Dr Bharat Pankhania, Senior Clinical Lecturer at University of Exeter Medical School
A conversation with Dr Bharat Pankhania a Senior Clinical Lecturer at the University of Exeter Medical School on COVID-19
by Jesica Fishburn/5th-May-2020
We were very fortunate to have an opportunity to speak with Dr Bharat Pankhania. He gave us his informed opinion about what the UK is likely to experience over the next several months in dealing with the Coronavirus in the UK.
Q. What do you think the future holds for us in the UK in dealing with the Coronavirus Pandemic?
In the next 9 months maybe we will have some medication, maybe we will have some success with a vaccine, maybe, maybe, maybe. Having said the maybe’s, we still need to completely, utterly, totally readjust the way that we live and the way we operate. We made China the factory of the world, making everything for us, and we are paying a big price. China suddenly stops making PPE we have healthcare workers in the UK dying, we have nursing homes with patients where infection has been introduced to them so they contract the disease and they die. Lesson 1 – make your own stuff. It is probably more sustainable too in the long run. The other important things are: either you want to change and adapt. or you don’t want to. There are countries that start changing and adapting the way that they are living to the new way, and they will take the lead. The countries that wish to say we carry on as normal, they will eventually find that people are dying and then the people will refuse to listen to their government. Having people refuse to listen to their government, there will have to be new governments because if the government is not of the people, eventually it will have to change.
Q. Based on the current information we have available, can we expect to see this virus dissipate completely or is it likely to return?
I expect, from the way that we are conducting ourselves, we will not see the disease disappear. We have looked inwards, led by the Americans, and I do not see any effort to help our relations and there is a lack of realisation or a lack of intent to say what happens in Africa comes to bite us as well. You need to suppress the infection in Africa, Asia, and the other poorer countries, otherwise, it is coming to bite you. You do need a multifaceted approach, whilst there is, it is not concerted because we are feeling ‘oh well we need to look after our own populations’. If I was to be a good advisor I would say: control it in your country, control it in other countries.
Q. Do you think that the way that we are trying to control it is the best possible way at the moment?
In the United Kingdom, we are lagging behind science. This is a very important point. The science has always been there. We know the science, we know the ABCDE and F of the science but for some miraculous reasons we have tried to morphs the science into something it is not. To give you an example, early in March the Chief Medical Officer said we are moving from containment to delay and therefore we are not going to contact trace and test. You will be aware now that today [5th May] we are trying to scale up testing and scale up contact tracing. Why? The answer is they made a wrong turn earlier on. They should have continued with contact tracing, containment, and testing. But they told us it was not necessary. And now they are telling us it is necessary. the consequences are that we now have a lot of cases, very shortly the UK will soon overtake Italy [note: which is now correct]. The UK could have done better.
Q. What would you like to see in the immediate future to try to control the spread of the disease?
We want an absolutely 100% independent advisory body. The advice that is being given can then be assured it is independent of any constraints and then you know what decisions the government make. At the moment we do not know what the advice is. The politicians are telling us that we are taking all the advice from the scientists but what don’t know what that advice was or is. There is a disconnect. I would say we have very good scientists and very good people. This is not rocket science, we have failed to do the basics: test – identify – isolate – contact trace – isolate – lockdown – ramp up hospital capacity and PPE. For some reason, we are just not doing what should be the basics.
Q. Are you suggesting we are simply catching up on our failures as opposed to having a good strategy?
It is an example of ‘the emperor has no clothes’. In the United Kingdom – and I am on record as saying this repeatedly – we are very good at emergency preparedness and resilience. Part of emergency preparedness and resilience involves planning for a very long time. We are very good at this. Having said that and finding that we are in the middle of a pandemic, we are wholly unprepared. It is unbelievable. We do not have proper plans that we are executing. What it is clearly showing us: ‘we have no clothes’. Our NHS system has no spare capacity, no spare anything, to deal with a pandemic. This is the painful bit, contrary to what we were led to believe that we can and will manage this, it appears we were underprepared.
Q. Just to reiterate, is the disease likely to return? Do we know how the disease is developing?
Well, what I am conjecturing here is, if we carry on the way we are the disease will come back. It will come back in flashes from Africa…from Asia…from South America. In other words, if you have a large number of people infected and a free circulation of virus it will keep on circulating amongst the population and keep on resurfacing. Whilst I don’t want this to happen, if we carry on in the way that we are, that is what will happen.
Q. Are you saying that the solution is a worldwide solution, you have to look at other countries too to stop this disease from spreading?
Absolutely. But this is not rocket science. This is fundamental, basic science.
Q. In your experience and research, have you ever seen a virus that behaves in this way?
Yes, this is nothing unusual. Do not be swayed by politicians saying we planned for influenza but we didn’t plan for anything like this. Nonsense. When we plan, we plan for a novel respiratory virus. It is likely to be influenza but it can also be coronavirus which is what is here. In other words, a respiratory agent. Therefore, the plans are interchangeable and always have been. It is completely wrong to say we never saw this coming or that we were unprepared. That is not true. The truth is: we do plan and we do prepare, we say that there may be a respiratory disease that appears so what are our plans and how do we execute them accordingly. To say that we never saw it coming and therefore we are unprepared is a lie.
Q. So how did we get to a situation where we were aware of this and yet still fail to control it?
It is under-preparedness and lots of excessive promises that were never kept. For example, in 2016 we [University of Exeter] undertook a simulated exercise called ‘Sygnus ’. That exercise identified weaknesses in the systems for the UK to deal with a pandemic, specifically a respiratory agent pandemic. Not necessarily influenza, something like influenza, but it could have any other name such as with the coronavirus. Having identified those deficiencies in 2016, nothing was done about it. It was ignored.
It gets worse. It was ignored, but we were not told it was ignored. It was just put on the shelf to be forgotten, hoping that it would never happen. Unfortunately, 4 years later a pandemic has appeared. We knew what to do as shown through exercise Sygnus, but we ignored it. That is what has happened.
Q. Other than an independent scientific adviory group, is there anything else you believe would be invaluable at this time now?
Yes. Roll the clock back 20 years. With respect to what we used to have with the National Health Service, we had lots of expert, well trained, qualified public health people, and environmental health officers. We had a proper infection control service. And we had independence. In other words, you identified an issue, you talked about the issue, and it was quite clear what you said, what you did, what you wanted and then what was done by the politicians and what was not. At the moment, we have got a mixed signal. NHS England is a public organisation, it is part of the government where many believe it is independent. Therefore, it is unable to gain independent advice if the government don’t like it. We need to understand the fundamentals of independence and what it means, whether it is influenced by the government or not. We need a reestablishment of those structures.
Q. Finally, is the pandemic likely to last until the end of the year?
I see no evidence that it will not carry on. Why would it? This virus is not going on holiday. If you do not introduce control measures, for example 1. Clear the population of the infection 2. Suppress it completely and utterly then 3. Border controls to stop people coming in, how on earth are you going to suppress it? I need to hear something similar to what New Zealand have managed to achieve and Australia. Then I will change my mind and say yes, we have also got it under control.
We would like to thank Dr Bharat Pankhania for sharing his time and opinions with us and we welcomed this opportunity to speak with him on the current pandemic.
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