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Sun 29 March 2020
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John Ashton, the former senior public health director who first questioned the UK Government’s response to COVID-19 on the BBC, finds a ray of hope.

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In the six weeks the SARS-CoV-2 virus made an appearance in the UK, an enormous amount of DNA has flowed under the bridge.

Hundreds of thousands of people have probably been infected worldwide, with a current death toll running into the thousands and now climbing steeply on a daily basis; a clinical matter has become highly political; large corporations are on the verge of bankruptcy; millions of people are in fear and panic buying in the shops; whole countries are in lockdown.

It is highly likely that the entire economic globalisation project is now in jeopardy and that the way we live our lives will have changed out of all recognition by the time this pandemic has run its course.

So what are the lessons so far?


Stalinist

When the first cases of the Coronavirus occurred in this country, there was a singular failure by the Prime Minister to appreciate the potential gravity of the situation.

This was initially manifested by his failure to convene and chair regular meetings of the emergency COBRA committee, the function of which is to get a strategic grip on major incidents of a threat to the country. In the ensuing wasted weeks, it was 13 days before the Chief Medical Officer was allowed to appear on the Today programme on BBC Radio 4, following the Government’s boycott of it.

The continuing response was then characterised by a progressively Stalinist centralisation of communications away from a marginalised Public Health England, leaving journalists and commentators tearing their hair out as they sought information and answers to increasingly pressing questions while the virus spread through the community in the absence of an extensive testing programme.

Any prospect of the transparency and openness of approach described in the out-of-date Government emergency planning documents quickly receded into the distance, together with the hope that the public might be treated as adults and equal partners in potentially the greatest threat to the nation since the Second World War and the May blitz of 1941, when thousands of citizens were killed by German bombs on a nightly basis.

As the severity of the situation slowly dawned on political leaders, Boris Johnson finally emerged from his burrow to chair a COBRA meeting at the beginning of March.


Reductionist

It soon became apparent that Johnson’s tactic of being flanked by a Praetorian Guard of, on the one hand, the Chief Medical Officer, and on the other, the Government’s Chief Scientific Advisor was to give the appearance of leadership whilst simultaneously setting up these senior professional figures to carry the can should everything go pear-shaped – as increasingly looked likely.

Nor were these eminent figures themselves in the clear, with their increasingly desperate claim of running an evidence and science-based model of the UK epidemic. This now appears to have been dependent on inadequate and flawed input data in the absence of extensive Coronavirus screening and testing, and a narrowly biological science which missed out a robust input – especially from the social and political sciences and the lived experience of the general public.

The lesson from the 2014 Ebola outbreak was that, no matter how sound the virology,  laboratory and clinical science, the anthropological insight was to change intimate body washing practices and it was therefore necessary to talk with the village women’s committees rather than the village chiefs. This cost four months in the fight against the disease – and was lost on our reductionist colleagues.

As the month wore on, the reluctance to share the workings out of the homework lying behind the so-called ‘scientific model’ became a major issue for professionals working in the field, the public and the media. This was brought to a head by the mysterious appearance of a post-hoc narrative from the Chief Scientific Advisor, implying that the cunning plan all along had been to let the Coronavirus run through the population in order to build up a spurious ‘herd immunity’ of 60%.

This development followed on from the failure to screen, monitor, test and manage the thousands of British residents who had returned from the high prevalence areas of Italy to melt back into their communities, and the potentially criminal acceptance of 3,000 Madrid football supporters, coming from a city in imminent lockdown, attending a European match against Liverpool, presumably to spend a night carousing on Merseyside.

It was at this point that the scepticisms of widely different groups began to converge, leaving the central effort looking increasingly desperate and incoherent. The ethical disaster of the proposed approach led to its swift abandonment.


Beating the Worst Case Scenario

I am writing this from my study in the Yorkshire Dales with Daniel Defoe’s account of the plague year of 1665 very much in mind.

Somehow, the Government and its advisors have managed to create a worst-case scenario to apply to their worst-case epidemic scenario of mass infection and death occurring over the next few months.

By failing to carry out systematic testing, to be open with the public and to share their data and workings-out, they have simultaneously destroyed trust and made it more difficult for social mobilisation to occur for a situation in which families, neighbourhoods and communities will have to step up and care for thousands of seriously ill people at home.

For most projections, there will just not be sufficient clinical staff, beds or kit to treat more than a fraction of patients in formal clinical settings, even before allowing for staff sickness absence and self-isolation.

Over the past few days, there have been growing signs of spontaneous local community organisation with groups forming over social media to recruit volunteers from the younger age groups least likely to be seriously affected by the virus. They will need to acquire basic nursing and caring skills, together with the logistical pathways to supply multiple oxygen units and treatment packages of pharmaceutical supplies for moderately-to-severe patients in their homes.

This may well transform the face of medical care delivery for all time, supported by online consultation and liaison medical practice. It could well be on the same scale as a similar transformation in our education system to online working, together with the wholesale adoption of 21st Century home working practice. A spin-off will also be a massive reduction in travelling, to the benefit of our planet Earth.

Dr John R Ashton CBE was formerly the North West Regional Director of Public Health, President of the UK Faculty of Public Health, and is a Consultant Advisor to the Crown Prince of Bahrain Corona Task Force.



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