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will pick up people, potentially with dead virus. Remember, it picks up an RNA strand that is 220 nucleotides long. That degrades much slower than the actual infection when you have it on board. After eight days, we cannot isolate live virus, but for up to 90 days you can isolate the RNA fragments and pick them up when you test, so, if you randomly go into schools, you might as well shut them down right now. It is not a process that I have recognised in 20 years’ experience of being a clinician, as a GP, or a process that is aligned with evidence-based medicine. If we are to go down those routes, we have to think of the wider context of what harms they introduce, what the social consequences are and what the plan is.’ The UK government rolled out mass testing and proposed mass testing in schools. Although, when mass testing was introduced in schools in March 2021, the less sensitive lateral flow test was used.

POSITIVE TESTS, CASES AND PATIENTS

This is an example of scary semantics rather than dodgy data. People who tested positive were called ‘cases’ and in one case I noted the word ‘patient’31 was used. Both ‘case’ and ‘patient’ imply illness and symptoms, whereas many of the positive test results were asymptomatic or post-infectious. A medical diagnosis of ‘case’ would normally involve symptoms plus a positive test, not a test on its own.

DEATH STATISTICS

I was flung into my armchair death-expert status by the whiplash of an epidemic and lockdown. The next chapter explains how changes to the death registration process mean there are now serious problems with counting the dead.

EMILY, 45, NURSE

A colleague who does the bookings emailed me to say, ‘You’ve got a patient coming in for an overdue blood test this afternoon, she’s really nervous and she’s been shielding since March. Can you meet her from the car to make sure she attends?’

It’s not unusual to have a nervous patient – needle phobia is certainly not uncommon! The appointment time came, but I was busy finishing off with another patient so I hadn’t made it out to the car park. As I completed some forms I suddenly heard shouting and screaming coming from the reception area. I rushed out and saw a lady, obviously very distressed, walking with two sticks and wearing a mask and visor, supported by a man. She was incomprehensibly sobbing, shaking and flushed, as she staggered down the corridor.

I rushed over (obviously in standard mask and apron) and tried to calm her down and ascertain what was wrong, encouraging her to come into the blood test room to sit down.

She continued to cry and hyperventilate. It was difficult to comprehend anything that she was saying. I was worried that she was becoming increasingly short of breath, so I encouraged her to remove her mask but her husband said she wouldn’t take it off because she was ‘too scared of the virus’.

I asked her if she was nervous about the blood test but she continued to cry in a distressed manner, saying over again, ‘I don’t want to die, I’m so frightened, I don’t want to die, I’ll die of anything but not that virus.’ I managed to get her to slow her breathing and stop moving long enough to get the sample. Her husband told me that this was only the second time she’d left the house since March.

11. COUNTING THE DEAD

We humans keep dying. We always have. We always will. In 2019, approximately 57,000,000 people died globally, and 600,000 people in the UK, which equates to 1,600 people per day. As the only real certainty of life is that we are all going to die, we should be better at the death business by now.

It’s important to count the dead. We count the big numbers and compare them annually – excess deaths are a barometer that ‘something is happening’. But we also need to know and record how people die, for public health management, planning NHS resources in the future, to inform government policy, for legal and jurisprudence reasons, and to provide certainty and alleviate the concerns and grief of the bereaved’s family.

While death and disease dominated the headlines in the UK for most of 2020, we’re not as good at considering our own demise. Perhaps the potent blend of death tolls in the headlines and our intrinsic fear of death blunted the nation’s ability to scrutinise exactly what these totals actually meant.

The UK’s emergency legislation in response to Covid-19 radically changed how deaths were registered. If the Imperial modelling that predicted 500,000 deaths came to pass, it would be essential to fast-track the registering and disposal of bodies. The UK did not want an Italy or Ecuador situation with bodies piling up. But this came with costs: at a time when it is crucial to understand why people are dying, we have less clarity due to the changes in registration and recording.

‘Unprecedented’ is a word that has been horribly over-used during the epidemic, but it should not equal ‘unplanned’. Ministers claimed not to have read the 2016 Exercise Cygnus pandemic planning report. Before Cygnus there was 2007’s Exercise Winter Willow, as well as detailed debriefs of SARS, MERS, H1N1 and even Ebola. Plans should have been robust and flexible, but the NHS and Public Health England were ill-prepared in terms of surge capacity and PPE stocks.

‘Unprecedented’ is no excuse when pandemics are the basic bread and butter of disaster planning. Lucy Easthope, disaster planner, has a special interest in preemptive pandemic and recovery planning. She is the visible representation of the depth and detail of the UK’s disaster preparation and puts the lie to the so-called lack of planning. She said, ‘The media and the government have sold the idea that no one could have expected this, but a pandemic is the most likely national risk, and very well prepared for in the Home Office and the Cabinet.’

Easthope is involved in planning

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