Mass
testing means lower fatality rates from coronavirus because it allows
detection of Covid-19 even in patients who suffer few or no symptoms,
and who have a much better chance of survival.
The
nose and the back of the throat are the two sites where the virus
replicates. Swab tests are taken to the pathology lab and used to
match the genetic material captured with the genetic code of
Covid-19.
Medical
staff taking the samples need to wear personal protective equipment
including gloves, gowns, masks and face shields.. I was horrified to
hear from a friend working as a hospital doctor that they are short
of these PPEs. But never mind because Boris Johnson assures us that
mass testing for Coronavirus is ‘coming down the track’ and will
be taking place ‘as soon as possible’.
As
I wrote yesterday, pathology labs in Germany have been conducting
about 160,000 coronavirus tests every week. In the UK they average
less than half that. And the pathology labs which undertake all this
have been undergoing privatisation for over twenty years.
The
Tony Blair / Gordon Brown governments reduced the number of hospitals
that had their own pathology services and initiated their
privatisation. Under the ‘hub and spoke’ model NHS trusts were
encouraged into partnerships with private companies.
Pathology
Clinitician, Denise Cooke, at Frimley NHS Foundation Trust has said,
“The big difference with an NHS-led pathology service is the
add-ons you get with it … So you absolutely get a clinically-led
service and that is not something you have to contract for or buy,
that is just the nature of the beast … On top of that you get all
the other things the NHS offers; so there is a very supportive
training and education programme … And then there is the ethos of
it. The public sector is about doing good for the public, it is about
making good use of taxpayers’ money for the public good … I think
there is a different ethos in the private sector … I’d say 99.9%
of people working in NHS pathology don’t do it for the money –
they have some connection with the NHS and what it strives for and
its reason for being.”
Here
are just a few of the private companies involved today with our
pathology labs:
Viapath
(Serco) who have been found to overcharge the NHS for diagnostic
testing amid allegations of cost-cutting and clinical failings.
Senior consultants have claimed that staff cuts and a lack of
investment since privatisation have left some laboratories close to
disaster. One claimed that Viapath had an “inherent inability… to
understand that you cannot cut corners and put cost saving above
quality.”
Integrated
Pathology Partnerships who were accused by Public Health England of
running NHS labs with quality weaknesses. They concluded that: 'A
number of working practices, particularly within the laboratory,
compromise service quality and potentially patient safety'.
Synlab
who were excluded from providing pathology services to Royal Free
London and UCLH as the company lied - the company said it was in the
process of developing a laboratory close to the two hospitals which
would meet the requirements of the tender, but this was not true.
Other
private companies involved today in NHS labs are, Alliance Medical,
InHealth, Health Services Laboratory, Sodexho, Life Healthcare, The
Doctors Laboratory Ltd and Mediscan Diagnostic Services. There are
more.
A
survey of 103 histopathology departments conducted in 2017 by the
Royal College of Pathologists, found that only 3% said they had
enough staff to meet the current clinical demand. 45% of departments
had to outsource work, while half of the departments were forced to
use more expensive temporary workers.
I
worry about what is really ‘coming down the tracks’.
The
coronavirus crisis has hit Germany with full force. Infections are
increasing rapidly with schools, factories and bars closed across the
country. According to data from Johns Hopkins University, there were
13,979 coronavirus infections in Germany on Thursday afternoon, (19
March) more than in any other country except China, Italy, Iran and
Spain.
But
Germany has only registered 52 deaths (20 March). Neighbouring
France, by contrast, reports 243 deaths. Spain has had 803 deaths.
The US, the UK and Italy all show case fatality rates significantly
higher than Germany.
WHY?
In
Germany there have been a high number of tests with laboratories
conducting about 160,000 coronavirus tests every week.
Mass
testing means lower fatality rate because it allows detection of
Covid-19 even in patients who suffer few or no symptoms, and who have
a much better chance of survival.
Experts
also point out that Germany now has the chance to prepare for a surge
in serious infections, with hospitals across the country expanding
intensive care capacity and boosting staff numbers and with a
government buying up as much critical equipment as it can.
Meanwhile
here in the UK Boris Johnson has set our minds at rest by announcing
yesterday ( 21 March) that good stuff is on its way.
“to
give you an idea of what is coming down the track, we’re in
negotiations today to buy a so-called antibody test, as simple as a
pregnancy test which can tell whether you have had the disease and
it’s early days, but if it works as its proponents claim, then we
will buy literally hundreds of thousands of these kits as soon as
practicable. Because obviously it has the potential to be a total
game changer.”
So
for the UK it is ‘‘negotiations’. ‘early days’, ‘as soon
as practical’ and ‘potential’ game changers.
We
have no idea how the Coronavirus epidemic will develop over the
coming weeks / months. We can say that since 2012 there have been a
120,000 deaths in the UK due to austerity policies.
Information
above comes from a FT article which is is here:
Barcelona
residents in Coronavirus lockdown bang pots and pans from their
windows and balconies. On 18 March protests were being held across
Spain to demand that Felipe VI's father, King Emeritus Juan Carlos I,
donate more than 100 million Euros to the public health authorities
amid the COVID-19 outbreak, an amount he reportedly received as a
donation from the Saudi monarchy.
This
comes from a tradition known in this country as ‘Rough Musiking’
- raucous noise used in protest against kings and queens, landlords,
tax collectors and other oppressors of the people!
I
remember helping organise the banging of drums, bells, cymbals and
other percussion instruments outside Westminster Cathedral when Tony
Blair was giving a ‘faith’ lecture there.
Who
would you like to ‘rough musik’ while we are in our Coronavirus
lockdown? Any ideas of who should donate their ill-gotten gains to
the NHS?
Boris
Johnson speaking on 15 March 2020 We are not, repeating not,
closing schools now. The scientific advice is that this could do more
harm than good at this time.
Boris
Johnson speaking on 16 March 2020 We think it’s much better
that we keep schools open for all sorts of reasons.
Boris
Johnson speaking on 18 March 2020 We think that now we must
apply downward pressure on that upward curve by closing the schools.
Every
time Johnson talks about his government policy on Coronavirus he
repeats these three words, “The scientific advice.”
What
is this newly discovered science of ‘upward / downward curves'
children? Put your hand down Johnson. You haven’t a clue.
“The
United Kingdom has an enviable reputation for resilience. In a
rapidly changing world, we are at the forefront of embracing new
opportunities and seeking innovative solutions to emerging problems.”
Foreword to Cabinet Office National Risk Register of Civil
Emergencies, 2017
In
the three years since its publication let us examine the innovative
solutions to the most recent ‘emerging problem', the COVID-19,
Coronavirus outbreak.
VENTILATORS:
These assist respiratory functions, pumping oxygen into the blood for
vital organs. They are the main supportive treatment for critical
stage COVID-19 patients.
Health
Secretary, Matt Hancock said he could not make guarantees that
everyone who requires a ventilator will get one, saying: “We don’t
make guarantees in healthcare”.
Dr
Chaand Nagpaul, Chairman of the British Medical Association says UK’s
lack of ventilators “is a result of a decade of under-funding”.
Former
NHS trust chairman Roy Lilley has said, “I mean we’ve seen this
coming. It’s pretty obvious we were going to need more ventilators
and somehow or other, either we’ve been left flat foot and haven’t
started to buy them quickly enough or we’ve tried to buy them and
they’re just not there.”
HOSPITAL
BEDS: Chairman of the British Medical Association, Dr Chaand Nagpaul,
said the UK has about “a quarter of the critical care beds that
Germany has and that the country’s “starting position
unfortunately has been far worse than many other of our European
nations”.
Europe
is the third biggest manufacturer of hospital beds after New Zealand
and the USA. Former NHS trust chairman Roy Lilley said “This is
capital equipment and the hospitals won’t have been buying them”.
He doubted European producers would sell to the UK now we are leaving
the EU.
PROTECTIVE
CLOTHING: The Times reports that, “frontline hospital staff fear
that doctors and nurses will die because of NHS guidance that they do
not need to wear full protective equipment when caring for virus
patients.”
TESTING:
The World Health Organization has criticised the approach of
countries like the UK that are not prioritising testing, with its
director General, Tedros Adhanom, saying “you cannot fight a fire
blindfolded … test, test, test”. The Guardian reports that a
junior doctor in an emergency assessment unit has started a petition
called “Test frontline NHS staff for Covid-19 as a priority”,
which has so far attracted nearly 700,000 signatures.
The
UK government’s chief scientific adviser, Sir Patrick Vallance was
asked if the UK should have mass testing on the scale of South Korea
which has tested more than 250,000 people out of a population of 51
million, and is bringing infections down. He replied, : “I think we
need a big increase in testing. That’s what I’m pushing for very
hard.”
PRIVATE
HOSPITALS: Spain and Portugal have led the way by requisitioning
private hospitals, their equipment and staff. The UK are going to pay
£2.5 million a day to ‘buy in’ these facilities.
LOSS
OF EARNINGS: In the UK those who have lost their incomes are entitled
to £94 a week. The Irish government is giving workers who have lost
their incomes the Euro equivalent of £203 a week. The generous UK
‘scheme’ doesn’t even cover the many phony self-employed. Firms
like DPD, a delivery company, is insisting that employees who
self-isolate will still have to pay the costs of renting vans and
equipment. And have I mentioned the homeless? It’s impossible to
voluntarily self-isolate if you are sleeping on the street. The state
should requisition hotels for the homeless. There they can be be fed,
kept warm and offered medical assistance.
CLOSING
SCHOOLS: The government’s reason for keeping schools open is that
working parents will be deprived of the free childcare they provide.
Schools across Europe are closed. In Boris Johnson logic it is better
for children to travel to school, mix with each other, come into
close contact with dozens of adults and spread the virus.
If
Jeremy Corbyn were PM today millions would feel more secure. Even
journalists like Robert Peston who spent years attacking him is now
making the case for something resembling a socialist response to the
crisis.
“ ‘Community
organising’ is one of the platitudes frequently offered when
someone is bereft of political ideas. It is hard to do and often very
dull. This time it is different.” As one Tory minister put it to
Peston, these principles imply that Boris Johnson will almost
certainly have to oversee a Government that for a good year or maybe
longer will look quite socialist. The Minister added, 'We'll find
ourselves implementing most of Jeremy Corbyn's programme'.
Boris
Johnson told business leaders yesterday that the effort to
manufacture more ventilators could be called “Last Gasp’.
Meanwhile the company ready and willing to make millions of them has
not received one order from the NHS. What a joker.
The
‘government’ is going to pay over £2.5 million a day to use
private hospital beds. Meanwhile the Spanish have requisitioned them.
This means the private health companies will make a profit out of the
pandemic. Coincidence or planned?
Theatres
are ‘advised’ to close but not ordered to. This means they cannot
operate insurance cover and many smaller venues and theatre companies
will go the wall, but hey a business opportunity for new property
development. Coincidence or planned?
The
UK is second from bottom in Europe for level of support to ill
workers. In France, employees can exercise what is known as “the
right of withdrawal” from work by walking off the job if they
believe their health and safety are at risk, without having wages
docked or facing punishment. In the UK no such luck with just £94.25
a week sick pay.
Meanwhile
non-tax payer Richard ‘hold em to Ransom‘ Branson asks for
£billions as airline ‘Coronavirus compensation’.
As
the Italians say (who are increasingly on strike over all this) BASTA
- enough. My Jewish friends would add ‘already’.
Keep well
and if you are able to, don’t get upset - organise.
Need
more information than you can get from MSN. Here are a few websites/
Facebooks for you. Twitter is also a useful source of information and
debate
William
Hannage, Professor of Epidemiology at Harvard University, says of
the UK, “Your house is on fire, and the people whom you have
trusted with your care are not trying to put it out ….the UK
government has inexplicably chosen to encourage the flames, in the
misguided notion that somehow they will be able to control them. I
assumed that reports of the UK policy (on Coronavirus) were satire
– an example of the wry humour for which the country is famed.
But they are all too real.”
This
fire is taking place while the Cardinal Richelieu of the Boris
Johnson regime, Dominic Cummings, sits at the centre of government
policy.
Cummings
wrote in a blog in 2016 that he is 'particularly interested in
public health and the field of epidemiology … It is already the
case that farmers use genomes to make predictions about cows’
properties and behaviour … It is already the case that in vitro
fertilisation can select the egg which will be most advantageous
with the highest prediction for IQ.’
These
are the thoughts and words of Boris Johnson’s senior adviser.
They
say judge a man by his friends. Cummings had Andrew Sabisky
appointed as his subordinate. A step too far when it emerged that
he had made comments in support of eugenics, and the relative
intellects of black and white Americans.. He resigned.
But
Cummings admits to a strong continuing friendship with Stephen Hsu,
a theoretical physicist who is currently searching for an
intelligence gene. Even though mainstream science has pretty much
scrapped the notion that race has any kind of biological basis long
ago, that hasn’t stopped Hsu from trying to link intelligence
with race .
So
Cummings, Sabisky, Hsu and we must assume Boris Johnson, are
eugenicists, believing in the practice of selection of ‘desirable’
traits for the ‘improvement’ of humans.
And
today their beliefs lie behind the “Herd’ policy of allowing
the Coronavirus to take its course and thereby dictating the
outcome of your and my fate.
Anthony
Costello, Professor of International Child Health and Director of
the University College London Institute for Global Health,
questioned the tactics behind the ‘Herd’ policy and argues they
are against the policy set down by WHO. He tweeted a series of
questions showing scepticism, including: 'Will it impair efforts to
restrict the immediate epidemic, and cause more infections and
deaths in the near term? He also questioned whether coronavirus
causes strong herd immunity or is it more like flu where new
strains emerge each year needing repeat vaccines?
We
like to criticise China as a totalitarian regime but there the
epidemic has been contained after seven weeks of intense national
effort, and by NOT following the ‘Herd Eugenicists’.
I
am not happy with Cummings and his friends having any say in my
possible mortality. Are you?
Here
are a few comments from leading medical professionals about the
Coronavirus crisis.
The
chairman of the British Medical Association, Dr Chaand Nagpaul ...
"Our starting position unfortunately has been far worse than
many other of our European nations – we have about a quarter of the
critical care beds that Germany has, as an example, so it’s really
critical, it’s really important that we now see transparently what
plans the government has to expand that capacity … And one of the
most immediate priorities of course is we don’t have enough
doctors. Before the outbreak we were 10,000 doctors short, so we’re
very worried and the doctors I represent are very concerned that they
don’t, for example, have adequate protection.”
Professor
John Ashton, a former regional director of public health for
north-west England ... “Right at the beginning of February Hong
Kong adopted a total approach to this, which is what we should have
done five weeks ago ourselves. They took a decision to work to three
principles – of responding promptly, staying alert, working in an
open and transparent manner … Our lot haven’t been working openly
and transparently. They’ve been just dribbling out stuff. The chief
medical officer only appeared in public after about two weeks. Then
they have had a succession of people bobbing up and disappearing.
Public Health England has been almost invisible … Boris Johnson
should have convened Cobra himself over a month ago and had regular
meetings with the chief medical officer with the evidence. The thing
should have been fronted up nationally by one person who could be
regarded as the trusted voice and who could have been interrogated
regularly. That’s not happened … We have a superficial Prime
Minister who has got no grasp of public health … Our lot are
behaving like 19th-century colonialists playing a five-day game of
cricket ...This virus will find the weak points. You can’t just
plan this from an office in Whitehall. It’s pathetic. The
government doesn’t seem to understand classic public health. You
need to be out and about. You need to get your hands dirty – though
preferably gloved and using frequent gel ...The hospitals are full at
the moment, A&Es are full, beds are full, intensive care is full
… there will not be enough intensive facilities and people will
have to be home-nursed … What the government should have been doing
over these last weeks, which they’ve thrown away, is to encourage
neighbourhoods, communities, supported by the local public health
directors and a joined-up NHS … They should have been much clearer,
sooner, about making it clear that people shouldn’t be travelling
so they could cancel their holidays and get their money back on the
insurance. They haven’t done any of that. Who’s going to look
after elderly people – stop them having to go out, do their
shopping for them? People should have been doing that planning –
they should have been pointed in that direction by the government.
There’s been no discussion about that at all.”
Dr
Richard Horton, Editor The Lancet .... warns that we risk
sleepwalking into a hurricane as officials delay their response to an
escalating crisis. He said Health Secretary Matt Hancock and Boris
Johnson “claim they are following the science, but that is not true
… The evidence is clear. We need urgent implementation of social
distancing and closure policies. The government is playing roulette
with the public. This is a major error.” He goes on to provide
perspective. “Coronavirus has saturated the attention of
politicians, policy makers, journalists, and even medical journal
editors for several months now. There seems to be no end in sight.
But while we wrestle with the difference between containment and
delay, prospects for a vaccine, and the mental state of an American
President who wilfully ignores the advice of his own Centers for
Disease Control and Prevention, we should not forget the threat posed
by other viruses. We should especially not forget HIV. There have
been around 100 000 confirmed cases of coronavirus infection
worldwide. Yet please don’t neglect the fact that 38 million people
globally are living with HIV, including 1·7 million children under
15 years. 1·7 million people are newly infected with HIV annually.
6000 women aged 15–24 years are infected every week. Coronavirus is
reported to have killed fewer than 4000 people so far. Meanwhile, 770
000 people die every year from AIDS-related illnesses. We should
certainly take coronavirus very seriously indeed. But we must also
put this new pandemic in perspective. So far, we have not.”
Dr.
Dominic Pimenta, cardiologist and author ... “The N.H.S. has never
been in a worse state going into something like this ... The dominoes
have been stacked for 10 years. It wouldn’t have taken much to tip
them over.”
Dr.
Nick Scriven, former president of The Society for Acute Medicine ...
“We’re already at maximum capacity and clearing out beds as best
we can.”
Dr.
Ganesh Suntharalingam, President of the Intensive Care Society ...
“We do have the advantage of a unified health care system, but
we’re also starting from further behind the start block than other
countries because we historically have fewer intensive care beds per
population, and they tend to be more full.”
My
friend Dr Irial Eno writes ... "I don’t want to be alarmist or spread
panic, but there are some really important things about the
coronavirus that the public aren’t not being told, and I fear that
as a country we are not acting quick enough and are sleepwalking into
a disaster. The following are my opinions but are supplemented by the
opinions or experiences of experts in this field.
Hundreds of
scientists have already criticised the government's strategy, with
240 signing an open
letter: https://www.ft.com/con…/f3136d0a-663e-11ea-800d-da70cff6e4d3,
and hundreds of behavioural scientists have said the issue of
'isolation fatigue' is not a reason to delay urgent isolation
measures: https://sites.google.com/view/covidopenletter/home
It
is important to start by saying that for young and healthy people,
the virus will most likely be either asymptomatic (you will not feel
unwell) or resemble a flu. It is not us who are at risk. It is the
older and unwell people in society who will be affected. In these
groups, it is not just like the flu. In these age groups the fatality
rates (‘FR’, the % of people with the infection who die) are high
– data suggests the over 70s have a FR of 8%, whilst in the over
80s it is ~15%; cardiovascular disease leads to a 11% FR, diabetes
7%... i.e. roughly 1 in 10 of those infected across these groups will
die.
We appear to be on exactly the same trajectory as Italy.
Our cases are increasing exponentially, and we are now at roughly the
same caseload when Italy began to quarantine certain areas two weeks
ago. Despite the measures they took, which some considered drastic at
the time, they are still completely overwhelmed.They do not have the facilities to care for everyone so are having to
triage patients in a desperate way: “Patients above 65 or younger
with comorbidities are not even assessed by ITU”. Read that again…
they are not even being assessed. They are so overwhelmed that people
over 65 or with comorbidities (other illnesses) are not even being
considered for advanced treatment.
Italy has one of the best
healthcare systems in Europe (public healthcare, properly funded!)
and as you can see from the above series of tweets they are unable to
cope with the situation they are now in.
The World Health
Organisation stated yesterday: “Our message to countries continues
to be: you must take a comprehensive approach to fight. Not testing
alone. Not contact tracing alone. Not quarantine alone. Not social
distancing alone. Do it all”. In the UK we are not doing it all,
and the WHO have expressed surprise and concern about our
government’s approach.
Richard Horton, editor of the Lancet
(prestigious medical journal) agrees with many others across the
healthcare world in stating in a series of tweets: “The UK’s
policy is not evidence-based because it seems to be ignoring the most
important evidence from elsewhere”; “What is happening in Italy
is real and taking place now. Our government is not preparing us for
that reality. We need immediate and assertive social distancing and
closure policies. We need to prepare the NHS. This is a serious
plea”; and, “The government is playing roulette with the public.
This is a major error.”
We need social distancing now. We need
drastic measures. Every day that we delay this represents a ~40%
increase in the total number of cases. The number of new cases per
day in the UK so far reflects this… Thursday 595, yesterday 798,
today 1,140. We are right at the start of the epidemic curve and in a
strong position to curtail it (see theoretical sketch attached).
Without doing anything, numbers of cases will continue to grow
rapidly.
Please consider the following individual actions. (Of
course, for some of you, these measures will be impossible because of
structural societal factors e.g. insecure employment or
accommodation. This highlights more than ever the need for much wider
social and political change, and we must pay attention to this need
from the unfolding crisis):
- Social distancing. Don’t go to
events with more than 20 people, avoid crowded places – public
transport, pubs etc. This is especially important if you are older or
have underlying health conditions, or if you spend time with people
in this group.
- Cancel larger events/meetings.
- Do not go
and visit elderly/at-risk friends or relatives.
- Try organising
within your workplace to see if it’s possible to work from home.
-
Stay home if you have any respiratory systems at all (cough,
shortness of breath, sore throat, runny nose, sneezing) or fever or
general malaise. Don’t let yourself be bullied by bosses or made to
feel bad for taking time off. It is not worth the risk.
- Wash
your hands a lot, or clean with hand gel if not possible. Especially
important before eating/touching your face.
This might all sound
over-the-top, and this is not going to be fun, but the better we deal
with this now the sooner we can go back to normal. I would so much
rather us be extra-cautious now than look back in several months with
regret.
There are loads of beautiful acts of community
solidarity, and things you can do to help out in your area, such as
posting this Viral Kindness card through your neighbour’s
doors.
Lastly, please make sure you are getting your information
from trustworthy sources. I’ve seen so much quack science recently…
false information about the symptoms of the disease, checking if
you’ve got it by holding your breath, false treatment advice such
as putting garlic cloves up your nose. It can be hard to know where
to look if you don’t have a scientific background. Stick to sites
such as the NHS for advice. I’m off work for the next few days –
if you want to ask any questions I can try to help.
Stay safe,
be sensible. Do it for our elders and those most at risk."
Meanwhile
Richard Branson wants £3.5 billion to keep Virgin Atlantic ‘healthy’
… You couldn’t make it up.