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The UK’s public health response to Covid-19

35 points by andyjohnson0 6y ago

TLightful 6y ago
... has been an unmitigated disaster.
Traster 6y ago
>If the government failed in its duty to protect the public, it also failed to protect staff in the NHS and social care by not delivering sufficient amounts of personal protective equipment (PPE) of the right specification, again deviating from WHO advice The government is currently telling anyone who will listen that hospitals have all the PPE they need. However, local nurses and doctors are co-ordinating with volunteers to supply hand sewn PPE because they've been told they can only order PPE for the autumn. My mother is having material delivered and is hand-sewing PPE for the local hospital. Yet the government claims this isn't needed. So whilst this review is pretty damning, let's remember this situation is far from over. The fact that the PM's political advisor was in the scientific advisory meetings tells you all you need to know.
- CodeGlitch 6y ago
  The lack of PPE is a world-wide problem. The UK imported tonnes of the stuff for Turkey, but it was deemed to be not fit for purpose. Other countries have been asking for water-proof coats, that can be used as washable over-garments. I don't think any government is going to come out of this scoring 100%.
  - makomk 6y ago
    It's a world-wide problem that the media in every Western country seem to be spinning as a unique failure of their government, often for cynical and stupid partisan reasons. Same with the global shortage of everything needed to carry out widespread coronavirus testing.
    - teruakohatu 6y ago
      Agreed. We had the same stories here in New Zealand, a country which currently has 40 active cases and less than one new case per day (7 day average). Yet we constantly hear how we are running out or going to run out of X or Y. More often than not I think it is logistics. Despite being a small country with centrally funded healthcare, the management of the health system is very decentralized geographically. So some doctor somewhere runs out of something, and runs straight to the media who are happy to run it on the homepage.
    - 7952 6y ago
      But then the government also politicise it by telling lies about there own performance. If there isn't enough PPE then they should admit to that.
  - TLightful 6y ago
    The UK response has been terrible in all respects. Please don't sugar coat it.
    - Angostura 6y ago
      Nope, in many repects it's been pretty good. The respects that it has been very poor at was: * Being complacent about the country's testing capacity * stopping testing outside of hospitals once the containment phase was deemed over * PPE logistics. (tough global problem) * Support for care-homes. * Westminster's lack of care when it comes to coordinating the loosening of lock-down with the devolved countries It was arguable that they should have started lock-down earlier, but given that the number of acute beds in the NHS wasn't overwhelmed, that's arguable. If you look at stuff like the furlough scheme, support for individuals and freelancers so people don't suffer too much economically by being locked down, it a pretty good and swift response.
      - TLightful 6y ago
        So, "nope", but, actually, "yeah". * unclear and delayed response to pandemic, * frequent lying and misinformation put out by ministers, * considering herd immunity with no vaccine, The list goes on and on ... Yes, the furlough scheme, is decent. But smacks of just throwing money at the problem to save the day. It's not a coordinated response, and we'll be paying for it for generations. I repeat my assertion. Thanks.
      - tonyedgecombe 6y ago
        Yet we still have the worst death rate in Europe. Why was Germany so much better off than us.
        arethuza 6y ago
        Isn't the answer at the moment "we don't know" - I'm no fan of the current government but I don't think it helps blaming them before someone has analysed the relevant facts.
  - yread 6y ago
    Letting Cheltenham festival (13-16 March) and other sport events go ahead with 10s thousands of people visiting should criminally punished
    - DanBC 6y ago
      In 2020 there were over 240,000 attenders for Cheltenham festival. The town has a population of about 100,000. Each day there were about 60,000 people at the track. People say the festival is outside so it's lower risk. That's ignoring the fact that people take trains to get here and they take buses to get from the town centre to the race track. They also meet in cafés, pubs and betting shops, although this year that was far quieter than previous years. Letting it go ahead was a baffling choice.
  - DanBC 6y ago
    Lack of PPE is a world wide problem. That problem is made worse in the UK because of the lack of planning and political disruption to NHS infrastructure. See for example the fucking shambles of Movianto[1] https://www.theguardian.com/world/2020/may/14/coronavirus-uk-privately-run-ppe-stockpile-chaos-movianto https://www.theguardian.com/world/2020/may/14/coronavirus-uk... We used to have NHS Logistics Authority, which changed to NHS Logistics, which was sold off to DHL Supply Chain (but managed by NHS Business Services Authority) and that was a disaster so we now have NHS Supply Chain. This waxing and waning of ideology (centralised control vs localism; NHS provision vs private provision) causes huge amounts of waste and harm in the NHS. It's also not as simple as tories=bad, labour=good. Selling it off to DHL happened under a Labour government; bringing it back under NHS Supply Chain happened under a Conservative government.
    - arethuza 6y ago
      "centralised control vs localism; NHS provision vs private provision" I've known some unscrupulous management consultants who would just recommend the opposite of what the current state was just to generate work.
- Angostura 6y ago
  My wife is a doctor in a London hospital, from what I gather, there is no particular PPE problem there at the moment.
  - TLightful 6y ago
    I'm sure the situation is uneven. https://www.bbc.co.uk/news/uk-52671814 https://www.bbc.co.uk/news/uk-52671814
    - Angostura 6y ago
      I absolutely agree the situation is likely to be uneven. So this is a tough one. Most organisations will have general rules about not bad-mouthing the organisation publicly and running comms through s comms office. I absolutely agree people should be able to whistle-blow, but if you were managing a hospital you'd probably be wanting people not to go grumbling to the press.
      - TLightful 6y ago
        Transparency is key right now. Your "grumble" is likely someone else's "professional concern".
        SiempreViernes 6y ago
        Arguably accuracy is more important than transparency, and people in general have a strong tendency to interpret a single account of "we're all out of PPE" as "there is a general shortage".
        TLightful 6y ago
        Agreed. This thread started with an n=1 datapoint of there being no shortages in London. Works both ways.
- benmmurphy 6y ago
  Is there any evidence that there has been excess deaths for NHS staff and that this has been caused by a lack of PPE? There is this study (https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-cov...) that suggests deaths are amongst NHS staff are not over-represented. There is also a remarkable correlation between the cumulative UK deaths from covid-19 in the UK population and among health and social care workers. Accepting a lag of one to two days, the ratio is very close to 1:200 so the deaths among health and social care workers are approximately 0.5 per cent of all deaths, suggesting they are not overrepresented. That is the only study I could find that tried to look at excess deaths for NHS staff. I think their suggestion that deaths are not overrepresented is not backed by their data because it doesn't look like they are adjusting for difference in base mortality rates between NHS workers and the general population. However, considering how people are claiming lack of PPE is killing NHS staff you would think someone would have checked by now whether NHS staff are actually dying at a higher rate! When NHS deaths were around ~80 I ran my own model adjusting by age and found 10 excess deaths. However, the way I interpolated the deaths in the population to NHS age bands was very dirty and I didn't adjust for sex and race. The NHS has BAME groups overrepresented in their work force and these groups have higher mortality rates.
- aries1980 6y ago
  > If the government failed in its duty to protect the public Most governments failed when they didn't start to tax the sh*t out of unhealthy food and ingredients. "Preliminary evidence suggests that the severity of symptoms associated with Covid-19 and the eventual outcome of being infected with this virus are associated with the health status of individuals prior to infection. Among the factors linked to an increased risk of hospitalization and mortality are overweight/obesity, insulin resistance and diabetes: these lifestyle-related diseases [...]" https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.22849 https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.22849
GEBBL 6y ago
And at the end of all this, you guys have Brexit. The UK is teetering on the cliff edge.
- CodeGlitch 6y ago
  People are still bitter about this aren't they? I voted remain but it's time to move on. The idea of a "cliff-edge" is yet to materialise.
  - cstross 6y ago
    The "cliff-edge" hasn't materialized because the UK is in a negotiated transition period during which nothing changes. That ends on December 31st, 2020. On January 1st, new arrangements are supposed to come into force -- except they haven't been agreed yet, apart from a customs barrier within the UK (between Northern Ireland and the mainland). Meanwhile -- before COVID19 -- Sterling devalued by about 20%, the government began borrowing heavily to cover a yawning revenue gap, an economic slowdown cost the UK economy more than the gross total of all UK payments into EU funds since joining in 1974 (many of which were redistributed right back in the UK), and we have a prime minister who, when told that the Confederation of British Industry was worried about his Brexit policies, famously said "f*ck business". Remember February/March, when everyone was sitting paralysed in the oncoming headlights of COVID19, wondering if it was going to be bad and if it was going to be necessary to make any changes? That's where we are with the end of the Brexit transition period, right now.
    - SiempreViernes 6y ago
      To be fair, "cliff edge" is not a very accurate description of how it will play out in practice: the effects did not kick in as sharply and consistently as they do going over an edge, and there's not really any hard rock at the bottom to smash things apart violently.
  - TheOtherHobbes 6y ago
    In fact we're living in the real world where most countries can see that the UK is about to slit its own throat in pursuit of a tabloid fantasy - which has been promoted by naive internal interests who are being taken advantage of by hostile foreign actors waiting to pick over the bones of whatever is left after the dust settles. Brexit makes as much practical sense as 5G COVID conspiracy theories. And they appear to have been promoted and astroturfed by the same sources, which should be a bit of a clue - as should the UK's utter failure to deal effectively with the pandemic.
amriksohata 6y ago
I agree that the UK response has not been as good as some other countries. I feel though there is a lot of political propoganda going on. This MP complained about a lack of PPE at a care home she worked in, but the care home sacked her for lying as they said they had plenty. https://www.bbc.co.uk/news/uk-england-nottinghamshire-52568038 https://www.bbc.co.uk/news/uk-england-nottinghamshire-525680...
- dijksterhuis 6y ago
  "effectively sacked" - quote from the MP. They cut her hours from 8 shifts over the two months of the height of the UK peak to 0 afterwards. Agreed, sounds like someone blowing smoke up somewhere dark.
- detaro 6y ago
  I've heard from quite a few people organizing DIY faceshield/mask production in the UK that they got brushed off by higher-levels as "not needed, we have proper stuff, thanks", but the actual employees needing PPE were begging them for it. Unclear how widespread that is, but still worrysome.
butler14 6y ago
It's a reasonable opinion piece and I agree with a lot of it -- particularly not having Cummings in SAGE meetings and the embarrassing state of PPE, but; "he floated an approach to “build up some degree of herd immunity” founded on an erroneous view that the vast majority of cases would be mild, like influenza" as far as anyone knows, they are. the (limited) data we have is making a strong case for that. and in any case, 'some degree of herd immunity' wasn't the policy, it was (and still is) an inevitable outcome we'll need to wait on Roche's antibody test to have a robust sense of how succesful our delayed lockdown (or sweden's complete lack of lockdown) worked
- TheOtherHobbes 6y ago
  You've just written off 50,000 excess [1] deaths in the UK and 90,000 deaths in the US as "limited data." And also repeated the lie about "herd immunity" somehow being a thing that magically happens because of exposure, and not because of vaccines. (It doesn't. Ask any surviving polio victims how "herd immunity" worked out for them.) [1] Excess meaning those people would not have died for some time yet - decades for those front-line workers who were in their 30s/40s/50s.
  - butler14 6y ago
    Raw death counts is only part of the picture. My reference to 'limited data' relates to the other side of the coin -- the long tail of people who have had it and who haven't died. We have solid projections of what number that might be based on random sampling and extrapolation. But we need a decent antibody test (and frankly, time) before drawing any conclusions. And all the evidence I've personally seen suggests that SARS-CoV-2 trains your immune system -- and that consensus is that it will. And if you accept that, you accept that some degree of herd immunity is an inevitability.
- DanBC 6y ago
  > 'some degree of herd immunity' wasn't the policy, It was the policy. They were pursuing herd immunity. They were talking about cocooning vulnerable people so everyone else could go about their normal activity, get infected, and develop herd immunity. We have government advisors saying this.
tompccs 6y ago
It's frustrating that all the valid criticism of SAGE and the scientific leadership of the UK (frankly they should all resign) is blunted by blatant propagandising over austerity and wider political beef. I cannot see the link between austerity and the disastrous herd immunity policy yet all of these articles in respected medical journals bring it up. These are supposed to be academic journals, not newspapers. It totally undermines their point by making them look politically motivated.
- arethuza 6y ago
  Looking at the graphs in this article there does seem to have been a fairly dramatic change in spending on the NHS as a percentage of GDP after 2010 or so: https://www.nuffieldtrust.org.uk/news-item/70-years-of-nhs-spending https://www.nuffieldtrust.org.uk/news-item/70-years-of-nhs-s...
  - tompccs 6y ago
    I'm not arguing about whether or not there were cuts in NHS spending or whether or not austerity was a bad policy. I'm asking what it has to do with the recommendations of a government committee made up of independent scientists. Why is this so hard to understand?
    - arethuza 6y ago
      The article seems to be covering the overall response by the UK health system - which would be made up of the capabilities of the NHS and how it was guided at a strategic level by SAGE and the government. Doesn't seem contentious to me that if the NHS has had the investment it perhaps deserved over the last 10 years then this might have contributed to a less than ideal overall performance?
- DanBC 6y ago
  Austerity meant the UK went into the pandemic with fewer nurses and fewer ICU nurses; fewer doctors and fewer intensivits; fewer ICU beds; fewer vents; less PPE, less testing; less capacity to ramp up testing; worse logistic supply; worse social care; worse nursing care; worse long term care for people who recover; worse safety nets for people who have short or long term illness as a result of covid-19; and a brutal benefits system for the people who lose their jobs as a result of covid-19. Public Health is a function of local authorities (not the NHS), and local authorities have had their funding slashed and that has been seen in the difficulties in test, track, and trace. We're not even able to test everyone who needs a test. We certainly can't track and trace people.
ageitgey 6y ago
I'm all for criticism and investigation. But it seems so early to make these kinds of definite proclamations. There is so much about the virus and how it's transmitted that we still don't understand. The UK government had no idea what they were doing, but really neither does anyone else. And until we are a little further along in successfully containing this epidemic, it's not going to be clear what the best course of action was. Here are some of the most basic things no one seems to have figured out yet: - As of today, there have been 23,953 deaths in England. Of those, exactly 33(!) involve someone <= age 40 without a co-morbidity. Across all ages, 95%(!) of deaths are people with a co-morbidity, typically diabetes (26%). Why does this disease attack so many diabetic people? What should we do to best treat or prevent it in that population? [1] - Why is the transmission rate in London so low now (R = 0.4, < 25 infections a day) while still high everywhere else in the UK (R = 0.7 - 08)? Is that because the lockdown in London is somehow different or better or because some critical segment of the population is immune now and slowing down transmission? Or something else? [2] - Why weren't the Nightingale Hospitals (field hospitals) needed? Were we just wrong about the need for ventilation? Was the lockdown super effective? Or something else? - How many people are currently immune? Different studies in place the immunity rate in London anywhere from 10% (tests) to 29% (statistical models). Several studies suggest that there is significant cross-immunity with preexisting coronaviruses causing much slower spread, but it's too early to know for sure and that could be totally wrong. - Why do some scientists think this will be a serious, on-going epidemic and others think the disease will "burn itself out" [3]? Is that based on science or wishful thinking? Because the difference in the best course of action would be significantly different if we knew the answer with a strong degree of certainty. - Why do some places with lax lock downs have lower death rates than places with severe lock downs? Why aren't we seeing big upticks in deaths in the US where they are just willy nilly opening the economy? Is it just lagging indicators or are we not totally sure yet how this disease spreads in the community? - How soon will we get an effective therapeutic? Will we really have a somewhat effective vaccine from Oxford in September or might we never have a vaccine? Will it matter anyway as immunity builds up in the population? How long are people immune? - What is the actual cost of locking down in terms of lives lost as a side effect in the long term due to economic, social and psychological effects? Is it minuscule or significant? Again, there will be plenty of time to bash the UK government after this is over. But it seems very early to be proclaiming that anyone has any idea what the right course of action was. This epidemic could totally vanish this year or it could go on for years. No one has any idea. [1] https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/ https://www.england.nhs.uk/statistics/statistical-work-areas... [2] https://www.mrc-bsu.cam.ac.uk/now-casting/ https://www.mrc-bsu.cam.ac.uk/now-casting/ [3] https://www.telegraph.co.uk/news/2020/05/16/coronavirus-could-burn-naturally-vaccine-not-needed-former-director/ https://www.telegraph.co.uk/news/2020/05/16/coronavirus-coul...
billme 6y ago
Infographic in the link article is worth a click: https://www.bmj.com/content/bmj/369/bmj.m1932/F1.large.jpg https://www.bmj.com/content/bmj/369/bmj.m1932/F1.large.jpg It is timeline graphic of the growth of the virus per country and actions taken by each country.
- billme 6y ago
  Anyone know what is causing the humps in the graphs of “confirmed cases” ? Looked at this before, at first I thought it was weekends being under reported, then people going out on weekends, etc. — but now starting to think it might be the R0 (reproduction number) is very high and the virus burns itself out among a social network. Any ideas what is the source of those humps?

35 points by andyjohnson0 6y ago

... has been an unmitigated disaster.

>If the government failed in its duty to protect the public, it also failed to protect staff in the NHS and social care by not delivering sufficient amounts of personal protective equipment (PPE) of the right specification, again deviating from WHO advice The government is currently telling anyone who will listen that hospitals have all the PPE they need. However, local nurses and doctors are co-ordinating with volunteers to supply hand sewn PPE because they've been told they can only order PPE for the autumn. My mother is having material delivered and is hand-sewing PPE for the local hospital. Yet the government claims this isn't needed. So whilst this review is pretty damning, let's remember this situation is far from over. The fact that the PM's political advisor was in the scientific advisory meetings tells you all you need to know.

CodeGlitch 6y ago
The lack of PPE is a world-wide problem. The UK imported tonnes of the stuff for Turkey, but it was deemed to be not fit for purpose. Other countries have been asking for water-proof coats, that can be used as washable over-garments. I don't think any government is going to come out of this scoring 100%.
- makomk 6y ago
  It's a world-wide problem that the media in every Western country seem to be spinning as a unique failure of their government, often for cynical and stupid partisan reasons. Same with the global shortage of everything needed to carry out widespread coronavirus testing.
  - teruakohatu 6y ago
    Agreed. We had the same stories here in New Zealand, a country which currently has 40 active cases and less than one new case per day (7 day average). Yet we constantly hear how we are running out or going to run out of X or Y. More often than not I think it is logistics. Despite being a small country with centrally funded healthcare, the management of the health system is very decentralized geographically. So some doctor somewhere runs out of something, and runs straight to the media who are happy to run it on the homepage.
  - 7952 6y ago
    But then the government also politicise it by telling lies about there own performance. If there isn't enough PPE then they should admit to that.
- TLightful 6y ago
  The UK response has been terrible in all respects. Please don't sugar coat it.
  - Angostura 6y ago
    Nope, in many repects it's been pretty good. The respects that it has been very poor at was: * Being complacent about the country's testing capacity * stopping testing outside of hospitals once the containment phase was deemed over * PPE logistics. (tough global problem) * Support for care-homes. * Westminster's lack of care when it comes to coordinating the loosening of lock-down with the devolved countries It was arguable that they should have started lock-down earlier, but given that the number of acute beds in the NHS wasn't overwhelmed, that's arguable. If you look at stuff like the furlough scheme, support for individuals and freelancers so people don't suffer too much economically by being locked down, it a pretty good and swift response.
    - TLightful 6y ago
      So, "nope", but, actually, "yeah". * unclear and delayed response to pandemic, * frequent lying and misinformation put out by ministers, * considering herd immunity with no vaccine, The list goes on and on ... Yes, the furlough scheme, is decent. But smacks of just throwing money at the problem to save the day. It's not a coordinated response, and we'll be paying for it for generations. I repeat my assertion. Thanks.
    - tonyedgecombe 6y ago
      Yet we still have the worst death rate in Europe. Why was Germany so much better off than us.
      - arethuza 6y ago
        Isn't the answer at the moment "we don't know" - I'm no fan of the current government but I don't think it helps blaming them before someone has analysed the relevant facts.
- yread 6y ago
  Letting Cheltenham festival (13-16 March) and other sport events go ahead with 10s thousands of people visiting should criminally punished
  - DanBC 6y ago
    In 2020 there were over 240,000 attenders for Cheltenham festival. The town has a population of about 100,000. Each day there were about 60,000 people at the track. People say the festival is outside so it's lower risk. That's ignoring the fact that people take trains to get here and they take buses to get from the town centre to the race track. They also meet in cafés, pubs and betting shops, although this year that was far quieter than previous years. Letting it go ahead was a baffling choice.
- DanBC 6y ago
  Lack of PPE is a world wide problem. That problem is made worse in the UK because of the lack of planning and political disruption to NHS infrastructure. See for example the fucking shambles of Movianto[1] https://www.theguardian.com/world/2020/may/14/coronavirus-uk-privately-run-ppe-stockpile-chaos-movianto https://www.theguardian.com/world/2020/may/14/coronavirus-uk... We used to have NHS Logistics Authority, which changed to NHS Logistics, which was sold off to DHL Supply Chain (but managed by NHS Business Services Authority) and that was a disaster so we now have NHS Supply Chain. This waxing and waning of ideology (centralised control vs localism; NHS provision vs private provision) causes huge amounts of waste and harm in the NHS. It's also not as simple as tories=bad, labour=good. Selling it off to DHL happened under a Labour government; bringing it back under NHS Supply Chain happened under a Conservative government.
  - arethuza 6y ago
    "centralised control vs localism; NHS provision vs private provision" I've known some unscrupulous management consultants who would just recommend the opposite of what the current state was just to generate work.
Angostura 6y ago
My wife is a doctor in a London hospital, from what I gather, there is no particular PPE problem there at the moment.
- TLightful 6y ago
  I'm sure the situation is uneven. https://www.bbc.co.uk/news/uk-52671814 https://www.bbc.co.uk/news/uk-52671814
  - Angostura 6y ago
    I absolutely agree the situation is likely to be uneven. So this is a tough one. Most organisations will have general rules about not bad-mouthing the organisation publicly and running comms through s comms office. I absolutely agree people should be able to whistle-blow, but if you were managing a hospital you'd probably be wanting people not to go grumbling to the press.
    - TLightful 6y ago
      Transparency is key right now. Your "grumble" is likely someone else's "professional concern".
      - SiempreViernes 6y ago
        Arguably accuracy is more important than transparency, and people in general have a strong tendency to interpret a single account of "we're all out of PPE" as "there is a general shortage".
        TLightful 6y ago
        Agreed. This thread started with an n=1 datapoint of there being no shortages in London. Works both ways.
benmmurphy 6y ago
Is there any evidence that there has been excess deaths for NHS staff and that this has been caused by a lack of PPE? There is this study (https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-cov...) that suggests deaths are amongst NHS staff are not over-represented. There is also a remarkable correlation between the cumulative UK deaths from covid-19 in the UK population and among health and social care workers. Accepting a lag of one to two days, the ratio is very close to 1:200 so the deaths among health and social care workers are approximately 0.5 per cent of all deaths, suggesting they are not overrepresented. That is the only study I could find that tried to look at excess deaths for NHS staff. I think their suggestion that deaths are not overrepresented is not backed by their data because it doesn't look like they are adjusting for difference in base mortality rates between NHS workers and the general population. However, considering how people are claiming lack of PPE is killing NHS staff you would think someone would have checked by now whether NHS staff are actually dying at a higher rate! When NHS deaths were around ~80 I ran my own model adjusting by age and found 10 excess deaths. However, the way I interpolated the deaths in the population to NHS age bands was very dirty and I didn't adjust for sex and race. The NHS has BAME groups overrepresented in their work force and these groups have higher mortality rates.
aries1980 6y ago
> If the government failed in its duty to protect the public Most governments failed when they didn't start to tax the sh*t out of unhealthy food and ingredients. "Preliminary evidence suggests that the severity of symptoms associated with Covid-19 and the eventual outcome of being infected with this virus are associated with the health status of individuals prior to infection. Among the factors linked to an increased risk of hospitalization and mortality are overweight/obesity, insulin resistance and diabetes: these lifestyle-related diseases [...]" https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.22849 https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.22849

GEBBL 6y ago

And at the end of all this, you guys have Brexit. The UK is teetering on the cliff edge.

CodeGlitch 6y ago
People are still bitter about this aren't they? I voted remain but it's time to move on. The idea of a "cliff-edge" is yet to materialise.
- cstross 6y ago
  The "cliff-edge" hasn't materialized because the UK is in a negotiated transition period during which nothing changes. That ends on December 31st, 2020. On January 1st, new arrangements are supposed to come into force -- except they haven't been agreed yet, apart from a customs barrier within the UK (between Northern Ireland and the mainland). Meanwhile -- before COVID19 -- Sterling devalued by about 20%, the government began borrowing heavily to cover a yawning revenue gap, an economic slowdown cost the UK economy more than the gross total of all UK payments into EU funds since joining in 1974 (many of which were redistributed right back in the UK), and we have a prime minister who, when told that the Confederation of British Industry was worried about his Brexit policies, famously said "f*ck business". Remember February/March, when everyone was sitting paralysed in the oncoming headlights of COVID19, wondering if it was going to be bad and if it was going to be necessary to make any changes? That's where we are with the end of the Brexit transition period, right now.
  - SiempreViernes 6y ago
    To be fair, "cliff edge" is not a very accurate description of how it will play out in practice: the effects did not kick in as sharply and consistently as they do going over an edge, and there's not really any hard rock at the bottom to smash things apart violently.
- TheOtherHobbes 6y ago
  In fact we're living in the real world where most countries can see that the UK is about to slit its own throat in pursuit of a tabloid fantasy - which has been promoted by naive internal interests who are being taken advantage of by hostile foreign actors waiting to pick over the bones of whatever is left after the dust settles. Brexit makes as much practical sense as 5G COVID conspiracy theories. And they appear to have been promoted and astroturfed by the same sources, which should be a bit of a clue - as should the UK's utter failure to deal effectively with the pandemic.

amriksohata 6y ago

I agree that the UK response has not been as good as some other countries. I feel though there is a lot of political propoganda going on. This MP complained about a lack of PPE at a care home she worked in, but the care home sacked her for lying as they said they had plenty. https://www.bbc.co.uk/news/uk-england-nottinghamshire-52568038 https://www.bbc.co.uk/news/uk-england-nottinghamshire-525680...

dijksterhuis 6y ago
"effectively sacked" - quote from the MP. They cut her hours from 8 shifts over the two months of the height of the UK peak to 0 afterwards. Agreed, sounds like someone blowing smoke up somewhere dark.
detaro 6y ago
I've heard from quite a few people organizing DIY faceshield/mask production in the UK that they got brushed off by higher-levels as "not needed, we have proper stuff, thanks", but the actual employees needing PPE were begging them for it. Unclear how widespread that is, but still worrysome.

butler14 6y ago

It's a reasonable opinion piece and I agree with a lot of it -- particularly not having Cummings in SAGE meetings and the embarrassing state of PPE, but; "he floated an approach to “build up some degree of herd immunity” founded on an erroneous view that the vast majority of cases would be mild, like influenza" as far as anyone knows, they are. the (limited) data we have is making a strong case for that. and in any case, 'some degree of herd immunity' wasn't the policy, it was (and still is) an inevitable outcome we'll need to wait on Roche's antibody test to have a robust sense of how succesful our delayed lockdown (or sweden's complete lack of lockdown) worked

TheOtherHobbes 6y ago
You've just written off 50,000 excess [1] deaths in the UK and 90,000 deaths in the US as "limited data." And also repeated the lie about "herd immunity" somehow being a thing that magically happens because of exposure, and not because of vaccines. (It doesn't. Ask any surviving polio victims how "herd immunity" worked out for them.) [1] Excess meaning those people would not have died for some time yet - decades for those front-line workers who were in their 30s/40s/50s.
- butler14 6y ago
  Raw death counts is only part of the picture. My reference to 'limited data' relates to the other side of the coin -- the long tail of people who have had it and who haven't died. We have solid projections of what number that might be based on random sampling and extrapolation. But we need a decent antibody test (and frankly, time) before drawing any conclusions. And all the evidence I've personally seen suggests that SARS-CoV-2 trains your immune system -- and that consensus is that it will. And if you accept that, you accept that some degree of herd immunity is an inevitability.
DanBC 6y ago
> 'some degree of herd immunity' wasn't the policy, It was the policy. They were pursuing herd immunity. They were talking about cocooning vulnerable people so everyone else could go about their normal activity, get infected, and develop herd immunity. We have government advisors saying this.

tompccs 6y ago

It's frustrating that all the valid criticism of SAGE and the scientific leadership of the UK (frankly they should all resign) is blunted by blatant propagandising over austerity and wider political beef. I cannot see the link between austerity and the disastrous herd immunity policy yet all of these articles in respected medical journals bring it up. These are supposed to be academic journals, not newspapers. It totally undermines their point by making them look politically motivated.

arethuza 6y ago
Looking at the graphs in this article there does seem to have been a fairly dramatic change in spending on the NHS as a percentage of GDP after 2010 or so: https://www.nuffieldtrust.org.uk/news-item/70-years-of-nhs-spending https://www.nuffieldtrust.org.uk/news-item/70-years-of-nhs-s...
- tompccs 6y ago
  I'm not arguing about whether or not there were cuts in NHS spending or whether or not austerity was a bad policy. I'm asking what it has to do with the recommendations of a government committee made up of independent scientists. Why is this so hard to understand?
  - arethuza 6y ago
    The article seems to be covering the overall response by the UK health system - which would be made up of the capabilities of the NHS and how it was guided at a strategic level by SAGE and the government. Doesn't seem contentious to me that if the NHS has had the investment it perhaps deserved over the last 10 years then this might have contributed to a less than ideal overall performance?
DanBC 6y ago
Austerity meant the UK went into the pandemic with fewer nurses and fewer ICU nurses; fewer doctors and fewer intensivits; fewer ICU beds; fewer vents; less PPE, less testing; less capacity to ramp up testing; worse logistic supply; worse social care; worse nursing care; worse long term care for people who recover; worse safety nets for people who have short or long term illness as a result of covid-19; and a brutal benefits system for the people who lose their jobs as a result of covid-19. Public Health is a function of local authorities (not the NHS), and local authorities have had their funding slashed and that has been seen in the difficulties in test, track, and trace. We're not even able to test everyone who needs a test. We certainly can't track and trace people.

ageitgey 6y ago

I'm all for criticism and investigation. But it seems so early to make these kinds of definite proclamations. There is so much about the virus and how it's transmitted that we still don't understand. The UK government had no idea what they were doing, but really neither does anyone else. And until we are a little further along in successfully containing this epidemic, it's not going to be clear what the best course of action was. Here are some of the most basic things no one seems to have figured out yet: - As of today, there have been 23,953 deaths in England. Of those, exactly 33(!) involve someone <= age 40 without a co-morbidity. Across all ages, 95%(!) of deaths are people with a co-morbidity, typically diabetes (26%). Why does this disease attack so many diabetic people? What should we do to best treat or prevent it in that population? [1] - Why is the transmission rate in London so low now (R = 0.4, < 25 infections a day) while still high everywhere else in the UK (R = 0.7 - 08)? Is that because the lockdown in London is somehow different or better or because some critical segment of the population is immune now and slowing down transmission? Or something else? [2] - Why weren't the Nightingale Hospitals (field hospitals) needed? Were we just wrong about the need for ventilation? Was the lockdown super effective? Or something else? - How many people are currently immune? Different studies in place the immunity rate in London anywhere from 10% (tests) to 29% (statistical models). Several studies suggest that there is significant cross-immunity with preexisting coronaviruses causing much slower spread, but it's too early to know for sure and that could be totally wrong. - Why do some scientists think this will be a serious, on-going epidemic and others think the disease will "burn itself out" [3]? Is that based on science or wishful thinking? Because the difference in the best course of action would be significantly different if we knew the answer with a strong degree of certainty. - Why do some places with lax lock downs have lower death rates than places with severe lock downs? Why aren't we seeing big upticks in deaths in the US where they are just willy nilly opening the economy? Is it just lagging indicators or are we not totally sure yet how this disease spreads in the community? - How soon will we get an effective therapeutic? Will we really have a somewhat effective vaccine from Oxford in September or might we never have a vaccine? Will it matter anyway as immunity builds up in the population? How long are people immune? - What is the actual cost of locking down in terms of lives lost as a side effect in the long term due to economic, social and psychological effects? Is it minuscule or significant? Again, there will be plenty of time to bash the UK government after this is over. But it seems very early to be proclaiming that anyone has any idea what the right course of action was. This epidemic could totally vanish this year or it could go on for years. No one has any idea. [1] https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/ https://www.england.nhs.uk/statistics/statistical-work-areas... [2] https://www.mrc-bsu.cam.ac.uk/now-casting/ https://www.mrc-bsu.cam.ac.uk/now-casting/ [3] https://www.telegraph.co.uk/news/2020/05/16/coronavirus-could-burn-naturally-vaccine-not-needed-former-director/ https://www.telegraph.co.uk/news/2020/05/16/coronavirus-coul...

billme 6y ago

Infographic in the link article is worth a click: https://www.bmj.com/content/bmj/369/bmj.m1932/F1.large.jpg https://www.bmj.com/content/bmj/369/bmj.m1932/F1.large.jpg It is timeline graphic of the growth of the virus per country and actions taken by each country.

billme 6y ago
Anyone know what is causing the humps in the graphs of “confirmed cases” ? Looked at this before, at first I thought it was weekends being under reported, then people going out on weekends, etc. — but now starting to think it might be the R0 (reproduction number) is very high and the virus burns itself out among a social network. Any ideas what is the source of those humps?