News from Nowhere 86 May 2020

Money talks

With so much money flying around it makes sense to get the health economists’ views on Covid-19. Where better to look than The Academic Health Economists’ Blog of May 4th 

Potential lessons for health economics relate to the communication of uncertainty and to economists’ influence on policy and the media. This is important when the impact of communication could manifest in changes in people’s behaviour, which could influence health outcomes for them and for the rest of humanity. 

When it comes to engagement with the media and policymakers, health economists should be supporting public understanding of opportunity cost. That’s because they are the discipline most familiar with the challenge of trading off health and economic impacts, which are the basis for ‘lockdown’ policy responses. There are also questions about health economists’ understanding of the ‘rule of rescue’ in the public’s preferences for the allocation of resources. News from Nowhere’s moles nod sagely. All that baroque technology assembled in huge hospital-warehouses, but hardly used, begs questions about whether the money invested in the machines might have made a difference elsewhere – in care homes, for example.

 Source: Anthony J Hatswell Learnings for Health Economics From the Early Stages of the COVID-19 Pandemic Pharmacoecon Open 2020 Apr 10;1-3. doi: 10.1007/s41669-020-00216-9

Name-calling

The Health Services Journal attracts a lot of on-line comments, mostly anonymous. Sometimes the comments get heated, like this one, part of a discussion of Covid-19 and the care home crisis.  “The BMA.….is now a ragbag collection of toadies, spivs and attention-seeking nobodies”. Well, that’s telling them.  But it is surely missing the point. The BMA is an example of a 19th century crafts union, which in their heyday were famously described as organisations for  ‘pompous trades and proud mechanics’.

Source:  Jack Serle  Doctors union ‘dismayed’ GPs asked to bring forward care home support Health Service Journal  30 April 2020

What’s the point of an Intensive Care Unit?

It may be easier to say what it is not. A very recent publication makes clear that use of ICU is not due to bed shortages. The paper’s authors say that some patients are not transferred to ICU for more intensive interventions because this would be the wrong clinical decision. “ICU is not [a place] where the sickest patients all come to die,” according to Dr Annemarie Docherty, a consultant in critical care and researcher at the University of Edinburgh. “For Covid, all we can offer is organ support while people are getting better. For a large number of people in hospital this is just not appropriate and people are unlikely to improve with these interventions.” This dose of reality begs a question: if medical interventions are futile for many people with Covid-19, where do palliative care services fit in?

Source: Docherty  et al Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol  https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1.full.pdf

Hygiene

How should we wash our hands? Advice from the President of the Royal College of Physicians says: “wash them as though you have just chopped up a jalapeño pepper and need to put a contact lens in”. NfN moles say: “We have all done it, and we get your drift, but it doesn’t need to be jalapeño peppers, they are a bit posh”.

Well, which are you?

Not long ago there were only two sorts of people, Leavers and Remainers. Now there are three. The Policy Institute at Kings College London has published a study of the three kinds of responses to Covid-19. There are Accepters, Sufferers and Resisters. Accepters (48% of responders) say they’re following lockdown rules completely or nearly all the time, are not losing sleep over coronavirus. Only 6% are arguing more with family or people in the home, whilst only 8% feel more anxious and depressed. They are favourable towards the government’s handling of the crisis, trust the government to control the spread of coronavirus, and trust the information it provides.

Sufferers (44% of responders) report feeling more anxious and depressed since lockdown measures were introduced, have slept worse than usual, and spend much more time thinking about the coronavirus than other groups. 93% say they’re following lockdown rules completely or nearly all the time –the highest of the three groups. Sufferers are most likely to follow official guidance on how to protect themselves and others, with 95% adhering to most recommendations. They support lockdown measures and additional police powers, think the government acted too slowly to control the spread of the virus and are less likely than other groups to trust the government to deal with coronavirus and to trust the information it provides. 

Resisters (9% of responders) are least likely to say they’re complying completely or nearly all the time with lockdown rules. Only around half support both lockdown measures and new police powers to enforce them.  58% agree that “too much fuss is being made about the risk of coronavirus” – around six times higher than the other groups. They are much less likely than other groups to be following official guidance, such as staying two metres away from others, more likely to be taking measures that are not recommended, such as homeopathic remedies  and are  doing things that go against official guidance, such as meeting up with friends or family outside the home. A third has contacted a counselling or support service, and half have argued with family or people they live with. Resisters are much more likely to believe claims that are false or currently judged to be unlikely, such as that coronavirus was created in a lab. They expect there will be a quick resolution to the coronavirus crisis and lockdown measures will end soon. 

Source: The Accepting, the Suffering and the Resisting: the different reactions to life under lockdown: Bobby Duffy (bobby.duffy@kcl.ac.uk)  and Daniel Allington (daniel.allington@kcl.ac.uk) The Policy Institute, Kings College London

Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/

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