COVID-19

Covid-19 discussion, bring your own statistics
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TopBadger
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Re: Wuhan Coronavirus

Post by TopBadger » Thu Feb 13, 2020 5:07 pm

My GP surgery put out an SMS on 24th Jan saying if visited China and feeling unwell with flu like symptoms then DO NOT ATTEND SURGERY and instead call in and a GP will call you back.

I doubt 111 are inviting possible cases to take public transport to sit in a crowded waiting room.
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Re: Wuhan Coronavirus

Post by Woodchopper » Thu Feb 13, 2020 5:48 pm

lpm wrote:
Thu Feb 13, 2020 3:25 pm
This person was given instructions over the phone on exactly what to do - but ignored them, showed up at the hospital reception desk and told them she was the coronavirus case. Which led to a scramble that would have been entertaining to watch.
The person is a Chinese national. Its possible they don't speak English well and may have misunderstood the instructions.

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Re: Wuhan Coronavirus

Post by nefibach » Thu Feb 13, 2020 5:54 pm

Really good post on masks:

http://www.cidrap.umn.edu/news-perspect ... n-covid-19

Choice quotes:
Yesterday the media reported that a Japanese doctor who was monitoring cruise ship passengers quarantined aboard the Diamond Princess in the port of Yokohama contracted the virus despite wearing gloves and a surgical mask. He joins the more than 500 healthcare workers in Wuhan, China, who have also reportedly contracted the disease—just by the middle of January.
A surgical mask, or procedural mask, is meant to protect the environment from the wearer.

"It's meant to keep the surgeon's respiratory issues away from a patient," Ribner explained. A surgical mask does a good job of trapping large droplets, and some aerosol transmission, he said. Many of the masks being worn in China, though, are not designed for medical use or to any standards and so their effectiveness in trapping droplets is unknown.
A respirator, such as an N95, fits tighter to the face and is meant to help protect the wearer from inhaling infectious droplets in the environment.
"Frankly, the WHO recommendation that surgical masks provide adequate protection for healthcare workers caring for COVID-19 patients is not consistent with data we have from similar transmission dynamics we see with influenza virus."
Worth reading all of it.

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Re: Wuhan Coronavirus

Post by nefibach » Thu Feb 13, 2020 6:07 pm

bob sterman wrote:
Thu Feb 13, 2020 7:58 am
Anyone know if the big jump in cases is newly presenting cases diagnosed yesterday using the new criteria, or a backlog of cases from the past couple of weeks that have been moved into the COVID-19 category because of the new criteria? Same for the deaths?
Apparently:
@DrMikeRyan To be 100% clear: 13,332 newly confirmed #COVID19 cases in Hubei province seem to be suspect cases going back some time that were not lab-confirmed and have been reclassified as confirmed on strength of chest imaging. Rest of china and world: lab confirmation still required.
https://twitter.com/kakape/status/1227987238811770880

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Re: Wuhan Coronavirus

Post by nefibach » Thu Feb 13, 2020 6:10 pm

Woodchopper wrote:
Thu Feb 13, 2020 1:12 pm
See my earlier post: viewtopic.php?f=10&t=747&p=18203&hilit= ... gal#p18203

As of last week only six labs on the whole continent were able to test for it.
Update on this:
#Covid19: Update on testing capacity in Africa. At the beginning of Feb. only Senegal & South Africa had labs that could test for the new virus. More can now (green) but the countries that can't still outnumber them. Countries in white are in a diff WHO region. source: @WHOAFRO

Image
https://twitter.com/HelenBranswell/stat ... 2145131520

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Re: Wuhan Coronavirus

Post by lpm » Thu Feb 13, 2020 8:26 pm

Woodchopper wrote:
Thu Feb 13, 2020 5:48 pm
lpm wrote:
Thu Feb 13, 2020 3:25 pm
This person was given instructions over the phone on exactly what to do - but ignored them, showed up at the hospital reception desk and told them she was the coronavirus case. Which led to a scramble that would have been entertaining to watch.
The person is a Chinese national. Its possible they don't speak English well and may have misunderstood the instructions.
Surely, surely, surely - even in Boris Britain - one of the more stupid countries on the planet - they will have anticipated that 99% of the people bringing this into the country will be foreigners? Foreigners who speak Chinese? (Our foreign secretary will have told the health secretary about a language called Chinese.) And there would be an automatic transfer at 111 to one of the few people in the UK who has learned to speak these languages of foreigners?

Or are we relying on foreigners understanding our English with the protocol being to speak it louder.
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Re: Wuhan Coronavirus

Post by nefibach » Thu Feb 13, 2020 8:50 pm

lpm wrote:
Thu Feb 13, 2020 8:26 pm
Woodchopper wrote:
Thu Feb 13, 2020 5:48 pm
lpm wrote:
Thu Feb 13, 2020 3:25 pm
This person was given instructions over the phone on exactly what to do - but ignored them, showed up at the hospital reception desk and told them she was the coronavirus case. Which led to a scramble that would have been entertaining to watch.
The person is a Chinese national. Its possible they don't speak English well and may have misunderstood the instructions.
Surely, surely, surely - even in Boris Britain - one of the more stupid countries on the planet - they will have anticipated that 99% of the people bringing this into the country will be foreigners? Foreigners who speak Chinese? (Our foreign secretary will have told the health secretary about a language called Chinese.) And there would be an automatic transfer at 111 to one of the few people in the UK who has learned to speak these languages of foreigners?

Or are we relying on foreigners understanding our English with the protocol being to speak it louder.
Apparently, she didn't actually call 111:
Contrary to previous media reports the woman did not ring the NHS 111 advice service before she went to the hospital. “If she had done that, things would have happened very differently when she got here. She wouldn’t have walked into A&E for a start and correct protocols would have been followed,” said a member of staff.
https://www.theguardian.com/world/2020/ ... -uber-taxi

As a recently arrived Chinese national, she simply may not have known what to do, and just did the obvious thing.

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Re: Wuhan Coronavirus

Post by nefibach » Thu Feb 13, 2020 11:33 pm

The quacks are out:
A guest on televangelist Jim Bakker's show suggested on Wednesday that a product sold on Bakker's website might be effective at protecting against and killing the novel coronavirus.

The guest, naturopathic Dr. Sherrill Sellman, said that Silver Solution—a product that can be purchased on Bakker's web store—has been found to be effective on viruses related to the one from Wuhan. Further, she said Silver Solution could bolster a person's immune system and potentially make their bodies less susceptible to the virus.
https://www.newsweek.com/televangelist- ... us-1487069

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Re: Wuhan Coronavirus

Post by OneOffDave » Fri Feb 14, 2020 9:02 am

TopBadger wrote:
Thu Feb 13, 2020 5:07 pm

I doubt 111 are inviting possible cases to take public transport to sit in a crowded waiting room.
You've obviously got little experience of 111 in real life then. They routinely give all kinds of spurious advice. It's also likely that they may not have communicated in a timely manner with the ED. It should be remembered that the 111 service is delivered by a range of providers across England. I usually get one member of the public inappropriately directed to me every other on-call week.

The processes at a number of EDs seems very poorly set up to cope with 'contaminated' individuals self presenting whether it's chemical or biological

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Re: Wuhan Coronavirus

Post by OneOffDave » Fri Feb 14, 2020 9:16 am

lpm wrote:
Thu Feb 13, 2020 8:26 pm
Surely, surely, surely - even in Boris Britain - one of the more stupid countries on the planet - they will have anticipated that 99% of the people bringing this into the country will be foreigners? Foreigners who speak Chinese? (Our foreign secretary will have told the health secretary about a language called Chinese.) And there would be an automatic transfer at 111 to one of the few people in the UK who has learned to speak these languages of foreigners?

Or are we relying on foreigners understanding our English with the protocol being to speak it louder.
Good luck finding people who speak Cantonese and Mandarin and are experienced enough to staff an offshoot of 111 and enough of them for a 24/7 service. It's not easy and it's definitely not cheap. As 111 isn't a nationally provided service, this also would have to be sourced by all the 111 providers

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Re: Wuhan Coronavirus

Post by Bird on a Fire » Fri Feb 14, 2020 11:45 am

OneOffDave wrote:
Thu Feb 13, 2020 2:42 pm
plodder wrote:
Thu Feb 13, 2020 2:31 pm
OneOffDave wrote:
Thu Feb 13, 2020 2:15 pm


If they don't have access to their own vehicle, how else should they get to hospital?
sh.t. Great idea. Someone ought to invent some sort of specialist transportation vehicle for people who need to get to hospital.
So someone who is basically healthy overall ties up an ambulance and specialist crew for several hours meaning people who are in acute need don't get one. You burn through your PPE and HART crews pretty quickly that way.
Out of interest, why would it be several hours? Is that due to the need to decontaminate the ambulance and change clothes and stuff?
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Re: Wuhan Coronavirus

Post by OneOffDave » Fri Feb 14, 2020 1:03 pm

Bird on a Fire wrote:
Fri Feb 14, 2020 11:45 am

Out of interest, why would it be several hours? Is that due to the need to decontaminate the ambulance and change clothes and stuff?
It goes roughly like this - Get to patient address and kit up in PPE, collect patient, drive to ED, wait at ED for medic to come out and take history from patient, wait for history to be relayed to right specialist to authorise testing, testing takes place. If patient is asymptomatic, patient is conveyed home to self isolate. Crew then take ambulance to decon location. Crew doff PPE with appropriate supervision. Ambulance gets deconned by specialist in correct PPE (again with appropriate doffing supervision). Ambulance needs to dry out/vent. Ambulance restocked and back on the run. Depending on the length or wait at the ED, there may be a need to swap crews and doff/don PPE as it's only effective for a set period of time. Also very fatiguing to wear high level PPE for long durations. The highest risk of contamination is during the doffing process which is why it needs to be properly supervised.

This is the fifth high consequence infectious disease outbreak I've been involved in at work in the last 18 months so getting familiar with it

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Re: Wuhan Coronavirus

Post by Bird on a Fire » Fri Feb 14, 2020 9:03 pm

OneOffDave wrote:
Fri Feb 14, 2020 1:03 pm
Bird on a Fire wrote:
Fri Feb 14, 2020 11:45 am

Out of interest, why would it be several hours? Is that due to the need to decontaminate the ambulance and change clothes and stuff?
It goes roughly like this - Get to patient address and kit up in PPE, collect patient, drive to ED, wait at ED for medic to come out and take history from patient, wait for history to be relayed to right specialist to authorise testing, testing takes place. If patient is asymptomatic, patient is conveyed home to self isolate. Crew then take ambulance to decon location. Crew doff PPE with appropriate supervision. Ambulance gets deconned by specialist in correct PPE (again with appropriate doffing supervision). Ambulance needs to dry out/vent. Ambulance restocked and back on the run. Depending on the length or wait at the ED, there may be a need to swap crews and doff/don PPE as it's only effective for a set period of time. Also very fatiguing to wear high level PPE for long durations. The highest risk of contamination is during the doffing process which is why it needs to be properly supervised.

This is the fifth high consequence infectious disease outbreak I've been involved in at work in the last 18 months so getting familiar with it
Thanks - I had no idea, and would have massively underestimated what's involved!
Born at 356.32 ppm CO2 #ShowYourStripes

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Re: Wuhan Coronavirus

Post by Gfamily » Fri Feb 14, 2020 9:40 pm

OneOffDave wrote:
Fri Feb 14, 2020 1:03 pm
This is the fifth high consequence infectious disease outbreak I've been involved in at work in the last 18 months so getting familiar with it
Obvious joke writes itself.
My avatar was a scientific result that was later found to be 'mistaken' - I rarely claim to be 100% correct
ETA 5/8/20: I've been advised that the result was correct, it was the initial interpretation that needed to be withdrawn
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Re: Wuhan Coronavirus

Post by Herainestold » Fri Feb 14, 2020 10:01 pm

OneOffDave wrote:
Fri Feb 14, 2020 1:03 pm
Bird on a Fire wrote:
Fri Feb 14, 2020 11:45 am

Out of interest, why would it be several hours? Is that due to the need to decontaminate the ambulance and change clothes and stuff?
It goes roughly like this - Get to patient address and kit up in PPE, collect patient, drive to ED, wait at ED for medic to come out and take history from patient, wait for history to be relayed to right specialist to authorise testing, testing takes place. If patient is asymptomatic, patient is conveyed home to self isolate. Crew then take ambulance to decon location. Crew doff PPE with appropriate supervision. Ambulance gets deconned by specialist in correct PPE (again with appropriate doffing supervision). Ambulance needs to dry out/vent. Ambulance restocked and back on the run. Depending on the length or wait at the ED, there may be a need to swap crews and doff/don PPE as it's only effective for a set period of time. Also very fatiguing to wear high level PPE for long durations. The highest risk of contamination is during the doffing process which is why it needs to be properly supervised.

This is the fifth high consequence infectious disease outbreak I've been involved in at work in the last 18 months so getting familiar with it
You obviously know quite a bit about this. How can we simplify and speed up this process?

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Re: Wuhan Coronavirus

Post by mikeh » Fri Feb 14, 2020 10:52 pm

First diagnosed case in African continent, in Egypt.

Could be here-we-go. Hopefully isolated case/limited spread.

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Re: Wuhan Coronavirus

Post by Gfamily » Fri Feb 14, 2020 10:56 pm

mikeh wrote:
Fri Feb 14, 2020 10:52 pm
First diagnosed case in African continent, in Egypt.
No longer in denial

(apols)
My avatar was a scientific result that was later found to be 'mistaken' - I rarely claim to be 100% correct
ETA 5/8/20: I've been advised that the result was correct, it was the initial interpretation that needed to be withdrawn
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Re: Wuhan Coronavirus

Post by Herainestold » Fri Feb 14, 2020 11:14 pm

Anti-Chinese racism w.r. t . Corona virus in America
A 16-year-old boy in California's San Fernando Valley was physically attacked this week by bullies in his high school who accused him of having the coronavirus — simply because he is Asian American. It is just the latest episode in a spree of racist incidents linked to the global health emergency over the novel coronavirus, now named COVID-19.

"He went to the hospital originally, and went to the emergency room," Robin Toma, the executive director of the L.A. County Human Relations Commission, said in a joint news conference with Los Angeles County public officials on Thursday. "They were taking MRIs to ensure he didn't have a concussion or other harm."
https://www.cbsnews.com/news/coronaviru ... ronavirus/

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Re: Wuhan Coronavirus

Post by bob sterman » Sat Feb 15, 2020 7:40 am

Herainestold wrote:
Fri Feb 14, 2020 10:01 pm
OneOffDave wrote:
Fri Feb 14, 2020 1:03 pm
Bird on a Fire wrote:
Fri Feb 14, 2020 11:45 am

Out of interest, why would it be several hours? Is that due to the need to decontaminate the ambulance and change clothes and stuff?
Ambulance gets deconned by specialist in correct PPE (again with appropriate doffing supervision). Ambulance needs to dry out/vent. Ambulance restocked and back on the run.
You obviously know quite a bit about this. How can we simplify and speed up this process?
Would it be possible to avoid using frontline ambulances to transport suspected cases where the patient is ambulatory and not likely to need treatment on route? E.g. patient transport vehicles? Or just rent some white vans? Less of a problem when they are off the road being decontaminated?

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Re: Wuhan Coronavirus

Post by Woodchopper » Sat Feb 15, 2020 8:52 am

OneOffDave wrote:
Fri Feb 14, 2020 9:16 am
lpm wrote:
Thu Feb 13, 2020 8:26 pm
Surely, surely, surely - even in Boris Britain - one of the more stupid countries on the planet - they will have anticipated that 99% of the people bringing this into the country will be foreigners? Foreigners who speak Chinese? (Our foreign secretary will have told the health secretary about a language called Chinese.) And there would be an automatic transfer at 111 to one of the few people in the UK who has learned to speak these languages of foreigners?

Or are we relying on foreigners understanding our English with the protocol being to speak it louder.
Good luck finding people who speak Cantonese and Mandarin and are experienced enough to staff an offshoot of 111 and enough of them for a 24/7 service. It's not easy and it's definitely not cheap. As 111 isn't a nationally provided service, this also would have to be sourced by all the 111 providers
Just to illustrate the costs.

It would take five full time and one part time Chinese speaking 111 personnel to provide 24/7 coverage in one area.

There’s 21 eight hour shifts in a week, and assuming people work one shift per day for five days then five people would cover 20 of those shifts. The additional part time person will need to work more than one shift though, as they’ll be needed to cover for absence due to sickness or training courses etc

This suggests that 111 staff are paid £30-40 000 per year. We can take the lower figure, but the actual cost of employing someone is going to be about double their salary (eg HR, pension, training, supervisor etc).

So the ballpark figure is an annual cost of £330 000 to make one Chinese speaker available. And that’s just in one area.

As Dave mentions, it may be difficult to find the right people. In addition there is the complication of Chinese dialects. Someone from Beijing may not even be able to understand instructions given by someone from Hong Kong.

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Re: Wuhan Coronavirus

Post by mikeh » Sat Feb 15, 2020 9:09 am

https://www.bmj.com/content/368/bmj.m62 ... aign=usage

One option being explored is home testing.

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Re: Wuhan Coronavirus

Post by lpm » Sat Feb 15, 2020 10:40 am

Woodchopper wrote:
Sat Feb 15, 2020 8:52 am
OneOffDave wrote:
Fri Feb 14, 2020 9:16 am
lpm wrote:
Thu Feb 13, 2020 8:26 pm
Surely, surely, surely - even in Boris Britain - one of the more stupid countries on the planet - they will have anticipated that 99% of the people bringing this into the country will be foreigners? Foreigners who speak Chinese? (Our foreign secretary will have told the health secretary about a language called Chinese.) And there would be an automatic transfer at 111 to one of the few people in the UK who has learned to speak these languages of foreigners?

Or are we relying on foreigners understanding our English with the protocol being to speak it louder.
Good luck finding people who speak Cantonese and Mandarin and are experienced enough to staff an offshoot of 111 and enough of them for a 24/7 service. It's not easy and it's definitely not cheap. As 111 isn't a nationally provided service, this also would have to be sourced by all the 111 providers
Just to illustrate the costs.

It would take five full time and one part time Chinese speaking 111 personnel to provide 24/7 coverage in one area.

There’s 21 eight hour shifts in a week, and assuming people work one shift per day for five days then five people would cover 20 of those shifts. The additional part time person will need to work more than one shift though, as they’ll be needed to cover for absence due to sickness or training courses etc

This suggests that 111 staff are paid £30-40 000 per year. We can take the lower figure, but the actual cost of employing someone is going to be about double their salary (eg HR, pension, training, supervisor etc).

So the ballpark figure is an annual cost of £330 000 to make one Chinese speaker available. And that’s just in one area.

As Dave mentions, it may be difficult to find the right people. In addition there is the complication of Chinese dialects. Someone from Beijing may not even be able to understand instructions given by someone from Hong Kong.
Seems trivially cheap? Google says there are 400,000 Chinese immigrants living in the UK . Given cultural traditions, these 400,000 people will probably spend £10 a month on face masks in an epidemic, £48m per year. When their family members come to visit we want them all to have ready access to healthcare - if only for the selfish reason that a major epidemic would cost the country something like £10 billion to £100 billion.

When it comes to finding the right people, that's trivial as well. There are a lot of people who live in China who speak the languages and dialects - China has, I believe, a large population. Millions. Maybe tens of millions. All it needs is a call centre offshoot in China. Every utility and bank has virtual combined call centres across multiple countries, using simple off the shelf telephone systems. In fact, the Philippines is already the world leader in call centres - make an enquiry about your mortgage or why your broadband isn't working and it's likely you will speak to someone in the Philippines - and they have a very large Chinese community. I bet I could call Concentrix or TeleTech or Sitel right now, be told immediately they employ 63 Fujianese speakers in Quezon City and get the service running by this time tomorrow.
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Re: Wuhan Coronavirus

Post by Woodchopper » Sat Feb 15, 2020 10:56 am

lpm wrote:
Sat Feb 15, 2020 10:40 am

Seems trivially cheap? Google says there are 400,000 Chinese immigrants living in the UK . Given cultural traditions, these 400,000 people will probably spend £10 a month on face masks in an epidemic, £48m per year. When their family members come to visit we want them all to have ready access to healthcare - if only for the selfish reason that a major epidemic would cost the country something like £10 billion to £100 billion.
Cheap compared to the cost of an epidemic. But not so easy for the people running 111 to just find a few hundred thousands of pounds at short notice.
lpm wrote:
Sat Feb 15, 2020 10:40 am
When it comes to finding the right people, that's trivial as well. There are a lot of people who live in China who speak the languages and dialects - China has, I believe, a large population. Millions. Maybe tens of millions. All it needs is a call centre offshoot in China. Every utility and bank has virtual combined call centres across multiple countries, using simple off the shelf telephone systems. In fact, the Philippines is already the world leader in call centres - make an enquiry about your mortgage or why your broadband isn't working and it's likely you will speak to someone in the Philippines - and they have a very large Chinese community. I bet I could call Concentrix or TeleTech or Sitel right now, be told immediately they employ 63 Fujianese speakers in Quezon City and get the service running by this time tomorrow.
Not quite that simple. Those call centre people also need to be medically qualified, speak fluent English (or how are they to be trained) and understand how the NHS works.

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Re: Wuhan Coronavirus

Post by mikeh » Sat Feb 15, 2020 12:06 pm

Woodchopper wrote:
Sat Feb 15, 2020 10:56 am
Cheap compared to the cost of an epidemic.
This statement can be applied to pretty much any aspect of an outbreak that should be in place in advance, but isn't. The economic cost will be many billions. It would cost maybe hundreds of millions to put the R&D in place to create and distribute a couple of vaccines, have diagnostics in place, and a therapeutic or two. That may not stop the outbreak altogether but would greatly reduce the health, societal and economic impacts. Pretty much all the public R&D around coronavirus prior to this outbreak was pre-clinical stuff, very little in the way of any potential products being tested in trials. Not so sure about private sector, but not necessarily a money-maker for them before a big event happens so doubt much was happening.

Since Ebola, there has been some small shift in thinking that R&D and public health investment in advance, rather than reactively, would be a good thing. But that requires multi-country cooperations, particularly around putting your hand in your pocket. The likes of the Gates Foundation and Wellcome Trust tend to pick up the slack to some extent.

But sensible and sustained political will across creeds, cultures and nations...?

Why hello Boris and Donald.

Oh.

And rinse and repeat for the next time. I am clutching at straws here, but one reason why there might be a shift in global thinking is the epicentre of this particular outbreak is in a high-income and globally influential country. West Africa lacks influence, China does not. So there may possibly maybe perhaps be some forward thinking after this, though wouldn't bank on it.

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Re: Wuhan Coronavirus

Post by bob sterman » Sat Feb 15, 2020 12:07 pm

Woodchopper wrote:
Sat Feb 15, 2020 10:56 am
Not quite that simple. Those call centre people also need to be medically qualified, speak fluent English (or how are they to be trained) and understand how the NHS works.
111 call centre people "medically qualified"? If you adopt a very loose definition of "medically qualified".

NHS 111 helpline scandal: 'Inexperienced teenagers are handling medical calls' to beleaguered phone service
https://www.mirror.co.uk/news/uk-news/n ... ed-7377760

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