Covid-19: A wake-up call
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2021 (Published 21 May 2020) Cite this as: BMJ 2020;369:m2021
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Dear Editor
BAME clinical and support staff are dying in disproportionate numbers, as are those in the general population.
The suggestion from the enclosed literature is that vit D helps the immune system resist viral infections, and that a good supply prevents the covid infection 10th day deterioration, with a 'cytokine storm' inflammation that damages the lungs, often with fatal results, and also the kidneys and other vital organs. A dark skin pre-disposes to vitamin D deficiency in the bleak UK climate.
The final process is of small clots affecting the lung blood vessels, and the kidneys. The last paper suggests that treatment with high doses of a heparin type anti-coagulant can reduce this clotting process, with a lower death rate.
BAME populations are more prone to cardiovascular disease, so that those of South Asian heritage are advised to keep to a lower BMI to prevent this. The risk factors for clotting are very similar to those predicting death in covid patients. There are difficulties in arranging a life-saving organ transplant in BAME populations, as their transplant antigens are different.
At a time of a pandemic, lower standards for the initiation of new treatments may be acceptable. If I were BAME, I would be taking vit D supplements, and would be demanding early treatment with anticoagulants if I were to develop serious complications of covid.
The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients.
.https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4
E. Laird, J. Rhodes, R.A. Kenny. Vitamin D and Inflammation: Potential Implications for Severity of Covid-19. Irish Medical Journal, 2020; 113 (5): P81
Association of Treatment Dose Anticoagulation with In-Hospital Survival Among Hospitalized Patients with COVID-19. Journal Pre -Proof.
https://www.sciencedirect.com/science/article/pii/S0735109720352189?via%...
Competing interests: No competing interests
Dear Editor
The BMJ has demonstrated, once again, the courage of its conviction to dispose its ‘Triple-A Process’ on the UK Government’s handling of the ‘COVID-19 Pandemic’ and denominated in a ‘Wake-up Call’ [1]! The ‘BMJ Position’, of course, does not reflect a ‘Unanimous Disposition’ [2] on the ‘Extant Conversation’ but clearly highlights the ‘Path to the Future’ in the ‘Fight’ against the ‘World’s Greatest Unprecedented Unseen Enemy’! Being a ‘Novel Coronavirus Disease’, the ‘COVID-19 Pandemic’ caught virtually ALL Governments in the World completely ‘Off-guard, Unprepared and Programmatically Paralyzed’ in their ‘Pandemic Interventions’! The UK Government is not extricated from this ‘Generic Disposition’ and this is the ‘Truth/ Fact’ amplified by the ‘BMJ Position’!! The UK Government was the ‘Arrowhead’ of the ‘4-Point Approach’ to tackling the ‘COVID-19 Pandemic’: Contain Delay, Research and Mitigate! This ‘Intervention Strategy’ was criticized for not including ‘Public Health Intervention’ for a predominantly ‘Public Health Scourge’!! It is doubtful how effectively the ‘WHO Standards for Containment’ were, in fact, implemented: Finding, Testing, Treating and Isolation!
The fact of being a ‘Novel Coronavirus Disease’ was the ‘Arrowhead of Unpreparedness’ in mounting timeously ‘Appropriate Interventions’ against the ‘SARS-CoV-2’ and the disease caused: ‘COVID-19’! The ‘Politics’ of the ‘Virus Origin’, ‘Virus Nomenclature’ and ‘Disease Nomenclature’ also conjointly mitigated against any ability or capacity of any Government to mount ‘Appropriate Interventions’ against the ‘COVID-19 Pandemic’. Indeed, the ‘COVID-19 Pandemic Information’ is remarkably still ‘Work In Progress’ and ‘Information in a Flux’! Much more is ‘Unknown and Uncertain’ about the ‘SARS-CoV-2’ and ‘COVID-19’ as increasingly much more is transmuting daily concerning the ‘Pandemic Information and Specifics’! This scenario creates ‘Pandemic Information Lacunae’ and since ‘Nature abhors Vacuum’, the ‘COVID-19 Infodemic’ finds its ‘Locus’ confounding further any ‘Appropriateness and Adequacy’ of ‘Articulated Pandemic Interventions’; The ‘COVID-19 Infodemic’ includes, among others: Misinformation, Disinformation, Myths, Memes, Rumours, Unscientific Claims, Misleading Communication, Information Toxicity, Misinterpreted Data, Downplayed Data, Inappropriately Contextualized Concepts, Politically-influenced Information, ‘Various and Varied Conspiracy Theories’ etc!
‘Politics’ has been another ‘Confounding Determinant’ which has remarkably compromised and polluted the Science, Facts and Evidence of the ‘COVID-19 Pandemic’ regarding several ‘Aspects’: The ‘Published Pandemic Data/ Computer Scientific Models Projected Data, Drugs in Clinical Trials, Candidate Vaccines in Various Phases of Clinical Trials, Diagnostic and Screening Tests in Use, Convalescent Serum and Antibodies Testing Tools etc! This further grows the ‘COVID-19 Infodemic’ with compromised ‘Data Integrity and Reliability’ and increasingly eroded ‘Principles and Ethos’ of ‘Clinical Governance’ and ‘Research Governance’!! Some Governments are ‘Controlling’ the ‘Foundational Pillars’ of ‘Clinical Governance’ and ‘Research Governance’ with the resultant ‘Collapse of the Foundational Pillars’ of ‘Data Governance’ still further worsening the ‘COVID-19 Infodemic’.
The UK ‘Scientific Advisory Group on Emergencies (SAGE)’ appears not to be spared the possible ‘Political Coloration’ in its ‘Work Output’ in the ‘Fight’ against the ‘Unprecedented Pandemic’! This, in fact, gave birth to the ‘Independent SAGE’ to assure ‘Politics-free Pandemic Interventions’!! The WHO recommends: ‘Politics should be Quarantined concerning COVID-19 Pandemic’! The Governments of the World MUST mount ‘Timeously Appropriate Interventions’ against the two ‘Unseen Global Enemies’: ‘COVID-19 Pandemic’ and ‘COVID-19 Infodemic’!! We need ‘Improved Global Health Literacy’ to mount ‘Appropriate Pandemic Interventions’!!
The BMJ/ Editorials in ‘Triple-A Process’ on the UK Government’s Handling of the ‘COVID-19 Pandemic’ is disposed thus:
Assessment: ‘Too Little, Too Late and Too Flawed’ [3]. The ‘Public Health’ was largely marginalized, decimated and fragmented and lack of ‘Clear Leadership at the Centre’ and no ‘Strong Operational Capacity at the Local Levels’ [1]! The ‘Public Health England’ is largely incapacitated re: Ability and Capacity to be appropriately relevant and effective in the ‘COVID-19 Pandemic Interventions’!!
Analysis: Several ‘Determinants’ are identified! They include, among others, lack of the following: Advance Care Planning, Optimal Resource Utilization, Transparently Communicated Evidence-based Decisions, Continued Regard of Social Care, Attention to the Welfare of Healthcare Workers, Prioritizing Care of the Elderly and the Vulnerable, Legislation to Reduce the Effects of Alcohol on Health and Society!
Action: ‘Wake-up Call to Reality and Plan a New Future’! The UK Government is expected to ‘Reconcile’ its ‘Intervention Strategies’ with the ‘COVID-19 Pandemic Realities’ and ‘Re-Strategize’ taking cognizance of the extant ‘Evidence-based Pandemic Information’ to mount effective and appropriate ‘Determinants-related COVID-19 Pandemic-specific Interventions’!
All Governments are also invited to the ‘Wake-up Call’ and should undertake a critical ‘Triple-A Process’ on their ‘COVID-19 Pandemic Situational Realities’ in order to ‘Rework their Interventions’ and adopting ‘New Approaches’ with ‘Evidence-based Information/ Data’! A critical review of their ‘COVID-19 Epidemic Curves’ should be undertaken. All Governments should strive to be ‘Ahead of their Curves’, rather than being ‘Behind their Curves’, and intensify ‘Appropriate Interventions’ capable of achieving the ‘Flattening of these Curves’!!
Beyond the ‘Catalogue of Devastations and Catastrophes’ wreaked by the ‘COVID-19 Pandemic’, all Governments should, in ‘Harkening to the Wake-up Call’, also evolve ‘Sustainable Interventions’ to ‘Optimize the COVID-19 Pandemic Benefits’ [4,5]! The appropriate harnessing of the ‘Pandemic Benefits’ will ultimately result in successfully ‘Weathering the Storm’: The ‘Unprecedented Pandemic of the 21st Century’!
Several ‘Lessons Learnt’ from the ‘Previous Epidemics/ Pandemics’ [6] should not be allowed to become ‘Missed Opportunities’ for ‘COVID-19 Pandemic’. Appropriate ‘Pandemic Interventions’ to optimize the ‘Lessons Learnt’ will also amplify successfully overcoming the ‘COVID-19 Pandemic’! The World is encouraged to learn a ‘Huge Lesson’ from the ‘African Ebola Scourge Success Story’ [5]!! This is a ‘Wake-up Call’ for ‘Appropriate Health Technology (AHT)’ for ‘Cost-Effective Sustainable Interventions’!!!
The ‘COVID-19 Pandemic’, as a ‘Novel Ravaging and Devastating Scourge’, caught all Governments in the World ‘Off-guard and Largely Unprepared’ and, hence, their ‘Pandemic Interventions’ have been mostly ‘Sub-Optimal’! All Governments, without exception, MUST now harken to the ‘Wake-up Call’ to own up to their ‘Unsatisfactory Interventions’ and strategically and programmatically begin anew with ‘Appropriate Triple-A Process-related Interventions’ to combat the ‘Devastatingly Ravaging COVID-19 Pandemic’!! A rational response to the ‘Wake-up Call’ may be a ‘COVID-19 Pandemic Benefit’ in the long run!!! The BMJ must remain focused and undeterred in its avowed commitment to ‘Best Practices’ in ‘Critical Objective Biomedical Journalism’!!!!
REFERENCES
1. Godlee F. Covid-19: A wake-up call. BMJ 2020; 369:m2021.
2. Powell DEB. Testing testing. https://www.bmj.com/content/369/bmj.m1918/rr-5 of 18th May 2020
3. Scally G, Jacobson B, Abbasi K. The UK’s public health response to covid-19. BMJ 2020; 369:m1932
4. Godlee F. COVID-19: Weathering the storm. BMJ 2020; 368:m1199 of 26th March 2020
5. Kickbusch I, Leung GM, Bhutta ZA, Matsoso MP, Ihekweazu C, Abbasi K. Covid-19: how a virus is turning the world upside down. BMJ 2020; 369:m1336 of 3rd April 2020
6. COVID-19: Lessons and Recommendations. www.isglobal.org/coronavirus of 12th March 2020
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria and
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementation.
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria.
*No Competing Interests.
Competing interests: No competing interests
Dear Editor
Fiona Godlee, the editor in chief of BMJ asks - How did a country with an international reputation for public health get it so wrong? calling this a wake-up call (1). How did the world, with a world of experience and expertise get it so wrong too? Could complexity thinking have stopped all of this? Is it a wake-up call for complexity thinking?
It’s not the science, or the lack of expertise of advisors or modeling experts, or poor political or policy choices, or history of bad preparation, etc, but all of the above and more, of how these come together in a nonlinear dynamic fashion to produce expected and unexpected outcomes, a complexity thinking (2).
But this is not enough. As the editor in chief says, there needs to be accountability – an open process of sharing the evidence and how decisions are made. This would lead to Feedback, Adaptation and Change with Emergence of better, as we FACE the reality of this pandemic together – a complexity thinking.
We have to be as cautious claiming following complexity science as in following the science, however. It also needs accountability, open discussion and debate, with a misstep made by the UK Govt senior political adviser, according to Taleb and Bar-Yam in The Guardian, weighing in also on science “The UK's coronavirus policy may sound scientific. It isn't.” They say that the UK govt adviser loves to theorise about complexity, claiming “but he’s getting it all wrong,” proceeding to describe errors in modeling and policy making (3).
A New England Complex Systems Institute Research Paper by Norman, Bar-Yam and Taleb in January 26, 2020 suggested that with conventional risk-management approaches considered inadequate in the midst of uncertainty and complex interconnected systems, and with the potential for irreversible catastrophe, a precautionary principle should be used: early intense measures at low cost to avoid very costly later actions, as has now happened (3,4). This was January 2020.
We can go back to the onset of the pandemic and the different actions globally since and ask – could a complexity thinking have made a difference to prevent, stop or reduce this pandemic, an irreversible catastrophe? This is important, to learn how best to manage this pandemic, and how to prevent the next. This is especially so in view of Dr Godlee’s concern of the “Sad litany of past and present decisions that have fragmented, decimated and marginalized public health in the run up to this moment when it is most needed" and her view that “Covid could lead us to do things we have long known needed doing” (1).
The editorial asks “Is this then a wake-up call we have needed to plan a new future?” It may be a wake- up call for complexity to help plan a new future - something we have long known needed doing.
The editorial also advises “…we must seize this crisis to build a healthier and more equal society.”
Complexity, the science for complex dynamic interactions could help with this, described in “Tsunami Chaos Global Heart,” a book subtitled “using complexity science to rethink and make a better world,” which includes health, equity, climate change and complex global issues, like this pandemic, and advocacy for teaching/learning complexity at all levels – to make a better world (2).
1 Godlee F. Editorial. BMJ 2020; 369:m2021 (Published 21 May 2020) doi: https://doi.org/10.1136/bmj.m2021
https://www.bmj.com/content/369/bmj.m2021 (accessed May 22, 2020)
2 Rambihar Vivian, Rambihar Vanessa. Complexity: the science for medicine and the human story. Corespondence: Lancet Vol 375, Issue 9721, p 1162, April 03, 2010 DOI:https:/doi.org/10.1016/S0140-6736(10)60512-0 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60512-0/fulltext
(accessed May 20, 2020).
3 Taleb N, Bar-Yam Y. The Guardian Opinion. Wed 25 March 2020. The UK's coronavirus policy may sound scientific. It isn't. https://www.theguardian.com/commentisfree/2020/mar/25/uk-coronavirus-pol... (accessed May 22 2020).
4 Norman J, Bar-Yam Y, Taleb N. Systemic risk of pandemic via novel pathogens – Coronavirus: A note, New England Complex Systems Institute (January 26, 2020) https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathogens-coronavi... (accessed May 22, 2020)
Competing interests: No competing interests
Dear Editor
Proposed Trials of Ivermectin for post-exposure prophylaxis of COVID 19
In contemplating the next phases of COVID management, we clearly need more options for disease prophylaxis, because ongoing COVID clusters seem guaranteed until/if effective vaccines can be developed and widely applied. Australia has done well in containing the first onslaught of the virus, with about 7,000 recognised cases and 102 deaths. However, after flattening the curve, we have COVID clusters in specific locations like nursing homes, abattoirs and fast-food chains; we wait for others in prisons, sports camps, boarding schools, institutions and the like, anticipate more with the relaxation of stay-at-home and social distancing policies, and with the resumption of public transport, air travel, cruises and tourism, and dread their appearance in Indigenous communities and health services, and disadvantaged settings generally.
There must be more discussions and trials of options for targeted and time-limited post-exposure prophylaxis (1) for contacts of people with diagnosed COVID infections, with the objective of reducing rate and severity of subsequent infections in those contacts and limiting further community spread. These interventions would be separate from, or additional to, other strategies like strengthened nonspecific population immunity (2), vaccines, or protection for people with sustained exposure, like the pending trial of hydroxychloroquine in health workers (3).
We argue for an urgent trial of Ivermectin for post-exposure prophylaxis in close contacts of known COVID cases. Ivermectin reportedly kills the COVID-19 virus in vitro, although, as yet, at very high concentrations (4). It is cheap, easily administered by mouth, well-tolerated, with a wide margin of safety; furthermore it already the subject of a $20 USD million repurposing venture for COVID treatment (5). However, we should not wait for results of controlled trials in clinical COVID cases; even negative results in that setting will not prelude potential benefit in prophylaxis, where the viral load in recently exposed people is less (6), immunity still intact and organ damage and superinfections not yet established. The stakes are so high, and the costs and dangers so minimal, that we are obliged to try it.
Wendy Elizabeth Hoy and Vishal Diwan
CKD.QLD and NHMRC CKD.CRE, Faculty of Medicine, The University of Queensland, Brisbane, Australia
Email: w.hoy@uq.edu.au
1. Davis JS, Ferreira D, Denholm JT, Tong SYC. Clinical trials for the prevention and treatment of coronavirus disease 2019 (COVID-19): The current state of play. Med J Aust. Published online: 27 April 2020.
https://www.mja.com.au/journal/2020/clinical-trials-prevention-and-treat...
2. Curtis N, Sparrow A, Ghebreyesus TA, Netea M, Considering BCG vaccination to reduce the impact of COVID-19. 2020; 16;395 (10236):1545-1546. doi: 10.1016/S0140-6736(20)31025-4.
3. Global clinical trial of 40,000+ healthcare workers begins to test in UK if chloroquine and hydroxychloroquine can prevent COVID-19; Source: Centre for Tropical Medicine and Global Health: https://www.tropicalmedicine.ox.ac.uk/news/copcov-begins-to-test-in-uk-i...
4. Caly J, Druce JD, Catton MG, Jans DA, Wagstaffb KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Therapy. Volume 178, June 2020, 104787.
5. Gates Foundation funded French Research Group commences Clinical Trial targeting COVID-19. www.trialsitenews.com, DOI April 26, 2020.
6. Coronavirus: does the amount of virus you are exposed to determine how sick you’ll get? theconversation.com Apr 7, 2020: https://theconversation.com/coronavirus-does-the-amount-of-virus-you-are...
Competing interests: No competing interests
Dear Editor,
Covid-19 has indeed been a wake-up call not just in medicine[1] but also society and the environment [1-3]. It is important that we learn from this pandemic and use it to make positive changes to our futures. One interesting area has been with regards to cardiopulmonary resuscitation (CPR) and treatment escalation and limitation (TEAL) decisions.[4,5] An area that has not been addressed is the positive impact of coronavirus on these discussions.
I have carried out a neurology inpatient based audit entitled “Covid-19: The impact on CPR and TEAL decisions”. This assessed the choices made pre and post the United Kingdom's nationwide lockdown at a tertiary referral centre in Birmingham for neurology inpatients during the month of March. The audit standard adopted was the professional guidance published jointly by the British Medical Association, Resuscitation Council and Royal College of Nursing in 2016.[6]
The first audit cycle looked at the three weeks prior to the SARS-CoV-2 lockdown (23rd March 2020). The reason behind this audit was two-fold: firstly the observation that decisions often weren’t made and secondly, the impending coronavirus pandemic. It is important to remember the consequence of 'no decision'. It is the default presumption of full escalation on the basis of 'least harm'. However this may not have been the patient’s wishes nor in their best interest.[7] Furthermore, the need to don personal protective equipment and the increased risks for the medical staff carrying out the resuscitation complicate the estimation of 'least overall harm'.[4,5] Within the first 3 weeks in March we had 47 neurology inpatients of which 13 had been admitted within that time frame and 21 were discharged. CPR and TEAL decisions were only made in 8.5% of this group. This is likely to be in keeping with the experience of colleagues from across the country as this is a common topic for audit in most specialties with marked variability.[8,9] From a neurology perspective the care of a large proportion of our patients is, by the nature of their problems, palliative. However this situation may last for decades thus resuscitation and escalation plans are generally not required acutely.
The Covid-19 pandemic rapidly changed all our lives including potentially cardiopulmonary resuscitation decision making as highlighted in the BMJ editorial by Zoe Fritz and Gavin Perkins published on 6th April 2020.[4] There has additionally been variability in the guidance across the United Kingdom.[5] Prior to this audit’s second cycle NICE published their Covid-19 rapid guideline regarding critical care in adults (20th March 2020).[10] This recommended the assessment of frailty in all adults admitted to hospital with an algorithm to aid escalation decisions. It is important to note the need for individualised assessment in any patient under 65 or of any age with stable long-term disabilities.
The second audit cycle addressed the weeks following the lockdown (from 23rd March 2020) with a dramatic increase in the decision rate initially to 87% during the first week then 100% decision rate following this. The intervention of Covid-19 made a significant difference to the process (Chi squared 33.3, p<0.00001). However this increase was marginally in favour of resuscitation 12 (52%) and full escalation 14 (61%) for those decisions made subsequent to the UK lockdown.
The reasons behind the increased resuscitation and escalation plans made is multifactorial and the outcomes can be dependent on how the topic is broached[9]. More receptive patients, relatives and medical teams as well as realistic prognostic and multi-disciplinary discussions are all likely to have contributed to the decision-making process. In these challenging times CPR and TEAL decisions have additionally often had to be discussed over the phone, which one might have thought would have had the opposite effect to the one found by this audit. There has also been a greater focus on these decisions from management with the regular Trust coronavirus emails that, we are all familiar with. If these results are replicated across specialties and hospitals, then now could be an important time to shape the future of escalation decision making.
The real test will come following this acute phase, with its constant media coverage, fear, and lockdown. We need to decide as a medical community and as the United Kingdom how to remove the taboo surrounding discussions on death and how it occurs.
References:
1. Godlee Fiona. Covid-19: A wake-up call BMJ 2020; 369 :m2021
2. Alderwick Hugh, Dunn Phoebe, Dixon Jennifer. England’s health policy response to covid-19 BMJ 2020; 369 :m1937
3. Renee N. Salas. Lessons from the covid-19 pandemic provide a blueprint for the climate emergency. BMJ Opinion 2020. https://blogs.bmj.com/bmj/2020/04/23/renee-n-salas-lessons-from-the-covi...
4. Fritz Z and Perkins GD. Cardiopulmonary resuscitation after hospital admission with covid-19. BMJ 2020; 369 :m1387
5. Mahase E and Kmietowicz Z. Covid-19: Doctors are told not to perform CPR on patients in cardiac arrest. BMJ 2020; 368 :m1282
6. British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. Decisions relating to cardiopulmonary resuscitation. 2016. 3rd edition (1st revision).
7. Fritz Z, Slowther A-M and Perkins GD. Resuscitation policy should focus on the patient, not the decision BMJ 2017; 356 :j813
8. Perkins GD, et al. Do-not-attempt-cardiopulmonary-resuscitation decisions: an evidence synthesis. Health Services and Delivery Research. 2016.
9. Pitcher D, Fritz Z, Wang M and Spiller JA. Emergency care and resuscitation plans. BMJ 2017; 356 :j876
10. National Institute for Health and Care Excellence. COVID-19 rapid guideline: critical care in adults [NG159]. 2020. Accessed at: https://www.nice.org.uk/guidance/ng159.
Competing interests: No competing interests
Dear Editor
A healthy diversity of views and untrammelled discourse is essential in any decent society. The editorial scepticism directed toward the current UK government does, I believe, reflect a general consensus view - both public and professional - and no hint of an apology is required. Supporting a government that has so conspicuously and horrendously failed the nation, no matter how frenetic their post hoc gyrations, would be a mistake.
Pandemics are foreseeable and foreseen.
On current evidence it is reasonable to assert that this Tory government and its immediate predecessors have demonstrated unequivocal maladministration, negligence and incompetence resulting in the largest loss of life in peacetime for a century, for which they must collectively bear direct and personal responsibility. No amount of misdirection of public attention to scientific advice received, referencing of ideological idées fixes, pleas of national poverty, lack of clear advance warning, simple force majeure or act of God will suffice as exculpation.
The Tories have been in office for more than a decade and have so damaged our country in that time that many tens of thousands of avoidable deaths are directly attributable to their acts and omissions. No other UK government has precipitated a reduction in life expectancy. The pandemic is not the only cause of excess deaths. There is no one else in the dock to share responsibility.
The central conceit in the Tory mindset is that a low tax, low regulation, small government posture is an intelligent or practical approach to government in the 21st century. This Tory approach is, in fact, a purposive abdication from the central responsibilities of government - to govern for the benefit of all. Laissez faire neocon free market ideology is no adequate substitute for effective government. Corralling a population without adequate regulatory safeguards in an economic free fire zone is unforgivably barbarous.
Modern, first world countries, like the UK, are terrifyingly expensive to run properly. Positing, as a policy virtue, not raising and spending the sums required to achieve a decent, equitable, educated, healthy, harmonious, productive, peaceful and orderly civil society is simply culpable idiocy of a very high order and, in our current predicament, the direct cause of death for many of our fellow citizens.
Aux armes citoyens!
Steve Ford
Competing interests: No competing interests
Dear Editor
Preventable Pandemic
The current COVID-19 Pandemic has changed the education system, destroyed the economy, devastated tourism and dismantled health infrastructures. It has also increased joblessness, distanced love, introduced risk in shopping, fear in travelling and threatened life in all age groups irrespective of socioeconomic status.
In thes 21 weeks, COVID-19 infection has spread across 213 countries. It has affected 5.2 Million people and it has caused over 3.3 lakh deaths.
As of now only 0.07% of the world population are affected by COVID-19 infection. But the vast majority of people are at increased risk because of lack of social distancing and self hygiene. Lack of specific antiviral drugs and vaccines have also added more difficulties in the management and prevention of COVID-19 infection.
The current COVID-19 Pandemic has exposed public health and other primary and tertiary health care infrastructure inadequacies in almost all countries.
Many factors like ego, blaming others and cutting the funds to control COVID-19 spread as revenge are not a good sign in tackling the worldwide problem that arises out of the current COVID-19 Pandemic.
This is not a time to blame and find fault with each other. But it is time to act jointly to beat the COVID-19 spread with like mindedness.
It is not a war against many enemies. But now the common enemy is a single agent in the air and by that everyone is facing the same risk.
So a global cooperated action with individual self hygiene and social distancing will help to avoid COVID-19 infection. The early invention of vaccine will helpful to prevent and eradicate COVID-19 spread.
Competing interests: No competing interests
Re: Covid-19: A wake-up call. One simple suggestion, if I may
Dear Editor
We Brits would be better served, IF:
Each of our Ministers listed their errors - blunders.
Then said: I apologise.
Then said: Now I will do this and that to right the wrongs.
This requires humility, a willingness to learn from others (even foreigners who learnt so much from us when we were capable of teaching).
Puffing up our collective chests and shouting - "world beating ....” should now be given up.
Competing interests: Might develop the DIS ease.