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Wednesday, March 04, 2020

Covid-19: Getting A Grip

As cases of Covid-19 approach six figures globally and have passed the half-century in the UK, our government has released its Action Plan (3 March). Before we look at it, let’s consider some other points.
We’ve been relatively lucky here and in the US. The virus reached us towards the end of the winter flu season and thanks to a reasonably cleanly populace and alert medics ready to jump on new cases and take the more serious to specialist facilities, the situation has the appearance of being so well under control that wiseacres are telling us we’ve been over-reacting and pass the port, old boy.
However, we could be in a Phoney War period. It seems that although Covid-19 is fatal to a small percentage, the potential scale of deaths relates more to the number of possible infections and nobody has an immunity. It’s not just a Chinese illness: early on, a Chinese study was released saying that East Asians might be more liable to contract the disease because of a genetic difference in their lung cells; yet as of 4 March 16:27 GMT , in Iran 92/2,922 have died, in Italy 75/2,502 – a death-to-case ratio of three per cent in each case.
This coronavirus has now hit Africa, South America and the Middle East, where health screening and treatment systems are not universally well-developed. A coronavirus simulation exercise conducted a few months before the real outbreak concluded that on average, the world’s nations were only forty per cent prepared to deal with a pandemic . ‘WuFlu’ could go on to brew away among the billions in the southern hemisphere, where autumn is on its way. There is also the Islamic community, for whom pilgrimage to Mecca is one of the Five Pillars of religious duty, incurring a ‘super-spreader’ risk as noted by Shahul H Ebrahim and Ziad A Memish in the Lancet (27 February). Moreover, there are many other holy sites visited by millions of pilgrims, including internally within Iran, so flight restrictions do not completely solve the problem.
A great global reservoir could be building up, and we shall know what we’re facing when Britain comes again to seasonal flu time. Paradoxically, the fact that for many the illness will be mild, even unnoticed, makes the situation worse because those people will likely go about as normal and stand to infect others. We should use our Phoney War period to plan and rearm.
So we shall. Tony Blair was fond of the phrase ‘joined-up government’, although in practice, joined-up writing looked like a bit of a stretch, except where systemic socio-economic and constitutional vandalism were concerned. Johnson’s first big test has turned out to be, not Brexit but disease. I don’t know whether it’s quite fair to suggest that Etonians generally have a penchant for delegation to ‘little men who do that sort of thing’ but BoJo’s appointee Dominic Cummings has arrived just in time to try out his own theories in respect of the effective management of public affairs, and I assume this ‘Coronavirus: action plan’ document has his fingerprints on it.
The challenge is to strike a balance between showing the government is prepared, and scaring us. It’s not so much a death-puppet that waggles at us, but the prospect of overburdened hospitals and health services, and significant disruption to daily life. 
At present, for every person who dies in hospital (thankfully, nobody in Britain, yet) there are several more in intensive care, plus further numbers within hospitals and even more at home. The team has thought of this (point 2.7) and estimates that at its peak the disease may cause up to a fifth of workers to be absent from duty. This has been repeated in the news media and BoJo has undertaken to allow Statutory Sick Pay to be paid from the first day of illness.
The general treatment strategy (2.9) is fourfold: Self isolation, managing symptoms, support for patients with complications, but most people to manage at home.
The wider strategy (3.7) is to Contain, Delay (to allow time for more clement weather, for research and the development of a vaccine – but paragraph 4.25 notes the need to weigh the ‘social costs’ of implementing actions), Mitigate the consequences, and continue with Research. À propos the last, the document notes (4.32) King’s College London’s work on ‘Emergency Preparedness and Response’ and (4.33) Imperial College’s unit developing Modelling Methodology.
The plan also reminds us of the complexities of devolved government, so HMG is taking that into consideration. Let’s hope that TV interviewers think twice before macho, pen-twiddling ragging of central government ministers about matters for which regional government is responsible .
A point that is both reassuring and worrying is in (4.8): ‘new powers for medical professionals, public health professionals and the police to allow them to detain and direct individuals in quarantined areas at risk or suspected of having the virus.’ Let us hope the Opposition will keep a beady eye on the potential for abuse of such powers, and insist on periodic reviews and sunset clauses.
The paper reminds us that Dad can’t do it all for us, and the advice is worth quoting in full:
4.34 Everyone can help support the UK’s response by:
• following public health authorities’ advice, for example on hand washing
• reducing the impact and spread of misinformation by relying on information from trusted sources, such as that on ,, , and
• checking and following the latest FCO travel advice when travelling and planning to travel
• ensuring you and your family’s vaccinations are up to date as this will help reduce the pressure on the NHS/HSCNI through reducing vaccine-preventable diseases
• checking on elderly or vulnerable family, friends and neighbours
• using NHS 111 (or NHS 24 in Scotland or NHS Direct Wales) (including online, where possible), pharmacies and GPs responsibly, and go to the hospital only when you really need to. This is further explained on the NHS website - and
• being understanding of the pressures the health and social care systems may be under, and receptive to changes that may be needed to the provision of care to you and your family.
• accepting that the advice for managing COVID-19 for most people will be self-isolation at home and simple over the counter medicines
• checking for new advice as the situation changes.
So far, so good – it feels as though intelligent management is in charge. ‘Keep calm, and carry on.’

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