Inside Health

Early complacency and cod science has and will cost lives, writes Professor Harry Burns

We are in a war, the Prime Minister tells us. Are we winning? I think we could, and should, be doing better. Initially, the UK government suggested that all that was necessary was to contain the outbreak by isolating those with positive tests and asking their close contacts to isolate themselves. By early March, it was pretty clear that this strategy had no hope of working. On 12 March, the Prime Minister announced a strategy aimed at “flattening the curve” – delaying the peak of cases until the NHS might be able to cope with the numbers infected. This approach, we were told was “following the science”. Unfortunately, the science they were following lasted about three days. By 16 March, a new approach, based on better science, was announced. Large gatherings were banned, sporting events postponed and, more recently, pubs, shops and businesses have been closed. Schools closed, first in Scotland and England followed soon after. We are in self isolation.

Understandably politicians are reluctant to take actions which adversely affect the economy and limit personal freedoms. However, this is a war which some countries seem to be winning. South Korea has apparently “flattened the curve” without radical restrictions. In February, it was reporting over 800 cases a day. Last Sunday, it reported 64 cases, the 12th day in a row it had fewer than 100 cases. How have they done this? They acted fast. Unlike many European governments, they rapidly implemented a plan to actively screen the population for positive cases, trace the contacts of those cases and isolate them. They set up 600 testing centres to screen people quickly and safely. They had 50 drive through centres in which drivers had their temperatures and a throat swab taken. Public buildings were using thermal imaging to detect people with high temperatures.

The UK government has announced that home testing will be made available to buy in Boots or on Amazon within days. That might help. However, testing by itself is not a panacea. It should be followed up by effective contact tracing and isolation of infected cases. In South Korea, forensic methods are used to trace contacts. When a case is identified in an area, local people are alerted by cellphone messaging. People who believe they may have been in contact with a case are encouraged to attend for testing themselves. If an individual is asked to self-quarantine, he must download an app which will alert authorities if he breaks quarantine. This is Big Brother in action, but it seems to be working and saving lives. Their hospitals seem to be under less pressure than we are seeing in Europe and, as well as now seeing fewer cases, their death rate is low at about one per cent.

This approach is probably only possible in a country with high levels of public trust in their government and a low level of idiots in the population who insist on ignoring advice. Can they be trusted to use the screening kits and isolate themselves? Doctors with symptoms of COVID-19 have been told to self-isolate for seven days and then go back to work without ever being tested. Getting extra testing kits will allow them to be tested. Presumably, their contacts, including patients, will be traced. Many health staff tell me their protective equipment has been late in arriving and seems inadequate. NHS Scotland is just coping in immensely difficult times. At a UK government level, however, a degree of complacency may have left effective action too late and our NHS may struggle in the weeks ahead. Professor Sir Harry Burns is director of global public health at Strathclyde University