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The UK’s public health response to Covid-19

bmj.com

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Re: The UK’s public health response to Covid-19

#51

Post by zelos »

dijksterhuis wrote: post #30
tonyedgecombe wrote: post #13

Earlier quoted context omitted.

Yet we still have the worst death rate in Europe. Why was Germany so much better off than us.

You're looking at the total number of deaths, not the death rate per capita. Every country has a different population size which means the total number of deaths needs to be normalised in order to be comparable. Belgium has the highest death rate per million population in Europe - 79.25 The UK is 4th in Europe behind Belgium, Spain and then Italy. https://coronavirus.jhu.edu/data/mortality The fact we're 4th does war…

From the linked article Germany's per capita death rate is a fifth of the UK's.

Re: The UK’s public health response to Covid-19

#52

Post by DanBC »

rvz wrote: post #22
tonyedgecombe wrote: post #13

Earlier quoted context omitted.

Yet we still have the worst death rate in Europe. Why was Germany so much better off than us.

Not only they tested early, they have the capacity to test ten if not hundreds of thousands of people a day and have laboratories spread across the country working with the government, rather than against it [0] Sure the UK was slow at testing but there are still ways of getting a private testing kit for yourself in the UK. Thus, it's very easy to blame the UK government for the high death rates and slow response whe…

> but there are still ways of getting a private testing kit for yourself in the UK.

If you have a private test, and that says you have covid-19, and then you die from covid, your death is not counted as a covid death in the daily figures. It might eventually be counted as a covid death by ONS.

https://coronavirus.data.gov.uk/about

> The UK total is not the sum of the 4 National totals as the pillar 2 cases cannot currently be included in the National totals. All other data on this website are based only on cases detected through pillar 1. Information about the different pillars is available on GOV.UK.

Re: The UK’s public health response to Covid-19

#53

Post by DanBC »

butler14 wrote: post #25

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 c…

> '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.

Re: The UK’s public health response to Covid-19

#54

Post by DanBC »

arethuza wrote: post #31
CodeGlitch wrote: post #18

Earlier quoted context omitted.

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.

I had kind of forgotten about the consequences of Brexit - but a recent interview on Radio 4 with someone from the US Department of Agriculture reminded me of the kind of problems ahead - he seemed to regard the (relatively) high standards of animal welfare in UK farms to be the result of unnecessary regulations, which sounded rather alarming to me.

There was an amendment to the Agriculture bill that would have banned some things like chlorinated chicken. That amendment was defeated. https://www.bbc.co.uk/news/uk-politics-52653607

It's a bit worrying.

Re: The UK’s public health response to Covid-19

#55

Post by arethuza »

DanBC wrote: post #43
CodeGlitch wrote: post #3

Earlier quoted context omitted.

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%.

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... 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…

"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.

Re: The UK’s public health response to Covid-19

#56

Post by butler14 »

DanBC wrote: post #53
butler14 wrote: post #25

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 c…

> '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.

I disagree.

The UK strategy was to not pull the trigger on lock down too early, and then to flatten the curve in a way that fills our front line health service's capacity without overstretching it.

All while increasing numbers of beds, ventilators and distributing PPE as widely as possible.

That's broadly what's happened.

Re: The UK’s public health response to Covid-19

#57

Post by arethuza »

tompccs wrote: post #44
arethuza wrote: post #42

Earlier quoted context omitted.

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-s...

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?

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?

Re: The UK’s public health response to Covid-19

#58

Post by DanBC »

ageitgey wrote: post #49

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 o…

> As of today, there have been 23,953 deaths in England.

No.

1) The actual number is 34,796 https://coronavirus.data.gov.uk/

2) That only includes people who were tested positive for covid-19. That's only tests carried out by government labs, not private tests. We've only just started to include deaths that happened outside hospital.

> Why weren't the Nightingale Hospitals (field hospitals) needed?

Because we didn't transfer elderly people from care and nursing homes to hospital. We left them to die in those homes.

Because we cancelled elective procedures, we converted operating theatres to ICUs, we changed nurse:patient ratios, to create surge demand.

Because we didn't have enough ICU nurses to staff Nightingale:London.

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]

Re: The UK’s public health response to Covid-19

#59

Post by DanBC »

tompccs wrote: post #36

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 tot…

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.

Re: The UK’s public health response to Covid-19

#60

Post by DanBC »

butler14 wrote: post #56
DanBC wrote: post #53

Earlier quoted context omitted.

> '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.

I disagree. The UK strategy was to not pull the trigger on lock down too early, and then to flatten the curve in a way that fills our front line health service's capacity without overstretching it. All while increasing numbers of beds, ventilators and distributing PPE as widely as possible. That's broadly what's happened.

https://twitter.com/BBCMarkEaston/status/1237694665824047111

"There's going to be a point, assuming the epidemic flows and grows as we think it probably will do, where you'll want to cocoon -protect- those at-risk groups so that basically they don't catch the disease, and by the time they come out of their cocooning herd immunity has been achieved in the rest of the population".

It's clear from this that the policy was to achieve herd immunity. Without a vaccine the only way to get herd immunity is to let everyone catch it. You don't want vulnerable people to die so you cocoon them, but you want everyone else to get it as soon as possible.

This is why mass events (eg, cheltenham gold cup) were allowed to go ahead; this is why the lockdowns were late and weak; and this is why so many people in the UK have died.

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