This Year’s Apocalypse
A Design for Living in the time of Coronavirus
[Edits moved to the bottom for ease of reading]
First, the bad news
Here’s the problem, so that you can understand where I’m coming from: I think we’re screwing this up — or rather, as with the climate crisis and the early days of HIV, and for sure as with Mutual Assured Destruction — it’s being screwed up for us. That is to say that Boris Johnson and his government are failing us in a critical moment.
The World Health Organisation has talked about “alarming levels of inaction”. I think that’s us (as well as, inevitably, Donald Trump. I’m just not getting into that. It’s terrifying, and I just… can’t. Look here.)
Here’s Professor John Ashton on the subject of the UK’s corona response:
Here’s the list I’m drawing on — the expertise pool. I cobbled it together this week, and it’s obviously incomplete, but equally obviously it’s got some very informed people on it and they’re all saying broadly similar things: the effective route is test widely, track contacts aggressively, isolate.
This is what South Korea has been doing, for example.
You cannot control the spread of the virus if you do not make a major effort to find it, and this is one of the things that we do not appear to be doing right now. As of yesterday, the number of tests we doing in the UK was falling as the number of positive results was rising.
And that does not appear to be a policy decision. It’s a shortage of testing supplies, which applies worldwide. (NB that, having left the EU and deliberately stepped away from their pandemic umbrella, we’re no longer part of the Union’s formidable procurement arm. That may not be affecting us now, but it could well have an effect on how fast we get vaccines or treatments, and what they cost.)
Anecdotally, NHS111 is describing the health service as “overwhelmed” — already. We have, incidentally, half as many intensive care beds per head of population as Italy — and I can’t find any reason to imagine we’re not on a track for the same situation they’re in.
For the record, that situation is horrible. (Go ahead and read the whole thread. It’s one of the most powerful things you’ll ever come across.)
Now… according to Peston today, there actually is a strategy at work here, and it’s somewhat interesting. In essence the government actually is proposing to take the hit, just not directly “on the chin”. The idea is that we will develop herd immunity: enough people will get the virus that over time the outbreak burns out and the disease can’t be transmitted any more. Since there’s no vaccine yet (and won’t be one for at least 18 months) there’s a degree of sense in that. The problem with lockdowns is that as soon as you unlock them the transmission starts up again and you have to do it all again.
But.
I’m actually fine with sequential lockdowns as part of a process of slowing the disease right down so that our health service is never overwhelmed. Throwing money at the problem this late in the infrastructural day can only do so much; our baseline health care has been eroded and is overstretched. We have 28 (count them) ECMO beds. Last time I checked, only 15 of them were available. I’m guessing it’s fewer than that now. The trick is to flatten the curve: slow the progress of the outbreak so that fewer people are seriously ill at any given time, and all of them can get the care they need.
We can’t cope with numbers like those in Italy even as well as they can, and they can’t cope well at all. We need to flatten the curve even more, and as far as I can tell we’re simply not doing that with the measures the government is currently employing. To continue the slightly tortured boxing analogy, we need to duck and weave and soak up a few body shots, wear the other guy down. Instead we’re basically standing still and in twelve days we may get a combo right in the kisser. The thing that makes this hard to understand is the speed of growth. I don’t think it’s technically exponential (after a few doublings it starts to flatten because there’s just no one left to infect) but it may as well be for how we struggle to grasp the speed with which it happens.
Basically: the government’s plan looks like weak tea, and I ain’t the only one saying so.
All right. That’s where I’m coming from. Now…
What do we do about it?
First:
WASH YOUR HANDS with soap or alcohol sanitiser for 20 seconds or more
CONTAIN ANY COUGHING OR SNEEZING in your elbow or your hankerchief etc
KEEP YOUR DISTANCE from anyone who’s coughing or sneezing — at least a metre
DON’T TOUCH YOUR FACE because surfaces retain virus and other goo (this one is REALLY hard, do it anyway)
SELF-ISOLATE IF YOU HAVE SYMPTOMS presumably you do not hate anyone enough to go out and give this to them
See the WHO guidelines here.
Second:
Ask the question, and get your political representatives to ask, too. WHAT is being done? WHAT MORE could be done? WHY do we not have this service, this capacity? WHAT COMPENSATION can I get if I can’t go to work? WHY IS IT NOT MORE? Demand better.
Third:
If this goes completely to hell — if the NHS is overwhelmed — there may be concrete ways in which we as individual humans can help and make things better for one another.
We’re going to need to be open to doing things for one another. Maybe it’s as simple as self-isolating. Maybe it’s sharing resources with your neighbours. Maybe it’s saving your shampoo bottles to turn them into ventilators. I don’t now what we’re going to need. Maybe if you take your camping mattress to the community centre it can be a bed for a low-tech ad hoc ward for mid-severity patients. Maybe we need to start looking at retasking industrial oxygen concentrators and improvising ICU spaces. Read the thread above and start thinking what might work. It would be great if we could get health professionals to tell us what they are likely need, although I don’t know if they’ll be able to do so without censure.
In the extreme case, here’s a moonshot question: could one design a simpler, easier-to-build, fast rollout ECMO machine?
But more important may be how to limit the number of people who get that bad. This may just come down to us being brilliant — and kind — because our governments are not.
Resources:
WHO “introduction to ncov” — basic online course on fighting the virus (various languages)
The Lancet’s free-to-access coronavirus resource
Folding@Home — taking on the virus directly with your desktop computer
My Twitter list of epidemiologists, MDs, journalists etc
[Edit March 15th:
So much is happening. Drugs are being tested, and some seem to help. Vaccine trials are starting. There’s hope. At the same time, it’s still terrifying. Some British experts continue to push back against their colleagues’ misgivings, and with far greater compassion than the official briefings.
Matt Hancock is saying the same thing. The government is announcing more stringent measures. Was this always what they intended? Or has the reaction pushed them? Will it be enough, soon enough to preserve the NHS’s function? They’re talking about renting 8000 private hospital beds, commandeering hotels, ramping up ventilator production. It’s March — it seems so late to be doing that.
Hope. Fear. Possibility. Desperation.
I’m going to leave this piece up, but not try to update it. Right or wrong, this was the moment as it happened. If you want to know what’s happening now, my Twitter List at the bottom of the page {ie above} is a decent one.]
[Edit March 13th:
There’s been some pushback around the government’s choices, especially on the subject of the Ashton interview I link below. If you look at the responses, you’ll see that Greg Fell is not a lone voice:
That said, there’s also been further push in the opposite direction —
Expert opinion is not — should not be — homogeneous. That said, if the government’s approach is “evidence-based” there are quite a few people in the discussion who feel that they are ignoring some crucial evidence.
So. It’s an evolving situation. Har de har.]
