Wednesday, April 15, 2020

Health Is Britain Undercounting the Human and Economic Toll of Coronavirus? - The New York Times

Health Health Mark LandlerHealth Stephen Castle





  • LONDON — As Britain closes in on 100,000 reported cases of the coronavirus — a solemn milestone in a contagion that has ravaged its political leadership — a raft of new statistics suggests that the government is undercounting the human, and economic, cost of the epidemic.


    The government’s Office of National Statistics released data on Tuesday revealing that the death toll from the virus could be at least 10 percent higher than the official toll of 12,107 because that number does not take into account people who die in nursing homes or in their own residences.


    At the same time, the Office for Budget Responsibility, a fiscal watchdog group, said the lockdown could shrink Britain’s economy by 35 percent in the second quarter and throw two million people out of work — a prediction even worse than the government’s darkest warnings.


    Taken together, these new numbers cast a grim shadow over Britain’s response to the epidemic, which has already been dogged by shortfalls in testing and questions about the supply of ventilators and protective gear.






    And the government, buoyed by the release of Prime Minister Boris Johnson from the hospital after his bout with coronavirus, found itself on the defensive about how it was handling both the surge in cases and the economic fallout.


    “It is important that we be honest with people about what might be happening,” the chancellor of the Exchequer, Rishi Sunak, acknowledged at a briefing on Tuesday. “These are tough times, and there will be more to come.”






    As in the United States and other countries, nursing homes in Britain have become hot zones for the virus. Two major operators have reported 521 deaths in their homes in recent weeks, many of which have not yet been reflected in the official statistics because of a lag in recording the deaths.


    The daily death toll, which is published by Public Health England, has become the main barometer for measuring Britain’s handling of the crisis. But it covers only patients who died in hospitals, which has aroused suspicions that the government is trying to improve its performance relative to neighbors like France, which includes nursing home deaths in its statistics.






    British officials said Tuesday that they would work to include the nursing home death statistics in the overall death figures, but noted it was difficult to do so because, unlike with hospitals, there is no centralizing reporting system for nursing homes.


    Britain’s chief medical officer, Chris Whitty, estimated this week that 13 percent of the country’s nursing homes, or more than 2,000 facilities, had been struck by outbreaks. The nursing staff in many of those homes have complained about an acute shortage of masks, gloves, and other protective gear.


    Critics said the government, in its intense focus on shoring up the National Health Service, was neglecting the nursing industry, which is more dispersed and run mainly by private companies and charities.


    “It’s almost as if the system has been stacked against them,” Baroness Ros Altmann, a member of the House of Lords who campaigns on behalf of the elderly, said to the BBC. “We’ve got to realize what’s happening and step up the measures we’re taking to protect vulnerable elderly people.”






    In the data released on Tuesday, the Office of National Statistics reported that from the beginning of the year until April 3, there were 217 deaths from the coronavirus in nursing homes in England and Wales; 136 in private homes; and 33 deaths in hospices.


    It estimated that 90.2 percent of deaths from the virus occurred in hospitals, while the rest occurred in nursing homes, hospices, or at home. The statistics do not include Scotland or Northern Ireland.






    But for the week of March 28 to April 3, the office reported 16,387 deaths in England and Wales, the largest weekly total since it began compiling data in 2005, and 6,082 more than the five-year average death toll for that week. It reported that 3,475 deaths were registered as involving coronavirus.


    This suggests either that people are dying of other illnesses at significantly greater than normal rates or that coronavirus is killing even more people than is being accounted for. Medical experts say the lockdown, and the strains on the National Health Service, are leading some people to put off elective surgery or treatments for chronic illnesses, which in turn leads to higher death rates.


    Devi Sridhar, the director of the global health governance program at Edinburgh University, said the fuzziness in the data was further evidence of the government’s failure to ramp up testing.


    “When you can’t test, there’s no way you can determine if the cause of death was coronavirus,” she said.


    While the government has promised to conduct 100,000 tests a day by the end of the month, it performed only 14,506 during the 24-hour period ending on Monday morning. That was lower than the 18,000 tests performed during a comparable period the previous weekend.





    Mr. Sunak, the chancellor of the Exchequer, did not dispute the economic figures from the Office for Budget Responsibility, though he highlighted its assertion that this was just one scenario and that the economy could bounce back quickly from a deep trough once the lockdown was lifted. But some economists said they were skeptical of a rapid return to normality.





    “I don’t buy that the U.K. is going to recover as strongly as the O.B.R. data would suggest,” said Simon Tilford, director of research at Forum New Economy, an economic research institute. “It assumes that a shock of this magnitude is not going to do any lasting damage to the economy.”


    Making up for lost consumption, particularly in the services sector, would be difficult, said Mr. Tilford, who described the long-term projections as overly optimistic. The report assumes that it is “possible to put the economy into deep freeze and for it to jump straight back to life,” he added.


    Playing down reports of tensions within the government over when to reopen the economy, officials rejected reports that the Treasury is pushing for a speedy end to the lockdown. Mr. Sunak said the key to returning to economic health lies in first overcoming the medical crisis.


    The lockdown is likely to extend well into next month.


    In a sign of troubles to come, companies are showing greater than expected interest in the government’s program to avert job losses by paying 80 percent of the wages of people unable to work because of the lockdown. In a survey, about 44 percent of companies said at least half their staff would be paid through the program.


    “The lockdown will clearly have a very significant impact on the economy including increased unemployment, lower government revenues and a higher level of national indebtedness,” said Mel Stride, chairman of the House of Commons Treasury select committee.











    • Updated April 11, 2020



      • When will this end?


        This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.




      • How can I help?


        Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities. More than 30,000 coronavirus-related GoFundMe fund-raisers have started in the past few weeks. (The sheer number of fund-raisers means more of them are likely to fail to meet their goal, though.)




      • What should I do if I feel sick?


        If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.




      • Should I wear a mask?


        The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.




      • How do I get tested?


        If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.




      • How does coronavirus spread?


        It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.




      • Is there a vaccine yet?


        No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.




      • What makes this outbreak so different?


        Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.




      • What if somebody in my family gets sick?


        If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.




      • Should I stock up on groceries?


        Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.




      • Can I go to the park?


        Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.




      • Should I pull my money from the markets?


        That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.




      • What should I do with my 401(k)?


        Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions — don’t! If your employer matches any part of your contributions, make sure you’re at least saving as much as you can to get that “free money.”











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    Health Is Britain Undercounting the Human and Economic Toll of Coronavirus? - The New York Times
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