I often get asked - “How long is this COVID19 pandemic going to last?”. The answer, according to the WHO, is that it is up to us. We can stop this. The only question is whether we will. Most countries in the world are acting vigorously to stop it with rigorous case finding, contact tracing and isolation. But the UK and, sadly, Netherlands have decided to follow another direction.
This can only be stopped if all countries are in it together, and for just one country to depart from this strategy means the virus will continue in that country and reinfect the rest of the world, at least until we have a vaccine, a year to eighteen months from now.
This means it is not going to stop until the UK reverses its decision to move from “contain” to “delay”. For as long as we don’t contain it, the UK remains a reservoir for the virus to reinfect the rest of the world.
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.
- Do they then isolate all the mild cases appropriately?
- Do they trace all their contacts and isolate them too?
- Do they do campaigns to educate our public about hand washing and other measures to keep themselves safe?
- Are they testing all suspected cases and are they doing surveillance of everyone with influenza like symptoms to catch COVID19 cases in the community early?
Also for specific vulnerable populations:
- Do they provide adequate personal protection equipment, and training, to protect all our health workers who work with COVID19 patients?
- Is adequate personal protection advice and equipment given to dentists, workers in care homes with COVID19 patients, nurses and midwives, as well as frontline doctors?
- Are those who care for COVID19 patients and contacts who self isolate at home given adequate instructions on how to keep themselves safe?
- Are they working to ensure that our overcrowded prisons with Victorian buildings are protected from COVID19.
- Is COVID19 testing giong to be available for free, and without questions asked, to homeless people and illegal immigrants?
So far they are not doing any of these things, and every day counts.
The Chinese have shown that it can be stopped.
Hubei had only 4 new cases on the 14th and 15th, only 1 new case on the 16th and had its first day with no new cases on the 17th. These are the only cases that originate in China. The rest of their cases are from other countries imported back into China by travelers from abroad.
The Chinese have shut down 14 new hospitals they built just to treat COVID-19 patients in Wuhan (see China's Xi Jinping pays first visit to coronavirus epicentre Wuhan). 4,000 of the 10,000 medical workers from outside Hubei province who were sent to deal with the outbreak were allowed to leave on the 17th March (see In China, life returning to normal as coronavirus outbreak slows)
The Chinese only used lock down for cities in Hubei province. Outside of Hubei they used quarantine, rigorous contact tracing and self isolation as their main strategy.
South Korea is using the same strategy as China used outside South Korea, without any use of lock down. At its peak on the 1st March it had 1062 new cases. It dropped to under 100 new cases on the 14th and has remained under 100 for the last three days to 17th March.
2020 coronavirus pandemic in South Korea - Wikipedia
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said that it is not a question of whether other countries can do the same. It is a question of whether they will:
"Several countries have demonstrated that this virus can be suppressed and controlled.
The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same; it's whether they will."
Transcript for WHO Emergencies COVID-19 Press Conference, 11th March 2020
When the WHO declared it a pandemic he said:
We are convinced that, although this is the first coronavirus to be labeled as pandemic proportion, at the same time we believe it will be the first also to be able to be contained or controlled.
Transcript for WHO Emergencies COVID-19 Press Conference, 11th March 2020
All the other countries are going to stop it. But it can’t stop as long as there is one country which is not containing it.Our chief medical officer is not listening to the WHO. He is an academic using a theoretical model he hasn't published. This means nobody else can examine his model. It is not even a preprint. It has no peer review.
A model is only as good as its assumptions. A model can’t be used to predict anything until it is tested against real world data for the disease they are modeling. Until then it is just a hypothesis.
Take this one that is in the news right now:
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.
Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand
They are using an influenza model. But it is not validated against COVID-19. :It is a different disease with almost no community spreading. Instead COVID-19 spreads mainly through only easily traceable close contacts. They don't simulate the effect of contact tracing and isolation. For an overview of it; 3 charts that helped change coronavirus policy in the UK and US
They tell us that the Chinese pandemic will flare up again as soon as they stop the containment measures. But as we have seen all the evidence is against this.
As China returns to normal, the risk isn’t reinfection from within China. The risk is reinfection of China from Europe.
Italy may be reaching the peak of its epidemic or even past it:
2020 coronavirus pandemic in Italy - Wikipedia
Based on the experience of China, South Korea and many countries with smaller outbreaks, Italy should be able to get its outbreak under control.
The US can do the same.
Sub-Saharan Africa is reasonably well protected. They have had devastating epidemics there such as Ebola and needed little convincing to act with utmost urgency to stop this pandemic spreading to their country. The WHO with its
Once that happens all the attention will be focused on the UK.
The pressure to stop our policy will be two fold - international pressure and also internal to the UK.
Our public will see that Italy has controlled its outbreak, and that the UK is not controlling its outbreak.
Europe as a whole may have peaked already
See
Warning, the section where I talk about the risk to UK doctors, nurses and hospitals is scary. But we can stop this. We in the UK must spread this understanding, explain to our fellow citizens that the approach our government is using is directly opposed to the advice of the WHO and pressurize our government to stop this NOW and go back to containment.
The point in saying these things is to get our government to stop. I am sure they will have to, soon, but every day of delay matters.
This is another article I'm writing to support people we help in the Facebook Doomsday Debunked group, that find us because they get scared, sometimes to the point of feeling suicidal about it, by such stories.
Please share with friends if it helps you - they may be panicking too
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. 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? Will all our emergency rooms require our staff to have full protection from COVID19?
No. The opposite.
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
- don’t have to wear eye protection in a general ward (doctors in Wuhan were infected with COVID-19 through the eyes)
- use an apron instead of a complete disposable gown even in high risk units, so that after leaving the ward and removing their aprons, they will be wandering around the hospital with COVID19 infected scrubs.
- They don’t wear the high tech FFP3 respirators even in high risk units any more, only for intensive care.
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.
WHAT HAPPENS TO OUR DOCTORS AND NURSES IF HALF OF THEM GET INFECTED WITH COVID19
This is what would happen to our doctors if we don’t shift back to containment. Here I am assuming half of them get infected. This seems likely as it seems bound to spread through most hospitals if nothing is done to protect our doctors.
For the older patients I am using the data for the first 1000 deaths in Italy and for under 50, data from China. For the sources see my: Deaths in Italy from Covid19 - similar to China - higher case fatality rate is due to more elderly patients affected
- 38 out of 38,000/2 die (20 - 29), 0.2%
- 90 out of 90,000/2 die (30 - 39), 0.2%
- 80 out of 80,000/2 die (40 - 49), 0.2%
- 168 out of 56,000/2 die (50 - 59), 0.6%
- 358 out of 26,500/2 die (60 - 69), 2.7%
- 463 out of 10,000/2 die (70+), 9.6 %
Total 1197
(I have rounded the numbers of doctors there to the nearest 500 in each group).
That makes it over 1000 doctors would die during the outbreak. I am using:
That would be more than ten doctors a day dying at the height of the outbreak.
There would be absolutely nothing to do about it since we need our doctors. You can close down sports matches but you can’t close down hospitals.
We would get many stories like this one of an Italian physician who continued treating COVID-19 positive patients although he knew his protection was inadequate due to running out of the right kinds of personal protection equipment:
Colleagues Mourn Italian 'Hero' Physician Killed by COVID-19
Here in the UK then the same doctor wouldn’t even know if his patients were COVID19 positive - not if they came in for a broken ankle say. Or a dentist with a patient needing a tooth extracted. Or nurses including nurses caring for patients at home, or midwives (some pregnant women might be COVID19 +ve)
The nurses would be in a similar situation:
- 54 out of 54193/2 (20–29) 0.2%
- 74 out of 73548/2 (30–39) 0.2%
- 94 out of 93566/2 (40–49) 0.2%
- 247 out of 82326/2 (50–59) 0.6%
- 227 out of 16789/2 (60+) 2.7%
Total 752 nurses die
Nurses, Midwives and Support staff by area, level, gender and age, January 2018 - NHS Digital
These dying doctors, dentists and nurses would soon cease to be little more than statistics.
Of course with the disease spreading through hospitals, large numbers of patients would also die. It's the same in care homes. The disease would spread to the care homes from the community via their carers.
The government haven't shared the details of their modeling, which is unpublished and has had no peer review. They also do not share figures of the numbers of deaths they expect. But Professor John Ashton said on TV that he believes they have predicted that if one case of COVID19 gets infected in a care home for the elderly, that 30% of them will die. That seems not impossible.
We must stop this and SOON!
I think we will. The UK is beginning to listen - deciding to increase testing of COVID19 cases for mild symptoms.
They could then morph to containing those cases and then start contact tracing again.
But every day of delay counts here.
EXPERTS SAYING WE MUST STOP
Many experts are weighing in saying the UK must go back to containment as a top priority or pointing out problems with their approach.I mention some or them here:
The UK government is responding to some extent. But it is still too slow, and it is not doing the correct actions to slow this down. It is treating it as if it was a nasty flu, when it is a different disease, spread in a different way, to very close contacts and prolonged contacts.
Our 1500 cases will become 15,000 cases in 10 days. Social distancing throughout the country is not the priority given that it spreads often through hospitals, prisons, care homes, clinics, and people visiting each other at home.
Telling people to stay at home when they are feeling sick for 7 days (or 14 days if they share the house with others) is not the solution either. COVID-19 remains infectious long after you feel completely well and is also infectious for a day or two before you get symptoms.
COVID-19 can be infectious for up to 14 days after you feel completely well. And why do these instructions say that you can leave your house a week earlier and infect others if you live on your own? How does that make you less of a risk?
You can read their advice here:
- Anyone with a fever or persistent cough should stay at home for seven days if they live alone or 14 days if they live with others. Anyone who lives with someone displaying coronavirus symptoms should also stay at home for 14 days. People who have to isolate themselves should ask others for help
- Everyone should stop non-essential contact with others. This is particularly important for people over 70, those with underlying health conditions and pregnant women
- People should work from home where they can
- People should avoid places like pubs, clubs and theatres. This applies especially to those in London which is "a few weeks ahead" of the rest of the UK
- People should stop all unnecessary travel
- By the weekend, those with the most serious health conditions - around 1.4 million with conditions such as heart disease, diabetes, or asthma - should be shielded from social contact for 12 weeks
But that is not needed and most of that makes little difference and will not protect health workers.
When you have 2000 cases or even 10,000 cases you don’t need to ask everyone in the UK to self isolate. You need to find those cases first, isolate them quickly, isolate all their contacts and then everyone else can continue life as normal. You do some social distancing and most important the advice on hand hygiene and other measures to deal with any that get through the net. But mainly you catch the ones you miss by asking everyone who gets a temperature to get tested for COVID19 and make sure you have the diagnostic test capability to test them all.
That is what China did. Do that promptly and fast and you can knock this back to clusters, and then eventually single cases and then it is gone.
That is what Singapore did, rapidly and early on, which is why it never had a large outbreak.
The only answer is to return to a rigorous methodical contain, and contact tracing, and fast. Every day of delay matters.
As for the contact tracing, China was tracing half a million contacts at the height of its outbreak. Ireland and Italy are using the power of voluntary community organizations to do it - as anyone can contact trace. Many countries are also using civil servants. These don’t need to be trained health professionals and we can certainly do contact tracing of many thousands of people. Mike Ryan in one of the WHO press conference said that during the height of the recent Ebola outbreak, the Congo, in Africa, was tracing 25,000 contacts in the middle of a war zone - a shooting war with actual weapon fire going on as they traced the contacts. Of course the UK can do this.
Even articles critical of the UK policy in the UK media just don't mention that the WHO repeatedly say with every single press briefing that this disease can be stopped.
The WHO epidemiologist are experts too, and experts with direct on the ground practical experience of fighting every kind of epidemic there is that troubles humanity. The WHO were responsible for overseeing eradication of smallpox, near eradication of Polio, eradication of malaria from many countries, and have just once more stopped the most recent outbreak of Ebola in the Congo.
So the alternative is not just to try to keep it at low levels of endemic. It is to stop it, eradicate it from the world.
IF YOU ARE A UK RESIDENT, PLEASE PUT PRESSURE ON OUR GOVERNMENT TO RETURN TO THE CONTAIN PHASE PROMPTLY
As a UK resident myself, I am going to keep posting these articles and do the very best I can to apply pressure on them to go back. I'm only one person but if we all put pressure on them they have to act.
I am sure they will change direction once people start seeing these deaths. But by then many of our hospitals will have been infected with COVID19 and it will be much harder to stop. I am writing this in order to try to press action on this sooner. This is not an academic exercise, these are real people's lives. Every day matters.
They are representing us and have to listen to their people. The individual members in parliament represent their constituencies. I know Boris Johnson has a massive majority of 74 in the current parliament but- that still means that if 38 (out of 298) of his party feel strongly enough to vote against him in a vote of no confidence, or even defect, he would be out of power.
So he has to listen to his MPs that make up his party, even if only 13% of them feel strongly enough about this to go against him. And make no mistake about it, the average MP is a decent human being, in politics to help the British people, and cares deeply for their constituents. They are not going to be well pleased, to say the least, when the doctors in their hospitals and the elderly people in care homes start dying - and they look at other countries, Italy is over the peak, China long ago, and it is clear it doesn't have to be like this.
I do think they are going to return to the contain phase eventually - but to do it now can be the difference between containing 2000 cases, and containing perhaps 30,000 cases 10 days from now.
We can do that too but if we don’t return to contain until the end of March, say, it would need a heroic effort like the effort of China to contain its outbreak in Wuhan at the end of January.
Wuhan started its lockdown at 1000 and ended up with over 60,000 cases by the time it was over.
I expect the UK to end up with something like that even if it returns to containment immediately because it has lost track of where the virus is in society and needs to find it again to start containing, and that takes up to 14 days for symptoms to develop.
But the Chinese did learn lots of clever ways to stop it quickly and if we learn from them, we could keep the numbers in the UK much lower. If we adopt their fever clinics and test everyone in the UK with a fever within 3 days of onsets that would help with rapid containment.
China had an entire country of a billion people to devote to the effort to contain it in Wuhan / Hubei province. Hubei province has a roughly similar size of population to the UK.
I think if it gets as bad as tens of thousands of cases, before we go back to containment, we probably can’t solve it by ourselves. To find the same level of a billion people to support our effort, we would need the help of the whole of Europe and the US. But if we only start a proper Hubei style lock down at 30,000 cases, it would be a far worse outbreak than Hubei, so we would also most likely need help from China and the rest of the world to stop our outbreak at that point.
We must act on this now, as fast as we can.
See also
- Experts Condemn UK's Response To COVID-19 - We Must Reverse This Now - Detect Mild Cases & Contain Swiftly To Save Lives
- COVID19 is being stopped - containment is the key - and every day of inaction increases the problem for those countries
Also to protect yourself:
- How To Protect Yourself From COVID-19 - And Help Stop The Spread - If Everyone Did This The Epidemic Would Soon Stop
- WHO Safe Hands Challenge - 11 Steps Wash For Thorough Protection From COVID19
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