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).