Showing posts with label Vietnam.. Show all posts
Showing posts with label Vietnam.. Show all posts

New Zealand, Vietnam - Elimination Strategy works - what is stopping others from doing what works?

Eridcation or Suppression? Australian TV asked the question whether or not elimination of community transmission of the virus vs eradication of the virus is the better choice.

  
They carefully avoided a direct or conclusive answer, and spun the elimination protocol outcome as a problem, closed borders, and suggested suppression as the favoured choice by omission.
They did not qualify suppression in terms of lives lost, impact of disease, and instead implied permanently closed borders would be a problem - without mentioning that a 2 week quarantine is not a closed border.
It was only a short piece, for a news segment, so obviously detail was not their intent. I am using this piece as an introduction. My thesis is simple. Elimination of uncontrolled spread of the virus from a given population/territory where a single Government operates is wholly feasible. New Zealand has proven this. Every time any reporter or member of the Press faces members of the UK Government, all they really need to be doing is repeating "New Zealand, New Zealand." Really. Their obsequious questioning is complicit in the crime being committed.

Now, June 21st, two months on from that news segment, and New Zealand is clear of SARSCOV2 virus, community transmission has been eliminated and there are no new cases of COVID19 after an eleven week intensive elimination protocol.

Vietnam is also clear and there are other States, such as Taiwan which have also eliminated the uncontrolled spread via community transmission within their populations, and others Finland, Norway are getting very close to clear by following the Elimination of uncontrolled spread of the virus protocols. Video : Vietnam - Dr. John Campbell speaks to a fellow Brit in Danang, Vietnam.
Sweden's failures. Sweden has been excluded from a Nordic Free travel Zone until it has mastered the virus, having chosen to ignore the elimination protocol in favour of a herd immunity approach, and shielding the vulnerable. It has failed. They got it wrong. Sweden's per capita death rate was 10 times that of it's neighbours, running to close to 10% of all confirmed cases/ Video : Sweden - Dr. John Campbell speaks about Sweden reviewing the data and their strategy.
Senecide Video: Sweden - Dr. John Campbell speaks with Dr. John Tallinger, a GP in Sweden, dedicated to working with elder patients, saving lives for COVID19 patients over 60 with chronic disease, with oxygen supplement, due to Swedish Health Governance policy directions to administer palliative care medications, rather than admit to general Hospital.


Neighbours can be a problem, if their arrogance inhibits sociality. Proof

Thus we have living proof, scientific proof, epidemiological, social, political and economic proof that Elimination of uncontrolled spread of the virus protocols can and do work. We have ample proof that herd immunity approaches are lethal. That said, this achievement requires a certain degree of discipline and commitment. It is not easy, by any stretch of the imagination. One has to 'stay alert'. Quarantine, and unacceptable failure. Then in June, New Zealand had two new cases, imported from Britain, by two sisters returning on June 7th, to visit a dying parent, who had become very, very close to death and who then died whilst the two sisters were in quarantine. Very sad for all concerned. The local officials allowed the sisters compassionate leave on June 13th to travel to their dying parent's family, to be with the surviving parent, which was before their quarantine time was up, but they did not test them. One of the sisters had already presented with flu-like symptoms and was not tested as it was believed the symptoms were due to a pre-existing condition. That was the first error. The second error was allowing them to travel unaccompanied by any officials, unguarded so to speak. There were a number of other errors made by the officials in handling the case. I assume some of those errors were compounded by the sisters British based perception of Corona Virus, as their behaviour would indicate. I will focus on that perception later in the article. As the symptomatic sisters symptoms became more severe, the sisters were tested on June 14th, and their tests came back, positive for both of them, on June 16th. They were placed in isolation.
The NZ contact trace system kicked in and located more than 300 people who could have been infected via these two sisters, within 24 hours, and placed all on quarantine, urging them to get tested.

"Health officials are tracing 320 people who are regarded as “close contacts” of the women, and they will be urged to get tested. Close contacts could include passengers on their flight to New Zealand and other quarantined travellers at their Auckland hotel, as well as hotel staff and flight crew. The women were now in isolation with a relative, officials said."
The whole affair brought to light how important discipline is in maintaining clarity and effectiveness of the protocols. That discipline depends on everyone fully understanding the evidence, the science and the public health risks and taking appropriate steps to maintain a virus free status, and to isolate as soon as any sign of infection emerges. Jacinda Arden spoke of these and said the errors were 'unacceptable' and ordered all compassionate leave to be suspended in future until they can be sure the best discipline is fully operational at all times.



The discipline of Government, it's officials and agencies and of the people is a critical element in any elimination strategy. From start to finish, and afterwards. People spread the virus. The virus is unlikely to travel on goods when proper screening is undertaken -and if a solid quarantine ans testing system is in place for all travellers, then the most likely un-quarantined infection route would be people smugglers, drug smugglers and so forth. Covert and unofficial lines of transmission which can only be countered by extreme vigilance, rapid and unrelenting action and confrontation. Systems exist for that purpose. Elimination Strategy is simple in principle, complex in practice, complicated by power gaming.

Elimination of uncontrolled spread of the virus - when there is a given population, a bordered territory and the state has the ability to pick up every symptomatic case, and has the ability to trace every contact, observe those contacts in quarantine and has top notch provision for treatment of anyone presenting with symptoms, away from the community, that state can eliminate the virus within that population. Bit by bit, day by day, until they close down all community transmission, and have everyone in treatment being cared for, and they have a situation where they have no new infections for two weeks after the last deaths, and the last recoveries from the disease, then that population can be sure that no more transmission of the live virus is occurring. The virus cannot live long outside the human body. It can only transmit from body to body. The State and community must still maintain vigilance.

This can be done, all of it, without total shut down. 12 weeks is the length of time it takes to move through this entire protocol in any population, the only limiting factor being the volume of resources deployed. Where community transmission is out of control, then massive resources are required because more ground has to be covered, rapidly.

Shut down is only needed when community transmission is out of control - which was the status in mid January in Wuhan, and in late February, March and into April in the UK. Community Transmission out of control. Unfortunately, community transmission is still out of control in the UK in spite of the effort and endurance of vast majority of British people staying home, staying safe. The UK has not managed to 'control the virus' and is perilously close to starting a second peak as I write. I say second peak, because for their to be a second wave, there must be a trough in between, and that is not the case.

This is entirely down to the failures of the UK Government to take the Elimination of uncontrolled spread of the virus route from the outset. The responsibility lies with the Conservative and Unionist Party Government, with Parliament and the News media, which has behaved in a most feeble manner. No-one else. Current estimates of excess deaths due to the virus and other effects from bad policy choices is 65,000+. This is terrifying and infuriating in equal measure. I am ok, personally. I have had the disease, five weeks of awful illness. I have lung and kidney issues since then, slowly improving. I have stopped smoking, and I am taking exercise every day and doing some running. This is not my personal fear anymore. I have degrees of immunity. I am resilient.

However at the age of 60, I have many friends whose situation is not so secure. Friends and family members with chronic disease conditions, cancer and other illnesses that put them all at greater risk of severe or even lethal outcomes should they become infected. They do not feel this government is doing it's utmost to protect them. They do not feel safe. I also have friends who have bought into the conspiracy theories, and others who are Brexiteers who support Johnson no matter what else is happening. But they are a minority. Most people I know are aware, paying close attention to the science and are taking care of one another, enduring the situation. Good people predominate.
The problem in the UK is not the people. The problem has been the UK Governments atrocious handling of the situation. The deliberate delays in responding at the beginning, the lack of PPE and other equipment, the wholly ill-advised and inadequate policies they have chosen, their deliberately confusing public messaging, the prevalence of unethical theory (Herd Immunity) and opinion over scientific, epidemiological and public health practice evidence, the lack of adequate support for pre-existing stresses across the community as they were shunted into sudden shut-down, the willingness of the Government to lie and dissemble about their failures and decisions, their readiness to place resources in the wrong hands, and a media that is even still unwilling to confront a lethally dishonest Government head-on have all combined to guarantee the spread of the virus and have lead to 60,000+ excess deaths within four months. Why did the UK Government avoid the obvious elimination protocol? It's not rocket science! Making Elimination Strategy Work.

To make Elimination of uncontrolled spread of the virus work the State and the people must have a rigorous discipline and there must be genuine trust in the process among the population.

To make Elimination of uncontrolled spread of the virus work the State and Health Authorities must have superb contact tracing up and running, the State must make quarantine and isolation treatment an integral part of track and trace, and it must be made as easy and as comfortable as possible for the people affected to comply, and the State must resource the protocols fully, no questions asked.
That means the State and Health and Education systems must have superb, honest and transparent communication to the population, at all levels, at all times. The only must the Boris Johnson was familiar with was the Island of Mustique. The Role of The Press.

The press and news media must be willing to debunk and dismiss all contheories, concepts such as herd immunity and other woowoo health claims, in order to insulate the population and the politicians from any possibility of such nonsense afflicting public policy or public behaviour.   Spreading lies to allow a virus to spread is not free speech!

We are all in this together.
It has to be that the entire population, the State, the press are operating on an evidence base for the correct action to be taken, so that the discipline is emergent, collective, engaged rather than imposed and draconian. Honesty must prevail, Scientifically and Ideologically.


The likes of David Icke, Nigel Farage, Trump and Johnson lies and manipulations such as the 'China Virus' idiocy, and other such statements by leading politicians and so forth cannot be allowed to run free. They have to be debunked. Openly, transparently. Honest Borders.

The State must also accept that it will have to police the borders intensely, that the populations holidays must be taken within the populations territory, that all private cross border travel must endure a well monitored quarantine, including billionaires in private jets, for as long as the quarantine is needed.

Immigration must cease until there are virus clear countries at both starting and ending journey countries, and it must also be disciplined by a two week quarantine.

Air travel for tourism, right now, is a luxury that we do not need. Air Freight is another matter. Land freight and sea freight must be handled with care.

Cross border Cruise and Tourism are luxuries - we do not not need them. When local populations take holidays in own countries, the income stays at home, this is better for everyone, and potentially there will be less carbon exhaust particulates in the air. Stop overs in infected areas cannot happen, of course. The workers need to be furloughed, for the 12 week period. The Companies can be helped.

Aviation and Tourism will take a hit, but only for as long as it takes to Elimination of uncontrolled spread of the virus s in departure/destination areas. Their ability to lobby governments to take stupid action has to be curtailed. They deserve support from the State just as any others do. According to their needs to stay afloat. 12 weeks, three months. It is not too much to ask, given the potential death toll of allowing the virus to infection millions upon millions of people, among them 11.5 million vulnerable people. Allowing Herd Immunity is cruelty.

The alternative to Elimination of uncontrolled spread of the virus is slowly achieving herd immunity across a given population at the practical HI level of 93% and unfortunately that guarantees that all vulnerable people WILL be exposed and that will come with a fatality and human damage cost which is unethical to consider for economic reasons, precisely because it is avoidable. It is wholly unethical to permit heard immunity by exposure. There is so much that is still unknown about the long term effects of this virus that to drop the precautionary principle at this early stages is epidemiological stupidity, and reckless misGovernance.

Unless a State Establishment wants to exploit the virus to rereig Economies and State systems, in which case ethics are irrelevant. Trump and Johnson are two leaders who have ably demonstrated that ethics mean nothing to them personally or politically. Go figure current policy behaviour and outcomes.
Which is precisely what the UK and US Governments are doing, today, right now, right before your eyes. They are exploiting the situation, and causing great harm. This is insane, and it is profoundly unethical. "New Zealand, New Zealand!" It has to be said, in the clearest possible terms. This cannot be allowed to continue into the autumn. it really cannot be allowed. Something must be done, and soon.
Kindest regards

Corneilius

"Do what you love, it is your gift to universe."

This blog, like all my other content creation work is not monetised via advertising. If you like what I present, consider sharing my content. If you can afford the price of a cup of coffee or a pint of beer/ale/cider for a few months, please donate via my Patreon account.

Thank you for reading this blog.

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Stop the Spread Explained: Healthy people are the main spreaders, vulnerable people suffer the most.



Stop the Spread Explained - as best as I can manage as a lay person.

My attempt to explain in laymans terms what Stopping the Spread of an infectious disease is all about, when we have no vaccine and no preventative treatment - and yes, healthy fit people are the primary spreaders of the infection because they move about a lot more than chronically ill people do, and they do not present with as much symptoms, so they can spread and not be aware of it. Wearing masks takes this into account, It is a precautionary measure. . No blame here, this is just how this SARSCOV2 virus functions. And people with chronic disease and immune system compromised status are the ones who suffer the worst effects. That's a lot of people - in the UK it is 15 million people, in the USA it is 83 million people. A family, society or culture is very much defined by how it relates to and treats the most vulnerable within it.

Stop the spread, eliminate the virus from a population, be it a village, a town, a city, a region or a country is a whole raft of measures that are designed to stop the spread of infection when there is no vaccine - that means to get to a point where there is no more active virus in the population within the given zone or territory. It is not a pick n mix list, any country dedicated to eliminating the virus from the population must do all of it. The weakest link must be strengthened to ensure the whole program works most efficiently.

If the virus cannot find new human hosts, it cannot replicate.

Transmission of infection across the community ceases. It stops finding new human hosts.

Then the vulnerable are much better protected.

That is what we ought to be aiming for.

* Important repetitive note : this virus is primarily spread by healthy people who show no symptom and the people it harms the most are those who have chronic disease conditions that compromise their immune response. Other super spreaders are people with symptoms left to self treat at home, in shared living spaces, apartment complexes.

Tourists, Immigrants and Business people travelling on air travel, in cruise ships, on holidays and so on, were the primary vectors of this infectious viral disease.

In the UK the population with chronic conditions and immune compromised status numbers some 15 million people, and it is not just the elderly, over 70s or people in care homes (441,000). In the US that population is 83 million.

Across all developed states, the numbers of potentially vulnerable people are significant.

The vulnerable are much  larger part of our population than anyone has really acknowledged.

It is worth noting that a small percentage of healthy people with no known or unknown underlying conditions also suffer some of the worst effects. So there is a risk, a gamble so to speak, even if it is very tiny, for healthy people who are exposed to the virus.

But for the vulnerable that risk is much, much greater. It is not a gamble they need imposed upon them.

The task before us, therefore, is to protect the vulnerable population by stopping the virus in it's tracks.

It doesn't necessitate heavy lock down, even though some states have used that.

Usually the reason for heavy shut down is that the virus has been allowed to go further than it ought to have been allowed. Shut down is a response to uncontrolled transmission.

Learning from experience?

UK Government Economic and Political policy was to not panic, in order to 'protect the economy'. In essence to deliberately allow the viral infection to run through the population, which was touted as 'herd immunity' - an a-scientific 'theory'. That was the original position,

While that aspect of the policy was 'dropped' (they stopped mentioning it) , and then denied, (they claimed it was never part of their considerations - an outright lie)  the policy of allowing a slow spread has been  maintained, and as such it has amounted to a continuation of the same policy - let the people take it on the chin, the healthy will gain immunity, shut the vulnerable away for 12 weeks.

There is no scientific basis for this policy, and certainly no public health basis whatsoever.

Vietnam and New Zealand acted early, and assertively, they acted as soon as any cases emerged.

First known case in UK was confirmed on 31st January, a Chinese couple returning from China to Newcastle, it was announced January 31st.  They had been in country for at least a week before that confirmation. The Wuhan epidemic was in full flow, and the UK was still receiving travellers from China, with no health checks at an UK travel entry points.

At that stage Italy was also seeing confirmed cases, and the beginnings of an epidemic, with thousands of ski holiday travellers from UK returning from Italy over February, without adequate checking or quarantine at entry to the UK, there was more infection being imported into the UK.

The time to act assertively is always as soon as the first cases emerge that are confirmed. A point worth repeating. It is also true that assertive action to quell community transmission must be taken at all times. You cannot allow even a slow spread of an infectious disease when you have neither vaccine nor treatment.

That said even if the infection has hit 10, or 15 or 20 percent of a population, when there is no vaccine, the stop the spread or suppression of virus protocols still apply and can still be implemented, and if done well, the policy will work.

The basic suppression of virus infection protocol is this :

A. From the very first cases, Government must give the citizens accurate clear direct information on the virus, how it is transmitted, and be transparent and honest in all communications - the first suggestion is that all mass events, public transport etc be curtailed - these are super spreader events. The UK government failed on that policy as Cheltenham Racing weekend was allowed to happen and a number of Football matches were allowed to go ahead.

People are asked to stay home for 8-12 weeks.

The State must support the citizens income for that period, and it must be fairly distributed, so that they can bear the burden.

All that money will be channelled into the local economies, which eases the stress on the economy at the local level. It is not wasted money. It is an investment in the health and welfare of the people.

B. Social distancing principles are put in place, to slow the spread, to give time for contact tracing etc, to work.

The Government must always be ensuring that people are very well informed as to why - you do not want to order people, you want to give them exact, detailed evidence based information. so that they are engaged in the process.

C. It is obvious that all social care and medical facilities must be fully equipped with PPE and other technical and logistical support for dealing with infectious disease, and have the ability to maintain standard services for the people who need their attention and care.

In China and Vietnam they created isolation treatment hospitals fever hospitals,  for treatment of people at the earliest possible stage of symptoms, to keep those ill people who were shedding viral away from the community. This stopped the spread and reduced cases escalating to severe or critical.

This must be enabled in both public and private care and health care settings. This means that they must be set up away from main hospitals. There can be no cutting corners in either environment.

D. The same applies to all institutional residential settings. If prisoners become infected,they must be removed from general population and treated in isolation.

E. We do not need health care 'heroes' - we need health care properly supported, well trained, not over stretched or over worked. UK has failed on all these areas.

(East Asian states had SARS and MERS in recent memory so their populations were alert to the methods having gone through them previously. )

Here is the basic process:

1. A case turns up at hospital or GP surgery, saying "I have fever, cough etc since yesterday." The earlier they report better. This is not a 'flu to be treated at home.

2. That person is tested (not just for SARSVOC2 Virus, but also for Flu and other Fever inducing diseases) and if found positive, with any infectious disease, is placed into treatment away from main hospital services in a Fever Hospital.

Government covers their income for the duration of their stay, average 2 weeks.

The Chinese and others have learned that Fever Hospitals are an effective way to treat cases of a specific virus or pathogen away from existing services so that escalation of cases are reduced, and so that cases can get the earliest and best possible treatment available. This reduces case fatality rates and protects main hospital ICU units. Those main hospital units can be expanded, and staff trained, more readily than entirely new ICU Hospitals can be built and staffed.

3. The person is questioned on his or her movements going back a week (standard incubation time, during which he or she might have been shedding viral particles that could infect other people) to draw a list of potential infectees - the list will be every person that the case spent more than 15 minutes with, in close contact, with attention paid to any public transport or crowded areas.

4. Contact tracing teams go out and visit each of those contacts, to check for symptoms, give advice and inform them of a 2 week quarantine - if they have symptoms, they go to Fever Hospital, with a contact trace carried out of their case. If no symptoms they are advised to stay on quarantine, and get in touch if any symptoms emerge - Government covers their weekly income for the 2 weeks of quarantine.

5. Repeat this for all cases and what you are doing is slowly but surely isolating all active infections, keeping an eye on potential new cases and finding out where people who have had the virus and had no symptoms are. And yes, teams of well trained people, who are good communicators must be assembled for this task to cover a large outbreak. I repeat that if Government is doing it's job, the communications of what is needed will be clear to all citizens, and they will have confidence in the teams of contact tracers, and will engage.

6. This is essential on closing down on the active virus. Chase every case, all contacts until no new cases emerge.

It is labour intensive, and smart phone tech can help make it a bit easier, but it cannot replace the human contact point - for example if an outbreak of cases occurs in your town, or neighbourhood, everyone is notified, by text or map, and people go into extra tight shut down, with hyper awareness of what to do if they get symptoms, vulnerable people get isolation treatment to protect them from being infected, people can provide help in shopping etc..

7. This helps being more precise in action, it can work without a major shut down if people wear masks, follow the protocols and are well disciplined - in the UK people are well disciplined, but the media have hyped the few who were not..

Contact tracing and mass testing makes the virus visible. 

That's the point. If we know where it is, then we can close it down
.
Obviously quarantine is essential at the borders of any territory, for all incoming travel, to maintain a virus free zone.

At their own expense, if foreign travellers or business, and if nationals returning, then the state funds it - use hotels close to entry points. This must be mandatory as the risk in not doing it is to great.

It is a process that has been tried and tested, it was developed during 1917-18 Flu Pandemic (even though they had no testing, or phones they applied the other human labour aspects and it worked well in limiting spread where it wass applied) and then refined during SARS in 2002-3, and MERS in 2012, Ebola  in 2013 -16.

It is an essential process for when an infectious pathogen is active and there is no vaccine or preventative treatment, and it has lethal outcomes for a significant part of a population.

In the case of this virus, it is spread rapidly by health fit people who show no obvious signs and for this reason shut downs are designed to slow the spread - and then you need the protocol above to STOP the spread. If you shut down, and do not follow the other protocols, there will be a drop off of infection rate, and as soon as you open up again, it will take off.

If we do not stop the spread, and eradicate the virus within a population it will continue to be passed around and that will expose those who are vulnerable because it's movement is invisible.

I wrote this song as an upbeat political protest song comparing New Zealand and others with USA and UK. There is room for more than hope in this crisis because we see proof positive of the stop the spread protocols.




this track is available as a free download as a .wav file (High res) on Soundcloud (above)

 or on Reverbnation as an ,mp3 file.


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Useful links

Short paper: Did we Eradicate SARS? Lessons Learned and the Way Forward

https://biomedgrid.com/pdf/AJBSR.MS.ID.001017.pdf

Guardian Article: "I’m an epidemiologist. When I heard about Britain’s ‘herd immunity’ coronavirus plan, I thought it was satire"

https://www.theguardian.com/commentisfree/2020/mar/15/epidemiologist-britain-herd-immunity-coronavirus-covid-19

Lancet paper on: Can we contain the COVID-19 outbreak with the same measures as for SARS?

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30129-8/fulltext

Wiki Page : Eradication of Infectious Diseases

https://en.wikipedia.org/wiki/Eradication_of_infectious_diseases

NHS England : Corona Virus - Expert Interview - What is contact tracing?

https://publichealthmatters.blog.gov.uk/2020/02/13/expert-interview-what-is-contact-tracing

Time Article : What We Can Learn From Singapore, Taiwan and Hong Kong About Handling Coronavirus

https://www.time.com/5802293/coronavirus-covid19-singapore-hong-kong-taiwan/

PR news article : Korean Government Communications during Corona Virus Epidemic

https://www.prnewsonline.com/South+Korea-coronavirus-communication

Vietnam's story - How Vietnam is winning its 'war' on coronavirus

https://www.dw.com/en/how-vietnam-is-winning-its-war-on-coronavirus/a-52929967

New Zealand:  New Zealand has ‘effectively eliminated’ coronavirus. Here’s what they did right

https://www.nationalgeographic.com/travel/2020/04/what-new-zealand-did-right-in-battling-coronavirus/


Fever Hospitals in Wuhan

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30744-3/fulltext

Fever Hospitals

https://www.scmp.com/news/china/society/article/3078397/china-style-makeshift-hospitals-could-help-coronavirus-hit


Kindest regards

Corneilius

"Do what you love, it is your gift to universe."

This blog, like all my other content creation work is not monetised via advertising. If you like what I present, consider sharing my content. If you can afford the price of a cup of coffee or a pint of beer/ale/cider for a few months, please donate via my Patreon account.

Thank you for reading this blog.

https://patreon.com/corneilius - donations gratefully received



The Fit, The Chronically ill, Poverty and the Economy - between a rock and a hard place. Stop the Spread.

The thing that strike me most about this virus SARSCOV2 is that it is a highly infectious viral infection, in that it transmits from human to human with relative ease.

There is a period where the infected person shows no symptoms,  the person feeling no symptoms is wholly unaware of it and is therefore spreading the virus to other human beings without knowing that he or she is a vector of the viral spread.

Therefore  the virus can run through any culture where there are many large group phenomena such as international travel on planes, boats, trains, shared public transport, pubs, clubs, football matches, prisons, care homes, parliaments, apartment blocks, temples of all kinds and large family homes and much else besides.

There is a blind spot among some fit healthy people that I have been feeling into and I will explore what this is in this article. "It can't be all that bad."



The dynamics of close urban living organisation and a silent virus.



In effect an invisible spread before any signs of it happening ever emerge.

Many people will become infected and they will show no symptoms at all. Their immune systems get on top of the virus before it causes any problems. Nobody is any the wiser. Nobody is at fault. We do not know why this is the case. All we have to go on is the experience. What happens.

Fit, healthy people can pretty much shake it off.  There are exceptions, of course, and whilst media tend to hype those or minimise them, we are still learning about the disease state as we go and fear is not really useful, whereas caution is.

Stay calm, act responsibly for the whole community.

For the people with strong immune systems the viral infection appears to them to be a not so serious problem. For some it's not. There is no way to predict in advance if one is one of the unlucky few. It is a gamble, a risk.

For people whose immune system is compromised, the issue becomes the disease, COVID19.

The disease is what happens when the virus begins to replicate faster than the body's immune system can cope with, and starts to impact on the body. When the body's immune system response is not robust enough to stall the viral replication which destroys body tissue.

That is what the disease is - the destruction of tissues within the body as the virus takes over cells and then destroys the cell once it has replicated many more copies within the cell, releasing the replicates which seek out new cells and these repeat the cycle, thus destroying enough cells to cause a variety of breakdowns depending upon which tissue is affected, that can then lead towards death : liver, kidney, gut, lungs and heart can all be impacted.

The disease COVID19 is really, really dangerous to a significant percentage of those who have chronic immune compromising health issues, or co-morbidity's.

That is why the Government and NHS has issued instructions to people at risk to shield themselves.

If you can imagine what it is like to live in what is called shielded status, where you cannot be touched by anyone in your immediate family, for months on end, for a year, for a year and a half. A situation where everything that comes to you has to be washed and cleaned, a situation where all your facilities such bath, toilet, clothes washing and handling and all your cooking, if they are shared,  must be policed with constant attention to detail every time anyone in your household uses those shared facilities. Imagine being confined to one room.  Imagine have to think about every move you might make outside that one room.

Add to that the conflicting narratives that percolate across news media and social media, spreading confusion and uncertainty, and then we can see that there is an extra avoidable element of situational  stress loaded onto people who are already dealing with significant stresses not of their own making.

Can you imagine living as an elder in care home that is shielded? The complexity and pressures that are added to those that already exist? What must it be like to be a carer at home?

What must it be like for carers working in large care homes?

In the UK population of people with multiple conditions is about 15 million people.  Not all are shielded of course. There are degrees of vulnerability.

In the USA it is about 83 million people.

The existing data from around the world suggests that about 20% of that cohort will, if exposed to the virus, experience severe and critical symptoms of the disease, and about half of those will potentially become fatal. Breakdown of the bodies systems and organs. This is a horrific way to die. 

How do we protect those people?

To protect the 10%  most at risk we must protect all of those people who could be vulnerable.

Co-morbidity, Disability and Vulnerability within a stressed culture.

The impact of multiple stressors on the human body and psyche that arise from living within a culture where chronic stress and inter-generational trauma patterns remain largely unresolved is well understood in the medical world and not widely understood across the grass roots.

Observe  how even media will publish articles that castigate people suffering from obesity: fat shaming is one aspect. Blaming smokers, suggesting they are doing it to themselves and should pay for their treatment, whilst protecting the Tobacco makers, even though we know that smoking involves addiction, The NHS offers treatment for that and other addictions.

There is the all too common negative attitude towards disabled people.

This makes gathering the intention of the population to focus on the needs of the vulnerable more difficult than in ought to be. Nonetheless the majority of people are decent, and will take into consideration the vulnerabilities of their fellow citizens.

To protect the vulnerable, those people with multiple combined health issues, the only proven strategy is to stop them from getting the infection in the first place.

They must not meet the virus.

We do not have a vaccine. There are no medicines that can reliably prevent escalation of the disease or can be used as treatments of the disease. There is evidence that vitamin D and C have offer some degree of immune system boost. There is evidence reducing stress reduces immune system effectiveness, so it stands to reason that reducing stress improves immune response.

SARS was a corona virus pandemic that happened in 2003.  It was less infectious than SARSCOV2  but more more lethal, with a case fatality rate of 60%, and because it generated symptoms rapidly it was much easier to trace and close down.

We still have no vaccine for that particular virus. The Governments in countries affected by SARS working with the WHO,  informed populations of the threat and what needed to be done, contact tracing, quarantine, treatment in isolation, limiting movement for a period, and they stopped the spread, and in time eradicated the virus from the population. The same procedure was applied in 197-18 epidemic. The process has been learned over a 100 year term, with new learnings since SARS in 2003. In clearest terms we know that suppression of transmission can lead to elimination of transmission, and that cause eradication of a virus that cannot live outside a human body.

We hear talk of a vaccine.

However vaccines are very difficult to make, and even more difficult to test to the degree that they can safely be used across entire populations. Such is the risk that Governments indemnify vaccine makers from litigation and financial compensation that arise when a few cases of vaccination cause severe and lethal reactions.

There are only two strategies that can protect vulnerable people in this situation.

One strategy is to isolate all vulnerable people from the general population, to isolate them from any possible community infection vector.  To enclose them behind a virus proof barrier.

That is really, really really difficult, and made much more difficult if you allow the rest of the population to slowly become infected while you wait for a vaccine. Waiting for a vaccine is not a health and safety protocol. Slow spread is not a health and safety protocol.

Those who service the vulnerable must  also be isolated from the general population.

If they become exposed,  then they must be set away from the vulnerable until they become provably immune, and can then re-introduced to continue their caring work - but they will still have to adopt clean site protocols upon entry into each caring facility as they could still carry the virus in by fomite transmission. Or they must live and work within the isolate environment of the point of care situation.

You have to somehow generate a population of immune people to service the vulnerable to maintain that separation from the virus, and you have to maintain that population in constant state of vigilant surveillance for viral particle presence.

The other way to protect the vulnerable is to stop the spread across the entire population.

That is to say to eliminate the transmission of the virus from within a given population, which leads to eradication of the virus. Stop the spread, spread the love.

This is also difficult, but it is proven. We know it works.

It was proven in SARS and MERS, and in other outbreaks of infectious disease where human to human transmission was the vector of spread. Suppression of the spread of infection, leading to elimination of community transmission and eventual eradication when the virus can find no new human hosts, and it dies out.

The process is complex, yes. It requires a lot of human resources, and a lot of co-ordinated action willingly undertaken by citizens, businesses and state officials. What makes it complicated are political and economic agendas intruding on the Health and Safety requirements.

New Zealand, Vietnam and others are showing that stopping the spread is a viable policy choice, across very different populations and economies.

Economics and Health and Safety.

Governments that have chosen the slow spread approach have all done so for economic and political reasons, not for health and safety or public health reasons.

And there is another dynamic that clouds the judgement of many people in this matter, going back to the start of this article.

Fit, healthy people are to a large degree thinking of and quite rightly concerned with how any of the protocols to stop the spread, social distancing, contact tracing and quarantine of workers, and a general shut down impacts them, their jobs and livelihoods. Because of the media narrative that the disease does not affect fit, healthy people, that many if not most will have no symptoms or will experience very mild symptoms,they are not so much worried about getting the infection and suffering severe symptoms.

Many believe that getting the infection will grant them immunity, and that as such getting the infection is desirable, to get it out of the way. This is understandable.  They have not been given the full accurate picture. 

Support - in economic terms - to take on the task of stopping the spread in the UK is minimal, and conditional and not well organised, as it was offered in an off the cuff move. This makes it less likely that working folk in the UK will readily consider what it might take to stop the spread - if your livelihood is under threat that is a reasonable feeling to have. They solution is to provide adequate and timely support. That is the job of the State in this kind of situation.

Austerity.

In the UK there is a further complication, that being cuts to public services  and the decades long policy of restricting support to disabled and chronically ill people who require state benefit support, as pursued under the policy banner of Austerity.

That the general population has been unwilling  or disinterested in confronting this over the past ten or twenty years or so in any meaningful manner is largely a matter of how media refuses to cover the dynamic honestly, how ineffective Parliament has been as a body with oversight that reins in harmful policies, and how the media and right wing politicians have been pursuing narratives that undermine empathy for people who need and deserve support - the attack on the welfare state as a thing that undermines the economy.

The UN report into the mistreatment of low income, unemployed, chronically ill and disabled people in the UK, by Government policy, was barely noticed by the population, and almost totally ignored by the largely right wing media, and robustly denied by Government, without any firm rebuttal - because there was and is no defence of those policies given the harm they have caused.

With regards to SARSCOV2 and COVID19 the Government attitude and it's stance is clearly focused on the economy, rather than on the welfare of the whole population, fit and vulnerable alike. The poverty of 14 million people in the UK is real. The feeling of deprivation amidst a growing population of billionaires whose wealth gains are in inverse proportion to the wealth losses from the low income groups is real.

Ironically, many of the fit and healthy feel as if they are being oppressed by the situation of the shut down. That said most people are adhering to the social distancing measures, and are diligent in their compliance and that is a really wonderful phenomenon - I know that most people are decent people, caring people. That decency is not reflected in the corridors of power, as the PPE scandal and others reveals.

And there is a large degree of confusion and resentment across the divided UK electorate  which is largely a consequence of Brexit and the deliberate bipolar adversarial dynamic deployed by it's proponents. So we can see that there's a lot going on here.

Protect the Economy, allow slow spread of the infection.

The confusion of political and economic and ideological perspectives in News media and across social media that filter perceptions of the nature of the threat and we have a perfect storm that creates confusion when what is need is clarity so that the population as a whole understands what is happening and what needs to be done.

Stop The Spread is the only viable policy facing this infectious disease.

Slow the Spread renders the whole population vulnerable. Loss of income is a serious leverage in deflecting attention from the realities of the Governments chosen stance. But we must transcend that and integrate it to resolve this situation.

What we are looking at is a factor that will determine the lethality of this viral infection will be socio-economic - low income population are much more at risk in any situation where an epidemic occurs.

This is born out by the most recent statistics produced by the Office of National Statistics.

Socio-Economic Status

Low income is a factor, as much as health and fitness, or lack of it in outcomes during an epidemic.

Universal Basic Income for the duration of a stop the spread policy duration could resolve that issue, and it would put cash flow into the local economies. 

Global international general trade must take second place for the duration. Internationally, resources movement must take precedence over personal travel so that areas that are less developed are more effectively supported in stop the spread policy implementation. We need every state to follow the stop the spread protocols. We have to help each other through this.

Tourism and Air travel are luxuries that must wait. Both were major vectors of the global spread of the infection. Nobody is talking of blaming either of these, and nobody should. That said, caution must be the stance, a until we are in control of the pandemic.

The dynamics of power as a factor in the exploitation of the situation.

Bullies will always, always seek to exploit any emerging vulnerability in a family, village, town, organisation, institute or population where they hold degrees of power over others. This is a behavioural dynamic, almost an un-thought about reaction other than they will think about how to maximise the opportunity - they will not have to think about choosing to exploit the vulnerability, that will feel natural, second nature to the bully.

Trump, Johnson et al are clearly part of a bullying dynamic, as are their hard core supporters. Their behaviour reveals this. The hatred poured out at those who are their political opponents, the bile and the misleading narratives with which they project and scapegoat others is well documented.

I think that British Government and their sponsors have made a  huge strategic error in allowing and endorsing a slow spread in order to protect the economy. That choice means that the hit to the economy will be much, much worse than if they had chosen the stop the spread policy, because it will mean extended periods of economic disruption as successive waves of opening up and closing down inevitably flow from the slow spread policy towards the fiction of 'herd immunity'.

The hubris and the arrogance of that decision stops them from admitting it, and now they are just bluffing through, which is why the media denial is so intense.

There is still time to stop the spread, but it means we must remove those in Government who refuse to take on that policy, because they have ideological and economic attachments to the slow spread policy and they cannot be trusted to carry through a stop the spread policy. Because they have already caused so much avoidable harm, they must be prevented from causing any more. They must be held accountable, and they must prevented from causing any more harm. The prevention of more harm has to be the primary concern right now.

We must address the issue of acknowledging that the often unspoken origin of distress, disease and ill health across entire populations lies in how power is mediated,  and where that observation is avoided, ignored, muted and suppressed - we must confront the deliberate gaslighting focus on what is 'wrong' within the individual, that avoids addressing what is harmful about the culture itself.

That is a serious problem - the resolution of which must come from a widespread, accurate and wholly evidenced understanding of the situation and fuller engagement across the population based on that understanding. Honesty and transparency matter profoundly. Spin causes harm. Lies are wholly unacceptable.






Kindest regards

Corneilius

"Do what you love, it's Your Gift to Universe"

Thank you for reading this blog. All we need to do is be really honest, responsive to the evidence we find,and ready to reassess when new evidence emerges. The rest is easy.