Dr John Ashton with his update on UK developments on the Coronavirus and the side-effects we are overlooking.
It is one week since Boris Johnson’s broadcast to the nation announcing the UK’s lockdown and much has happened.
The numbers of cases of the Coronavirus has continued to escalate – although in the absence of systematic testing we remain in the dark as to exactly what the incidence of new cases is or the prevalence in different parts of the country or different groups. On the face of it, London remains the most affected region, closely followed by the West Midlands and then the North West. Meanwhile some areas – notably the North East, South West, East Anglia and rural regions – still seem to have relatively few cases.
In a rational world, we would still be trying to contain the epidemic in those parts with a lower number of cases, through a combination of of screening, testing, triaging, isolation and quarantine and treatment of those seriously ill in our precious infectious disease and intensive care facilities – as has happened in those countries that appear to have got on top of COVID-19. But, this is not a rational world, and the UK is not in the position it could have been in had the lessons from the large-scale epidemic flu Cygnus Exercise of 2016 been learnt and the recommendations made in its subsequent report not been pushed off the agenda by Brexit.
In the absence of reliable testing data, the best we can do is turn to the sharply increasing numbers of deaths for an indication of what is happening and the challenge the country now faces.
From 237 deaths on 21 March, the tally topped 1,000 within one week, reaching 1,019 on 28 March. With a doubling of the total numbers of deaths now occurring every two days, the UK is facing the possibility of reaching levels of COVID-19 mortality seen in Italy, which had 4-6,000 deaths by the second week of April and tens of thousands by the end of the month.
It would help if the Government released the data of calls per area to the NHS 111 service with regards to the Coronavirus to local government authorities, to help them plan resources and support in the absence of testing. This would be invaluable and should be remedied soon.
Meanwhile, the miscellaneous band of soothsayers and academic modellers are divided between those who think the UK will get away with under 20,000 COVID-19 deaths and those who still think we are headed for between 250,000 and 500,000. Whoever is right, the potential impact on each of us, our families, the economy and our way of life will be profound. With the Government now on virtual lockdown – following the belated action of an unprepared administration and its wayward advisors, whose initial approach to making the hard decisions was to outsource them to headteachers, supermarkets and individuals – an alien looking at Earth from Mars might conclude that we are now in what amounts to a whole nation refugee camp.
In It Together
On finding oneself dropped into such a situation, the advice is clear.
The first thing to do, rather than rushing round treating a relatively small proportion of those requiring medical attention, is to carry out a quick census of the skills and abilities of those in the camp and to set about social mobilisation to ensure that the relatively small group of professionals is multiplied manyfold.
Joseph Stalin’s question as to the relevance of the Vatican State during World War Two – “how many divisions has the Pope?” – is apposite here. The practical answer being: “Not many apart from a few in fancy dress, outside the Vatican itself, the strength of the Catholic Church being in its millions of lay adherents.” Similarly, it is in the social mobilisation of communities across the length and breadth of the country that our greatest hope lies in minimising the impact of the worst threat to public health since the Spanish Flu pandemic of 1918-19.
The wonderful response of communities everywhere in self-organising over the past few weeks, together with the recent flood of volunteers to the NHS demonstrates the amazing social mobilisation that the UK could have put into action earlier, had the Government treated the public as adults and embraced an open and transparent approach to communications.
What we have a right to expect of our Government, even at this late stage, is the first duty of government: that it deploys its power, authority and resources to keep its frontline citizens safe. So far, when it comes to testing frontline health workers and providing them with Personal Protective Equipment (PPE), it has failed abysmally. The Government announced that the testing of health workers in England was to be rolled-out this weekend and has made various promises on PPE – but promises must be kept.
Assuming that the logistics are finally sorted out, and that the supply of these essential items, together with thousands of ventilators, can be matched with staff who have had to enhance their skill-sets in a matter of days, we still face an immense challenge that calls for cool heads, clear minds, social solidarity, and a practical – as much as an academic – approach and resourcefulness.
The sequence of viral inputs from affected areas between January and March – which has included cruise ships, returning half-term holidaymakers from Austria and Italy, and football supporters from Madrid, together with the Cheltenham race meeting – have ensured that we have experienced a series of locally-seeded outbreaks in different parts of the country, each with its overlying trajectory, a series of dynamic tectonic plates.
With London at the front-end of the first wave, the peak in the numbers of sick and those who succumb will probably come as we head through April into May, with other geographical waves following as we head into the summer. Unless ‘herd immunity’ – consisting of around 90% of the population having experienced the virus – is actually reached over the next few months, we may well have further outbreak waves as next winter comes round and it may be next year before we can look forward to whatever the new normality brings.
In the enormity of what we face, the dramatic changes to everyday life and the diet of daily bad news, it can be easy to overlook other important matters and the collateral damage being caused.
Women about to give birth, for instance, are having their options for births closed down, along with home and midwife-led units – throwing them onto the possibility of an unsafe hospital environment. The large numbers of sexually active people, whose access to birth control and sexual health clinics had already been limited through austerity cuts are not now seen as a priority. Those with serious mental health conditions are experiencing their professional advisors being diverted to work on the Coronavirus crisis. Others who come to mind include the homeless, many of whom are vulnerable drug users, sex workers, those enduring domestic violence and those whose legal status in the country is contested.
We should be concerned for all of these people, if for no other reason than that their wellbeing may affect our own. To those who are unbelievably and most sadly taking the view that the Coronavirus is nature’s way of culling the weak and unproductive, or that the deaths that are occurring now were likely to have occurred soon anyway, I would just remind them that no man or woman is an island and that everything may be relative until it’s a relative.
Dr John Ashton is a leading international authority on public health and a member of the Crown Prince of Bahrain’s Corona Task Force.