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Do or die…
Covid-19 , Issue 1519
WHAT’s most striking about Britain’s idiosyncratic approach to tackling the coronavirus pandemic is the lack of public support from senior scientists and public health experts outside the government circle.

covid-19.jpg Most support Boris Johnson’s belated attempt at lockdown but worry that the UK is two weeks behind the curve, particularly in London. Many believe he wasted nine weeks on “nuanced nudging” when the evidence from China and Italy was clear that tougher methods would be needed. Many remain incredulous at the lack of testing and contact tracing, not just in the community but of NHS staff, who don’t know if they have it so err on the side of caution and remain off work.

Johnson has ignored the evidence-based advice from pandemic experts in the World Health Organization and gone it alone. Britain is forging a brave new path in the new era of pandemics. Will we take back control of the virus in 12 weeks, do or die; or will we lose control of all the other things that kill us?

Numbers game
SO far this year, as the Eye went to press 159,987 people had died in the UK, 1,228 (and rising rapidly) with coronavirus, and 158,759 of things that don’t make the news. Assorted Imperial College professors predict that if we continue lockdown until June and turn the NHS into a Covid-19 service, deaths with coronavirus could be restricted to 5,700-20,000. Roughly, out of every 10,000 people in the UK, 9,996-9,999 would not die with coronavirus.

However, all 10,000 will be affected by social and economic lockdown, and many by cuts to other health and social services. Far more than 5,700 could die from the side effects of our strategy. And yet if the government had continued with its “herd immunity” plan (as Donald Trump is doing), 260,000 people could have died with the virus. Some may have died soon of something else, but the headline figure was a little on the high side even for Dominic Cummings, the prime minister’s brain (“chief adviser”, surely? Ed). This sudden surge in demand would crash the health service; hence the decision to crash the economy instead. But could we have stopped the pandemic if we’d got a grip earlier?

Bug’s life
A VIRUS, according to the late Nobel Prize-winning immunologist Sir Peter Medawar, is “simply a piece of bad news wrapped up in protein”. How bad the news depends on whether you’ve had it before.

This particular coronavirus is “novel”; our immune systems have never seen its RNA message, so the damage it’s causing is significant, particularly for those with bodies weakened by age and disease. The virus exists merely to replicate and is extraordinarily good at it. The saliva of Covid-19 patients can contain half a trillion virus particles per teaspoon. A cough or a sneeze shoots out a mist of millions which hang around in the air long enough for you to take in tens of thousands of virus particles in a single breath, in between your husband’s coughing fits. The most successful viruses learn to live in their hosts, rather than kill them. If the host dies, they die. The problem is, humans aren’t a natural host for these SARS (severe acute respiratory syndrome) viruses.

How to stop a pandemic
IN the SARS outbreak of 2003, there were no deaths in Britain thanks to brilliant global public health cooperation. Important lessons were widely shared about essential control of future disease outbreaks in an excellent book called SARS – How a Global Epidemic Was Stopped.

“Transparency,” it said, “is the best policy. Some countries did not acknowledge openly the presence of SARS or downplayed its extent. One nation’s weak response could endanger the world’s public health security. 21st-century science played a relatively small role in controlling SARS; 19th-century techniques continued to prove their value.” Developing diagnostic tests was crucial, and then the old methods of relentless testing, contact tracing and isolation stopped it becoming a pandemic.

Another lesson was that “animal husbandry and marketing practices seriously affect human health.” The 2003 SARS coronavirus originated in animals. Indeed, 75 percent of emerging infectious diseases now come from domestic or wild animals. Bats, birds, pigs, pangolins. Surely we’ve learned the lessons of 2003?

Bat-shit crazy
A STUDY of the genome of the SARS-CoV-2 published in Nature on 17 March has pinned it not on mad scientists wanting to rule the world, but on bats. It probably crossed to humans in the live animal markets of Wuhan, which are still the perfect storm for transmission.

The virus was on the wall in 2003, but unhygienic veterinary, slaughter and husbandry practices, and an illegal global trade in exotic animals for food, have continued unabated. Bats are fortunately a protected species in the UK, even if Waitrose has run out of grouse. Elsewhere, they should only be sold pre-cooked, chlorinated or as part of a ready meal.

No place like home
THE Chinese got off to a slow start with Covid-19, trying to cover up the outbreak in Wuhan. A courageous whistleblowing doctor, Li Wenliang, tried to raise concerns but was targeted by the Chinese police for scaremongering and subsequently died, reportedly of Covid-19. Then China delayed reporting the outbreak to the international community, until it became so big you could see it from space. Finally, they remembered the chapter in the book on transparency and started sharing their expertise.

The Chinese realised from previous SARS outbreaks that most spread occurs in family groups, and the last thing you want to do is isolate them all in a house together. Random temperature checks, virus testing and contact tracing on a grand and relentless scale is followed by separation from family and transfer to a hospital for the really sick, or to a massive sanatorium full of other Covid-19 patients for the rest. It’s the only way to break the chain, and perhaps not as grim as it sounds. Group exercising and singing is allowed, and you don’t have to worry about infecting anyone because they’re already infected.

Home has always been a risky place to be confined in, particularly for those who lack the luxury of space. Falls and fractures are likely to increase, with a toxic combination of a crowded house, toys and toddlers on the stairs, anger, alcohol and domestic abuse. Stray cigarette butts will start some house fires. And an estimated 7,100 people may die prematurely from this home confinement due to poor diet, poverty, inactivity, rickets and suicide. If we focus all our resources and attention on reducing the risk of Covid-19, other equally unpleasant risks may rise up. Child abuse is a major concern.

On the plus side, home confinement is leading to a reduction in pollution, littering, road traffic accidents and dog shit on the pavements (only one a day allowed), and an increase in birdsong and the life expectancy of asthmatics (if they escape the virus). It’s beautiful out there without humans.

U-turn if you want to
RISK management in a pandemic is unbelievably complex, trying to balance the deaths due to loss of livelihood, poverty and depression from sending a third of the world’s population home to hide, the deaths due to increased waiting times for treatment of urgent non-infectious conditions such as heart disease and cancer, and the rapid number of deaths in a short space of time from Covid-19, which will overload most health service and mortuaries, but not for ever.

In such circumstances, anyone is allowed to U-turn provided they own up and end up facing in the right direction.

The Chinese did the first U-turn, swiftly followed by the World Health Organization (WHO), which reassured us the threat was “moderate” until 30 January, when it was subtly upgraded to “international emergency”. Travel instructions were initially confused but it issued clear guidance on the essential protection of healthcare workers and the need to ramp up testing, trace contacts and isolate to break the chain. Enforced social distancing was vital. Britain slept.

MD will U-turn if necessary. I was initially reassured by Dr Richard Horton, editor of the Lancet, who tweeted on 24 January: “A call for caution please. Media are escalating anxiety by talking of a ‘killer virus’ + ‘growing fears’. In truth, from what we currently know, this virus has moderate transmissibility and relatively low pathogenicity. There is no reason to foster panic with exaggerated language.”

Horton did his own quick U-turn the next day, observing: “A third of patients [in Wuhan] required admission to ICU. 29% developed ARDS [adult respiratory distress syndrome]. Few countries have the clinical capacity to handle this volume of acutely ill patients. Yet no discussion.” He has now made it his mission to show how ill-prepared and tardy the government and public health response has been in the UK, and how health and social care services will collapse under the extra burden.

In fact, both Horton’s tweets are right. The virus is less infectious than, say, measles and less of a killer than ebola. When “ebeasles” comes along, we really will be screwed. For now, it’s the health and social care workers, and those with bodies weakened by pre-existing disease, who are most at risk.

Survival of the fittest
THE elephant in the room in this pandemic is not just our poor public health response, but our poor public health in general. The general health of Brits, Americans and other rich nations in general is dire. This pandemic will very likely demonstrate survival of the fittest. If ever there was a time to give up smoking and get fitter, it’s now.

MD is currently doing all his consultations by Skype and doing his best to reduce his blood pressure before joining the NHS frontline. I’d quite like a mask too.

Unfit for purpose
THE government’s plan A was to promote herd immunity, telling the public that 60-70 percent would likely get it anyway, and mildly, and they’d be doing the sick a favour by licking door handles and lavatory seats to build up herd resistance. Without vaccines, it’s a high-risk strategy – like parents who hold measles parties so their kids can catch it “naturally”, then run screaming to the NHS when they realise what an unpleasant, even lethal illness it can be (and, like HIV, it came from our conquest of animals).

The big flaw in the herd immunity plan came from the ridiculous idea that 60-70 percent of the UK population are fit and healthy. Many young and middle-aged people have a full house of chronic disease. They were never going to get Covid-19 “mildly” and would die with octogenarians in an overwhelmed NHS, alongside exhausted frontline staff.

Hence the screeching U-turn. Overnight, we went from “catch it now to build up our immunity” to “avoid it at all costs, to stop killing nurses and sick people”. Seldom has a message been more confused. The next cunning plan was “voluntary distancing” based on “nuanced messaging”. It relied on the British being jolly decent people who willingly do the right thing, if only they could remember what it was.

ANY doctor could have told Johnson voluntary nudging was doomed to fail. Patients remember 0-14 percent of what doctors tell them. Many don’t follow our advice (hence the staggeringly high rates of chronic disease). Around a third of drugs are taken properly, a third are taken sporadically, and a third are stored in the cupboard under the sink in case of a Soviet invasion.

Humans can resist everything apart from temptation. If you tell people they’re at very low risk but they shouldn’t go to bars, restaurants, cafés and gyms, and then keep them open with their near bankrupt owners’ pleading faces staring out, you won’t get much compliance.

High-risk, anti-social health behaviour is normalised in the UK. Drink-driving, texting while driving, not vaccinating your kids, smoking with your kids in the car, not washing your hands between shitting, sex and spring rolls, coughing in your doctor’s face from two feet, not picking up your dog poo etc.

Our public health disaster is a real test for Johnson, who by nature is very socially permissive. Until recently he was shaking hands and huddling close to his advisers in briefings. If you want to sell social distancing, you have to follow it too. The non-verbal message was: “I’m saying all this but I don’t really mean it.” By the time he finally sounded like he meant it, it was too late for him and it may be two weeks too late for the country. We won’t know until the tests are back. If only we were doing them…

A HOSPITAL during a pandemic is not a peaceful place to die. We need to dramatically increase community and home palliative care facilities, for those who don’t want to be in the queue for intubation. British figures for ICU survival with Covid-19 currently show 66 percent of those intubated have died, so ventilators are saving about a third of severely ill patients, even fewer among the elderly.

Better for many to get the best possible end-of-life care at home. That’s where we should really be putting our resources. And when all this is over, we need to help those recovering after intensive care, and those grieving a death that was in isolation, because of the risk of infection.

BORIS JOHNSON may yet have the last laugh if he can keep deaths down to 5,700 without destroying everyone’s livelihood. But models are simplistic security blankets for a reality that is far more complex and unpredictable. They can be way off the mark.

It could equally be that the virus has the last laugh. Remember, it exists only to replicate, and is even better at its job than Johnson. In the meantime, wash your hands, keep your distance and try to have five portions of fun a day.

PEOPLE are learning to cope without the NHS. Many accident departments are half full as people realise that a paper cut isn’t an emergency after all. The chorus of “coming over here and taking our jobs” has been silenced, as people realise that one in eight NHS staff are from overseas and one in four aren’t completely white, even behind the mask. The anti-vaxxers have shut up and, like everyone else, are praying for a vaccine.

All NHS and social care staff have been given free car parking. It should be made permanent. And the selflessness of 600,000 volunteers for the NHS – not just doing it to get out of the house – far outweighs the anti-social antics of six dim youths huddled round the swings. Bats are even returning to roost in Wuhan. Just don’t eat them.

More top stories in the latest issue:

ISAACE HAZE
Criticised for his mixed and reckless messaging on CV-19, the PM now brings Isaac Levido, who led the less-than-honest Tory election campaign, into his comms team.

MONEY TALKS
Why the World Health Organization is so indulgent of China, source of Covid-19 and many state-sponsored porkie pies.

HEALTHY RETURNS
For private health companies with sickly balance sheets, the invitation to join the war effort and help the NHS is a big, taxpayer-funded life saver.

SHORT SHRIFT
The big ‘respectable’ hedge funds who’ve ignored the pleas of Bank of England governor Andrew Bailey and are still shorting struggling British companies.

EMBASSIES LIGHT
UK embassies and consulates have shed so many staff in recent years it’s no wonder Brits stranded abroad have struggled to get consular help.

KILLER INSTINCT
The clinical negligence lawyer who is already advising how to sue the NHS if people think they’ve contracted Covid-19 on health service property.

POSTAL DISORDER
A six-page special on the Horizon IT scandal and how the Post Office wrecked the lives of its own workers.

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Crisis brings out true national spirit as Brits grass up neighbours to police… Stable Door Strategy slammed by World Horse Organisation… Britain now completely socialist, says a victorious Jeremy Corbyn… World King Cnut rethinks how long it will take to turn back tide… Love in the Time of Corona, a Sylvie Krin Royal Special… Police Urge Archers Fans not to Drive to Borsetshire… Nightmare for virus as it tests positive for Weinstein.

Banks a million
Slicker on Rishi’s bailout

Horizon scandal
Six-page special on the Post Office pariahs

Posh tosh
Julian Fellowes’ Belgravia

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Private Eye Issue 1518