Coronavirus: the epidemic we deserve

17/04/2020

A paper in early February on the spread of Covid-19 in China published in the Journal of the American Medical Association (JAMA) noted that 41 percent of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.

The event had Dr Tom Frieden, a former director of the US Centers for Disease Control (CDC), writing for CNN News, telling us it was "big news". In plain English, he said, it means that nearly half of the initial infections in this hospital appear to have been spread within the hospital itself.

This, he added, is called nosocomial transmission, observing wryly that doctors use big words to hide bad things: "Nosocomial means caught it in the hospital", he explained, then going on to set out a series of controls which should be applied to contain the problem.

At that early stage, not much was known in Western countries about the extraordinary infectivity of the SARS-Cov-2 virus, but it was not long before Chinese academics and physicians were writing about concerns which had arisen regarding hospital-acquired infections.

The strategy adopted by the Chinese authorities to avoid further problems was to build what were called shelter hospitals in open areas such as stadiums or exhibition centres. As of 5 February – two days before the publication of the JAMA report, 12,000 beds had been built, serving around 9,000 in-patients.

Of particular interest and relevance to the UK, the Chinese reported that, by 22 February, 3,019 healthcare personnel were reported to have been infected. Among them, 1,716 had confirmed infection and five had died of Covid-19. In Wuhan city alone, 1,080 healthcare personnel were infected. However, at the shelter hospitals, with more than 5,000 healthcare personnel, none had been infected between 5 February and 30 March.

This strategy is hardly rocket science. When confronted with an epidemic of a highly infectious disease, for which there was no known cure and no vaccine, the very last place patients should be taken is a busy district general hospital, full of ill people and staff, where they will be exposed to this infection. These units are simply not designed to handle infection on this scale.

Thus, with half a century of experience behind me in infection control, mainly but by no means exclusively in the food safety setting, when I first focused on the Covid epidemic in early March - breaking away from my long-term focus on Brexit – I noted that, while building brand new hospitals in the style of Wuhan was probably not practical, there were buildings which could be pressed into service as single-purpose coronavirus hospitals.

I noted that photographs from the 1918 Spanish flu epidemic showed sports halls, leisure centres and even aircraft hangars being used. There was no reason, I wrote, why we could not adopt the same strategy. This, I felt, "might be faster and easier than converting space in existing hospitals, where infection controls will be needed to protect existing patients and the staff caring for them".

Meanwhile, the geniuses at the Department of Health and Public Health England were embarking on exactly the programme the Chinese had already abandoned, stuffing district general hospitals with staff and equipment, ready to take in thousands of infected people off the streets and put them precisely where they should not be - institutional incompetence of galactic proportions.

Only latterly, towards the end of the month – with crucial weeks wasted – did we get reports that London's ExCel centre was to be converted into a makeshift 4,000 bed "field hospital", after a similar initiative had already been taken in Madrid.

This was the first of what were to become known as "Nightingale Hospitals" and although they have been commissioned at record speed, with units in Birmingham and Manchester coming on-stream and others following, still the lessons haven't been learnt.

Rather than diverting Covid-19 patients to the London Nightingale, last we heard (before reports seem to have dried up) was that the unit was holding a mere 19 patients. The London ICUs, we were told, were "coping" and the new facility was being used just of overspill, with barely any demand for that.

Once again, it seems, the Department of Health and Public Health England geniuses have done precisely the wrong thing. As it stands, they have already converted the NHS into what is effectively the National Covid Service. But, instead of taking the opportunity of taking the pressure off the established hospitals – and the infection with it - they are repeating their previous errors.

Needless to say, both patients and staff are paying the price for what is an episode of monumental stupidity that almost beggars description. Already, we have seen some reports of patients going into hospitals with minor conditions, such as here and here, while untested staff are infecting their own patients.

And, with the disease spreading to care homes – not least because infected patients have been discharged from NHS hospitals – these institutions are becoming death camps for the elderly, while care staff are dying in their dozens.

Although actual UK reports of Covid-19 nosocomial infection are relatively uncommon, that is unlikely to reflect reality. The NHS is notoriously secretive about its infection rates, even going to the extent of concealing outbreaks and pressurising doctors to remove references to hospital infection from death certificates.

So manifestly obvious is this a serious problem that we even have an article written by a man with "absolutely no medical or epidemiological qualifications", who has got the point that eludes the politicians, the media and the nation.

As for the fabulous fourth estate, it has managed to close its eyes to the obvious and is joining forces with the government to turn the Covid-19 epidemic into a low-grade soap opera, co-opting hard-pressed but "heroic" NHS staff into a drama with a cast of thousands, ignoring the utterly crass failures of the planning system that has put them under so much pressure.

And not for the first time, Denis Staunton, London correspondent of the Irish Times has put his finger on a uniquely British phenomenon.

With almost 14,000 hospital deaths from coronavirus and Thursday's toll of 861 the highest in Europe, he writes, Britain is suffering more from the pandemic than any of its neighbours. Internationally, he adds, its government's response to the virus has become a byword for tardiness and incompetence as it struggles to catch up on testing, contact tracing and protective equipment for health workers.

But, he observes, as far as most of the British public is concerned, Boris Johnson and his government are doing a fine job, taking the right decisions at the right time. A new poll by Ipsos MORI shows a sharp increase in the prime minister’s popularity, an improvement in his party’s and for the first time this year, a majority saying Britain is moving in the right direction.

But mostly, the support comes from characterising the "battle" against the virus "as a national effort to protect the NHS". In so doing, Staunton says, "Johnson has tapped into a deep vein of British national identity".

Staunton then enlists David Lidington, the former cabinet office minister, to tell us that the NHS "… is seen, and the government has realised this and embraced this, as an institution that represents a particular embodiment about how the UK thinks of itself collectively. It's up there with the armed forces and the monarchy as a great national institution".

Yet, what is being perpetrated on the British public, with the connivance of the media, is a cruel deceit, where prime minister Johnson has described the British public having "formed a human shield around this country’s greatest national asset – our National Health Service". We are told that the purpose of the lockdown is not to protect the nation, per se but to protect the NHS and stop it from being overwhelmed.

Instead of seeing through this patronising and misleading guff, however, the bulk of the population seemingly falls in with it, lauding the unnecessary dead in the manner of fallen heroes, supporting talk of the NHS - in all its glorious incompetence – being awarded the George Cross.

And then we have the utterly fatuous and embarrassing display of public emotion, with the moronic clapping and banging of saucepans every Thursday night (pictured).

Rather than cries of outrage at the way the system has been so abused, and is so egregiously failing that ordinary people dare not use their own hospitals, it seems that the nation has entered into its second childhood, simpering after its masters and allowing itself to be distracted by facile displays, instead of demanding that the government is held to account for its failures.

Says Staunton, the prime minister has invited the people "to put their faith in their own feelings rather than in the cold, unforgiving evidence of the daily death toll". And, like imbeciles they are, the gullible masses have fallen for it, hook line and sinker. We are, it seems, getting the epidemic we deserve.

Contrary to the government's slogan, as long as the hospitals themselves are reservoirs of infection, they will keep the epidemic going, re-seeding the community (together with the care homes). The lockdown, now renewed, is not necessary to protect the NHS. It is needed to protect us from the NHS. Until they sort out the hospitals and care homes, it will be unsafe to lift it.