CASES (not deaths) and therefore vulnerable to variation in percentage of Covid sufferers who get tested and reported.

But South Korea is a vigorous tester and has got it under control. Some people think China is lying, but even they don't say the virus is rampant in China _now_

I've been thinking about this Editorial in the Lancet. I don't think it is entirely fair to blame the government or the NHS England board.

Conflict of interest - I hate the government for Brexit, and I in general no fan of committees, which NHS England Board presumably is.

However, just because I don't like someone, or think it would be depressing to have to spend one's life in committees all the time, doesn't mean I automatically think they are wrong about everything.

These extracts, with which the editorial leads, were from responses from healthcare workers when the Lancet editor wrote to them asking for their experiences in the Covid outbreak.

In general, when they are busy, people mostly do not respond to surveys unless they are very keen to send a message.

In a crisis like this:

Nobody can possibly be happy, unless they are frankly bananas in the head

Fundamentally they are unhappy about the Covid outbreak

But there is no point them accusing Covid of messing everything up for everyone: they have to blame someone, and blame always goes upwards.

The nice thing about the upward blame game is that everyone can agree on the direction of "up".

“It's terrifying for staff at the moment. Still no access to personal protective equipment [PPE] or testing.”

Yes, but they are terrified of the virus, not of the Government.

Boris Johnson may be a Brexit Bimbo, but he is Albert Einstein in comparison to the Stable Geniuses.

The editorialist seemingly failed to see the irony of placing these two remarks adjacent to each other:

“Rigid command structures make decision making impossible.” “There's been no guidelines, it's chaos.”

There is always a tension between autonomy and standardisation. Different people want different degrees of being told what to do.

In a properly functioning system, some people will always want less structure, while others want more.

“I don't feel safe. I don't feel protected.”

Correct assessment of the situation. If people felt safe going to work on a covid ward, they would be mad. It is not safe to have Covid coughed on you, even if you have an N95 mask which reduces the coughage by 95%.

“We are literally making it up as we go along.”

Correct. This is because Covid is new.

“It feels as if we are actively harming patients.”

I feel like I am the Prima Ballerina of the Moscow Ballet.
But I have no evidence of this, so I don't write to the Lancet about my feelings on my dancing skills.

“We need protection and prevention.”

Agreed. If the Government were stockpiling millions of N95 masks etc, for use only by cabinet ministers and other high ups, I would be pretty angry.

But they aren't. In a country like ours, they would never be able to hide it.

“Total carnage.”

I imagine that was a jocular remark; I have heard it used for a busy on-call where patients come in faster than we can see them.

It doesn't actually literally mean carnage, i.e. a massacre.
NHS England did not go on a shooting spree.

"NHS Trusts continue to fail miserably."

Well well well!
Had the commenter said "My NHS trust was fine before but has catastrophically failed to deal with Covid," I might believe them. But clearly the commenter has chronic unhappiness with their trust.

“Humanitarian crisis.”

In the UK it isn't yet, but it will be. This does not automatically mean people should be resigning etc.

“Forget lockdown—we are going into meltdown.”

Someone must have a low melting point. At the time that would have been written, there was no melting yet in the UK.

It is anticipatory panicking, like a patient screaming before the needle hits the skin. It's not helpful.

“When I was country director in many conflict zones, we had better preparedness.”

Correct. That is because it was a service perfected for a conflict zone, expecting Very Bad Things to happen randomly.

Our health service is designed to run cheaply in steady peacetime. The most exciting thing it is designed for is winter.

We may *say* we want more money to be spent on health, but funnily enough when we come to vote, we always seem to vote for less taxes 8-)

“The hospitals in London are overwhelmed.”

This is entirely factually untrue.

They *will be*, but they are not today nor have been by the Covid. Northwick Park Hospital got overfull briefly, but that is one hospital and the extreme state was only for a few hours.

“The public and media are not aware that today we no longer live in a city with a properly functioning western health-care system.”

Interesting. This is a "when did you stop beating your wife" question!

"The public and media are not aware that Darrel Francis is a Martian".

They are indeed not aware,

But they should not be aware,

Because I am not.

“How will we protect our patients and staff…I am speechless. It is utterly unconscionable. How can we do this? It is criminal…NHS England was not prepared…We feel completely helpless.”

They are clearly not speechless!

They are not specifying the crime they think someone has committed.

NHS England was definitely not prepared. I am no fan of authorities telling me what to do, and no special fan of NHS England.

But for decades we have bene forcing NHS England to deliver good quality, cost-efficient care, for conditions that were _actually happening then_.

Covid is a new thing. We are not ready. No organisation or government can or should have been ready.

The only people who are ready is those crazy people who lived in bunkers with months of canned food, in case of nuclear war or zombie attack. That doesn't make the crazies right.

Let's stop trying to pass the blame upwards.

Blame the Government, and NHS England etc, for things it gets chronically wrong _normally_, and only if you can think of a cost effective solution for them and convey it cogently.

Don't just complain because you are unhappy.

Instead, let's do our best to tackle the unexpected, unprecedented, once-in-a-century pandemic.

Laugh at the government and NHS England if you like (I delight in doing this!) but remember it is just gallows humour, to release the tension.

I am continually amazed at the organisational and leadership skills of my colleagues.

I mock them for their trust in random ratios of pressure, and their trust in the Ross-Braunwald made-up mortality curve, but then I am stunned into silence when they produce well-constructed Covid plans.

If you are not up to your eyeballs in Covid today, I recommend this online seminar this afternoon:

Starts 1400 British Summer Time (1300 GMT, 1500 CEST)

Link:
https://teams.microsoft.com/dl/launcher/launcher.html?url=/_%23/l/meetup-join/19:meeting_YmY4NjI1NTktMDZjNi00MDhmLWE5MDctZjYzN2U4YjQwZmM2@thread.v2/0%3Fcontext%3D%257b%2522Tid%2522%253a%25222b897507-ee8c-4575-830b-4f8267c3d307%2522%252c%2522Oid%2522%253a%2522535da1d1-7c7d-4b37-a836-a26af4a6d75f%2522%252c%2522IsBroadcastMeeting%2522%253atrue%257d%26anon%3Dtrue&type=meetup-join&deeplinkId=73304774-a77f-4767-aed6-2405b8f60b07&directDl=true&msLaunch=true&enableMobilePage=true&suppressPrompt=true