Tell the truth and act on evidence

Stop terrorising people in to continued irrational behaviour with evidence free policy. Start telling the truth - that true mortality ranges from 0 1-0.4% based on prevalence testing internationally. Start sharing openly source and detail of advice. Move the narrative towards personal health responsibility for issues including obesity and the associated diabetes, hypertension and cardiac disease. Share uncertainty openly and with honesty. Consult wider than the usual Scottish government "go to experts". In particular we need more than a dentist with an "Honorary" professorship as a public face for communication. Engage proper public health experts with specific expertise in outbreak control and economists. This is not about theoretical epidemiological modelling alone. Specifically we require a detailed strategy to deal with, by isolation and containment, hospital and care home nosocomial infection. This will require testing and separation of infected patients and staff into separate facilities including the use of the SECC facility. We cannot lock down the population as the wrong solution to this specific problem. Carry out whole population sampling of representative areas - e.g electoral wards to identify "point" prevalence of PCR positive tests at that time. Follow up all cases including asymptomatic for longitudinal outcome data. Facts: Transmission risk outdoors is effectively non-existent. Restart outdoor work. There was and is no evidence for 2 metre social distancing. Reduce this to 1 metre. The epidemic trajectory had already eased prior to lockdown with lighter measures as evidence by "peak death" on April 8th. Learn from this. MANDATE wearing of face coverings in enclosed public places. At least 80% compliance is required to deliver the key public health benefit of PREVENTING TRANSMISSION BY AN INFECTED wearer to others. Give Vitamin D supplements to everyone. There is strong observational data showing that all the highest risk groups have lower Vitamin D levels. This applied in Spain and Italy as well. While observation is not causation the association is strong and there is no known harm from Vit D supplements. Act now according to the precautionary principle.

Why the contribution is important

Any strategy has risks. We have managed to be almost entirely wrong at every stage with hubris and failure to prepare being particularly evident. This compounded by reactive political responses rather than a careful strategic plan. Lockdown was too late as a strategy to eradicate the disease in the absence of proper testing and tracing. Accept the boat was missed and move on The direct damage in terms of illness and lives will now be much the same but over a longer time frame. What we can now reduce is the future catastrophe from unimaginable economic and social damage with future health damage on a much greater scale than the short term excess in mortality. People need to understand that this is a short term epidemic which is manageable with proper strategy is at risk of being turned in to a trans generational economic and health catastrophe by continuing as we are. Not least there will be no jobs for many, probably most currently on furlough and we cannot pay for it. What I have outlined is something resembling a strategy. Surprise me by implementing it.

by Malcolm24 on May 08, 2020 at 07:55AM

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Comments

  • Posted by jonsnow May 08, 2020 at 09:45

    Totally agree. And would reiterate that at some point the Scottish Government must recognise that the mortality rates are a reflection of the health of the Scottish population. We need more policies that encourage personal responsibility for health.
  • Posted by matheson May 08, 2020 at 11:25

    Disinformation...according to John Hopkins site (8th May) lethality rates vs confirmed cases is running between 4% (US) and 1% - UK is about 1.5%. So it's 10 times worse than stated above.
  • Posted by PhillDrolls May 08, 2020 at 17:02

    Broadly agree - it's up to the government and the media to change the message. I can see from Zoom meetings and email that some of my colleagues are happy to drag out this situation (i.e. getting paid to watch TV). Stop encouraging them!
  • Posted by Malcolm24 May 08, 2020 at 18:34

    I regret that "matheson" has confused the case fatality rate (CFR) in populations such as U.S and U.K where testing has only been carried out on those with symptoms attending health care facilities. This is what is reported on Johns Hopkins site. It does not include those who have symptoms and are never tested (vast majority in U.K) nor of course those who do not have symptoms or have atypical symptoms not fitting the narrow diagnostic criteria. Where data exist from China or whole population samples in towns in Italy and Germany and the USS Theodore Roosevelt, many and indeed in young healthy populations, the majority develop no or few symptoms. Furthermore these studies have shown a higher prevalence of antibodies in the population than clinical infection (I know there remain issues with antibody testing but this is mostly false negatives which if anything would favour even higher asymptomatic numbers). Similar reasons explain in large part the apparently low death rate in Germany. The initial surge was in relation to fit skiers returning from alpine resorts with minor symptoms who were tested early, as a result their contacts were tested too. Many were test positive but again never developed clinical disease. All these data support an Infection Fatality Rate (IFR) at much lower levels within the ranges I state. Much of this is dynamuc information. True figures for epidemics only emerge later. Sometimes never - we still debate plague and 1917-1919 pandemic influenza. Excess death rates will give us a better clue. Sadly many will be the avoidable results of our poor response. I could go on with the Pakistan and African paradoxes however I will simply say that the information I quote Is either from direct communication, such as from colleagues in Germany who are collating information for the Federal Government , or based on extensive Global Health training and experience including epidemic management. Please do not call it disinformation.
  • Posted by argallan May 09, 2020 at 12:41

    Well said Malcolm, the disinformation is coming from governments and their cheerleaders in partisan media who have created a climate of fear to strip us of our liberties.
  • Posted by tapestry7829 May 09, 2020 at 23:04

    Completely agree with this
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