More on covid pandemic 2020-2?
Britain at the time of Our Plan to Rebuild – a strategy of sorts
I wouldn’t go to the extent of calling it a strategy, but things have changed slightly with the policy of restoring some aspects of life in Britain to the time before the start of the pandemic – what we are having to call the ‘new normal’, which has an indeterminate end.
This was introduced to the British people by means of a muddled and confused television broadcast by the Buffoon on Sunday evening 10th May (although with speculation about what he would say going on for the best part of a week before) and then a ‘detailed’ document – Our Plan to Rebuild – made public on the afternoon of the 11th May. (I’ve linked to an annotated version, where I’ve highlighted things which struck me as I read it. Might make quicker reading for those who don’t want to go through the 51 printed pages.)
Testing
As always pole position in these posts. Unfortunately not good news for the Buffoon and his government.
On 4th May, Grant Shapps, the Transport Secretary, admitted that;
‘If we had had 100,000 test capacity before this thing started and the knowledge that we now have retrospectively, I’m sure many things could be different.’
Hindsight’s a wonderful thing – everyone can be correct after the event. However, another pandemic, because of the way society is organised at present, is more than likely in the not too distant future. That means the lessons from the present, covid-19 pandemic have to be learnt by those who have the ability to influence matters. From what we’ve learnt about preparations for a potential pandemic (prior to the covid-19 outbreak), where we were told was all in hand and that the country was well prepared for whatever any pandemic would throw at us, we will have to monitor, very closely, what happens after covid-19 is a bad memory.
On 7th May it was reported that Coronavirus testing restricted across London after chemical shortages – this at the same time as the Buffoon ‘promised’ the number of tests by the end of May would be 200,000 per day (still a remarkably small number to that which is really required to ensure efficient and meaningful contact tracing).
A week ago an article reported the UK Government was in talks with the huge pharmaceutical company Roche over the provision of an antibody test – this is the test that tries to see if someone has had the virus (whether with symptoms or asymptomatic) and whether they are, therefore, possibly immune. There’s been some controversy over the reliability of these tests but that won’t stop 1) Roche selling such tests and making millions, or 2) this Government buying such tests which don’t do what it says on the tin – ref. PPE from Turkey last month.
Test-track-trace
Dr Jeanelle de Gruchy, President of the Association of Directors of Public Health (UK), Radio 4, World at One, commenting on the UK’s test-track and trace strategy, 7th May;
Q. What role can local health authorities play in the programme of contract tracing?
‘I think, as we have found in the last few months, local public health teams and indeed local councils and the voluntary sector have played a huge role in actually addressing or tackling covid on the ground in local places. And what we’re trying to do, and say to national now, is ‘you need to listen to the experiences of how things work on the ground’. We know we all have a lot of work to do on the ground in making contact tracing accepted and the best that it can be at stopping the disease.’
Q. Can you explain why its important this is done at a local level?
‘Somebody has got a phone and they have been asked to go home and self-isolate, what we need to know is does that person live by themselves, do they have access to food or medication? Then what if that person is a teacher or parent or a pupil and the school wants to know and understand what to do next. So who can explain and advise the school? What if its a business owner? They might need support. So from the phone call we say ‘please go and stay at home.’ There’s a lot of work that needs to go into making accepted the programme that people stay at home and self-isolate.’
Q. What sort of numbers are we talking about?
‘18,000 is what they are talking about nationally. Councils have got teams of people already working, as I said, in supporting local communities that are coping with covid. This is now the next phase of that. We will be using all our local teams working on this.
What we would say is that a lot of this does need resourcing. Local Government, local Public Health are working at full capacity and we need to ensure that we’ve got the funding and resources available to make that be the most efficient programme that we can locally so we really get a grip on the disease.’
Q. Resources you don’t have at the moment?
‘We have experienced a lot of cuts over the last few years and that has meant fewer people on the ground so we are working from a lower base. We know the Government’s made money available for local government to respond to covid but we would say it still falls short of what’s required. Some of the contact tracing needs to be real show leather on the ground. Getting out, finding people who might not have access to a phone or might be in a certain circumstance where they don’t engage with a national service at all. We need to be out there ensuring that we find those people, that we support them to self-isolate and that does take resources so that’s something we would ask for. As you design a national programme, that absolutely needs to be delivered locally, as well, and in an integrated way. We need locally to have those resources to make it happen.’
What is highlighted here is that the cuts the Tories have made in the last 12 years or so, all as part of austerity (to mitigate the disaster the very system they represent had caused in the first place) has resulted in the country being unable to confront the pandemic. This is in all services that have been stretched in the last couple of months due to these cuts in finance, the NHS, local government as well as the education sector which will face problems in the future to get things back working.
There have also been criticisms of the way the contact tracing is planned to be implemented – some of which are based on the Government trying to follow this policy ‘on the cheap’ (10th May).
NHSX app – and the pilot on the Isle of Wight
Professor Tim Spector, professor of genetic epidemiology at King’s College, London, criticising the, what he considered, failings of the NHSX app which is presently being piloted on the Isle of Wight and which is planned to be rolled out across the UK later in the month. The Government has refused to work with his team on a symptom app which has been collecting information from, now, more than three million people since March. On 10th May he said;
‘The virus effects people in many different way, we have about 15 different symptoms, all of which can be associated with having a positive virus swab test. So the idea that we reduce this really complex, mysterious, virus just to two little symptoms and rely all of our strategies on that is going to miss about half the cases really makes no sense in the current environment.’
On 6th May there were other doubts about the NHSX app when some ‘experts’ were suggesting it was vulnerable to ‘malicious false alerts’, although to be fair this has also been said about the Apple/Google app which is being used in many countries.
Another aspect of depending upon technology to do the work in the UK is the fact not everyone updates their Smartphones at the same way they change their underpants – as is the case in a number of the more prosperous countries in Asia. That means the app won’t work in a Smartphone a few years old, mainly as they don’t have Bluetooth – as mentioned in a previous post.
A little bit of the technical aspects of the pilot – and also a schematic of how it will work. It includes reference to the source code in an effort to ally fears of those who don’t trust the authorities when it comes to surveillance.
There was also bad news for the app when it came to security. Anonymous sources revealed the app had initially failed all of the tests required in order to be included in the NHS app library, including cyber security, performance and clinical safety.
To add to confusion from Government’ statements on Sunday and subsequently an article on one of the IT websites reported that NHSX was even developing a second app – which is without the privacy and security issues mentioned above. If so it makes you wonder what will come next.
Experts – and when (or if) they will arrive at a consensus
Since the beginning of the lock down we have been constantly told the Government is ‘following scientific advice’ – the problem is there’s no real consensus when it comes to that advice. There are many examples of this and although in the situation of an unknown virus it shouldn’t be a surprise theories differ, in fact that’s the way science advances.
However, there must come a time when a general consensus is arrived at for the world to go forward – we have it with the climate emergency why not in how to deal with a pandemic? Confusing scientific advice on top of confusing political advice is a recipe for disaster. There are a number of examples of varying points of view in the last five weeks but one that stands out is the wearing of face masks/some sort of covering over the nose and mouth.
Although some ‘experts’ were fighting their corner over this at the beginning of March there does seem to have been a move. It is now accepted the wearing of masks won’t, in any meaningful way, protect the wearer, however if someone is unknowingly infected the wearing of a mask may (and it is considered only a may and not really a significant, measurable effect) prevent that person from passing the infection on to another.
However, the way it has been dealt with is that mask wearing is becoming more common but by the fearful – as they think they might be protected if they wear one – and not by those who understand it might possibly prevent the spread from themselves. Hence not, in the main, based on scientific evidence but because the scientists couldn’t get their act together early on.
We then have the crazy situations of high profile scientists going against their own advice. The recent case of Neil Ferguson having a visitor to his home which breaks the lock down guidelines is one thing, his excuse/reason is another. He stated that as he had already contracted the infection, and survived, he had an element of immunity and so it was OK for him to do what he did. However, that’s the very argument used by other scientists who disagreed with the lock down in the first place. They were arguing for testing and selective isolation and letting the rest of the population carry on as normal so that, over a period of time, a certain amount of ‘herd immunity’ would be build up in the population.
Views on the ‘next stage’ and how to go forward
As the Buffoon turned the transition from the lock down to ‘a still not entirely clear’ move to the ‘next stage’ many have been expressing their views on how this should be done – and also expressing their fears if certain issues were not addressed sufficiently well.
(Here I’m including a couple of interviews from commentators who were talking about this a month ago – so readers can consider if a) those ideas were correct and b) if any good points have been taken on board by the Government.)
David Nabarro, World Health Organisation (WHO) Special Envoy for Covid-19, speaking on the Radio 4 programme ‘Today’, 13th April;
‘This virus isn’t going to go away and we don’t know if the people who have had the virus stay immune afterwards and will not get it again. And we don’t know when we’ll have a vaccine. … So what we’re sating is get society defended. Yes, we’ll have to wear masks, yes, we’ll have to do more physical distancing, yes, we must protect the vulnerable but most importantly we all learn how to interrupt transmission. It’s a revolution!’
Professor Susan Michie, Behavioural Science adviser, speaking on Radio 4, World at One, 14th April;
‘There’s a lot of new behaviours that people will have to learn to adopt and that’s going to require different types of things. In addition to that it’s living with uncertainty and carrying on for a long time, many many months, if not years into the future. And I think there is something new that people won’t accept. I think people had thought this was going to be a few weeks, or may be months of difficulty, then we’ll be able to get a test and then we’ll know we’re immune and then we can go back to our normal business.
What’s become very clear is that that won’t be the case and so its absolutely imperative that if we are to keep the number of deaths down that people really do learn very simple steps that are very difficult to adopt behaviours.
Not touching your eyes, nose and mouth. Washing your hands when you come in from buildings, before eating and preparing food. And these things take time to build into habit. But we need to make them habit just as cleaning our teeth is now habit.
…. People touch their face 20 plus times an hour without being aware of it.
… The government needs to be very clear, very precise and very evidence based and really explain to people why these measures, that are effortful, that may be restricting what we want to do and why are these necessary? So we need specific clear advice but also explantation if the government is going to carry on taking the people with them.
… There’s been so much uncertainty about the nature of the virus, the nature of the transmission, the nature of the type of tests we need. All of these issues are still being studied and new knowledge is coming up every week.
So we’re in a very uncertain situation. But in that uncertain situation there’s a real need to be clear and evidenced based as we can in terms of what we’re expecting who to do what. And there has been confusion, we still carry on receiving confusing messages. For example, the whole issue about non-essential work. There seems to be a lot of people who are having to do non-essential work and working in unsafe working conditions when that doesn’t seem to be policy.’
One idea that doesn’t seem to be have been included in the ‘Our plan to rebuild’ is one from Edinburgh, 6th May, which suggested a lock down exit plan which allowed for restrictions to be eased for 60% of population. Aspects might be in the next stage but what are missing are the two words ‘segmenting and shielding’, which is a concept I hadn’t seen described as such before.
Carl Heneghan, Director of the Centre for Evidence Based Medicine at Oxford University, on Radio 4, World at One, 7th May;
Q. You’ve always been sceptical of the need for the whole economy to be shut down. Is the Government being too cautious?
‘There comes a time in what we’re calling the [economic] depression in the lock down and people need to remember that austerity is a major threat to people’s livelihoods but also a major threat to health. Post 2010 120,000 excess deaths occurred because of austerity. What we now need to do is move to a situation where we can feel confident about moving back to what we call ‘mitigation’. And ‘mitigation’ is what is happening in Sweden and you do that in a staged way.
There are three concepts that are really important.
The first is the concept of health security, the ability of our nation to secure proficient, affordable and consistent health care supply for our requirements, a resilience to cope and then we use the evidence and data to drive a regional approach to this because it’s a very different outbreak to places like the south west compared to London, and if we do that well and we remain confident, we can use the evidence to understand what’s happening.
This virus will be with us for a few more months, into July, and then we will have pockets of outbreaks but in this stage, if we manage that well, we test, track and isolate, we can be confident we can overcome this infection and get to a point where we can rebuild the economy.’
Q. We keep hearing the Government is focussed on R rate. Are you suggesting there should be a different approach in different parts of the country?
‘R is a very interesting concept, generally the R number will be calculated after the event when people come back and say we understand what has happened. With this infection we are clear there are people spreader events, its very difficult to manage in confined spaces like nursing homes, in hospitals. What we should be doing is using the data that can reassure us.
For instance, since the peak admissions have come down by 72%, deaths are also halving every two weeks. So I would focus on the evidence at hand, use the data from admissions and ambulance calls, and check 111 calls. And if they start to go up when you open schools you understand the impact of what you’re doing, in terms of the evidence that matters.’
Q. Would opening schools be one of the first things you should do?
‘With a staged approach next week I would get some of the businesses going, I would monitor the evidence, then I would start to roll out primary schools, bring them back in a staged manner. Now I’m only talking about what our neighbours are doing, do it in a staged way and you use the evidence to understand the response of what you are doing. For example, if you opened up the Tube and it started to get overcrowded and what we saw was a spike in admissions, a spike in concentration, you would understand clearly that was a threat you’d need to reduce.
So what I’m saying is use the evidence to drive response and not use models to try and think about what you might think is going to happen in the future. Evidence shows we need to manage it.’
Q. One of the ‘Five Tests’ was whether the NHS will be overwhelmed. Would it be so in a ‘second wave’?
‘What I think needs to happen is a resilience to cope. The NHS now has to think about structure and strategy. Our neighbour Germany has more beds so they did not have to do what we had to do which was to build Nightingale Hospitals. The second concept is that we need to go back to the concept of ‘fever hospitals’, where we understood that to manage infection you had to have personal protection equipment there all the time. So I say we need more hospitals built in the community, more beds and some of them to be repurposed as infection hospitals … If we do that we can train for an infection outbreak and when they come we can have added facilities so we don’t have to shut down all of the NHS – which we’ve done this time, which has a potential to cause collateral damage to other conditions.’
Mark Woolhouse, professor of infectious disease epidemiology at the Usher Institute in the College of Medicine and Veterinary Medicine, University of Edinburgh and presently one of the Government’s scientific advisors, 10th May;
‘There should be a change of approach. We can’t stay at home forever, with the current R number as it is, the rate of the decline of the virus. If we’re trying to get down to positions where there are literally only hundreds of new cases a day in the UK we are going to be in lock down for months. So something has got to change both to our approach in controlling the virus but also in the messages that goes with that.’
Francis O’Grady, General Secretary Trade Union Congress (TUC), on ensuring employers should be legally responsible for providing a safe working environment for workers returning after lock down, on 10th May;
‘At the moment we’re in the strange situation where people can’t socialise particularly with their extended families, without risking a big fine. Yet what goes on behind workplace doors, according to the Government, is a matter for individual employers discretion.’
The Swedish compared to the British experience
Since the coronavirus started to take hold in Britain I was sure the ‘run and hide’ approach proposed by the incompetents in control of the country surely couldn’t have been the best way to approach a pandemic. We were, in effect, doing nothing other than what the population did during the Black Death of 1348 or the Great Plague of London in 1665. Hadn’t our increase in medical knowledge and out immense technology taught us anything in those intervening hundreds of years?
Whilst not wishing to undermine the problems involved nor the threat this most simple of organisms poses to human life it will not be defeated if all we do is let it run its course without attempting to tackle it face on. If not outbreaks will be causing disruption and chaos for years.
Military phraseology has been used constantly since the first cases and deaths were reported in the UK, ‘we are at war’, ‘front line’, ‘collateral damage’ (an odious term that’s unfortunately become part of the language now), etc. But to use other military analogies the British response is similar to the disastrous retreat of Dunkirk in 1940 – which was then turned into an amazing victory. What followed Dunkirk was four years where there was no significant British army presence in Europe and the brunt of the fighting against the Hitlerite forces was taken on by the Soviet Union and the Red Army. In a similar way the British response to covid-19 is one of waiting, hoping, praying, some one, some where will come up with a solution to the problem.
Doctor John Lee, retired Professor of Pathology and former NHS Consultant Pathologist, Radio 4, World at One, 12th May;
Q. What’s the most important thing we should bear in mind about the R number?
‘The trouble with what’s happened is we are in such an extraordinary situation that governments are looking for a sort of secure way out. I think they fastened on to the R number as an idea of certainty to allow us to map a road out of this.
The trouble with the R number is that it is a modelling output, it’s not a number we actually know what it is. It’s based on a lot of variables which are constantly changing, things like; how infectious the disease is; how the population behaves; what the immunity is doing and even, possibly, how nasty the virus is. It’s nastiness might have been changing during the epidemic and obviously lots of people are starting to get asymptomatic infections and we don’t know who they are, we don’t measure them, its all going to make a difference to the R number.
The thing we have to understand is that epidemiological modelling is even more like weather forecasting rather than laboratory science and the lock down, changes in behaviour that we’ve had, social distancing, we have to ask ourselves, ‘would we be willing to undergo this sort of change in our lives on the basis of a long range weather forecast based on poor data?’ That’s essentially what we’re doing with epidemiological modelling with the R number.’
Q. Is every country measuring R in the same way?
‘I don’t know to be honest. I would imagine it’s similar because epidemiology is a subject and people draw to each other amongst that subject. Whether the data is the same, whether measurements and the testing is the same, whether the population measures are the same, clearly there are differences between countries. What is quite striking to me is the fact the R number is very similar in lots of countries and you have to ask the question whether anything could have been done which made a big difference to it. Everybody’s assuming the lock down has been changing the curve and that social distancing has been changing the curve but actually, when you compare different countries, the curves aren’t that significantly different.
This is a respiratory virus that probably spreads on the wind and in the air. We’re sharing air spaces in shops and in work and all this and it’s not clear, to me, that those drastic actions that we’ve been having have really been making such an enormous difference to the curves which might have been slightly similar anyway.’
Q. You think the lock down has been pointless?
‘Well, I wouldn’t say pointless because this is a new virus and so what we were going to have was a big spike of cases and that is what we have seen. The lock down has, possibly, flattened that spike a bit and it has allowed us to build up extra capacity in the NHS but the point is, when we look back on this in 3, 4 or 5 years time, it’s not clear that the actions would have made any difference to the actual total number of people who have died due to the virus because it’s now out there, it is going to spread in the population so what we’re doing at the moment is prolonging an economic misery and damage to health, direct damage to health, because of the lock down.’ (Interruption.)
Q. Don’t we have the evidence of other countries who acted more quickly having lower death rates?
‘The thing is this is a new epidemic so some countries seem to have been able, by very rapidly acting on the very severe model of disease containment, to have contained the disease. But, of course, unless they keep themselves isolated for ever the virus is going to spread again. It seems to me surely what we should be doing, and I think the Swedish model is a better model, what we should be doing is to find a sustainable way to live with this virus rather than go into a panic mode of shutting everything down and then we have to persuade ourselves sooner or later that the sky is not falling and come back out again in which case the virus will start to spread again, that we have to live with it.
I think we’re in much better position to live with it now than we were before because we do have extra capacity in the NHS, we do understand more about the virus, we have got better supportive treatment.’
Johan Giesecke, who helped shape Sweden’s approach to coronavirus, says lock down does not protect vulnerable in care homes. The important aspect here is the care homes. In Britain it was known from the very beginning that it was in care homes where the vast majority of the very much most vulnerable would be found.
But what did the Government do in Britain; basically ignored those vulnerable people; denied the care workers Personal Protective Equipment (PPE); was slow in doing anything when both the deaths in care homes started to rise and there were countless calls from those working in the sector that decisive action was needed, yesterday; never accepted that cuts in this sector over years had made the vulnerable even more so; and continued to play to the gallery in its so-called policy of containment. And it took the Government weeks to even start to count people dying in care homes (or in their own homes).
What all the above has meant is as of 13th May, almost half of all the deaths attributed to covid-19 have now occurred outside hospitals; the daily death rate is now greater in care homes than hospitals; and it’s almost certain that before this first wave is over (let alone any subsequent ‘waves’) more people would have died due to the virus either in care homes or in their own homes. And that doesn’t take into account any ‘collateral’ deaths – when people have died due to lack of access to normal NHS facilities and treatment.
Greater surveillance worldwide on the back of covid-19
Some time ago, can’t find the exact reference, there was suggestion in South Korea that those who might be ordered to stay at home, if they were identified as being a risk through the electronic contact tracing, and had been ordered to self-isolate, would have to wear an electronic wristband – connected to their Smartphone to ensure they didn’t break the quarantine.
Coronavirus lock down causing ‘creeping’ expansion of intrusive surveillance tactics. It’s in times of crisis capitalist governments use the fear and chaos, which is normally a backdrop to the event, to introduce laws and ‘temporary’ measures to help them deal with the situation. However, there has been a tendency for these laws to remain (if only in the background – consider the Prevention of Terrorism Act 1974, which was renewed, almost as a formality every six months for fifteen years) and the temporary becomes permanent. And then it’s too late.
In the article of The Independent, 26th April, Clare Collier, the advocacy director of the human rights group, Liberty, said;
‘We will make it through this crisis but we must do so with our rights intact. … The police have been handed sweeping powers in response to the coronavirus outbreak, and the expansion of intrusive surveillance is troubling. …. Overzealous policing will undermine public trust in the authorities, which is vital for protecting public health. Meanwhile, the normalisation of surveillance and the concerning techniques we have seen in recent weeks could have impacts which last far beyond this pandemic.’
Snippets of news – which I haven’t had the chance to put here before
As before some of these bits might be slightly out of date, but they are all part of the story of how this pandemic raged through Britain – not least due to the incompetence of the Buffoon and his cohort.
I reported on this a few weeks ago, shows the sort of society in which we live the charlatan is still getting away with it – Camberwell church continuing to sell fake Covid-19 cure.
Being at home all the time causes all kinds of problems, some which have existed long before the arrival of the virus but also some that have been exacerbated by the forced lock down. Domestic abuse cases have already been recorded as increasing in number in the last five weeks and the Government threw a few crumbs to the problem. Almost immediately declared too little and too late.
Sarah Green, of the End Violence Against Women Campaign, said, way back on 11th April;
‘a lot more money needed for support services throughout the country.’
Airlines are always in the news, either begging for bail outs or not abiding by their legal requirements when it comes to refunds. As with many issues they are flagged in the media before they actually become policy, so was the case with the 14-day quarantine for air passengers’ arriving at UK airports. (A policy which I think is somewhat strange, even though it is happening in other countries in Europe, and is, as are many policy decisions, a refusal to face the problem and look for solutions.) This is also mentioned in the Our plan to rebuild document.
Also in the most recent document is the new covid-19 alert system.
A few points about the lack of planning by the Government when it came to providing the necessary equipment to the NHS and care homes as well as the drugs necessary to keep people alive in Intensive Care.
a) ventilators
b) reusing PPE
c) intensive care drug shortage
d) changes in guidance in using PPE
Public support universal basic income, job guarantee and rent controls to respond to coronavirus pandemic, poll finds. Many say things will be different after the virus is brought under some sort of control – however the situation of the majority of the population could get worse or better. If it is left to the politicians and the establishment to decide it will be the former.
A BBC Panorama investigation broadcast on Monday, 27th April, revealed key items of PPE were not included in the government’s pandemic stockpile when it was established in 2009. According to the BBC, the government subsequently ignored warnings from its expert pandemic committee recommending the purchase of missing stock. The investigation also revealed millions of medical face masks are currently unaccounted for. The 2009 stockpile list included 33m masks, but only 12m have been handed out.
There’s an ongoing debate on how the virus is spread. Most people, myself included, from what we’ve been told so far, believe the virus is spread in the air, small droplets from an infected person then entering the system of another near by – the whole social-distancing theory revolved around this form of transmission. However studies have proposed transmission might be through virus aerosols.
What will happen to the climate emergency when covid-19 is history? Many of us would like the matter to be addressed seriously and there are already calls for that. However, that will be an uphill struggle. The economy will be in a mess (and unless things changed radically) the ‘recovery’ will follow the same pattern as it had in the past, i.e., looser regulation ‘to get things moving’; less control of those regulations that do exist; lack of money to invest in projects which might not give a quick return; less money so people use older materials, as in cars and other less environmental equipment; unless a solution is found soon – a growing dependence upon private transport as public transport is discouraged and will get even worse than it was pre-March 2020; and the issue falling from the headlines.