
The UK’s public health response to Covid-19 - andyjohnson0
https://www.bmj.com/content/369/bmj.m1932
======
Traster
>If the government failed in its duty to protect the public, it also failed to
protect staff in the NHS and social care by not delivering sufficient amounts
of personal protective equipment (PPE) of the right specification, again
deviating from WHO advice

The government is currently telling anyone who will listen that hospitals have
all the PPE they need. However, local nurses and doctors are co-ordinating
with volunteers to supply hand sewn PPE because they've been told they can
only order PPE for the autumn. My mother is having material delivered and is
hand-sewing PPE for the local hospital. Yet the government claims this isn't
needed. So whilst this review is pretty damning, let's remember this situation
is far from over.

The fact that the PM's political advisor was in the scientific advisory
meetings tells you all you need to know.

~~~
CodeGlitch
The lack of PPE is a world-wide problem. The UK imported tonnes of the stuff
for Turkey, but it was deemed to be not fit for purpose. Other countries have
been asking for water-proof coats, that can be used as washable over-garments.

I don't think any government is going to come out of this scoring 100%.

~~~
makomk
It's a world-wide problem that the media in every Western country seem to be
spinning as a unique failure of their government, often for cynical and stupid
partisan reasons. Same with the global shortage of everything needed to carry
out widespread coronavirus testing.

~~~
teruakohatu
Agreed. We had the same stories here in New Zealand, a country which currently
has 40 active cases and less than one new case per day (7 day average). Yet we
constantly hear how we are running out or going to run out of X or Y. More
often than not I think it is logistics. Despite being a small country with
centrally funded healthcare, the management of the health system is very
decentralized geographically. So some doctor somewhere runs out of something,
and runs straight to the media who are happy to run it on the homepage.

------
butler14
It's a reasonable opinion piece and I agree with a lot of it -- particularly
not having Cummings in SAGE meetings and the embarrassing state of PPE, but;

"he floated an approach to “build up some degree of herd immunity” founded on
an erroneous view that the vast majority of cases would be mild, like
influenza"

as far as anyone knows, they are. the (limited) data we have is making a
strong case for that.

and in any case, 'some degree of herd immunity' wasn't the policy, it was (and
still is) an inevitable outcome

we'll need to wait on Roche's antibody test to have a robust sense of how
succesful our delayed lockdown (or sweden's complete lack of lockdown) worked

~~~
DanBC
> 'some degree of herd immunity' wasn't the policy,

It was the policy. They were pursuing herd immunity. They were talking about
cocooning vulnerable people so everyone else could go about their normal
activity, get infected, and develop herd immunity. We have government advisors
saying this.

~~~
butler14
I disagree.

The UK strategy was to not pull the trigger on lock down too early, and then
to flatten the curve in a way that fills our front line health service's
capacity without overstretching it.

All while increasing numbers of beds, ventilators and distributing PPE as
widely as possible.

That's broadly what's happened.

~~~
DanBC
[https://twitter.com/BBCMarkEaston/status/1237694665824047111](https://twitter.com/BBCMarkEaston/status/1237694665824047111)

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

It's clear from this that the policy was to achieve herd immunity. Without a
vaccine the only way to get herd immunity is to let everyone catch it. You
don't want vulnerable people to die so you cocoon them, but you want everyone
else to get it as soon as possible.

This is why mass events (eg, cheltenham gold cup) were allowed to go ahead;
this is why the lockdowns were late and weak; and this is why so many people
in the UK have died.

~~~
butler14
that's a pretty cynical interpretation that confuses the practical and
biological inevitability (herd immunity) with one of the many method(s) by
which we get there (shielding vulnerable groups)

a great many things have gone wrong -- but I don't think the overarching UK
strategy, or even the timing of executing it -- has necessarily been one,
based on existing data

------
amriksohata
I agree that the UK response has not been as good as some other countries.

I feel though there is a lot of political propoganda going on. This MP
complained about a lack of PPE at a care home she worked in, but the care home
sacked her for lying as they said they had plenty.

[https://www.bbc.co.uk/news/uk-england-
nottinghamshire-525680...](https://www.bbc.co.uk/news/uk-england-
nottinghamshire-52568038)

~~~
detaro
I've heard from quite a few people organizing DIY faceshield/mask production
in the UK that they got brushed off by higher-levels as "not needed, we have
proper stuff, thanks", but the actual employees needing PPE were begging them
for it. Unclear how widespread that is, but still worrysome.

------
billme
Infographic in the link article is worth a click:

[https://www.bmj.com/content/bmj/369/bmj.m1932/F1.large.jpg](https://www.bmj.com/content/bmj/369/bmj.m1932/F1.large.jpg)

It is timeline graphic of the growth of the virus per country and actions
taken by each country.

~~~
billme
Anyone know what is causing the humps in the graphs of “confirmed cases” ?

Looked at this before, at first I thought it was weekends being under
reported, then people going out on weekends, etc. — but now starting to think
it might be the R0 (reproduction number) is very high and the virus burns
itself out among a social network.

Any ideas what is the source of those humps?

------
ageitgey
I'm all for criticism and investigation. But it seems so early to make these
kinds of definite proclamations. There is _so much_ about the virus and how
it's transmitted that we still don't understand. The UK government had no idea
what they were doing, but really neither does anyone else. And until we are a
little further along in successfully containing this epidemic, it's not going
to be clear what the best course of action was.

Here are some of the most basic things no one seems to have figured out yet:

\- As of today, there have been 23,953 deaths in England. Of those, exactly
33(!) involve someone <= age 40 without a co-morbidity. Across all ages,
95%(!) of deaths are people with a co-morbidity, typically diabetes (26%). Why
does this disease attack so many diabetic people? What should we do to best
treat or prevent it in that population? [1]

\- Why is the transmission rate in London so low now (R = 0.4, < 25 infections
a day) while still high everywhere else in the UK (R = 0.7 - 08)? Is that
because the lockdown in London is somehow different or better or because some
critical segment of the population is immune now and slowing down
transmission? Or something else? [2]

\- Why weren't the Nightingale Hospitals (field hospitals) needed? Were we
just wrong about the need for ventilation? Was the lockdown super effective?
Or something else?

\- How many people are currently immune? Different studies in place the
immunity rate in London anywhere from 10% (tests) to 29% (statistical models).
Several studies suggest that there is significant cross-immunity with
preexisting coronaviruses causing much slower spread, but it's too early to
know for sure and that could be totally wrong.

\- Why do some scientists think this will be a serious, on-going epidemic and
others think the disease will "burn itself out" [3]? Is that based on science
or wishful thinking? Because the difference in the best course of action would
be significantly different if we knew the answer with a strong degree of
certainty.

\- Why do some places with lax lock downs have lower death rates than places
with severe lock downs? Why aren't we seeing big upticks in deaths in the US
where they are just willy nilly opening the economy? Is it just lagging
indicators or are we not totally sure yet how this disease spreads in the
community?

\- How soon will we get an effective therapeutic? Will we really have a
somewhat effective vaccine from Oxford in September or might we never have a
vaccine? Will it matter anyway as immunity builds up in the population? How
long are people immune?

\- What is the actual cost of locking down in terms of lives lost as a side
effect in the long term due to economic, social and psychological effects? Is
it minuscule or significant?

Again, there will be plenty of time to bash the UK government after this is
over. But it seems very early to be proclaiming that anyone has any idea what
the right course of action was. This epidemic could totally vanish this year
or it could go on for years. No one has any idea.

[1] [https://www.england.nhs.uk/statistics/statistical-work-
areas...](https://www.england.nhs.uk/statistics/statistical-work-
areas/covid-19-daily-deaths/)

[2] [https://www.mrc-bsu.cam.ac.uk/now-casting/](https://www.mrc-
bsu.cam.ac.uk/now-casting/)

[3] [https://www.telegraph.co.uk/news/2020/05/16/coronavirus-
coul...](https://www.telegraph.co.uk/news/2020/05/16/coronavirus-could-burn-
naturally-vaccine-not-needed-former-director/)

~~~
DanBC
> As of today, there have been 23,953 deaths in England.

No.

1) The actual number is 34,796
[https://coronavirus.data.gov.uk/](https://coronavirus.data.gov.uk/)

2) That only includes people who were tested positive for covid-19. That's
only tests carried out by government labs, not private tests. We've only just
started to include deaths that happened outside hospital.

> Why weren't the Nightingale Hospitals (field hospitals) needed?

Because we didn't transfer elderly people from care and nursing homes to
hospital. We left them to die in those homes.

Because we cancelled elective procedures, we converted operating theatres to
ICUs, we changed nurse:patient ratios, to create surge demand.

Because we didn't have enough ICU nurses to staff Nightingale:London.

Of those, exactly 33(!) involve someone <= age 40 without a co-morbidity.
Across all ages, 95%(!) of deaths are people with a co-morbidity, typically
diabetes (26%). Why does this disease attack so many diabetic people? What
should we do to best treat or prevent it in that population? [1]

~~~
ageitgey
You've confused England with the UK (England, Wales, Scotland and Northern
Ireland).

------
GEBBL
And at the end of all this, you guys have Brexit. The UK is teetering on the
cliff edge.

~~~
CodeGlitch
People are still bitter about this aren't they? I voted remain but it's time
to move on.

The idea of a "cliff-edge" is yet to materialise.

~~~
cstross
The "cliff-edge" hasn't materialized because the UK is in a negotiated
transition period during which nothing changes. That ends on December 31st,
2020. On January 1st, new arrangements are supposed to come into force --
except they haven't been agreed yet, apart from a customs barrier _within_ the
UK (between Northern Ireland and the mainland).

Meanwhile -- _before_ COVID19 -- Sterling devalued by about 20%, the
government began borrowing heavily to cover a yawning revenue gap, an economic
slowdown cost the UK economy more than the gross total of all UK payments into
EU funds since joining in 1974 (many of which were redistributed right back in
the UK), and we have a prime minister who, when told that the Confederation of
British Industry was worried about his Brexit policies, famously said "f*ck
business".

Remember February/March, when everyone was sitting paralysed in the oncoming
headlights of COVID19, wondering if it was going to be bad and if it was going
to be necessary to make any changes? That's where we are with the end of the
Brexit transition period, right now.

~~~
SiempreViernes
To be fair, "cliff edge" is not a very accurate description of how it will
play out in practice: the effects did not kick in as sharply and consistently
as they do going over an edge, and there's not really any hard rock at the
bottom to smash things apart violently.

------
TLightful
... has been an unmitigated disaster.

------
tompccs
It's frustrating that all the valid criticism of SAGE and the scientific
leadership of the UK (frankly they should all resign) is blunted by blatant
propagandising over austerity and wider political beef. I cannot see the link
between austerity and the disastrous herd immunity policy yet all of these
articles in respected medical journals bring it up. These are supposed to be
academic journals, not newspapers. It totally undermines their point by making
them look politically motivated.

~~~
arethuza
Looking at the graphs in this article there does seem to have been a fairly
dramatic change in spending on the NHS as a percentage of GDP after 2010 or
so:

[https://www.nuffieldtrust.org.uk/news-item/70-years-of-
nhs-s...](https://www.nuffieldtrust.org.uk/news-item/70-years-of-nhs-spending)

~~~
tompccs
I'm not arguing about whether or not there were cuts in NHS spending or
whether or not austerity was a bad policy. I'm asking what it has to do with
the recommendations of a government committee made up of independent
scientists. Why is this so hard to understand?

~~~
arethuza
The article seems to be covering the overall response by the UK health system
- which would be made up of the capabilities of the NHS and how it was guided
at a strategic level by SAGE and the government.

Doesn't seem contentious to me that if the NHS has had the investment it
perhaps deserved over the last 10 years then this might have contributed to a
less than ideal overall performance?

