The confusion created by the government’s approach to dealing with the Covid-19 epidemic is irrespective of whether the approach they have taken is right or wrong. Here are some of the issues:
1. The approach taken is at variance not only with advice from the WHO but also from the proven experiences of positive actions taken in China and South Korea, and negative ones because of delayed reactive rather than pro-active measures such as Italy and now Spain.
2. The reliance on ‘science’ as a sacrosanct entity. Science is never dogmatic and is flexible and acts and seeks new evidence especially in a novel complex evolving situation as in this case. A lot needs to be known about the nature of the immune response as to whether it is lasting and also as to whether it is an antiseptic immunity or a protective immunity. Whether this virus will be seasonal or not also remains to be seen. Part of the government’s approach appears to be directed at ‘buying time’ until the summer when the transmission may decrease, but this is not known. An interesting fact is how mortality is very much age related and how children do not seem to get serious disease. This of course cannot be because they are less more immune, because they are not but it may point out to a possibly immune response to the virus that is causing the pathology. This concept called a cytokine storm is very well known and developed in models of other diseases such as SARS-CoV, influenza virus, and dengue virus infections.
3. Because there is still much to learn about Covid-19 it seems counterintuitive to rely on a single mathematical model in talking this virus. If we can have a different range of models that can be discussed, then that would open up the possibilities. Modelling would surely also be seriously influenced by actual practice and experience of those who have handled the infection.
4. Some of the decisions seem to be political rather than medical and scientific. Some of them are very soft excuses, such as people getting fatigued if measures are introduced too early. This is a serious situation, a matter of life and death, will people be fatigued.
5. Reliance on protecting the elderly and vulnerable seems to ignore the fact that there is still considerable mortality in younger age groups (see table above) and also the effect of swamping of the health services such as seen in Italy and Spain which will increase the mortality in all age groups.
6. The government does not have a highly visible campaign that is coordinated and reassuring. The PM has not been heard off for many days. Some measures are leaked without careful consideration of their impact or of details of how they are to be implemented.
7. There is a total lack of organization at local levels. This is because of neglect of the role of councils in this respect. This means that communities will have to organize themselves locally without a central structure. The Tories mantra initiated by Thatcher “There is no such thing as society” is coming home to roost with a vengeance. What should be happening now is the appointment of wardens through councils and wards according to current councils and that these will receive some training as to various actions needed, not only to see that the vulnerable are protested, but also that some of these recommendations are followed because policing locking up a few million pensioners is not going to be easy.