Thread by @DrLeeJones

Why containment of #COVID19 has already failed in the UK: a thread.

My partner comes home with flu-like symptoms. Calls 111. They say: you're not old or in contact with diagnosed cases; you'll be fine.

This implies that those diagnosed with COVID19 have the virus. Wrong. 1/16

c.80% of #COVID19 victims have mild symptoms. Many are asymptomatic. If you only test those with severe symptoms/ close to known cases, you'll miss these people, who will nonetheless be able to spread the virus to others.

2/16

Compare this to S Korea. They test widely, on demand and at random - even offering drive-through testing, with testing down to 10mins. They thereby identify many more COVID19 carriers, who can be isolated, limiting its spread.

scmp.com/week-asia/heal…

3/16

UK is way behind Korea on testing rates. Accordingly, we're just touching the tip of the iceberg. The disease is spreading without being recorded.

The way knowledge of cases lags behind #COVID19's spread is dealt with at length here. medium.com/@tomaspueyo/co…
4/16

Accordingly, as govt has just now admitted (while I'm writing this thread!), 5000-10,000 additional people already have the virus in the UK - versus just 373 confirmed cases.

bbc.co.uk/news/live/worl…

7/16

Obviously, many tests will be negative: in SK, 98% are. This may seem wasteful. The flip-side is that more cases are caught and contained, curbing #COVID19's spread and arguably reducing fatalities. Current fatality rate in SK is just 0.8%, << global average of 3.4%.

5/16

So why hasn't UK tested more? It lacks the capacity. It does about 1,500 per day, taking a full 24hrs (vs. SK's 40mins). It is only scaling up to 8,000 per day. It could run at max. capacity for 3 weeks and still have tested fewer ppl than SK.

england.nhs.uk/2020/03/nhs-to…

6/16

This isn't simply about austerity, though that hasn't helped. Fundamentally, since its inception, the NHS has always been a healthcare rationing system. It is very *efficient*, i.e. it delivers surprisingly good outcomes given that it's starved of resources. 7/16

But that doesn't mean the NHS is good in an *absolute* sense. Health *outcomes* are worse than many other countries. But we can't have a rational conversation about healthcare provision here, thanks to the sacralisation of "Our NHS".

ifs.org.uk/uploads/HEAJ63… 8/16

So, while the UK govt may be "following the science" on #COVID19, in the NHS rationing system, science is mediated through greater resource scarcity and penny-pinching cost-benefit analysis than in other healthcare systems. 9/16

So, when there are only 1,500-8,000 tests for #COVID19 per day, they are rationed for the highest-risk groups. Makes sense, but will inevitably result in many missed cases and allow the disease to spread. 10/16

Also, the fundamental task of any capitalist state is to keep the economy going. Factor that into your cost-benefit analysis and draconian containment measures at an early stage of the disease look very unfavourable. 11/16

Hence also the decision to "delay" the virus, i.e. shift peak into summer when NHS resources are less pressed. In essence, the govt immediately accepted that, given resource scarcity, #COVID19 couldn't be halted, only spread out to avoid exceeding NHS capacity. 12/16

There are also other trade-offs that exist regardless of the healthcare system. Closing schools can deprive key workplaces (care homes, hospitals, supermarkets) of workers. Prolonged lock-downs can also be v difficult for older and poorer people, etc. 13/16

And, ultimately, there's no vaccine yet & likely won't be for over a year. So, unless you can contain 100%, long-term (extremely hard!), it will spread & the only way to defeat the disease is for people to get sick and recover, acquiring immunity. 14/16

Ultimately, these decisions make sense at a population level. They deploy scarce resources for maximum benefit. But that's of little comfort to individuals who will get ill or die. 15/16

I see govt has just advised everyone with a cough/ fever to stay home for a week. That's a step forward, not least for my partner. Stay well, folks. Based on the Italian experience, you won't want to see the NHS if you don't. 16/16

weforum.org/agenda/2020/03…

Sorry, this is meant to say ONLY those diagnosed have the virus!