En mycket intressant artikel i Telegraph som redogör för skillnaden i angreppssätt mellan de asiatiska länderna och västvärlden. En skillnad i inställning som leder till skillnad i förmåga och i resultat. Kommer den västerländska fatalismen att överleva Covid-19? Eller kommer vi att lära oss att göra rätt från början och i tid?
”Superintressant genomgång av skillnader mellan brittisk och sydostasiatiska pandemiplaner. Jag fäster mig särskilt vid: 1) I Sydostasien inte bara tydliga regler om stora beredskapslager av skyddsutrustning i både hem, arbetsplatser och vårdapparat, utan dessutom stora PCR-lab som bara står och väntar på att behöva användas för att detektera luftvägsvirus i stor skala vid en hotande pandemi. 2) I Storbritannien utgick man tydligen – till skillnad från i Sverige – redan från början från att en annalkande pandemi inte skulle gå att hejda.
Revealed: Why Asia was better prepared to fight the coronavirus than Britain
While Britain’s pandemic plan assumes a new virus will be unstoppable, Asian countries focused on containment in a bid to minimise mortality
Nicola Smith 18 April 2020 • 9:30pm
To understand why southeast Asian countries are still open for business and recording deaths in the low hundreds, while Britain is in lockdown and thousands are dying, it is instructive to compare the different nations longstanding pandemic response plans.
“Sheltering is a measure to restrict most people’s social activity and is different from isolation and quarantine…. It targets the whole population in a community… The public is asked to stay at home for their safety,” says Taiwan’s Influenza Pandemic Strategic Plan, which was first written in 2006 and anticipates the need for a possible lockdown.
In Singapore pandemic planners were also ready.
“Coronaviruses undergo genetic mutations and recombination at a rate similar to that of influenza viruses”, says its Pandemic Readiness and Response Plan For Influenza And Other Acute Respiratory Diseases.
“Our objective is to sustain the nation through the first epidemic wave by minimising mortality and morbidity through the use of measures that are proportional to the assessed public health impact, while ensuring preparedness for vaccination of the entire population” Singapore adds.
Now to Britain and its plan, which was updated after the H1N1 swine flu pandemic of 2009 and published by the Department of Health and Social Care in 2011.
“It will not be possible to stop the spread of, or to eradicate, the pandemic influenza virus, either in the country of origin or in the UK, as it will spread too rapidly and too widely”, says the UK Influenza Pandemic Preparedness Strategy.
“The expectation must be that the virus will inevitably spread and that any local measures taken to disrupt or reduce the spread are likely to have very limited or partial success at a national level and cannot be relied on as a way to ‘buy time’.”
The Telegraph has obtained all of the publicly available national pandemic plans for southeast Asia and compared them to Britain’s own.
The analysis reveals not just differences in tone but in detail. While Britain’s plan assumes a new virus will be unstoppable, the Asian plans major on containment in a bid to minimise mortality. Specifically, the Asian plans all foresee and plan for:
Large scale testing capacity
South Korea, which has conducted more Covid-19 tests per head of the population than any other country, had 17 regional and local labs in place ahead of the pandemic, all capable of carrying out PCR [“do I have it?”] tests at volume.
“During the early stages of the pandemic when testing volume is heavy, private facilities may be used to perform RT-PCR tests for the detection of new cases of infection”, its planning document notes.
“The purpose of surveillance is to enable the early detection of unusual cluster or abnormal clinical symptoms, and to understand characteristics of the virus and mutation trends”, says Taiwan’s plan, which also put in place considerable testing capacity.
Contact tracing and quarantine
A major element of all the Asian documents, including Vietnam, Malaysia and Thailand.
“Contact tracing is the process of identification of people who have possibly been infected after exposure to cases with infectious diseases for the purpose of containing the spread of the disease. Following contact tracing, phone surveillance or quarantine may be necessary”, says Singapore’s plan.
“If the contagion of novel influenza virus increases among humans, aggressive treatment and public health intervention shall be instituted to mitigate the health impact and to maintain social functions and economic activities during a pandemic”, says Taiwan.
South Korea also lays out plans to “aggressively track down contacts and isolate them at home”.
Personal Protective Equipment (PPE)
Planned for not just in terms of stockpiles but local manufacturing capacity. In Singapore all businesses are advised to maintain a “3 to 6 month stockpile” of surgical masks, gloves, hand sanitizer and other equipment.
South Korea advises all households to “stock enough basic supplies to last for about 4 weeks”, while Taiwan notes that the family is “the basic unit of the community and the core of the pandemic preparedness program”.
It adds: “Under ordinary times, face masks enough to meet requirements of family members should be stored at home, thus, during a pandemic, families would not have to worry about mask shortage, so that a massive wave of panic buying could be prevented”.
Central medical stores of PPE in Taiwan are rolled over every year in order that no element of the stock is ever out of date. In 2019, this accounted for 28 per cent, 35 per cent and 18 per cent of its vast stockpile of surgical masks, N95 respirators and gowns respectively.
Surveillance at border crossings and ports
Asian countries all have major sections in their pandemic plans dedicated to the surveillance, testing and possible quarantine of all inbound passengers at ports and borders.
This is in stark contrast to the UK plan which only provides for passengers to “be encouraged to self-report symptoms to crew and ground staff to enable information gathering, investigations and treatment to be undertaken”.
In most Asian countries, Covid-19 tests and/or a 14 day precautionary quarantine are now required at all borders and have been for some time. In the UK, plane loads of Romanian fruit pickers are arriving yet there are not even temperature checks at our airports.
Why was Asia better prepared?
In addition to the detail, the Asian plans have a sense of urgency and military style direction throughout which contrast sharply with the discursive tone and constant mentions of “proportionality” that permeate the British plan.
Although most southeast Asian countries anticipated the possibility of a total lockdown in their plans, most have avoided it in the current outbreak because of the way they preplanned for these and other preventative measures to be put in place. The economies of Taiwan, Singapore, South Korea, Vietnam and Malaysia all maintain a strong pulse as a result.
Most experts point to Asia’s experience of Sars, Mers and other outbreaks to explain why they were better prepared.
Dr John MacArthur, country director of the US CDC in Thailand, said: “The Association of Southeast Asian Nations, or ASEAN, region has a long history of battling emerging infectious diseases going back more than 20 years.
“The region has experienced Nipah, SARS, avian influenza or bird flu, pandemic influenza, Zika, and of course now COVID-19. Because of their earlier experiences, ASEAN Member States were quick to agree to the international health regulations and work towards achieving the core capacity requirements under this new framework,” he added.
Chen Chien-jen, vice president of Taiwan makes a similar point in an exclusive interview with the Telegraph today.
“In 2003 we had a very severe SARS outbreak in Taiwan. We learned a lot about prudent action, rapid response and early deployment… If close contact tracing is done well then disease won’t be spread.” Professor Daneil Falush, a geneticist at the Institute Pasteur in Shanghai, China, believes UK and much western pandemic planning is characterised by a “fatalism” not evident in Asia. He says East and West “frame” their view of fighting new diseases differently.
”’There is no other realistic way out of Covid-19 to building up ‘herd immunity’ through vaccination/infection.’” This in my mind is the herd immunity mentality. It’s a way of framing the argument. “The alternative framing is: ”there is no other realistic way out other than reducing viral transmission to zero’. That’s how they see it in Asia.”
China’s publicly available pandemic plans are thin but emphasise quarantine and isolation of infected individuals – a tactic it has used to good effect to contain the virus, if it’s data can be believed.
Professor Falush is not clear if China’s initial lockdown was pre-planned but thinks it had little choice – a herd immunity strategy would never have washed there.
“They are very conscious that their legitimacy is based on protecting the Chinese People and therefore had to act. In the west, it has never been viewed in those terms. Scientists are fatalistic. They say you just can’t do it [contain the virus].”
Britain did not just write a pandemic strategy document. It tested its pandemic response plan four years ago when it simulated a pandemic almost identical to the Covid-19 outbreak.
Code-named Exercise Cygnus, the simulation took place in October 2016 and involved all major government departments. It is known the exercise revealed holes in the UK’s pandemic strategy but it is not known if those fighting the outbreak in the drill ever sought to contain the contagion.
In short, was a fatalistic or ‘herd immunity’ view taken even when a full-blown simulation showed it would result in Britain’s hospital wards and mortuaries overflowing?
The Telegraph has asked for the reports on Exercise cygnus to be made public under the terms of Freedom of Information Act (FOIA) as they may inform the response to the current Covid-19 pandemic.
However, last week the government formally refused the request. “We are withholding this information under Section 35(1)(a) of the FOIA, which provides for the protection of information relating to the formulation and development of government policy,” it said.
Labour has called on ministers to publish Cygnus now to help inform the response to the Covid-19 pandemic.
“There are serious questions for ministers on what lessons were learnt from the Cygnus pandemic drill, which can only be answered by publishing its conclusions and the actions taken as a result,” said Jon Ashworth, the shadow health minister.
grundbemanningen för hemtjänsten och avlastningen som kommer till pappa och hans livskamrat rullar 18 personer. Sedan en tid tillbaka finns många sjukdomsfall i personalen. De ersätts av vikarier och extrapersonal.
Utöver detta ansluter ibland enstaka praktikanter eller personer på introduktion. Pappa har räknat att de senaste…
Pappa är förtvivlad och står i begrepp att inte släppa in hemtjänsten mer, en samhällsservice han och hans livskamrat är beroende av. Han pekar på att det finns arbetsgrupper som i åratal använt till exempel munskydd i kontakten med patienter – tandläkare, tandsköterskor och tandhygienister.
Han undrar varför inte hemtjänstpersonalen kan ha ett munskydd de drar upp när de är i så nära kontakt med sin brukare. När Linköpings universitetssjukhus testade sin personal kom de till slutsatsen att man kan bära på covid-19 utan att uppvisa symptom.