"Not everything that is faced can be changed, but nothing can be changed until it is faced" - James Baldwin
Monday 23 March 2020
Medics Speak Out
are a few comments from leading medical professionals about 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.”
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.”
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.”
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
Nick Scriven, former president of The Society for Acute Medicine ...
“We’re already at maximum capacity and clearing out beds as best
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.”
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.
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
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
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
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.
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
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
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.
be sensible. Do it for our elders and those most at risk."
Richard Branson wants £3.5 billion to keep Virgin Atlantic ‘healthy’
… You couldn’t make it up.