It seems possible, and perhaps probable now, that UK government policy, followed by the Scottish and other UK governments, has been fatally flawed when dealing with covid19. That is the opinion of Professor Anthony Costello, former Director of WHO who has a piece in the New Statesman.Here is an extract.
“Marc Lipsitch and colleagues, from Harvard and Nanjing universities, report that between 10 January and 29 February Wuhan hospitals faced on average 637 intensive care unit patients and 3,454 serious inpatients every day. Instead, be like Guangzhou, the largest province in China, where strict disease control measures were implemented within one week of case importation. Between January 24 and February 29, Covid-19 accounted for an average of just 9 ICU patients and 20 inpatients on each day.
The British government did not listen. We had two months to get prepared for large-scale tests in the population, contact tracing and quarantine, to be like Guangzhou rather than Wuhan. Yet the advisory committee, comprising clinical knights of the realm, virologists, mathematical modellers, and behavioural scientists led by a former director of David Cameron’s Behavioural Nudge Unit, decided British science knew best.
We don’t know if they ever sought advice from China or Korea, where population testing had been ramped up to over 20,000 per day. Or from epidemic control experts at the WHO like Bruce Aylward, Maria van Kerkhove or Mike Ryan, who continually emphasised the importance of speed and data collection in the community. Instead they relied on mathematical models with incomplete datasets.
On 12 March, at Boris Johnson’s press conference, Patrick Vallance, the chief scientific adviser, announced that they had moved from a “contain” to a “delay”. We were four weeks behind Italy’s epidemic, he said, so the modelling told us we could phase in social distancing measures gradually to flatten the epidemic. People with symptoms should stay at home for seven days. Population testing would be stopped (it’s not clear if it had ever started) and 60 per cent of our population would become infected over the next few months building up “herd immunity”. Chris Whitty, the chief medical officer, said he didn’t think the mortality rate would be more than 1 per cent. The mainstream media swooned with their effortless, calm and professional authority.
Even a Sun journalist could do the maths. 400,000 people might die. Many of us in the public health community were horrified and questioned the science. Luckily, the whole policy unravelled over the weekend. Neil Ferguson’s team at Imperial College, one of their key groups, re-entered data from Italy into their models, which showed a higher proportion of hospital admissions required intensive care. The NHS would face meltdown, they concluded. And Adam Kucharski’s modelling group from the London School of Hygiene and Tropical Medicine, other key advisers, reported that by the time a single death occurs, hundreds to thousands of cases are likely to be present in that population.
At a second PM press conference on 16 March, the whole strategy went into reverse: from the gradual mitigation and herd immunity plan back to intensive suppression of the epidemic. Social distancing had to start immediately. We still had time, said Vallance, and they hoped for no more than 20,000 deaths now. How many cases were there? They didn’t know. Around 1100 reported from tests, but it could be ten thousand, said Sir Patrick. Two days later, he suggested 55,000 possible cases, figures plucked out of the air without mathematical justification. And how were we doing with tests and case detection. Er…4000 per day, but we hope to get to 25,000. When? In a month.
When several of us raised questions about the failure to plan for testing, and the apparent lack of epidemic control expertise, or WHO inputs, we were reassured the strategy was based on the “very best British science”.
Right now, the epidemic appears to be surging through London, Hampshire and the Midlands. Without testing we have few data to inform us. No hospital admission data has been presented. A junior ITU doctor wrote to me saying they had three patients on ventilators on 15 March, which rose to 20, including a health worker, just two days later. Numerous reports criticised the lack of protective equipment in hospital. Quarantine rules told every health worker to stay at home for 14 days if they or anyone in their household had symptoms. No hotel accommodation had been requisitioned for those who wanted to avoid family contact, and no health workers were being tested. On this basis, the work force would quickly collapse.”
I would like to know if and when the Scottish government is going to order large scale testing for covid19 with follow up identification of contacts of those testing positive.