The Thin End

The UK government has now published its plan for Personal Protective Equipment) for frontline health workers. The plan incorporates 3 strands for guidance, distribution and future supply.  It seems to follow the kind of line adopted by the Health Secretary when he urged doctors and nurses to treat PPE as a 'precious resource' and not to misuse it.   This wasn't well-received by bodies representing the various strands of Health Care workers, not least the Royal College of Nurses.  The plan instead restates the obvious.   1) guidance: being clear who needs PPE and when, and who does not, based on UK clinical expertise and WHO standards. This will ensure workers on the frontline are able to do their jobs safely, while making sure PPE is only used when clinically necessary and isn’t wasted or stockpiled 2) distribution: making sure those who need PPE can get it and at the right time. The government will ensure those who need critical PPE receive...

It is said that COVID-19 doesn't discriminate. This isn't strictly true. If you live in poor housing conditions and overcrowding you are more likely to be affected by the virus. More than a quarter of a million households in the UK are living in overcrowded private rented housing. 300,000 households are squeezed into inadequate social housing. People living in poor housing are more likely to have underlying respiratory conditions, more likely to find social distancing difficult. It will be more difficult to maintain hygiene levels. More overcrowding means greater stress and mental health issues. Little of the problem of overcrowding is being addressed by the government, and there is little to no help being offered to help these families cope with the COVID-19 lockdown. Poor housing conditions and overcrowding has increased over the last decade as the most vulnerable have been affected by austerity.  This is why we have said before that austerity kills.  It increa...

Who should lead on the response to a public health crisis such as the COVID-19 pandemic?   In a commentary in The American Journal of Medicine noted public health experts have said that appropriate concerns – not fear – should play a significant role in the emerging pandemic, and political leaders should empower public health officials to drive the response. Our political leaders are quick enough to say they are 'being led by the science', but this is to a large extend disingenuous.  Science cannot tell politicians what to do.  It can only advise and given assessments of the probable consequences of decisions.  But those decisions must be taken by politicians.   The decisions are based on balancing different objectives - the economy, social impact, the effectiveness of any course of action, public attitudes and compliance - there is no one set of expertise on these.  Psychologists, sociologists, public health experts, epidemiologists, clini...

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 ...

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 ...

We often hear the expression 'on top of the detail'.  The forensic analysis of instant media more often will find politicians wanting when it comes to specifics.  An interviewer comes to the studio well briefed with a specific set of details, the politician comes having to anticipate what they might be asked.  It is a game of cat and mouse, chasing around the issues. Andrew Neil on the BBC uses the technique of catching politicians on detail, or on what they might have done or said at some time in the past, long or short.  "I put it to you that....", "No, no, this is what you said in 100 AD." Does it get us anywhere? We could say that politicians should know the detail.  But is that really sensible?  Good decisions may be influenced by details, or by what is called 'fact'.  Yet, decisions are often made on a balance of probabilities and not on 'facts'. Boris is a broad-sweep politician Boris Johnson is a broad sweep politician....