Locking down without a rigorous test and trace programme as recommended by the WHO will not get us where we need to be
Coronavirus is the only show on the planet. Each and every one of us is apotential victim of this virus. Is the NHS prepared? The virus could infect 60% or more of the UK population if unchecked.
One factor that makes Coronavirus harder to control than SARS is that it appears to be possible to infect others before sufferers know they are ill. The scale of this pandemic could easily be comparable with the 1918 Spanish flu – worse than anything we have seen in modern times.
The three key symptoms of COVID-19 are reported as fever, cough and shortness of breath, although not every person infected will manifest all of these and some people may not show any.
We understand that these symptoms usually occur between 2-14 days after exposure, based on what has been observed with the SARS and MERSCoV viruses. Most people will feel like they’ve got a particularly nasty dose of flu – for approximately seven days – and then recover.
A minority of people – especially those with existing heart disease, respiratory disease, diabetes, hypertension, and/or cancer – develop more serious breathing difficulties and these are the ones advised to contact the emergency services.
Of this minority, 20% need ICU care and around 15% of those people die, based on current mortality rates.
Researchers currently think that between five and 40 coronavirus cases in 1,000 will result in death, with a best guess of nine in 1,000 or about 1%. An individual’s prospects depend on a range of factors: age, sex, general health and the health system you are in.
The elderly and those with some chronic health conditions are more likely to die if they contract coronavirus, with men faring slightly worse than women. Your prognosis also depends on the level treatment you get. Medical staff also seem to be at significant risk, perhaps from extended or intensive exposure to the virus, making it particularly urgent for the government to sort out its inability to provide suitable personal protective equipment (PPE) to all NHS staff.
It sounds and looks as if this virus is highly transmissible. As a new virus, its full capabilities and potential are not yet fully understood. London is worst affected, but the rest of the UK will soon be hit with a similar surge if the right measures are not taken.
At a certain point, it becomes less about trying to stop an outbreak from entering a country and more about doing what we can to reduce the damage it causes, goals that tend to require different strategies.
The key steps the government must take to prepare include:
- several thousand corona beds (15% of patients)
- self-quarantine of patients
- no admission for patients without breathlessness
- remote consultations for mild cases
- ICU beds with ventilatory care for at least 3% of expected infection numbers
- listing of hospitals with ECMO (extra-corporeal membrane oxygenation) machines
- PPE for at least 5 staff per patient per day
- N95/FFP2 surgical masks available for all staff as recommended by WHO
- hand sanitisers production capacity of millions per day
- healthcare staff provided with coronavirus handling training -including retired doctors and nurses
- an army of persons trained in handling dead bodies of infected cases
- a team of dedicated mental health councillors to tackle coronavirus anxiety
- government-imposed price cap on masks and other related diagnostics and PPE
- correcting and even censoring myths and fake news on social media.
Staff are the most valuable asset of our NHS. They will react with energy and flexibility, but urgent measures must be taken to support their health and wellbeing – for the benefit of all of us.
But are they?
Boris Johnson keeps repeating his claim that the NHS is well prepared to deal with coronavirus. But the vast majority of the medics I talk to strongly disagree!
Lisa Anderson, a consultant cardiologist at London’s St George’s hospital, articulated the concerns of doctors when she told Andrew Marr on Sunday that staff are not getting the equipment they need.
Anderson said the government had changed NHS rules and was no longer compliant with World Health Organization (WHO) recommendations, which require a full gown and visor. NHS staff only have to wear a simple face mask, short gloves and a pinafore apron.
This is not just about the risk to us and our families. We are travelling home on the tube, on buses, we are cross-infecting everybody at the moment.
Doctors are worried that the NHS is already stretched and under heavy pressure – and especially that it has too few intensive care beds and that GP surgeries are struggling to meet patient demand.
A&E waiting times were already the worst on record before this crisis. Intensive care units are at capacity and are struggling to admit patients who are critically unwell or awaiting cancer surgery.
Boris Johnson’s Covid-19 strategy dangerously leaves too many questions unanswered. Relying on Herd immunity was total madness. Not testing populations is negligent; keeping the NHS staff without PPE is criminal.
Johnson’s failure to include these basic provisions in his ‘strategy’ will ensure that the virus spreads and will cause more infections and more deaths in the near term.
Without rigorous testing, tracing of contacts and proper equipment, we are fighting a purely defensive battle – and doing so with at least one hand tied behind our backs. You can’t win a football or a cricket game by only defending – you have to attack as well.
To win, we need to attack the virus with aggressive and targeted tactics.
We need to follow tested policies – as practiced by China, South Korea, Singapore, Taiwan and India – to suppress the epidemic. And we need to hope that a vaccine and reliable treatment becomes available quickly.
We need to act now and act fast. Every day of delay will mean more people become infected or die.
We have to attack the virus to win – defensive restrictions are not enough.
Dr Kailash Chand OBE is an award-winning GP and former deputy Chair of the British Medical Association. He is writing in a personal capacity.
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