On the one hand there are those who view it in a totally positive light and see it helping to improve the lives of millions of people as its applications (particularly perhaps medical ones) grow and make life easier and safer. On the other hand are those who see it as a clear and present danger to human existence, with the possibility of an ‘extinction event’ occurring in the not too distant future. An article in a recent edition of the British Medical Journal Global Health¹ helps to clarify the issues in non-technical language.    

The authors suggest there are three categories of   threat to human health and well-being from the misuse of AI. Firstly there is the threat to democracy, liberty and privacy. The enhanced ability to process vast amounts of data, develop targeting and mis-information and implement-enhanced systems of surveillance could lead to increased societal divisions and entrenchment of inequalities.

Secondly there are threats to peace and safety caused by the ability to develop and deploy lethal autonomous weapon systems (LAWS) that have enhanced lethal capacity together with dehumanisation of use of lethal force.

Thirdly there is the threat to human work and livelihoods as a result of large-scale replacement of work and employment through AI driven automation. The subsequent health outcomes from widespread unemployment are likely to be increasingly adverse for physical, mental and spiritual health worldwide.² 

We also face the existential threat of the emergence of self-improving Artificial General Intelligence (AGI). This could augment all the problems listed above, disrupt systems we depend on, use up resources we depend on and ultimately attack or subjugate humans.

Apparently the simplistic ‘couldn’t we just turn them off’ solution isn’t tenable – by the time they were an obvious threat we could be too dependent on the continued functioning of multiple networked AI and AGI systems to survive without them.

Another area for concern is how interaction with intelligent machines may affect the emotional development of children.³ Research by Kate Darling⁴ indicates that children who grow up interacting and playing with robotic pets are well aware that the robots are not alive, but they understand them as being ‘alive enough’ to be a companion or a friend. It seems many children develop a new category – or new way of thinking – about their robotic toys.

As one group of researchers wrote: “It may well be that a generational shift occurs wherein those children who grow up knowing and interacting with life-like robots will understand them in fundamentally different ways from previous generations.” ⁵ In other words, how might human relationships become distorted in the future if children increasingly learn about the meaning of love and intimacy from their interactions with machines?

So how do we respond to all this? It is good to remind ourselves that we are all created in God’s image, and that human creativity, imagination, the ability to do science and medicine and develop useful technology like AI all result from our God-given capacity. Unfortunately of course we are not perfect, so the freedom God has given us allows us to do harm as well as good. Our capacity for self-delusion and arrogant pride can also stop us seeing the potentially destructive consequences of what  we may create. 

We face the age-old dilemma of should we do or create something just because we can. History suggests that we almost always choose to do first and only consider the necessary ethical behavioural constraints later. It seems to me that with AGI there must be international monitoring and agreement about boundaries and precautions to limit and control the development of this technology which we are only beginning to grapple with. We need to lobby our elected representatives to press for the setting up of an international AI/AGI monitoring body. This is perhaps especially needed from those of us living in the UK, as our current Prime Minister wants to establish the UK as a key development hub for AI development and regulation.⁵

We can I think take some encouragement from the nuclear industry, where we have an immensely powerful technology that could be used for the destruction of mankind as well as for the (not without risk and problems) powering of electricity generating plants. Knowing the likely outcome, the nations of the world that have the capacity have managed by the grace of God not to use a nuclear bomb in war for the last 78 years. 

There are international agencies actively monitoring the production and use of nuclear materials. Surely we urgently need the same for AI, to ensure we can reap the benefits of this technology whilst minimising the risks and harms. Unfortunately AGI may prove much harder to control than nuclear power, but it is a challenge that as God’s vice-regents on Earth we cannot afford not to meet. 

This post first appeared on the PRIME monthly international email. Reposted with permission.

Images – All images were created by PRIME’s PR & Communications Manager using AI with Vecstock.

References

1. https://gh.bmj.com/content/8/5/e010435
2. Religion as a social force in health: complexities and contradictions. BMJ 2023; 382 doi:      https://doi.org/10.1136/bmj-2023-076817  
3. https://www.johnwyatt.com/the-robot-revolution-is-comingbut-are-christians-ready/
4. http://gunkelweb.com/coms647/texts/darling_robot_rights.pdf
5. https://www.reuters.com/technology/uk-must-seize-opportunities-ai-remain-tech-capital-pm-sunak-2023-06-11/

Dr Huw Morgan is a retired GP Training Programme Director in Bristol, UK and a former PRIME Education Lead and Executive Member. This article is based on a previous personal blog post by Huw Morgan.

Sadly, the ever-increasing specialism we see in the medical world furthers the concept of fixing the part, making it harder to see the whole, especially if we work in isolation rather than in a team. In this Covid era, where fortunately the need for and benefit of compassionate care has been emphasized both in the medical world and public media, our care and support for each other has become even more vital in underpinning our care of the patient.

This was expressed recently in Dame Claire Marx’s candid and refreshing resignation letter as Chair of the UK General Medical Council, which we reproduce here in part.

Dear Colleagues,

I wanted to write to you all to let you know that I am stepping down from the GMC, having recently been diagnosed with pancreatic cancer.

Since receiving this news, I’ve been reminded once again of the importance and power of kindness in everything we do as doctors.

Compassionate leadership has been a cause I’ve championed throughout my career, from my early days as a surgeon, to my position as Chair of the GMC. Now, as a patient, I’ve appreciated that kindness from my medical team and found its impact to be profound.

As doctors, the interactions we have with our patients are a crucial part of the medical care we provide. Our empathy and professionalism shape a patient’s experience almost as much as our diagnostic ability or surgical skills, and they shape our own experiences as clinicians.

As an orthopaedic surgeon, I was often in the fortunate position of being able to ‘fix’ my patients. Performing a hip replacement and knowing how much it would improve someone’s quality of life is immensely satisfying.

But receiving my diagnosis reinforced for me that neat outcomes aren’t the norm in most areas of medicine. Many doctors carry this weight, but kind words can soften the blow of bad news, and empathy and understanding undoubtedly ease the burden. There is no greater comfort than human connection.

The events of the last year and a half have meant many doctors have been dealing with unimaginably sad situations. Facing them has required great fortitude.

In those dark moments, it is the support of our colleagues that pulls us back up. Being able to laugh and cry together, to share our experiences and lean on one another provides the courage to keep going. In a profession that rises or falls on the strength of our teams, dignity and respect for each other is indispensable. So, in addition to compassion for our patients, we must show respect and kindness for colleagues.

Perhaps then, in areas of the world where medical citadels were once resistant to prioritising care and compassion, we will now find open doors that PRIME as an organisation is able to walk through. As well as sadness then, is this also a time of greater opportunity to bring God’s Kingdom into the medical world?

Dr Robert Sadler is Chair of PRIME Management Team. This article is republished from their website by kind permission.

Gradually shifting the terms of the debate and hence the questions asked about it in public surveys, from ‘assisted suicide’ to the muddier waters of ‘assisted dying’ was another masterstroke. Resolutely opposed as I am to legalising doctors assisting patients to kill themselves or to intentionally kill them at the patient’s request, when faced with a YES/NO tick box after the question ‘Do you support assisted dying?‘ even I have ticked YES in the past. At that time I used this term to refer to symptom control by palliative care teams during the dying process. If you ask that question you will get a very different set of responses from asking ‘Do you think doctors should legally be able to help patients kill themselves?‘ This is far less ambivalent but campaigners for assisted suicide know it will get far fewer positive responses, so they will never ask it.

Massaging the numbers of supporters is another well-known ploy in campaigning. Nobody likes to be in a minority do they? There are some 195 countries in the world and only 24 jurisdictions in 12 countries* have made assisted suicide (which for obvious reasons I will continue to call it here) legal (or at least decriminalised). Only seven of these (The Netherlands, Belgium, Luxembourg, Spain, Canada, Colombia and Western Australia) have legal euthanasia as well as assisted suicide.

So only around 10% of the world’s countries have legalised assisted suicide, though the number of people with access to assisted suicide in such countries was recently estimated at 200 million, which is around 2.5% of the world’s population.

You would never know this, however from the recent posting by Humanists UK who have taken manipulation of language to new depths in their Mapping Assisted Dying Laws around the World. According to this map, either assisted dying or a form of euthanasia is lawful in 67 countries thus making it appear that over a third of countries allow assisted dying or a form of euthanasia.

How has this trebling of nations allowing legalised assisted dying or euthanasia been achieved?  By including nations which permit what they term ‘voluntary passive euthanasia’. Having spent the last decade educating a generation of students why this misleading term is best avoided, the use of it here perfectly illustrates why it should be dropped. The Humanists’ website does correctly explain in a footnote that ‘“Voluntary passive euthanasia” refers to the cessation or refusal of life-sustaining medical treatment, which will eventually result in death’ but how many readers will understand that this means it is not euthanasia at all?

Stopping or refusing life sustaining medical treatment can often involve difficult ethical issues but it is not a form of euthanasia by definition, in which doctors take action to end patients’ lives by administering lethal drugs. If refusal or cessation of life-sustaining treatment is included in the map, it is no longer representative of a true picture of the extent of global legalised assisted suicide and euthanasia but rather leads to confusion and obfuscation of the true picture. The compilers themselves seem to demonstrate this very confusion by including some countries such as Trinidad and Tobago and UAE, both in the list of countries in which ‘assisted dying is unlawful’ and also in the list of countries which allow ‘a form of voluntary passive euthanasia’.  No further evidence than this is needed as to why the latter term is confusing.

Truth matters, especially when an organisation seeks to ‘make sense of the world through logic, reason, and evidence’. It should be of the utmost importance for Christians, too, who should also attend to such important ways of understanding. The misuse of language in order to obscure the truth is upbraided many times in scripture. ‘Woe to those who call evil good and good evil,’ Isaiah 5:20 warns. But perhaps the most chilling reminder comes from Jesus himself in the Sermon on the Mount: ‘But let your “Yes” be “Yes,” and your “No,” “No.” For whatever is more than these is from the evil one.’ (Matthew 5:17).

Trevor Stammers is a freelance author and editor and retired GP and Associate Professor of Bioethics. This article first appeared on the CMF UK Blog and is republished here by kind permission of the author and CMF.

The long-awaited news

So, on Wednesday 2 December, the UK became the first nation in the world to approve the Pfizer-BioNTech coronavirus vaccine for medical use.  The UK’s Medicines and Healthcare products Regulatory Agency (MHRA), the medicines watchdog, had given it the thumbs up and granted it temporary authorisation.  The roll-out could begin.  Indeed, a lorry containing 800,000 doses of the vaccine was soon on its way from Pfizer’s production plant in Belgium.  V-day was almost here – within a week vulnerable citizens should be getting the jab.  The news was greeted with some cringe-worthy headlines, such as ‘what a shot in the arm for Britain’, ‘the candle of hope is now burning brighter’ and ‘a day to remember, frankly, in a year to forget.’  Apparently, the organisers of Wimbledon, Royal Ascot and the British Grand Prix have stepped up plans to host capacity crowds next summer – what a game-changer this vaccine is!

But let no-one forget the serious science and those steadfast scientists behind this medical triumph, namely a viable vaccine in 10 months instead of the usual 10 years.  Several researchers should be named in the Queen’s New Year’s honours list.  They deserve our profound gratitude.

A brief history of vaccination

Vaccines are a brilliant piece of medical weaponry.  Globally they save some 2 to 3 million lives each year from a range of diseases, such as diphtheria, tetanus, influenza, measles, mumps and rubella.

Vaccines have a fascinating history.  The main man here is Edward Jenner, an English country doctor with a novel notion.  He was the eighth of nine children born to Stephen Jenner, the vicar of Berkeley in Gloucester, and his wife.  During his medical practice Dr Jenner observed that milkmaids were generally immune to smallpox.  Jenner’s hypothesis was that the pus from their mild cowpox infections, an occupational hazard, protected them from the virulent smallpox.

On 14 May 1796, Jenner tested his hypothesis by inoculating James Phipps, the eight-year-old son of his gardener.  He scraped cowpox pus from the hands of Sarah Nelmes, who had caught it from a cow named Blossom.  Jenner inoculated Phipps in both arms that day.  A fever developed but no infection and no subsequent disease even when James was injected with smallpox material.  Bingo!  Vaccination was established, so called because ‘vacca’ is Latin for cow.  And such has been the success of vaccination that in 1979, smallpox was declared to be eradicated across the entire world.  Nice historical digression, wonderful treatment.

Should we be sceptical about vaccines?

Yes, a healthy dose of scepticism, rather than destructive cynicism, is appropriate whenever scientists, politicians and other so-called ‘experts’ speak.  Medicine is always experimental with associated risks – even a seemingly safe drug like paracetamol can be dangerous for some people.  And experimental science is based on the null hypothesis – a claim is not true until demonstrated otherwise.  So 1 Thessalonians 5:21 rings out, ‘Test everything.  Hold on to the good.’

The Big three

Of the 60 or so vaccines in phase 3 trials around the world, three are currently favoured by the UK government.  They are the Pfizer-BioNTech (US-German) vaccine, with two others from Moderna (USA) and Oxford-AstraZeneca (UK) waiting in the wings.  In common with all vaccines, they work basically by priming a person’s immune system to recognise and fight viral and bacterial infections.  These Big three are therefore regarded as the long-term answers (in contrast to the temporariness of lockdowns) to controlling SARS-CoV-2, the virus that causes Covid-19, the disease.  They have all come through rigorously-conducted clinical trials in phase 3 involving thousands of human volunteers.

There are several classes of vaccines, but the Big three consist of two types.  First, there are messenger RNA (mRNA) vaccines.  These take a portion of the genetic code of the spike protein, those knobbly bits on the virus, and when injected into human cells they produce spike protein to train the body to produce Covid-19 antibodies.  This mRNA technology is smart, but as yet untried.  It is the basis of both the Pfizer-BioNTech and the Moderna vaccines.

Second, there are adenovirus vaccines.  The genetic code of the spike protein is added to a different, benign virus.  In the case of the Oxford-AstraZeneca vaccine, the latter is a harmless chimpanzee cold virus known as ChAdOx1.  Again, when injected into humans, the vaccine cells prime the body to produce Covid-19 antibodies.

As more vaccines come on stream other types, such as protein subunit and inactivated virus vaccines, will become more familiar as will manufacturers’ names like Novavax, Valneva, SinoPharm and Sputnik V.  The last two originated in China and Russia (of course!), where the authorities have pressed ahead with vaccinations without waiting for the results from large-scale efficiency trials and subsequent approval.

Besides the differing modus operandi of the Big three, other of their properties also vary.  For example, in phase 3 trials, the Pfizer-BioNTech and Moderna vaccines were reported to be 95% efficient, while the Oxford-AstraZeneca product performed between only 62 and 90%.  The Pfizer-BioNTech vaccine must be stored at -70⁰C and is stable for only 5 days at 4⁰C, while the Moderna product can be stored at -20⁰C for up to 6 months.  The Oxford-AstraZeneca vaccine retains long-term stability at 4⁰C, namely within a domestic refrigerator, making it easier to handle.  Also costs vary.  The UK vaccine is cheapest at £3 per dose, followed by Pfizer-BioNTech’s at £15 and Moderna’s at £25.

Logistics of vaccinating

As wonderful as vaccines are, they need to be injected, from vial to deltoid.  It will take years to vaccinate a significant proportion of the world’s inhabitants.  Even the double-jabbing of much of the UK’s population is a massive undertaking.  About 400 million doses of different vaccines have already been purchased by the UK government.  The 40 million procured doses of the Pfizer-BioNTech vaccine will be sufficient for only about a third of UK citizens with the required two-shot regimen, administered 2 to 3 weeks apart.

How is this grand roll-out going to work?  Of course, GPs will play a central role.  And already midwives, dentists, airline staff, St John’s Ambulance volunteers and others have been recruited and trained in the vaccinator’s art.

The precious vaccine has been distributed in unmarked vehicles and stored in guarded facilities across the UK.  There have been reports of malicious hackers attempting to disrupt this supply chain.

Priority lists have been drawn up.  First, it is planned that care home residents and their staff plus healthcare workers will receive the jab during early December.  However, therein are considerable obstacles.  First, the Pfizer-BioNTech vaccine is relatively unstable.  It is packed in boxes with dry ice for transporting and then it requires -70⁰C freezers for intermediate storage in hospital laboratories and the like.  The vaccine comes in vials of 5 doses, in large batches of either 975 or 4,875 vials per box.  Once opened that vaccine can be stored in a normal refrigerator, but only for 5 days.

So the plan is to distribute the vaccine to hospitals first, and then GPs and city hubs in stadiums and conference centres.  Within those sites healthcare workers can attend and be easily vaccinated.  But care home residents present another problem – most cannot attend vaccination hubs and the stored vaccine cannot be readily divided and stored as small sets of 20 or so for convenient care home usage.

Some additional questions

Everyone has questions.  What about known adverse side effects of Covid-19 vaccinations, such as injection site pain, fever and fatigue?  Will they deter people from going for the second jab?  What about having the first jab at a mass-vaccination site and the second at a GP’s surgery?  Must both jabs use the same vaccine?  Will vaccination dates be monitored?  Will records be kept?  If so, who keeps them?  Will ‘vaccination passports’ be issued as proof of protection?  And what about Covid-19 immunity over time?  Will it be effective for a year, a decade, a lifetime?  Or will revaccination be needed every year, like the flu vaccine?  Although the Big three seem to be effective in the prevention of symptomatic Covid-19 in people over 65, will these vaccines prevent transmission across all age groups?  And children have not been tested in these phase 3 trials, so what about vaccinating them?  And what happens if, and when, the coronavirus mutates, as other viruses often do?  Will current vaccines still be effective?  And when will the pharmaceutical companies improve their transparency?  When will they produce detailed, peer-reviewed reports of their methods and results?  At the moment we are subjected to scientific communication via press releases.  Should vaccinations be compulsory for all, or for certain occupations?  And if so, what about conscientious objection?

There are other questions, but, as yet, there are few answers principally because this anti-coronavirus enterprise is novel.  Covid-19 is a new disease, these are new vaccines and this mass vaccination programme is a new undertaking.  As the months pass more data, knowledge and insights will helpfully develop.  The future looks (mostly) bright(er).

Conspiracy theories

Some people do not like vaccination.  As well as those with vaccine hesitancy, they include the anti-vaxxers, misinformed sceptics and conspiracy theorists.  Here is a sample of negative memes circulating on social media.

In 1998, The Lancet published a study by Dr Andrew Wakefield and 12 colleagues that purported to find a link between the measles mumps and rubella (MMR) vaccine and autism in children.  However, the paper was later reported to be seriously flawed and fraudulent.  It was subsequently retracted by The Lancet.  Moreover, Wakefield lost his medical licence to practice.  But the saga lead to a fear over vaccination safety, a fear that has persisted and become a totem of the anti-vaxxer community.  The outcome was a significant reduction in vaccination rates and some countries, including the UK, lost their measles-free status.

Because the mRNA type of vaccines, including those from Pfizer-BioNTech and Moderna, contain a fragment of genetic material from the virus, some fear that this could alter the DNA makeup of vaccinated people.  True, this m-RNA vaccine technology is new and never before used, but both biological science and the clinical trials give no support to this suggestion of infection or insertional mutagenesis.  The mRNA is quickly degraded and leaves no residue.

How about this for another conspiracy theory?  It claims that coronavirus vaccinations are a cover for implanting trackable microchips into people.  And Bill Gates, the billionaire co-founder of Microsoft, is reckoned to be behind the scheme.  Despite a lack of evidence a YouGov poll in May found that 28% of Americans believed this wild and crazy ploy to be true.

It is sad to report that some Christians consider that these Covid-19 vaccines are malevolent.  Chief among them is the rapper and fashion designer, Kanye West.  During an interview, published in a July edition of the New Musical Express (NME), he revealed his suspicions about a Covid-19 vaccine, calling it ‘the mark of the beast’ (Revelation 13:15-17).  He claimed, ‘It’s so many of our children that are being vaccinated and paralyzed.  So when they say the way we’re going to fix Covid is with a vaccine, I’m extremely cautious.  That’s the mark of the beast.  They want to put chips inside of us, they want to do all kinds of things, to make it where we can’t cross the gates of heaven.’  This is not only an example of a poor understanding of vaccination medicine, it is also dreadful theology.  Yet it attracts a following.

And some ask, why get vaccinated against Covid-19 when the chances of dying from the virus are so remote?  An anti-vaxxer’s campaign on social media has stated that the recovery rate from the disease is 99.97% and therefore getting Covid-19 is safer than having a vaccination.  This claim is based on a statistical blunder.  The 99.97% figure is erroneously referred to as the ‘recovery rate’.  The truth is that about 99.0% of people who catch Covid-19 survive it.  So around 100 in 10,000 will die from it.  This is a far higher figure than the 3 in 10,000 as suggested on social media.  And anyway, vaccination is about more than death rates.  It is also about protecting the NHS from being overburdened with Covid-19 patients, as well as a personal and societal effort to protect others.

And there is the persistent allegation that Covid-19 vaccines are grown on foetal cells derived from abortions.  This important issue was discussed more fully in Coronavirus – Part 1, which can be viewed here. The conclusion was that, yes, abortion is an evil, a grave injustice, and yes, some vaccines commonly use cellular material originally derived from historic abortions, known as immortalised epithelial cells, such as HEK-293, in the production of vaccines, but not as components of any current Covid-19 vaccines.  Therefore, Christians may, with clear consciences, use Covid-19 vaccines, but with conditions as previously laid out in Coronavirus – Part 1.  Nevertheless, Christians will disagree on this issue.  And they may refuse to be vaccinated.  Yet, we should all bear in mind both Matthew 7:12 and Romans 14.

There is a reason I do not subscribe to Facebook, Twitter and the like.  Some of these social media giants have recently promised to remove from their platforms the false claims and conspiracy theories about Covid-19 vaccines.  We shall see.

Long Covid-19

This is potentially one of the greatest Covid-19 unknowns.  It is becoming clear that many organs besides the lungs are affected by the coronavirus and there are many additional ways the infection can affect a sufferer’s health.  While most people with Covid-19 recover and return to normal health, some patients have symptoms that can last for weeks, or even months, maybe years.

These long-term symptoms commonly include fatigue, shortness of breath, cough, joint and chest pain.  More serious long-term complications appear to be less widespread.  They typically affect different organ systems in the body, such as the cardiovascular, causing inflammation of the heart muscle, the respiratory system, causing lung function abnormalities and the renal system, causing kidney injury.  In addition, there are reports of smell and taste problems, sleep issues, difficulty with concentration, memory troubles, depression and anxiety.  The significance of long Covid-19 is unknown.  What is known is that Covid-19 can be more than an acute infection.

In conclusion

There is a growing, and dangerous, perception that because we have vaccines coming on stream the Covid-19 pandemic is over, or at least, almost over.  The truth is in three little words – IT IS NOT.  The death toll in the UK has recently passed 60,000.  That is the fifth highest figure in the whole wide world.  The rate of deaths, expressed as deaths per million population in the UK, is the fourth highest in the world.  Reported new cases of Covid-19 in the UK are still between 15,000 and 20,000 each day.

We are not doing well.  Things will not get better by Christmas, or maybe not even by Easter.  We need to behave like the best citizens – hands, face, space.  And we need to behave like the best Christians – pray, think, help.  And when the opportunity arises, roll up your sleeve and get vaccinated!

This post was first published at johnling.co.uk and has been reposted with permission.

When councils in the UK delivered emergency food parcels to people who were shielding, they provided pork products to Muslim families. As well as leaving struggling families with insufficient food, this has been described as an example of structural and institutionalised racism in our society, where the views of minorities are not considered. How much greater are the global implications of such thinking?

John Donne’s 1624 essay Meditation XVII contains the famous lines below. The language of the essay is archaic, but the message is pertinent.

No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were: any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bells tolls; it tolls for thee.

Meditation XVII, Devotions Upon Emergent Occasions, John Donne

Even high-income countries are struggling to meet the medical and economic needs of their populations. Middle- and low-income countries have greater dilemmas. They have imposed lockdowns to prevent virus spread but have often had to lift them prematurely. Where people are dependent on working to earn money for food for the day, the risk of infection is measured against the risk of starvation. If markets close, traders cannot earn, and local people cannot obtain food. If farmers cannot work their fields, whole communities are at risk from crop loss and hunger. There are much wider issues than caring for those who become seriously ill, something which is challenging enough in itself.

We are entering world recession. The longer-term effects are going to be massive. The most vulnerable nations and communities are at highest risk. Appealing to the world’s leading industrial nations, the G20, to increase support, Mark Lowcock has estimated that ‘due to disruptions to health systems caused by the pandemic, some 6,000 children could die each and every day from preventable causes, while annual deaths from HIV, tuberculosis and malaria, could double’. He went on to say that ‘the prospect of cascading crises more brutal and destructive than anything the virus alone can do must jolt us all out of our comfort zone’. (Read the full report here.) This is not a welcome message, but we must listen to it.

The words of the Persian poet Saadi Shirazi, who had travelled widely and seen war and devastation, are woven into a carpet displayed on a wall at the United Nations headquarters.

Human beings are members of a whole,
In creation of one essence and soul.
If one member is afflicted with pain,
Other members uneasy will remain.
If you have no sympathy for human pain,
The name of human you cannot retain.

Bani Adam, Saadi Shirazi

This message has been received and acted on in positive ways. Scientific cooperation has largely replaced competition. New information about the coronavirus has been shared rapidly. International partnerships are working to trial potential Covid-19 vaccines. Health services have changed rapidly, and clinical teams have cooperated in new and unusual ways across the world. It is important not to lose this momentum, and we will need to go further.

How then should we as individuals and health professionals respond to this global crisis?

It is all too easy to become immersed in our own local and personal problems, which may at times feel overwhelming. Certainly, we need to pay attention to our own needs and those of our friends, colleagues, and neighbours.

We also need to pay attention to the needs of the wider world, however uncomfortable that may be. We need to value our International links, listen to each other and pray for each other. We need to remember the words of John the Baptist: ‘Anyone who has two shirts should share with the one who has none, and anyone who has food should do the same.’ (Luke 3: 11)

The concept may seem simple, but working it out in practice requires thought, hard work and commitment. It is costly. In sharing our resources, we may find ourselves with less for ourselves than we would wish. It is a price we may need to be willing to pay.

Dr Rebecca Torry is a GP with the UK’s National Health Service (NHS). Her post, reproduced here with permission, first appeared in the Prime International Network’s email campaign on 21 August 2020. It has been edited for style.

When Boris Johnson announced a UK-wide lockdown, my immediate response was fear and dread. Many people are currently living in fear of catching COVID-19, and understandably so. However, for some of us, this virus may present a greater risk to our mental health than it does to our physical well-being.

I find myself in this category. I have struggled for many years with recurrent depression and OCD, and I have learnt that getting well and staying well takes a lot of effort and persistence.

For me, it also takes consistency; change is my nemesis. A new job, increased workload, moving house or anything else new and stressful can threaten to trigger a relapse. Many of the things that keep me well involve getting out of the house. For example: going to work, being involved in a church community, playing with my wonderful nephews, socialising with friends, or simply stroking every fluffy dog I meet in the park! Lockdown has put a temporary pause on many of those things and has summoned back my old foes, change and isolation.

Let me be clear, lockdown is an essential part of fighting this virus, and it is important that we comply with these restrictions. I am not complaining about the lockdown, and I am immensely grateful for those still going out to work on the frontline. However, this crisis impacts all of us, and some will struggle with the emotional impact more than others. For instance, some of you may already be dealing with a mental illness and find that your treatment and support has been interrupted or reduced because of this crisis.

These are tough times, and a lot is outside of our control. However, thankfully there are still some things you can do to look after your mental health or, if already unwell, to help you recover. I’ve chosen seven to get you started.

1. Be careful what you feed your mind

We feed our minds just like we feed our bodies. Right now, watching the news excessively and constantly scrolling through social media is the psychological equivalent of drinking poison – it will make you sick.

More specifically, it may provoke anxiety, despair, increased loneliness and even hopelessness. Yes, you may want to keep up to date with what’s happening in the world and stay informed of ever-changing guidelines, but you should limit how much time you spend doing this. Set a time each day that you will engage with the news, limit that time to no more than 30 minutes and then put the news away. Unless you live in a cave with no contact from the outside world, other people will inform you of anything important you have missed.

2. Routine, routine, routine

Full disclosure: I hate routine. Routine is boring. I want to get up when I feel like it, stay up as late as I want and do my work at whatever time I choose. However, this would be a very bad idea. Sometimes the things which help us mentally are boring but necessary. Routine is one of these things.

Your daily routine has changed, so make a new one that you can stick to throughout lockdown. Plan a time to get up in the morning, a time to complete whatever tasks you need to, a time to exercise, relax and connect with others and a time to go to bed. Then stick to it. Making yourself go to bed at a reasonable time may be boring, but it is essential. Your brain needs sleep, so give it what it needs. If you struggle with sticking to schedules, don’t beat yourself up but do try again tomorrow. Eventually, you will get into better habits.

3. Go outside and exercise

I hate exercise. Believe me, I much prefer sitting on the sofa watching Netflix while scoffing a crème egg. However, the evidence is irrefutable – regular cardiovascular exercise improves mental well-being. It releases endorphins, increases energy and improves self-esteem.

The problem is when you are depressed or anxious, the last thing you can be bothered doing is going for a run or hopping on your bike. If your motivation has disappeared, then start small. If you have somewhere green within walking distance, then why not unplug, leave your phone at home, listen to the birds and notice the sensation of breathing in the fresh air.

Even if you prefer exercising indoors, make sure you still use that one permitted trip out every day. You may not enjoy it at the time, but you will feel better afterwards. If you are struggling to do this, ask someone to text you each day and check you have done it. And ignore your brain when it creates excuses to stay indoors – you really won’t freeze or melt in the rain, you have a coat for a reason!

4. Spend time with God

Just as physical health impacts you mentally, so does your spiritual well-being. Don’t get me wrong, mental well-being is not the aim of spending time with God, rather it is to deepen our relationship with him, be transformed by the Spirit and bring God glory.

That said, it also improves mental well-being. In this time of global crisis, the only true and lasting peace is the peace of God (Philippians 4:7). The only real comfort and hope is to be found in the one who has conquered death and gives everlasting life.

There is so much other noise competing for our attention, even in lockdown, so make sure you are taking time each day to listen to the voice that matters most. Cast all your anxieties on him for he really does care for you (1 Peter 5:7).

5. Connect with others

Good relationships are key to mental health, and yet mental illness can torpedo your motivation to connect. When I am depressed, I desperately want to withdraw from everyone and everything. Being around others feels exhausting and socialising can trigger self-critical thoughts such as ‘I’m so boring’, ‘nobody wants me here’ and ‘I’m a burden.’

However, withdrawal makes depression worse. Let me repeat that: withdrawal makes depression worse. Right now, we are physically distanced from one another, but we need to stay socially connected. So, pick up your phone and reply to your messages. If you live with someone, spend time with them. Say yes to that Zoom call and connect with the people who care about you. You may not want to, but you need to, and the more you force yourself, the easier and more enjoyable it will become.

6. Challenge unhelpful thoughts

Right now, your mind may be predicting worst-case scenarios or telling you lies about yourself or about God. For example, ‘my loved ones will definitely die’, ‘I am so useless for not being able to help’, ‘God must not be loving or in control’, ‘I will certainly fail my exams’ or ‘I’m a failure for feeling like this.’

Do not trust all your thoughts because thoughts can lie. Unhelpful thoughts left unnoticed and unchallenged can lead to anxiety, despair, inappropriate guilt or misdirected anger.

If you are struggling emotionally right now, then take notice of what you are thinking, write those thoughts down, and check out if they are in keeping with reality. If you feel anxious, perhaps write your worries down as they arise, place them in a jar and give that jar to God in prayer each day.

If you struggle to challenge negative thoughts by yourself, then share them with someone you trust and listen to their perspective on them. However, set limits around this, so you don’t ruminate on them all day. Most importantly pray that God will guard your mind and help you believe what is true and reject what is false.

7. Ask for help when you need it

Those of us who work in or are training in caring professions are notoriously bad at seeking help. Yet if you are struggling emotionally, this is the bravest thing you can do. Speak to someone you trust, phone your GP or make use of other support services.

However, maybe you have already done that, but now it feels like that help has disappeared with social distancing. I know things are more difficult, but there are still people you can talk to. Your GP or mental health practitioner has not disappeared and will be doing phone consultations. Many counsellors are offering online video sessions; crisis helplines are still running. A&E remains open, and the people who have been helping you still exist and still care about you.

This season will pass and face to face support will resume. Until then, focus on the resources that are available and do the things which you can do to aid recovery.

Written by Ashley Stewart. Ashley is a former NHS doctor and works part-time as a school counsellor as well as being UK CMF’s Associate Head of Student Ministries.

Reposted with permission from CMF UK Blogs.

This morning I read a news article entitled ‘What am I still allowed to do?’ It outlined what the new UK-wide lockdown means for each of us and when we can leave the house. In many countries around the world, similar measures have come into effect in the last few weeks.

However, whilst we are not allowed to do many of the everyday things that we take for granted, praise God, we can still do the most important and useful thing of all – we can pray! So, here are some ideas of how to pray for the Christian healthcare staff who are part of our church family and those further afield.

As a former NHS doctor, my heart goes out to all the healthcare staff, some of whom are my closest friends, who are facing this pandemic on the frontline. Right now, doctors, nurses and allied health professionals are facing increasing demands and pressures which they know will only get worse over the coming weeks.

Many are being redeployed to work in new specialities, take on new roles, cover different wards or patient groups and crash-learn complex, new skills in record time. Some will be working in the new, temporary field hospitals, like the Nightingale Hospital at the Excel Centre in East London. They will be dealing with high concentrations of COVID-19 patients, increasing their risk of exposure.

They will work ridiculous hours, care for unprecedented numbers of seriously ill patients, and they will feel the emotional burden of dying patients and grieving families. During this time, some of them will watch as colleagues, friends and family become ill as well. While most will recover quickly, some of them will not. Others will have to self-isolate from their immediate family if they have spouses, children or parents in a vulnerable category. This will lead many to live for extended periods away from the family home in temporary accommodation.

Those who are senior managers, consultants and senior nurses will carry the responsibility for making difficult decisions about who gets treated and who does not, based on imperfect knowledge. They know that their decisions will have life and death consequences for thousands of people.

It’s a grim picture I have painted, I know, but I don’t want to sugar-coat it: this will be tough. Exceptionally tough. Our brothers and sisters need our prayers!!

So, what can we pray? Well here are ten ideas to get you started:

1. Pray for the peace of the Lord, which transcends all understanding to fill their hearts and minds and pray that others will see this peace and be pointed to Jesus. Pray that when surrounded by pain and despair they will be filled with the joy of the Lord and will experience this joy every day as they serve those God has placed before them.

2. Pray for opportunities to share the hope and love of Christ with their patients and colleagues; pray for boldness to take these opportunities when they arise and wisdom to know how to use them.

3. Pray that they may endure suffering, adversity and hardship well – not giving in to moaning or complaining but bearing hardships and difficulties with grace and in the joy of the Lord. Pray that they might know the blessing of sharing in the sufferings of Christ, and in so doing be his witnesses to colleagues and patients.

4. Pray for their safety and that of their families. Pray that they will have suitable protective equipment and that they will recover quickly if they become unwell themselves.

5. Pray for wisdom to make good decisions; for skill as they perform various tasks and for patience with everyone they encounter (especially when they are exhausted, hungry and the demands seem unrelenting).

6. Pray that they will be able to ‘switch off’ mentally when they go home, that they will have the emotional and spiritual support that they need; that they will have sufficient time to rest and do things they enjoy. Pray that they will get good, restful sleep.

7. Pray for those who are separated from their loved ones, that they will feel connected to the church community and others who love them. Pray that they will have someone they can offload to without feeling they must censor what they say.

8. Pray that they will have the wisdom and courage to ask for help – whether that is asking for senior help when they feel out of their depth clinically or help to cope with the impact this is having on them personally. Pray that help will be readily available and that they will not be embarrassed about needing it.

9. Pray that God will help them not to make any serious mistakes, especially when they are exhausted and working in unfamiliar areas, and that any mistakes they do make will be caught in time or easily rectified. Pray that they will know the grace and peace of God if they do make mistakes, that they won’t be overwhelmed by guilt and will know the support and compassion of their colleagues and governing bodies.

10. Pray against feelings of inappropriate guilt – guilt that they should be doing more, guilt that they may transmit the virus to family members or already have, guilt that they had to allocate resources to one patient over another etc. Pray that they will know that God is in control, and that they will accept the limits of their responsibility.

Then after you have prayed for them, let them know you are praying for them – ask them for more specific prayer points and think about how else you can serve them at this time. Could you drop a meal off on their doorstep to heat up after a busy shift? Could you give them a quick call or text to check how they are? Could you offer to do their shopping for them when they might not have the time themselves or may not be able to find the groceries they need?

‘What am I still allowed to do?’ While some physical freedoms have been removed for a short while, praise God that we have the eternal freedom to boldly approach our Heavenly Father who loves us dearly and controls all things!

By Ashley Stewart, Associate Head of Student Ministries at Christian Medical Fellowship in the British Isles.
Adapted and reposted with permission from CMF Blogs.

This is a short summary of a briefing paper – please read the full version for a more thorough consideration of the issues.

As doctors based in the United Kingdom’s National Health Service (NHS), a well-resourced healthcare system, we approach the subject of healthcare rationing with a degree of humility. However, as the COVID-19 pandemic progresses, resource allocation is becoming increasingly challenging for all nations. We seek to consider how, as Christians, we can begin to address some of the difficult ethical challenges facing our healthcare systems.

When asked, what is the greatest commandment:

Jesus replied: ‘“Love the Lord your God with all your heart and with all your soul and with all your mind.” This is the first and greatest commandment. And the second is like it: “Love your neighbour as yourself.”’ [1]

Loving our neighbour may look quite different from one person to the next, based on clinical need and health status. Yet love must remain at the heart of all our decisions.

The demand for intensive life-saving resources from seriously unwell patients is rising rapidly. Managing this demand has involved measures such as testing, contact tracing, quarantining and social distancing. There are many examples in scripture of increasing the supply of resources in times of challenge through faith and prayer,[2] recruiting more workers,[3] training and releasing new leaders.[4]

Despite efforts to increase capacity, we are still facing the potential for a shortage of resources. Using Beauchamp and Childress’ four pillars of medical ethics[5] as a framework, let us consider a Christian response.

Respect for patient autonomy

If a patient has capacity and refuses escalation in care, this cannot be forced on them, even if this seems unwise. [6] Similarly, if a patient insists that they should be for full escalation of treatment, it may still be clinically appropriate to withhold certain treatments that are unlikely to be of benefit [7] or cause harm. Some patients, particularly those frail and elderly, might choose to stay at home (ideally with the support of high-quality palliative care), to allow a more natural death in the company of those they love.

Beneficence – maximising benefit with good stewardship of resources

As Christian healthcare workers, we are called to be good stewards of our resources.[8] However, utilitarianism[9] – ‘the greatest good for the greatest number’ – often makes us deeply uncomfortable. The COVID-19 crisis is an example of an extreme circumstance with an overwhelming need and limited resources, where a soft utilitarian ethic may be justified.

Where resources are insufficient, it seems reasonable to prioritise access to intensive interventions for those who are most likely to benefit. However, the application of this principle is challenging, as our knowledge about COVID-19 is patchy but expanding.

The overarching priority when deciding who should receive treatment during this crisis is: how likely a person is to survive and the speed of anticipated benefit. Relevant factors include:

• Severity of acute illness
• Presence and severity of comorbidity
• Frailty or, where clinically relevant, age [10]

We must acknowledge that rationing in the context of a pandemic will cause moral distress to healthcare teams and should look to model what it means to promote wellbeing in our colleagues, as well as our patients.

The Word of God repeatedly commands us to be compassionate, just as our Heavenly Father is compassionate:

Finally, all of you, be like-minded, be sympathetic, love one another, be compassionate and humble.[11]

Despite increasing stress and pressure in this time, the command remains. We should seek the compassion and comfort of the Lord, so that we may pass it on to those around us.[12]

Distributive justice – ensuring impartiality, equality and fairness

As Christians, we affirm that all people have intrinsic value and significance, being made in the very image of God,[13] and are equally worthy of care. That all people are equal does not mean they should all receive the same treatments.

However, justice becomes corrupted if it discriminates in favour of some lives over other lives. Throughout scripture, we see that all people are of equal worth, and we should not favour individuals based on their social,[14] financial,[15] or other status – our God abhors favouritism and loves impartiality.[16] Indeed, we are called to be advocates of the vulnerable.[17]

We must also consider the access of non-COVID-19 patients to scarce healthcare resources. How do we care for those requiring other urgent treatments when our hospital resources are close to exhaustion? These are very difficult challenges and we need to pray for wisdom.

Non-maleficence – minimising harm

During this COVID-19 crisis, decisions around withdrawal of treatment (such as invasive ventilation) may, out of necessity, occur sooner than would happen under normal circumstances, and on grounds of resources. Withdrawal of treatment is not morally equivalent to intentional killing.[7] In those circumstances, death is already in the room, and allowing a death to take place is not the same as causing death.

Nonetheless, these kinds of existentially burdensome decisions, in addition to potential legal ramifications,[18] will be emotionally, morally and spiritually distressing for those clinicians having to make them. Complex decisions around rationing may be best made in discussion with a second opinion, and even by committee.[19]

Conclusion

This COVID-19 pandemic provides a clarion call to pray for clinicians, managers, politicians, and all involved in the response. We should pray for new solutions, innovations and technologies to support healthcare delivery and an end to this challenging crisis.

Ultimately, we should seek wisdom from the Lord.[20] We, our families, and our wider Church family all across the world, are praying for you and other healthcare professionals all around the globe. We must endeavour to be good stewards, whilst also lobbying for sufficient resources. We must strive to affirm that compassion is key, all people are equal, and all are worthy of care.

Dr Melody Redman – Paediatric Trainee & Leadership Fellow, Sheffield, UK
Dr James Haslam – Consultant in Anaesthesia & Intensive Care Medicine, Salisbury, UK

References

1. Matthew 22:37-39
2. Matthew 14:19; 2 Kings 4:1-7
3. Matthew 9:37-38
4. Numbers 11:16-17; Luke 10:1
5. Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th edition. New York: Oxford University Press, 2001
6. Treatment and care towards the end of life: good practice in decision making. General Medical Council, July 2010. bit.ly/2UG7g7C [accessed 5 April 2020]
7. Haslam J. Withdrawing and withholding medical treatment. CMF File 62, 2017. cmf.li/2HUkFCG [accessed 5 April 2020]
8. Matthew 25:14-30 15
9. Bentham J. An introduction to the principles of morals and legislation (1789). Garden City, NJ: Doubleday, 1961
10. Coulson-Smith P, Lucassen A. Clinical ethics guidance during the COVID-19 pandemic. University Hospital Southampton (UHS) Clinical Ethics Committee, 30th March 2020 (unpublished)
11. 1 Peter 3:8
12. 2 Corinthians 1:3-4
13. Genesis 1:27
14. Galatians 3:28
15. James 2:1-9
16. Proverbs 24:23; Romans 2:11; Luke 14:13-14
17. Proverbs 31:8-9
18. Statement on legal liabilities of clinicians as individuals during Coronavirus Pandemic. Intensive Care Society. bit.ly/2QYRQJG [accessed 5 April 2020]
19. Truog RD, et al. The toughest triage – allocating ventilators in a pandemic. NEJM, 2020. DOI:10.1056/NEJMp2005689
20. James 1:5

How many people will die in the UK as a result of the COVID-19 pandemic? According to the scientists it will be between 20,000 and 500,000 depending very much on how we respond.

A team at Imperial College has produced a paper which this week has prompted the government to embark upon a range of new measures to stop the spread of the disease.

If we do nothing and just let the virus pass through the population unhindered – in the hope of producing so-called ‘herd immunity’ – then 81% of people would be infected and 510,000 would die from coronavirus by August.

If we adopt a mitigation strategy – trying to slow its spread to prevent a massive peak in cases that would overwhelm the NHS many time overs – we can expect 250,000 deaths.

But a suppression approach – breaking the chains of transmission in order to stop the epidemic in its tracks – would reduce total deaths to thousands or tens of thousands.  

The government has now concluded that suppression is the only viable line of approach. Their chief scientific adviser Patrick Vallance told a committee of lawmakers this week that 20,000 deaths would then be ‘a good outcome in terms of where we would hope to get to with this outbreak’.

Why has China done so much better than us?

But this raises a huge question. If 20,000 deaths is a ‘good outcome’, and the best we can hope to achieve, then why have there been only 3,000 deaths in China where the outbreak actually started?

On a population basis (the UK has 67 million people and China 1,435 million) the UK equivalent deaths to that in China would be just 140 had we handled it as successfully as them. 20,000 is over 140 times this figure.
So, what have the Chinese done differently? And what, by implication, have we failed to do?

The control of the spread of coronavirus in China is remarkable but real. Today’s figures show a total of 80,000 cases but only 10-20 new cases a day. There are still also 10-20 deaths a day from the virus in China but these are almost all people who were infected weeks ago. Things have tailed off massively.

But China has also achieved this fall-off much more quickly than other countries. 80,000 cases in China amounts to 56 cases per million population which is a better measure of how badly the virus has affected any given country.

By contrast Italy, with 31,000 cases to date, has 521 cases per million, almost ten times the China figure.

In fact, today on 18 March (and these figures are obviously increasing daily) there are 32 countries or territories with a higher density of cases than China. Some of these are small population states like Luxembourg, Andorra and San Marino, but others include Spain, Germany, France, Switzerland, Netherlands, Norway, Austria, Belgium and Denmark.

The two anomalies are the US and UK – today with 20 and 29 cases per million population respectively – but we know from the number of deaths alone in these two countries that the true number of those infected is much higher than this. Vallance said yesterday that a ‘reasonable ballpark’ current figure for the UK was 55,000 cases, not the 1,900 actually reported.

The reason the US and UK total case figures are so low is because we are doing so few tests for the virus. I’ll come back to that.

China’s remarkable success in controlling the virus is documented in the Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) dated 16-24 February. You can read the whole report here but there is an excellent summary here.

The diagram reproduced below from page 29 of the report (you can view it more easily here) shows the number of cases against time in China along with the major interventions made to try and slow the disease.

The outbreak was first announced on 30 December and the new coronavirus was isolated on 7 January and its gene sequence publicly shared on 10 January. The number of new cases per day peaked at around 3,000 just over two weeks later on 26 January but had fallen to fewer than 500 cases daily by 14 February.

A paper published on 16 March in Science shows that the virus first got away on the Chinese because they were unable to identify and isolate the very early cases.

They estimated that 86% of all infections were undocumented prior to the 23 January 2020 travel restrictions. The transmission rate of undocumented infections was only 55% of documented infections, presumably because those affected had less severe symptoms, yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the initial rapid geographic spread of the virus.

However, after the initial stage China got quickly on top of the outbreak through a vigorous programme of widespread testing followed isolation of those affected, backed up by travel restrictions.

Testing for coronavirus in China and the UK

China has a policy of meticulous case and contact identification for COVID-19. For example, in Wuhan more than 1,800 teams of epidemiologists, with a minimum of 5 people/team, traced tens of thousands of contacts a day. Contact follow up was painstaking, with a high percentage of identified close contacts completing medical observation. Between 1% and 5% of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location.

But the effort outside of Wuhan was also huge. In Shenzhen, for example, the infected named 2,842 contact persons, all of whom were found, when testing was completed for 2,240 it was found that 2.8% of those had contracted the virus. 

Within weeks following the identification of the virus, a series of reliable and sensitive diagnostic tools were developed and deployed. By 23 February, there were ten kits for detection of COVID-19 approved in China by the NMPA and several other tests had been entered in the emergency approval procedure. Overall, producers have the capacity to produce and distribute as many as 1,650,000 tests/week.

In stark contrast, based on figures available on 13 March, the UK had carried out around 30,000 Covid-19 tests, at a median of 1,600 tests per day so far in March. 

The World Health Organization director-general, Tedros Adhanom Ghebreyesus, said this week that he had a simple message to countries on how to deal with the coronavirus outbreak sweeping the globe: ‘Test, test, test.’

Speaking during a news conference on Monday he urged countries to test more suspected cases, warning that they ‘cannot fight a fire blindfolded’. 

But fighting the fire blindfolded is essentially what the UK and US have been doing – simply because there are not enough testing kits. This was admitted by UK government adviser Professor Chris Whitty this week.

On 6 February, the World Health Organization said it had already shipped 250,000 tests to more than 70 laboratories around the world.

But as WHO shipped hundreds of thousands of tests, broader US testing struggled to begin. The US kits, developed by the CDC, were found not to be working as expected, which eventually required test kits to be re-manufactured. In fact, earlier this week it was reported that the US lags almost all developed countries in testing for the virus.

Whilst the abundance of testing kits in China meant that everyone with a fever or who had had contact with an infected person was tested, the shortage of testing kits in the UK has meant that tests are not even available for doctors on the frontline or for high-risk patients at risk. In fact, the only people being tested until very recently were those with severe symptoms admitted to hospital.

What this means is that those with less serious cases of COVID-19 have been able to roam free to spread disease, and frontline people (doctors and other health professionals), who are unwell but do not actually have the virus, are being unnecessarily quarantined for 14 days along with their families when they could be treating patients.

A pandemic out of control

It is now over two months since China initiated its control programme and countries seem now to be in two groups – those where the virus appears to be propagating largely out of control (mainly Western Europe) and those in East Asia where there has been success in getting on top of its spread.

The diagram below, produced by an Australian epidemiologist, demonstrates this dramatically.

Cases (and deaths) in Europe and the US are spiralling out of control but in Singapore, Japan and Hong Kong – using more of a Chinese approach – the curve is considerably flattening over time.

Just today an article in Science has attributed South Korea’s astounding success so far to the most expansive and well-organized testing program in the world, combined with extensive efforts to isolate infected people and trace and quarantine their contacts. South Korea has tested more than 270,000 people, which amounts to more than 5,200 tests per million inhabitants. By contrast, the US has so far carried out 74 tests per 1 million inhabitants, data from the US Centers for Disease Control and Prevention show.

South Korea’s experience shows that ‘diagnostic capacity at scale is key to epidemic control,’ says Raina MacIntyre, an emerging infectious disease scholar at the University of New South Wales, Sydney.

Reports last week from Italy described doctors opting not even to assess high risk patients, let alone tube and ventilate them, because they were simply overwhelmed by the numbers (see frightening twitter thread here and also Lancet paper from 13 March here). Spain is following closely but other countries including Germany, UK, Netherlands and Switzerland, are only a week or two behind.

It is a fundamental principle in medicine that there is no treatment without diagnosis. We need more testing kits rapidly deployed. It is incredible that even at this late stage we don’t really know who has the disease and who doesn’t.

There are already many types of testing kits available and capable of mass production. Can the UK government expedite the approval process as China so successfully did to bring them on stream?

Of course, all the other measures to prevent spread, which the UK has already implemented and with which we are well familiar, are absolutely necessary and right. And we need many more doctors, oxygen and ventilators to provide support for the rising tide of severe cases.

The figures for China are that 20% of all cases needed hospitalisation and oxygen often for weeks and 25% of these (5% overall) needed ventilation or ECMO. When we consider that the UK until recently only had 4,000 ventilators, 80% of which were already occupied, we can start to appreciate how serious this is.

But it is also clear that had we deployed more rigorous testing and contact tracing in the early stages of this pandemic we would not be in the position we are now.

We pride ourselves in the UK on both our standard of medicine and on the NHS. But we are lagging far behind those in China and other East Asian countries in our management of this crisis.

Whether it is too late to rectify this only time will tell. Will we end up in the UK with 20,000 deaths, 250,000 or 500,000?

What is clear is that many times more than 140 will die (the number of deaths the UK should have if equivalent to China on a population basis). That total will be passed in the next few days and advisors are predicting that new cases per day will not peak for another 10 to 14 weeks. The peak of the death rate will be two to three weeks after that.

It is clear that, as of this week, the UK government is now much better informed and pulling out all the stops to beat this challenge (helpful summary here). As we all work together we pray that these efforts will be successful and that the UK death toll is much closer to 20,000 than 500,00.