COVID-19 UK & Beyond

[mojomonkey]

Priti Patel channelling her inner Dianne Abbott numeracy skills. Maybe she should stick to smirking from home.

[Freggyragh]

17 hours ago, woolley said:

Bla, bla, bla. 

“

On the evening of January 31, Boris Johnson sat before a fireplace in 10 Downing Street and told the nation, in a televised address: “This is the moment when the dawn breaks and the curtain goes up on a new act in our great national drama.”

He was talking of finally delivering Brexit, or what he called “this recaptured sovereignty.” Until that moment, Johnson’s premiership had been utterly absorbed by delivering on that challenge.

With Brexit done, Johnson had the chance to focus on other matters the following month, among them the emerging virus threat. But leaving the European Union had a consequence.

Between February 13 and March 30, Britain missed a total of eight conference calls or meetings about the coronavirus between EU heads of state or health ministers – meetings that Britain was still entitled to join. Although Britain did later make an arrangement to attend lower-level meetings of officials, it had missed a deadline to participate in a common purchase scheme for ventilators, to which it was invited. Ventilators, vitally important to treating the direst cases of COVID-19, have fallen into short supply globally. Johnson’s spokesman blamed an administrative error.”

https://nationalpost.com/pmn/health-pmn/johnson-listened-to-his-scientists-about-coronavirus-but-they-were-slow-to-sound-the-alarm-2

[P.K.]

17 hours ago, woolley said:

Reposted from IOM thread. Probably more relevant here:

It is good to be able to take a look at things from an apolitical viewpoint. I would be genuinely interested to read any other views about how or if this could have been handled more effectively, and who should have done what, when. I don't mean banal political rhetoric.

That is a massive ask. Trying to compress months of a pandemic into posts on MF.

Firstly my rhetoric is never banal.

Secondly be careful how you use the term "political". Here's why:

If a tape-monkey sends the wrong reel off to BACS is that a political act? No of course it isn't. It's just a stupid mistake made at the end of a night shift. Roger so far over? However the upshot of this was that London's Traffic Wardens got paid twice and the Metropolitan Police Officers not at all.  This led to "Questions In The House" as it's called over the actions of a Met Police outstation called, iirc, JADPU.

So, like a lot of other things, a little fuckup ended up as a political act because it's in the HoC where the ramifications got played out.

So here is what I think maybe a good baseline to establish the situation prior to Covid-19 inevitably reaching the UK. It is a letter from a doctor pleading with the Prime Minister to actually listen to what he's being told to by the medical professionals and act accordingly. It is not a political letter. It is simply spelling out what is happening in the hospital where he works and asking for things to be done to turn the situation around. Written last December - which now seems years and years ago. Please DO NOT enjoy!

Dear Boris Johnson,

In medicine – unlike politics, where anything seems to go these days – we have situations called “never events”. These are instances that occur when a patient is seriously harmed in spite of all the protocols and protective measures to prevent this happening. “Never events” are such serious, manmade disasters that most clinicians involved in them will bear the burden of such tragic events for the rest of their careers.

Like many junior doctors who have worked in overwhelmed and understaffed A&E departments, I’ve seen things happen as a result of the overstretched conditions that I believe should be classed as “never events”. Since 2016, nearly 5,500 patients have died in England alone as a direct result of having waited too long to be admitted to hospital. To put that in perspective, that’s nearly twice the number of people killed in terror attacks in the UK since 1970. We should be outraged.

Prime Minister, can you please try and imagine for one moment working as an NHS paramedic, doctor or nurse in conditions so overstretched that ambulances have to endure dangerous queues and we see patients die on corridor trolleys as a result? Just stop for a moment – please – and think of the human consequences of your NHS underfunding. The NHS everywhere is desperately underfunded and understaffed – and this is on you and your party of government. Your refusal to correct these systemic problems has created more than 5,000 of these “never events”. Prime Minister, you have failed these patients and your negligence has contributed to their deaths.

You and your party have had nearly a decade to leave the health service in a better state than when you found it. On every objective metric, the Conservative party has failed in that, and we see this in our NHS hospitals every single day. England is short of 40,000 nurses and 10,000 doctors, A&E waiting times are the absolute worst in NHS history, our cancer patients are waiting longer than ever to be seen, you have shut down too many district hospitals, you have left us with too few hospital beds, social care is a mess, mental health care is inaccessible, and you have destroyed our capacity to provide a multitude of services in the community to keep people healthy and out of hospital. And now nearly 5,500 people have died as a direct result of your policies. This is the legacy of the “one nation” Conservative party.

If you care about fixing this, stop coming into our hospitals for surreptitious, unannounced photo opportunities because you’re scared of us asking you tough questions – and start listening to our medical experts instead. We don’t need more privatisation from American companies. We don’t need more expensive consultants and middle management getting involved.

We need you to listen to Dr Katherine Henderson, the president of the Royal College of Emergency Medicine, who says: “Patients have been let down repeatedly by a parliament that has consistently failed to grasp the scale of the problem … Our staff are stretched beyond their limits … At its simplest we need more beds, we need more staff, we need more social care. Politicians must make this happen.”

When a “never event” occurs in a hospital, the clinicians involved are often subject to very lengthy investigations and serious consequences are meted out that sometimes include them losing their licence to practise medicine. After nine years of gross negligence, nine years of lecturing the British people about how the “one nation” Conservative party is the choice to make the NHS safer, more efficient and more productive, we’ve seen what Tory governments have accomplished: the worst A&E waiting times in NHS history and people dying in corridors in the fifth richest country on Earth.

 You are not fit to lecture us any more about what we need in our NHS hospitals. You have failed the British people, failed my beloved Worcestershire Royal hospital, and failed our brilliant and hardworking NHS staff nationwide who have been traumatised by your negligence. Because the safety of our patients has now been threatened to such a significant degree, I am exercising my right as a whistleblower in clause 29 of my contract to speak out – outside your sanctioned channels – because this has happened too many times in hospitals across the country, and the British public has a right to know exactly who is responsible.

Prime Minister, the NHS is not safe in your hands. Your negligence and that of your party over the past decade has contributed to the deaths of nearly 5,500 patients, and if you were a junior doctor like me, your licence would now be revoked, and you would be sent to prison.

[woolley]

2 hours ago, Freggyragh said:

“

https://nationalpost.com/pmn/health-pmn/johnson-listened-to-his-scientists-about-coronavirus-but-they-were-slow-to-sound-the-alarm-2

This is actually a very good, very fair assessment of what has happened since January. Did you read it? It chronicles how opinion was divided among the scientific community, and particularly that the government followed the advice of their experts pretty much to the letter. This should be no surprise, because in such a situation, and considering the eventual and inevitable public scrutiny, it would be a brave politician who acted against that advice.

Can we draw any conclusions on the question I posed regarding what should have been done differently, when and by whom? The internet is full of nutters posting bile that the virus deaths are down to "the cruel Tories", but are we saying that Jeremy Corbyn would not have followed the very same advice in the very same way? Would Labour have faced down the government scientific advisors and told them in no uncertain terms that they were wrong and alternative scientific opinion needed to be harnessed instead? I surmise that they would have done exactly the same things as have been done, with pretty much the same result, but they would still have blamed the Tories for not preparing earlier. The heavy death tolls across Europe and elsewhere indicate that nobody really has this under control, and we are only seeing the first wave of infection.

It would seem that if there was a mistake by the government it was in believing the calming words of their own scientists for too long - difficult to do otherwise when the scientists are the experts and you are a layperson - and an element of those scientists tellling the government what they wanted to hear about the level of threat. Once the virus was charging around the world, I don't think that much could have been done to obtain more PPE because the available supply was already multiple times oversubscribed.

 

[woolley]

2 hours ago, P.K. said:

That is a massive ask. Trying to compress months of a pandemic into posts on MF.

Firstly my rhetoric is never banal.

In reality, when you write a letter to the PM and publish it, you just publish it and this one is certainly playing to the gallery. It is highly unlikely to go before the PM's eyes no matter how politicised it is. You cannot but have sympathy with people who are stretched providing the service. You can blame the government if you think that despite ever increasing amounts of money being thrown at the NHS it is still not enough, or you can look at the management within the organisation itself for not getting the best out of what resources are available. Possibly some of both.

[Chinahand]

I'm still trying to understand why Germany is fairing so much better.  Is it just statistics and luck or is there something systematically better which they have done?  I suspect it is more quickly getting testing and contact tracing into action.  I realise the Tories-are-evil-set will say the systematic destruction of the nhs is the reason, but the nhs hasn't been systematically destroyed.

It's interesting that the first major outbreaks weren't in major population centres in either Italy or Germany, while it looks like the virus has spread more in urban London (and New York) in the UK (and the US).  It is easier to isolate Modena than a suburb of London, and it only takes a few days before exponential growth makes contact tracking futile.  It is sad to say taking an extra few days to make decisions may be the issue.

[P.K.]

8 minutes ago, woolley said:

In reality, when you write a letter to the PM and publish it, you just publish it and this one is certainly playing to the gallery. It is highly unlikely to go before the PM's eyes no matter how politicised it is. You cannot but have sympathy with people who are stretched providing the service. You can blame the government if you think that despite ever increasing amounts of money being thrown at the NHS it is still not enough, or you can look at the management within the organisation itself for not getting the best out of what resources are available. Possibly some of both.

You can't say that it is published to play to the gallery because as far as I'm aware it was only published in the Guardian. 

The point being made is that the PM was simply not listening to the medical experts. Or if he was, and he should have been, then he was ignoring what they were telling him. As to "you can look at the management within the organisation itself for not getting the best out of what resources are available" the author clearly states "We don’t need more expensive consultants and middle management getting involved" which I could well agree with.

In a follow up to this the author said "We are currently running at 120% of capacity. Just a normal day" which tells a story in itself!

So the backdrop for the Covid-19 story in the UK just has to be that the NHS was underfunded, undervalued, short of facilities and staffing and very very demoralised....

[woolley]

9 minutes ago, P.K. said:

The point being made is that the PM was simply not listening to the medical experts.

This simply isn't true. Read Freggy's link.

[woolley]

10 minutes ago, P.K. said:

  the author clearly states "We don’t need more expensive consultants and middle management getting involved" which I could well agree with.

In a follow up to this the author said "We are currently running at 120% of capacity. Just a normal day" which tells a story in itself!

So the backdrop for the Covid-19 story in the UK just has to be that the NHS was underfunded, undervalued, short of facilities and staffing and very very demoralised....

"Expensive consultants and middle management getting involved." This sounds very much like a criticism of the internal organisation, doesn't it?

I think the funding has gone up substantially over recent years, but no matter how much you throw at it, the call will always be "not enough".

[P.K.]

19 minutes ago, Chinahand said:

I'm still trying to understand why Germany is fairing so much better.  Is it just statistics and luck or is there something systematically better which they have done?  I suspect it is more quickly getting testing and contact tracing into action.  I realise the Tories-are-evil-set will say the systematic destruction of the nhs is the reason, but the nhs hasn't been systematically destroyed.

It's interesting that the first major outbreaks weren't in major population centres in either Italy or Germany, while it looks like the virus has spread more in urban London (and New York) in the UK (and the US).  It is easier to isolate Modena than a suburb of London, and it only takes a few days before exponential growth makes contact tracking futile.  It is sad to say taking an extra few days to make decisions may be the issue.

After 31 deaths Germany started locking down on the 20th March.

They have been testing 500,000 people a week.

They have three times the medical facilities (hospital beds and staff to service them etc) than the UK.

Since 2010 the number of NHS beds has dropped to it's lowest ever figure of 127k. Although some of the 16000 or so beds lost were in mental health which has given rise to the "bed blockers" of today.

[P.K.]

11 minutes ago, woolley said:

This simply isn't true. Read Freggy's link.

I did read it.

And I think this is still true:

On 3/21/2020 at 11:50 PM, P.K. said:

Boris Johnson is completely useless and totally out of his depth. 

One important test of leadership is never, ever be afraid to challenge the SME's.

Johnson has clearly not done this. But only because he figures that for SME's read fall guys. Only last week you were supposed to go to the match and infect a couple of people! What?

They keep bleating that the UK is three weeks behind Italy. Errrr excuse me PM and SME's but we are three MONTHS behind China! Who appear to have it under control. They also reported that a Japanese flu jab made quite a difference. So where is it?

The "only testing in hospital" was another massive blunder. As the WHO told them "How can you deal with a virus when you don't know where it is?"

The town of Vo in Italy was suffering from the virus. As part of a research effort they tested all 3,300 people in the town. They turned up various folks who were asymptomatic. They quarantined them and the virus with it. No more cases in Vo.

That's the thing. There is a whole raft of best practices and methodologies developed over the last few months that our lot just seemed to ignore. Johnson has a very great deal to answer for.

 

[woolley]

25 minutes ago, P.K. said:

 Although some of the 16000 or so beds lost were in mental health which has given rise to the "bed blockers" of today.

I do agree with this. If there was one thing that is needed above all others it is a network of some sort of halfway house facilities which would free hope large numbers of beds in hospital wards. Should be a national priority.

[Manximus Aururaneus]

53 minutes ago, P.K. said:

 

Since 2010 the number of NHS beds has dropped to it's lowest ever figure of 127k. Although some of the 16000 or so beds lost were in mental health which has given rise to the "bed blockers" of today.

I'm sorry but those 'facts' are a gross distortion of the truth for nothing more than your own personal political aims.

The '16,000 or so beds lost in MI' are actually a tiny fraction of a process first proposed in 1956! ( Guillebaud) and are not the main reason for bed-blocking you suggest.                   

The process has gone under different names since then but most people would have heard of it as 'Care in the Community' - a program that initially came about not because of government (of any party) cuts, but as a result of public pressure for liberalisation of the rights of the mentally ill to be de-institutionalised and of various horror stories emerging about treatment inside the huge, mostly Victorian, mental hospitals. It was pursued for a decade prior to Thatcher, during Thatcher, during Blair and Brown, and continues today.

Simon Duffy 'The hero of deinstitutionalisation' was awarded the Albert Medal for the same in 2008. The 'NHS and Community Care Act of 1990' was in full swing in 1993.

Not far from you, Winwick Hospital (just off the junction M6/M62) - one of the largest MH's at 7,000 beds was closed in March 1997 as a specific part of the scheme.

The NHS can be sorted, and now is as good a time as any, but for that to happen some people are going to have to come to terms with the fact that the required improvements will have to take priority over vested interests and party politics. 'Make your mind up time' fast approaches. Good decisions cannot emerge from ideological bunkum.

[Freggyragh]

2 hours ago, woolley said:

This simply isn't true. Read Freggy's link.

The government were listening to their own scientists, but not the broader scientific community and didn’t compare notes with other European countries, which they were repeatedly invited to do. Consequently, as the scale of the problem became apparent, Ireland, Germany, et al, who had been in the meetings with Italy, France and Spain, were able to move a week or so earlier. It’s pointless pointing fingers now though. Brexit got done, the people who believed in it won a referendum and were well prepared to suffer all sorts of consequences if it meant there would be no further cooperation with the neighbours. I think it’s a lesson learned, ie the EU are ok, we play footy and drink beer with them, they like the U.K., and we like them, and it’s the weird religious folk in US we really need to avoid having to deal with. 

[woolley]

27 minutes ago, Freggyragh said:

The government were listening to their own scientists, but not the broader scientific community and didn’t compare notes with other European countries, which they were repeatedly invited to do. Consequently, as the scale of the problem became apparent, Ireland, Germany, et al, who had been in the meetings with Italy, France and Spain, were able to move a week or so earlier.

This isn't inconsistent with my appraisal. I think what you describe is the inevitable consequence of the straitjacket of the system. If anyone should have been drawing from all shades of scientific opinion it would seem to be the leading government scientists at a scientific peer to peer level, rather than the politicians. They could then interpret the alternative views they were hearing into a form the politicians could work with. At first they didn't want to hear this because, for absolutely certain, the permanent staffers guard their empires jealously, and they don't like to be told they are wrong. In the end they probably did speak to those outside agencies and amended their advice to the government. "The right action at the right time."

I'm not saying that the government couldn't have done better in some ways, there is always room for improvement. If you are going to have a state scientific expert establishment on the payroll though, your default position has to be to trust it.  If you don't, if you are going with your gut, you might as well dispense with it, rely on outside agencies and spend the money saved on healthcare. Some people just will not see things as they are. They would prefer to lay 10,000 deaths solely at Johnson's door and have him shot at dawn for mass murder. It's quite ludicrous.

 

It will be interesting to watch events in Sweden who have been following a much looser lockdown than anyone else.