An appeal to party leaders to take action against Covid 19…

Dear Party Leaders,

I am sure this is a stressful time for all involved in making major decisions. I have had a lot of experience in the past preparing for outbreaks. I learnt a lot from these experiences. The pace of information flow is rapid and changes almost daily. Decisions change over time depending on new information. I want to make a scientific argument why we can no longer continue to follow the UK mathematical model and resultant public health plan for Covid 19.

My background is in Infectious Diseases, having worked in the Australian and Republic of Ireland health care systems, and as an Infectious Diseases Consultant in the Belfast Trust between 2006 and 2018. I have an MSc in epidemiology and I observed outbreak preparedness planning for the 2001 terrorist anthrax attacks, and SARS.  I worked on the pandemic influenza planning in 2009, and Ebola virus preparedness in 2014 in Northern Ireland.

I have followed the Covid 19 epidemiology both internationally and locally. Professor Chris Whitty (Chief Medical Officer, England) and Public Health England produced a webinar on their strategy and I was aware of their planning.

Over time new information has come to light and many studies are in progress. As this is a novel virus there are many unknowns. The case fatality rate has varied depending on whether a health care system collapses or not. It was higher in Wuhan but lower in other parts of China where health care did not collapse. There is ongoing research to discover if people were infectious before displaying symptoms. I have seen this figure change over time as new data emerges.

Italy was a shock to many. The problem was that Italy and many other countries used a narrow case definition to test for Covid 19. They focused on returned travellers from high risk areas and contacts of cases. It is now obvious that this policy did not detect transmission within the community, allowing uncontrolled spread to take place in the community.

Part of Public Health England’s strategy was to do background surveillance looking for any evidence of community transmission unrelated to travel or contact with known cases.  They have Flu spotter GP practices, some of which are testing for Covid 19’s presence in the community. They have also been screening ICU pneumonia cases.

I do not have direct access to the NI PHA data, but interrogating their published data, NI appears to have done considerably less testing compared to the UK overall, adjusted for population size. The proportion of positive cases has also been higher, suggesting a continued focus on testing people with travel history or contact with a case. It is my understanding, having spoken to colleagues within the Belfast Trust and other NI trusts that we have not been systematically looking for Covid 19 in the community outside risk groups. The NI case definition has widened to include severe pneumonia in the last few days and testing has increased. However, as our prior testing and surveillance patterns have differed compared to Public Health England, in my opinion we have diverged from PHE strategy, and it is no longer valid, indeed dangerous, to follow their mathematical model when our data relating to community presence is deficient in comparison. I have shared my concerns with colleagues both inside Northern Ireland and outside Northern Ireland and they agree with my assessment.

At this stage we do not have a good idea of our local transmission in the community and where we are on the epidemic curve. In my view, this far into the epidemic, and seeing how the cases have soared in other countries, I do not think we have time to do an analysis of community screening at this stage. The stakes are high here, and I would plead that the safest way forward is to revert to the WHO principles and introduce public health measures seen in many other countries.

Photo by geralt is licensed under CC BY-NC-SA

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