Thread by @danielgoyal

Covid-19 and Herd Immunity

What is the clinical harm associated with pursuing a herd immunity policy?

1/15

#GovernmentCovidCatastrophe
@IndependentSage @DMinghella @doctor_oxford @ShaunLintern @dgurdasani1 @trishgreenhalgh @Kit_Yates_Maths @chrischirp
@TheBMA #TeamNHS

Putting aside whether it will work or whether a Health Immunity Strategy (HIS) is ethically right...

What will be the CLINICAL harm to the UK public of allowing SARS-CoV-2 to spread without any mitigation strategies?

We know access to healthcare during a pandemic saves lives and prevents disability.

We know the greatest barrier to a "catastrophic loss of life" with HIS is healthcare availability @wtgowers @ChrisCEOHopson

We are also aware of some of the secondary effects:

- Long COVID

- Shortened Life expectancy due to delayed diagnoses such as cancer, stroke, heart attacks, etc..

- Reduced quality and quantity of life due to cancelled operations.

But, what many might be unaware of (and going by @BorisJohnson and @sajidjavid previous actions this includes those making the decisions) is what happens when bed capacity goes beyond 85%.

It is @NHSProviders upper limit of safety (albeit most European neighbours quote 80%)

It may seem to the uninitiated that we are fine, there are still 15% beds available - the NHS isn't at capacity yet.

This is FAR from the truth

When beds are tight, we (those of us on the front door) must avoid admissions of patients we would - if capacity had been 70% - admit

We must discharge people before they are ready and often with higher risk - both of clinical deterioration and readmission.

Waiting times for essential tests and treatments lengthens, and again, we know this affects morbidity and mortality.

And yes, staff get knackered too.

Some nations have pursued herd immunity. One would have to agree with Prof Gower's assessment back in March 2020:

The loss of life and harm to the economy of herd immunity would be simply too great.

theguardian.com/world/2021/may…

The limit, Prof Gower writes, is healthcare capacity. We have no-where near the healthcare resources to consider a herd immunity strategy without a 'catastrophic loss of life'.

So then, if, as all evidence suggests, this government has pursued a herd immunity without:

1. More beds than before the pandemic (only country I am aware of worldwide that has less beds than pre-pandemic)
2. Any triage system in place for COVID patients
3. Any follow-up service

4. Bolstering primary care (and we know there is money - double the entire primary care budget has been allocated to Test and Trace that is now largely defunct)
5. Protection or mitigation of the vulnerable
6. Informing the public
7. Preparing in anyway at all it seems

10/15

...then there will be much greater harm than is necessary.

To be clear, I do not agree with a herd immunity strategy - their is neither the evidence it works nor does it fit with the values of humanity.

The point:

Is this another example of an ideological or populist snap decision without any plan or strategy or available competency to deliver it?

Undoubtably, the harm in terms of years of life lost will be, IMO, amongst the worst experienced anywhere in the world.

What's needed:
1. The public must speak out
2. Local authorities must take action
3. Rapid expansion of basic healthcare capacity
4. Triage and follow-up COVID cases (early intervention reduces healthcare burden)
5. Redeploy! To primary care and to urgent secondary care services

Repeating the same thing and expecting a different result is foolish.

This government has demonstrated it is neither willing nor able to respond to mass causalities.

We need local leadership to step up.

END