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You’ll have made your mind up about BoJo’s film, last night.

Truth to tell, if the environment is safe and we could distance, a lot of us would be back at work already.  I don’t think he changed much, apart from emphasis.

We are still left with one question; are we coming out of lockdown too soon?

If you do, you’ll end up like Germany, with the numbers going up again.

We are told, decisions are based on the science, but I’m bound to ask; is the science any good?

For starters; 

Decisions are based on the movement, up or down of the ‘R-number’.  The average number of people an individual might be expected to infect, at a single point in time.

‘R’ will be higher on a cruise ship than on the Isle of Skye and higher in a care home, than in your home.  It’s also impacted by social distancing and we know compliance has been good-to-variable.

‘R’ will vary from place to place, situation to situation and minute by minute.  There is no, ‘one R-value’ beyond mathematical jiggery-pokery… or what seems to me, not much more than an educated guess.

The R-value is not based on hard data, because we have no hard data.

We have no complete picture of who has CV-19, who has had CV-19 and recovered.  If we did, R-values would change.

CV-19 data sets are incomplete and probably show the tip of the iceberg.  The ONS says 400,000 people could, currently be infected and 20k could be infected every day.  Imperial College say, the number infected by March 30th, could have been between 800,000 and 3.7million.

We know; 10% of cases are severe, 60% mild, 30% are asymptomatic.  Well, we think we know.  As we don’t really know who has had what and when, we don’t really.  

We have a limited number of tests available, every day and for reasons the government is unable to explain, testing opportunities are not taken up.  We have nothing like a big enough picture to base decisions on.  

We appear not to have data on infection patterns, geographical hot-spots, demographics and all the other information epidemiologists need, to do a proper job.

Franky, the R-value looks, to me, insufficiently reliable to base life-losing, business-rescuing decisions on… but it’s all we appear to have.

From the outset, experts disagreed on the R-values from the infection’s, so-called ‘uncontrolled‘ stage; WHO said R2.5, Imperial R3.  The settled R2.6,  looks like a ‘flip a coin and call it quits’.

Intermediate stage; the ‘assumption’ for R, posh word for guess, falls to 1.4.  Finally, lockdown R0.7, we think.

Add to that the variable, no one wants to talk about, the progress of herd immunity and you can make up your own R number.

It gets worse; there is a long lag between getting infected and developing symptoms.  Add to that the fiasco-testing-regime and the time it takes to get a result, it might mean a 15 day delay in knowing what’s what. 

There’s more; about 30% of people tested, for CV-19 give a false negative.  False positives are much lower but there is an error rate in all testing.

Different countries do things differently, there is no, one, international spreadsheet everyone fills in everyday.  We have knowledge gaps and choices and opinions and that means we can’t really do reliable, basic forecasting.

Care home contagion is not resolved, the emerging difficulty in mental health establishments is likely to be the next big scandal and unless we move all BAME personnel out of the front line, there will be more unnecessary deaths. 

Transmissibility is not dependent on just biology… geography and economics have a lot to do with it. 

If the politicians, making the decisions, drop the ball, it will be the NHS that will catch it.

Science is knowledge attained though study or practice and its application…  

In the CV-19 crisis, science is starting to look like an art-form.  

Whatever picture the No10 Press palaver wants, they’ll paint.

News and Comment from Roy Lilley

Contact Roy – please use this e-address roy.lilley@nhsmanagers.net

Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.