Clinical Indications based on Clinical Evidence

We have been asked what our recommendations are within our organisation.

Firstly, we always recommend that every individual affiliated or associated with our organisation follows the local laws, rules, policies and recommendations. It is important to be aware of the National Health Plan, local laws, cultures and customs, and to consistently comply with regulations. It is also important to be curious and ask questions, respectfully, to gain a better understanding about risks and benefits, strengths and weaknesses, and to consider the clinical evidence, and it is appropriate to share concerns.

Secondly, when national and local laws allow, these are our recommendations, based on clinical evidence, good medical practice (General Medical Council) and appropriate legislation to safeguard adults and children such as the Mental Health Act, the Childrens Act and the Human Rights Act.

Clinical Indications based on Clinical Evidence:

Many doctors agree that good medical or clinical practice and medico-legal consideration dictate that – 

A. For individuals without symptoms or a raised temperature – 

1. the WHO and ECDC guidelines have to be followed regarding masks (no indiscriminate mandatory mask wearing indoors or outdoors)

2. curfews, lockdown and travel related quarantine (or mandatory self-isolation) must be discontinued

3. travel, businesses, art and music performances must resume and public spaces such as beaches must be opened 

B. For individuals with vaccines – the above applies.  

C. Individuals with symptoms, an elevated temperature or recent exposure to a confirmed case should be asked to engage in PCR tests and protocols such as quarantine or stay at home become relevant, clinically indicated and evidence-based in these contexts.  PCR tests cannot be mandatory for healthy individuals. 

D. For individuals at high risk for severe COVID-19 different recommendations are required for instance self-isolation or ‘stay at home’ where possible is relevant, however, protective factors must be included in recommendations.  Capacity and competency must be considered, as per good medical practice and medico-legal guidelines.  

E. Evidence-based initiatives such as washing hands before touching the face or eating, not sharing food or drinks, social distancing, covering mouth and nose when coughing or sneezing, and remaining at home if symptoms, contacting medical professionals without delay, remain relevant for all individuals in all contexts. 

It is important that the general public is educated regarding evidence-based protective factors and risk factors in the context of respiratory infections. Please see previous comments relating to protective factors, normalcy, liberty, autonomy, the immune system, general health and mental health.

Comments such as “you can make people sick if you have no symptoms” and “but we don’t know who are high risk”, which many “doctors reported from the start make little clinical sense, because it is relevant for many infectious diseases and usually a small part of the population” cannot lead to 80-95% of the population being exposed to high risk (up to 400-500%) and harm without clinical evidence that benefits outweigh risks.  This is especially relevant for children.  

If individuals are concerned that they might be high risk, they should seek immediate medical advice or remain at home as much as they can, self-imposed self-isolation is associated with a very different risk profile compared to mandatory indiscriminate self-isolation.  

The determining factor in every clinical decision is – is this decision right for this patient weighing specific potential risks and potential benefits for this patient in this context at this time.