Monday 13 April 2020

Can the NHS take it?

Herd immunity, a phrase spat out by Beth Rigby and Adam Boulton, is in fact the only route out of our crisis. A six month lockdown is not going to find any obedient takers. There is a small chance people might go for a in and out type strategy where we get sent home again for a few weeks for a week or two out again. This will work better when we have an antibody test.

What I have not seen though, amongst the cheerleading for the NHS, is that when reality hits in a few weeks time, it could get nasty. For lockdown to end, we need to accept ongoing illness and deaths. The NHS workers have to deliver this and risk themselves at the same time. Over time, when they see everyone else going back to normal this will be resented by them - as I would myself.

Where is the danger money? Where is the 💯 effective PPE and process?

Without these it is only a matter of time until the unions strike or the NHS suffers mass illness and nurses and careers stop going to work. I think both of these remedies can be found but they need to be high on the Government’s  agenda. Also it needs to be clear to the public that we are expecting those in the NHS to suffer as footsoldiers in war and to treat them with the respect this deserves.


Ken from glos said...

At last a dose of reality.

Sackerson said...

As I understand it, the strategy is 'slow burn' so the NHS can deal with the cases and also all the other usual demands. Sooner or later everyone's going to be exposed to the virus; slowing down the pace will minimise deaths from all causes, not just coronavirus.

E-K said...

We can't afford to sacrifice young doctors like this and while we all cower China mops up our crown jewels from something they started.

We're going to have to take a bit mortality hit and we're growing to realise it.

It may well be too late to avoid being owned by Beijing. We've been caught napping and we have to take on our own Left (BBC etc) before we can even start anything.

They defaulted to full anti West mode from the start. Trump bashing, Boris bashing but no scrutiny of China whatsoever.

Nick Drew said...

Excellent post, deserves broadcasting

E-K said...

Sackerson - The strategy is to extend the pandemic and therefore the economic lockdown.

Clearly a cost (in lives) comparison has not been done between deaths by Covid 19 and death by starvation.

Sackerson said...

@E-K: you're saying the economic damage is intentional, a primary aim?

DJK said...

"Herd immunity, ... is in fact the only route out of our crisis."

Sorry, but this is not true. Letting the disease slowly rip through the population is not the only way. China, South Korea, Taiwan etc, and even Australia and New Zealand have shown that through agressive testing, contact tracing, mass surveillance, closed borders, etc. it is possible to keep the disease under control. It's not life as normal, but it's better than everybody waiting to get it, with an uncomfortably high chance of death or disablement. 100 doctors have died in Italy, how is that better than having a compulsory phone app?

E-K said...

Sackerson - No. Democracies could not resort to gunpoint - the only truly effective way to deal with a pandemic.

A short and TOTAL lockdown in hotspots.

Instead we are half hearted which will not see off a virus bit will utterly wreck the economy. All done because politicks does not allow the hard decisions we need.

Thud said...

Well this certainly cheered up my morning! I'm off to let the chickens out.

Anonymous said...

As @Sackerson says, the aim is to ensure we have the capacity and capability to handle the covid cases *as well as* most BAU.

The duration of the lockdown is a commentary on how flexible and capable we are as a nation, as well as the spare capacity in the NHS. If the NHS was as badly funded as Labour says, then we need a lockdown for seemingly endless months and have some questions for the Tories afterwards. If it's as well funded as the Tories claim, then we'll be in lockdown for a couple of months at most, and Labour can wind their necks in.

We don't seem to be doing bad, the press have even begrudgingly applauded the Nightingale pop-ups, even though they're not quite as 'sexy' as the Chinese knocking together a Lego hospital using portakabins as bricks.

The delays to other operations indicates we have nowhere near enough spare capacity as we should though, whilst there's no way any system could be reasonably expected to absorb something like this, the amount of time it's going to take to get things back to normal-ish doesn't look good from a health or political perspective, but thats a debate for next year, when things are more manageable and politics can get back to throwing brickbats.

@EK - no one is going to starve from lack of supply, lack of money maybe, but not of food.

I was speaking to a local publican, who has had to start selling takeouts to get some income in (we opted to support them and have a day off from cooking) - staff are furloughed, but grant/loan money is awkward as effectively self-employed, and payments are months away.

There's going to be a political cost for how Sunak and the Treasure has approached keeping people and companies heads above water. The choosing of a bureaucratic method of disbursing financial help is definitely very British, just not the good side of being British.

Last time I mentioned this, someone snarked that I should read the news, I'd rather speak to fellow business owners to be honest.

I'm incredibly fortunate that I'm able to keep earning, my current project is actually related to the virus, and I'm aware that many are not as fortunate, are struggling, and promises of help are easy to speak, but don't put food on the table if they take weeks and months to deliver.

The Tories are doing well in the polls, helped that Boris is personable (can you imagine the same support for PM Corbyn in intensive care? More likely several Blairites, wrapped up in PPE, yanking out out plugs in his room), but I can see Starmer completely dissembling the support for business afterwards.

Sobers said...

" Letting the disease slowly rip through the population is not the only way. China, South Korea, Taiwan etc, and even Australia and New Zealand have shown that through agressive testing, contact tracing, mass surveillance, closed borders, etc. it is possible to keep the disease under control. It's not life as normal, but it's better than everybody waiting to get it, with an uncomfortably high chance of death or disablement. 100 doctors have died in Italy, how is that better than having a compulsory phone app?"

And you plan to keep those measures in place for ever then? Any artificial barriers to this virus will only keep it at bay for as long as they are in place. Remove them and it just comes back. New Zealand are idiots, they are trying to quarantine themselves from the world, once they open up again they get it in spades. Even if they didn't get it immediately the entire population would be sitting ducks for one case landing on their shores from somewhere.

The only way out is herd immunity so that the virus cannot survive within the population and dies out naturally. Then you're safe, until the next version of course.

Lord Blagger said...

1. Why isn't the NHS following NICE guidelines? £20,000 per QALY. They have spent millions per QALY

2. Long term 100% increases in NHS spending in real terms has taken place. NHS productivity up 5%. The reason, its all gone on wages, and they still complain they want more.

3. Lansley reforms. The NHS demand and got autonomy. Government's job was to extract the cash from us, and the have done.

Remember that 350 million on the bus? Since the referendum spending is up 513 million. And still they whinge.

4. Remember Shipman. Killed over 200. Will never happen again. We will put in place monitoring to stop it.

Then you have Gosport, where one Doctor killed over 600. NHS admits to it. Public inquiry. For some reason, there's no trial. So why?

Simple. Regulator and insurance elements in the NHS are in cahoots. If there was a trial, that's over 600 damage payments that would have to be made. So the victim and their families pay.

NHS estimates 12,000 killed a year, but remember, they didn't detect Barton or Shipman.

DJK said...

There's a slightly racist assumption about that strict control measures are OK for Asians but won't work in Europe.

Ultimately, as many people have said, the only long term solution is a vaccine, and/or better treatments. That's a couple of years away.

But the herd immunity 'plan' is deeply flawed. For starters, the assumption that herd immunity will be reached is at best unproven. Then again, it requires that the huge increase in NHS capacity is semi-permanant, and even then, at the present rate of progerss it will take a couple of years before any kind of herd immunity is reached.

In the meantime, our border may be open, but people from a Britain where the disease is rampant would be barred from visiting most parts of the world. And do you really think that life would go back to normal? Remember that the football league and many organisations shut before the lockdown. Simple self-preservation will keep people at home if they know that mixing carries a high chance of a fatal disease.

Sorry, but there are no easy solutions here and whatever mix of policies is adopted, normal life will not be coming back for some considerable time.

david morris said...

"we are expecting those in the NHS to suffer as footsoldiers in war and to treat them with the respect this deserves".

Front line NHS staff, no question

Diversity & Clownworld Management back office staff ?

No chance

A good start would be the NHS logisics division being closed down (senior management sacked/no compensation). Amazon/Ocado & a phoenix NHS logistics division to bid for the contract of moving NHS materiel around the country.

BlokeInBrum said...

"self-preservation will keep people at home if they know that mixing carries a high chance of a fatal disease."

But we know that for the majority of people in good health that there isn't much danger.
The one thing that we don't have at the moment are good data wrt. the prevalence of Covid in the wider population, mainly because they don't have sufficient numbers of accurate tests to do them. When they have tested up to now, it's been statistically useless with inaccurate tests on non-randomly selected subjects (ie. those presenting with symptoms in ICU)
Until we have accurate figures for transmissability and lethality then the government won't be able to make any decisions based on a firm scientific basis. We also don't know yet if any of the trials which are ongoing with other drugs such as chloroquinine are proving to be successful. If they do prove to be useful, and the transmission rate isnt as high as we think, then that's the way out of our current predicament.

BlokeInBrum said...

I can also say that human nature being what it is, that it is unlikely that we can maintain lockdowns for an extended period in democratic countries.
A few weeks are tolerable for most people, but after that, the self employed, the small business owners, those on low wages with no savings, will start to have existential issues.
Coupled with the fact that certain demographics won't be bothered about obeying the lockdown, such as the youth, then we need to be planning now, to be getting things back to normal.
I went off cycling the last couple days around some of the more 'ethnic' parts of Brum the other and noted that it was the only part of the world that seemed to be continuing on as normal with all the back street chop-shops and the street markets all carrying on with business as usual.

E-K said...

We'll soon understand why seals dive into water full of killer whales.

This isn't the first time our young have been ordered into battle without PPE.

Our soldiers had to do it and died in their hundreds in the ME.

The BBC didn't make a fuss out of it. No weekly applause.

Neither situation is right btw.

Matt said...

Bearing in mind that the more ethnic populations of the UK have some of the more severe health conditions (due in many cases to marrying cousins), exposing themselves to a greater risk of catching COVID-19 isn't the most sensible thing for them. It might not cause too much os an issue to many but bear in mind they are a disproportionate drain on the NHS already so we don't need them filling up more beds.

Don Cox said...

I think "antigen" in your first paragraph should be "antibody". The presence of the antibody tells you that a person has had the virus and recovered.

Don Cox

Jan said...

It was only a question of time before there was a disease outbreak to which no-one is immune and doubtless it will happen again at some stage in the future. This happens to all biological populations and we are no different from any other species although we like to think modern medicine can save us. There's not much point in blaming the Chinese.

You can also consider it as "gaia's revenge". We've abused our position in nature, causing massive pollution and the earth is getting it's own back and killing some of us off. This is how nature works.

BlokeInBrum said...

"gaia's revenge"

The Earth is billions of years old.

The Universe is empty and uncaring and doesn't give a shit about us one way or another. In the grand scheme of things, we could have all out Nuclear Annihilation and lay waste to the Earth.

It would still recover and we would be nothing more than a blip in the timeline.

E-K said...


Many good reasons to blame China.

All this debt we're piling up. They owe us a reset.

We can stop them buying up our crown jewels at rock bottom and owning us.

We can stop them releasing more deadly contagion on us if we blame them and change our relationship

They did lie, they did oppress whistle blowers, they did fail to close down their own airports and this is the fourth deadly virus they've unleashed since 1956.

Mr Ecks said...

We have had worse flu outbreaks than this. The world --esp political pork--has lost its marbles. The LD needs ending NOW.While we still have an economy left. Unfortunately we have a bunch of BluLabour chumps who think printing funny money means they have all the time in the world to swan about.

They will soon discover otherwise and the rage--once people know they have been impoverished or ruined over a damp squib flu--will be off the scale. All those now talking about Churchill Johnson will be screaming for his head.

andrew said...

(so far), NHS deaths seem to be mostly retired doctors returning to work and others over 50.

Not that it is better in any way, but, it has been drilled into us that if you are under 50 and healthy, the risk is low(*).

If the death count spreads across all ages and the facts change, yes, expect things to change.
Few join the NHS expectng to die before their time.

(*) quite how it somehow became 'ok' (perhaps not the best choice of words) that if you were over 50, or ill, your chances dropped dramatically is something I missed.

Compared to some other countries we have not been paying the insurance premium that is excess capacity and this has been under govts of all flavours.
Perhaps that will change now.
Wouldn't bet on it though.

Nessimmersion said...

The German insurance led system is proving to be much better at building capacity and coping with emergencies. At what point do we stop sacrifices to our national totem pole and allow people to have a first world health care system.

Similarly, multiple reports now out of some US states letting Drs use Hydrochloroquine mixtures as a prophylactic, at what point would the NHS consider doing this or would they rather lose a few hundred more doctors while a proper study is carried out?

E-K said...

Nessimmersion - Germany also happens to manufacture PPE (and not share it with the rest of the EU)

To those who say we can't starve because we have livestock.

I noticed before this crisis that you couldn't buy crab for love nor money. The trawler men around here were doing a roaring trade with someone if not the British.

Will our critically devalued £ enable us to compete with others to buy our own beef ? Or will farming be nationalised ?

CityUnslicker said...

Nessimmersion - we do have a national blindspot over the NHS and this crisis will only exaccerbate it. Now Boris too has been saved by them there will be little talk of lessons learned for the NHS.

I can already see post this the only debate will be re herd immunity and how evil Tories are for thinking through the options.

Nessimmersion said...

As seen elsewhere:
Our NHS, which art the best health service in the world
Hallowed be thy name, budget, staffing level and administrative structures
Thy Police State come
Then it will be done
In the UK as it is in China
Give us this day our daily bread, milk and just one form of exercise
And forgive us our trespasses into the 2 metres social distancing zone
as we forgive them that trespass against us, but only after a severe fine or imprisonment
And lead us not into economic meltdown
But deliver us from a bit of a tickly cough
For thine is the wisdom, informed by 100% accurate mathematical modelling
The power to make us worry
For ever and ever