One of the welcome features of the response to the COVID-10 pandemic worldwide is a new-found respect for experts, for evidence and for data. In the UK, the Scientific Advisory Group for Emergencies has occupied centre-stage. Even its sub-committees NERVTAG, SPI-M and SPI-B have entered into public consciousness.
Wales has a representative on the SAGE committee, and the Welsh Government has its own Chief Medical and Chief Science Officer to provide independent advice. Scotland has, however, gone one step further in establishing its own scientific advisory group which has now met five times. It consists of leading experts in medicine and public health, including Devi Sridhar of Edinburgh University, who has been a very vocal critic of the UK approach on testing.
I wrote to the First Minister to ask him to appoint a similar scientific advisory group for Wales. Wales, after all, has a different demographic structure, and a different urban/rural mix, to England which may affect the modelling on how different policy approaches might work. There is also a debate between scientists on the best approaches to combating the disease which is reflected in the range of policies adopted by different governments across the world. A scientific advisory group for Wales could help the Welsh Government interpret the evidence from SAGE, using Wales-specific data and drawing on the growing body of international evidence.
On Friday the First Minister did announce the creation of a wider group to advise himself on policy but there are no more details at this stage.
There are two areas this group should look at immediately I believe:
Exit Strategy
Many countries that have successfully suppressed the number of new cases have done so through the adoption of a policy of testing, contact tracing and case isolation. The First Minister has agreed to ask SAGE if it will conduct separate modelling of a testing and tracing policy for Wales. But the Scottish Government has and produced its own Scotland-specific modelling of the COVID-19 Pandemic, and their Advisory Group in its meeting on April 6th advised in favour of the “consideration of the potential role of contact tracing and case isolation.”
Early treatment
In addition to testing and contact tracing, another common factor is emerging as a possible explanation as to why some nations and regions have achieved markedly lower fatality rates from COVID-19. There is already a shift in treatment away from mechanical ventilation which has a poor prognosis for many patients to a variety of non-invasive approaches. This raises the question of whether more patients could be treated earlier, even at home, before their symptoms become more serious and intubation for the critically ill becomes a necessary option.
A Chinese study in the Annals of Intensive Care based on experience in Jiangsu Province concluded that early screening of critically ill patients and early intervention can reduce patient mortality. Starting earlier, in essence, better enables a still healthy body to mount a successful immune response. A study by physicians from Bergamo, Italy published in the New England Journal of Medicine has recommended a combination of “early oxygen therapy, pulse oximeters, and nutrition delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments” as a means of preventing hospital-acquired infection. Early diagnosis and treatment, enabled, of course, through its impressive record on mass testing, have featured prominently in Germany’s approach to COVID-19.
Advisers advise, ministers decide - as the old saying goes. But deciding on the advice you need is sometimes the most important decision of all.
It is now clear that the removal of a society’s civil liberties by state sanctioned decree is the biggest threat to us. It was based on no real science (just a rush politically to be seen to be doing something) and is totally flawed. Do tell us Mr. Price why this disease that in the main kills the very elderly (that is not being callous just a fact as most would have died in the next few months anyway – that is why they are in nursing homes in the first place) and 9 out of 10 have pre existing conditions is so serious because it may kill 20,000 – 40,000 in the UK whilst cigarette smoking kills 80,000+ a year in the UK. I haven’t seen a single cigarette under lockdown.
A recent paper from the USA “Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019” again confirms that most “Most of the hospitalized patients had underlying conditions”. Including “Among hospitalized COVID-19 patients, hypertension prevalence was 50% (range across age groups = 18%–73%), and obesity prevalence was 48% (range across age groups = 41%–59%).”
“During March 1–30, underlying medical conditions and symptoms at admission were reported through COVID-NET for approximately 180 (12.1%) hospitalized adults 89.3% had one or more underlying conditions. The most commonly reported were hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%)”
The implication being that much of the morbidity supposedly caused by the virus is actually mostly self inflicted and thus why has no country yet prescribed statutory exercise regimes as opposed to lockdown? The cynic in me would say that, amongst other reasons, there is not much profit for big pharma and the medical industrial complex in going down that route.
https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6915e3-H.pdf
The reality is that you failed as politicians to fund and prepare the NHS properly for such an event. The event itself is no more serious than a severe flu outbreak, you are just following the herd to be seen to be doing something and have completely trashed Wales’ economy as a result
Perhaps Wales should start listening to some experienced scientists? Professor Johan Giesecke, one of the world’s most senior epidemiologists, advisor to the Swedish Government (he hired Anders Tegnell who is currently directing Swedish strategy), the first Chief Scientist of the European Centre for Disease Prevention and Control, and an advisor to the director general of the WHO, lays out with typically Swedish bluntness why he thinks:
UK policy on lockdown and other European countries are not evidence-based.
The correct policy is to protect the old and the frail only.
This will eventually lead to herd immunity as a “by-product."
The Imperial College paper was “not very good” and he has never seen an unpublished paper have so much policy impact.
The paper was very much too pessimistic.
Any such models are a dubious basis for public policy anyway.
The flattening of the curve is due to the most vulnerable dying first as much as the lockdown.
The results will eventually be similar for all countries.
Covid-19 is a “mild disease” and similar to the flu, and it was the novelty of the disease that scared people.
The actual fatality rate of Covid-19 is the region of 0.1%.
At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available.
https://youtu.be/bfN2JWifLCY