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Coronavirus: a change of pace?

2020-03-15 07:12:26

Working from basic principles, from what I've been taught and put into practice, yesterday I advanced the view that, in order to bring this Covid-19 epidemic under control, the first and urgent need was "the rapid identification (and confirmation) of the sources of infection".

Identification, of course, requires testing. And those who are shown to be positive must be isolated from the population until they have ceased to shed the infective virus.

Then, I write, bearing in mind that these people may have infected others before being removed from the infection chain, one must carry out a rapid process of contact tracing, with testing to establish whether they have been infected, and isolation of those who are infective.

This is about breaking the chain of infection and is such a fundamental process that one would barely have thought it necessary to state it. Yet, not only does one get shouted down on Twitter for saying so (or ignored), the progenitors of an obviously flawed control policy still have the support of the overwhelming majority of the public.

Yet, here we have the WHO saying effectively the same thing that I've been writing. Countries, it says, should find and test every case of coronavirus to stop the pandemic.

"You can’t fight a virus if you don’t know where it is", the WHO's director general, Dr Tedros Adhanom Ghebreyesus, said at a briefing on Friday. "Find, isolate, test and treat every case to break the chains of Covid transmission. Every case we find and treat limits the expansion of the disease".

However, Johnson's administration has declared that it will no longer try to "track and trace" everyone suspected of having the virus. Instead, testing is to be limited to patients in hospital with serious breathing problems.

As to those who think they are suffering the illness, they are told not to contact the NHS helpline or even their GP. They are merely told to go away and be ill in their own homes – but only for seven days, which is actually far too short.

Thus, despite this being a notifiable disease, the bulk of the disease – with the encouragement of the government – will not actually be notified. There is no formal contact tracing and no quarantine of families, so those who pick up the virus from sufferers are free to wander abroad, potentially infecting all those the meet.

I simply cannot emphasise enough, or often enough, how wrong that is. This is not a question of fine judgement or choice between widely accepted options. This is a denial of the basic, established principles of outbreak control. The government is ignoring the wisdom of thousands of practitioners over the years, who have learned what works and what doesn't and passed their knowledge down the generations for it to become the established practice.

Instead, it seems, we get the "modellers", this breed of people who sit in their offices feeding incomplete data into their computers, making assumptions based on questionable theories, only to churn out the inevitable "garbage" which comes from putting in garbage.

And here, it should be very obvious to anyone with half a brain that, if you are going out of your way not to test patients, and then trace and test contacts, you are essentially flying blind. No amount of computer modelling will help you predict the coming shape of the epidemic because you are not gathering the information needed.

Then, of course, you get the other end of the spectrum, with self-important analysts playing with their computers to come up with statements of the bleedin' obvious, for instance that additional healthcare provision is needed to reduce the number of deaths.

However, with the Daily Mail already reporting that hospitals could stop treating the most severely ill coronavirus victims if the outbreak escalates, resulting in patients with a poor prognosis being taken off ventilators in favour of those with better survival chances, it seems that the government might be waking up to the extent of the crisis which threatens to engulf us.

This might, of course, have something to do with the fact that there were 1,140 confirmed cases of Covid-19 reported in the UK yesterday, up from 798 the previous day, with 342 additional cases making for another record increase. We are now seeing cases double every three days.

The Sunday Times believes this and the government's new-found enthusiasm for action is related, while another factor might be the Guardian's Opinium poll. It finds that only 36 percent of respondents trust Johnson in his handling of the epidemic.

What the government has in mind, according to Robert Peston (and now picked up by other newspapers), are a number of measures which would include enforced isolation of people over 70, who will be ordered to stay at home or in care homes for four months.

Then, in a "wartime-style" mobilisation effort, the government is planning to requisition hotels and other buildings as temporary hospitals, as well as taking over private hospitals. Army hospitals will be used.

The government will also order the temporary closure of pubs, bars and restaurants - some time after next weekend's ban on mass gatherings – and the closure of schools for perhaps a few weeks, but with skeleton staff kept on to provide childcare for key workers in the NHS and police.

On top of that, we are to see a number of companies being asked turn over production facilities to the emergency manufacture of ventilators, as a Europe-wide hunt takes place for additional machines. Germany, it appears, has ordered an additional 10,000 ventilators from a domestic supplier.

In Italy, where cases have now reached 17,660 and 1,328 patients have died, the country's only producer of ventilators, Siare Engineering, has been asked by the government to ramp up production from 125 to 500 units a month.

All this should have been in hand weeks, if not months ago, and if the UK government is planning to launch a programme of setting up emergency hospitals, it has yet to specify how it will staff them, especially as the NHS is chronically short of staff.

One almost imagines, though, that ministers and officials have been reading this blog as they say that what keeps them awake at night is the fear that if the epidemic becomes too great they would have to make appalling decisions, such as that the NHS would stop treating people over a certain age, such as 65.

"Everything is aimed at making sure the NHS is not overwhelmed, to save lives and to prevent hideous choices having to be made", an anonymous source tells Peston.

Some of this seems to be confirmed by health secretary Matt Hancock. In an authored piece in the fanboy gazette, he first takes time out to deny that the government is pursuing herd immunity as a goal or strategy. "Our goal is to protect life from this virus, our strategy is to protect the most vulnerable and protect the NHS through contain, delay, research and mitigate", he writes.

He then talks of a "call to arms" for a drive to build the ventilators and other equipment the NHS will need. "We now need any manufacturers to transform their production lines to make ventilators. We cannot make too many", he says.

Then, in the planning is what he calls measures to "shield" older and medically vulnerable people from the virus, with everyone being given "help to ensure they get the support they need to stay at home, and to protect them from the consequences of isolation".

In the coming week, we will see an emergency bill, "to give the government the temporary powers we will need to help everyone get through this", which – according to the Mail on Sunday - will have the Army on the streets guarding hospitals and supermarkets.

Thus, despite the obvious and very glaring deficiencies in the government's handling of this epidemic, there is at last a feeling that Johnson and his crew are beginning to take it seriously. One can only hope that what little is on offer will not be too late, while we still wait for further improvements.