Paul Nuki Profile picture
25 Oct, 11 tweets, 3 min read
1/ Super interesting new info coming out on Exercise Cygnus, the 2016 dry run for a UK outbreak, since its formal publication was forced least week. Raises some important questions on current response... #COVID19
2/ First the sexy bit. Jeremy Hunt, then health minister, "stopped playing" on first day of exercise after being asked to turn off the ventilators of 4,000 people. He says it was 'morally repugnant' and prompted a rethink on triage. Not all agree... telegraph.co.uk/global-health/…
3/ “The hospitals were full and Hunt was asked to make the call as part of the exercise. But instead of doing so he basically said ‘I’m not playing anymore’. People were very cross as it mucked up the exercise”, said one source.
4/ Hunt sees it differently: “In the exercise, Jeremy was asked to make a decision switch off all the life support machines in the country leading to an immediate 4,000 deaths. He believed that was morally repugnant so paused the exercise to explain ....
4/ "that if ministers were being asked to make such decisions we were clearly not dealing with the issue in a sensible way. The result of Jeremy's intervention was extensive and important rethinking about how we avoid getting into such a situation... during the current pandemic”
5/ But what was actually done after Cygnus. The report orders the CMOs of four nations to come up with proper triage protocol, including a "proposal for who would make the decision to move to population-based triage and in what circumstances”. Was this ever done?
6/The only triage protocol I know was produced in a bit of rush by NICE and published on March 21. It sifted on frailty and age. telegraph.co.uk/global-health/…
7/Cygnus made other recommendations. An analysis of NHS surge capacity; a calculation of lives saved/lost by closing hospitals to regular business; a "rapid discharge protocol" for placing hospital patients into nursing homes SAFLEY to mention a few. Where is it all???
8/ Not all Cygnus chores were laid at the door of the NHS. The Department of Education was asked to “examine the impact of school closures on society", for instance, and create backup plans. Did it do it? I don't think so. It didn't even fill in its evaluation of the exercise...
9/ Full analysis here which is free to read: telegraph.co.uk/global-health/…
10/ Jonathan Ashworth, the shadow health sec, to raise formally: “We know ministers were slow to respond ....
There are serious questions as to what they learned from Cygnus and whether they implemented its recommendations. I will be raising this in the Commons when we return”.

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More from @PaulNuki

4 Oct
1/5 It was a real pleasure researching this piece on social distancing - thanks to @HowardMarkel Dr Martin Cetron @mlipsitch and all the others who helped... #Covid_19

telegraph.co.uk/global-health/…
2/ We should not be surprised Geroge W grasped this with both hands. He and Cheney had good reason to be worried by existential threats. The 9/11 attacks in 2001 were quickly followed by anthrax, early outbreaks of H5N1 and Sars. Here's their pandemic severity index...
3/ Bush also did more than anyone to tame the HIV epidemic by launching the game-changing @PEPFAR programme... he did a huge amount in public health, saving millions and should be credited with it...
Read 5 tweets
15 Sep
1/6 Interesting to talk to @BillGates for the launch of the #Goalkeepers report on the UN's #SDGs. His key message: development now in reverse and we need to unite to build up again. Also good on: Sweden, WHO, Vaccines, and the prospects for winter telegraph.co.uk/global-health/…
2/6 On the coming months: “I'm pessimistic about what the fall in the northern hemisphere is likely to look like. If we don't have interventions, the death rate in a number of countries including the US will go back up to the levels that we had in the spring."
3/6 On a vaccine: “By next summer, we'll be getting vaccines out to all the countries of the world... I'm optimistic that next year will be the year that we bring the numbers down very, very dramatically, and that this thing will be over by sometime in 2022.”
Read 6 tweets
27 Aug
1/ We don't hear much of Europe's CDC @ECDC_EU but it has been a major force in shaping the pandemic response. I talked to its top expert Sergio Brusin for his predictions and reflections - you may be surprised by a lot of it...
telegraph.co.uk/global-health/…
2/ Brits will remember Mr Brusin for warning, on March 8, that the UK was following Italy's trajectory and needed to lock down within days. The PM ignored him but he was right then and so it's worth listening to him now...
3/ Mr Brusin is now more upbeat. "The ICUs are not clogged and our health services now have much better planning and response times. So, I am optimistic we will not see the big horrible scenes we saw in March and April, but we will see a lot more cases," he says.
Read 9 tweets
25 Aug
Africa officially declared free of wild polio today. An amazing achievement, hard-won. Now only Pakistan & Afganistan left. If we can kill it off there it will become the second disease after smallpox to have been eradicated #Polio #InfectiousDiseases

telegraph.co.uk/global-health/…
Many other infectious diseases could be targeted for eradication. I think I'm right in saying the three biggest killers remain TB, Malaria and HIV in that order.....
But the numbers - and quality life years gained - by eradicating less widespread viruses like polio remain immense. Look at this chart showing the fall in polio paralysis and think of the suffering alleviated ...
Read 5 tweets
20 Aug
1/4 Sometimes, just sometimes, good journalism can change the most stubborn minds. See this on how a brilliant interview by @niccijsmith appears to have caused Washington to adjust its intelligence assessment of China's role in the #COVID pandemic....
telegraph.co.uk/global-health/…
2/ Here's the May 6 interview with Taiwan's Yin-Ching Chuang, the 1st foreign official to get to Wuhan. He witnesses a senior central gov official admonish a local official for continuing to deny the possibility of human to human transmission on January 13 telegraph.co.uk/global-health/…
3/ As Nicola says, the information adds "context to the actions or inactions that created a deadly pandemic, taking the complications of human nature into account...
Read 4 tweets
16 Aug
The Government has announced is splitting up @PHE_uk PHE. You may think this a good or bad thing but do not be fooled. The agency is in many ways infuriating but most of what it is blamed for is the fault of others ...

telegraph.co.uk/politics/2020/…
2/ That change is afoot should not come as a surprise. The Gov's exit strategy of May 11 flagged: "a rapid re-engineering of government’s structures and institutions to deal with this historic emergency". Some may cast this as politically opportunistic, others as necessary...
3/ It is fair to say PHE response has been "sluggish" but it is blamed for much that has nothing to do with it or is beyond its control. Duncan Selbie, CEO, has been far too shy in making this clear. I'm delighted he talked to us for this piece....
Read 21 tweets

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