Richard North, 12/03/2020  
 


Italy, with an aging population, has the world's highest daily deaths from Covid-19. Figures currently stand at 12,149 cases with 827 fatalities, up from the previous 10,149, an increase of 22.8 percent.

Worryingly, the illness has killed five percent of known cases. But the death rate is even higher in the worst-affected region, Lombardy, where it is now eight percent, more than double the rate recorded in Wuhan. The global average death rate is 3.5 percent.

That much we're getting from the Wall Street Journal, but many other newspapers – such as the Mail, are picking up on the disaster that is playing out in southern Europe.

In particular, attention is being drawn to the publication of the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI), described by one commenter as the "most extraordinary medical document" he's ever seen.

"In a context of grave shortage of medical resources", it says, "the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care".

On that basis, it says, "It may become necessary to establish an age limit for access to intensive care", adding that: "This is not a value judgments but a way to provide extremely scarce resources to those who have the highest likelihood of survival and could enjoy the largest number of life-years saved".

This, however, is already behind the curve, with the ITV website reporting on feeds that were being aired yesterday on Twitter. It cites a doctor identified as Martina Crivellari, an intensive care cardiac anaesthesiologist at the San Raffaele Hospital in Milan.

She says: "There are a lot of young people in our Intensive Care Units (ICUs) - our youngest is a 38-year-old who had had no comorbidities (underlying health problems)". Adding that there are, "A lot of patients need help with breathing", she complains that there are not enough ventilators.

"They've told us", she then says, "that starting from now we'll have to choose who to intubate - priority will go to the young or those without comorbidities. At Niguarda, the other big hospital in Milan, they are not intubating anyone over 60, which is really, really young".

Another, unidentified doctor, who works at Niguarda Hospital, says, "We have closed down entire wards, and reduced the number of beds in traditional wards. All operations have been cancelled, GP surgeries closed so the that the GPs can come in and be ward doctors".

He then tells us: "The number of ICU beds has been tripled. There was even pressure to take over our Cardiac ICU. All the resuscitation bays are full. They're having to triage, deciding who to intubate and who to let die".

This is the fate that awaits us in the UK, while the main focus of the Johnson administration still seems to be on getting us to wash our hands, with many papers yesterday carrying a full-page advert instructing us to spend at least 20 seconds on our ablutions.

Yet, while the chancellor in his budget yesterday committed an additional £5 billion to supporting the fight against coronavirus, pledging to give "whatever it takes" to fund the NHS, there is no indication that there are any serious measures being taken to increase critical care provisions, to the extent that the emergency requires.

Of the £5 billion on its way, we are told that the NHS will spend most of its share on its most precious resource: its staff, who account for 70 percent of its budget. Specifically, it could use the fund to pay the 18,000 final-year nursing students, whom Simon Stevens, CEO of NHS England has said would be drafted in to help boost the NHS workforce "when the worst came".

Alongside that, we are told to expect that, today – after cases yesterday jumped to 456, with eight deaths recorded, the government will announce that it is moving from the containment to the "delay" phase, in accordance with its action plan.

Ironically, in that plan, we are blandly informed that one of the government's planning principles is to: "maintain trust and confidence amongst the organisations and people who provide key public services, and those who use them". For many, though, that ship sailed a long time ago.

Thus, when the government moves to the "mitigate" stage when it pledges to "provide the best care possible for people who become ill", and "support hospitals to maintain essential services", even the fanboy gazette exposes the lies. Asking, "Will your local trust have enough beds to deal with coronavirus?", the only thing we can conclude from the data provided is "no".

Bed occupancy rates are at their second highest on record in England, even before demand is expected to spike due to coronavirus, with no available bed for adult critical care in 11 NHS Trusts.

With NHS England already operating at 92 percent capacity for general and acute care beds, and 75.3 percent for critical care, such a period of "huge pressure" on the NHS "will make it impossible to provide a bed for all the coronavirus cases", the paper says.

That leaves the idea of flattening the curve as the only alternative to what an Italian doctor called "carnage". But that requires a level of restrictions that this government is not, as yet – if at all – prepared to impose. And even then, the residual case rate would still swamp the available medical facilities.

So, what we are left with is a strategy that has been dubbed "keep calm and wash your hands", mainly on the assumption that the primary mode of spread is through direct, person-to-person contact, with the virus having been picked up from contaminated surfaces.

Yet, while the European Centre for Disease Prevention acknowledges that there is so far no evidence of airborne transmission, it recommends "a cautious approach" due to lack of studies excluding this mode of transmission.

In fact, there is good reason to assert that the role of airborne spread is more significant than is generally believed. Recently a senior Chinese official has said coronavirus can infect people via airborne transmission, with another report claiming that the virus can travel twice as far as the official "safe distance" and stay in the air for 30 minutes.

As pointed out here, aerosol spread requires a different control strategy, which means that, as Bloomberg suggests, if locking down millions of people proves successful elsewhere, and the virus spreads uncontrollably across Britain, the current policy will look like a terrible mistake.

In terms of curtailing the outbreak, if the disease is primarily transmitted by aerosol, hand washing is largely irrelevant. On that basis, one sees the focus on hand washing as classic misdirection, getting people to focus on one thing so that they won't notice what else is going on.

It also helps to have tame ICU consultants to tell us that "nothing can be done" to enhance ICU availability. This reduces the impact of the death rate, as no blame is attached to this government (Johnson) for its failure to provide the necessary facilities.

With that, I'm more and more leaning towards the view that the government is adopting a non-interventionalist strategy in order to let the virus rip through the population. It actually stands to gain very substantially from the deaths of the old and the sick, as long as it can avoid the political fallout. 

Its main activity, therefore, is blame avoidance and blame transference, aided by the fact that the Labour Party is no longer offering any coherent opposition.






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