UK response to COVID-19: will society be the same again?

I write on 18th March 2020. Nothing will ever be the same again; a previously unknown virus that crept into our consciousness at the beginning of February has now spread around the world in a matter of weeks crashing economies, spreading anxiety and panic, killing thousands and throwing governments into chaos. What are we to make of it?

‘Problems worthy of attack prove their worth by hitting back’ goes the Grook by the Danish poet Piet Hein. Nowhere can this be more true than in the field of public health and infectious disease, where nature has more tricks up its sleeve than we can imagine. Nevertheless, it seems we are prepared to take our eye off the ball and allow the arrangements for public health to be neglected, fragmented and under-resourced. In this case, the pangolins are coming home to roost.

From the very beginning the UK response to possibly the greatest threat to public health since the Spanish flu of 1918/19 has been inadequate. Initially, Prime Minister (PM) Boris Johnson didn’t see fit to convene and chair the emergency committee ‘COBRA’, didn’t allow his Chief Medical Officer (CMO) Chris Whitty on to the BBC Radio 4 ‘Today’ programme, and generally played down the prospects threatened by a virus that had wreaked such havoc in China. By the time the PM chaired his first COBRA meeting the damage had been done; there had been no effort made to take strategic stock of what was about to unfold, to monitor, screen and test for COVID-19, particularly in the thousands of Brits and others returning from skiing holidays in the heavily affected areas of Italy. Furthermore, in an amazing display of corporate negligence, 3000 Madrid football supporters were allowed to leave a city on virtual lockdown and attend a match at Anfield, carousing the night away in Liverpool and no doubt seeding outbreaks for the weeks ahead . In a heavily laden irony, one of the first Liverpool victims was himself a local consultant, who had been skiing in Italy and had returned to practice for several days before exhibiting symptoms.

As the nightmare scenario evolved the PM, CMO and Chief Scientific Officer proudly proclaimed that they were pursuing a science-led approach to managing what was rapidly emerging as a disaster based on a flawed bio-statistical model. With so little COVID-19 testing going on, COBRA predictions were shown to be inaccurate almost overnight as, during last weekend, it became apparent that the epidemic curve was reaching a doubling of cases and deaths every few days, threatening to bring the NHS to a halt along with a significant increase in deaths.

Less than 24 hours after the PM held his first press conference on the pandemic, the country feels as if it is in meltdown. From laissez-faire to national curfew, we are now faced with trying to suppress a pandemic and subsequently terrified population. At this stage, restoring trust in our politicians and professional leaders is going to be a tough, not least because they have wilfully pursued a narrow technocratic approach to something that a was inevitably going to require social mobilisation. There are estimates that we will require eight times as many critical care beds as are currently available to deal with the need, which brings a sharp dose of reality into academic deliberations. Inevitably, this burden will fall on ordinary men and women who have so far been uninformed beyond the incitement to wash their hands regularly with soap and water.

As I write in self-isolation from my rural study, I am angry and frustrated but simultaneously curious about what transformational change may occur to the way we live as a result of this crisis. Out of this may come a retreat from globalisation and our fetish for frivolous travel; it may instil new patterns of living, working and study, most suited to the internet age; together with a transformation of clinical practice to embrace remote consultation, advice and care. However, before we get to that we must deal with a situation that is bringing the country to a halt and may well last over a year. The light at the end of the tunnel is the thousands of volunteers who have been stepping forward over the past few days to form community-based ‘Citizen COBRAs’ to take charge and respond to the stress of their fellow humans and to restate forcefully that ‘Yes, indeed there is such a thing as Society’.

What are your thoughts? Was the response of the UK Government to the current outbreak of COVID-19 satisfactory? How will it impact future society? Let us know your thoughts in the blog below. 

Comments (21) Add yours ↓
  1. Una Sharkey Contact support worker

    John can you please share. And thank you for being a light in such grave times.

    March 18, 2020 Reply
  2. Roger Kirby Professor of Urology

    Another great blog here:

    March 19, 2020 Reply
  3. Roger Kirby Professor Roger Kirby

    Check out John’s latest rather abrasive comments:

    March 19, 2020 Reply
    • Mick Ord PR/media consultant

      They’ve been ‘removed by the user’ Roger.

      March 20, 2020 Reply
  4. Roger Kirby Professor of Urology

    Helen Meese, vice chair of biomedical engineering at the Institution of Mechanical Engineers, told HSJ there were several constraints on using non-medical firms in the manufacturing of ventilators, as the government has suggested.

    Health and social care secretary Matt Hancock recently tweeted to call for “all manufacturers who can support out national effort for #coronavirus ventilator production” to contact the Government Business Support team, part of the Department for Business, Energy and Industrial Strategy.

    But Dr Meese said: “Ventilation equipment, like all medical devices, is very strictly regulated to ensure patient safety. We must be clear, that while many engineering companies and individuals have come forward to support this initiative, it will take several weeks, if not months, to ensure the right processes are in place to increase production of these precision parts.”

    March 19, 2020 Reply
  5. Stewart Fleming Ex US Editor Financial Times

    This government’s responsibility for our parlous state of affairs remains unacknowledged of course. The shortage of respirators, and trained nurses to operate them, which is now forcing it to take firmer action, may in part be a legacy of the government spending economies post 2007/8: it is however, another indication of how slowly Prime Minister Johnson reacted to the virus even after it had exploded in Lombardy.

    There was a fascinating letter in the Financial Times yesterday from Professor Ariberto Fassati, a specialist in cellular and molecular biology at UCL, pointing out that within days of the genetic code of this virus being sequenced several Asian countries, including South Korea, were already preparing the mass testing programmes which have contributed to their success in curbing its reach. They did not only test hospital staff and patients (as we have sought to do) but also taking samples across the population to get a picture of who had the virus, to conduct contract tracing and targeted quarantining. They also began to use mobile phone technology, he says, to inform the public about local outbreaks.

    In the UK we were testing 1,000 plus a week to begin with, but primarily in the hospital environment, and originally not staff as I understand it ; then we targeted testing 5,000 but it is not clear whether we are there yet; then Prime Minister Johnson announced a 10,000 target – we are nowhere near it yet: now the target is 20,000. This is just another example, amongst many, of the government’s face-saving campaign of words and rhetoric at a time when the Republic of Ireland has already set up a community testing station in Croke Park, its national sporting stadium – the equivalent of Wembley or Twickenham.

    We have a government which is good at populist electoral politics but hapless at actually developing policy and delivering it. It is clever at sound bites, “take back control,” “ get Brexit done,” and now “whatever it takes,” but a shallow administration, an emperor without clothes, when suddenly faced by the real world.

    After the general election it was lost in hubris, consumed with its Brexit triumph and busy preparing its next Brexit victories e.g. “reshaping” government – so it could be run by Dominic Cummings’s (subservient) “weirdos and misfits” rather than experienced civil servants. The complexities of governing were a black hole in the head of most ministers, a reality they did not even faintly understand because of their limited ( if any) experience of actually “governing.”

    We shall see whether it can now adjust to reality, whether it has indeed begun to appreciate the “experts” it derided not long ago or is simply using its impressive scientific advisers as stooges who will be blamed for things going wrong. Its agenda is not primarily driven by science ( see below). It is driven by politics with science forcing it to change gear constantly as reality bites.

    As Professor Nicolas Taleb said on the BBC this week, we discovered in 2007 that computer models (whether economic – then it was the probability based “value at risk” financial models which failed – or medical) are only as good as the data you feed into them. If the data is poor or out-of-date, in this case partly because you were not testing adequately, the data which comes out will be poor or out-of-date.

    So, far from “leading the world” in the fight against the corona virus as the populist, hubristic, still electioneering Johnson claimed this week in his TV appearance, the only world leadership we are facing is in the number of dead per head of the population when the final count is made.

    According today’s Times, Johnson is, even now, refusing to join a European union joint procurement mechanism to acquire ventilators and protection equipment for medical staff, a stance which is politically driven and surely not based on the advice of his vaunted scientific advisers. Unless reversed, this posture, the Times says, puts not just patients but, critically also, medical staff ( so fulsomely praised in public by these hypocrites) at greater risk than is necessary.

    In an interview with Sam Fleming of the Financial Times today, Thierry Breton, the EU Industry Commissioner, who is helping coordinate the EU’s response to the crisis, noted how he had been in direct contact with Mark Zuckerberg of Facebook and the leaders of other social media giants, to ensure that they now recognised their social responsibilities; how he was talking to the chief executives of companies like LVMH in France and Zara in Spain, and many others in other EU countries, co-ordinating their efforts at switching to the production of medical supplies; and how he is speaking with China’s industry minister to facilitate Chinese support as the crisis seems to be passing its peak there.

    Cooperating with our nearest neighbour, not still threatening in public a politically driven “hard Brexit” in December, should now be our Prime Minister’s top priority.

    March 19, 2020 Reply
    • Chris Baldwin Director

      I have been concerned by the concentration of efforts on cleaning up the mess rather than preventing it. Now the strategy of shutting down public contact will have devastating economic effects which will surely cause more deaths. Meanwhile, obvious preventative methods such as eye protection and face masks are being shunned with no discussion of the evidence. In fact Asian countries which have used these methods to stop public transmission have started to see some success.

      There is also prior evidence that face masks used by the public lower hand to face contact even if the masks themselves do not provide a barrier to the virus. Simple washable masks could easily be used by the public, even ‘snood’ scarves. These methods must be explored quickly. We have only days before the economic impact of social distancing policy causes long terms and catastrophic harm to the world’s economy.

      See “Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial.” Aiello et al. The Journal of Infectious Diseases.

      “Unmasking the Confusion of Respiratory Protection to Prevent Influenza-Like Illness in Crowded Community Settings” Titus L. Daniels, Thomas R. Talbot, The Journal of Infectious Diseases.

      March 20, 2020 Reply
  6. Thomas Stonier Urology ST3

    Great blog. Pretty incredible response from the Government given they had the chance to review the response of two other major healthcare systems yet didn’t seem to pick up on the lessons in time.

    As I sit here currently recovering from COVID, there is still mass confusion on the frontline about which symptoms mean you should go home and isolate? Whether we can get tested or not? What does an exposure to a positive patient mean? (I’ve had one friend told to return to work on Elderly Care Ward as he was asymptomatic, despite sharing accommodation with 10 people most of whom have symptoms, and some test proven cases).

    The future will be a very different place as you say, with this likely to accelerate our (much needed) progression to video consultations. This will make a huge difference in the care of young/working patients where a clinic appointment would only take up 10mins of their days vs half a day (once travel and waiting times are removed for them).

    However for now a period of at least 3-6 months social distancing and curfews seems unavoidable. It is hard to see how this can end until herd immunity or vaccine come in. The next critical step for the economy will be the creation of the antibody test to at least allow those exposed to return to work.

    March 19, 2020 Reply
  7. Roger Kirby Professor of Urology

    On Monday (23 March) LSHTM’s free online course COVID-19: Tackling the Novel Coronavirus gets underway for 3 weeks.

    It already has 58,000+ participants signed up.

    The LSHTM Viral podcast continues to provide regular updates from LSHTM experts and has been streamed more than 40,000 times. The most recent episode features Adam Kucharski on the scientific evidence informing the UK government’s response, with a new episode out today.

    Next week LSHTM will be holding our second livestreamed COVID-19 Q&A for the public to ask questions about the outbreak and receive expert answers. This will be broadcast on the LSHTM YouTube and Twitter on Wednesday 25 March at 1pm GMT.

    Finally, LSHTM’s researchers continue to appear in the world’s news media providing ongoing expert analysis – the highlights are featured on our blog.

    You can keep up to date with the latest coronavirus research, news and other activities from LSHTM at

    March 21, 2020 Reply
  8. Brian Dye Lawyer

    The OP is quite right that a “lockdown” rather that a mitigation or suppression strategy, had it been implemented at the outset, could have stunted the spread of the virus. But there is no use crying over spilt milk. That’s in the past.

    Looking at the present situation as a lawyer, not a doctor, the life-saving issue in the short term is this: We are about to have a mammoth surge in critical cases. But it will take time to ramp up production of ventilators. In the interim, how do we get a ventilator for everyone who needs one, when we don’t have enough of them in the UK and won’t be able to buy them on the world market in time?

    Dr Meese’s opinion as quoted by Professor Kirby is that: “Ventilation equipment, like all medical devices, is very strictly regulated to ensure patient safety. We must be clear, that while many engineering companies and individuals have come forward to support this initiative, it will take several weeks, if not months, to ensure the right processes are in place to increase production of these precision parts.”

    I’m afraid not. Dr Meese’s approach is a very good one in ordinary times. But we just can’t have a policy like this at the present time, because it will involve terrible numbers of, I say, avoidable deaths. We are fighting battle. We cannot just leave fellow citizens to suffer horrible deaths while taking months to produce perfect machines “very strictly regulated to ensure patient safety”. People are dying.The public are entitled to demand that this problem is resolved. Now. “Action this day” was Churchill’s phrase.

    In all frankness, if I’m dying of CV, I won’t care if my ventilator has been thrown together out of an old accordion, a fire-bellows, a length of hoover pipe, a dustbin lid, and a snorkel mask, as long as it works.

    Fortunately, we don’t have to go to such lengths yet.

    In Canada in the last few days an ICU respiratory medicine consultant with some DIY skills has found a way of bypassing ventilator units so that he can run 9 lines off 1 ventilation unit. I make no apology from taking the story on this out of the Daily Mail rather than Pubmed.

    Now let’s imagine that something like this does actually work. If it does, we have the potential to do a DIY job to turn the 4,500 ventilators in the UK into 9 line units. Instead of dealing with 4,500 patients at a time, we can now deal with 40,500 patients. Since it’s taking 18-22 days in Italy to resolve each critical case, one way or another, that means, we’d turn over each of the 9 lines 17 times a year, and we’d be able to treat 688,000 critical cases in a year, just using a “jerry job” like this. Ok, so it’s not perfect, that’s fine. In my job, in heavy litigation, I’m often sent out into battle with imperfect material and I just do the best I can, and do you know what I find – if you fight, you often win through. I expect doctors are doing that all the time. We need to do something like that in these cases. Let’s have some optimism. We can do this.

    Almost anyone reading this blog has more medical expertise than me. Please put pen to paper: I’d like to hear how each of you would leverage the 4,500 NHS ventilation units we have to tide us over until new ventilators can be manufactured, without anyone being turned away because there are insufficient units. Please don’t say it’s impossible, because it isn’t.

    March 21, 2020 Reply
  9. Roger Kirby Professor of Urology

    Underspending on the NHS for the past decade is now coming home to roost. In the UK, the low number of ventilators is already a huge controversy. The NHS has just 4,000 – forcing the government to put out a desperate appeal for manufacturers to urgently build more. Furthermore, the UK has just 6.6 intensive care beds per 100,000 people – half the number in Italy and about a fifth of the total in Germany. Jeremy Hunt sounds caring and sensible now, but it was under his watch that the junior doctors – whom we need so desperately now – were alienated by a long drawn-out dispute about their pay and conditions. We reap what we sow!

    March 21, 2020 Reply
    • Nicola Stingelin Ethicist

      Yes. Sad, But correct.
      Question: what can we do to start sowing more fruitful seed?

      March 24, 2020 Reply
  10. Roger Kirby Professor of Urology

    Dr Gabriel Scally, President of RSM Epidemiology & Public Health Section, has been critical of the UK government’s response to coronavirus:

    March 24, 2020 Reply
  11. Tarik Amer Consultant

    Thanks for this informative blog. On the ground, in my own department in Lanarkshire, it has been inspiring to see the speed and commitment with which uncertainty has been embraced by all team members to streamline operating lists, do remote clinic consultations, set up a Microsoft Teams remote MDT meeting for the first time.

    Embracing digital has been key to our teams plans like so many of your own I am sure; Whatsapp, induction app workspace to name but a few. If anything positive can come out of this catastrophe is that rapid change and innovation can happen in the NHS if we let it.

    March 24, 2020 Reply
  12. Roger Kirby Professor of Urology

    Social distancing for everyone in the UK
    * On Monday, new guidance was issued by the government requiring the public to stay at home at all times apart for in a limited set of circumstances.
    * Avoid contact with anyone displaying symptoms of Covid-19, the key ones being a high temperature and/or a new and continuous cough.
    * Avoid non-essential use of public transport
    * Work from home unless absolutely necessary
    * Only leave the house for exercise once a day
    * Use shops as infrequently as possible and only for basic necessities such as food and medicines
    * Avoid gatherings with your family or outside in groups of more than two people. Keep in touch using the phone, internet and social media
    * Use the phone or online services if you need to contact your GP or other essential services

    March 25, 2020 Reply
  13. Nicola Stingelin Ethicist

    The quote from Dr Gabriel Scally is indeed important and worrying. The horse has sadly already bolted in the current crisis in many respects. Vital is going to be that we do not neglect – starting now – planning what can be done and must be done (lessons learnt plus..) to improve the situation in the next crisis. RSM to take a leading convening role?

    Thanks Tarik for your input.
    Although it is essential that we remain analytical and fact-driven critical regarding what is being done, we need distingish between this important science driven task and supporting and expressing our thanks to all of us engaged in the various front lines is simply doing all we can to help.

    March 25, 2020 Reply
  14. Brian Dye Lawyer

    In a previous post I called for contributions from readers on how in the short term, until ventilator production is ramped up, we can leverage the 4,500 ventilators we have in the NHS (+ any grabbed from the private sector) to help multiples of that number of patients, demanding them in their hour of need. I said that if any of us are dying of CV, we won’t care if ventilators have been thrown together out of old accordions, fire-bellows, lengths of hoover pipe, and snorkel masks, as long as they work.

    This is exactly what they have done in Italy, where the ICU specialists have now actually cobbled together ventilators out of snorkel masks, and where specialist valves have been produced on an emergency basis using 3D printers in the same way as 3D printers are now sometimes used to make surgical models.

    A Canadian ICU consultant has come up with a way to put 9 lines, instead of 1 line, into respirators to try to save 9 lives per machine instead of 1:

    OK, it’s Heath Robinson stuff, and Dyson is hoping to produce 10,000 newly designed units deliverable early April, but that is not enough. Lives are at stake and we need immediate ways to deploy and leverage every respirator we can. I’m posting (a) to call for further ideas and (b) to circulate the above ideas in a single post so that medical people can re-circulate them on social media to help get focus on how we can meet the demand. The alternative of turning patients away, or turning patients off machines to meet fresh demand, because there are not enough ventilators, is the not the way forward, when there are alternatives, easily achievable, such as these.

    Since we have just been told today that they think the NHS can cope – on a national basis – with the demand, I hope it is not thought wrong to believe that we should be planning the way forward on the exact opposite basis.

    So I consider we need tackle the scarcity of respiration by immediate emergency methods. A key point is that R0 of Covid-19 in London is, or probably is, much higher than R0 in most other cities or areas of the UK, because of London’s special size, density, transportation system, location of major airports etc. So we are likely to see is demand for respiration in and around London far exceeding respirator availability at London NHS Trusts. Already in Italy there have started to run medical trains to transport the sick out of overstretched Lombardy to other areas of Italy which have a locally lower R0 than Lombardy and which have not yet been overwhelmed. So, I think, soon we’ll have to plan such trains too. But we have an additional real problem as Roger Kirby points out: we only have a national average of 6.6 acute beds per 100,000 of the population. So I don’t see transportation of the sick from London to other NHS Trusts outside London as a viable solution to the immediate short term problem of lack of ventilator availability that will happen as our cases double repeatedly over the coming days. As I see it, we have urgently to become able to leverage/cannibalise/stretch our existing scarce respiration resources and, as well, to throw together some bandaid type emergency solution measures so as to cope. In New York, when they run out of respirators as are apparently they think they will very shortly, they are even considering tracheostomies though which oxygen can be pumped from small bags pumped by hand as emergency measures!

    We are talking about short term measures about how we cover the gap until the ramp up of ventilator production come through. There is a lot of handwringing going on in the press and on some medical blogs (not at Trends!) but what I would like to hear, if possible, is: what are readers’ ideas for practical, not by any means perfect, just practical, ways to save lives in the short terms if and when we run out of one-to-one ventilators.

    March 26, 2020 Reply
  15. Roger Kirby Professor of Urology

    Bahrain’s response to Coronavirus:

    March 26, 2020 Reply
  16. Brian Dye Lawyer

    Great news. The Guardian reports tonight that NHS planners are exploring whether each of the NHS ventilation machines could be adapted to keep two patients alive, instead of one, “drastically increasing capacity at a stroke”.

    We can be sure that the adaption of the equipment is straighforward because, after some research, I’ve tracked down that the adaption methodology has in fact been described and trialed by Neyman and Babcock as described in their paper “A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge” published in 2006 Journal of Academic Emergency Medicine 05.009 to which I provide a link below:

    Babcock has also published a youtube video showing how simple the adaption is and how it is done:

    Those who read this (exciting) paper and view Babcock’s demonstration will see that, with some straightforward re-routing and additions of fairly standard tubing, up to 4 lines per ventilator can be provided, thus offering a, rapid, efficient, immediate and not technically challenging way of ventilating four patients off one machine. This approach therefore offers the potential of quadrupling of our national ventilator capacity in a matter of few days and, if implemented, offers the chance to stay ahead of the surge in demand for ventilators we are about to experience.

    As Babcock points out, cross contamination isn’t a major issue here, if all the patients on one machine have already tested positive for Covid and don’t have another communicable disease.

    So let’s just re-emphasize the import of this idea: if the idea works, we can, as a short term measure, before new ventilators ordered by the Government arrive, which may takes weeks, immediately, and at almost nil cost, double or quadruple our ventilator capacity, and probably no-one who needs a ventilator will need to be turned away because there are insufficient machines. If correct, it is an immediately implementable and practical way of saving potentially a huge number of lives, and I again invite readers to use their contacts and social media to get the idea through to the people with the power to consider and deploy it. At minimum we should start immediate trials.

    March 26, 2020 Reply
  17. Roger Kirby Professor of Urology

    More thoughts from Professor Ashton:

    March 27, 2020 Reply
  18. Nicola Stingelin Ethicist

    The role of the media in a global health panademic; need for rethinking? I lived for several years in the CSSR under the communist regime in the eighties. I do not take these matters lighty. However, here below a letter I have sent today to Independent Press Standards Organisation and Editors’ Code Committee.

    What do you think?


    “Ground for Complaint: Mail online publication 19:30, 25 March 2020; updated: 19:47, 26 March 2020 “Rapper M.I.A. declares she would ‘choose death’ over getting a coronavirus vaccination“(see annex). (“The Article”) Byline Eve Buckland

    The author considers that the Article is contrary to the Editors’ Code of Practices based on it being contrary to the public interest (that the Code states as including protecting public health or safety). The recently passed UK Coronavirus Act clearly indicates that preventing the spread of a virus in a pandemic is in the public interest. At such time as a vaccine be available, its wide-spread uptake will be essential.
    In the time of a public health emergency such as COVID-19, considerations of acceptable (or even necessary) ‘enforcement and ‘responsibility’ come to the fore.

    Those who are in scant possession of some freedoms (the economically disadvantaged, those with physical and mental vulnerabilities), need particular respect and care. Collective and individual duties take precedence over ‘I’; there is no ‘I’ in ‘global health emergency.’ There is no ‘p’ and ‘f’ for ‘press freedom’ in ‘global health emergency’.

    The vaunted value of our freedoms becomes secondary to concepts such a solidarity. The preservation of future liberties is perversely premised on renouncing freedoms, including fundamental freedoms such that of the press.

    The author opines that the Article also contravenes the Editors’ Code of Practices, Clause 1: significant inaccuracy. There has been a significant amount of attention given in 2020 in the media and scientific literature to the risks to society – particular minors – caused by lowering immunization rates regarding those vaccines that have the level of scientific evidence required before a licence is granted.

    This debate has indicatively led to major media stakeholders such as Facebook stating that they will take action on anti-vaccination groups “spreading misinformation” on their site. Facebook also pledged to reject any adverts it deems to include false information on the topic.

    Main stream online and print media are surely called upon to meet such standards and undertake such action in the time of a global health pandemic, and desist from promulgating statements and positions that are contrary to scientific evidence and add to risks of damaging public health.

    At the very least, Editors should self-regulate to avoid any editorial decisions that could contribute in tone and content to the spread of the pandemic virus.

    Request for Amendment to the Editors’ Code

    Consideration should urgently be given the amendment of the Code so that in times of public health emergencies, the reporting of stories based on scientific inaccuracies when the inaccuracies run counter to the public health, and run counter in fact, spirit or intention to government public health emergency measures, should not be printed by the media – unless accompanied by a statement of fact of equal size and prominence by an expert authority carrying equal media weight.

    Concluding Comments

    Any form of press control is clearly a serious matter, and in no circumstance to be taken lightly. At the very least, a multi-stakeholder and multi-disciplinary discourse is recommended?

    The author is happy to elaborate and substantiate statements made in this letter if requested to do so.”

    March 29, 2020 Reply

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