Newsnight’s Kirsty Wark interviewed Dr. David Nott to examine a little considered perspective on the Covid 19 crisis: how it will impact refugees, those trapped in conflict zones and the impoverished Developing World in general. Dr. Nott is a massive personal hero of mine; I have been fortunate enough to hear him speak at the Royal Society of Medicine and to chat with him after his presentation. His contribution to trauma Surgery in some of the world’s most dangerous conflict zones has been long sustained and truly remarkable. In the interview Nott was his usual pragmatic, thoroughly down-to-earth self as he spoke with great humility about how he had felt compelled to pitch in and retrain to join the front lines in intensive care; it was typical of his selfless dedication to the medical profession.
Dr. David Nott just published an article in the Lancet that was quite critical of the Government’s unfathomable delay in taking action. He pointed to a paper out of Hong Kong, published on the 30th of January, containing a telling quote from the author, Professor Woo, with a note of warning that: “Large cities overseas with close transport links to China could also become outbreak epicentres unless substantial public health interventions at both the population and personal levels are implemented immediately.” Nott emphasised that it had been published back on January 30th saying that he did not understand why, “from an epidemiological standpoint, why nobody picked up this and waved this red flag, because we had four weeks really of everybody just shrugging their shoulders and thinking it was all going to go away as if it was nothing to worry about.”
Dr. Nott stressed that he is very worried about refugee camps, areas of conflict and the situation in the Developing World. He said how, “in the UK we had the equipment, the ventilators, we had Nursing staff, we had Doctors and when you think about the results we had… this disease is so virulent, so dangerous and so pathogenic.” He referenced a study that showed, “it causes such high mortality that results recently from the Intensive Care Society have shown that 65% of patients, in the best hands possible, died and if you had another problem on top of that… then you had an 80% chance of dying on a ventilator.” He was obviously referring to those who become hospitalized not the total of those infected, however, Dr. Nott is not a raging alarmist and he does not just reel of shocking numbers like that lightly or without sound statistics from credible peer reviewed studies to back up his claims.
Dr. Nott elaborated on how we have another crisis looming. He said, “David Milliband, with the International Rescue Committee, has shown that if we don’t do anything, in the next few weeks 500 Million to one Billion people will become infected and of that 3 Million will possibly die, that is in the low income countries, hostile environments and so on.” Nott said that, “the big problem is that it is nothing to do with ventilator support in these countries it is all to do with nutrition. We really, really, have to ramp up public health support in all these countries, otherwise it’s too late.”
Kirsty Wark interjected, “you saw the failure of international cooperation in Syria, what you as a Surgeon are saying is that you have doubts about international cooperation here unless its led by someone specific, not a country, not a group, not a committee.” It was a valid point that Nott was eager to respond to, saying that: “the big problem how I see it is this, it is a big problem a global problem and we are all in our countries dealing with the problem on our own and making big mistakes.” I was quite shocked to hear him say “not our country, but other countries are making huge mistakes;” personally I think we have made some pretty catastrophic mistakes, but perhaps he was trying not to burn bridges.
Dr. Nott evoked crisis policy in the past saying, “when you look at the Ebola crisis and you look at what happened to the monetary system in 2008, it was led by global leaders and that was America, but now I don’t think we have got that global leadership anymore.” That’s a serious understatement! David Nott went on to say that, “what we really, really need is in a Global Pandemic Executive, that can go to every country of this world and say we have learned from this Pandemic, we have learned how to deal with it, we know what the problems are…” Kirsty piped up saying, “led by whom?” Nott replied without hesitation, “led by David Milliband, without a shadow of a doubt, you have got somebody who is a respectful statesman, a politician with an enormous track record and he needs to be in charge of it.” I would certainly trust the recommendation of an experienced disaster medic like Nott.
Kirsty Wark probed further asking Nott, “you say some of these refugees, in dire straits, will try and come here and that they will then re-infect the west and you paint a gloomy picture, but I wonder if there is anything that gives you a thread of hope in all this?” David Nott had to admit that, “no there isn’t, we really need to get our act together within the next few weeks.” As he described it, “what we have now is this time that is like February was for us this year, we have now got their February this time, so we’ve got four weeks to do as much preventative treatment, as much preventative care as we possibly can. We need to ramp up public health services get people in, water consultants, engineers; make sure that all these countries have proper hand washing, have facilities for social distancing because that is the only way that this virus is going to be contained.”
Kirsty Wark thanked Dr. David Nott. It was such a thoroughly respectful, non adversarial and informative interview that I was quite taken aback; it was a return to a forgotten era where the BBC honestly did their level best to inform the public as best they could and without political bias. I think that Kirsty Wark recognized that Dr. Nott had a very important message to deliver and she focused on helping him get that message across in the most effective way. It was a really impressive interview so I wanted to feature it here and remind people that, as dire as our situation might seem here in the UK, the challenge faced in the Developing World will be truly staggering. It was reassuring to see the BBC feature a few days ago on how South Africa has coped so far, it was a real testament to President Cyril Ramaphosa’s decisive leadership that, from the same starting point and with much greater challenges, they have experienced a far lower death toll than we have here in the UK.
The issue of how Developing countries will cope with Covid 19 has been bothering me since the very beginning of the outbreak as my 2009 ten country tour of sub-Saharan Africa doing a “Needs Assessment of Anaesthesia Care” exposed me to just how severely deprived and overwhelmed their healthcare systems were under routine circumstances. Having worked as a Medical Volunteer myself in Surgery following disasters, including in the conflict zone of Aceh after the Boxing Day tsunami, I have great respect for Dr. Nott’s huge contribution as he has faced the toughest of challenges. He spoke at the RSM after returning from a dangerous mission to Syria, a country that he told us, was one of the few in the world to not be a signatory to the Geneva Convention. The International Rescue Committee funded one of my projects in Aceh and I know from dealing with them that it is a very professional organization; we would do well to follow Dr. Nott’s advice.
I now from my Conflict and Catastrophe Medicine training with the Worshipful Society of Apothecaries that there are internationally defined spaces assigned to each and every person housed in a refugee or IDP camp, but there is little scope for Social Distancing. It is hard to provide enough water supplies for drinking without the burden of greatly increased hand washing. Sheltering those displaced by our proxy wars, and feeding those forced into starvation due to our alignment with foreign despots, has remained a massive challenge for a very long time. Aid money has been weaponized to dominate resources and wealth at the expense of ordinary people who are swept aside as collateral damage in the carnage we leave behind. We have barely scratched the surface on alleviating global poverty and I doubt there is the political will to intervene now and fix major problems in a few short weeks.
A chain is only as strong as its weakest link; Mario Cuomo, the Governor of New York State, has just recently learned to appreciate that reality. After years of the US clinging to their costly for-profit Healthcare system they are discovering the horrific ramification of not instituting the kind of universal access common in most industrialized democracies. The people the US has refused to treat, those who are denied access to healthcare, represent a fertile breeding ground for diseases that, in a highly mobalized society, are capable of sweeping the entire country in a matter of days. America is right on track to have the highest per capita death toll in the world, but shamefully we are not that far behind.
The untreated prevalence of Covid 19 in the Developing World increases the likelihood of mutation to an even more deadly strain that we absolutely cannot allow to incubate unimpeded. The Spanish Flu epidemic morphed into a more deadly disease that hit many countries with a second wave of infection and death; we cannot be certain that a vaccine will save us from a similar fate. Covid 19 will not cease to be “our problem” when it is eliminated here! We cannot simply detach the UK from the enormity of the far greater looming crisis overseas because we are just one international flight away from importing a new wave of infection. As Dr. Nott reminds us, this is such a virulent, highly infectious virus that we must treat the global population as one; if we fail to heed his advice we will be forever held hostage by its lingering presence in the poorer nations of the world.
I fear that this Tory Government seriously lacks the expansive humanitarian thinking to take a leadership role in driving this urgently needed international rescue agenda. This could all have been so very different without the grotesque injustice of the Covert 2019 Rigged Election. A progressive Government could have made a significant difference, not only domestically here in the UK following a decisive action approach, similar to South Africa, to save countless lives; we could be beyond the crisis and ready to demonstrate global leadership countering the toxic interventions of Donald Trump. If we fail to investigate and correct the injustice of the stolen election we are destined to continue on the current trajectory of disaster as Boris Johnson strips away every last vestige of democracy in the UK. There is still time to correct the damage and forge a recovery, so we must not give up the fight.