Sunday, 21 June 2020

Why? What? How?

As a newly qualified medic, in what is now the historical past, I asked my mentor, Professor McClellan, what advice he would give a young surgeon just starting on his career. The Prof was famed for his pithy and occasionally abrupt responses, especially to anything he considered a "stupid" question. He was asked to give us our valedictory lecture on, "The use of visual perception in diagnosis" after telling us what a load of management speech gobble-de-gook it was, his opening slide came up with the statement "Use your fucking eyes" and he proceeded for an hour to hold our attention showing why. All he said, in answer to me, was when training and working with McIndoe during the Second World War, McIndoe gave him this advice,  "Always before you implement any treatment plan ask yourself three questions:
  1. Why are you going to operate in this way?
  2. What is the objective evidence it is the best way?
  3. How could you do it better?"
This was a methodology that did me well in my professional career both inside and outside of the medical world. I was always looking for conferences and meetings, in my field of expertise, I could attend; well before CPD was a requirement for continuing registration.

From the comfort of retirement I still follow the activities of the healthcare world, for example, wondering at the amazing epidemiological contortions of the anti-vaxxer brigade as they seek to prove that herd immunity does not work and vaccination is in fact very dangerous. They ignore the realities of the mass chicken pox or measles epidemics which up to the mid 50's when vaccination programs got going, killed both adults and children and left many others with long term damage to their lungs and internal organs. The point here is there have always been adverse reactions to vaccinations in a small number of people but the unfortunate damage to a few has long been thought worth the benefit to the many.

So to our current epidemic, Corona Virus or Covid-19.

We are seeing the usual cadre of Scotch Unionists lining up, with the support of the BBC and other media, to find "SNP baaaad" stories in an attempt to seek some sort of political leverage to obfuscate from their main parties' abject failures in England over the handling of the Covid 19 pandemic. It was a pleasure to see the Tory's Carcrash Carlaw at last being handed his arse on a plate by the First Minister during FMQs last week. Sadly the political finger pointing by the Unionists will continue, a finger pointing that will ignore what actually is, so they can create a mythical bubble of what they would have done.

From my angle as a medical professional there are a number of "Why are / were you operating in this way?" in this way which need thinking about.

Take, what I will call, the "Nike Incident".

Evidence has now come to light, when concerns arose that there was a possibility of a Covid transmission risk at the meeting in February, test and trace was effectively applied to all attendees still in Scotland with great success. The test and trace was carried out in line with the, then, WHO best practice advice for Covid 19 control.

So why, when it was clear Scotland was already seeing an increasing number of Covid cases in early March, was the "test and trace" system not developed further?

Given how well the outbreak in Scotland was otherwise handled between NHS Scotland and The SNP Government, this jars. I have tried to think about it and my only answer is; the decision not to seek to contain by "test and trace" was due to UK funding problems, the need to stick to COBRA agreed protocols or lack resource availability because of the need to focus healthcare staff in hospitals.

We now know the "Imperial College" model being used by the UK Government to inform COBRA outcomes in February and March was way off the mark estimating the "doubling rate" of Covid 19 spread at seven days rather than the WHO indicator of three days, WHO advice being based on the objective evidence of the spread in Wuhan, Spain and Italy. I would suggest, rather than this being another Tory calumny, it is more likely a UK Government preferring to hear the view which politically suited it, a situation that many who have dealings with the UK Government can attest to. Simply think Blair and Saddam's weapons of mass destruction.

The problem for a SNP Government looking at differing advice which points down a different pathway is they were stuck in an agreement which said the devolved governments would take the lead from COBRA meetings (aka the UK Government line). To go against this line would have potentially serious impacts on "Barnet consequentials". Taking a different line would mean loss of balancing income from the spend in England on Covid activities. It was only when the furlough program was rolled out for England that the SNP started to diverge from the "UK" Covid script and develop their own lock down program for Scotland and utilise business funding support, via "Barnet consequentials", in a different way.

The positive impact on Covid disease control, in Scotland, since this move away from UK to Scotland specific Covid measures has been clearly evidenced, even to the point Scotland now has a test and trace organisation set up using local Health board's staff along with designated Covid focused GP practices all of which follows WHO advice on best practice and has been applauded by a WHO rapporteur in its application.

How could it have been done better?

The jury is out until all the medical evidence is available yet is clear that being tied to UK leadership via Cobra and reliant on UK funding has had a direct impact on Scotland's ability to deal with the epidemic in a Scotland friendly manner. Once freed of "UK" constraints the ability to change tack when the evidence indicated a need to is self apparent. There has to be a long hard look at what went on in Scotland's care homes but the scathing judgement by the Sheriff on the owners and operators of the Skye Care home is indicative of where the problem lies. It is not with NHS Scotland or the SNP Government but the corporates who own and run many of these facilities for the benefit of their tax dodging backers in the British Virgin or Cayman Islands rather than those in their care. All the squealing trying to persuade us otherwise by Carlaw and Murray (both funded by Care Home Corporates) should fall on deaf ears.

Scotland has survived better, with better outcomes for Covid suffers and fewer deaths per million of population in spite of a UK Government which has blundered, failed and lied to the people of England at every turn, basing its Covid policy on what is best for the Tory Party and its Brexit fantasy, rather than what is best for the citizens of England.

Being independent would have been a good start to dealing with the epidemic better.