London:The UK government has rightly said it was and would be guided by science. Nobody expects politicians to be scientists or scientists to be politicians. The scientists concerned with UK coronavirus are the Scientific Advisory Group for Emergencies (SAGE). Both scientific and political opinions combine to make strategy in the coronavirus emergency.
Both the government’s and SAGE’s advice have evolved rapidly as coronavirus has spread worldwide. The advice over the past week to protect the NHS from being overwhelmed with critically ill patients has been dynamic, from last week hoping to cultivate “herd immunity” and expecting up to 500,000 deaths, Monday announced almost an instant “lockdown” advocating total social-distancing for a period of 21 days, Thursday announced the situation was likely manageable for the NHS and a new UK fatalities expectation of circa 5,700. The peak is now expected in mid-April and not mid-May.
The herd immunity strategy assumed that at least half UK’s population would become inevitably infected, but was contested by other experts, partly because of the lack of testing involved; testing to know the extent and spread of the menace is essential to decision making. Other scientific experts argued for containment to prevent the infection from spreading.
Academics, scientists and mathematical modellers all have a part to play in deciding a consensus on strategy. Differences of opinion are not a good look for the government. To be challenged so publicly at the onset was an embarrassment, although most of the terrified population succumbed readily to the social-distancing advice that followed. In future, folks will want to know if the fatality estimates were exaggerated to make folks compliant.
There remains the mystery why UK is not conducting testing NHS frontline staff until the first week in April. Is this a residual herd immunity strategy? Thus, if UK gets a second wave of Covid-19 a good proportion of frontline staff will have developed immunity.
Italy’s scientific advisor Walter Ricciardi, reacting to the overcrowding scenes on London’s underground as key workers struggled to get to work, said UK’s lockdown came ten days too late, since it is now thought UK’s patient zero occurred in mid-January.
The Office of National Statistics shows that the combined deaths for England, Wales and elsewhere in January, February and March 2019 were between 53,000 and 43,000, the number decreasing as the weather improves; later with hindsight it will be interest to review how Covid-19 alters that figure.
There are subtle differences day to day, with government advice. On 23 March the advice published was to stay at home with only essential outings permitted (unless you were a key worker). On Thursday the advice was to go to work (but work from home if possible). Was this an attempt to soften the blow of the economy grinding to a halt, or to allow for some of that herd immunity to build up, especially since there is talk of an antibodies test to help people who have had the virus return to work?
The risk level of Covid-19 to UK has been raised to high. This reporter found the National Risk Register of Civil Emergencies (NRR) published in January 2012 on the gov.uk website, which provides an overview of the kinds of civil emergency that could affect people in the UK. Out of the 80 threats listed, Zoonotic diseases feature as having an overall relative impact score of 2/5, whereas pandemic influenza scores 5/5. The relative likelihood of Zoonotic disease occurring in the next five years (since 2012) is between 1 in 200 and 1 in 20 and for pandemic influenza it is between 1 in 20 and 1 in 2. For pandemic influenza the assessment is “Many millions of people around the world could become infected, causing global disruption and a potential humanitarian crisis. The latest World Health Organization estimates are that between 2 million and 7.4 million deaths may occur globally… In the UK, up to one half of the population could experience symptoms; potentially hundreds of thousands of deaths may occur. It is likely that there will be widespread social and economic disruption; significant threats to the continuity of essential services; lower production levels; shortages; and distribution difficulties.”
On Zoonotic diseases “Most of these newly recognised infections are zoonotic, that is they are naturally transmissible, directly or indirectly, between vertebrate animals and humans. By their very nature, zoonotic infections can be more challenging to monitor. Although it is unlikely that a new infectious disease will originate in the UK, it is highly probable that one will emerge in another country. Given the ease and speed with which people can travel around the world, a new infection could spread rapidly before it is detected, and be transmitted to the UK. New diseases therefore pose a potential threat to the health of the UK population, and may present social and economic challenges.” Nobody could have imagined these risks to be combined.
NRR was first conceived in 2008 and the last update found by this reporter was in 2017, the risk evaluations are the same and the response to a flu pandemic is listed as “Detection, Antivirals—the Government stockpiles enough antiviral medicines to help treat people showing symptoms during a flu pandemic. Antivirals can help treat flu symptoms but are not a cure- Vaccines and personal protective equipment”. All of these responses were slow off the mark. In 2017 NRR zoonotic diseases get a lower profile, some historic examples are given, in case of an occurrence the response would be containment and strict movement controls—Eradication and vaccination.
Britain has chosen to buy British ventilators from Dyson and Gtech, a government spokesman suggested that the email invitation to join the EU joint ventilator procurement scheme was not received.
City Airport has morphed into RAF Nightingale to support the Excel Centre that is London’s new Corona hospital, with 500 respiratory beds immediately available and a future capacity of up to 4,000. Similar temporary hospitals are planned for Birmingham and Manchester.
David Nabarro, WHO’s coronavirus special envoy and Imperial College academic, praised China’s response to their epidemic, then warned “once an outbreak has been contained and ended, we should be prepared for it to return.” In February, Dr Nabarro called for governments to cooperate and put political differences aside. He said: “High-quality cooperation between governments is the only way in which human suffering can be reduced.”
There is some evidence that countries are working in tandem, a cursory look at the dates that international air services were suspended and the dates forecast for resuming show remarkable alignment.
Nobody could have anticipated Covid-19 but its devastating human and economic impact shows international collaboration and sharing data is essential for detection, prevention, research and results. To this end following the virtual G20, Boris Johnson has announced £210million to fund vaccine research.