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Coronavirus: a lack of preparation (again)

Anyone who has been tracking Brexit over the years has learnt to accept that the media, in general, is issue illiterate and largely ignorant on the detail of the functioning of the European Union. And I cannot honestly say that any media organ has got to grips with the technicalities of Brexit, or the options available.

The Covid-19 epidemic, however, has brought to light a new dimension of ineptitude into the legacy media as we see it adding a level of innumeracy so profound that it makes a nonsense of any attempt to track the progress of the epidemic through popular media reports.

Never more so has the aphorism been true that if you don’t buy a paper you will be uninformed but, if you do buy one, you will be ill-informed.

To pick on one example, illustrative of the broader tendency, we see in the online edition of the Mail – the content of which appears in the today’s print edition – the “revelation” from Dominic Raab that the lockdown will continue.

That, obviously, is fair enough. It comes straight out of yesterday’s presser, with him warning that “the worst is yet to come”, as officials announce 717 more UK deaths. But, says the paper, the “daily toll drops for a third day in a row”.

It is, as one might expect, this last comment that is particularly irritating. As we have learned, the figures released daily by the Department of Health/Public Health England are composites of multiple days and do not represent any single day. Therefore, no valid trend can be inferred from these figures which, even without the many other errors that could affect them, could conceal an underlying increase.

For sure, the death toll (for the UK), in reverse order, for the last three days stands at 917, 737 and 717 – ostensibly giving some grounds for optimism. But, the current NHS England figures are incomplete and it will take as long as a week before any meaning can be drawn from them.

Furthermore, that latter statement is an absolute. The corrected figures for the last three days, again in reverse order, stand at 516, 443 and 118 deaths. But as the reports come in on successive days, these will be corrected, and corrected again, over the next two weeks. Each figure will look very different from what it is now.

One wonders, therefore, from where Raab gets his information that allows him so confidently to assert that “the worst is yet to come”. It can’t be the hospital admission figures, which are supposedly coming down (in London, at least). Perhaps it is the daily mortuary figures, which are not released publicly, but which will give a rough indication of which way the trend is going.

Whatever the source of Raab’s information, his caution is reinforced by CSA Vallance, who tells us that the lockdown measures will only be lifted “when we are firmly the other side” of the peak, and the rate of infection is coming down. “It would be a complete waste of everything everyone has had to do until now”, he says, if measures were lifted too soon and the infection rate simply rises again.

Here, though, Vallance seems to be exploiting the gullibility and technical illiteracy of the media, as a drop in the infection rate is by no means sufficient grounds to lift the lockdown.

In fact, it was only a few days ago, widely reported by the media, that the World Health Organisation set out its criteria for easing restrictions.

It lists not one but six “important factors to consider”. Only the first is that transmission is controlled. Secondly, sufficient public health and medical services, which includes the ability quickly to detect, test, isolate and treat new cases as well as to trace close contacts.

Thirdly, outbreak risks in special settings like long-term care facilities must be minimised, fourthly preventive measures must be in place in workplaces, schools and other places where it’s essential for people to go, fifth, importation risks must be managed; and sixth, communities are fully aware and engaged in the transition.

Arguably, the UK currently fulfils none of these criteria and even if we saw transmission declining, there would be considerable difficulty in coming up to specification on the other factors – and especially the “test and trace” elements of the public health system.

If, however, the media are content to boil down the criteria into the one factor – whether the transmission rate is down – ministers once again will have been allowed to fudge issue and allow the country to drift into a relaxed lockdown, for which it will be almost completely unprepared.

Specifically, despite the merits of “test and trace” having been well-rehearsed, with good evidence of its value coming from Taiwan, South Korea and New Zealand, there are no indications whatsoever that the UK government is preparing to enhance its public health measures.

Interestingly, even in the United States, with Boston, Mass the example here, the need to track down contacts and test them is being recognised. An “army” of workers is being recruited in Massachusetts, where state officials say they will eventually deploy nearly 1,000 people to do contact tracing.

In the UK, of course, we have local authority environmental health departments which, if pushed (even to the extent of calling up recently retired officials) could field as many as 10,000 trained staff. But there is not the slightest indication that government intends to use this resource.

Neither do we see any serious measures in place to address the serious situation in care homes, where Covid-19 is quite evidently rampant. Rather, the government seems to be intent on sweeping under the carpet this epidemic within an epidemic.

The point here though is that, if infection is rampant in care homes, these units become reservoirs of infection which can re-introduce Covid-19 back into the community even when it otherwise seems to be under control. For a very good reason, therefore, the WHO wants outbreak risks in special settings controlled.

Furthermore, this will extend beyond just care homes to hospitals (which are themselves major reservoirs of infection), and to facilities such as prisons and immigration detention centres, as well as homeless hostels and other accommodation centres where infection can easily be spread. At the very least, there needs to be enhanced surveillance and routine background testing. Yet, as we see, not even suspected Covid-19 cases in care homes are being tested.

As to the risk attendant on workplaces, the private sector has been active in protecting employees, but the efforts have been patchy. In the construction industry, for instance, hygiene facilities were often minimal and social distancing non-existent.

Before we could be sure that it was safe to go ahead with workplace relaxation, we would need to see very clear and sector-specific rules from government, with effective enforcement measures in place.

The “importation” issue is another questionable area. While some governments are imposing mandatory quarantine on travellers coming into their countries – with supervised hotels set aside for this purpose – almost daily we see reports of people flying in from hotspots all over the world and being allowed entry into the UK without screening or any mandatory isolation.

Finally, it is debatable as to whether the public is “fully aware and engaged”, to the extent that any transition to a more relaxed regime can be self-policing. But unless we can be confident that people will not go beyond the limits set, then any relaxation could become a very dangerous experiment.

Relaxing the lockdown, therefore, is more than a matter of government offering a few facile slogans and letting nature (in the form of SARS-Cov-2) take its course. This needs to be a structured, carefully managed process.

But, unless the public debate can progress beyond simplistic considerations of a drop in the transmission rate, we risk being as unprepared for the relaxation as we were for the original lockdown.


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