Coronavirus: Stay At Home V "Herd Immunity"

The Coronavirus is a horrible disease that is much worse than the flu with a mortality rate between 1% and 5% depending on where you live.There's a lot of misinformation floating about it. This is what I know to be true.

In the West, there's a massive disparity between countries that provide healthcare to the people and those that leave people to fend for themselves, for the most part. The result is that more people are dying in the laissez-faire countries than in the more socially concerned countries. I'm going to look at three areas that need attention:

• Testing
• PPE
• Prevention

Testing

In Germany, they do more testing and have better outcomes, but whether or not that's reflective of their healthcare is up for debate; most Western countries are only testing some sick people. Germany is testing everyone.

The answer to why Germany's figure is so much better partly lies in the way the case fatality rate is calculated.

The figure is produced by dividing the number of deaths by the total number of confirmed cases.

This means if a country only tests seriously ill patients they will have a higher case fatality rate, as a higher proportion of these patients will die. - Coronavirus: Why Germany has such a low COVID-19 death rate, by Alice Udale-Smith and Carmen Aguilar García for Sky News

Here in the UK they're only testing some of the sickest people. As a result, not everyone who needs treatment are getting it and some are dying at home. Even then, they're not being tested. For this reason we may never know the full death toll. A similar story is unfolding in America.

Nudge theory - "Let 'er rip!"

In countries where governments are more concerned for their people there are more hospital beds as well as testing, and a detailed plan for how to deal with outbreaks of disease. Meanwhile, in countries where we're mostly left to fend for ourselves, the original plan was based on "Nudge theory," the idea being to let the pandemic rip through the population, leaving the survivors immune so we could go back to work. The thing is, we're not really set up to deal with a large number of very sick and dead people. Emergency measures such as refrigerated tents for storing bodies and asking firefighters to pick up the dead are being implemented. Basically, callously letting a chunk of the population die so we can get back on with our lives presents a logistical and infrastructural nightmare for a country that expects the market to provide. It won't.

PPE

Personal protective equipment provision should have been the first thing to sort once we realised the Coronavirus was going to be a problem. It wasn't. Even now, when we're seeing it as a national emergency, medical professionals are being obliged to work without it. One doctor in America was fired for complaining about it on his social media account. The UK is no better.

The A&E nurse urged the Department of Health to intervene to ensure workers are better protected from Covid-19. Speaking on the condition of anonymity to BBC Northern Ireland's Nolan Show, she said the World Health Organisation's recommended medical masks, gown, gloves and eye protection feels insufficient. "These masks are like paper masks with an attached face shield on them, they are not seal-proof masks; we were fit-tested several months ago to wear respirator masks, FFP3 masks, which we're now not getting to wear at all," she said. "They are sealed masks which are fit tested to ensure there is a correct sealed fit on our face, they cover the nose and the mouth and they ensure that no droplet is going to get in through the mask that we could inhale in."

It comes amid the death of GP Dr Habib Zaidi, who passed away in Southend hospital. Although not confirmed, it is believed the 76-year-old may be the first doctor in the UK to die from Covid-19. - Nurse urges Government to provide more PPE in fight against coronavirus - ITV News

While the WHO (World Health Organisation) works on helping countries to obtain much-needed supplies (turns out the market doesn't provide!), we're finding out the hard way that the biggest killer of all is complacency. Don't get me started on ventilators - there aren't enough, though we've been promised more.

Prevention

Prevention, as they say, is better than cure. When the Coronavirus began to tickle the edges of my consciousness I was complacent, believing that it would be contained and controlled as efficiently as SARS was at the beginning of this century. I was wrong. Why? The main reason is politics; market-led policies and magical thinking encouraged a widespread belief that the individual alone is responsible for his or her care; it's not the government's job to keep you healthy. There are two areas to compare and contrast here:

• Disease control strategy
• Healthcare politics

While both are intertwined, a "Me first" attitude can easily scupper the best of intentions. Let's take a closer look.

Disease control strategy

I'm still amazed that the strategy successfully used against SARS wasn't implemented early enough to prevent the coronavirus from becoming a pandemic. This is what they did:

• 12th March 2003: The World Health Organization (WHO) issued a global alert for a severe form of pneumonia of unknown origin in persons from China, Vietnam, and Hong Kong. CDC activated its Emergency Operations Center (EOC) two days later.
• The following day, CDC issued first health alert and hosts media telebriefing about an atypical pneumonia that has been named Severe Acute Respiratory Syndrome (SARS). CDC issues interim guidelines for state and local health departments on SARS. About a week later, CDC issued infection control precautions for aerosol-generating procedures on patients who are suspected of having SARS,
• By the end of the month, biosafety measures have been implemented, lab tests are ongoing, and they'd worked out who was catching it and where they'd been. Domestic guidelines were issued for managing exposure as the disease became more widespread, at which point pandemic planning went into effect. Travel advisory notices were issued to warn against travelling to the Far East.
• The following month, there were 115 cases in the USA from 29 states with no fatalities. CDC issued guidance and established community outreach teams. By mid-April they'd sequenced the genome and grown a cell culture, the idea being to make a vaccine for it. Health alerts were issued RE: Canada. This went on and off until mid July.
• In the first week of May, they'd had no new cases. By July 2003, it was over in America.

Early intervention by the Center for Disease Control, cooperation with other countries and WHO, and compliance by the people involved stopped the disease in its tracks. Had we repeated this, could we have stopped the Coronavirus? It's possible, but not probable because of the increased population density, increased travel, and the asymptomatic transmission of a virus with a longer incubation period. To be honest, the best we could have done is slow it down, which is what we're trying to do now.

Healthcare politics

The state of politics around healthcare has drastically changed since 2003, when George Bush was president of the United States. While I'll gleefully slag him off for his response to Hurricane Katrina, for the wars in Iraq and Afghanistan, and for the implementation of mass surveillance, I'll give him props for the way he handled SARS. I was expecting the same thing to happen this time around but in 2020 the man at the helm is Trump, and he's a liar and a fool who spreads misinformation. One man, who believed what Trump said about a cure, ingested fish tank cleaner because he thought the magical ingredient was in it. His wife, who also took it, survived. The worst thing he did was to close the Pandemic Preparedness Office because his predecessor, Barack Obama, had created it. His administration denies that this has anything to do with their flat-footed response to the Coronavirus, and blames China for being slow to report it. But they were slow to report SARS, and we beat that.

Meanwhile, here in the UK, years of austerity are coming back to bite us and the much-vaunted "internal market" for procurment in the NHS has broken down.

By mid-March many elements of the internal market within hospitals had been put on hold, as some wards had stocked up on personal protective equipment leaving other wards in the same hospitals short. The purchasing and distribution of Covid-19 supplies was instead centralised within hospitals – meaning purchases no longer needed to come out of ward or department budgets. Since then the procurement of coronavirus supplies has been centralised nationally – with the government coordinating daily deliveries of supplies to hospitals.

Hospitals usually have their services commissioned by CCGs, with payments made on a cost-per-case basis and each intervention given a set price in a national tariff  – but this system has now been thrown out of the window, with the government requiring that hospitals are instead given block contracts to provide acute Covid-19 care. 

Even the procurement of ventilators, which is now being funded and coordinated centrally, marks a huge step away from the normal system of hospitals, or departments within hospitals, being individually tasked with procuring necessary equipment in the most cost-effective way. - Coronavirus Has Destroyed the NHS Internal Market Overnight, Proving That It Never Worked, by Jo Sutton-Klein for Novara Media

We've got shortages of everything and private hospitals are being asked to help. 

This changes everything

The cold wet fish of reality is hitting us hard, exposing the flaws in our leaders, in our society, and in capitalism. Are we going to go back to business as usual when this is over or are we going to learn from it? I, for one, hope it ushers in a better, kinder society in which workers are rewarded for their labour, not taken for granted. I want to see better healthcare provision and pandemic planning baked into government policy. This never needed to happen in the first place. It didn't need to go this far. We're not immune and we're not immortal, so please, for the time being, stay at home until you are advised otherwise. I know you're going stir crazy but hopefully next time this happens, we'll be ready for it.