Sunday 10 May 2020

Closing the Stable Door After the Herd Have Bolted?

Scientists do studies and advocate actions (some with more success than others), whereas politicians (if they are in 'power') take actions. The phrase "following the Science" is fairly meaningless as a range of actions will be advocated by scientists and the politicians choose which to go with. I was stimulated to write today by an article on the epidemiology concept of 'harvesting' by Richard Coker (https://www.theguardian.com/commentisfree/2020/may/08/care-home-residents-harvested-left-to-die-uk-government-herd-immunity ). His basic point is that, in all probability, at the start of the Covid-19 outbreak in the UK, there was a political decision to follow the 'herd immunity' concept. This was the argument that, having a certain critical percentage of the population with antibodies against an infective agent (achieved by vaccination), provides protection for the whole group. As there was no (and will not be for some time) vaccine for Covid-19, this would have to be achieved by people getting infected and recovering from the disease. This had to be abandoned when it became clear (it should have been evident from the Italian experience) that a) there was a danger of the health services being overwhelmed and b) that elderly people were particularly likely to die from the infection. Consequently, we had (and still have) a lockdown situation but this has not protected the elderly in care homes who have been effectively 'harvested'. 
Being an Emeritus Professor (like Coker), I have certain freedoms that may not be available to younger colleagues (my reputation is based on a body of work that is already completed and I no longer have to consider whether my actions/opinions will influence my ability to attract grant funding to enhance my promotion prospects). Also being of a certain age, means that I have had recent first-hand experiences of the UK's National Health Service (NHS), Care Homes as well as the vagaries of Political  decision making. I think that I would go further than Coker. The 'herd immunity' concept  only made sense if Covid-19 was relatively benign (like a very mild influenza rather than like so-called 'Spanish flu' or MERS). Clearly, this was not the case, so the government focussed its ill-prepared resources on 'saving' the NHS. So this is where limited supplies of Personal Protective Equipment (PPE) and initially fairly rudimentary testing for the virus were directed (and we have had numerous illustrations of how difficult and dangerous things have been for people working in that organisation). Care Homes in the UK are, however, rather than being a well-loved (and politically sensitive) national institution, are operated by a variety of 'providers' who have to obtain their finances from a variety of sources (NHS, local government and their own occupants). As people living in care homes will be elderly and/or medically-challenged as well as being 'contained' within buildings, the only way they could have been protected in the early stages of the Covid-19 pandemic was to 'throw' everything at them. This would have meant a) an immediate banning of visitors (difficult to do because of the varied ways in which the care homes operate and the impact of such a move on the care home residents); b) early and repeated testing of the people working in care homes to ensure they didn't bring the virus into their establishment (it was in stead directed to testing people in NHS hospitals who showed Covid-19 symptoms); c) providing the care homes with adequate quantities of PPE (they seem to have been largely left to their own devices) and d) an urgent upskilling of the medical aspects of care home workers. None of these things happened, so the 'harvest' of elderly folk in care homes occurred (and is still occurring).

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