Introduction

We are two months into the world’s most significant pandemic in decades. In terms of public concern only HIV struck as deep to the heart of the British people in this way. COVID19 is huge and it is getting bigger, the cases increasing exponentially, with a roughly ten fold increase every 8 days. In two weeks we can expect 100,000 clinical cases, in three weeks 1 million without immediate action.

The UK was well aware of the science behind the virus before it arrived on our shores and before it started to rise exponentially two weeks ago. It hasn’t yet done anything significant to clamp down on the spread, certainly by comparison to the response of many other nations. Six weeks ago the Bow Group put out the call for border restrictions, a public health information plan, and to ensure those already at high risk to be reminded of the need for vaccinations against pneumococcus and flu. This proposed roll out prophylaxis, vitamin D supplement and public health information is based on evidence of efficacy in existing practice with the aim of prevention against this deadly disease, and in no way obstructs current government policy.

I have been working in the field of politics and policy development (with a particular focus on health policy) for the past three years, but have been contacted to return to frontline clinical work, likely in emergency care, in the coming days. I am proud to join the fight against COVID19 but naturally am concerned of risks to my own health and that of my NHS colleagues. Concerns have been raised about risks to frontline staff and the lack of personal protective equipment. It is vital we avoid incapacitation of the workforce early on in the fight back. This has prompted me to consider the significance of risk reduction for all but especially frontline NHS staff, and chemoprophylaxis must be considered part of that. These medications and their use are well established and the proposed protocol is in effect shovel ready pending clinical approval.

Dr Jonathan Stanley MBChB MRCS (Medic), Senior Research & Health Policy Fellow, The Bow Group 

Disclaimer

We introduce this proposed strategy bundle only to facilitate professional and political discourse and do NOT propose that the general public obtain or take chloroquine unless directed by a licenced medical professional and without a valid prescription.

This is solely an article for discussion and is not a prescription, nor can it be used as a proxy to a prescription or otherwise as a clinical directive.

Key Facts

• The current mortality rate for declared and closed coronavirus cases is 10%*, with 20% developing severe pneumonia*. These figures have been consistent in China & Italy, which have had long-term exposure. Based on those figures if 80% of the UK population are infected (as the Chief Medical Officer has projected) without comprehensive remedial action 8-10 million people will potentially develop severe pneumonia and 3-4 million people will be at risk of dying. Globally that would translate to 1 billion being at risk of severe pneumonia and 400 million being at risk of death. *(Source,*Source)
• The UK currently has among the lowest number of hospital beds in Europe per citizen with 2.5 per 1000 people, or 167,600 beds*. 4123 beds are intensive care equipped with ventilators, or 6.6 per 100k people. 83% of intensive care beds are currently occupied with 600 available*. The European average is double at 12 intensive care beds per 100k people*.(*Source, *Source)
• Based on current rates of infection the UK will see reported cases rise to 10,000 within a week, and 1 million within a month.*(*Source)
• Chloroquine is an antimalarial drug that is cheap and has been in use for over 50 years.
• Prophylaxis is the use of a drug at a lower dose than for treatment of infection, to prevent that infection developing and to do so while keeping side effects to a minimum.
• Given mounting evidence published on the efficacy of the use of chloroquine derivatives for the treatment of COVID19, and China’s COVID19 protocols published in English by the Japanese Society of Infection Prevention and Control,* we are taking the unprecedented step of publicly calling for the UK government to consider our proposed strategy for the formal mass prophylaxis against Sars-CoV-2, the virus behind COVID19. (*Source) 
• We take this unusual step in the face of rapidly changing government attitude to the pandemic and to ensure a timely and open debate within the medical profession.
• We present a sample protocol for chemoprophylaxis of Coronavirus for discussion of the concept.

Summary

It is likely that all UK hospitals will be completely overwhelmed and will not even be able to offer care to the seriously ill and dying. Some western countries may fare slightly better in terms of beds & ventilators, but all will likely experience overwhelming demand.

Six weeks ago the Bow Group warned the arrival of coronavirus to Britain was inevitable, and urged the government to undertake remedial action in restricting border access and preparing the NHS and the public. Seven days ago the Bow Group called for a rethink on the government strategy on COVID including social measures to protect the most vulnerable including housing the homeless, direct funding of foodbanks and ensuring the supply of domestic utilities. 

Coronavirus will have a major long-term impact on the UK and global economies, causing shortages and unrest. 

All of these elements make this likely to be the worst national crisis Britain has faced since WW2, and the worst domestic crisis we have ever faced. Urgent, extraordinary, and comprehensive action is therefore required.