Richard North, 13/03/2020  
 


As a working assumption, we can take it that what happens in Italy today will be visited on the UK within 2-3 weeks, give or take. So, while Italy goes into "lockdown", we now enter the "delay doing anything" phase, as our revered prime minister blusters his way through another press conference.

The maths are simple. Cases are doubling every four days, so, by the end of the week we can expect around 1,000 cases. In less than three weeks – assuming the rate of increase remains constant – the total number of cases will have reached 16K.

It is difficult to predict the number of hospital admissions that will generate, but a 20 percent uptake will generate over 3K cases. If the government continues its restrictive definition of a case, the percentage could be higher.

On the other hand, normal procedure for dealing with a surge is to release about ten percent of capacity, which would amount to about 3K beds. In exceptional circumstances, that might increase to 20 percent. But that can only be kept up for a short period. People insist on getting ill for other reasons and, after a while, the pressure builds to breaking point.

If we take a sustained rate of ten percent, by the end of three weeks, the capacity of the NHS to deal with the Covid-19 epidemic will have been exceeded. Even with exceptional measures, it will not be able to handle the ongoing case load from in-house resources for much longer.

Even then, it would be foolish to assume that the rate of increase will remain constant. It would be just as foolish to assume that the so-called "delay" phase will have any material effect on the shape of the epidemic curve.

A "jittery" Johnson, though, seems to have swallowed the Kool Aid on "flattening the curve", arguing that delaying the peak "will mean the NHS is in a stronger state to face the challenge it poses".

But since the Department of Health control model seems to be based on the assumption that the principal mode of spread is by direct contact (either with other people or with contaminated surfaces), ruling out airborne spread, it is unlikely that any new measures will succeed, and the NHS will still be overwhelmed.

Thus, within about three weeks, we must be prepared for the very real possibility that the NHS will have reached saturation point. If the rate of increase speeds up, saturation will be reached earlier. Either way, when the hospitals can no longer cope, as in Italy at the moment, triage procedures will have to be applied and very ill patients will be turned away.

To reduce that prospect, the NHS will require the provision of entirely new resources which, at present, are not available to it. And it is not enough to wait until existing services are swamped before reacting. The government should be gearing up now, on the basis of reasonable worst case assumptions.

To achieve this, it is not enough for the prime minister simply to babble about coronavirus being "the worst public health crisis for a generation", as he has done. The government should put its money (or our money) where its mouth is and formally declare an emergency, invoking the Civil Contingencies Act.

That way, it can requisition premises such as sports centres, and mobilise the resources needed to turn them into functional emergency treatment centres. For that to happen, thousands of people must be recruited, positioned and trained, equipment bought and installed, and systems organised.

That there is no indication of this happening is illustrative of the general lack of grip displayed by the prime minister and his control team. That lack of grip has brought into play Prof John Ashton, a former regional director of public health for north-west England, launching "a devastating critique of the government's handling of the coronavirus outbreak in the UK, saying it is too little too late, lacks transparency and fails to mobilise the public".

In particular, he criticises the government's late start, its inability to stay alert and its failure to work in an open and transparent manner. "Our lot haven't been working openly and transparently", he remarks, "They've been doing it in a (non) smoke-filled room and just dribbling out stuff".

Of the chief medical officer, he complains that he only appeared in public after about two weeks. Johnson, he says, should have convened Cobra himself over a month ago and had regular meetings with the CMO with the evidence. "The thing should have been fronted up nationally by one person who could be regarded as the trusted voice and who could have been interrogated regularly. That’s not happened", he adds.

And, very much supporting what I have been writing about, he warns that the NHS is "not in a position to cope with the large numbers of people who could become seriously ill". Says Ashton, "It's a joke when they put up people to say they are really on top of it and if it spreads at a community level the NHS will cope, it's always coped. The hospitals are full at the moment, A&Es are full, beds are full, intensive care is full".

It does not take a genius to work this out. In fact, no end of people – professionals and otherwise – have been warning for some years that the NHS is not equipped to handle an epidemic of this nature.

"Current contingency plans", Ashton notes, "assume that up to 80 percent of people could get infected and four percent of those are likely to have serious illness". That translates into big numbers "and there will not be enough intensive facilities for them and people will have to be home-nursed", he says. And, in the circumstances, it is painfully obvious that home nursing for many is a death sentence.

Even former Health Secretary and current Chairman of the Health Select Committee, Jeremy Hunt, is breaking ranks. He challenges the logic of delaying social distancing measures, saying, "I'm surprised we're not moving sooner". His view is that the places that have succeeded "are the ones that moved earliest to social distancing".

He thus thinks "people will be concerned that we're not moving sooner to more social distancing, for example banning external visits to care homes", adding: "I am concerned because we've got four weeks, We're four weeks behind Italy and what we do every single day of those four weeks is absolutely critical".

To explain why the government seems so extraordinarily reluctant to take very obvious and necessary action, one can pick up on Robert Peston's observations, where he is amongst the first in the legacy media to cotton on to herd immunity.

The strategy of the British government in minimising the impact of Covid-19, he says, is to allow the virus to pass through the entire population so that we acquire herd immunity.

But, Peston says, the assumption is that the speed of the epidemic can be delayed. Then, those who suffer the most acute symptoms are able to receive the medical support they need, and the health service is not overwhelmed and crushed by the sheer number of cases it has to treat at any one time.

Thus, we are back full-circle with the government effectively gambling that it has got its epidemic modelling right, and that the epidemic is going to behave as it expects. But, to play this game without the safety net of emergency treatment centres is as close to criminal negligence as it is possible for a government to get.

Of the measures announced yesterday, Ashton dismisses them as "a kind of ragbag with no particular logic to it". He adds:
The fact that they are now declaring we're moving into this second phase, as if it's some kind of planned event, is really meaningless. We need to mobilise the whole community response to this and they are behaving in a top-down way, in a half-hearted way, so it's neither one thing nor the other.
The Guardian is hardly less acerbic, declaring that the new measures to achieve delay are minimal compared to those taken in other countries. "In Italy", it says, "more than 1,000 have now succumbed. The old and other vulnerable groups will suffer. The overstretched NHS is surely not prepared for the numbers who will be falling sick in short order".

Noting that the head of the WHO has called on states to take "urgent and aggressive action", it suggests that the UK apparently is not prepared to do so. "If Boris Johnson's judgement is wrong", it says, "the price will be a high one".

Thus, when Johnson tells us that: "I must level with the British public: many more families are going to lose loved ones before their time", and then stressed the importance of maintaining public trust and confidence in "what we're doing throughout this challenging time", he doesn't perhaps realise that that ship sailed a long time ago.

One wonders, though, whether he even cares.






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