by Les
May
MY wife and I
are old enough to be considered ‘vulnerable’. We chose to
isolate ourselves from 21 March, which is a few days before the
government introduced the ‘lockdown’. At this moment I
have no expectation that we shall ever be able to take up what we
thought of as normal life before this; seeing our grandchildren,
spending time with our friends, an occasional meal out or a visit to
the theatre.
Though I have watched hours
of news reports, daily briefings, read innumerable reports and
searched the World Wide Web for information, I have been left
puzzled by one thing; why did the government allow the SARS-CoV-2
virus, the causative agent of Covid19, to become established
in the British population?Yesterday the BBC Parliament channel repeated a broadcast of a Select Committee hearing of 25 March 2020 which included oral evidence given be Professor Neil Ferguson of Imperial College. At the time Ferguson was recovering from a Covid19 infection and it was not always easy to hear clearly what he was saying, but he said, or appeared to say, that the reason attempts to confine the virus and so prevent it becoming established, was a lack of testing and contact tracing capabilities.
At this point someone, and I am not pointing the finger at Ferguson as this was clearly a political decision, shifted the goal away from preventing further deaths to just controlling the spread in such a way as to prevent the capacity of the NHS to deal with cases becoming overloaded, or as it came to be called ‘to flatten the curve’, and accepting the additional deaths which would be the inevitable consequence.
If indeed lack of testing was one of the reasons for abandoning efforts to confine the outbreak then I find this rather strange. The WHO guidance on contact tracing does not make reference to testing, it seems that a medical diagnosis is sufficient to initiate contact tracing. Ebola was initially recognised in 1976 though no specific test was available for several years. The guidance is given below.
‘People in close contact with someone who is infected with a virus, such as the Ebola virus, are at higher risk of becoming infected themselves, and of potentially further infecting others.
Closely
watching these contacts after exposure to an infected person will
help the contacts to get care and treatment, and will prevent
further transmission of the virus. (my
emphasis)
This
monitoring process is called contact tracing, which can be broken
down into 3 basic steps:
Contact
identification:
Once someone is confirmed as infected with a virus, contacts are
identified by asking about the person’s activities and the
activities and roles of the people around them since onset of
illness. Contacts can be anyone who has been in contact with an
infected person: family members, work colleagues, friends, or health
care providers.Contact listing: All persons considered to have contact with the infected person should be listed as contacts. Efforts should be made to identify every listed contact and to inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms. Contacts should also be provided with information about prevention of the disease. In some cases, quarantine or isolation is required for high risk contacts, either at home, or in hospital.
Contact follow-up: Regular follow-up should be conducted with all contacts to monitor for symptoms and test for signs of infection.’
https://www.who.int/news-room/q-a-detail/contact-tracing
But having ruled out the labour intensive process of contact tracing and isolation, and moving to the present containment/mitigation strategy it seems likely that at some future date that is precisely what will have to be implemented. This is what Neil Ferguson is quoted as saying on the Imperial College website
‘The challenge that many countries in the world are dealing with is how we move from an initial intensive lockdown… to something that will have societal effects but will allow the economy to restart. That is likely to rely on very large-scale testing and contact tracing.’
If
the government is hoping that the ‘testing’ will be a reliable
antibody test it is possible it will have a long wait as this does
not seem to be on the horizon at the moment, so we are back to asking
why contact tracing cannot follow a medical diagnosis.
I
have previously commented on the proposal to develop an ‘app’ for
use in contact tracing. Even the USA is recruiting staff involved in
census data collection to assist in contact tracing. Perhaps the UK
should do likewise now and not leave it until
‘they get round to it’.
Rigorously
making sure that no potential virus carriers enter the country
without being quarantined and tracing and isolating contacts if this
fails, would have been costly to the economy because of its effects
on trade as well as to our personal freedom to move freely to and
from other countries. But are the uncertainties of the present
situation really better?
In
case you think I am using 20/20 hindsight in constructing my comments
I’m not. On 14 March just at the time the UK government was
abandoning any attempt to confine the outbreak Martin Hibberd,
professor of emerging infectious disease at London School of
Hygiene and Tropical Medicine, was quoted in The
Times (page 7) as expressing concern about government planning
that the virus cannot be stopped and instead aiming for a controlled
peak in the summer which assumed a large proportion of the population
would become infected and recover.
Even
before there were any cases in the UK on
25 January the website
‘Technical Politics’
published a long article about Covid19 which ended by saying ‘Our
Government needs to be ahead of the game: ahead in its thinking and
in its action’
and included the following questions;
If the pandemic reaches the UK, where will suspected sufferers be treated?
What facilities will be designate for the treatment of sufferers?
Who will staff those facilities?
What palliative care can be provided prior to the development of a vaccine?
Who needs to go to work, and who can stay at home?
If school is cancelled, will teachers get paid?
How will the supply chain bear up under the circumstances?
What happens if Britain is not able to import that which it does not produce?
What about people working in the private sector?
How will the economy bear up?
Will companies lay off workers and if so, are we ready for an increase in unemployment?
How to make sure that public finances don’t take such a great hit that a debt crisis is caused?
What about the risk of civil unrest?
http://northernvoicesmag.blogspot.com/2020/03/we-are-following-science-oh-really.html
***********************************
Posts
No comments:
Post a Comment