Intended for healthcare professionals

Letters Public inquiry into UK’s response to covid-19

Not yet time for a public inquiry into UK’s response to covid-19

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2674 (Published 08 July 2020) Cite this as: BMJ 2020;370:m2674
  1. Andrew N Bamji, retired consultant rheumatologist
  1. Rye TN31 7ES, UK
  1. bamji{at}btinternet.com

Now is not the time for an inquiry into the response to covid-19.1 There are too many unknowns to draw conclusions. In response to the five points suggested by McKee and colleagues for scrutiny:

  1. Acute clinicians weren’t included in discussions—why? Covid-19 kills people; local government leaders are unlikely to be able to contribute to the clinical discussion of how to stop this

  2. Procurement review must be set in context with other countries’ experiences. Mechanical ventilation is unhelpful in many cases (because the alveolar epithelium is damaged) so the purpose of Nightingale hospitals needs review

  3. Did structural disconnect between health and social services alter spread? Doubtful. SARS-CoV-2 was far more infectious than believed. The care home “epidemic” might have been caused by the directive to empty hospitals without testing before discharge

  4. Any ethnic predisposition to covid-19 might be genetic, and presenting the subject simply in sociological terms is unscientific. Bringing in representatives from “the communities involved” only pays lip service to political correctness.

  5. Brexit is irrelevant.

We need immediate development of treatment to stop covid-19 from being life threatening. Serious multisystem disease is a function of deep viral exposure and a subsequent cytokine storm. The second has hardly been addressed. We need to start using tests that indicate risk—oxygen saturation measurement (as suggested in The BMJ2 and, as I have been arguing for weeks, using pulse oximeters) and serum ferritin and D-dimer, which indicate cytokine overactivity and thrombotic risk.

We also need to develop cytokine storm management, using cytokine blockers, low molecular weight heparin, and steroids. Reserving these for late cases or using too little will fail. Antiviral agents might reduce the ongoing storm but don’t mitigate a storm that is already present.

These need to be in place before a second wave of infections. Then patients might not die. A second wave is unstoppable if large numbers of infected people are asymptomatic. What matters is treating people who are severely ill with things that work. Deciding how is a matter for clinicians.

In the 1968 influenza epidemic (which killed twice as many people as covid-19 has yet done), there was no panic.3 An interesting subject for an inquiry.

Footnotes

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

References

View Abstract