Month: May 2020

Categories
News

UK Covid-19 Messaging – Episode 2

For the start of our UK “Covid-19 messaging” series please click here.

This is the message Boris Johnson apparently wanted to impart to the citizens of England on May 22nd 2020:

Then came the news that BoJo’s “senior aide” Dominic Cummings had risked spreading the virus by driving from London to Durham. By the morning of May 24th the front pages of the “conservative” mainstream media looked like this, with thanks once again to Neil Henderson‘s Twitter feed:

On the evening of May 24th Boris retweeted a message from 10 Downing Street, then somewhat unusually stood behind the lectern at the Covid-19 daily briefing and refused to throw his top aide to the dogs. Try starting to watch the video at around 4:30:

The following morning I found myself agreeing with a Daily Mail headline for probably the first time in living memory:

Alternative points of view were less critical of Mr. Cummings’ actions:

I wonder how the Times’ promised “cabinet backlash” will pan out? I also cannot help but wonder how many Great British citizens will ignore the messages imparted in any future Tweets by Boris Johnson.

Categories
News

Why are so many English workers dying from Covid-19?

This surprising news from John Burn-Murdoch of the Financial Times greeted me on my Twitter feed this morning:

The article by Janine Aron and John Muellbauer that John linked to points out that:

Excess mortality is a count of deaths from all causes relative to what would normally have been expected. In a pandemic, deaths rise sharply, but causes are often inaccurately recorded. The death count attributed to Covid-19 may thus be significantly undercounted. Excess mortality data overcome two problems in reporting Covid-19-related deaths: miscounting from misdiagnosis or under-reporting of Covid-19-related deaths is avoided. Excess mortality data include ‘collateral damage’ from other health conditions, left untreated if the health system is overwhelmed by Covid-19 cases.

To obtain cross-European comparisons requires data collation from individual national agencies – unless the Z-scores compiled by EuroMOMO for 24 states are used. EuroMOMO’s timely measures of weekly excess mortality in Europe allow comparisons of the mortality patterns between different time periods and countries, and by age groups.

Analysing excess mortality using EuroMOMO Z-scores rather than just deaths attributed to Covid-19 Aron and Muellbauer discovered that:

Most disturbing is the comparative story for the 15-64 age group, where England’s relative record in excess mortality in the Covid-19 era is strikingly higher than in the European countries. The 15-64 age group includes the mass of the working age population. At its peak in week 15, it is 2.8 times worse than the weekly peak in next worst country, Spain, around 4 times worse than France and Belgium, and more than 5 times worse than in Italy. Within the UK, excess deaths for this age group are also strikingly worse for England than for the other nations. Puzzling too, is that Z-scores in the 65-74 age group for England, see Table 2, are similar to the 15-64 age group. By contrast, in the five European countries, excess deaths in the 65-74 age group are about twice as high as for the 15-64 age group, though still below the 65+ age group.

England is the only country in Europe, for which Z-scores for the 15-64 group had not decreased below about 2 by week 18, ending 3 May.

What is the reason for this strange English anomaly? Watch this space!

Categories
Testing

The UK Government’s Covid-19 recovery strategy

Fresh from some very mixed messaging in the United Kingdom’s mainstream media, yesterday the UK Government announced the release of their “Covid-19 recovery strategy”:

This document describes the progress the UK has made to date in tackling the coronavirus (COVID-19) outbreak, and sets out the plans for moving to the next phase of its response to the virus.

The strategy sets out a cautious roadmap to easing existing measures in a safe and measured way, subject to successfully controlling the virus and being able to monitor and react to its spread. The roadmap will be kept constantly under review as the epidemic, and the world’s understanding of it, develops.

The section of the roadmap of most interest to us is 5.6, “Testing and tracing”. There we learn that:

Mass testing and contact tracing are not, in themselves, solutions, but may allow us to relax some social restrictions faster by targeting more precisely the suppression of transmission. The UK now has capacity to carry out over 100,000 tests per day, and the Government has committed to increase capacity to 200,000 tests per day by the end of May.

The Government has appointed Baroness Harding to lead the COVID-19 Test and Trace Taskforce. This programme will ensure that, when someone develops COVID-19-like symptoms, they can rapidly have a test to find out if they have the virus – and people who they’ve had recent close contact with can be alerted and provided with advice. This will:
● identify who is infected more precisely, to reduce the number of people who are self isolating with symptoms but who are not actually infected, and to ensure those who are infected continue to take stringent self-isolation measures; and
● ensure those who have been in recent close contact with an infected person receive rapid advice and, if necessary, self-isolate, quickly breaking the transmission chain.

This cycle of testing and tracing will need to operate quickly for maximum effect, because relative to other diseases (for example SARS) a proportion of COVID-19 sufferers almost certainly become infectious to others before symptoms are displayed; and almost all sufferers are maximally infectious to others as soon as their symptoms begin even if these are initially mild.

For such a system to work, several systems need to be built and successfully integrated. These include:
● widespread swab testing with rapid turn-around time, digitally-enabled to order the test and securely receive the result certification;
● local authority public health services to bring a valuable local dimension to testing, contact tracing and support to people who need to self-isolate;
● automated, app-based contact-tracing through the new NHS COVID-19 app to (anonymously) alert users when they have been in close contact with someone identified as having been infected; and
● online and phone-based contact tracing, staffed by health professionals and call handlers and working closely with local government, both to get additional information from people reporting symptoms about their recent contacts and places they have visited, and to give appropriate advice to those contacts, working alongside the app and the testing system.

All of this begs several questions, from our perspective at least:

  • Why the sole emphasis on “widespread swab testing”? Why not so called “saliva tests” for example?
  • How is the “new NHS COVID-19 app” going to work? Not least because the most vulnerable people in our communities are unlikely to be the proud possessors of a recently released smartphone.
  • How will the “valuable local dimension to testing, contact tracing and support” be integrated with the eventual NHS Covid-19 app?

Watch this space to discover if we ever get answers to these and other questions!

Categories
News

Covid-19 Messaging in the United Kingdom

With apologies to Neil Henderson here is a sequential set of “front page news” headlines from the Great British mainstream media over the past four days:

When the Danse Macabre is over and the inevitable “second wave” of Covid-19 invades “This royal throne of kings, this sceptred isle” who do you suppose will take the blame?

Here is our glorious government’s alleged message du jour:

Plus some creative alternative messages gleaned from Twitter this morning:

[Edit – May 11th]

Here is the Daily Telegraph’s version of Boris Johnson’s speech to the once United Kingdom, pre-recorded then broadcast at 19:00 hours British Summer Time:

The mainstream media’s response this morning, via Helena Wilkinson for a change:

Categories
News

Easing the UK Covid-19 lockdown

The hints are dropping with greater frequency. My Member of Parliament writes to tell me that:

The Prime Minister has said today during Prime Ministers Questions that he will be setting out the next steps that the UK will take this coming Sunday. I await his comments with bated breath – as I am sure many others do.

I certainly have my breath bated! The note continues:

On the subject of tracing and tracking cases, the Health Secretary Matt Hancock said this yesterday:

“We are developing a new test, track and trace programme to help to control the spread of covid-19, and to be able to trace the virus better as it passes from person to person. This will bring together technology through an app, an extensive web of phone-based contract tracing and, of course, the testing needed ​to underpin all that. The roll-out has already started on the Isle of Wight, and I pay tribute to and thank the Islanders for the enthusiasm with which they have taken up the pilot. I hope that we learn a lot from the roll-out, so that we can take those learnings and roll the programme out across the whole country.”

He added that “…the more people who download the app, the more people will protect themselves, their families and their communities.”

Here’s a recording of this evening’s Covid-19 daily briefing in Downing Street, hosted on this occasion by Robert Jenrick, Secretary of State for Housing, Communities and Local Government:

At 49:30 Keith Rossiter, representing the Western Morning News and Cornwall Live, asks some South West specific questions. One of his questions was:

Sir Patrick Vallance suggested on Tuesday that regions with fewer cases of Covid-19 could come out of lockdown early. How would that work and, if it were to be implemented, what support might there be for Devon and Cornwall Police – already over-stretched – to prevent a large scale invasion of the Westcountry?

Robert’s answer?

We’re providing additional funding to forces and the Home Secretary is speaking with national police chiefs to ensure they have the right guidance and consistent messaging they can use to enforce the lockdown rules when that’s required. As we’ve seen so far the vast majority of members of the public have chosen to do so and adhere to the messaging and most police forces have been able to support the lockdown measures through consent which is the way we want to do things in this country but in the isolated number of cases when this has not been possible they’ve had tools at their disposal to fine and enforce the lockdown.

So no confirmation that easing of the UK lockdown will start in South West England, but no denial either. Whilst we wait for Sunday’s announcement, here’s what Sir Patrick Vallance had to say yesterday. According to Cornwall Live:

England’s chief scientific adviser has hinted that rural regions, such as the Westcountry, might have their Covid-19 lockdown eased sooner than big cities.

Sir Patrick Vallance told MPs on the Health and Social Care Committee that the disease was more prevalent in cities and densely populated places than in rural areas.

But he acknowledged that a regional approach would require the flow of people between regions to be controlled.

Last month former health secretary Jeremy Hunt, who is now chair of the Health and Social Care Select Committee, named Cornwall as an area that could have its restrictions lifted before the rest of the UK.

[Edit – May 7th]

Does this retweet tell this morning’s horror story adequately?

Watch this space!

Categories
Testing

Mass Periodic Testing for Covid-19

We have reported recently on both the United Kingdom’s attempts to meet their stated “100,000 tests per day by the end of April” target and the subsequent setting up of the “Independent SAGE” committee by Sir David King, which we initially dubbed the “Alternative SAGE” committee, or “Alt SAGE” for short.

The first Independent SAGE committee meeting will be broadcast on YouTube at 12:00 BST today. We cannot help but wonder if they will discuss the concept of “Mass Periodic Testing”, or MPT for short.

The idea was introduced by Professor Julian Peto from the London School of Hygiene and Tropical Medicine in a letter to the British Medical Journal on March 22nd 2020. Here is an extract:

In Editor’s Choice of 19 March Godlee mentions the urgent need for increased capacity to test frontline healthcare workers serologically to verify their immunity to the covid-19 virus. Even more urgent is capacity for weekly viral detection in the whole UK population. This, together with intensive contact tracing, could enable the country to resume normal life immediately. The virus could only survive in those who are untested, and contact tracing would often lead to them. Within the tested population anyone infected would be detected within about a week (0 to 7 days plus sample transport and testing) of becoming infectious.

Prof. Peto’s suggestion involves testing the vast majority if the population of the UK for Covid-19 every week. His letter continues:

Centrally organised facilities with the capacity to test the entire UK population weekly (in 6 days at 10 million tests per day) can be made available much more quickly and cheaply than a vaccine, probably within weeks. This heroic but straightforward national effort would involve a crash programme to enlist all existing PCR (polymerase chain reaction) facilities, acquire or manufacture the PCR reagents, and agree protocols including a laptop program for barcode reading in smaller laboratories. The US Food and Drug Administration (FDA) has just authorised a test kit for detecting the Covid-19 virus that can be run on machines used in the NHS for HPV screening. Only laboratories that do PCR routinely would participate, subject to central quality control and at cost price. The Wellcome Sanger Institute, UK Biocentre, and smaller academic laboratories, together with all commercial facilities, should have enough machines or can get more immediately from the manufacturers. The 24-hour extra staffing to run their machines continuously would be bioscience students, graduates, and postgraduates familiar with PCR who already work in or near the laboratory. Processing capacity equivalent to 4000 Roche COBAS 8800 systems is needed, and the UK may already have both the machines and the trained staff in post or immediately available.

Roche cobas 8800 PCR testing system

As you may have noticed, such a “heroic effort” has not yet begun. We have not yet achieved a consistent 100,000 tests per day, let alone the 10 million tests per day envisaged by Julian Peto. Skipping to his conclusion:

By the time the first test is done there may be more than a million infected people who must be treated or remain quarantined at home or in care until all residents at the address test negative. That unavoidable crisis for the NHS would be ameliorated by earlier diagnosis and treatment, and hence reduced pressure on intensive care, and by having all staff as well as patients tested regularly. Contacts of positive people who test negative could choose continued home quarantine or, at little extra risk, choose to join a group of up to 10 test-negative contacts (usually with other family members). Subsequent weekly national testing, together with behavioural changes and efficient contact tracing, would find progressively fewer infections and might soon be extended to a month. This emergency system would only be needed for about 2 months but could be rapidly reintroduced to control any future epidemic caused by a new virus.


Five weeks have elapsed since the letter was published, and an avoidable crisis for the NHS is still ongoing. According to Boris Johnson’s Twitter feed over the weekend:

However according to today’s Daily Telegraph:

When today’s lunch time meeting has concluded will the Alt SAGE committee have recommended an “end [to] the absurd, dystopian and tyrannical lockdown”, mass periodic testing or some alternative “middle way”?

Watch this space!

Categories
News

Sir David King convenes Alt SAGE Covid-19 committee

Idly perusing the online version of The Sunday Times in anticipation of more BoJo bashing I instead stumbled across some discreet Dom bashing from an illustrious source. According to an article by Caroline Wheeler, Deputy Political Editor of the Sunday Times:

The government’s former chief scientific adviser is convening a rival panel of experts to offer advice on easing the lockdown.

Tomorrow Sir David King will chair the first meeting of the group, which is designed to act as an independent alternative to the government’s Scientific Advisory Group for Emergencies (SAGE).

The move comes after weeks of unease about the transparency of SAGE decision-making. It has emerged that 16 of the 23 known members of the committee, which meets in secret, are employed by the government.

The independent group will broadcast live on YouTube and take evidence from global experts. It aims to present the government with “robust, unbiased advice” and some evidence-based policies to tackle the Covid-19 pandemic.

The committee will formally submit its recommendations to the health and social care select committee, heaping pressure on Boris Johnson as he draws up the government’s lockdown exit strategy.

The whole idea sounds crazy, until you consider how the official Covid-19 daily briefings are already spinning like crazy!

Sir David also has his very own Twitter feed, via which he announced:

Getting back to Caroline, she added:

Speaking before tomorrow’s meeting, which will be followed by a news conference, King said: “Science is fundamentally a system based on peer review. When it comes to scientific advice of any kind, transparency is essential.”

He added: “I am not at all critical of the scientists who are putting advice before the government . . . but because there is no transparency the government can say they are following scientific advice but we don’t know that they are.”

Dominic Cummings, a top aide to the prime minister, has attended the secret meetings of SAGE.

“Cummings is an adviser to the prime minister. And the chief scientific adviser is an adviser to the prime minister. So there are two voices from the scientific advisory group and I think that’s very dangerous because only one of the two understands the science,” King said.

The committee has a draft agenda and is seeking to end the pandemic “with the fewest casualties possible”.

Currently the YouTube URL at which tomorrow’s Alt SAGE meeting will be broadcast has not been revealed, so…..

[Edit – May 12th]

The Independent SAGE committee have just published their recommendations. We “retweeted” them forthwith!

To summarise the committee’s recommendations to Her Majesty’s Government concerning “Transitioning from lockdowns and closures”:

Four key components to managing transitions and modulating restrictive measures

  1. Public health and epidemiological considerations must drive the decision-making process.
  2. Available capacity for dual-track health system management to reinstate regular health services, while at the same time continuing to address COVID-19.
  3. Leveraging social and behavioural perspectives as tools for responsive engagement with populations.
  4. Social and economic support to mitigate the devastating effects of COVID-19 on individuals, families and communities.

Six conditions should be used as the basis to implement/adapt transitioning of measures

  1. Evidence shows that COVID-19 transmission is controlled.
  2. Sufficient public health and health system capacities are in place to identify, isolate, test and treat all cases, and to trace and quarantine contacts.
  3. Outbreak risks are minimized in high vulnerability settings, such as long-term care facilities (i.e. nursing homes, rehabilitative and mental health centres) and congregate settings.
  4. Preventive measures are established in workplaces, with physical distancing, handwashing facilities and respiratory etiquette in place, and potentially thermal monitoring.
  5. Manage the risk of exporting and importing cases from communities with high-risks of transmission.
  6. Communities have a voice, are informed, engaged and participatory in the transition.

Four cross-cutting mechanisms that are essential enablers throughout the transition process

  1. Governance of health systems.
  2. Data analytics to inform decisions.
  3. Digital technologies to support public health measures.
  4. Responsive communication with populations.

We “tweeted” a question to the powers that be:

We haven’t received an answer as yet.

Watch this space!