Coronavirus: a global examination of disparate national containment techniques

Whilst Justin Trudeau and his wife hit the headlines as the first world leader victims of Coronavirus and Trump suspends all flights from central Europe, examining the vastly disparate techniques of the nations across the world is leading many to question the UK government. This morning we have moved into the “delay phase” – the new advice is to self-isolate for 7 days if you have any symptoms that match the Covid-19 illness. Phoning NHS 111 is only for the most unwell and new distancing rules for people you share a household with are now in effect. However, the British government have shied away from what many other countries are doing and are not currently advising the closure of schools, postponing mass gatherings or other more serious social distancing.

Oddballs, weirdos and nudge theory

On Wednesday, Bloomberg published a piece talking about a very shady sounding crack team of psychologists who are advising the government to convince the British public to focus on hand washing. Whilst we already know Dominic Cummings has been working on recruiting ‘oddballs and weirdos’ to his teams, how much of the advice is evidence-based? 

The key to the new advice seems to be behavioural psychology rather than solely epidemiological. Professor Chris Whitty, the Chief Medical Officer and Chief Scientific Officer Sir Patrick Vallance talked yesterday about the “enthusiasm” of the country in following self-isolation and the behaviour of the population in responding to what Johnson termed the “worst public health crisis for a generation”.

Italy’s warning

Stark warnings are coming out, anecdotally, from Italy, whose death toll is almost on a par with its recovered numbers. Italian doctors are taking to social media to advise countries like the UK to take action now. The WHO also warned that several countries are not taking aggressive enough action against what it is now classifying as a pandemic. Yesterday Johnson and his advisors advised we were four weeks behind Italy, sparking others to suggest that’s at least two weeks out.

Source: Information is Beautiful

Tedros Adhanom Ghebreyesus, the WHO’s director-general said they were ringing “the alarm bell loud and clear” and sent an urgent message to nations to learn from successes, act together “in unison” and “find, isolate, test and treat every case, and trace every contact”.

Though China’s techniques have been criticised as ‘draconian’ by the UK’s media, it has ultimately been successeful, according to Ghebreyesus. Calling China’s response “aggressive”, the WHO praised it for slashing the new cases with its measures, which include everyone wearing masks, isolation centres for the infected, constant temperature checks and mandatory use of hand sanitiser on entry to every building.

We have had one government minister, Nadine Dorries, who had been in contact with Boris Johnson at Number 10, who has now tested positive for Coronavirus. Similar has happened in Spain, where they have reacted to the news by testing their entire government. Junior Health Minister Nadine Dorries’ case of Covid-19 has not prompted the same response here, however, as there are currently no plans to test any of the ministers or other people who came into contact with her.

All this comes as daily cases in Hubei – the origin of the outbreak – were lauded as a new low. Ireland closed all schools, Scotland banned public gatherings of more than 500, Andalucia in Spain went into lockdown and Belgium and Portugal have closed their schools this morning.

Ardent labour supporter and former Public Health England regional director, Professor John Ashton slammed the government on Newsnight, calling the government’s response ‘complacent’. 

Editor of the Lancet, Mr Horton, agreed, saying that the UK government was “playing roulette” with the public whereas former Health Secretary, who resigned his post in July 2019, Jeremy Hunt, also said he was ‘surprised’ and that our failure to stop public gatherings was “concerning”. “We have just four weeks until we get to the stage Italy is at”.

At the time of writing, 11 people in the UK have died, 596 have tested positive for Coronavirus and yesterday the CMO said it was entirely feasible that between 5,000 and 10,000 people already have the virus. Prime Minister Boris Johnson admitted that people will die “before their time” in his press conference, flanked by the UK’s most senior scientist and medical officer.

Sir Patrick Vallance on public gatherings and schools

Sir Patrick Vallance (Source: Wikipedia)

This morning, on BBC news, Sir Patrick Vallance said the biggest change was that the population had now been told to self-isolate for the slightest sign of illness. He said that eventually we may move to advice that whole families should self-isolate, not just those who are affected. He admitted that closing schools is actually a very effective way of stopping flu pandemics, yet the “role of children” within the Coronavirus spread was currently unclear. He said that we would have to close the schools for up to four months, which could cause problems and would not stop children from mixing. “Schools would have a lesser impact than [those measures that have already been put into place] and need to be done at the right time of the outbreak to have the effect and that right time isn’t yet: doesn’t mean it won’t come, doesn’t mean that it isn’t one of the things that we will keep in absolutely regular update.”

On the point of mass gatherings, he said it was most likely that closing mass gatherings was also unlikely to make much difference. “Closing mass gatherings may have an effect on its own, but it’s a relatively small effect […] and on its own doesn’t make a difference and isn’t one of the top things that you need to do to try and control this”.

However, the European Center for Disease Control (CDC) has warned that countries should aim for “a rapid shift from a containment to a mitigation approach” and said countries absolutely should bring in the ‘social distancing’ measures that Boris Johnson currently seems to want to defer and avoid at present.

Releasing a stark warning, it stated “[t]he risk of healthcare system capacity being exceeded in the EU/EEA and the UK in the coming weeks is considered high,” yesterday. It was mainly concerned with the strain on the UK’s health system, advising “”Social distancing measures should be implemented early in order to mitigate the impact of the epidemic and to delay the epidemic peak,” the organisation said.

“This can interrupt human-to-human transmission chains, prevent further spread, reduce the intensity of the epidemic and slow down the increase in cases, while allowing healthcare systems to prepare and cope with an increased influx of patients.”

The European response

Italy seems to have the most stringent measures, as its death toll is severe and sustained. In order to move around the country you need special permission and many other countries have severely restricted its citizens from visiting. All schools in the country are closed until April. The social media reports – and those verified from the media – seem apocalyptic in a country with healthcare that doesn’t differ too much from our own. Medics describe desperate, “war-like” scenes. One nurse told the Guardian “[it is] a war that isn’t fightable with traditional arms – as we don’t yet know who the enemy is and so it’s difficult to fight. The only weapon we do have to avoid things getting even worse is to stay at home and to respect the rules, to do what they did in China, as this is paying off.”

Bergamo doctor Daniele Macchini wrote on social media “The situation is nothing short of dramatic. The war has literally exploded and the battle is uninterrupted, day and night.”

An anonymous anaesthetist has sparked an investigation at the Papa Giovanni XXIII hospital after telling local paper that life and death decisions are being made “by age and health conditions … as in situations of war”.

Greece has banned anyone from attending sporting events for the next two weeks, but the fixtures will still go ahead without spectators. It has also closed several schools in the most affected areas. 

France has closed all Universities, schools and nurseries, with their President, Emmanuel Macron declaring Covid-19 as the “most serious health crisis for a century”.

Belgium and Portugal also announced school closures this morning. 

The US and Canada

Trump’s decision to block travel from the EU (except the UK) was a shock announcement on Wednesday, one that was harshly criticised by the European Bloc. Attractions including the Smithsonian, all Broadway theatres and Disneyland in Florida have all closed. 

The rest of the world

In total, the UN says that 29 countries have closed their schools, including China, Mongolia, Japan, Algeria, Iran and Iraq. Russia has closed schools in select locations.

Australia are also following the Scottish model, banning gatherings of more than 500 whilst they struggle with panic buying of toilet paper.

Economical concerns

Yesterday’s volatile stock market was also a major cause for concern – the Dow and S&P plunged to levels not seen since 1987.

Meanwhile, people are asking what medical advice would be were there no economical concerns and concern for the older population and immunocompromised rises. The New York Times yesterday published a scathing piece, entitled “UK shields its economy from the virus, but not yet its people”. 

Reporting that Devi Sridhar, Global Health Governance program director of Edinburgh University expressed surprise at the measures, stating that “we should be banning public gatherings. I don’t know why we haven’t taken that step”.

Rishi Sunak, the new Chancellor of the Exchequer (Source: Wikipedia)

Perhaps most telling, however, that the economy seems a firm priority for the goverment, was the statement from the new Chancellor of the Exchequer, Riski Sunak, when presenting his new budget on Wednesday. [This new budget] “represents one of the most comprehensive economic responses of any government anywhere in the world to date.

Medical advice from NHS 111 and what you should be doing

It’s worth bearing in mind that the new advice is significantly different in several important ways. NHS 111 telephone line is under enormous strain, so calls to the health advice line are solely for those who are struggling with breathing or other urgent (non-Coronavirus related) illnesses, as usual. 

If you have any of the symptoms of Coronavirus – which are a high temperature, a dry cough or any shortness of breath, you should consult the NHS 111 Coronavirus symptom checker. This will likely tell you, if these symptoms are new, that you (the affected person) should stay at home for a period of seven days. Those who live with you should follow a range of measures to avoid developing symptoms which include staying three steps (or two metres) away from an affected person. Bed-sharing should be avoided and those who are affected with symptoms should stay on their own in a room, clean the bathroom after they have used it and not share cutlery, crockery or any other personal hygiene items. 

Having begun self-isolation on Wednesday ourselves, just one day before that advice changed, with two small children I am responsible for, the limitations of this are major. We ran out of milk and bread almost instantly as we took the decision for my husband to also work from home. Luckily a neighbour visited a supermarket for us and another let us piggyback on their scheduled delivery due on Saturday.

A petition on the UK Government’s petition website to close the schools has just surpassed 425,000 signatures today at 8:25am on Friday 13th March, which means that Parliament will be forced to consider it for a debate and will respond. Parents across social media are split, with many fearing closures but also preferring to pull their children out of school. 

With Boris Johnson bucking the trend across Europe and the rest of the world, despite warnings from Italians, the European CDC, the WHO, Scotland and Ireland’s measures, I guess it’s time to keep calm and carry on. Keep washing those hands to the tune of Happy Birthday. Some of your more elderly relatives might not hear that little ditty again.

 

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