Sandydragon wrote:Son of Mathonwy wrote:Eugene Wrayburn wrote:One of the more ridiculous ideas around is that the response to this crisis is somehow apolitical and any criticism should wait until we've counted all the dead. What utter bollocks. Examination of what is going wrong is how you stop it from continuing to go wrong. It's the only way you bring pressure on a sitting government. Now if it were the tax rate or something less critical then maybe there would be an argument for it. On the other hand this is about thousands of deaths which could be preventable, so no it shouldn't wait.
Absolutely. Adding in the deaths outside hospitals, we're probably losing 1000 people a day to this disease, largely unnecessarily (if you see how successfully some countries have treated this), so this is a live problem: every day counts. Also, as for the same reason - our ongoing failure to take the most effective action - we are stuck in economically catastrophic lockdown. Every day is a further blow to the economy; there will be all manner of ill effects which will fall hardest on the most vulnerable.
The reason why we are losing that number people every day is due to decisions take weeks ago. That number will drop as the current lockdown has an effect. We don't have testing in place (that's a fair point to argue) to do anything more nuanced and there is no vaccine. At the moment there is no alternative to the lockdown until the numbers have decreased a lot and then some elements can be relaxed. Knowing how many are dying in care homes won't affect that strategy one jot. Bemoaning the lack of testing kits is valid but do you not think that urgent efforts are being made to try and procure accurate kits? Moaning about lost weeks of inactivity is a fair point, but it doesn't change where we are now and can wait for the inquest.
As for looking after those economically affected by the lockdown, the government had released a vast amount of money to handle that short term. Of course its not perfect, it never is, but perhaps they deserve a little credit for not just letting people sink.
Question the government should be addressing now:
More PPE
A plan to end lockdown.
Anything else is less important. In a criss situation you prioritise, it really is that simple.
Agreed, we are losing that number because of decisions made (or not made) in the last couple of months. The numbers are dramatically lower than they would have been without lockdown and dramatically higher than they would have been had the lockdown come in earlier. Hopefully the daily numbers have passed their peak and will come down soon.
I agree we have to lockdown at the moment - we need to use all weapons (and lockdown is a blunt, but heavy weapon) until the cases come down. But I disagree that there is nothing nuanced we can do at this point. We need to identify cases - by symptoms if no tests are available - and trace contacts. This is what Singapore did (without high tech, just with people), and South Korea, and Taiwan, and others.
The number dying in care (or otherwise untested and out of the hospital system) might add as much as 50% to the reported figures, so I really think that would have to be taken into consideration in any strategy. It's not like it's a marginal item.
I hope the best efforts are being made now to procure PPE and tests. GIven the competence seen in earlier weeks, I doubt that the best people are running the process, but yes, most likely they are working hard on this.
I agree we need more PPE and a plan to end lockdown, but a good plan will include other elements which need to be prioritised (they should have been done from the start, but we are where we are, so they should be started now). So I would say our priorities are:
1) We must not run out of PPE, vital intensive care equipment such as ventilators, medical staff to treat critical patients
2) We need a targeted approach to suppressing the virus, that is:
- i) Locate the infected, by the following means:
- a) Random testing (when widely available)
b) Self-diagnosing by symptom and logging via website, phone app, phoneline
c) Diagnosing by symptom by health visitors, community workers, by phone or door-to-door
ii) Isolate households where there is an infection
iii) Trace contacts of the infected and isolate their households
- a) By asking the infected for their recent movements
b) By other means such as phone apps etc
iv) A record of the above is needed so that we know the extent and location of (presumed) immunity in the country; with additions as follows:
- a) documented past symptoms
b) antibody testing (when available)
3) We need make adjustments to "business as unusal" eg
- i) The wearing of masks where close contact is unavoidable eg on public transport, crowded offices, face-to-face with the public
ii) The adjusting of workplaces eg work from home where possible, increase distances between staff where possible
4) We need to be told what the lockdown reduction strategy is eg
- i) When will restrictions be reduced - when cases reduce to a certain approxmate level?
ii) In what order will restrictions be reduced?
Re 2) we seem to be remarkably uninterested in such a strategy, despite the fact that this method allowed SK and Singapore to suppress the virus without significant economic restrictions,
which casts doubt as to how we can do without repeated lockdowns ourselves if we don't adopt it. Staff need to be trained for this, but we have large numbers currently not working, so let's train them
now.
This is a quote from Dr Michael Ryan of the WHO:
"I listened to the president of Singapore this morning and he had a conference call with the director general; and the clarity of that in Singapore, that ability not only to isolate cases but to rapidly detect illness in the contacts and remove those contacts should they become sick, was a central part of that. And as he said, they’re using apps now to do that. They’re testing apps, but that they didn’t do it with apps Singapore. They did that with community workers, with public health workers visiting the houses, checking on people, checking their health status every day and saying, “How are you? Have you got a fever? Have you got a cough?” And if a contact is developed a cough or a fever, they were taken immediately for testing.
So yes, we need the information technology tools. They help. They are not the solution. Right now, we don’t have an alternative to what we would’ve considered in the old days. boot-leather epidemiology. Public health practitioners, doctors, nurses, community workers, working with communities to detect cases at community level. And the most likely person to become a case is someone who’s been a significant contact of another case."
