Friday, 27 November 2020

Why we need a risk based approach to beating Covid

 Now we all know what tier we are in and how we will be spending Christmas. We have to recognise that the government has a nearly impossible job in balancing the measures needed to keep people alive against the needs of the population to exist and the needs of the economy to pay for the measures. I've restricted my criticisms to when it is absolutely clear that the government is making a terrible mistake, such as the 'eat out to help out' scheme. There are several things we've learned. The first is that lockdowns do work in their goal of bringing down the rate of transmisison of the virus. We all hate the concept but the reason we have to some extent contained the outbreak is because the government has made us all lock ourselves away. It is pretty clear to me that both times, the government did it too late in the day, meaning more damage was done to the economy and our mental health than needed. A lockdown is a very blunt instrument. It is like using a sledgehammer to bang in a nail, it will bang the nail in but there is bound to be all manner of collatoral damage. Any sane person would only use a sledgehammer to bang a nail in if the nail had to be banged in and there was no more appropriate tool. 

Given that the first lockdown was implemented in a panic when it was clear matters were getting out of hand, we can't blame Boris for grabbing the biggest tool in the toolbox and whacking away. For the second lockdown, the government sort of manufactured the crisis itself, with its cash bung to get us all socialising. As a business owner, I watched with horror as the government spent hundreds of millions getting us to do the least sensible thing possible in the middle of a pandemic. what bemused me was that the scheme was not tied in to the launch of the track and trace app. A cash bung to get us all using it would have mitigated to some extent the effects.

Having got us all merrily reinfecting each other, once again a lockdown was inevitable and once again it was done too late. Once again they haven't learned the lesson of "Eat out to infect your Granny" and are set to repeat the fiasco with the easing of restrictions over Christmas. Much as it would be lovely to see people, I can't see any way another spoke and another lockdown can be avoided, once we've all travelled around spreading the virus along with peace and goodwill. 

The more I think about it, the more I am reminded of Margaret Thatcher and her response to the AIDS epidemic. AIDS coincided with the period in my life when I was most sexually active. After the sexual liberation of the 60's and 70's, it was a very bad hangover. Thatcher never struck me as someone who felt comfortable publicly discussing sex. Her section 28 laws were highly repressive for the LGBTQ+ community. When it became clear that AIDS was a major threat to the population, Thatcher put her Victorian morality to one side and followed the science. Her government set about educating the nation about risky behaviour. They realised that telling promiscuous people not to have sex was ridiculously stupid, so they educated us with how to mitigate the risks. The condom was the primary weapon. Many people have different ideas abut what Thatchers greatest achievement was, but for me it will always be persuading sexually active people to wear condoms. Whatever you may think of Thatcher, that probably save half a million lives. 

Fast forward to late November 2020. Where is the condom (so to speak)? Well there are two main 'condoms' one is a facemask and one is sanitising your hands. These are the measures that scientist are advising are the best way to combat transmission. I don't really recall anyone saying that wearing a condom was an infringement of your rights back in 1984. What is clear is that the government has got the message about masks completely wrong. It spent months saying they were useless before doing a massive U-turn. I've read things that suggested that the initial reluctance was all about the lack of available PPE for health workers. If this is true, it is a damning indictment. They should have levelled up with us.

There seems to me to be a marked reluctance to 'trust the science'. I recall back in 1984 there were conspiracy theories about AIDS. It was allegedly manufactured by the CIA to wipe out Gay people and black people. I shudder to think what would have happened if Bill Gates made condoms back then. 

The reason the UK did well with the IADS epidemic and so badly with Covid is because back in 1984, the government treated us like adults, laid out the risks, told us sensible mitigations and spent a lot of money making sure the message got through. We learned what were 'risky behaviours'. My greatest criticism of the government of Boris Johnson is that we've not been treated like adults in the same way. Pubs are shut /opened not on the level of risk they pose but because they are in areas with a high transmission rate. The figures show that going to the supermarket is far more risky, but they've had no restrictions placed on them.

I regularly go to all sorts of pubs. Between the two lockdowns, I probably visited 20 different ones. A couple had no mitigations at all in place, some were completely covid safe (given my understanding of the rules) and some were somewhere in between. In my view, every establishment that is open to the public should complete a risk assessment and submit it to their local authority.They should have it readily available for customers to review and any that do not perform the mitigations properly should be closed. Establishments that are safe, conversely, should be open. It is far safer to meet friends in a regulated, safe pub than to sneak around to their house. The government should be able to identify risk hot spots. I would refuse entry to all public places if people do not have the track and trace app (unless they have a very good reason). By plotting peoples movements, hot spots should be identified. The app should also be able to identify where establishments are not enforcing social distancing rules.

The bottom line though is that most people will not die of covid, even if infected. Most will have symptoms no worse than a bad cold or flu. The vulnerable groups are well known. They have had no proper protection from day one. This is where the risk is. As our knowledge of the disease has evolved we should have improved our methods of keeping the vulnerable safe. We havent. Any risk assessment should identify how people at risk will be managed in any environment. If we knew the hotspots where people with the disease are most likely to pass it on and we identify those who most need protection, we should be able to mitigate these risks.

What we have is rules that state you can't drink eight pints of Guinness and eat a pickled onion in a pub, but you can sink six bottles of Malbec and have a pasty and chips. If you think that is a science based approach to managing the risks of covid, I'm afraid to say I think you are off your trolley.

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