Corona viru

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What a difference a day makes!

On Sunday I posted about a likely shift in gear as the government responded to a growing chorus of concern about the scale of the response to COVID-19. I agonised over sharing a link to an article by Tomas Pueyo which painted a rather bleak picture and was urging radical action on social distancing immediately. I did not want to contribute to a growing sense of unease. Little did I know.

I have more confidence now and believe yesterday was merely an introduction of what is to come and that by the end of the week legislation will be in place to enforce a much more rigid programme of social distancing, nay social isolation.

The report from Imperial College London has focused policy makers minds with its projections of a quarter of a million deaths unless radical action is taken to slow the spread of the disease. This would overwhelm the NHS and involve medial staff making live or die decisions.

There were a number of criticisms one could make about yesterday’s speech and it is easy to snipe from the sidelines. however phrases about what we are “going to recommend” do not help. And suggesting what people do is too weak. There may not be the legislation to back up clear instructions at the moment but that should not prevent them from being given and it is a matter of days, maybe hours, before that legislation is in place.

Two things are absolutely clear:

  1. Social distancing should be taken really seriously. No social gatherings at all. There is plenty of guidance on this. One practical piece of advice, have a soap dispenser that you have to step over to get into your home. As soon as you come in from outside wash your hands before you touch anything. The virus can remain on surfaces for 72 hours+
  2. Isolated individuals and families, particularly the elderly, who do not have local support will need help from their neighbours. Such help is the right thing to do from a moral point of view but also from a public health point of view. If people are infected  and hungry they will go out. Unless they are critical hospitals will not be interested. There is not the infrastructure of public social care support to help them. It is going to come down to neighbours to help them maintain the isolation.

Yesterday was tantamount to a declaration of war. Like all wars it depends upon public servants to be won. Sometimes that is the soldier, this time those on the front line are doctors, nurses and a range of other healthcare workers. We should not however forget the private sector workers who are on the front line particularly those operating the supermarket tills and transport staff who interact with the hundreds of members of public every day.

What is crystal clear now is that time is of the essence, and no longer should we underestimate what a difference a day makes.

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Corona Virus

To date the Prime Minister has struck what feels like a sensible balance between recognising the seriousness of Covd-19 and reassuring people that the UK is in the best possible position to deal with the problem. Certainly he is a shining example of leadership when compared with his opposite number in the United States. It is interesting, in a year when health care was already a major election issue in the US, how the benefits of a free-at-the-point-of-use National Health Service are thrown in to sharp relief when a public health emergency occurs. 

One has to have sympathy with political leaders at the moment. We are all beginning to learn about the complexity of responding to a pandemic which seems to be highly contagious. Just adapting to the speed of change is itself a challenge with the infection rate roughly doubling every 6 days.

At the moment much is made by the PM about how the government is following the advice of the experts.  whenever he makes a statement to the nation about the disease he is flanked by the Chief Medical Officer and Chief Scientific Advisor. He is always careful to preface his words with a statement about how the government is being guided by the science.

Clearly the government must take account of the science. As so often President Trump is helpfully providing an excellent object lesson in what happens when you develop policy in a science free zone.

Having said this however, the policy response has to balance a whole host of factors which do not simply drop out of the epidemiological science. There are alternative strategies which might be adopted which all come with their own risks. Ultimately it is the politicians who decide what the policy response is and whilst I have real sympathy for them they cannot hide behind their advisors. It may be that the PM speaks so frequently about following the science because he thinks it will be reassuring to the public. And it is, however he should not think it is a get out of jail free card if the strategy, which seems markedly different to that being adopted in other places, proves to be wrong.

The government Corona Virus Action Plan seems all very sensible with a reassuring institutional infrastructure to provide guidance and leadership in managing the national response. There is also clear advice about what infected individuals need to do, how the virus is spreading and how the government is responding. Transparency and consistent messaging is vital in maintaining public confidence.

There is a growing chorus of concern however that the government are not taking drastic enough action quickly enough. It has been suggested that part of the strategy is to try to secure herd immunity as soon as possible. Without a vaccine this is likely to result in a  high level of mortality amongst older people. The pressure, from dissenting voices, or the rational tipping point for some version of lock down seems to be approaching fast. This weekend there are announcements about new legislation early next week that will impact everyone. 

One of the voices calling for early and drastic action is Tomas Pueyo. He has produced an article, “Corona virus: Why you must act now“, illustrated with a series of graphs showing the progression of the disease in different countries and what appear to be the most effective strategies to contain or delay the spread of the virus. Chart 7 is probably the most shocking giving some indication of the scale of the actual incidence of the virus as opposed to just the numbers of those who have died or tested positive. It shows that the scale of infection is quickly many times greater than the latter two figures might suggest.

I have never heard of this person, but he has been referenced quite widely including by Edward Luce, an excellent opinion writer in the Financial Times. I have checked some of the numbers he quotes with other reputable sources and they seem to be consistent. It is a sobering read. I suspect its urgent tone is about to be reflected in a gear change in the UK’s response. I suspect we are all about to lose a month or more of our social lives. Given the mortality rate amongst older people it is a small price to pay to keep our grand parents and older parents alive.

Finally, I have read a fair amount about this virus and as yet have heard no mention of raging diarrhea  as being one of the symptoms or outcomes. Of course the sale of toilet rolls may actually be a good proxy measure for the level of fear the virus is generating.