Thread by @andrewleedr

Musings today:

The problem I think with the current approach to COVID19 is we are approaching it the wrong way round, from the wrong end of the telescope.

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COVID19 is a public health problem that requires a public health approach & solution. Trouble is, we often try to solve public health problems with healthcare solutions from a healthcare perspective.

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If you had cancer, it would be nice to have the best cancer diagnostics & treatments. But wouldn’t it be better not to have had cancer in the first place? What if we eliminated smoking & in doing so prevented thousands of cancers?
Similarly, COVID19 is a preventable disease.

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Our focus is often on the downstream effects & consequences rather than the upstream causes &drivers. This means we end up focusing most of our energies & resources on trying to manage healthcare demand.

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That was a focus early on in the pandemic, with concerns about hospital (and ICU) capacity to meet demand from COVID19 infections being a key priority. This might attenuate deaths.

But, no amount of ICU beds or Nightingale hospitals will stop a pandemic.

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The focus currently is on the debacle around testing capacity for test and trace. But this is still just secondary prevention. Infections have already occurred & many further transmissions may already have taken place by the time people are traced. So not the magic solution.
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There is no perfect test or test system that will detect ALL cases. So some will be missed, especially those that are asymptomatic, and it only takes a few cases to sustain an epidemic. So "managing" infection numbers alone doesn’t solve it.
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Having a testing system is useful, but what is vital is for infected individuals to self-isolate. This breaks the chain of infection. Tests help confirm cases, but it's possible to identify suspects syndromically(based on symptoms) without a test & institute control measures.
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We need more primary prevention: This all depends on changing behaviours. People complying with self isolation advice when symptomatic. People complying with face masks, handwashing, social distancing, etc… We need the support of the public if we are to beat this pandemic.
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