufacturers and gave it to Ford - a car-maker. The "experts" in plane-making, when it turns out, were not very expert in making aircraft in a hurry. Similarly, I would aver, if you want to ramp up intensive care provision, the very last thing you do is ask an intensive care consultant.

This, would seem to play to the Gove-like anti-expert tendency, but it doesn't really. If I was to be treated in an intensive care unit, then I would doubtless want to be in the care of experts such as Mr Daniels, but it is probably the very fact that he is an expert that rules him out from pronouncing on how to speed up the service. He is not able to think outside the box.

Daniels admits that, under current circumstances, the NHS is "never going to be ready", and patients are going to go untreated. But if we change the parameters, things could look very different.

Thus, in this emergency, the issue should not be how to deliver high quality care, consistently to all patients who are presented for treatment, as is undoubtedly Mr Daniels's aim, but how to save as many lives as possible. And turning away the majority of patients untreated, reserving high quality care to the lucky (or privileged) few, is not the answer.

Instead, we need to look at a "good enough" service that, on balance, will save significantly more lives overall than would have been the case had modifications not been made.

In my earlier post, I suggested that the job could be standardised and broken down into component parts, with tasks allocated to "crews" who can perform with considerably less training and without experience. Thus, when Mr Daniels refers to the need for an extra 10,000 nurses, the response is that we don't need that many.

For instance, current practice demands a nurse-to-patient ratio of 1:1, and a ratio of 2:1 in high dependency units. Dealing with what amounts to a "standard" illness, however, technicians can deal with the bulk of the tasks, leaving – by way of example – one fully trained and experienced nurse to supervise ten patients rather than one.

One can make a parallel here with wartime combat medics. Ideally, it would be nice to have a fully-trained doctor attached to every platoon in the front line, but there were never enough doctors to go round. Thus, combat medics were used, some with only the most basic of training. Lives could have been saved with more doctors, but more lives were saved by having medics than by not having them.

The trouble is that, to take such an approach requires vision, determination and considerable courage – generically known as leadership. It needs someone who can transcend the limitations of his advisers and think about what should be done, rather than what he is told can (and can't) be done. This, I suppose, is the difference between a Churchill and a Chamberlain.

Unfortunately, in Johnson, we seem to have someone much closer to Chamberlain than the revered war leader, as brought into high focus by John Crace, who remarks on how ill-at-ease the prime minister is in dealing with a situation for which, quite obviously, he is ill-equipped.

One can actually see why the man is more at home delivering folksy health education lectures on personal hygiene, or addressing flood victims in Bewdley, weeks after the event. Unable to step outside his comfort zone, he is leading the race to the bottom.

Yet, for all that, it really is quite staggering that the fanboy gazette continues to leap to the defence of its man, even when it is painfully evident that he is not up to the job.

In an editorial headed "Sensible, proportionate behaviour is the way to respond to Covid-19", it tells us that, the Government's approach "is guided by the knowledge that the NHS doesn't have the spare capacity to deal with an outbreak of Italian proportions". Thus, it declares, "it is relying on people behaving sensibly and acting proportionately, virtues with which most of our readers would no doubt concur".

What that amounts to is that the government knows the NHS can't cope, so Johnson is hoping the epidemic will go away all by itself, as long as we all take "sensible, proportionate behaviour", like – presumably - washing our hands.

In effect, the Telegraph, and by inference the government of which it is so supportive, is seeking to convert a government responsibility into a personal one. If the epidemic escalates to the Italian level - with the death toll increased by more than a third, up by 168 to 631, and rising – then it is our fault. The government is not to blame.

I am sure that overworked Italian doctors at the epicentre of Italy’s coronavirus crisis will be sympathetic to that line. They are warning that they are being forced to overlook older, sicker patients to focus on those who are younger and more likely to survive. After all, if governments are not responsible for providing sufficient ICU facilities, then deaths through lack of facilities must be down to personal failings.

In that context, we now hear of health minister Nadine Dorries in isolation after testing positive for coronavirus. As she is an occasional visitor to No.10 and has been there recently, the disease is moving closer to the heart of government than is comfortable for its denizens.

Dorries herself, who is a symptomatic case, to her credit expresses concern about her 84-year-old mother who is staying with her and began with the cough today. But then the stupid woman spoils it all by signing off with: "Keep safe and keep washing those hands, everyone".

Since personal responsibility is all the vogue and the government puts such faith in hand-washing as a means of controlling the epidemic, I wonder, if it turns out that she has signed off what amounts to the death warrant of her mother, she will accept any personal responsibility. Could it have been because she didn't wash her hands often enough? 

And, further into this epidemic, when younger sufferers find that their elderly relatives, in the style of the Italian response, can't even get treatment, are they going to accept personal responsibility for the consequences? Will they accept that it is because of their lack of "sensible, proportionate behaviour"?  That is where the Telegraph is taking us,.

Or will they, as the body count begins to mount, be asking why the government has failed to perform the most basic of its functions – that of protecting the lives of its citizens. Johnson may want us to take responsibility, but I suspect most people will end up being less agreeable than the fanboy gazette.