Among the more controversial comments from last week’s political debate was Farage’s comments regarding HIV and his suggestion that we should treat British people first and that it would be unchristian to do otherwise. Of course he offered no evidence to back up his claim (same as his previous attempts to claim 80% of pickpockets were Romanian, again no evidence given to support this), so I think we can dismiss it as more ramblings of a one balled racist loon.
However I would argue that what this comment does is to betray a dangerous flaw in both his, and the Tory party’s, policy of denying NHS treatment to non-nationals. For disease and viruses do not respect economic nor political boundaries. Such a policy therefore puts many UK citizens at grave risk and threatens to undermine the UK’s entire healthcare policy, which has stark implications for us all.
Let me illustrate my point by us imagining the following scenario. We have a woman, who works in London as a short order cook, whom we’ll call Eve. She’s recently arrived to the UK and therefore does not qualify for NHS treatment (or at least she’s unsure and reluctant to go to a hospital and be presented with a bill). She could be from Eastern Europe or beyond or perhaps even a British born person (or the spouse of a brit) whose given up their citizenship while living abroad and is one of many who fall through the cracks in the UK’s immigration system.
Either way, she starts to feel ill. But as she’s on a low wage and her boss doesn’t give sick pay (which is illegal but still goes on). So she continues working, potentially infecting others in work or on the commute. When she gets sufficiently ill that she thinks of going to a hospital, one of her friends text’s her a link to a Daily Mail article, which convinces her not to go, besides she’s starting to feel better again. Unfortunately, this apparent improvement, is merely because the virus has entered its final more critical stage. Within 24 hrs she starts to get very ill and ends up collapsing in a convulsing fit in the middle of a packed London tube train.
What Eve did not realise is that she was in fact patient zero in a new viral pandemic. It could be a new more deadly variant of pandemic flu, or some other form of respiratory infection, perhaps a form of Ebola or HIV that’s developed the capability for airborne transmission, or it could just be a new virus that’s managed to jump the species barrier. It sort of doesn’t matter. Either way, the point is, we have a new viral infection and thanks to the policies of the Tories and UKIP it would potentially be now out in the open and spreading rapidly.
Should you think the scenario I’m painting sounds a little far fetched, well you see that’s the scary thing it isn’t! New viruses do pop up all the time, some are pretty harmless, others have killed millions. And one common start point for such events, as portrayed in the scarily scientifically accurate film Contagion, is when animals are slaughtered and in the handling of raw meat, as this presents an opportunity for a virus to jump species and start infecting humans.
For example, while we don’t know where exactly the 1918 Spainsh flu pandemic started (called so because wartime censorship stopped media outside of Spain from reporting it), but its likely it started off in the US. Indeed some even go so far as to pin point one cook’s assistant Albert Gitchell in Fort Riley, Kansas as the likely patient zero. It should be noted that on this base the Army kept and slaughtered pigs, and kitchen staff such as Gitchell would have contact with the animals (both before and after slaughter), and we now know that the virus in question was a variant of H1N1, a form of swine flu.
So suffice to say that anyone involved in the handling of raw meat or the slaughter of animals is a very likely candidate for patient zero in the case of any new infection. And the bad news is that lots of those involved in these industries, but in the UK, the EU and in the US, tend to be migrant workers. People who both Farage and Cameron are on record of wanting to strip of their access to medical care.
And incidentally, many HIV or Hepatitis victims got sick from things such as blood transfusions so infection isn’t their fault and I fail to understand why they should be punished for it.
So denying anyone treatment creates a major weakness in our healthcare system, for in the event of a new pandemic the first few days are crucial in determining whether a ring fence can be thrown up and the infection contained. Its a bit like defending against an amphibious assault, the first 72 hours can determine whether the invader will be held at the beach and then thrown back into the sea, or whether they’ll be able to push deep inland and break out of their landing zone. Furthermore while a few dozen men can defend a beach against attack, if the enemy breaks in land you’re going to need alot more troops, at least a 1:1 forces ratio to stop them. Similarly with medicine a handful of doctors and nurses can contain an outbreak in its earliest stages, but if it breaks out into the general population its very possible the healthcare system will be overwhelmed by the number of patients.
Previous epidemics have been stopped thanks to good detective work and swift action by healthcare workers. For example, the Nigerian outbreak of Ebola, the 2003 SARS outbreak, which was a very close run thing, as was MERS in 2012. However crucially in many of these outbreaks, the virus had a relatively slow rate of infection and the initial patients arrived in hospitals alive and concious and thus were able to pass on key nuggets of information to doctors, allowing them to diagnose what was wrong (difficult when a doctor is faced with a virus he’s never seen nor heard of) and so that the patients movements can be traced and those who they’d had contact with can be identified and isolated.
In our scenario, our patient now arrives in a London hospital, unconscious and unresponsive. There is a very strong chance of miss-diagnosis. And in any event doctors will be focused on just keeping her alive, not having time to worry about the root cause of the problem (particularly as they don’t know who she is or what she does for a living, so no alarm bells have been set off). Consequently its very likely that the first the NHS will realise what they are facing is when hundreds of people across London and the south east descend on hospitals reporting similar symptoms.
And again if that sounds far fetched, that’s the scary thing – its not! Its believed that the bulk of the victims of SARS, which infected over 8,000 and killed nearly 800 people can be traced to a single sneeze in a hotel lift lobby. And again this is despite the fact that the individual in question, was a doctor who was already on his way to hospital as he guessed he needed treatment.
So in all likelihood in our scenario by the time the NHS wakes up to the crisis, its too late, the virus is out, its not going to be possible to contain it. It will sweep the country and the globe infecting millions and causing all manner of economic chaos, which would make any amount of money spent on NHS tourism seem like a rounding error.
Worse still, the fatality rate of many viruses depends on the level of care a patient receives. This is why Ebola has a fatality rate varying from 25% (with good treatment) to 90% (with poor or non existent medical care). But health care workers often make up the brunt of early casualties in any pandemic (with SARS a large proportion of its victims were health care workers). This means that as the numbers of staff drops and the number of patients rises, the fatality rate starts to climb.
Consider that a repeat of the 1918 pandemic would result in 25% of the UK population being infected, with 10% of those being sufficiently ill that they’d require intensive care treatment….but we’ve only hospital beds for less than 1% of those infected! This is why estimates for the death rate of such an outbreak vary from the high tens of thousands, to just shy of half a million perhaps 1 in 12 people in the country!
An if Farage or Cameron thinks they are safe from this hiding behind their private medical insurance, think again. The last think any private hospital wants is a deadly virus running around their place of business bumping off paying punters. They don’t have the resources to cope with such a thing and they’ll be sending anyone with such symptoms down to the nearest NHS hospital, or more than likely some sort of improvised field hospital in a school gym somewhere. And keep in mind that people in the same age groups as many of those inclined to vote Tory or UKIP are likely to make up a disproportionate number of those dying from any new pandemic.
And should you think the scenario I paint seem bleak, lets repeat the exercise in the US. While Obamacare has ensured most Americans now do have access to healthcare, there are some who are falling through the cracks….and there will be even more of those if the Republicans have their way. And again those who aren’t receiving coverage are the most likely to be infected first should a new virus emerge. But as viruses don’t respect economic boundaries, all it takes is one sneeze over a few cheese burgers in the back of a fast food joint and suddenly many middle class Americans are getting more than they bargained for with that happy meal.
And how would the US private healthcare system cope with a new pandemic?…probably very badly if the evidence from Ebola in the US is anything to go by, where a host of amateurish screw ups nearly led to disaster. And naturally the panic in America (Americans not exactly known for calm and rational reaction to a crisis, again look at the US media reaction to Ebola) will be all that greater.
I’ve long assumed that the US private healthcare system will last up until the next major pandemic. Because after tens of millions of Americans submit simultaneous claims in the order of tens of thousands each, at the same time hospitals are reeling from the billions in losses from patients whom they treated who weren’t covered (they are legally required to stabilise any patient who comes in) and the insurance industry is facing a few million simultaneous life insurance pay outs. Its possible that the whole US insurance industry could well be driven to bankruptcy, likely prompting a bailout of the US healthcare system by the US government that will make the 2007 bank bailout seem small. And result in de-facto state funded universal healthcare in America in all but name (perhaps they’ll called it Freedom Care or Patriot Care) ;D
So given these facts should we pay for these HIV treatments, something that would cost (at worst) about 0.18% of the annual NHS budget? Well of course we should! Any amount spend on treating non-residences healthcare is going to pale in comparison to the incalculable costs if a pandemic were to be allowed to get started.
Like I said at the beginning disease, cancer and other health problems do not respect economic or geopolitical boundaries. I always view healthcare as being like insurance, you don’t want to pay it, but you know you’re screwed if the worst happens without it. So literally trying to save a few pennies that amounts to a rounding error (in the grand scheme of things) would be madness, immoral and definitely unchristian.