Intended for healthcare professionals

Editor's Choice

Covid-19: Acts of omission

BMJ 2020; 370 doi: (Published 23 July 2020) Cite this as: BMJ 2020;370:m2929

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  1. Kamran Abbasi, executive editor
  1. The BMJ
  1. kabbasi{at}

The UK government is becoming known for acts of omission. No evidence exists of Russian interference in the 2016 Brexit referendum because the government didn’t and won’t look for it. Nor does it seek lessons from an immediate public inquiry to inform a future surge of covid-19.1 Nothing predicts behaviour like behaviour, and if over 60 000 excess deaths in six months will not force behaviour change then perhaps nothing will?

The pandemic is at its global height and anything but in retreat, exploiting a philosophical battle between prioritising health or banking on the economy. In the UK and US, the economy has won out. Wealth before health. Elsewhere, the role of health in generating wealth, and the emerging evidence behind it, is better understood.2 The European Union, for example, has announced a €750bn (£680bn; $860bn) coronavirus recovery fund.3 Out of the EU, England is marginalising independent scientific advice.45

Acts of commission are faring little better, as the persistent struggles with testing, contact tracing, and local data flows demonstrate.67 Positive talk doesn’t paper over the burden on health professionals and their need to rest and recuperate, or the lack of public confidence in seeking urgent care during a pandemic.89 A genuine opportunity exists to build back better by reducing unnecessary healthcare or making better use of hospital medicines data.1011

Clinicians can at least focus on clinical skills. Anosmia is among the myriad clinical presentations of covid-19, and one of the most talked about. Half of all patients with covid-19 lose their sense of smell, but most recover it within four weeks.12 The key challenge is staying alert for an alternative explanation. At the other end of the clinical spectrum, severely ill patients with breathlessness and agitation require palliation and clear communication about prospects with family and carers.13 As the system flails, health professionals are relied on to hold it together.

Despite encouraging reports about a possible covid-19 vaccine,14 expert consensus is that the winter will bring another surge of cases. Covid-19 is no mere political power game. Further mishandling of the response will lead to more excess deaths, and premature death is a losing game for both people and the economy.


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