Covid 19: Christmas relaxation will overwhelm services
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4847 (Published 15 December 2020) Cite this as: BMJ 2020;371:m4847Read our latest coverage of the coronavirus outbreak
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Dear Editor,
The BMJ has a long history of being an impartial, fair and evidence-based medical journal. However, under its current editors, in step with the BMA’s leaders, it has taken on a consistent political slant. I was disappointed but not surprised to see the latest intemperate media soundbite from the BMJ (“We believe the government is about to blunder into another major error that will cost many lives.”). The BMJ has repeatedly attacked the Johnson government as it grapples with the coronavirus pandemic, seeking to construct a narrative of blame, “failings” and “blunders”. The BMJ has shown much less interest in how the pandemic started (key to preventing future pandemics), the struggles that other European nations with high population densities have faced, the balance between legislation and individual liberty in democracies, how restrictions affect quality of life, jobs and the economy (which funds the NHS), and whether there may be helpful learning points emerging for NHS, care home and Public Health England managers. As a doctor and BMA member, I do not feel it is the place of the BMJ and BMA to campaign against our elected government, and would encourage them to represent their subscribers and members by instead engaging constructively with it during the biggest crisis we have faced since the Second World War.
Competing interests: No competing interests
Dear Editor,
This systematic review and meta-analysis of 54 studies found that household COVID19 transmission from asymptomatic SARSCoV2 carriers was only 0.7%.
That's within homes, close to relatives for many hours, without wearing masks.
Why would stores, restaurants, buses, register higher infection rates than this?
Reference
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774102
Competing interests: No competing interests
Dear Editor
I think the joint editorial is timely and well thought through, but unfortunately, not wholly supported by the UK & devolved governments for some valid reasons. However, it misses the 'elephant in the room'. It's now nearly a month since Oxford vaccine success was announced and filed for MHRA approval. It's about ten days since the Lancet publication of their scientific paper for Phase 3 trial results (both Pfizer & Moderna have not published their results in a peer review journal yet, but Pfizer's product has been approved by both the MHRA & FDA, and Moderna's is about to be authorised (EUA) by FDA). It's unclear why the MHRA, UK is taking so much time to approve the Oxford vaccine while Covid is wreaking havoc & untold misery, and hundreds of people are dying everyday in the UK. At its lowest efficacy it is 62% effective and there have been no hospitalisation or serious disease three weeks after the 1st dose.
Vaccination with Pfizer's is at a snail's pace and won't improve shortly in UK due to supply issues (for lipid nanoparticles). MHRA needs firm pressure perhaps not a rude threat as was the case for the FDA from Trump's office, but MHRA needs to be moving quickly - absolutely no time for dithering. There cannot be a million doses of vaccination per day in UK without it, and many lives & livelihoods could be saved without further prevarication. It's eminently doable and no reason to start the Oxford vaccine roll out after Christmas!
Competing interests: No competing interests
Dear Editor,
I have noticed something unusual about ONS data on deaths linked to influenza in England and Wales in 2020.
There was a spike in influenza linked deaths, peaking in April 2020, in week 15. I cannot find any similar spike in any previous year, in the UK, the US, or in WHO data. All the data I can find suggests influenza linked deaths peak in mid-January in the northern hemisphere every year.
What was unique about 2020? On 23rd March 2020, three weeks before the peak of influenza linked deaths, a national lockdown was imposed on the UK.
Yours sincerely,
Dr Nigel Wilson MRCGP FFOM
Retired Occupational Physician
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri...
Competing interests: No competing interests
Dear Editor
Healthy people are being compelled to wear masks, to be tested with questionable PCR testing, and to be quarantined on the basis of questionable 'positive' tests. In South Australia and elsewhere, people are expected to have their every move tracked by QR codes in case of 'outbreaks'. People of all ages are now potentially at risk of mandatory coronavirus vaccination, possibly every year or even more often, with fast-tracked coronavirus vaccine products, for a virus which isn't a threat to most people, certainly not to those under 70 years.[1]
And all this is supposedly to protect health services, such as the NHS in the UK, which apparently are not fit for purpose, and not equipped to respond to need, e.g. respiratory illnesses which emerge every year, particularly in the elderly. If all the money and resources that are currently being spent on questionable testing[2] and the more than 200 coronavirus vaccine candidates[3], were instead spent on finding effective treatments and preventatives for the vulnerable, how much better off might we be?
To put things in perspective, consider that over the past eleven months, globally 1.64 million deaths have been attributed to COVID-19.[4] These 1.64 million deaths must be seen in context with the 56 million deaths expected in the world annually.[5]
There has been a disproportionate and ill-targeted response to SARS-CoV-2, a response which has created dramatic upheaval throughout the world. Deaths and 'case' numbers attributed to COVID-19 have been used to impose serious restrictions on people's right to free movement and association, resulting in massive damage to the economy and social interaction. There must be independent and objective critical analysis of the global statistics being used to impose draconian restrictions.
Our 'liberal democracies' are being turned upside down by the current response to SARS-CoV-2, with civil liberties being trashed, and police forces being unleashed on those who dare to protest publicly. This is the most shocking political experience of my lifetime, at the hands of 'our own governments'.
Academics from various disciplines, e.g. via advisory groups such as SAGE, have influenced politicians, who appear to have yielded completely to these people, and imposed onerous on-going restrictions on the community. But who are these academics? I asked this question in my BMJ rapid response: Who are the members of SAGE? There must be transparency and accountability for coronavirus policy.[6]
At last The BMJ is eliciting some information, for instance we're finding out about conflicts of interest of SAGE members which were previously not disclosed.[7] There is much to consider here, not just about SAGE, but also about other groups, there's a vast network which is influencing coronavirus policy.
This is an extremely serious political situation - the quest must continue for transparency and accountability for the disproportionate and ill-targeted SARS-CoV-2 response.
References:
1. See deaths by registered age group. Deaths registered weekly in England and Wales, provisional: week ending 4 December 2020. Office for National Statistics: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri...
2. Elizabeth Hart BMJ rapid response: Coronavirus mass testing - a gross waste of money and resources: https://www.bmj.com/content/371/bmj.m4460/rr-2
3. Peter McIntyre et al. COVID-19 vaccines - are we there yet? Australian Prescriber, 17 December 2020: https://www.nps.org.au/australian-prescriber/articles/covid-19-vaccines-...
4. Number of novel coronavirus (COVID-19) deaths worldwide as of December 16, 2020, by country. Statista: https://www.statista.com/statistics/1093256/novel-coronavirus-2019ncov-d...
5. Worldometers: https://www.worldometers.info/ accessed 18 December 2020.
6. Elizabeth Hart BMJ rapid response: Who are the members of SAGE? There must be transparency and accountability for coronavirus policy: https://www.bmj.com/content/371/bmj.m4235/rr-1
7. See: Rebecca Coombes. Covid-19: SAGE members' interests published by government 10 months into pandemic: https://www.bmj.com/content/371/bmj.m4911 and Paul D Thacker. Conflicts of interest among the UK government's covid-19 advisers:https://www.bmj.com/content/371/bmj.m4716
Competing interests: No competing interests
Dear Editor
I suggest that the Archbishops plus the “Supreme Governor” (HM the Queen) switch Christmas Day to 7 January 2021 and the Prime Minister locks down the UK forthwith - till Christmas Eve 6 January 2021.
This would save a few hundred lives.
The Russians already celebrate the birthday of Jesus on 7 Jan.
Like Becket, I will pay the price.
Competing interests: No competing interests
Dear Editor
This overtly political editorial and its fearprovoking speculation seems to me have more of the flavour of a medical Pravda article than an objective or constructive view of the situation. Music to the ears of those still intent on not only repressing proper debate about the glaringly obvious mismanagement but who are blind to the huge and inappropriate level of suffering of many sectors of the population which shows no sign of abating. The gross consequences will reverberate for even decades. Cost benefit analysis anyone? Who has counted the cost of these QALYs?
Who cares about the huge deficiencies in RT PCR testing? Who can explain how this vaccine adds value or will change anything worthwhile? Who treats anyone with Ivermectine in the UK and why not? There is something earnestly religious about the search for heresy in those who ask reasonable questions. "First do no harm" - well, there's a fail straightaway. If we want to succeed remember it's the experienced sergeant majors who win the campaigns, not the staff officers. Sadly it's the Politrucs and Witchfinders who are calling the shots, it seems.
Competing interests: No competing interests
Dear Editor
Regarding Roger Arguile's rapid response, I can't agree at all with his argument
The medical profession including public health specialists and researchers have sought to influence public health and public health care policy on many occasions over the years and thank goodness for that. It is a key part of our role.
Smoking, Clean Air, Health and Socioeconomic Inequality, Alcohol, Food, Drugs and Obesity Policy, Child Health, Control of Infectious diseases from Cholera to Malaria to TB to Malaria to HIV to name but some areas concerning communicable and non communicable disease, where medicine and medical research have been highly influential in changing policy stances.
Medics have also helped lobby government for NHS funding or staffing, for social care solutions, for allocation of medical research funding and, more recently, to minimise the risks of Brexit to the nation's health and healthcare, and so we should.
In turn, medical or health service management journals as professional publications have just as much right as national newspapers or political parties or partisan policy think tanks to lobby and influence. The delivery of clinical healtchare is not divorced from wider public policy - far from it.
Moreover, health economists, health policy analysts and public health experts who DO have the kind of expertise that Mr Arguile assumes they have not, have written in these pages about the trade offs between health protection, the economy and employment with regard to Covid (and indeed Brexit) policy.
They are all exercising a legitimate function.
Finally, this is not a simple matter of individual rights, individual choice, autonomy and agency, any more than are speed limits or car emissions or state pensions policy. This is about populatiion wide health protection which goes beyond the right of individual citizens to self determination, even when that might put other citizens at risk or put avoidable strain on public services and potentially deny access to others.
His comments are reminiscent of US doctors being told to "stay in your lane" over gun ownership.
David Oliver
Competing interests: No competing interests
Dear Editor
Regarding Roger Arguile's rapid response, I can't agree at all with his argument
The medical profession including public health specialists and researchers have sought to influence public health and public health care policy on many occasions over the years and thank goodness for that. It is a key part of our role.
Smoking, Clean Air, Health and Socioeconomic Inequality, Alcohol, Food, Drugs and Obesity Policy, Child Health, Control of Infectious diseases from Cholera to Malaria to TB to Malaria to HIV, to name but some areas concerning communicable and non communicable disease where medicine and medical research have been highly influential in changing policy stances.
Medics have also helped lobby government for NHS funding or staffing, for social care solutions, for allocation of medical research funding and, more recently, to minimise the risks of Brexit to the nation's health and healthcare, and so we should.
In turn, medical or health service management journals as professional publications have just as much right as national newspapers or political parties or partisan policy think tanks to lobby and influence. The delivery of clinical healtchare is not divorced from wider public policy - far from it.
Moreover, health economists, health policy analysts and public health experts who DO have the kind of expertise that Mr Arguile assumes they have not, have written in these pages about the trade offs between health protection, the economy and employment with regard to Covid (and indeed Brexit) policy.
They are all exercising a legitimate function.
Finally, this is not a simple matter of individual rights, individual choice, autonomy and agency, any more than are speed limits or car emissions or state pensions policy. This is about populatiion wide health protection which goes beyond the right of individual citizens to self determination, even when that might put other citizens at risk or put avoidable strain on public services and potentially deny access to others.
His comments are reminiscent of US doctors being told to "stay in your lane" over gun ownership.
David Oliver
Competing interests: No competing interests
Re: Covid 19: Christmas relaxation will overwhelm services
Dear Editor,
It is the responsibility of healthcare professionals to present patients with the available options for managing their conditions, including the potential benefits and anticipated negative consequences of each option. Patients then weigh the potential benefits and drawbacks of each option, and juxtapose them with their wider life goals and preferences. We generally accept that patients might not choose the option that is most health or life preserving because they might value other things more. We accept that forms of cancer treatment that might only minimally extend life are not always a reasonable choice or that a patient might chose not to wish to have CPR performed if they suffer a cardiac arrest. While all people tend to value health to some extent some might value friendship and family life over their health. Of course, having good health helps with having fulfilling relationships with others, but often it is having these relationships is the primary goal of tending to one's health. If you are elderly and might die soon anyway, you might wish to take the risk of meeting others and dying sooner over living longer and potentially not meeting anyone. Not everyone values the same basic goods of life (e.g. as presented by New Natural Law theorists) to the same extent.
Governments need to balance how they prioritise these goods, which is very difficult, especially in a liberal and pluralistic society which largely tries to refrain from making judgments on how to prioritise such goods. The authors of the original article have rightly highlighted the potential consequences of the Christmas relaxation of the lockdown measures (which relaxation has now been cancelled). Yet, we should simultaneously not expect governments and citizens to make decisions based on their consequences on the NHS and people's health. Health is a good, but not the only, or even supreme, good. Liberty, friendship and family are other goods. People also need to have hope to live their lives well, and governments need to be trusted if people are to obey them. It is not clear that the general mood in society following the cancellation of the Christmas relaxations will not have graver consequences than the original relaxation would have - this is anyone's guess. But it would not be irrational for the government to allow these relaxations - it would simply not have aimed at maximising the benefit to the NHS and people's health. We would not expect patients to always act to maximise their health, why would we necessarily expect the government to do it - it did not get voted in solely on the basis of their health policies.
Why we might wish people and governments to promote health in general, we should not be surprised if they make decisions where they balance different goods and not just maximise health. This might not be generally helpful to us as healthcare professionals, but it is neither irrational nor is it different how we often make decisions in our personal lives.
Competing interests: No competing interests