Everyone in the UK - please share this widely, this and other posts that explain what is happening in the UK. We have to act, and act promptly. Every day of delay makes things worse.
First if you are in the UK you may be unaware of what the WHO themselves say as it is not normally reported here in the UK since it conflicts with what our scientists say.
There is so little understanding of this in the UK. Few seem to know about it in the general public.
The WHO are the world experts on this topic and are responsible for overseeing the eradication of polio, also eradicating malaria from many countries and near eradicaton of smallpox, also in stopping many outbreaks of Ebola and they respond to 200 or more epidemics every year. These people are absolute experts on this topic. Meanwhile the UK experts base their experience for dealing with COVID19 mainly on flu.
The WHO are to be respected and listened to.
Dr Tedros, director general of the WHO said on monday in his “test test test” speech that we all have a duty to stop this virus not just for our own countries but also for the other countries with weaker health care systems that it could spread to.
He is especially concerned about what happens if it spreads to countries with people weakened by AIDS or with malnourished children or refugee camps - and any country that doesn’t stop it becomes a source for it spreading more easily to those countries. The WHO is acting to reinforce their health systems to cope and unlike Europe most of those countries have been preparing with the greatest urgency for this disease for weeks now. Still, they will struggle to contain this disease if it gets to them in large numbers, for instance, from the UK.
This is the video of the WHO press briefing on 16th March with my summary of opening remarks and official transcript
It may be a good one to share to raise awareness of what the WHO themselves say.
YES THIS VIRUS CAN BE STOPPED
The good news is that China contained it and many other countries are already containing it. We can too. We can stop it,and must..
On the 18th March, China had its first 24 hours with no new cases infected within China. They had 34 new infections from patients who returned from other countries, 21 of those in Bejing. March 19: Daily briefing on novel coronavirus cases in China
This is the clearest indication yet that COVID-19 can be completely stopped by case finding, contact tracing, quarantine and isolation of the contacts. The Chinese economy is gradually returning to normal, transport resuming even in Hubei province, restaurants opening, businesses restarting, schools opening.
WHAT ABOUT A SECOND WAVE?
China are still on alert for COVID-19. They have kept the bed capacity and the ventilators to deal with new cases if they arise. They have very rapid detection of the virus. China they have got the time from onset of symptoms to first detection of COVID-19 in a patient down to 3 days.
So, if there is the beginning of a "second wave", China wiil be able to nip it in the bud before it starts. Outside of Hubei province the only provinces with more than 1000 confirmed cases are Guangdong, Henan, Zhejiang, and Hunan. Eight of their provinces have contained it at less than 100 cases.
If there is a second wave there seems no reason why it should surge even as far as 1000 cases, most likely not even as far as 100, just through rigorous case finding, contact tracing, quarantine and isolation.
See also my
WHAT IS THE UK DOING?
The UK however have abandoned the approach of the WHO.
They have started to do tests again but they have not yet come around to say they are going to try to find all the mild cases, contain them and trace all the contacts and isolate those, as the WHO say has to be done.
I think surely they will eventually do this. The evidence from the rest of the world is so clear that countries that act promptly to contain all cases are able to stop it.
Please don’t be scared by this. You can protect yourself and your loved ones, and protect others too by breaking chains of transmission that pass through you. The government are not yet explaining this to us properly.
Then, if we act together we can get our government to change its direction and save lives. A government is made up of MPs and the MPs for the large part care deeply for their constituents. They need to be made aware what is going on. They are objecting already, but they are not well informed about the background of the WHO.
FEELINGS STRONG IN THE UK ABOUT OUR APPROACH
Here is one MP showing how feelings are strong already about the risk for our health workers and old people with this policy:
https://twitter.com/BBCPolitics/status/1240255298423717889Here Boris Johnson responds that he is acting on the best scientific advice.
I think he may well be unaware of what the WHO are saying - politicians are not expert on science. They are often not especially scientifically literate, and rely on their advisors for that. Boris Johnson has a degree in the classics, ancient literature and classical philosophy and he then went on to be a journalist.
He is relying here on his chief medical adviser Dr Whitty - and he also doesn’t explain to the public that the WHO are asking all countries worldwide to continue with containment and contact tracing.
WHO continues to recommend that isolating, testing and treating every suspected case, and tracing every contact, must be the backbone of the response in every country. This is the best hope of preventing widespread community transmission.
WHO Director-General's opening remarks at the media briefing on COVID-19 - 18 March 2020
Of course Boris Johnson, and Dr Whitty too for that matter, want to slow it down. If they thought they could stop it this would be their top priority.
Yet the WHO say it can be stopped and this is where it gets strange.
Even politicians here are unaware of what is going on. For instance Jeremy Corbyn would surely criticise Boris Johnson on this point if he knew about it, but he doesn't mention it.
It is the same for many experts too - and it sounds like it is the same in the Netherlands who are following the UK's lead here. These experts don't seem to be aware of what the WHO say. Or they are discarding it because it doesn't fit their paradigms for flu (more at the end of this post)
Scientists of course can and do come up with different ideas about how to tackle a pandemic. However, why don’t they make it clear to the British public that what they say differs from what the WHO say?
I think that our advisors should be saying something like this:
“In every press briefing the WHO have said that this disease can be stopped and that it is not a question of wether we can any more but if we will.
Also there was a joint WHO-China report with an international team of 13 experts lead by Bruce Aylward and 12 Chinese experts and they also concluded that it can be stopped after studying it on the ground in China including a day and a half in Wuhan.
However as chief medical officer for England I have looked at the situation and by my best expert opinion is that it can’t be stopped for reasons x y z and so the UK policy is …”
That then would be scientific integrity. Then our PM, advised in this way by his chief medical officer, would then assess for himself whether to follow the advice of his chief medical officer or of the WHO in full awareness that they are giving different advice.
Our politicians then could also discuss whether this is the path we should follow, and so could the general public. For the most part the ordinary people in the UK have no idea there is even a divergence of views here.
Also we as a country would know what is going on and all this would be explained on the TV news and in the media.
It is okay for experts to disagree but if they have good reasons to do so, they should tell us all upfront why they are doing this.
They should not only make it clear that they are following a different path from the WHO. They should say in detail what they think is wrong with the WHO's analysis and advice, or why they think it can’t be applied to the UK situation.
They should also explain clearly to the British Public that in the opinion of the WHO this course of action endangers people not just in the UK but also in countries with weaker health care that we may infect with our outbreak.
As the virus moves to low-income countries, we're deeply concerned about the impact it could have among populations with high HIV prevalence, or among malnourished children.
WHO Director-General's opening remarks at the media briefing on COVID-19 - 16 March 2020
They should explain to us why it is they are continuing with this plan faced with this warning from the WHO and explain what they are doing to eliminate the risk to other countries from exported cases from the UK.
I live in the UK and nobody is doing any of this in the UK. There are letters from experts and politicians outraged by what is happening but though mentioned, they are basically dismissed.
There seems to be almost no awareness that the WHO are even saying this.
I don't think any of our politicians know this either. Nobody is challenging Boris Johnson on this basis or even mentioning it, on the BBC, even the Guardian usually very critical of the government, the experts on twitter etc.
THE EXPERT PROJECTIONS IN THE UK ARE ADAPTATIONS OF INFLUENZA MODELS WITHOUT CHANGING THE TRANSMISSION DYNAMICS AND WITHOUT MODELING CONTACT TRACING
The experts in the UK are doing projections which they create with simple adaptations of models they previously developed for influenza. They change none of the assumptions in the models about how influenza is transmitted and expect them to work for this very different disease that is not a version of flu but a coronavirus and is alos different in how it transmits from SARS too.
Their models are only validated against influenza outbreaks and not against data for COVID19.
It doesn't necessarily follow that actions that help suppress an influenza outbreak will also be optimal for COVID19 without testing a model. A model is just a hypothesis and should not be used for prediction until it is validated against the data you are modeling.
They should explain this too to the general public too and then tell us why we should believe their conclusions from their theoretical models based on flu over the practical experience and the direct research in China and the findings of the experts in the big report co-lead by Bruce Aylward, an epidemologist who was a lead of the global polio eradication campaign for many years.
This, for instance, is the model that has been headline news in the UK recently which they say has lead to the UK government modifying some of its ideas - but still nowhere near the WHO approach and nowhere near contain.
You may have seen this graph reproduced from their paper which leads them to predict a second surge if we don’t let it spread a bit now:
They say in the paper itself that their model’s basic structure is as previously published. There is nothing there about modifying the spread dynamics to model for COVID19 instead of influenza:
We modified an individual-based simulation model developed to support pandemic influenza planning to explore scenarios for COVID-19 in GB. The basic structure of the model remains as previously published. In brief,individuals reside in areas defined by high-resolution population density data. Contacts with other individuals in the population are made within the household, at school, in the workplace and in the wider community.
Paper Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand
Popular exposition here: 3 charts that helped change coronavirus policy in the UK and US
SOME OF THE DIFFERENCES BETWEEN FLU AND COVID-19 NOT MODELED HERE
There the main difference is that flu spreads easily in the community amongst large groups of people, in schools, and has symptomless spreaders, about a third of us are which makes contact tracing impossible.
Meanwhile COVID19 almost only spreads through prolonged or very close contact e.g. families visiting each other or in hospitals, prisons, old people's homes and some religous situations. These people know each other, or the organizers of the events know them all.
This is why COVID19 spreads mainly through easily traceable close contacts - a method that wouldn't work for flu.
STRIKING EXAMPLE OF CONTACT TRACING TO FIND EVERY CASE IN SINGAPORE - TOTAL POPULATION OF 5 MILLION AS LARGE AS SCOTLAND
You can see this especially strikingly for Singapore.
There may be a very small amount of community spread in the genuine sense such as is the norm for flu - but it must be very small because tracing the first 266 patients in Singapore they didn’t find any.
All the cases traced back all the way to China.
These were some of the early cases in Singapore:
What we know about the locally transmitted coronavirus cases in Singapore
If there was large scale local spreading in Singapore, and this was causing serious illness or killing people, they would have reported to the clinics or hospitals and we should have come across some of those cases by now.
However all the cases at least through to the first 266 can be traced all the way back to China. Here is just a small part of their big chart.
Explore it here:
You couldn’t do that with flu. If any of those people had passed it on to someone in a bus, coach, plane, train, waiting in a queue or something, it would be impossible to do this contact tracing.
But it’s mainly things like people in the same family, maids etc. Also notice that most of the cases are end points in this graph, which means they don’t infect anyone. This virus spreads by just a few people of the many already infected spreading the virus to many. Then just one or two of those spread to more,\ and so on.
Also we know this graph is complete, apart possibly from symptomless non spreaders, because they test everyone in Singapore for COVID19 that presents with fever or respiratory symptoms in a population of over 5 million and these are the only cases they found.
COVID19 in Singapore shows there can't be a hidden population of symptomless superspreaders
Hong Kong and China have also done a fair bit of testing in fever clinics too, and so has South Korea.
Even for South Korea most of their nearly 8000 cases are from a few well defined huge clusters.
This is what makes it so different from flu.
IMPERIAL COLLEGE LONDON’S MODEL ASSUMES ONLY A THIRD OF THE TRANSMISSION CHAINS CAN BE STOPPED BY QUARANTINE AND ISOLATION
Much of information for this section comes from this report:
Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
In the Imperial College London model:
According to the big WHO-China joint report however
In the Imperial College model also
In the WHO - China report
According to the WHO
As for community spread, there may be some genuine community transmission between random people who don’t know each other or some common third person. However there is so little that none has yet been detected in Singapore which is our country with the best data on the topic. That should be close to 0%.
When stopping an epidemic you don’t need to stop all transmission chains. If e.g. R0 is 2 then it is enough to break more than half the chains. They assume 2.4 . If in their model more than 60% (e.g. 75%) of transmission chains were broken, it would eventually stop altogether.
There are two forms of transmission that seem to be driving the spread. There is prolonged contact and there is brief but close contact. In both cases the main thing is the people concerned know each other, so you can do the contact tracing.
They don’t model contact tracing and isolation of contacts, or isolation of individuals within a household, just quarantine of entire households.
This is why quarantine doesn't work by itself in their model, while in South Korea, Singapore, China etc, they are containing it with mainly quarantine and contact tracing.
The contact tracing is part of the solution to end this. The WHO recommends that everyone does contact tracing. If they want to investigate this in a model they should model contact tracing and seehow effective it is. The countries that do comprehensive contact tracing have had most success in stopping the spread.
OUR DISTINGUISHED ACADEMICS ARE NOT VALIDATING THEIR MODELS AGAINST THIS CONTACT TRACING DATA FOR COVID19
When I say these distinguished academics are not validating or checking their model - I mean they have not checked it against this detailed data.
However, instead of concluding that their model needs a radical revision to model this new virus, they wait for more “good” data from the field that fits their paradigm and discard the data that doesn’t fit it as anomalous.
This is not “good science” but it is a natural thing for humans to do.
Such models have to be validated against the data to provide even a qualitative prediction. Until then, they are unconfirmed scientific hypotheses.
There is nothing here to contradict the conclusions of the WHO that this pandemic can be stopped.
EXAMPLE OF VENETO IN ITALY
The Italians have become acutely aware of the value of extensive testing and contact tracing for saving lives. Michele Zanini has shared a number of figures on twitter that bring this out strikingly.
Of all the provinces, Veneto is the one to adopt the WHO recommendations most rigorously. They did more tests than any other province per 100,000 people:
This has paid dividends. In this figure notice how low the cummulative number of deaths is for Veneto starting from the tenth death:
They also have far fewer health workers infected as a percentage of the total cases, 3% as compared to 13% for Lombardy:
Michele Zanini tweets that they routinely test caregivers and other workers with greatest exposure to the population:
They routinely testing all caregivers & other essential workers w/ greatest exposure to the population (e.g., supermarket cashiers & law enforcement). This might in part explain why there are 25x more caregivers infected in Lombardy vs. Veneto (Lombardy is 2x the pop)
These measures may be part of the reason of Veneto’s success in keeping the deaths down so low compared to other provinces.
With this experience from the front line in Italy, you can understand the reaction of the colleagues of Professor James Smith to our Governments announcement that it would stop quarantining and containment and stop testing and tracing contacts:
- Italian colleagues opinion is not translatable in polite way
Text on the image:
Devi Sridhar - Colleagues all think we are doing it wrong - Professor of global health, Edinburgh
Prof. Sunit K. Singh - Not ethical to make hunmans guinea pigs in name of "Herd Immunity" - Prof. and head of microbiology, BHU
James Smith - Italian colleagues opinion is not translatable in polite way - Vice principal and prof, Edin.
Martha - How do we learn about this disease and its transmission by only counting those in hospital? - BA (Hons). LLB. MSc.
[note for autistic readers -when Prof Singh talks about "human guinea pigs" it is hyperoble. He doesn't mean they are literally experimenting on us like guinea pigs. He means that the actions they are doing implementing an untested academic theory to deal with this outbreak, instead of the practical advice of the WHO, is like experimenting on guinea pigs in effect not in intention.]
I do hope we reverse this change of direction soon, but the sooner the better!
WHY IS COVID19 SO DIFFERENT FROM FLU?
First, there is no evidence of any airborne spread (as there was for SARS)
COVID19 spreads by the droplets we expel when we cough or sneeze, and the way they fall on surfaces. Some of these fall in other people’s noses, eyes or mouths, and others fall on surfaces which people then touch, then touch their noses, eyes or mouths and so infect themselves. It can’t infect us through the skin.
However it is that the infection actually happens, they can tell from those who got it that there are two situations where you can get it
This virus has an affinity for the lower respiratory tract and not much of an affinity for the upper respiratory tract so it has trouble entering the body originally and may require a very high viral load to get started.
Since it is such a different disease, different even from SARS, a model of spread designed for flu would not necessarily be expected to work unmodified for COVID19.
COMMUNITY SPREAD IS NOT DRIVING THE COVID19 PANDEMIC - UNLIKE FLU
This virus mainly spreads in places where people are in contact for a long time. It just doesn’t seem to happen that someone coughs on you a few times in a supermarket or on an underground train and then you have the disease.
I need to be careful here. The WHO and other experts are stressing that it is important to protect oursevles against community spread.
They are not saying it is okay to go around coughing on people if you have COVID19 or that it is okay to let others cough on you or that it is okay to skip quarantine.
There may well be a small risk of community spread.
With even the minutest spread, for someone with COVID19 even to go shopping is like playing russian roulette with someone else’s life.
But the community spread risk is very small for this disease, unlike for a flu outbreak. So small that you’re containment measures only need a small element of social distancing, for instance certain kinds of large groups.
South Korea and Singapore, also China outside of Hubei province didn’t need to do any lock downs.
This is the real data from the world:
COVID19 is a new disease and could resurge. However there is little evidence yet that it will surge up again.
China has stopped it just about completely, and has had days with no native Chinese cases. They are restarting their economy, opening restaurants, restarting travel even in Hubei province.
There has been no second wave yet. The Chinese are prepared for one if it happens. They have kept bed space, ventiliators etc to be able to stop it as they stopped the first one.
During the first wave, most provinces outside of Hubei had only a few hundred cases.
China can now detect a new COVID-19 case within 3 days of symptoms starting because of they way the public there now go to fever clinics to be tested as soon as they have a fever and because of a huge testing capacity.
So China is not going to have a second wave like the first one even if it does resurge. The rest of the world could do this too. We can stop it, from the experience of China this is clearely something that can be done with this virus. Then we can monitor with extensive testing of anyone with flu symptoms to see if there is a second wave. With testing in place, we can stop any such second wave as well before it happens.
Dr Bruce Aylward talks about the Chinese response and compares it to the UK response here. His main point is that as a new virus then there is room for different ways to try to tackle it but his advice for the UK would be they have to adapt rapidly if they find that their methods are not working as expected.
https://youtu.be/vsV_PJ3txn8?t=465‘We’re all guinea pigs because it’s a new virus’ – WHO’s Dr Bruce Aylward
Note for autistic readers - by “guinea pigs” they don’t mean that it is an experiment on us by people who don’t care who lives or dies. It means that those concerned do care, but as it is a new virus then it is something we have to learn about from experience of what works and what doesn’t work.
What we know for sure from our experiences so far is that we do as the Chinese did, and as Singapore and South Korea are doing, we don't have to just flatten the curve. Those projections with a second wave don't take account of the unusual way that COVID19 spreads and the way that it can be stoppped by contact tracing unlike flu. They can’t model what happens in the real world with COVID-19 until they add modeling of contact tracing.
So we can handle this if needs be. But so far there is no evidence that COVID19 will resurge like this.
Also COVID-19 could transfer to humans again from its original reservoir, perhaps in pangolins (not discovered yet). But if so, again, the Chinese will spot it within days now they know how to detect it, and handle the second wave in the same way they handled the first wave in provinces outside of Hubei province.
DURATION OF QUARANTINE FOR COVID19 AS RECOMMENDED BY THE WHO
The WHO advise if someone is a covid 19 case for the mild version of the disease, they must quarantine for the period of sickness + 14 days.
So, if you do have it, and it is genuinely COVID19, then after it has run its course and you are completely symptomless, you are asked by WHO to continue to stay in quarantine for an additional 14 days after that in case you infect somone else.
Others in the same household as a confirmed case are treated like any other contact - they self isolate from each other and the suspect case for 14 days and then if they didn’t have it they are virus free.
You are also infectious for 1–2 days before you show symptoms. That is why they ask contacts to self isolate even when they have no symptoms once they are known to be contacts with a COVID19 case. If you got them to isolate only once they have symptoms then it is too late).
UK’S GUIDELINES - MIGHT THEY EVEN INCREASE THE SPREAD?
However the UK again has developed its own guidelines that differ from the WHO. Their objective is to just slow down the spread with minimum inconvenience. Meanwhile also since they are not testing any more, everyone in the UK with a flu / dry cough / fatigued feeling like a bus has hit you has to consider themselves to be a potential COVID-19 case.
The UK government tells people living alone should self isolate for 7 days.
For those in a household withothers, they ask them to continue living with their household and isolate the entire household from the rest of the world for 14 days.
This would work with flu. People with flu can infect others any time from 1 day before they develop symptoms to up to 7 days after onset of symptoms. Some people with weakened immune system or children may be able to infect others more than 7 days after the start of a flu infection, but this is rare.
With the mild cases of COVID-19 then at 14 days they are likely over the sickness, but remember the WHO say they are still infectious for another 14 days after they have recovered, not 14 days from onset of symptoms.
Many with the mild symptoms take two weeks to recover from the symptoms. At that point they are symptom free but will be infectious for another two weeks after that.
Also, remember they don’t ask the household to self isolate from each other.
So, the government is asking them all to stay indoors in the same small volume of space for those two weeks. If the patient is COVID-19 positive, then the family are all sharing the same air and breathing in droplets from the COVID-19 patient, and touching surfaces the COVID19 patient has touched..
This is is creating the prolonged contact which seems to be what this virus needs to spread.
This seems likely if anything to increase the amount of spread.
So now the first case is over their symptoms but still infectious for up to 14 days. The other members may be infected now but presymptomatic. At that point the entire household can now leave their house and do what they like and pass it on to others.
This delays the spread back to the community for 14 days, yes, but then at the end of that period you likely have increased the number of cases by prolonged contact.
If people right now are following those instructions, we can expect a surge of COVID-19 cases two weeks from now when they start to return to the community after their two weeks isolation.
I think it is possible that our government’s instructions are acting to increase rather than decrease the rate of spread of this virus, though not immediately, delayed by two weeks.
THE FLU TRANSMISSION MODEL IS THEREFORE NOT OBVIOUSLY SUITABLE FOR THIS DISEASE
This is why a model of transmission for flu is not at all obviously suitable for this disease. It has to take account of its unusual transmission dynamics where the transmission is to people that the case already knows or to an event where typically they know each other.
This also makes the hospitals, prisons, old peoples homes etc top priority to protect because they are the places where people spend a lot of time in prolonged contact.
ON A PERSONAL LEVEL, RISK OF TRANSMISSION IN THE COMMUNITY IS LOW
On a personal level your risk if you go out and about in the community, from this data is very low, and then by the hand hygiene, respiratory etiquette and not touching your face you can reduce it to the point you can be confident you didn’t get this virus.
You are far more likely to get it from someone visting including a relative. You may also get it through close contact with a friend or colleague.
You can catch it in just one day, you don’t have to wait for weeks to get it. The German cases were acquired quickly and an early example in China was of one family that visited another family in Wuhan for a day and I think they all got it.
However you may also get it after prolonged contact.
PROTECTING DOCTORS, CARE HOMES, HOSPITALS, SURGERIES AND PRISONS
From the experience of other countries, those are the things they should focus on most of all.
Then there is the way they are doing almost nothing to protect care homes, hospitals, surgeries, and dentists from patients who may have undetected mild cases of COVID19. Or prisons. These are not their center of attention.
They have even downgraded the level of protective equipment recommended to doctors working with known COVID 19 positive patients.
See my
This is not a theoretical study, it is real life with real people’s lives at stake. These places have been involved in spreading and amplifying COVID19.
As far as I know, ours is the only government that has policies that actively encourage community spread through doctors and care homes, again by this false analogy with flu and by reducing adequate protection even for known COVID-19 cases
CANNOT PROTECT HEALTH WORKERS EXCEPT BY GOING BACK TO CONTAIN PHASE
What’s more we are not going to be able to protect our health workers unless we go back to the contain phase - or perhaps with very rapid testing in a few minutes.
The thing is you can only protect your doctors and nurses if you know that patients have COVID19. If someone comes in with a broken ankle, and they are coughing and sneezing - do you get on full protective gear with face guard, or can you treat them without any special equipment?
There are tests under development that could detect it within half an hour, but that still is not enough for an emergency response.
In a more urgent situation, if you are treating an accident or other life and death situation then you may have seconds to make this decision. What do emergency response teams do if they find someone who has been involved in a car accident, with no knowledge of whether or not they have COVID-19?
Public Health England have actually downgraded their protection even for doctors treating known COVID-19 patients.
COVID-19: infection prevention and control
As you can see, as of 17th March, doctors
All this equipment used to be worn by anyone entering a room where a COVID19 patient is being isolated, even before definitive assessment of them as a possible case.
The guidelines were changed on the 6th March.
This is what it used to say:
The following PPE is to be worn by all persons entering the room where a patient is being isolated (either before definitive assessment, or once assessed as a possible case):
- long sleeved, fluid-repellent disposable gown – wearing scrubs underneath obviates problems with laundering of uniforms and other clothing
- gloves with long tight-fitting cuffs
- FFP3 respirator conforming to EN149 must be worn by all personnel in the room. Fit testing must be undertaken before using this equipment and a respirator should be fit-checked every time it is used
- eye protection, such as single use goggles or full-face visors, must be worn (note prescription glasses do not provide adequate protection)
The PPE described above must be worn at all times when in the patient’s room (see putting on and removing personal protective equipment)
However now that they are no longer even testing mild cases it has got worse than that.
There will be patients with COVID19 treated in general hospital emergency rooms with staff that have no idea they have the virus and not taking any precautions at all.
We can’t shut down hospitals and stop treating people with a broken ankle in case they might have COVID19. It is not practical to treat everyone in the UK as if they are a COVID19 patient without testing them. It is not practical to test everyone who comes into accident / emergency either, as it takes several hours to do the test. Also right now, there is a shortage of tests and we couldn't do that.
We have to go back to containment. Also now that we have lost track of the virus we have to step up our diagnostics capability, and test everyone in the country with a fever, like the Chinese do.
Within a few days we could locate the majority of COVID19 patients in the UK if we did what the Chinese did. The tests themselves cost $5 each for the WHO and more like $50 each in the US. It is expensive to do so many tests, but far less disruptive and expensive than what our government is doing.
MY PERSONAL RISK
Many of those I help are concerned about my personal risk as I live in the UK and am 65 years old
I am keeping myself safe. I live by myself so there isn't much possibility of contamination if nobody visits me and I don't visit anyone else and don't travel. The UK is saying we should only do essential visits of each other, and my social life is largely online, so I am doing this too.
So the main way I could get COVID-19 is if I go shopping. When I do this, I am careful not to touch my face, wash my hands when I get back and clean all the surfaces I touched to get back into the house with soapy water. I also keep a distance from anyone who might be coughing or sneezing, in my case that is easy living half a mile outside of a remote village in Scotland on the Isle of Mull.
I think my main personal risk would be if I had a broken ankle or a bad toothache and needed care from a hospital or a dentist. The government here are not acting to make sure hospitals and dentists are protected from treating mild cases of COVID19. Any hospital or dental surgery could have treated a mild case of COVID-19 before me, including mild cases that can infect others before they develop symptoms or for up to 14 days after symptoms cease.
So - I think we have to assume that any hospital or dentists surgery might have COVID-19 endemic to the facility - especially since this often happened in Wuhan in the early stages of their epidemic. This will be very unlikely to start with. As for Wuhan we could go some days before the first outbreak in a hospital, clinic or surgery - but it becomes more likely for as long as this policy continues.
So I am especially careful not to break an ankle or do anything risky like that and not eating sweet things so as not get a toothache. Those are probably wise things for others to do if you live in the UK.
Your personal risk is very small if you are under 40, only 1 or 2 in 1000 and less than that for younger people, and then your risk of getting it from a surgery or hospital here is surely very low too.
At my age, 65, I have a 3 % or so risk of dying if I get COVID19 so have to take especial care.
WHY OUR GOVERNMENT NEEDS TO BE AGILE AND RESPOND RAPIDLY IF ITS MEASURES DON’T WORK
All of our governments advice seems to be based on measures they know from experience help with flu rather than the new measures developed in China, Singapore, South Korea, Italy etc that work with COVID19.
As Bruce Aylward said the most important thing here is to be agile, to be able to quickly respond and change direction if your methods are not working.
They need to get up to speed fast and change their ideas rapidly. It needs to be evidence based, based on evidence for COVID19 rather than influenza.
There are signs of this already. Look at the deaths from COVID19 in the UK doubling every 2 days. Usually it is every 3–4 days. Their measures may be making things worse.
With a doubling time of 2 days it would continue
200, 400, 800, 1600, 3200, 6400, 12800.
We could have 12,800 deaths by two weeks from now, at this rate, increasing 64 fold every fortnight. That’s more deaths than in the whole world right now.
If it doubles every three days this happens three weeks from now and if it doubles every four days, it happens four weeks from now.
NOTE I AM NOT SAYING THIS WILL HAPPEN
There is no way we go as far as that.
If we don’t stop this approach RIGHT NOW, it will soon be in a situation as difficult as Italy and if we do nothing for another 10 days it can easily begin to get as bad as WUHAN or worse.
GOVERNMENTS NEW MEASURES ARE STRONGER BUT ARE THEY WHAT IS NEEDED?
The governments increase in testing to 25,000 a day is a welcome step in the right direction. But there is far more they have to do.
Also for specific vulnerable populations:
So far they are not doing any of these things, and every day counts.
They are doing many other radical things that would work for flu but for the most part are untested for COVID-19
Details here:
We don’t really know the number of cases infected now until they do rapid and extensive testing. But if the cases are doubling only every 3 days instead of every 2 days, then that would be a ten fold increase every ten days. 1000 cases become 10,000 ten days later, then 100,000 then within a month, 1 million, more than ten times worse than the total cases for Wuhan.
We crossed 1000 cases on the 14th of march. That makes it the 24th when we may hit 10,000 cases and 3rd of April when we may hit 100,000 cases. If the government’s actions are actually accelerating spread due to using the wrong paradigm of flu instead of COVID19 it may even happen faster.
PARADIGM SHIFTS AND TRAINED INCAPACITY - WHY DON’T THE UK EXPERTS SEEM TO SEE ANY OF THIS?
I think myself it is an example of a paradigm shift as in Thomas Kuhn's "The Structure of Scientific Revolution".
Paradigm shift - Wikipedia
They are using the flu paradigm and everything else is checked according to how it fits that paradigm and they are discarding information and advice that doesn't fit it.
This can often seem puzzling to non experts because you are not invested in the old paradigm. You can't see things the way they do with their decades of experience working in great details with all the intricacies of transmission mechanisms of flu.
I think it is also related to Thorstein Veblen's idea of "trained incapacity". He has a rather unflattering analogy with chickens:
By trained incapacity he meant that state of affairs where one's very abilities can function as blindnesses. If we had conditioned chickens to interpret the sound of a bell as a food-signal, and if we now rang the bell to assemble them for punishment, their traiing would work against them. With their past education to guide them, they would respond in a way that would defeat their own interests.
Thorstein Veblen - Wikipedia
We are not talking about chickens and a simple conditioned response here of course. Our experts are erudite, highly educated, and very intelligent .
However paradigm shifts can be tricky for even the most intelligent. I have a special interest in the history of Maths.
Back in Sumerian times then they put a mouth picture over a number, meaning “part” to turn e.g. the number 5 into 1/5
So the Sumerians could notate any number, e.g. 5 and a single part as a result of any number of divisions e.g. 1/5.
However they had no way to notate, say, 3/5.
For instance they couldn’t notate 3/4. Instead they had to notate it as
For centuries an entire civilization of people with the same genes as us, as intelligent as us, never invented the idea of a ratio.
You can do the same calculations with these methods, but they become increasingly hard to do, with many more stepsas the calculations get more complicated.
Ratios would have made many calculations they had to do so much simpler for them, but the idea never occurred to them. Not even their equivalent of our best scientists or mathematicians were able to think of this idea. Put Albert Einstein back into Sumerian times, raised as an orphan there, and he wouldn’t think of it either.
That’s an example of a paradigm shift.
There are many others in maths. There was huge resistance in the middle ages to the introduction of negative numbers in equations.
Before negative numbers were accepted by mathematicians - then they had many different forms for the quadratic or the cubic. You always had to rearrange the equaation to make sure all the coefficients are positive. As they went through the steps to solve the quadratic, they had to keep everything positive because they didn’t think negative numbers were valid numbers. This lead to many different techniques you had to learn to solve a quadratic and even more so for the cubic with this clumsy notation.
It took until the fifteenth century for negative numbers to take off in Europe.
As late as 1758 the British mathematician Francis Maseres wrote that negative numbers
"... darken the very whole doctrines of the equations and make dark of the things which are in their nature excessively obvious and simple" .
Now we learn about negative numbers as children. Back then it was an advanced subject for their equivalent of university level maths with the experts arguing about whether it was valid to use them or not.
I hope this helps you have more sympathy for these experts. They are not stupid, or arrogant or unethical. Just facing a paradigm shift, and their vast experience of influenza has caused a “trained incapacity” that makes it really tough for them to change this paradigm. So they are discarding the evidence against their ideas over and over.
Their own erudition is the thing that is causing them problems.
They will come around eventually. I expect it to worsen over the weekend and by the end of next week it should be increasingly obvious that this approach is not working.
But we don’t have time for this; every doubling of cases makes it a longer and more difficult task to contain this and stop it - we must act promptly to stop it as fast as we can right now.
SO WHAT DO WE DO NEXT?
This is draft for a petition to the UK Government (or possibly two separate petitions).
My first draft of the petition was rejected - you can see it here: Petition: The UK government must immediately return to the contain phase for COVID-19
Here is my new draft:
The Government must quarantine COVID-19 cases and isolate contacts immediately
The Government must follow WHO recommendations to isolate, test, and treat every suspected case, and trace every contact, and to make this the backbone of its response to COVID19.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said: "Several countries have demonstrated that this virus can be suppressed and controlled. The challenge for many countries ... is not whether they can do the same; it's whether they will." The UK is one of the few countries to stop contact tracing and quarantine. We must join the rest of the world in solidarity to suppress and control this virus, both for ourselves and for the other countries that will be infected by the UK if we don't.
Then another one:
The Government must test everyone with influenza-like illness for COVID19
The Government must also test everyone with influenza-like illness for COVID19 as recommended by the WHO-China Joint Mission headed by Dr Aylward and Dr Liang and published on 25th February
Singapore, Hong Kong, South Korea and China have all shown the value of extensive testing for COVID19. This is a proven method to nip new clusters of infections in the bud, reduce the numbers of deaths and save the lives of frontline health workers.