Self Isolation Day 11

*

March 13th 2020

Guest post by Mr. Saltycat

The UK government has come in for a lot of criticism from medical experts and even the former Health Secretary Jeremy Hunt for its strategy dealing with the Coronavirus.

It would appear that the strategy is for the Coronavirus to slowly spread amongst the British population in the hope that a herd immunity will develop once people have developed antibodies to the illness.

Hence its reluctance to adopt the mass lock down measures we have seen used successfully in China and which are currently being used in Italy.

The British government claims it is merely following scientific advice.

David Halpern, A member of the committee managing the government's response to the pandemic, told the BBC that:

“There’s going to be a point, assuming the epidemic flows and grows as we think it probably will do, where you want to cocoon, you want to protect, those at risk groups so that they basically don’t catch the disease, and by the time they come out of their cocooning, herd immunity’s been achieved in the rest of the population”.

Waiting for the Coronavirus to infect to 60% the population, which underpins the British government strategy, is full of dangers. The danger being that you totally overwhelm the National Health Service which could not cope with the numbers of people currently seeking hospital care in northern Italy.

This strategy completely ignores the current experience of Italy where exponential growth of the Coronavirus is overwhelming its hospitals. The Lombardy region of Italy has a world-class health system and it is been overwhelmed by the numbers of people needing care. It isn't just elderly people with underlying health conditions who are needing critical care.

Warnings from Italy

Several doctors in northern Italy have issued urgent appeals to other countries urging them to learn lessons from Italy's current health crisis.

Dr. Daniele Macchini, who works at the Humanitas Gavazzeni hospital in the northern city of Bergamo, warned on a lengthy Facebook post about the dangers of complacency in combating the highly infectious Coronavirus:

“After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.
“I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder.’’

Italian hospitals stretched beyond capacity

He noted how the exponential spread of the virus has filled hospitals beyond capacity:

“The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.’’
“And there are no more surgeons, urologists, orthopaedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.’’
“Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.”

It’s not just flu

Dr. Macchini was scathing about people who take the attitude that this is just like seasonal flu and therefore you don’t need to change your daily routines:

“Now, explain to me which flu virus causes such a rapid drama. … And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is ‘temporarily’ put in crisis, the epidemiological disaster is taking place.’’
“So be patient, you can’t go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.’’
“I finish by saying that I really don’t understand this war on panic. The only reason I see is mask shortages, but there’s no mask on sale any more. We don’t have a lot of studies, but is panic really worse than neglect and carelessness during an epidemic of this sort?”

Rationing of resources threatens lives

Another doctor from the Bergamo region, an anaesthesiologist Christian Salaroli,told the Italian newspaper Corriere della Sera that doctors are having to ration intensive care and forced to choose who to treat based on who has the greatest chance of survival. She said, "We can't attempt miracles. It's the reality."

The Italian society of anaesthesiology and intensive care published 15 ethical recommendations that should be considered when deciding upon admission to intensive care units. Age and probability of survival are amongst the criteria to be considered by doctors on the front lines.

These warnings have been amplified by the article published in Newsweek by an Italian doctor working in the Lombardy region.

Criticism of US/UK approach

She criticised the current strategy being followed in Britain and the United States which refuse to introduce widespread social distancing measures as used in China and currently in Italy:

“I’m a doctor in a major hospital in Western Europe. Watching you Americans (and you, Brits) in these still-early days of the Coronavirus pandemic is like watching a familiar horror movie, where the protagonists, yet again, split into pairs or decide to take a tour of a dark basement.
“The real-life versions of this behaviour are pretending this is just a flu; keeping schools open; following through with your holiday travel plans, and going into the office daily. This is what we did in Italy. We were so complacent that even when people with coronavirus symptoms started turning up, we wrote each off as a nasty case of the flu. We kept the economy going, pointed fingers at China and urged tourists to keep travelling. And the majority of us told ourselves and each other: this isn't so bad. We're young, we're fit, we'll be fine even if we catch it.’’

She noted that Italy’s complacency in the initial stages of the global pandemic when it was largely confined to China is costing Italy very dearly:

“Fast-forward two months, and we are drowning. Statistically speaking—judging by the curve in China—we are not even at the peak yet, but our fatality rate is at over 6 percent, double the known global average.’’

The reality of the Coronavirus in Milan’s hospitals

“Put aside statistics. Here is how it looks in practice. Most of my childhood friends are now doctors working in north Italy. In Milan, in Bergamo, in Padua, they are having to choose between intubating a 40-year-old with two kids, a 40-year old who is fit and healthy with no co-morbidities, and a 60-year-old with high blood pressure, because they don't have enough beds. In the hallway, meanwhile, there are another 15 people waiting who are already hardly breathing and need oxygen.’’

Social restrictions urgently needed in all countries

She warned that until the global pandemic has peaked the only solution is for all countries to impost social restrictions:

“And if your government is hesitating, these restrictions are up to you. Stay put. Do not travel. Cancel that family reunion, the promotion party and the big night out. This really sucks, but these are special times. Don't take risks. Do not go to places where you are more than 20 people in the same room. It's not safe and it's not worth it.

It’s not just the flu

She bitterly criticised the attitude it’s just like flu and most people will survive an encounter with the virus:

“But why the urgency, if most people survive?
“Here's why: Fatality is the wrong yardstick. Catching the virus can mess up your life in many, many more ways than just straight-up killing you. "We are all young"—okay. "Even if we get the bug, we will survive"—fantastic. How about needing four months of physical therapy before you even feel human again. Or getting scar tissue in your lungs and having your activity level restricted for the rest of your life. Not to mention having every chance of catching another bug in hospital, while you're being treated or waiting to get checked with an immune system distracted even by the false alarm of an ordinary flu. No travel for leisure or business is worth this risk.’’

Call to action

Her article finishes with an appeal for ordinary people to take action, where governments concerned with their economies, refuse to do so:

“But if your government or company is slow on the uptake, don't be that person. Take responsibility. For all but essential movement, restrict yourself.
This is epidemiology 101. It really sucks. It is extreme—but luckily, we don't have pandemics of this violence every year. So sit it out. Stay put. Don't travel. It is absolutely not worth it.
It's the civic and moral duty of every person, everywhere, to take part in the global effort to reduce this threat to humanity. To postpone any movement or travel that are not vitally essential, and to spread the disease as little as possible. Have your fun in June, July and August when this—hopefully—is over. Stay safe. Good luck.’’

UK government failing its people

I find myself for the first time ever, agreeing with former Health Secretary, Jeremy Hunt’s criticism of the British government. The UK government’s failure to deploy a widespread social containment strategy is a ticking time bomb.

“I think it is surprising and concerning that we’re not doing any of it at all when we have just four weeks before we get to the stage that Italy is at.”

Exponential growth of the virus threatens to overwhelm the NHS
An NHS doctor who is treating Coronavirus patients has warned that the British people have no idea of how bad things will get over the next period. She explains how the NHS does not have the resources to cope with the exponential growth of the virus:

“For an idea of how quickly case numbers can explode, look to Italy. One week after it hit 320 cases, the country reported 2,036; a week later, nearly 10,000; next week that number will likely rise to 50,000 or more. There’s nothing I have seen that tells me the exact same thing isn’t coming for us in the UK. We only have around 4,000 intensive care unit (ICU) beds in England, 80% of which are already full. If we follow the same trajectory as Italy, with 10% of Coronavirus patients needing ICU treatment, we will need 200 beds next week, 1,000 the week after. That’s already the entire ICU capacity. Every two days after that, we will need twice the number of beds again. ‘’

NHS short of resources due to Tory government cutbacks

The ICU doctor noted how glaringly inadequate are the resources the NHS has compared to China and Italy:

“China had the capacity to build 2,000-bed hospitals, lock down 750 million people, and fly in thousands of medical staff. Italy, despite having a well-resourced healthcare sector, has been overwhelmed. With 100,000 missing staff, 10,000 missing doctors, 40,000 missing nurses and around £3bn missing from our budget, we have neither Italy’s well-resourced healthcare system nor China’s capacity.’’

UK government failing to prepare for the coming epidemic

Of great concern are her claims that the government has not put in place measures to deal with the coming epidemic:

“If we are going to be throwing everybody we have at this in two weeks, why aren’t we training them now? We should be throwing every single resource we have at this, immediately. Rishi Sunak promised “unlimited money” to fight the pandemic – and yet we haven’t seen anything. We should be recalling every medic we can find, rapidly training up existing staff and resourcing central hospitals with every scrap of PPE and ventilation equipment we can lay our hands on. Hospital managers should be told to do whatever they have to, and don’t worry about budget constraints or fiscal penalties. The government should be providing the public directly what we need to contain the epidemic: hand washing areas at transit hubs, supplies at foodbanks, mass disinfection of public transport. We are far behind where we need to be, and every second lost will cost lives.’’

Ordinary people everywhere have a duty to act responsibly and without panic in protecting themselves and their families by adopting the kind of social distancing measures recommended by Italian doctors on the front lines of the pandemic.

UK cases (as of yesterday) are 798, and 11 dead. Local and mayoral elections in May are to be postponed for a year.