Monday 23 March 2020

Medics Speak Out


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:…/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:


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.



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