We’re at war with an invisible enemy: here’s how we fight it
BY ADAM HAMDY
I previously wrote two pieces challenging the government’s assumptions. Read the deep dive here and the short dip here. Now, the government’s advisers have now admitted they got their assumptions and modelling wrong. By their own reckoning, the government’s initial approach, if implemented, would have led to an additional 250,000 deaths. I hope the British people will learn from this near catastrophe.
We’re living in unprecedented times, and very little is known about COVID-19. This is a time for transparency and collaboration, sharing data and opening models to scrutiny. We need to take an open source approach to problem solving. Ideas should be widely shared, challenged and tested, particularly when lives are at stake, and we should recognise that practical ideas can and will come from all quarters, not just those with the longest list of academic qualifications. Industrial cleaners might have better suggestions for how to regularly disinfect public places than epidemiologists. The analysts at Bet 365 might have better modelling capabilities to help predict risk in specific circumstances than any government scientist. Many businesses saw what was happening in China and moved manufacturing, banned travel and retooled systems to support homeworking, responding far quicker to the emerging crisis than government – we need to tap into their forecasting and supply chain expertise now.
I believe there are a number of conceptual and practical steps the government can take to help us effectively navigate the stormy waters that lie ahead.
Conceptually, I believe the government needs to change its thinking in three key areas:
HEALTH AS AN ASSET
I previously wrote,
“There are two types of people. Those who know and accept we’re now living in a pandemic world and those who don’t. Our priorities and decision making processes need to radically change. Trying to impose the pre-pandemic model on the pandemic world, simply won’t work.”
Health now has true economic value. China took urgent decisive action and has been rewarded with an economy that is slowly starting to get going again. International companies such as Apple have recognised China’s success and reopened stores, while they’re closing them elsewhere in the world. Corporations will reward governments who put public health first. Companies big and small want to know their employees and customers are safe.
AN OPEN SOURCE RESPONSE
The British government has run an atrocious communication campaign and has been slow to share information. As the modelling error demonstrates, the government must be transparent with its thinking. Key assumptions must be subjected to scrutiny and models must be rigorously tested. Challenge and ideas must be accepted from anywhere. What matters is the strength of the idea, not the person or organisation it originated from.
RISK MANGEMENT AS A WAY OF LIFE
I’ve been listening carefully to Professor Chris Whitty, Sir Patrick Vallance and Matt Hancock and some of the things they’ve said have shocked me. Obviously there’s the ‘herd immunity’ theory which merits no further discussion, but they’ve also said things like ‘there’s no point testing people at airports because we would only catch two-thirds of infected people’. ‘There’s no point doing temperature testing because people could be suffering with a cold or flu.’
These statements show a misunderstanding of how COVID-19 will be beaten. Until the day before yesterday, the government had been banking on a magic bullet – the slow and steady infection of the population. We, and, more importantly, they now know there is no magic bullet.
The only way to defeat COVID-19 is to use a whole of government, whole of society approach that minimises risk in as many ways as possible. In the short term that is likely to mean a city or nationwide lockdown until our epidemic can be brought under control. It’s going to be longer and more drastic than it would have been if the government had acted to implement more modest measures sooner, but we are where we are. In the absence of a cure or vaccine, the government must use the time the lockdown brings to implement medium term measures that will protect against another outbreak or second wave. None of these measures will be a magic bullet, but working in concert, they can minimise the risk of COVID-19 and its burden on the NHS and economy.
I believe the government needs to take the following practical steps:
Appoint an individual with executive authority to work across different ministries who is responsible for the national response to contain and ultimately eradicate COVID-19. The Prime Minister cannot do this job. He needs to get back to being a Prime Minister, and government advisers should not be put in a position of making and implementing recommendations. There needs to be someone responsible for implementation who can challenge assumptions and coordinate a whole of government, whole of society response.
Communication needs to be timely, clear and unambiguous. Far too many people are still under the impression COVID-19 is a mild illness. There needs to be a comprehensive public information campaign to clearly communicate the risks and complications that can arise from the disease. People must be made aware how serious it is, so they realise why they must alter behaviour and take steps to help prevent transmission.
The government must also provide information about confirmed cases at a local and sectoral level. If particular industries/sectors are prone to infection, greater controls should be implemented. If particular towns are suffering outbreaks, people should be informed so they can alter behaviour to reduce risk. In an epidemic, granular information can help prevent the virus spreading and help save lives.
In addition to granular data about transmission and spread, in the absence of sufficient hospital beds, the government needs to communicate guidelines for the treatment and care of people in their homes.
Re-institute testing and contact tracing as extensively as possible. Chase the virus and do not let it take root in communities without a fight. China has been quarantining recovered patients for 14-days after clinical recovery and two negative tests to minimise the risk of recovered patients infecting others. Without testing, how will people know whether they’ve just had a cold or flu, or if they’ve had COVID-19 and should protect others by quarantining themselves once they’re no longer symptomatic?
The government needs to close the schools immediately, and shut down the country for all but essential travel – to and from work, for supplies and medical care. The schools are acting as transmission vectors, and as I’ve repeatedly said, children’s clinical characteristics of being largely mild or asymptomatic make them perfect transmitters of the virus. Italy’s experience shows the longer you leave schools open, the more infection you will be sending into the community when you finally close them.
Use the time the country is in lockdown to put in place measures that will protect against future outbreaks. Airport screening might only capture 30% of cases, but temperature checks at offices, schools and public venues might capture another 25%. Widespread use of masks might reduce transmission still further. Disinfectant rollers at the top of London Underground escalator handrails would reduce contact risk. Limiting tube carriages to 50 occupants would use the virus’s transmission probability against it. Look to build those percentages wherever possible. Create enough friction against the virus with lots of practical measures and the overall risk will greatly diminish. There are thousands of such measures, which collectively would minimise risk. Let’s use our time wisely and put these measures in place while the country is confined to quarters.
Public health is at a premium. We’re going to need more hospital beds and ventilators. We also need to invest in rapid testing technologies to enable individuals, businesses and organisations to quickly detect COVID-19. Learn from South Korea and buy the expertise and technology that enables that country to run what is probably the most successful contact tracing operation in the world.
In addition to a vaccine and cure, we must also invest in scientific research to better understand the characteristics of COVID-19 and its long-term risks to human health.
Use the monitoring and risk mitigation tools to reduce transmission risk, but be ready to act swiftly if signs of an outbreak appear. Transparent, granular local information and rapid and extensive testing should mean a decisive local response should be sufficient to contain future outbreaks and prevent them escalating to a national level.
If we make these conceptual and practical changes, I believe we can balance the needs of public health and economic prosperity and effectively manage risk until the magic bullet of a vaccine or cure is finally delivered. The government needs to stop giving COVID-19 the time and space to flourish. It needs to act decisively and take charge of the situation to neutralise this urgent threat.
Adam Hamdy is a novelist and screenwriter who has previously worked as a management and healthcare consultant. Follow him on Twitter: @adamhamdy