First, as a reminder to all of you, do protect yourself using the simple methods recommended by the WHO, not just physical distancing. Learn how to wash your hands thoroughly, and avoid touching your eyes, nose and mouth with unwashed hands, also cover a cough with your elbow not a hand.
COVID-19 is not like flu. It's only transmitted via the larger droplets that fall to the ground in seconds. These methods only reduce your risk of flu but are very effective in stopping COVID-19. These methods work and can save you from a potentially serious disease and may even save your life. They also protect others who might get the disease from you.
The WHO also recommends that all countries use the classic health tools of case finding, isolating cases, contact tracing, and strict quarantine of the contacts. This is a proven approach that so many countries are using to contain #COVID19. So why isn't the UK doing this?
Allyson M Pollock, professor of public health at Newcastle university put it like this:
Case finding, contact tracing and testing, and strict quarantine are the classic tools in public health to control infectious diseases … In Singapore, Vietnam, and South Korea meticulous contact tracing combined with clinical observation plus testing were vital in containing the disease ....
The reasons why tracing was stopped, against WHO recommendations, have not been published. It seems to be connected to a shift from “contain” to “delay” in the government’s action plan, when contact tracing was replaced rather than supplemented with other control measures.
The WHO also say that these measures are the best way to exit from a lockdown.
Here is Devi Sridahr saying the same thing
The WHO recommend an isolation period far longer than for the UK - through to two weeks after all symptoms are over. You can leave isolation sooner if you have two negative PCR tests 24 hours apart.Here is our exit strategy - an aggressive test, trace and isolation strategy. Excellent from @devisridhar , Professor of Global Public Health, Edinburgh University. We need to massively scale our testing capacity and recruit contact testers. Lets get moving. #COVIDー19 pic.twitter.com/UWXucFNjxZ
— baz smith #FBPE (@BazzieSmith) April 11, 2020
Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve and monitoring should continue for the duration of home care. WHO Director-General's opening remarks at the media briefing on COVID-19 - 16 March 2020
Detailed advice here: Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts
Meanwhile the UK recommends a far shorter isolation period of only 7 days for people who live alone, or until their fever stops if the fever continues for more than 7 days. If the cough continues they don't need to self isolate. For instance Matt Hancock, our Public Health Secreatry recently returned to work after 7 days of isolation at home for COVID-19
... after 7 days, if you do not have a high temperature, you do not need to continue to self-isolate. .... You do not need to self-isolate if you just have a cough after 7 days, as a cough can last for several weeks after the infection has gone
The advice for cases of COVID-19 in households also differs - the WHO recommend far stricter measures to prevent infecting other members of the household, and preferably isolation in a separate location (hotels, community centers, sports stadiums etc).
The central question is, why does the new “delay” phase not have strict case isolation (away from the household). Why did they abandon testing for mild cases, and contact tracing? Also why was the isolation period reduced to 7 days?
We can find out by reading the paper the team published, their Imperial college study. This has the UK policies on household isolation etc as their table 2.
I have summarized the main differences between their simulated flu pandemic and the real world data used by the WHO:
Text [for those who rely on auto translate]
Real world data used by most countries and WHO ✔
Imperial College simulated flu used by the UK X
- Covid-19 is infectious through to two weeks after symptoms cease ✔
Isolation period for a single person is through to 7 days after symptoms start X- Most of the transmission in China was in households. Most of the rest was close or prolonged contact - other countries similar. ✔
A third of the transmission is to random strangers in the community X- Nearly all transmission of COVID-19 is from cases with noticeable symptoms at some point ✔
A third of the transmission is from cases that never feel sick XThe background is from the WHO COVID-19 Dashboard for the 10th April
Here are some quotes from the study by the UK COVID-19 response team led by Neil Ferguson published on 16th March to back this up. This is the paper that has the UK policies interventions as its Table 2:
Isolation period for a single person is through to 7 days after symptoms start X
"Symptomatic cases stay at home for 7 days, reducing non-household contacts by 75% for this period. Household contacts remain unchanged. Assume 70% of household comply with the policy." [Table 2]
A third of the transmission is to random strangers in the community X
"With the parameterization above, approximately one third of transmission occurs in the household, one third in schools and workplaces and the remaining third in the community."
"Transmission events occur through contacts made between susceptible and infectious individuals in either the household, workplace, school or randomly in the community, with the latter depending on spatial distance between contacts."
[Although they don’t say so in the paper, the reason that flu transmits so readily in the community is because it is airborne, as was proven in 2018: 'Just breathing' is enough to spread flu]
A third of the transmission is from cases that never feel sick X
"We assume that symptomatic individuals are 50% more infectious than asymptomatic individual"
"We therefore assume that two-thirds of cases are sufficiently symptomatic to self-isolate (if required by policy) within 1 day of symptom onset, and a mean delay from onset of symptoms to hospitalisation of 5 days"
WHO:
Covid-19 is infectious through to two weeks after symptoms cease ✔
For mild laboratory confirmed patients who are cared for at home, to be released from home isolation, cases must test negative using PCR testing twice from samples collected at least 24 hours apart. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve and monitoring should continue for the duration of home care.
WHO Director-General's opening remarks at the media briefing on COVID-19 - 16 March 2020Detailed advice here: Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts
Most of the transmission in China was in households. Most of the rest was close or prolonged contact - other countries similar. ✔
In China, human-to-human transmission of the COVID-19 virus is largely occurring in families. … Among 344 clusters involving 1308 cases (out of a total 1836 cases reported) in Guangdong Province and Sichuan Province, most clusters (78%-85%) have occurred in families
According to current evidence, COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes. In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported. In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures or support treatments that generate aerosols are performed …
This is different from SARS. There were several clear examples, for instance in one incident, 20 people got SARS from one infected person on Air China Flight 112. Yet for COVID-19, it doesn’t seem to happen.
Nearly all transmission of COVID-19 is from cases with noticeable symptoms at some point ✔
Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.
Report of the WHO-China Joint Mission
The latest research still comes to the same conclusion, see WHO Covid-19 transcript 6th April: Presymptomatic and asymptomatic spread
For more details see my
This shows the difference these have on our policy:
WHO recommendations based on real world data ✔
UK recommendations based on Imperial College simulated flu X
- Covid-19 cases isolated from household immediately in hotels, stadiums or strict separation, carer and patient wear masks ✔
Covid-19 cases isolate with the household, try to reduce contacts X- Isolation lasts through to 14 days after symptoms resolve ✔
Isolation lasts until fever stops, can end isolation with persistent cough X- Trace contacts and quarantine immediately ✔
Contacts don’t need to be traced X
For details and cites for all this, see my
I don’t doubt the UK’s resolve to stop COVID-19 for a moment. But I do question the scientific basis for our decisions.
The WHO recommendations have the potential to save tens of thousands of lives in the UK.
Text: UK stands resolute on COVID-19 but policy comes from table for a SIMULATED flu pandemic with almost no input from the real world
I have also done some graphics to explain why case isolation and contact tracing is needed and why it is important to use the correct isolation period.
First using the Simpsons to illustrate case isolation
Text:
Simpsons - UK policy all stay at home
Day 1 Homer tests +ve
Day 10 Margo +ve
Day 15 Grampa +veDay 24 Grampa in hospital
Day 50 Grampa diesSimpsons - WHO advice Isolate mild cases
Day 1 Homer +ve COVID-19
Homer isolates to hotel in Springfield with other mild cases
Nobody dies.Nearly all other countries do this
I got the Simpsons screen grab here: The Color Yellow – Dead Homer Society
China’s policy of rapidly isolating COVID-19 cases away from their households was one of the main reasons for their success.
Everyone should want to do this because it stops the outbreak and it also potentially saves lives of their loved ones at home in their households.
Text: These aren’t intensive care beds. These are isolation beds for mild cases in China to protect their families from them, so they don’t infect anyone else in the household.
The main job of the nurses was to prevent them getting bored.
The UK is just leaving them at home to infect others in the same household
There is very little equipment in them. Just beds and privacy barriers. Minimal medical equipment - because they didn’t need it. Image from the Xinhua News Agency - I got it from this story:
COVID-19 | Wuhan closes makeshift hospital as new cases in China drop sharply
This page has a photo of the inside of an active ward during the pandemic with close ups of the beds and some patients: Nearly all of China's new coronavirus cases outside Wuhan from abroad
China tried getting people to isolate at home, early on in their outbreak. It backfired badly.
According to Xiao Ning, a researcher from the Chinese Center for Disease Control and Prevention, in one province, 80% of the cluster infections came from people who were told to rest at home.
The same happened in Italy early on, they found growing evidence that if one person is told to stay at home they gradually infect the rest of their family. So, Milan started to seize hotels for patients with mild symptoms.
Home isolation of mild COVID-19 cases is a mistake: China to Italy
Then, our isolation period is far too short to totally stop transmission to others.
Prince Charles & Camilla share a laugh - photo by Andy Gott
Text: Prince Charles got COVID-19
Camilla did not get COVID-19
But 7 days isolation is not enough (by WHO) so he could still be infectious and she could still get it (unless they did the -ve tests)
Of course I very much hope this doesn’t happen, but if Prince Charles is indeed still infectious he could still give it to her, or indeed, he could still give to others in the Royal Family that he has close contact with.
It is the same for Matt Hancock, our health secretary, out of isolation after 7 days. He also is still infectious unless he has had those two -ve tests, and I don’t think they do them. He could still give it to others in the cabinet, health ministry etc.
This may seem surprising for flu - but it isn’t flu. SARS was infectious typically for three weeks. COVID-19 seems to be infectious for even longer.
For more details with cites
Covid-19 is also infectious for a few people up to several days before they develop symptoms.
Most of the infection seems to happen later, but it can often happen at the very early stage when they are just starting to feel unwell. For details see
Contact tracing helps to find cases early on, before they develop symptoms or in the first few days of symptoms, and quarantine of contacts ensures they are isolated from others before they become infectious.
Text: With contact tracing
Day 1: Barney has Covid-19. Doesn’t know. Homer gets itDay 3: Berney tested. Homer traced. Homer quarantined. Nobody else gets it.
The UK government did this contact tracing through to 11th March but don’t do it any more.
As an example, as soon as our prime minister Boris Johnson was tested positive, they should have quarantined all his contacts. That would include almost the entire cabinet for 14 days as well as everyone in 10 Downing street that had close contact with him. They would have had to continue via video conferencing.
This greatly reduces the amount of transmission his contacts can do to others before they themselves feel sick enough to self isolate.
Even now, if we isolate everyone in the UK with COVID-19 as well as their contacts, then soon most of us could then gradually return to normal life again with a slow unwinding of the lock down after that has been done.
Life is more difficult for those in isolation, but this policy protects everyone else. As for the ones in isolation, the mild cases get the right treatment, and the close attention they need, and it can save their lives too.
People with COVID-19 who self medicate at home can die suddenly because of lack of oxygen which is easily fixed in a hospital.
For instance, they may not realize that for COVID-19, blue lips are a sign you need urgent help and may die if not treated. Only some cases feel breathless. Others are like high altitude climbers, they feel they are breathing fine but because of the damage to their lungs, are not transferring enough oxygen to their lungs. No amount of home remedies can fix this.
For medical details about this and the fascinating difference between two types of patient, the ones that feel breathless and the ones that don’t and the different effects on their lungs see:
The mild cases should also want to do this because the people who are close to them are protected from them if they didn’t get it yet.
The country as a whole can resume business.
DO ANTIBODIES PROTECT AGAINST COVID-19?
Many experts have spoken up saying that we don’t know enough to stay that the antibodies for the virus that causes Covid-19 prevent reinfection or for how long.
A big question is whether this coronavirus infection will provide lasting immunity: is a person who has “seroconverted” and shows IgG against coronavirus antigens safe to go out without fear of re-infection? And that we don’t quite know yet. The record with past coronavirus pathogens is mixed. We’re going to know eventually, and it could be a key to get past this whole epidemic, but we need more data to be sure. We also don’t know how long such immunity will last, obviously. Months? Years? How many? There’s no way to speed that data collection up; we’ll find out as time goes on.
The hope is that they do but we don’t know. With SARS and MERS nobody has ever been reinfected. Some people keep the antibody levels high, years later, some don’t. However nobody has ever been reinfected by SARS or MERS because of the low numbers of cases so there is no way to know how protective the antibodies are to reinfection.
Also we get infected by the same cold virus over and over in our lifetime but we don’t care, it’s just a cold. Unlike flu, the coronaviruses that cause some of our colds are very stable so they don’t do this by evading the immune system. It might be that the antibodies don’t provide as much protection as they do for other viruses. The same could happen with COVID-19.
Then finally vaccine development for SARS turned up situations where the immune system backfires that the antibodies generated by the vaccine actually made the disease worse the second time around, as happens with Dengue fever. They needed to redesign the vaccine to avoid that immune system backfiring by triggering the right rather than the wrong antibodies.
It is not that likely but not impossible that some antibodies to the virus SARS-CoV2 which causes COVID-19 might even make a second infection worse than the first.
See my
The Imperial college paper says
On recovery from infection, individuals are assumed to be immune to re-infection in the short term. Evidence from the FluWatch cohort study suggests that re-infection with the same strain of seasonal circulating coronavirus is highly unlikely in the same or following season (Prof Andrew Hayward, personal communication).
Matt Hancock says
“We’ve now bought 3.5 million antibody tests that will allow people to see whether they have had the virus and are immune to it and then can get back to work,” Hancock said at a news conference.
“We expect people not to be able to catch it, except in very exceptional circumstances, for a second time.”
I think they have backed down on that now. The antibody tests would not necessarily prove that you are safe from reinfection. Probably most people would be but it is no guarantee. We just don’t know enough about this disease yet.
LOCK DOWN PERFECT TIME TO DO THIS CASE FINDING - AND THAT’S HOW TO EXIT FROM LOCK DOWN
The UK’s policy is to exit the lockdown as soon as we reach the peak. The idea is to watch for signs that we have reached it, and then gradually ease restrictions. The aim is to not overwhelm critical bed capacity and to try to buy time before a vaccine - but the vaccine likely won’t be ‘till next year at the earliest.
The WHO say the way to exit from a lockdown safely is to do case finding, isolation, teating the cases, contact tracing and quarantine.
A lockdown is a perfect opportunity because it has reduced our contacts, from 20–30 to perhaps 4, or 8 or 10 - which makes it much easier to suppress the virus through contact tracing on top of case isolation.
Many in the UK may not know what the WHO recommendations are, or may have forgotten them, so here is a brief summary, with links to the technical details of their recommendations:
Our real priorities for COVID19 according to the WHO
- Test all suspected cases for COVID19, isolate them while waiting for the test, and quarantine anyone who has it.
- Trace all contacts of confirmed cases from 2 days before onset of symptoms. Ask all contacts to isolate themselves until 14 days after the contact
- Test all contacts for COVID19 if they show any symptoms.
- Quarantine anyone who has it until 14 days after they get better.
- Physical distancing is a defensive measure. All it can do is to buy us time. We can’t win without going after the virus
This is how Dr Mike Ryan put it in the press conference on Monday 22nd March.
All that we get from movement restrictions and people staying at home and all of these measures; we buy some time, we take the heat out of the epidemic or the pandemic, we buy some time.
… one of the key ways we can move forward is a massive scale-up - in public health capacities to do case finding, isolation, quarantine of contacts and being able to go after the virus rather than the virus coming after us
There is a very, very precious window now in which we can prepare to do that.
Also
You can't win a football game only by defending. You have to attack as well.
Asking people to stay at home and other physical distancing measures are an important way of slowing down the spread of the virus and buying time – but they are defensive measures.
To win, we need to attack the virus with aggressive and targeted tactics – testing every suspected case, isolating and caring for every confirmed case, and tracing and quarantining every close contact.
Neil Fergusson et al do look at this possibility for their lockdown exit strategy:
Through the hospitalisation of all cases (not just those requiring hospital care), China in effect initiated a form of case isolation, reducing onward transmission from cases in the household and in other settings.
At the same time, by implementing population-wide social distancing, the opportunity for onward transmission in all locations was rapidly reduced. Several studies have estimated that these interventions reduced R to below 1. In recent days, these measures have begun to be relaxed. Close monitoring of the situation in China in the coming weeks will therefore help to inform strategies in other countries.
The measures used to achieve suppression might also evolve over time. As case numbers fall, it becomes more feasible to adopt intensive testing, contact tracing and quarantine measures akin to the strategies being employed in South Korea today. Technology –such as mobile phone apps that track an individual’s interactions with other people in society –might allow such a policy to be more effective and scalable if the associated privacy concerns can be overcome.
However, if intensive NPI packages aimed at suppression are not maintained, our analysis suggests that transmission will rapidly rebound, potentially producing an epidemic comparable in scale to what would have been seen had no interventions been adopted.
You don't use the health system for contact tracing as they are overwhelmed with the health care response. .Countries have repurposed civil servants from other branches of government and also used community orgnaizations for contact tracing.
With physical distancing the number of contacts per case are greatly reduced so if we introduce contact tracing now, each contact will only have a few people. It might even be that their only contacts are in the household. Then they need to find out a way to isolate infected cases away from households.
Once you have tens or hundreds of thousands of contacts one of the main challenges is maintaining the database of all the contacts and making sure they are all looked after. E.g. they might phone each one up once a day or whatever is required. It is easy to do with 100 but it's a bit like an internet company, what works with 100 may not scale up to 100,000 so you have to plan for that as well. These are all things we can do.
THIS IS A WAY TO GET THROUGH THIS WITH FAR FEWER DEATHS
We will get over this one way or another but we will have far fewer deaths if we aggressively go after it in households like this.
For more about this see my:
Also my longer:
Wth the real world disease contact tracing is the key to it all.
All this is not rocket science. It is just looking at what has worked for other countries and concluding, if it worked for China, South Korea, Singapore, Spain, Italy, it will work for us.
Mike Ryan put it like this:
In some senses transmission has been taken off the streets and pushed back into family units. Now we need to go and look in families to find those people who may be sick and remove them and isolate them in a safe and dignified manner so that's what I was saying previously; the transition from movement restrictions and shut-downs and stay-at-home orders can only be made if we have in place the means to be able to detect suspect cases, isolate confirmed cases, track contacts and follow up on the contacts' health at all times and then isolate any of those people who become sick themselves.
who-audio-emergencies-coronavirus-press-conference-full-30mar2020.pdf
WE ARE DOING SO MUCH WITH HUGE RESOLVE - BUT ALL FOCUSED ON PHYSICAL DISTANCING
It is SO frustrating. We are working so hard on it. We have done such huge things, made many sacrifices, closed down businesses, schools, universities, and people are pulling together in remarkable ways to help each other and get through it.
Here for instance is the Queen's speech asking us all to follow the government's policy on physical separation, and that we will get through this together to better times where we can meet up again.
I see this as a matter of understanding, not motivation.
Our prime minister Boris Johnson is not a scientist. He read Classics, ancient literature and classical philosophy at Baliol college Oxford. He was advised by his chief medical officer that this is what to do. They in turn were advised by the scientific advisory group for emergencies, SAGE who also advised that this was what to do.
As you see, Boris Johnson did everything properly according to how it should be done. He did as his chief medical officer said, in turn advised by SAGE, and he clearly believes that it can't be suppressed and that we have to delay it as long as we can to reduce the pressure on our health system.
He is also prepared to take resolute policies to stop it. Unfortunately this seems to consist mainly in stepping up on the physical distancing more and more, as they find it has less effect on the increase in cases per day than expected. Indeed so far there is no clear noticeable effect.
One of their main focuses at present is to ramp up on their restrictions on physical distancing, possibly they might even close local parks. The Communities Secretary Robert Jenrick asked about whether they will close parks and open spaces in our cities said it was an absolute last resort:
'it would be very unfortunate if we had to do so and make it harder for people, particularly people who live in flats in towns and cities, to get the exercise they deserve.'
So it is not a question of resolve. It is of the data that feeds the policy.
They believe that stopping airborne transmission by physical distancing irrespective of whether people are talking to each other, coughing or sneezing, is the absolute top priority to try to slow down this virus. This is because the simulated flu pandemic is airborne.
They don't believe that isolation of cases, contact tracing, testing for the virus in hospitals, prisons or care homes, or isolating patients from their own homes are policies that are worth focusing on. This is because of all the asymptomatic cases and the random transmission to others in the simulated flu pandemic as well as its short period of infectousness.
Just more and more of the physical distancing.
We are doing everything except isolate the mild cases. Also this is not for any political reason. It’s not economics - the case finding and isolation would be much less costly than this policy (including the cost of ramping up on diagnostic testing capabilities).
Ending the lock down sooner because of case finding, contact tracing and isolation again would be a major economic saving. There can’t be any economic motive behind ignoring this advice.
The only reason we don’t do that is because of a bit of maths in a theoretical model.
I have a good first class degree in maths. I know that maths like that is not the real world. It’s just maths. Whether it fits the real world depends entirely on whether the data that it is based on matches the real world data.
We need to be lead firmly by experimental science not only theoretical science during an emerging outbreak of a novel disease. There is a time lag for theoretical science - they adjust their ideas after the experimental data is confirmed every which way, and has become incontrovertible and established science for months or years, and has been summarized in major systematic review articles.
But we don’t have time for that in the rapidly evolving knowledge of an ongoing pandemic.
SPREAD THROUGH HEALTH CARE WORKERS HAVE BEEN OF ESPECIAL CONCERN FOR COVID-19
The WHO are very concerned about the infection of health care workers. Going back to the report:
"There have been reports of COVID-19 transmission in prisons (Hubei, Shandong, and Zhejiang, China), hospitals (as above) and in a long-term living facility. The close proximity and contact among people in these settings and the potential for environmental contamination are important factors, which could amplify transmission."
The Imperial college model doesn’t include any modeling of spread in health care facilities, prisons, or care homes.
The Director General of the WHO on 10th April talked about an alarming trend that some countries are reporting up to 10% of the health care workers infected. Some are infected at home or in the community and bring it to work. Some are infected because they are late in recognizing it as COVID-19 as it spreads through the health care and some it’s because they are not used to working with infectious respiratory diseases and they are tired and have long shifts with inadequate breaks.
In some countries there are reports of more than 10 percent of health workers being infected. This is an alarming trend.
WHO Director-General's opening remarks at the media briefing on COVID-19 - 10 April 2020
If 10% of our doctors get it in the UK I make it that 244 die. In Italy as of writing this, 109 doctors that have died so far If 10% of our nurses get it, I make it 139 nurses would die.
If 40% of doctors get infected then it's nearly 1000 die. If 40% of nurses get infected then it's over 500 die.
These are very rough ballpark figures, it could be less or more. The deaths happen starting at the end of the second week most in the third or later weeks of symptoms. So most won't happen for a few weeks yet.
As of 11th April, Matt Hancock says 19 health workers in the UK have died so far.
Techy details (indented)
For the older patients I am using the data for the first 1000 deaths in Italy and for under 50, data from China. These figures are roughly consistent with the early figurs for the US. For the sources see my: Deaths in Italy from Covid19 - similar to China - higher case fatality rate is due to more elderly patients affected
- 8 out of 38,000/10 die (20 - 29), 0.2%
- 18 out of 90,000/10 die (30 - 39), 0.2%
- 16 out of 80,000/10 die (40 - 49), 0.2%
- 34 out of 56,000/10 die (50 - 59), 0.6%
- 72 out of 26,500/10 die (60 - 69), 2.7%
- 96 out of 10,000/10 die (70+), 9.6 %
Total 244. For the numbers in each age group I am using:
(I rounded the numbers in each group to the nearest 500)
The nurses would be in a similar situation:
- 11 out of 54193/10 (20–29) 0.2%
- 15 out of 73548/10 (30–39) 0.2%
- 19 out of 93566/10 (40–49) 0.2%
- 49 out of 82326/10 (50–59) 0.6%
- 45 out of 16789/10 (60+) 2.7%
Total 139 nurses die.
For age group figures for nurses: Nurses, Midwives and Support staff by area, level, gender and age, January 2018 - NHS Digital
I couldn't find figures for hospitalization and for critical care for each of those groups. However by the rough estimate that 20% need hospitalization and 5% need critical care, if you assume 10% of the 1.2 million full time staff working in the NHS get COVID19, 24,000 of the full time NHS staff need hospitalization and 6,000 need intensive care.
I didn’t try to estimate the number of patients that would die in hospitals who are there for other conditions if, say, 10% of patients get COVID-19.
So far we have had 19 health workers die as of writing this.
'She loved her job': The NHS staff who've died
The UK government doesn’t seem to have any estimates on what percentage of the NHS workforce have COVID-19. There are figures about the number self isolating with suspected coronavirus or isolating at home with their household because another member has the suspected coronavirus but no breakdown and no way to know without tests how many actually have it.
REQUEST FOR URGENT EVIDENCE BASED SCIENCE DEBATE
We need an urgent debate between the theoretical scientists driving the UK policy and experimental scientists. Not a political debate, just hard headed examining of the scientific evidence base of the paper.
We don’t have the time for an academic systematic review. Such a review is thorough and reliable but it takes months.
We need an urgent immediate debate and one that everyone can listen to, any scientifically literate person can hear what the arguments are for and against the UK policy.
It is urgent because if the WHO are right, then with our decisions, we can save thousands of lives.
The experts should also consider what are the most urgent interventions we need right now.
TOP PRIORITIES RIGHT NOW
We certainly need to : stop all Covid-19 outbreaks that must be happening in hospitals and care homes - other countries had them by now & the only reason we don't see them is we are not testing. Then isolate cases away from households. Then contact trace - far easier during lockdown
The experts need to work out what are the most important things to do and in what order and how. But from the experience of other countries, likely top priorities include
- Suppressing any outbreaks of COVID-19 amongst patients in hospitals, care homes, prisons and amongst doctors and nurses [from experience of other countries with similar numbers of cases this must have happened by now]
- Increasing isolation period to the WHO period of 14 days after symptoms cease or two -ve tests 24 hours apart
- Establish temporary wards for these mild cases in hotels, stadiums, community centers etc
- As tests become available test everyone who is at home with COVID-19 type symptoms and isolate them to those temporary wards or give them instructions for safe isolation at home following the WHO recommendations after inspection of the home by a clinician.
- Meanwhile improve advice for isolation for people with suspected COVID-19 at hom.
- Support and advise people at home with COVID-19 type symptoms - and to make sure they go to hospital immediately if they have symptoms that are of immediate concern (e.g. breathless or blue lips)
- Greatly incresae accurate diagnostic test capacity by any means possible, as soon as possible
- Start contact tracing and rapidly scale up - this is easiest to do in a lockdown
We can be innovative and branch out, like the Faroe Islanders who adapted tests that were originally used for finding viruses in salmon. Of course they have to be accurate but we can broaden the net of who does them. Faroe Isles - example of COVID-19 case isolation, contact tracing and quarantine done properly
This conference doesn’t need to be in person, indeed in the current situation it is probabaly best if it is not, to help reduce spread of COVID-19.
A teleconference on YouTube would work fine.
It should include UK theoretical scientists and a wide range of selected experimental scientists who have experience in fighting epidemics, and who know about the real life characteristics of COVID-19.
The UK theoreticians need to be put on the spot and required to give answers to awkward questions from them about the evidence basis and how reliable and accurate their model is for guiding UK policy.
This matters because if the WHO advice is correct, our second precious opportunity for stopping this outbreak is already closing in many countries and adopting an experimental science based approach just one day sooner will save many thousands of lives.
The window for containing the virus at the subnational and national level is closing in many countries.
WHO Director-General's opening remarks at the Mission briefing on COVID-19 - 9 April 2020
See
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