Day: 1 April 2020

Low trust in UK government: Debunking needed

Angelina 6 Comments

Note: this is about right now. This is not to say that I applaud this government and its approach, not at all.

The UK government has lied a lot in the past ten years and also often sucks at communicating well. That is causing some problems now, I noticed on Twitter.

“There are 12,000 ventilators” followed by “8,000 within the NHS” does not by definition mean that the government is lying but may mean that its communication skills are not up to par.

It could mean:

  • 4,000 on the way to the NHS;
  • 4,000 within the Navy, Army, Air Force, private facilities and also some on the way to the NHS;
  • etc.

Something similar is going on with COVID-19 tests and reagents. It is very hard to find info in the UK as it is a low-transparency country. (I for example found detailed information about a local water treatment facility (Budd’s Farm) in the Netherlands some years ago, but was unable to find much about it in the UK.)

I looked into it, found some info on the CDC site, spotted the name Roche, and remembered something I had read in the Dutch news. The Netherlands is much more transparent than the UK, so I looked into that angle.

It may also be helpful to keep in mind that the Netherlands is a highly egalitarian country. A lot of the wheeling and dealing that goes on in the UK would not be permitted in the Netherlands. (I am not saying that none goes on there.)

Roche makes a lot of the equipment needed for the tests and that equipment requires certain chemicals to run. Roche also manufactures the required lysis buffer and was briefly not able to keep up with global demand.

It initially was not willing to share the secret “recipe” either. It did later release it after all, but it is actually not that easy to make so it cannot simply be made by anyone and has to involve certification of the labs who make the stuff. Roche currently is able to keep up with demand again, so I understand.

In addition, the Dutch health minister, too, mentioned shortages in other test-related materials on 27 March.

(The UK government specifically mentioned a shortage of swabs.)

Main source (a reliable Dutch newspaper): https://www.trouw.nl/zorg/farmaceut-roche-deelt-toch-het-recept-voor-coronatests~bdb6a844/

I am assuming that the UK is using the same test as the Netherlands or a very similar test (which is also likely the same as the US is using). (I have a report – collection of international information – from a Belgian university in my pc that probably has details on that; I will see what it says and add that info later.)

Conclusion: The UK government for once appears to be NOT LYING.

The information given by the UK government appears to match the information available in the Netherlands.

(The – possibly inadvertent – spin in the UK currently appears to be coming from… Labour?, I say tentatively, on the basis of the tweets that I saw.)

(As I have posted some tweets from Tory MPs in the past, I should also do it with tweets from other MPs. I have no idea what was said during Newsnight)

From the “living paper” report in my pc (“Overview of information available to support the development of medical countermeasures and interventions against COVID-19” by Martine Denis, Valerie Vandeweerd, Diane Van der Vliet, version 23 March 2020):

“Testing methods
A list of assays commercially available for diagnosis of COVID-19 is updated by FIND (https://www.finddx.org/covid-19/). Assays that are still in development stage are also presented.”

The report has a lot more information on testing, but does not state details on which country is using which tests and protocols. If you click on the above link, however, you’ll find a lot of information that indicates that Covid-19 testing requires rigid procedures to be able to work. In other words, ramping up capacity is likely not as simple as some MPs think it is.

(For comparison: You wouldn’t want a sloppy pregnancy test that is often wrong either.)

Triage, bias and Covid-19

Angelina Leave a comment

I am currently watching “When They See Us” on Netflix (which I signed up for for a month and which will expire in a few days and I won’t renew it). It is based on real events and contains some vintage Trump. It is about bias and how it can ruin people’s lives.

This morning, I signed up for an online seminar to do with “Disability, Health, Law, and Bioethics”.

Triage and Covid-19. How can you be as fair as possible? By applying non-discrimination. By being as random as possible.

Just like it is not fair to rule against pregnant women because they require more care, it is not fair to rule against people with disabilities and other health challenges in addition to Covid-19.

Unless it is on purely medical grounds.

What do I mean by the latter? An extreme example is that there is no point in treating a dead person for Covid-19. The only rule would have to be whether a treatment would make sense, medically speaking. That’s likely easy enough to determine is still much easier to type than to do. (I have to define this.)

That a situation might be more complicated should not play a role.

If you were to apply such a biased rule with regard to disabled people, you would also have to apply that rule with regard to pregnant women. (Otherwise you are clearly discriminating against disabled people. That would even be illegal, wouldn’t it?)

But there is not enough staff and there are not enough mechanical ventilators.

So what do you do?

First come, first served. It is the only thing that makes sense.

Because it is more or less random.

You could argue that this would disadvantage the person whose spouse’s car broke down on the way to the hospital. Socioeconomic circumstances are a great discriminator, unfortunately.

Then I thought about it some more.

Well-to-do people generally go to – have access to – different hospitals and health-care providers.

And when I think about disabled people being at a disadvantage because they may for example take more time to get into a car, well, they also tend to have people around them who can assist, even now (I should damn well hope so!), while, say, the dad with two kids also has to manage the kids and get his seriously ill wife into the car.

So that probably more or less evened out.

If an ambulance is called, the process is the same regardless of who the patient is (or damn well should be).

There is the factor of distance to a hospital, but you could get stuck behind an accident in traffic a block from the hospital or have very light traffic from further away. That’s likely more or less random.

Plus, in most places, traffic is light right now.

Seems to me that “first come, first served” and then, while in hospital, those who require a ventilator first get one first.

Nobody should be taken off a vent purely to make way for someone else.

Also, because taking someone off a vent would have meant that the effort spent on the person who gets taken off the ventilator would likely go to waste.

That would not be an efficient use of resources.

(I know that having been on a vent for a while can help a person, but he or she should only be taken off the vent for medical reasons that only have to do with the person in question.)

The only fair way to triage people is severity of complaints, randomly. Skin color or disability or nationality or hair color and even age should have nothing to do with it.

I feel some protest in me when I think about the age factor. That comes from some bias in me.

Shouldn’t a 75-year-old make way for a 36-year-old if they have the same severity of complaints?

I notice that bias, with interest and surprise, and then I override it.

No. That would be discrimination.

And that would not be fair.

(If the older person in question makes that choice and states that he or she does not want the ventilator and states that it should go to someone else, that’s a different matter.)

Severity of complaints and “first come, first served” should be the only principles to base triage on.

I see no other way to keep triage fair.