Covid-19: what should have been done and what is to be done

This list of failings is not just being wise after the event. All but one of the measures have been applied elsewhere in the world or even belatedly in the UK.

General principles

Make sure that the National Health Service can not only cope with seasonal emergencies but also can gear up quickly for the sudden unforeseen. There were warnings with the swine 'flu pandemic of 2009 and later bird 'flu epidemics, so much so that the Cameron government commissioned the Cygnus exercise. The findings were virtually ignored. A strategic stock of personal protective equipment for health service and social care workers has to be maintained and any time-limited items replenished. The English stock was run down.

Learn from others' experience

If an exotic disease emerges elsewhere and its symptoms are known, test incomers for those symptoms. Do not wait for the perfect specific test. As we know now, asymptomatic victims will be missed but the most obviously infectious cases can be identified and possibly hundreds of lives saved. This is what Taiwan, with justified suspicion that they were on the edge of a new SARS, did from January 1st.

Do not wait for the World Health Organisation or the European Centre for Disease Control. They are worthy bodies good at organising public health campaigns but because of bureaucracy, move slowly. 

Protect people most at risk

In addition to providing PPE to health and social care personnel, press retail outlets and public transport organisations to do the same for their staff who have to interact with the public. Do not force hospital staff to work overtime - stress increases the risk of infection. And the one original suggestion I would make is to stand down over-50s, given that this is the cohort most at risk.

Use existing techniques and facilities

Identify hot-spots and apply quarantine ruthlessly. New Zealand did the latter. Use the existing contract tracing arrangements for notifiable disease, "boots on the ground" and encourage local community coordination and action. In addition to China, Italy, France and Spain soon emerged as spreading centres of the disease, but the UK delayed quarantine measures until  July. Do not stake all on new technology. South Korea achieved wonders with a smartphone-based track and trace system, but this is probably the most connected and tech-savvy country in the world. Ceredigion has shown the way with traditional methods and common sense. Although infection figures have risen with the influx to Aberystwyth of students for the new term, the county maintains the lowest infection figures in Wales. 

Take the public with you

When you say you are consulting people before imposing control measures, really consult. Listen to people and, when you reach a decision, inform them before you release it to the media.

There is more that can be done, no doubt

 - but surely if the measures above had been applied swiftly, there would have been no need for a general lock-down, with all the implications that had for the economy. Local clusters of infection would spring up but they could have been identified swiftly and dealt with.

Herd instinct is an illusion. It is based on the experience with the MMR vaccine, which does give practically life-time protection. Documented reinfection cases show that Covid-19/SARS2 behaves more like other corona viruses, such as those that cause common colds. 

Cummings and Johnson continue to make mistakes. There is not just one alternative to draconian lock-downs; Phil Hammond MD writes in the current Private Eye:

"No one sensible is suggesting the virus should be allowed to run free.
But plenty of sensible people are wondering how other countries are
controlling the virus without the need for more lockdowns.

"Wild spread of Covid-19 is slowed by doing the basics: hands, face, space
and indoor ventilation. Because so much spread is asymptomatic, it is
vital to stamp on symptomatic infections as soon as they occur. The UK's
test and trace system cannot cope. It has rationed tests so thousands
can't get them, and delayed contact tracing of more than 15,000 positive
tests by up to 10 days because of a 'computer glitch'. So up soars the
wild spread.

"Countries with a grip on the virus without lockdowns have ruthless test
and trace systems. Testing, reporting, tracing and quarantining are all
done at high speed, with high efficiency. The poor are supported to
isolate. There is a focus on breaking chains of transmission. Each new
case is treated as if it were the first. And levels of public trust and
compliance are high because the public services are efficient."

To see how the UK is doing in comparison with other countries, CNN and Johns Hopkins University provide figures here.