What would you do about coronavirus in the UK if you were in charge?

[Yew]

I don't think it would be a popular measure at first, but realistically speaking it is the only way of effectively stamping out the disease, if that is the approach you want to take. The current approach gives us the worst of all worlds, with everyone inconvenienced to a certain degree, likely for an indefinite period of time, because a few people have the disease. Better to massively inconvenience a very small number of people for a short period of time.

There's no evidence of any disease being wiped out without herd immunity. It has never happened, there are no exceptions.

 

[Bletchleyite]

Are you being serious? Army checkpoints? <insert facepalm meme here>

Yes. If you're going to lock down a local area, it will only work properly if you wholly prevent travel to and from it. The alternative is to lock everyone down.

There's no evidence of any disease being wiped out without herd immunity. It has never happened, there are no exceptions.

SARS-CoV-1 has near enough gone.

 

[Bantamzen]

Yes. If you're going to lock down a local area, it will only work properly if you wholly prevent travel to and from it. The alternative is to lock everyone down.

Wow, just wow! You really are enjoying dreaming up ways to make other people's lives more miserable than they are already are.

 

[Bletchleyite]

Wow, just wow! You really are enjoying dreaming up ways to make other people's lives more miserable than they are already are.

No, I'm coming up with ways to make the measures actually work to reduce or eliminate COVID. Short term pain for long term gain.

 

[Yew]

SARS-CoV-1 has near enough gone.

Which was certainly never in as widespread transmisison as COVID-19, perhaps there was a chance back in Whutan in January, but it's incredibly unlikely now that there is worldwide transmission

 

[DB]

SARS-CoV-1 has near enough gone.

That was contained in the early stages, as was MERS.There is not a single case of a virus which has achieved significant and distributed spread being wiped out, with the exception of Smallpox which took not far short of 200 years from the first vaccine.

The idea that this virus can be eliminated in any fairly short timescale is frankly luducrous.

 

[jtuk]

Open the country. Simple as that. Encourage people to work from home, encourage minimal measures to have some sort of social distancing (e.g. something as simple as saying people with surnames from A-M do their shopping on odd days, everyone else on even days), and put into place proper protections for care homes, although with Covid having run through half of them already, this would probably have little effect.

Rationale is:

- The dangers of death from Covid at all levels is a fraction of what was first feared, and in the range of a standard flu
- There is a clear contradiction between the fear that it is incredibly easily transmitted and the number of actual cases tracked. We have almost certainly had tens, if not hundreds of times more actual infections than have been already detected, or that have been put off by pre-existing immunity. As such, it's thought that we are at herd immunity in certain areas (London for one) and close enough in others.
- There is no fear of overwhelming the NHS. Covid NHS usage is down at 1-2% of what it was at peak, so while we will see an increase in cases, we will almost not see an associated level of increase in hospitalisations or deaths. The biggest danger to the NHS right now is that there's no economy left to fund it.
- It is obvious at this stage that more damage is being done to people's health outside of Covid than by Covid itself, be that cancelled operations, missed checks for cancers, heart problems, or mental health issues from the actions taken, job losses etc, and this cannot be allowed to continue.
- It is increasingly obvious that Sweden has got the approach right and we should mimic it. We will have a level of Covid increase in the short term while we get to their levels, but it is nothing the country can't handle.
- Trying to get cases to zero is unrealistic.

 

[Bantamzen]

No, I'm coming up with ways to make the measures actually work to reduce or eliminate COVID. Short term pain for long term gain.

No, you really aren't. Viruses don't give a stuff about army checkpoints, they don't give a stuff about lockdowns, masks, visors, one way systems or any other punitive measures that clipboard carrying petty bureaucrats dream up.

 

[Bletchleyite]

No, you really aren't. Viruses don't give a stuff about army checkpoints, they don't give a stuff about lockdowns, masks, visors, one way systems or any other punitive measures that clipboard carrying petty bureaucrats dream up.

Viruses do "give a stuff" about people reducing their movement and interaction with others. That's exactly how you stop them, and to completely stop them you need to completely stop that interaction.

 

[talldave]

No, I'm coming up with ways to make the measures actually work to reduce or eliminate COVID. Short term pain for long term gain.

You can't eliminate it. The half baked "whack-a-mole" approach is simply dragging the process out. The fastest solution, as already proposed by someone else, is to use minimum measures necessary to prevent NHS being overwhelmed. That's it.

 

[AdamWW]

You can't eliminate it. The half baked "whack-a-mole" approach is simply dragging the process out. The fastest solution, as already proposed by someone else, is to use minimum measures necessary to prevent NHS being overwhelmed. That's it.

OK. You're in charge.

Your sole aim is to prevent the NHS being overwhelmed.

What do you do now, and why?

 

[talldave]

OK. You're in charge.

Your sole aim is to prevent the NHS being overwhelmed.

What do you do now, and why?

Not ask you for help.

I'm off to the shops, maskless.

 

[Bantamzen]

Viruses do "give a stuff" about people reducing their movement and interaction with others. That's exactly how you stop them, and to completely stop them you need to completely stop that interaction.

You can't eliminate it. The half baked "whack-a-mole" approach is simply dragging the process out. The fastest solution, as already proposed by someone else, is to use minimum measures necessary to prevent NHS being overwhelmed. That's it.

Exactly, these ridiculous notions of eliminating the virus are just creating more & more problems.

OK. You're in charge.

Your sole aim is to prevent the NHS being overwhelmed.

What do you do now, and why?

Firstly stop using silly, punitive measures to appear to be doing something. Then work the data, who is most a risk, how can we better help them stay safe? Understand the risks and mitigate for them. In the case of this virus we know damn well than the elderly, particularly in health and care scenarios are by far the most likely to be at risk. So fund additional help in these areas, set a minimum standard of hygiene, conduct regular tests, talk to families to help them better understand what they can do to help. Sure its not as sexy for the lockdown fanatics, but it would make a difference.

 

[Mojo]

1: no social distancing or shielding
2: everything open but with distancing measures and masks; shielding paused
3: as 2 but social venues outdoors only other than use of toilets
4: the lockdown we actually had
5: no leaving home for any reason unless in an ambulance, Army distributes emergency food/medicine packages etc

I think this is roughly what Australia has.

Rather like America, it varies locally. Melbourne has today just introduced some pretty draconian restrictions.

“

• CURFEW: You must stay home from 8pm to 5am, beginning tonight. The only reason to leave home outside of these hours is for work, medical reasons or care giving.
• ESSENTIAL SHOPPING: Shopping limited to one person per household per day. You must stay within five kilometres of your home when doing essential shopping (unless the closest supermarket is more than 5km from your home).
• RECREATION: Recreational activity no longer allowed.
• EXERCISE: Only one hour of exercise permitted per day, no further than five kilometres from home. Exercise groups limited to two people, regardless of whether they’re members of the same household.
• CHILDCARE + KINDER: From 11.59pm on Wednesday only children of essential workers in ‘defined industries’ and vulnerable children may attend. Defined industries will be announced tomorrow.
• WEDDINGS: Not permitted from 11.59pm Wednesday.“

 

[AdamWW]

Not ask you for help.

I'm off to the shops, maskless.

OK I deserved that.

Looking at it again my post looks rather rude, which wasn't the intention.

Going back to the opening post, I asked if people could explain what their goal would be, how they'd achieve it and why they think it would work.

You have a goal - prevent the NHS from being overwhelmed.

In the spirit of the topic of this thread, do you have a plan for what you'd do to achieve it that you can share with us?

 

[thejuggler]

My goal would be whatever is in the regularly reviewed pandemic plan.

The actions would be in line with the pandemic plan which would include clear and concise messaging. This would have started in late 2019 early 2020 when the virus was identified in China and updated in February when the first cases were identified in York.

I would hope any Government would realise they don't know everything and can't control everything, but they can and should plan and have enough confidence in those who do know about these things.

 

[talldave]

Yes, I'd give the requirement to stay within NHS capacity to qualified experts and implement their plan. I'd ensure that unqualified morons like Dominic Cummings had no say in what happened.

I know you're trying bait me into a game of Fantasy Virus Manager, but I'm not qualified. I can express my opinions on facts but that's about it.

 

[Jamiescott1]

Tell everyone to get on with it, those who need to shield do so and, if of working age, apply for medical certificate that allows them access to a furlough scheme. Sorry it sounds harsh but is the only way I can see out of this. Someone needs to make some tough decisions but no politicians are prepared to do so.

My suggestion too.

 

[AdamWW]

Yes, I'd give the requirement to stay within NHS capacity to qualified experts and implement their plan. I'd ensure that unqualified morons like Dominic Cummings had no say in what happened.

I know you're trying bait me into a game of Fantasy Virus Manager, but I'm not qualified. I can express my opinions on facts but that's about it.

OK fair enough.

But I'm not sure how different that would look to what we are doing now.

Here is my non-expert take on it - as ever I'm happy to learn from those more knowledgeable to me.

Opening things up changes the rate of change of infections, not the overall infection level.

And once it starts to go up, the increase accelerates.

So as infections increasee, you're probably going to have to put restrictions back in at some point to keep infections steady at the level (much higher than now) that the health system can cope with - and you have be very careful you don't do that too late.

The government could have opened up more quickly and locked in a much higher infection level to keep the health service occupied. But it's not clear to me that the benefits of doing that would outweigh the disadvantages.

 

[DelayRepay]

If I was in charge, my priority would be delivering the world leading test and trace system we were promised, rather than what we have. I'd make sure those who needed to isolate were properly supported financially and practically (e.g. priority immediate supermarket deliveries).

I would make it a criminal offence to leave your home if instructed to isolate by the track and trace system. There would obviously be some limited exceptions but these would be clearly defined. Anyone who should be isolating but isn't should be arrested by the police and placed in a cell until the isolation period has passed. I realise that this may require 'Nightingale' style prisons to be opened. The cost of this would be covered by charging the occupants an appropriate rate for their accommodation.

 

[Freightmaster]

Viruses do "give a stuff" about people reducing their movement and interaction with others. That's exactly how you stop them, and to completely stop them you need to completely stop that interaction destroy the economy.

Edited for accuracy...





MARK

 

[Smidster]

It is a very good question - while I think this Government is generally incompetent they are in an almost impossible scenario - everything you do is going to hurt someone either physically or economically.

On a practical side I think I would effectively close the borders as much as possible - it is hard enough fighting what we have in the country already without importing additional problems. If you need to travel it is a 14 day Quarantine at a hotel managed by the Government. As great as travel is now is not the time to be doing it.

My focus would then be to remove as many restrictions for as many people as possible but be as transparent as possible when putting restrictions in at the local level through an x-level system so people know exactly what is expected of them in each stage - there have been far too many times when people have not had a clue what is happening or why.

Beyond that test test test and use that to really zoom in on localities and focus on those specific areas that are causing problems. That would involve much stricter restrictions than in March - I am thinking you would effectively cordon off areas.

The other thing is to not give people false hope or make statements I might need to walk back later. Over the next few months there will undoubtedly be times when we take a step back as for all the modelling we don't really know what impact any particular measure will have and there will be times when opening something up is worse than we forecast and needs to be reversed. Statements like "all OK by Christmas" do nobody any good.

 

[Smidster]

Are you being serious? Army checkpoints? <insert facepalm meme here>

Why not?

If you know that you have a significant problem in one place (in this case London) why would you not do everything you can to stop it getting out of that area?

In our case in March I doubt it would have worked - there were too many cases seeded across the whole UK by people coming back from Europe but in future it seems logical.

What is happening in Melbourne could be your blueprint with a 5km limit and checkpoints all around the city.

 

[Richard Scott]

I'm becoming more convinced that people are extremely deluded about this virus. Closing borders, road blocks and what other measures are not going to eradicate this virus. As we have seen some countries have tried and to be honest are not succeeding unless they isolate themselves forever. The other issue is thus virus is not the worst ever and I'm afraid as with all things like this there will be casualties. That is the reality. Locking down or whatever else just delays the problem. We all need to realise this fact.

 

[Domh245]

The talk of locking down London is odd. It's quite obvious that the virus was in existence elsewhere in the country, and likely to be established as well. The key difference is that London encouraged a high rate of infection but I doubt that there was particular amounts of transmission from London 'outwards' - some transmission, sure, but a hard lockdown would have accomplished nothing in terms of preventing footholds occurring in the rest of the UK

 

[Bantamzen]

Why not?

If you know that you have a significant problem in one place (in this case London) why would you not do everything you can to stop it getting out of that area?

In our case in March I doubt it would have worked - there were too many cases seeded across the whole UK by people coming back from Europe but in future it seems logical.

What is happening in Melbourne could be your blueprint with a 5km limit and checkpoints all around the city.

Well perhaps because people from outside of London travel too. Shocking I know, but it does happen...

Seriously though, it is now well believed that covid was doing the rounds up here in Baildon as far back as mid December. So checkpoints on the M25 probably would not have helped much.

 

[DB]

I'm becoming more convinced that people are extremely deluded about this virus. Closing borders, road blocks and what other measures are not going to eradicate this virus. As we have seen some countries have tried and to be honest are not succeeding unless they isolate themselves forever. The other issue is thus virus is not the worst ever and I'm afraid as with all things like this there will be casualties. That is the reality. Locking down or whatever else just delays the problem. We all need to realise this fact.

I agree. Prior to this most people would have thought the concept of completely eradicating a cold or flu virus with a worldwide spread completely unrealistic, but they seem to expect it here. There also seems to be a completely unrealistic view of the timescale in which a vaccine (if one is developed which works) can be rolled out worldwide.

Many also seem to be regarding it as being in the same league as something like Ebola, which again is clearly not the case - all the evidence now seems to indicate that it's not that much worse than flu.

 

[AdamWW]

OK some really interesing views.

I have some thoughts of course...

Whatever we do there will be a negative impact but, unfortunately, this has escaped our politicians and a certain number of society who think we can protect everyone. As we have seen with current system this isn't possible and where are we? Stuck in a rut with no foreseeable way out.

I've seen quite a few comments about how politicians are unaware of the negative impact of the various measures they've taken. If so, they aren't reading their scientific advice because all this is being pointed out, as a browse through the SAGE documents will show.

One approach might be to
a) advise the public, constantly updated with regular changes, as to our best understanding of how the disease may be transmitted, its current prevalence, and in what circumstances one is most likely to catch it (eg suppose that might be: at home, low risk; on a beach or in a park, low risk; in a pub/nightclub/etc, high risk) and the likely health impacts and so on
b) deny any health service involvement in the treatment of Covid19 except for defined essential workers (such as, health workers, carers, utility maintenance, etc). You're on your own.
c) armed with that information, allow people freedom to do whatever they want; businesses ditto. Give people personal responsibility for their own actions, rather than centralising decisions, with the attendant criticism that this inevitably draws from whichever sector happens to see itself as negatively affected and/or unfairly treated.

I'm surprised nobody has commented on this. I find the idea that you would refuse health care to someone with Covid-19 pretty horrifying. I don't know how you'd get health workers to go along with this.
And the problem is that for a lot of people the choice would be between risking their lives, and financial ruin. And it would be highly discriminatory, when you look at who is more likely to be able to continue to work at home and who can't.

1 metre social distancing, restrict superspreading events where you are with the same people in close contact for extended periods (nightclubs, conferences etc). Extensive hand washing. A big push on hygiene education. Everything else as normal. Keep an eye on hospital admissions, and prepare to introduce further measures only if there is a danger of the health service being overwhelmed.

OK so open up but stop if the heath system is overloaded. More on this later.

No detriment policies to those who have to self-isolate, 100% pay, and any booked events reimbursed by the Government. We should not allow perverse incentives, so that doing the right thing makes people lose out more than absolutely necessary.

Apart from that, I'd try to balance restrictions to keep the NHS around (random figure here) 80% full, and only impose restrictions if there's a risk of overwhelming. The original "flatten the curve" aproach.

Well supporting people who need to put themselves out for the greater good sounds like a good plan, doesn't it?

So again we go as far as we can while keeping the health service OK.

Now? we can’t afford to lock down again, deprive our kids of more education etc... I don’t think the current strategy is working. I may simply go for the ‘strongly advise the vulnerable to shield and allow the virus to work through the healthy’ as, statistically, this is unlikely to overwhelm the NHS, provided a full shielding package was rolled out and care homes were properly locked down (staff living there etc)

OK so your view is that we don't need to worry about overwhelming the health service. I don't think that's true (see below).

Open the country. Simple as that. Encourage people to work from home, encourage minimal measures to have some sort of social distancing (e.g. something as simple as saying people with surnames from A-M do their shopping on odd days, everyone else on even days), and put into place proper protections for care homes, although with Covid having run through half of them already, this would probably have little effect.

Rationale is:

- The dangers of death from Covid at all levels is a fraction of what was first feared, and in the range of a standard flu
- There is a clear contradiction between the fear that it is incredibly easily transmitted and the number of actual cases tracked. We have almost certainly had tens, if not hundreds of times more actual infections than have been already detected, or that have been put off by pre-existing immunity. As such, it's thought that we are at herd immunity in certain areas (London for one) and close enough in others.
- There is no fear of overwhelming the NHS. Covid NHS usage is down at 1-2% of what it was at peak, so while we will see an increase in cases, we will almost not see an associated level of increase in hospitalisations or deaths. The biggest danger to the NHS right now is that there's no economy left to fund it.
- It is obvious at this stage that more damage is being done to people's health outside of Covid than by Covid itself, be that cancelled operations, missed checks for cancers, heart problems, or mental health issues from the actions taken, job losses etc, and this cannot be allowed to continue.
- It is increasingly obvious that Sweden has got the approach right and we should mimic it. We will have a level of Covid increase in the short term while we get to their levels, but it is nothing the country can't handle.
- Trying to get cases to zero is unrealistic.

Again - the view that we won't overwhelm the NHS.

It is thought by some people that we are at herd immunity, but it certainly isn't the consensus and there are what look to me to be very good arguments that it unlikely that we have. The idea that if we opened up significantly we would see increases in hospital admissions is I think very optimistic (to put it mildly).

Sweden's approach was to bring in restrictions - some quite harsh (e.g. no non-essential travel). Not enforced directly by law, but people were told not asked to do it. They've now - as we have done - relaxed things, but not back to normal.

Then work the data, who is most a risk, how can we better help them stay safe? Understand the risks and mitigate for them. In the case of this virus we know damn well than the elderly, particularly in health and care scenarios are by far the most likely to be at risk. So fund additional help in these areas, set a minimum standard of hygiene, conduct regular tests, talk to families to help them better understand what they can do to help. Sure its not as sexy for the lockdown fanatics, but it would make a difference.

I would hope all of these are happening anyway.

Yes, I'd give the requirement to stay within NHS capacity to qualified experts and implement their plan. I'd ensure that unqualified morons like Dominic Cummings had no say in what happened.

I know you're trying bait me into a game of Fantasy Virus Manager, but I'm not qualified. I can express my opinions on facts but that's about it.

OK fine - the reason I'm pushing is that as I've said before I'm not convinced that a strategy of protecting the health service looks much different to what we are doing.

But OK - we protect the NHS and ask the experts how to do it. I like that. See my closing comments for what I think that means.

My focus would then be to remove as many restrictions for as many people as possible but be as transparent as possible when putting restrictions in at the local level through an x-level system so people know exactly what is expected of them in each stage - there have been far too many times when people have not had a clue what is happening or why.

Beyond that test test test and use that to really zoom in on localities and focus on those specific areas that are causing problems. That would involve much stricter restrictions than in March - I am thinking you would effectively cordon off areas.

The other thing is to not give people false hope or make statements I might need to walk back later. Over the next few months there will undoubtedly be times when we take a step back as for all the modelling we don't really know what impact any particular measure will have and there will be times when opening something up is worse than we forecast and needs to be reversed. Statements like "all OK by Christmas" do nobody any good.

So much as we are, but done more competently?

OK - so the most popular view seems to be that the aim should be to relax as much as possible while protecting the health system (or perhaps that we don't need to worry - we know that it will cope no matter what we do)

I've argued above that I think this looks very much like what we are doing - unless we have the capacity to cope with dropping all restrictions, then at some point we have to prevent infections from increasing, which requires measures to be taken to keep infection levels constant, which is where we are now.

This paper, which I found today, (from the Academy of Medical Sciences, and input to SAGE) gives a very good view of how much capacity we have in the health service. It's a long document, but to summarise:
- We have a huge backlog of non-Covid cases to deal with. So anything we do to increase Covid numbers compromises our ability to start catching up with everyone else who needs hospital care.
- The headroom to get through this Winter is likely to be low - the system normally struggles somewhat (though social distancing etc. may reduce flu transmission)
- Capacity is likely to be less than during the initial peak for many reasons, including that we just can't afford to turn operating theatres etc. back into emergency wards - we have to be able to deal with non Covid conditions.
- Nightingale hospitals don't provide extra hospital capacity because the only way to staff them is to rob staff from elsewhere - they only work as some kind of intermediate step from hospital to going home
- We don't want to send potentially infectious patients into care homes any more - but of course this reduces capacity.

They are fully aware of the downside of the things we are doing go prevent transmission and the need to reduce the impact on mental and physical health as much as possible and mention (though this is perhaps out of their remit) the dangers of people suffering financially.

So overall - I think I can summarise their recommendations as saying that what it takes in order to have some confidence that the health system will cope over Winter is to do what we can to limit the rise of infection numbers, but to accept a value higher than 1 for seasonal reasons (and therefore will go down again in the Spring) rather than impose another national lockdown.

But it is clear that they are saying in order to avoid the health service from collapsing we need to carry on for now much as we are.

(But people have made some good comments on this thread on how we might be doing that better).

 

[talldave]

I'm sure I read back in May that 1 in 6 Londoners had had it. That figure must be higher now, has anyone seen more recent estimates? The higher the figure the better.

 

[Richard Scott]

I'm sure I read back in May that 1 in 6 Londoners had had it. That figure must be higher now, has anyone seen more recent estimates? The higher the figure the better.

Exactly and true of the whole country, more people that have had it more chance we have of getting on with life, why can't some people see that?