Thanks, Anthony. When the pandemic broke, I was chair of the BMA Public Health Medicine Committee (PHMC), and a PHE CCDC in Surrey and Sussex. (One of the first UK cases to be identified was one of our residents.)
I was horrified at the time by many aspects of the pandemic response. The complacency and political infighting that delayed useful action. The decision that respiratory spread didn't happen, and therefore that mitigations like masks were useless, even harmful. The advice that asymptomatic transmission did not happen (if we didn't already know from experience in eg China and Italy, our Brighton case and the secondary and - particularly - tertiary cases meant we knew early on that it does). Looking forward there are so many lessons which seem to be being sidelined or ignored. One of these is respiratory protection for HCWs. https://peterenglish.blogspot.com/2023/08/all-healthcare-workers-should-get-used.html
Another is planning for pandemics with different transmission modes - including drafting legislation. The ludicrous situation in which a couple were hounded by police and prosecuted for walking on deserted mountain paths, when outdoor transmission risks are very low; and where laws were passed for immediate implementation, while politicians couldn't accurately describe what they said, an police struggled to know what to do...
We should draft laws, to be published and available to enact when needed (an appropriate use of secondary legislation); and services should run exercises so that when and if a particular set of rules becomes law, they already know what powers they have and what they are required to do…
I could go on. The myth that children couldn't get infected or transmit Covid.
I had intended to add that the "rules" early on were clearly ridiculous. We were obliged to treat people as zero risk for infection until they had tested positive for Covid-19. Given that:
* Covid is transmissible before the onset of symptoms - typically for about 7 days, but with infectiousness diminishing rapidly after day two or three…
* At this point, the only available test was a PCR test, with a sensitivity of about 70% given best practice in sample collection - so it missed >3 out of every 10 cases…
*People would usually present after 24-48 hours of symptoms if at all (remember, the really serious symptoms were a consequence of the immune hyper-response, and didn't kick in until about day 10, so early cases were frequently mild flu-like illness)…
*It generally took at least 48 hours to get the results of the test.
…So, by the time they had to start self-isolation, they would already have infected nearly all the secondary cases they were likely to have infected without any isolation...
We were not permitted to say "this person has been in close contact with one or more cases and has symptoms consistent with Covid-19, so they should self-isolate".
We also found that the Department for Education insisted on keeping cases and almost-certainly-infected pupils in school until the whole school had become infected, and would not allow early interventions to minimise spread within schools. This policy alone must be responsible for the death of numbers of school staff and parents.
The crazy policies relating to discharging people into care homes as long as they hadn't been proven by testing to be positive for Covid-19 - or even if they had.
PHE and its predecessors have a terrible track record for communicating with staff, and this continued (we had to read lots of emails, many duplicates, and even late-forwarded emails with instructions that had already been superceded; the organisation failed to take on a librarianship type role, curating guidance and relevant science publications for staff, for example).
The workload simply from our one case (and the associated secondary and tertiary cases) was overwhelming - we certainly couldn't have managed to investigate all subsequent cases the same way.
But the failure to learn from overseas and early cases; and the failure to follow basic public health principles of preventing onward spread of diseases - indeed, the requirement to act contrary to our professional judgement, eg with the transfer of patients to care homes - did cause moral injury.
Devi Sridhar made it abundantly clear that you need to act fast.
"Jan 26, 2020
Too much fear of overreaction. Better to react and prevent something than wait and have to treat it later (core tenet of public health). Being blamed later for overreacting comes with the territory."
Thank you so much for this. The failures of state and I include Government scientists were the reason I was so grateful to find Independent Sage and its reputable scientists. You were all proven right and continue to be right so I thank you for keeping us informed.
Thanks, Anthony. When the pandemic broke, I was chair of the BMA Public Health Medicine Committee (PHMC), and a PHE CCDC in Surrey and Sussex. (One of the first UK cases to be identified was one of our residents.)
I was horrified at the time by many aspects of the pandemic response. The complacency and political infighting that delayed useful action. The decision that respiratory spread didn't happen, and therefore that mitigations like masks were useless, even harmful. The advice that asymptomatic transmission did not happen (if we didn't already know from experience in eg China and Italy, our Brighton case and the secondary and - particularly - tertiary cases meant we knew early on that it does). Looking forward there are so many lessons which seem to be being sidelined or ignored. One of these is respiratory protection for HCWs. https://peterenglish.blogspot.com/2023/08/all-healthcare-workers-should-get-used.html
Another is planning for pandemics with different transmission modes - including drafting legislation. The ludicrous situation in which a couple were hounded by police and prosecuted for walking on deserted mountain paths, when outdoor transmission risks are very low; and where laws were passed for immediate implementation, while politicians couldn't accurately describe what they said, an police struggled to know what to do...
We should draft laws, to be published and available to enact when needed (an appropriate use of secondary legislation); and services should run exercises so that when and if a particular set of rules becomes law, they already know what powers they have and what they are required to do…
I could go on. The myth that children couldn't get infected or transmit Covid.
I had intended to add that the "rules" early on were clearly ridiculous. We were obliged to treat people as zero risk for infection until they had tested positive for Covid-19. Given that:
* Covid is transmissible before the onset of symptoms - typically for about 7 days, but with infectiousness diminishing rapidly after day two or three…
* At this point, the only available test was a PCR test, with a sensitivity of about 70% given best practice in sample collection - so it missed >3 out of every 10 cases…
*People would usually present after 24-48 hours of symptoms if at all (remember, the really serious symptoms were a consequence of the immune hyper-response, and didn't kick in until about day 10, so early cases were frequently mild flu-like illness)…
*It generally took at least 48 hours to get the results of the test.
…So, by the time they had to start self-isolation, they would already have infected nearly all the secondary cases they were likely to have infected without any isolation...
We were not permitted to say "this person has been in close contact with one or more cases and has symptoms consistent with Covid-19, so they should self-isolate".
We also found that the Department for Education insisted on keeping cases and almost-certainly-infected pupils in school until the whole school had become infected, and would not allow early interventions to minimise spread within schools. This policy alone must be responsible for the death of numbers of school staff and parents.
The crazy policies relating to discharging people into care homes as long as they hadn't been proven by testing to be positive for Covid-19 - or even if they had.
PHE and its predecessors have a terrible track record for communicating with staff, and this continued (we had to read lots of emails, many duplicates, and even late-forwarded emails with instructions that had already been superceded; the organisation failed to take on a librarianship type role, curating guidance and relevant science publications for staff, for example).
The workload simply from our one case (and the associated secondary and tertiary cases) was overwhelming - we certainly couldn't have managed to investigate all subsequent cases the same way.
But the failure to learn from overseas and early cases; and the failure to follow basic public health principles of preventing onward spread of diseases - indeed, the requirement to act contrary to our professional judgement, eg with the transfer of patients to care homes - did cause moral injury.
I am immunosuppressed. Oh, how I would love to “move on”!
Indie_SAGE are the best! Thank you.
Devi Sridhar made it abundantly clear that you need to act fast.
"Jan 26, 2020
Too much fear of overreaction. Better to react and prevent something than wait and have to treat it later (core tenet of public health). Being blamed later for overreacting comes with the territory."
Thank you so much for this. The failures of state and I include Government scientists were the reason I was so grateful to find Independent Sage and its reputable scientists. You were all proven right and continue to be right so I thank you for keeping us informed.
Excellent. Thank you