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 UK government won't tell us who sits on the body advising them on how to deal with the COVID-19 pandemic. It isn't surprising because what we do now know is that it lacks critical expertise in virology, immunology. This lack of expertise certainly shows at the daily media briefings, which seem more to do with putting a government spin on stories than revealing what is happening. To the greatest extent, we are being kept in the dark. Take today, for example. The Health Secretary Matt Hancock came up with this shockingly misleading statement. He told us that “The UK has already gone past the number of tests per day for instance that they carry out in South Korea, we’re approaching the levels that Germany undertakes" This just is not the case by any reading of the statistics. The UK’s daily testing average over the past week has been just shy of 23,000 tests a day. Germany has been carrying out 450,000 tests a week, according to its foreign minis...

While the UK Government is not doing enough, our doctors and nurses are struggling at the frontline. Some are losing their lives to COVID-19. Instead of addressing the issues, the government are asking doctors and nurses to use personal protective clothing in ways that are considered dangerous. The Royal College of Surgeons has issued a statement saying that doctors should not be coerced into putting their lives at risk. Meanwhile, doctors and nurses are being gagged from speaking out about the shortages. Responding to criticism that Prime Minister Boris Johnson missed five emergency COBRA meetings, the Education Secretary said at the press conference today, Sunday: "This is a whole government effort. We are doing everything that is required, everything that is needed." Well, what is needed is PPE and testing, among other things, and on both these fronts the government is failing to do everything required. Our doctors and nurses are being asked to put their lives at f...

As we move to the 'surge stage' in the coming weeks of COVID-19 deaths in the UK, we do need to get more detailed information on deaths outside hospitals. This week the Office for National Statistics reported the highest total number of deaths since ONS weekly death reporting began in 2005.  That gives us some idea of what the underreporting of COVID-19 deaths might be. It is extremely difficult to be sure.  One question is to what extent the virus is the cause of deaths that would not have happened without an infection, and to what extent it is hastening deaths that would have occurred in any event.   The provisional number of deaths registered in England and Wales in the week ending 3 April 2020 (Week 14) was 16,387; this represents an increase of 5,246 deaths registered compared with the previous week (Week 13) and 6,082 more than the five-year average.   COVID-19 was mentioned in 21.2% of all deaths registered in that week - a significant ...

If health care resources and staff are stretched to the limit, difficult life or death choices must be made.  Who to treat? That will be the question. At ordinary times decisions might be made based on whether treatment will do more harm than good.  It might even be the patient who decides.  End of life decisions are more often like that.  Will further treatment help? But these are not regular times. The British Medical Association guidance on pandemics says "In dangerous pandemics the ethical balance of all doctors and health care workers must shift towards the utilitarian objective of equitable concern for all – while maintaining respect for all as ‘ends in themselves’." If resources are spent on saving the life of one person at the expense of many others, how then is that balance to be made? One thing is sure.  Our actions are also part of this ethical mix.  Our efforts will determine whether or not the anticipated surge in those requiri...

Scientists across the globe are searching for a vaccine against the virus that causes COVID-19.  Let's applaud them too. A vaccine for the COVID-19 virus is still said to be 'a long way off' with best estimates being early next year.    The first potential vaccine entered clinical trials on 16th March 2020.  Vaccines cannot be conjured with a magic wand. Ordinarily, vaccines can take up to ten years to produce. The first Ebola vaccine took five years, and that was considered fast. The imperative is now to find a COVID-19 vaccine a lot faster.   Teams across the world a working flat out developing and testing possible agents. One reason it usually takes so long is what is termed the attrition rate - that is, the number of potential vaccines that don't make it through trials. The failures could be hundreds.  Safety and effectiveness are of paramount importance, and that means rigorous testing. The production of a vaccine isn't what we see in t...

There is some good news on the horizon.  The government might meet its target of 100,000 tests for COVID-19 by the end of the month. Testing is vital to bringing us all out of lockdown, getting people back to work, and gradually returning to normality. The US company producing the tests here in the UK has ramped up the facilities for its manufacture.  But initially, the tests will be for the antigen, indicating whether someone has got the virus.  We also need to test for the presence of antibodies, showing whether someone has had the infection and has developed an immunity. Meeting the testing target offers hope that the lockdown can be released gradually, perhaps first, with those who have recovered from the virus. Slowly, people can get back to work, getting the economy moving once again and critically enabling key health workers to return to the frontline. One thing the lockdown has demonstrated is just who our key workers really are.  The many we...

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...

We have heard enough excuses from the UK government.  They keep promising to deliver on protective clothing for our doctors and nurses, and they promise to roll out testing in the population.  In both, they have failed to deliver.  In the next two weeks, we will see a massive increase in the numbers of COVID-19 cases and deaths here in the UK and across the world.  We must stand by our frontline staff. They must have the protective equipment they need. We also need urgently now to roll out testing to the public so we know what is happening and who has built immunity, else we are acting in the dark.  We need honesty now from the government about the difficulties in doing that. It is vital that the authorities maintain public trust. That can only come from honesty. This is why it is vital that our doctors and nurses must be free from threats so they can also be honest in their appraisal of what is happening on the ground.  There should be...

The good news is that interventions and social distancing are working.   An analysis by researchers at Imperial College London has found that, across 11 countries, since the beginning of the epidemic, 59,000 [21,000-120,000] deaths have been averted due to interventions.  Keeping up the interventions is estimated to save in the long term up to 40.6 million people who would have died but for restricting the spread.  Whilst we might be critical of the tardiness of some governments in their response to the pandemic, the message is clear; intervention works.  More needs to be done.  In the United Kingdom there is an urgent need to ensure that front-line health workeres get the protective equipment they need.   It is also vitally urgent that testing kits are rolled out as promised, not just for health and social care workers but for the population.  Many more lives can be saved if this is done.  With testing for immunity, we can get...

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 ...