The Thin End

Test, track and treat must be an essential ingredient coming out of COVID-19 lockdown.  This was acknowledged by the British Prime Minister, Boris Johnson, in his statement to the House of Commons today spelling out a little more detail of the strategy moving forward.  With more testing, it will be possible to predict at a more localised level in the community where infections will spread and target both community testing and more social interventions on high-risk areas in the future.  This might then prevents further national lockdown in response to any rebound of the virus.  The Prime Minister rightly refers to the R-value in informing strategy. It represents the rate of infection - or how many people can be infected by another.  At the outset, this was above 3, and anything above one means a dramatic increase in infections and deaths.  The Prime Minister also, on that basis, is right that there might be a need for differences in approach in di...

The sad truth is that the UK was strategically poorly prepared for COVID-19. We seem to have learnt very few lessons from previous virus pandemics. South Korea learnt those lessons, and they also followed the WHO advice to "test, test, test." We are not alone in acting too little too late.  Most European countries and also the USA appear equally ill-prepared.  Our strategies are led more by panic than clear thinking.   To fight a virus such as COVID-19 preparedness matters.  To save lives, we have to be ahead of the curve.  Most authorities are behind it. We seem to be at that point in a game, when the enemy is coming so fast that we really can't keep up with it and so we shoot, shoot, and shoot, only to find we have run out of ammunition.  The lesson is that we need the resources if a strategy is to work. A plan without resources just isn't worth the paper it is written on. Logistics matters.  We should not have frontline medical staff c...

The coronavirus shut down has made us all more aware of the problems of loneliness.  Loneliness itself can be a cause of mental health problems, of morbidity and of premature death.   A new study in the United States shows the impact of loneliness on the end of life experience.  In a study of Americans over age 50 years who died between 2004 and 2014, individuals who were characterized as lonely based on survey results were burdened by more symptoms and received more intense end-of-life care compared with non-lonely people. In the 2,896-participant study, which is published in the Journal of the American Geriatrics Society, one-third of adults were lonely. In addition to having an increased likelihood of experiencing troublesome symptoms at the end of life, isolated individuals were more likely to use life support in the last 2 years of life (35.5% versus 29.4%) and more likely to die in a nursing home (18.4% versus 14.2%) than non-lonely individuals. Dr Nauz...

Many people will be affected COVID-19 beyond those directly infected by it.  Lives will be lost as a result of the efforts to save lives from the virus.  This is a sad reality of the response to the pandemic. As we focus on the potential loss of life through the virus, we need also to consider why so many others have had to put off possible life-saving treatments, or had operations cancelled. We must also consider that the long term impact of the economic consequences will be considerable. The problems we face are due to a decade of austerity, which made preparations for a pandemic almost impossible to achieve. Of course, resources are always going to be stretched in such circumstances.   But it would be wrong to assume that such a pandemic was unforeseen.   On the contrary, all NHS Trusts have made some contingency plans for such a virus. It would be easy enough to imagine that a decade of underfunding of the NHS has had no significant impact.  Bu...

Conspiracy theories tend to go viral on social media.  No surprise, then, that this would be so for COVID-19.  Support for the conspiracy theories comes, not from an evidence base, but mostly from people's instinct to think that the crisis created by the current pandemic is inexplicable.  From the title, you might expect an exposure of a major conspiracy to either cover-up of manufacture the COVID-19 virus.  There is no need for such theories.  The only conspiracy is that between our immune systems and the virus, and our trying to find a way to deal with the current crisis.    A pandemic was expected at some time because it is like such viruses that they will mutate and find ways to bypass our defences.   It is a constant game between viral agents and our immune systems.  Each, as it were, biologically trying to outwit the other.   So viral mutations are not rare.  A virus might also transfer across speci...

Prime Minister Boris Johnson was surprisingly upbeat at his news conference in saying effectively that the United Kingdom will see the Covid-19 crisis through in twelve weeks, or as he put it 'turn the tide'.   Was he right to be so optimistic? It is always good for leaders to offer hope and maintain morale, but where is Boris getting his twelve-week estimate from? Boris' twelve weeks probably comes from the modelling.   The models predict that 50% of cases will come in the first three weeks and 90% over nine weeks.  Currently, we see cases doubling about every four days, which is very much in line with the modelling. The governments objective is to delay the peak, pulling it out so that the burden on the NHS is reduced.  It is a strategy to buy time.   If it works, it might save lives because it will free up resources to deal with the severity of cases. Nonetheless, challenging life and death decisions will have to be taken by clinicians about who ...

There are good reasons why the UK government needs to do more to roll out testing for coronavirus. First, because without doing so, we are working in the dark about the spread of the virus in the population.  Second, because those who have been infected with the virus and recovered would have built up immunity, and it would prevent unnecessary confinement. The more we get a grip on that kind of knowledge, the more people we can get back to work. The WHO was right at the outset to call for widespread testing: test, test, test.   We should not be making plans in the dark. Testing played a vital role in South Korea in their apparently successful attempts to gain control of the virus. The South Koreans introduced testing tents in the streets.   Testing wasn't an add on.  It was a vital plank of the Korean strategy. Testing can save lives.  If people are sure they are infected with the virus, then they could get treatment at an early stage and increase ...

So much now depends on developing a vaccine against COVID-19, but how long could that take? The best estimate is that it would take at least twelve months. The best chance currently is one being developed in the United States. One way to generate a vaccine is to replicate the bit of the virus that causes the immune system to react, but without the virus' potential for taking over the cells of the body that host it. It is a bit like finding a key that fits a lock but doesn't allow the thief to enter. The estimate is that a vaccine for Covid-19 is at least 12 months away. A trial of a vaccine has begun in the United States. The group based in Seattle, Washington, had been working on a similar virus and so have been able to switch to Covid-19. They have reproduced a bit of RNA that acts as a template for a bit of the virus that would be recognised by the immune system.  It is an ingenious trick they are using, which is to use a bit of RNA to get cells of our bod...

Shocked into action by the potential mortality from the coronavirus pandemic, governments around the world are acting to release huge sums of money into their economies.  Today, the UK chancellor announced that he was making available over £330 bn to support businesses during the crisis.  This is by far the biggest ever peace-time intervention in the economy.  It is right that governments should respond.  Millions of lives depend on them doing so.  But it should make us think about whether we have been getting our priorities right in the past, and whether we are now doing so.   Poverty kills just as relentlessly as does the coronavirus.  It attacks the most vulnerable.  Yet, the government invests too little in preventing it.  This has been particularly so over the last decade, where both child poverty and pensioner poverty have increased.  Poverty comes in different ways.  A report two years ago showed...

For the first time since WW2, we are reminded of how facing a major crisis we must pull together as a society. The coronavirus pandemic has exposed how fragile our social infrastructure has become after a decade of austerity.  Whilst not making the response to COVID-19 party political, the Tory government must acknowledge the need to invest in our communities, in social care, and other key services.  These are just as vital to our economic well-being as any factory. But this requires the government to ensure there is support for our key services.  We must never again allow our social support system to become so fragile. Just as bridges and roads, rail-links and ports are vital to our economy, so also is the fabric of our health and care system.  The government must once again start investing in people and communities. Much will be done by volunteer support groups, and that is a wonderful thing.  Indeed, we must all consider what it is we are doing fo...

During this Coronavirus pandemic, We often hear it said that we should 'follow the science'.  That, of course, is better than simply dipping your finger in the air to test the humidity!  But can the science work fast enough to inform debate when it comes to the difficult decisions to be made by politicians?  The answer is that it cannot.   The problem is that science works through a long process of experimentation or data acquisition, writing of papers, which then go through a peer review before being published. Cutting short any of this process weakens the strength of the science.  With the Covid-19 pandemic, events are occurring faster than science can function. What then happens is mostly speculation based on judgement, whether by specialists or not. Epidemiologists, virologists etc. are called upon to give their view on what is likely to happen. Few of them stress the problem that science doesn't work that way.  We all either feel ...

The coronavirus is a nightmare for any government, and the UK Health Secretary has difficult choices to make.  The worst-case scenario is worrying.  The government should be preparing for the worst.  To date, the UK is in a containment phase of the crisis.  Other countries have already moved to measures to prevent the virus from spreading.  Managing the spread of the virus means drastic social and political action as evidenced in Italy. One wonders why the government is waiting.  There is no reason to suppose that the virus is not spreading in the UK just as it is in France, even if it has not reached the levels seen in Italy. Stopping the spread would mean taking strong measures that would impact adversely on the economy.  The government will also be mindful of the risks of panic in the population. Many experts are warning that the UK has only a few days if it is to take action that would prevent the virus spreading as it has done in Italy, ...