A critical care doctor working in a UK: The initial UK government approach has been a total failure.

Originally posted on Reddit — reprinted in full, in case it disappears.

Q: There’s been a lot of confusion regarding the UK government policy re Herd Immunity and being contradicted by different officials. Was this ever part of the administrations plan, or was it just a miscommunication from BoJo? I understand if you don’t have details and are the wrong person to ask.

A: I’m sad to say that I do have the details, and there has been intense discussion about this over the past weeks. To answer your question: “herd immunity” would have been a beneficial outcome to slowing virus growth to a prolonged period of time. It was not a primary outcome.

That said, the official policy was wholly wrong and when all the dust has settled, when all the costs and lives have been counted, people have to make their governments accountable.

I’ll tell you what happened in the UK.

Over the past decade, eminent figures in public health developed complex models that would help inform the UK response to a pandemic. The response plan would allow slow spread through a population and a number of deaths that would be deemed acceptable in relation to low economic impact. Timing of population measures such as social distancing would be taken, not early, but at a times deemed to have maximal psychological impact. Measures would be taken that could protect the most vulnerable, and most of the people who got the virus would hopefully survive. Herd immunity would beneficially emerge at the end of this, and restrictions could relax. This was a ground-breaking approach compared to suppressing epidemics. It was an approach that could revolutionise the way we handled epidemics. Complex modelling is a new science, and this was cutting edge.

But a model is only ever as good as the assumptions you build it upon. The UK plan was based on models with an assumption that any new pandemic would be like an old one, like flu. And it also carried a huge flaw – there was no accounting for the highly significant variables of ventilators and critical care beds that are key to maintaining higher survival numbers (https://www.newstatesman.com/politics/health/2020/03/government-documents-show-no-planning-ventilators-event-pandemic).

So, come 2020 and COVID-19 causes disaster in China, Iran and Italy. Epidemiologists and doctors from around the world observe, and learn valuable lessons:

* the virus is insidious with a long incubation, any population actions you take will only have an effect weeks later
* the virus spreads remarkably quickly and effectively
* the virus causes an unusually large proportion of patients to require invasive ventilatory support
* early large scale testing, and social distancing measures, are effective at stopping exponential growth
* stopping exponential growth is VITAL to preventing your critical care systems from being overwhelmed.

Everyone in the world could see these things. But despite this, very few governments chose to act.

The UK did the opposite of acting. In an act of what I see as sheer arrogance, they chose to do nothing, per the early stages of their disaster plan. There was some initial contact tracing, but this stopped when it was clear that there was significant community spread and exponential growth. And after this? They did not ramp up testing capabilities. They did not encourage social distancing. They did not boost PPE supply, or plan for surge capacity. They ignored advice from the WHO, public health experts in other country; epidemiologists, scientists and doctors in their own. I can tell you with certainty now that they did not even collect regular statistics for how many COVID patients were being admitted to critical care in the UK. They did nothing.

What were they thinking? Maybe that what had happened in China, and was happening in Italy, couldn’t possibly happen in the UK, right? It was impossible. The persisted with the original plan with no modification.
Well COVID-19 is not flu. That is perfectly clear. And it was clear that the UK numbers were following, exponentially, the same trend as Italy. But still the government and their advisers stuck to their guns and put out reassuring messages. I would ask here – why did they still think we would be different?

Finally, a team at Imperial informing the government’s response put up-to-date COVID-19 data into the historical models that the UK plan was based on (https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf), and predicted in a best case scenario 250,000 deaths and excess of 8x surge capacity of UK intensive cares. They concluded that our approach was wrong, and that “Epidemic suppression is the only viable strategy at the current time”.

Where are we now?

The government has instituted a number of measures that they previously called “unscientific”, but has not mandated them.

We are far, far into the exponential curve both in deaths and critical care numbers, and there is at least two weeks more growth until any of the half-hearted measures taken might kick in.

We do not have sufficient testing capability for even hospital patients, who sometimes wait days for a test result. There are not enough tests for anyone in the community, or any healthcare workers who might have symptoms.

Hospitals are scrambling to produce surge capacity, and several smaller hospitals in London are now overwhelmed with COVID and out of ventilators.

There is clearly not enough PPE in the country and we are rushing to secure supplies.

Don’t believe the UK government propaganda when they say that they are only advancing along the same plan at a faster pace. It is total bollocks. Their plan was wrong, kaput, totally broken. They chose to perform an experiment on an entire population, a trial of ‘new epidemic mitigation strategy in UK’ vs ‘epidemic suppression in rest of the world’. They didn’t listen to other experts from all over the world, and in this arrogance they did not observe the lessons or data that was there, plain to see. They have backtracked completely and are now doing what most world public health experts and what the WHO asked them to do in the first place. They’ve wasted a month, at least.

Will they suffer? Hell no. It will be the vulnerable in the population, the unlucky young, and the medical staff at the front line.
When the final counts return in months or a years time, don’t let them get away with it.

Via: I’m a critical care doctor working in a UK high consequence infectious diseases centre. Many units are totally full, and we are scrambling to create more capacity. The initial UK government approach has been a total failure. Ask me anything. : Coronavirus