On Wednesday the British Medical Association (BMA) released new ethics guidelines to doctors that might mean that older patients who are deemed to have a lower chance of surviving a Covid-19 infection might be denied life-saving ventilators, which are in such short supply that they will be kept for patients deemed more likely to survive.
The BMA advice, in a grim 9-page guide, says in a section on triage, that “It is possible we could reach a point where the decisions made in triage will determine whether potentially large numbers of individuals will receive life-saving treatment or not”.
“…We know that current data about COVID-19 show a strong correlation between older age and mortality. Although work has not been done yet to establish whether this reflects an actual effect of age, or simply a correlation between age and co-morbidities that will affect survival rates, it is likely that the most challenging triage decisions will be made for these groups. If they become necessary, these decisions must not be solely based on age.”
Limits to the level of risk
But the BMA is also very critical of the failure of government to provide the necessary equipment and resources to doctors and other health staff. “Health staff, and other staff essential to the running of health services cannot be expected to expose themselves to unreasonable levels of risk where employers have not provided, or have been unable to provide, appropriate protective equipment…In the BMA’s view, there are limits to the level of risks doctors can reasonably be expected to expose themselves to as part of their professional duties.”
Doctors would not be under a binding obligation, it says “to provide high-risk services where employers have failed to fulfil at least minimal obligations to provide appropriate safety and protection and to protect doctors and other health professionals from avoidable risks of serious harm.” We agree whole-heartedly with that, and it applies to all NHS staff and particularly those on the ‘front line’.
NHS staff are particularly at risk and are handicapped by the failure of government to introduce a wider regime of testing. The World Health Organisation and numerous scientists, especially epidemiologists, have argued for a month and a half that testing is the central element in the monitoring and management of the epidemic. “Test, test, test”, the director of the WHO said, weeks ago.
Germany leading in EU testing
Whereas Boris Johnson’s policy seemed to be just buggering on, at least in the beginning, in countries like Japan and South Korea, there have been substantial national efforts to roll out hundreds of thousands of tests. Germany is leading the way in Europe, with somewhere between seven and ten times the daily number of tests in the UK. Now it seems, about three or four weeks later than it should have been, the government has finally woken up to the value of testing, with a goal of testing 100,000 a day by the end of the month. Note that this is only a “goal” and not a solid commitment. NHS staff particularly will be anxious to see if that goal is reached.
Mass testing in Italian town
The significance of testing in getting to grips with the way the virus spreads and its true mortality rate have been highlighted by two sets of data from different parts of the world.
The Financial Times on March 17, reported on a regime of mass testing in the small town of Vo, in northern Italy, near Venice. In a town of only 3,300 inhabitants, health workers introduced a policy of mass testing and isolating those with a positive result. Many people were tested more than once. The upshot that they were able to contain the virus relatively easily and quickly. Interestingly, their data showed that “half of the carriers had no symptoms.”
This result chimes with the data published more recently in an article in Nature magazine, March 26. The article dealt with data taken from the cruise ship Diamond Princess, which was quarantined in Japan and at one time was the largest outbreak outside of China, with 700 of the 3,700 passengers and crew infected. Once in quarantine, Japanese officials conducted more than 3,000 tests, with many passengers and crew tested more than once, beginning with those with symptoms.
Cruise ship data now assessed
The Diamond Princess data is now offering insight into the spread of the virus over time, in what amounts to a human laboratory. It has to be borne in mind that a much bigger proportion of the passengers were elderly than is the case in the general population. Nevertheless, even with this relatively older population, it was found that many showed only mild symptoms and 18 per cent of those infected showed no symptoms at all.
“That is a substantial number,” the co-author Gerardo Chowell, a mathematical epidemiologist, told Nature magazine. “But the passengers included a large number of elderly people, who are most likely to develop severe disease if infected, so the share of asymptomatic people in the general population is likely to be higher,” In all, only 7 deaths were recorded, a mortality rate of about 1%, again low for a relatively old population.
This at least is a glimmer of optimism in an epidemic being turned by the ‘free-market’ and governments around the world into a complete shitshow.
April 3, 2020
