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!

Categories
Testing

Covid-19 testing in the UK

On April 2nd 2020 (not the first!) the UK Government’s web site published a press release stating that:

The UK will carry out 100,000 tests for coronavirus every day by the end of this month, Health Secretary Matt Hancock pledged today.

Increased testing for the NHS will form part of a new 5-pillar plan, bringing together government, industry, academia, the NHS and many others, to dramatically increase the number of tests being carried out each day.

Professor John Newton the Director of Health Improvement for Public Health England, has been appointed to help deliver the new plans and bring together industry, universities, NHS and government behind the ambitious testing targets.

So how is Matt’s pledge and John’s delivery plan looking at the end of April? According to the Department of Health and Social Care‘s latest daily update:

As of 9am 30 April, there have been 901,905 tests, with 81,611 tests on 29 April.

Not quite there yet then, though there is still one more April update to come! Much more recently another Government press release on April 28th announced that:

Anyone in England with symptoms of coronavirus who has to leave home to go to work, and all symptomatic members of the public aged 65 and over, will now be able to get tested, the government has announced today.

This will mean people who cannot work from home and those aged 65 and over can know for sure whether they have coronavirus and need to continue isolating.

Members of their households with symptoms – a new continuous cough or high temperature – will also be eligible for testing.

Anyone eligible can book a test using an online portal.

The government also announced that NHS staff, care home staff and care home residents will be eligible for testing whether or not they have symptoms.

How’s that coming along do you suppose? I’m over 65 and I’d very much like to know for sure whether I have had coronavirus. I even have some of the symptoms! However there is evidently a problem. The Government’s online testing portal told a familiar tale yesterday evening:

Today I discovered via Twitter that somebody else managed to get further through the process than I did, only to discover:

I myself am also forced to wonder why on Earth a United States credit checking agency such as TransUnion should be involved in the process of obtaining a long overdue test for a UK citizen suffering from the symptoms of Covid-19?

Answers on a virtual postcard in the space provided for that purpose below! Should I receive an answer to that question I’ll pose another one:

What does the UK Government make of this proposal in the British Medical Journal for “Mass periodic testing” of the citizens of this sceptred isle?

At the end of (say) 3 weeks of lock-down all households and care homes would return self-taken swabs taken on that date from all residents. All residents would test negative in most homes, so most people could resume normal life within a month of starting the lock-down.

Meanwhile on the NHS front line:

[Edit – May 1st]

Here is the BBC’s video of this evening’s Covid-19 daily briefing from Downing Street, hosted by Matt Hancock:

Fast forward to 36:40 where Channel 4’s Victoria Macdonald asks:.

There was a report in the HSJ that a sample would only be counted once it had been processed, but that testing has been changed and it’s counted once it’s been posted out. Is that the case?

Matt swiftly passed that buck to Professor John Newton, and it’s not until 38:40 that Victoria receives an answer:

There’s been no change to the way that tests are counted. As we’ve developed new ways of delivering tests we’ve taken advice from officials as to how this should be counted.

So, the tests that are within the control of the programme, which is the great majority, are counted when the tests are undertaken in our laboratories. But any test which goes outside the control of the programme, they’re counted when they leave the programme, so that is the tests that are mailed out to people at home and the tests which go out in the satellite. So that is the way they are counted, have always been counted, and the way we were advised to count them by officials.

So that’s the way they are counted, have always been counted, and the way we were advised to count them by officials.

According to Matt Hancock:

That’s all set out on gov.uk

Whilst according to the BBC:

The total testing figure includes 27,497 kits which were delivered to people’s homes and also 12,872 tests that were sent out to centres such as hospitals and NHS sites. However, these may not have been actually used or sent back to a lab.

According to my hasty mental arithmetic:

122,347 – 27,497 – 12,872 = 81,978

Those mysterious “official” bean counters have a lot to answer for!

[Edit – May 8th]

The UK Government’s Covid-19 “contact tracing” smartphone app created by NHSX is now available to residents of the Isle of Wight as part of an initial trial. Here’s an initial review of the app:

Isi’s Dad’s thoughts? Here’s a brief summary:

The app is named NHS COVID-19, and is described by the NHS as “an automated system for rapid symptom reporting, ordering of swab tests, and sending targeted alerts to app users”. It’s one of three parts of the trial which has just started here, the other two being:

  • “web-based Contact Tracing and Advisory Service (CTAS) and increased capacity to provide tailored alerts to all contacts by phone.”
  • “widespread availability of rapid swab testing kits to make sure confirmed cases remain in isolation, and support rapid detection and isolation of higher-risk contacts.”

This is quite different from what has been generally reported: the NHS sees the app primarily for rapid symptom reporting and the ordering of swab test kits.

Installing and configuring the app is simple, provided that you have an iPhone running iOS 11 or later, or a compatible Android phone, about which I will say no more…

Early indications here are that this app protects the user’s privacy, doesn’t track users at all, doesn’t flatten batteries, and is unobtrusive to the point where you can’t even tell whether it is detecting contacts. It doesn’t appear to be the contact tracing app which was expected, though: it’s not ‘track and trace’ so much as ‘diagnose and test’, and may explain where Boris Johnson intends sending his promised 200,000 test kits a day.

Categories
News

Covid-19 in the UK in May 2020

We’re starting this thread a couple of days early, because here in the United Kingdom a variety of things have changed regarding the reporting of Covid-19 “statistics”.

First of all the daily reports from the Department of Health and Social Care: now include “all deaths where a positive test for COVID-19 has been confirmed”, not just those “in hospital”. As the explanation on the DHSC web site puts it:

From 29 April 2020, DHSC are publishing as their daily announced figures on deaths from COVID-19 for the UK a new series that uses improved data for England produced by Public Health England (PHE). These figures provide a count of all deaths where a positive test for COVID-19 has been confirmed, wherever that death has taken place. Figures for Scotland, Wales and Northern Ireland have already begun to include deaths outside hospitals, so this change will ensure that the UK-wide series has a shared and common definitional coverage. This updated statement explains what the new data are and how they differ from both the data series previously published by DHSC and the figures produced by the ONS.

Separately, to improve the timely availability of data on deaths in care homes involving COVID-19, the ONS and the Care Quality Commission (CQC) agreed to publish from 28 April 2020 provisional counts of deaths in care homes, based on statutory notifications by care home providers to CQC. A separate explanatory statement about these new data has been published jointly by the ONS and CQC.

In addition to that change there is now a new section of the UK Government web site devoted to “National COVID-19 surveillance reports“. The most recent report at the moment:

Summarises the information from the surveillance systems which are used to monitor the Coronavirus Disease 2019 (COVID-19) pandemic in England.

The report is based on week 16 (data between 13 April and 19 April 2020) and where available daily data up to 22 April 2020.

COVID-19 is the disease name and SARS-CoV-2 is the virus name.

The report includes sections devoted to UK “Community surveillance”, “Primary care surveillance”, “Secondary care surveillance”, “Virological surveillance” and “Mortality surveillance”. In the latter section it points out that:

In week 16 2020 in England, statistically significant excess mortality by week of death above the upper 2 z-score threshold was seen overall, by age group in the 15-64 and 65+ year olds and sub nationally (all ages) in all regions (North East, North West, Yorkshire & Humber, East & West Midlands, East of England, London and South East & West regions) after correcting GRO disaggregate data for reporting delay with the standardised EuroMOMO algorithm (Figure 18). This data is provisional due to the time delay in registration; numbers may vary from week to week.

The recent “spike” appears to be statistically significant! However despite that, this report and the rest of the virtual paperwork emanating from the UK Government still fail to address the question we posed last week:

How will the UK Government build on the amazing community solidarity we have seen in the past few weeks and reassure the citizens of the nation that lifting the lockdown won’t result in further out-of-control outbreaks?

Whilst we continue to wait for an answer, here are the new “positive test” daily death numbers from the DHSC:

They do of course beg the question of how many “untested” deaths due to Covid-19 are occurring. Regular readers will be aware that we have been following the modelled future death projections of James Annan. Here’s his first update using the DHSC’s new numbers:

[Edit – May 5th]

The Office for National Statistics have released their latest weekly “death certificate” data. Here are the “main points” from their report:

  • The provisional number of deaths registered in England and Wales in the week ending 24 April 2020 (Week 17) was 21,997, a decrease of 354 deaths registered compared with the previous week (Week 16); this is the first decrease in the number of deaths since the week ending 20 March 2020 (Week 12) but is 11,539 more than the five-year average for Week 17.
  • Of the deaths registered in Week 17, 8,237 mentioned “novel coronavirus (COVID-19)”, which is 37.4% of all deaths; this is a decrease of 521 deaths compared with Week 16 (39.2% of all deaths).
  • The number of deaths in care homes (from all causes) for Week 17 was 7,911, which is 595 higher than Week 16. The number of deaths in hospitals for Week 17 was 8,243, which is 1,191 lower than Week 16.
  • In London, over half (50.5%) of deaths registered in Week 17 involved COVID-19; the North West and North East also had a high proportion of COVID-19 deaths, accounting for 38.8% and 38.0%, respectively, of deaths registered in these regions.
  • In Wales, there were 413 deaths registered in Week 17 involving COVID-19, accounting for 36.7% of all deaths registered in Wales.
  • Of deaths involving COVID-19 registered up to Week 17, 71.8% (19,643 deaths) occurred in hospital with the remainder mainly occurring in care homes (5,890 deaths), private homes (1,306 deaths) and hospices (301 deaths).

Here are those numbers in graphic detail:

[Edit – May 12th]

The latest weekly Covid-19 update has been issued by the Office for National Statistics. Here’s the summary on Twitter:

33,337 / 21,647 = 1.54

[Edit – May 19th]

The latest weekly update from the ONS has been published:

Plus some additional detail:

Deaths in care homes made up 36.0% of all deaths in Week 17, 35.7% in Week 18 and 33.6% in Week 19 (Figure 7). Between Week 18 and Week 19, the number of deaths in care homes decreased by 33.7% to 4,248. However, the proportion of care home deaths that involved COVID-19 continued to increase, and 39.2% of all deaths in care homes involved COVID-19 in Week 19.

Watch this space!

Categories
News

Matt Hancock’s “scientifically valid” answers

Yesterday evening Matt Hancock was behind the lectern for the latest of Her Majesty’s Government’s Covid-19 “daily briefings”. Here’s a recording of the whole show:

There follows our edited highlights. First of all note that at around 5:00 into the video Matt says:

Building on successful pilots, we’ll be rolling out testing of asymptomatic residents and staff in care homes in England and to patients and staff in the NHS. This will mean that anyone who is working or living in a care home will be able to get access to a test whether they have symptoms or not. I’m determined to do everything I can to protect the most vulnerable and we now have the capacity to go further still. So from now, we’re making testing available to all over 65s and their households with symptoms and to all workers who would have to leave home in order to go to work and members of their households, again, who have symptoms. So from construction workers to emergency plumbers, from research scientists to those in manufacturing. The expansion of access to testing will protect the most vulnerable and help keep people safe and it’s possible because we’ve expanded capacity for testing thus far.

However he doesn’t go so far as to commit to a time scale for that “roll out”! Allegedly front line NHS staff are having problems getting tested, so when will the necessary extra testing capacity for OAPs and care workers be rolled out? Matt didn’t say.

We have previously mentioned the New Scientist’s coverage of the coronavirus crisis, and their chief reporter Adam Vaughan asked the final question of the evening at ~56:15:

Hi, you said you were recruiting 18,000 contact tracers. I wanted to ask, how many do you have today, what date will you hit 18,000 and how important are those tracers as a strategy for controlling the virus after the lockdown? And secondly, we heard today that the NHS contact tracing out where will be ready within three weeks. What’s your goal for the number of people you want to download it and how will you incentivise them to do so?

After a brief(ish) hesitation Matt answered as follows:

I knew we’d get some tough questions from the New Scientist! The answer to your questions are as soon as possible and as many as possible. But I know that’s not exactly a numerical answer. We’re recruiting the contact tracers. I’m sorry I don’t have the information to hand as to exactly how many we’ve recruited, but that is underway. We hope to have the contact tracers who will help when we find a positive test to work out who they’ve been in contact with and make sure they do the appropriate thing. We hope to have the contact tracers in place before or at the same as the app goes live and you’re right on the app.

We’re expecting that to be ready by the middle of May and both of these things together, because they work together along with the testing and they’ll help us to keep the level of new cases down once we’ve used social distancing measures to get those new cases down. That’s the best thing for health and it’s the best thing for the economy. It’s a work in progress. I appreciate that, other than saying the middle of May, I haven’t given you numerical details. I don’t have the data to hand, but I’ll try to find that for you. And then on the how many people, the more people who download the app and keep their Bluetooth on, the more effective the app is going to be.

So there is no answer other than as many as possible because if everybody downloads it will just be more effective at spotting who people have been in contact with through contact tracing and helping alongside the human contact tracing for people to be able to keep the R down by catching those who they may have transmitted the disease to. It’s also of course tied with the rules around isolation because if you are … What really also matters is if you’ve been in substantial contact with somebody who’s tested positive, making sure we get the right rules around what that person is then required and asked to do is also a critical part of this, this infrastructure that we’re building.

It seems Adam wasn’t entirely happy with that answer, so he asked a supplementary question:

From what you’ve just said, you said that the human contact traces and the app will work in tandem, and you’re saying if the app is coming in three weeks, does that mean the target for the 18,000 is in three weeks?

Mr. Hancock retorted, quick as a flash:

Before or at the same time as the app. Yeah.

Okay. Good stuff. Thank you very much indeed. Great to have the New Scientist at the Downing Street briefing and I hope my answer was scientifically valid. Thank you very much for joining us and no doubt see you again soon.

I paraphrase the Health Minister’s words only slightly:

“I know that’s not exactly a numerical or a scientific set of answers.”

Categories
News

Boris Johnson returns to work

Last night an article by Gordon Rayner in the online edition of the Daily Telegraph assured us that:

Boris Johnson is expected to announce plans for easing the lockdown as early as this week after he returned to Downing Street on Sunday night to take full-time control of the coronavirus crisis.

The Prime Minister will on Monday morning chair his first meeting of the Covid-19 “war cabinet” since he was taken to hospital more than three weeks ago, and is ready to resume his role hosting televised Number 10 press conferences.

I took a dim view of that suggestion on Twitter:

This morning the Prime Minister had returned to Downing Street from his country residence and gave this speech to the nation:

According to The Daily Telegraph’s Twitter feed this morning:

However according to The Independent’s Twitter feed:

Meanwhile according to The Times’ Twitter feed this morning:

Here are some of the Prime Minister’s actual words, transcribed from the recording above:

It follows that this is the moment of opportunity, this is the moment when we can press home our advantage. It is also the moment of maximum risk because I know that there will be many people looking now at our apparent success and beginning to wonder whether now is the time to go easy on those social distancing measures.

I know how hard and how stressful it has been to give up even temporarily those ancient and basic freedoms, not seeing friends, not seeing loved ones, working from home, managing the kids, worrying about your job and your firm.

So let me say directly also to British business, to the shopkeepers, to the entrepreneurs, to the hospitality sector, to everyone on whom our economy depends: I understand your impatience, I share your anxiety. And I know that without our private sector, without the drive and commitment of the wealth creators of this country, there will be no economy to speak of, there will be no cash to pay for our public services, no way of funding our NHS.

And yes I can see the long term consequences of lock down as clearly as anyone. And so yes I entirely share your urgency. It’s the government’s urgency. And yet we must also recognise the risk of a second spike, the risk of losing control of that virus and letting the reproduction rate go back over one, because that would mean not only a new wave of death and disease but also an economic disaster and we would be forced once again to slam on the brakes across the whole country and the whole economy and reimpose restrictions in such a way as to do more and lasting damage.

And so I know it is tough and I want to get this economy moving as fast as I can. But I refuse to throw away all the effort and the sacrifice of the British people and to risk a second major outbreak and huge loss of life and the overwhelming of the NHS. And I ask you to contain your impatience because I believe we are coming now to the end of the first phase of this conflict.

And in spite of all the suffering, we have so nearly succeeded. We defied so many predictions. We did not run out of ventilators or ICU beds. We did not allow our NHS to collapse. And on the contrary we have so far collectively shielded our NHS so that our incredible doctors and nurses and healthcare staff have been able to shield all of us from an outbreak that would have been far worse. And we collectively flattened the peak.

And so when we are sure that this first phase is over and that we are meeting our five tests – deaths falling, NHS protected, rate of infection down, really sorting out the challenges of testing and PPE, avoiding a second peak – then that will be the time to move on to the second phase in which we continue to suppress the disease and keep the reproduction rate, the R rate, down, but begin gradually to refine the economic and social restrictions and one by one to fire up the engines of this vast UK economy.

And in that process difficult judgements will be made and we simply cannot spell out now how fast or slow or even when those changes will be made though clearly the government will be saying much more about this in the coming days.

And I want to serve notice now that these decisions will be taken with the maximum possible transparency. And I want to share all our working and our thinking, my thinking, with you the British people. And of course, we will be relying as ever on the science to inform us, as we have from the beginning, but we will also be reaching out to build the biggest possible consensus, across business, across industry, across all parts of our United Kingdom, across party lines, bringing in opposition parties as far as we possibly can, because I think that is no less than what the British people would expect.

Which version of this Covid-19 “story” do you prefer to believe?

Categories
News

Wear homemade masks when you venture outdoors

The Guardian repeats today what we have been saying for quite some time:

The public should wear homemade masks when they venture outdoors to help reduce the spread of coronavirus, according to scientists who claim Britain’s masks policy does too little to prevent infections.

Prof Sian Griffiths, who led the Hong Kong government’s investigation into the 2003 Sars epidemic, said Britain should adopt the same approach as the US, where people are advised to make their own “cloth face coverings” and wear them in public spaces.

Trish Greenhalgh, a professor of primary care health sciences at Oxford University who recently completed a review on face masks, also advocated the use of masks in public and suggested an old T-shirt combined with kitchen paper would suffice.

The Guardian has some suggestions on how to make your own face mask, as indeed do we. Take a look here.

However some would have you believe that wearing a face mask is not such a great idea. The New Scientist for example. According to Jessica Hamzelou in a possibly paywalled article:

As cases of covid-19 continue to rise, many people are choosing to wear a face mask when out in public – but do they work?

Some have also been using cloth face coverings, but these aren’t up to the job, says Raina MacIntyre at the University of New South Wales in Sydney.

In 2015, MacIntyre and her colleagues ran a clinical trial pitting cloth masks against medical ones. The team provided 1607 healthcare workers at 14 hospitals in Hanoi, Vietnam, with either disposable medical masks or reusable cloth ones, which could be washed at home at the end of the day they were worn. Those that wore cloth masks were significantly more likely to catch a virus, the team found.

It seems that I need to point out to Jessica that just because an academic study finds that DIY masks aren’t as effective as pukka medical masks that doesn’t mean that they are useless. She continues:

But what about the rest of us? In an attempt to answer this question, Paul Hunter at the University of East Anglia, UK, and his colleagues looked at 31 published studies on the efficacy of face masks.

Overall, the evidence suggests there may be a small benefit to wearing some kind of face covering. They do seem to prevent sick people from spreading the virus, but the evidence is weak and inconsistent, says Hunter.

“Our view is that there was some evidence of a degree of protection, but it wasn’t great,” he says. “So we still don’t effectively know if face masks in the community work.”

It seems masks “prevent sick people from spreading the virus”. You can spread the SARS-CoV-2 virus before you show any symptoms, so wear a mask to prevent other people possibly catching your bugs!

Scientists say so, and somewhat grudgingly so does the New Scientist. In the current climate I wouldn’t go out in a public place without one:

Categories
News

The Green Party’s Community Shield

This morning the Green Party announced their vision of a novel coronavirus “Community shield” via a press release on the web site of Caroline Lucas:

I have called on the Government to adopt the advice of the World Health Organisation on community-based testing and contact-tracing to prevent the further spread of Covid-19 and as a precondition for any relaxation of the lockdown. 

The First Minister of State, Dominic Raab, has set out five conditions for the lifting of the lockdown but they do not include the clear WHO advice that health systems must have the capacity to “detect, test, isolate and treat every case and trace every contact”.

A Green Party report, published on Tuesday and put together by the party’s health team with input from other experts, makes the case that we will prevent further Covid-19 outbreaks and new lockdowns only if there is a network of community-based protection schemes, or “community shields”, which can respond quickly to any re-emergence of Covid-19 once the current lockdown is lifted. 

These “shields”, co-ordinated by Public Health England’s regional Outbreak Management Teams, would be created by bringing together and building on existing systems including the NHS 111 phone service, GP surgeries and local authority public health teams to identify those with symptoms, arrange for their testing and then, crucially, trace all their contacts in order to stamp out outbreaks of the virus in the communities where it’s happening. 

It seems as though the Green Party have been considering an idea we have been putting considerable thought into over recent weeks as well! It further seems as though the concept will be brought before the UK’s “virtual” parliament this afternoon:

If attempts to lift the lockdown are made before this infrastructure is in place, we’re likely to see a repeating cycle of national lockdowns as surges of new cases of the virus occur. 

I plan to table an Early Day Motion on Tuesday when Parliament re-opens calling for community-based protection schemes to be put in place.

It will be very interesting to see if the issue does get debated, and whether anything changes as a result! As Caroline Lucas puts it:

The Government record on testing in this crisis has been poor, with a change in strategy which squandered vital time, and mixed signals coming from ministers and scientific advisers who have even suggested that WHO advice doesn’t somehow apply to Britain. It would be criminally negligent if it compounded this error by failing to listen to the WHO’s advice on the criteria which need to be in place before lifting the lockdown.  It is profoundly worrying that the “Five Conditions for Exit” announced by First Minister Dominic Raab last week made no mention of this advice.

A community shield approach wouldn’t only help trace outbreaks of the virus where they occur and allow a swift response, it would also provide support to Covid-19 patients by monitoring their condition by phone and app, leaving them safely at home but not isolated.  This would give people the reassurance they need to exit lockdown with confidence when the time is right.

Preparations need to be made now to allow these “shields” to be in place for the ending of lockdown once the upward curve of infections has been brought down.  The system could be activated immediately in communities where the infection rate is low, and rolled out more widely as the number of cases declines.

People need the reassurance that lifting the lockdown won’t result in further out-of-control outbreaks and this would help give it to them – and build on the amazing community solidarity we have seen in the past few weeks.

The full report is available on this link – Building a Community Shield to Suppress the Coronavirus April 2020.pdf

How will the UK Government “build on the amazing community solidarity we have seen in the past few weeks” and reassure the citizens of the nation “that lifting the lockdown won’t result in further out-of-control outbreaks”?

Watch this space!

Categories
News

How Britain sleepwalked into disaster

It’s not often that I praise the reporting in the assorted organs of News UK. Usually quite the reverse! However this morning I commend to you this frankly shocking article by the Sunday Times Insight team, including on this occasion Jonathan Calvert, George Arbuthnott and Jonathan Leake:

Coronavirus: 38 days when Britain sleepwalked into disaster

I strongly suggest that you read the article from start to finish, always assuming that you have a strong enough stomach. Here are a few brief extracts:

On the third Friday of January a silent and stealthy killer was creeping across the world. Passing from person to person and borne on ships and planes, the coronavirus was already leaving a trail of bodies.

The virus had spread from China to six countries and was almost certainly in many others. Sensing the coming danger, the British government briefly went into wartime mode that day, holding a meeting of Cobra, its national crisis committee.

But it took just an hour that January 24 lunchtime to brush aside the coronavirus threat. Matt Hancock, the health secretary, bounced out of Whitehall after chairing the meeting and breezily told reporters the risk to the UK public was “low”.

This was despite the publication that day of an alarming study by Chinese doctors in the medical journal The Lancet. It assessed the lethal potential of the virus, for the first time suggesting it was comparable to the 1918 Spanish flu pandemic, which killed up to 50 million people.

Unusually, Boris Johnson had been absent from Cobra. The committee — which includes ministers, intelligence chiefs and military generals — gathers at moments of great peril such as terrorist attacks, natural disasters and other threats to the nation and is normally chaired by the prime minister.

Johnson had found time that day, however, to join in a lunar-new-year dragon eyes ritual as part of Downing Street’s reception for the Chinese community, led by the country’s ambassador.

It was a big day for Johnson and there was a triumphal mood in Downing Street because the withdrawal treaty from the European Union was being signed in the late afternoon. It could have been the defining moment of his premiership — but that was before the world changed.

Over on the “Consequences” section of the Arctic Sea Ice Forum we have been discussing the “Chinese coronavirus” since January 25th, and before that in other threads on the forum. By way of just one example:

Judging by footage from a hospital in Wuhan, it is a serious problem over there.

An epidemic would also overwhelm healthcare here in Sweden. Which patients would be given the few available respirator beds when there are too many very sick people?

Since he obviously didn’t heed that early warning signal I can only assume that BoJo isn’t too concerned about an Arctic sea ice tipping point either?

The Insight team continue:

Sure enough, five days later, on Wednesday January 29, the first coronavirus cases on British soil were found when two Chinese nationals from the same family fell ill at a hotel in York. The next day the government raised the threat level from low to moderate.

On January 31 — or Brexit day, as it had become known — there was a rousing 11pm speech by the prime minister promising that withdrawal from the European Union would be the dawn of a new era, unleashing the British people, who would “grow in confidence” month by month.

By this time there was good reason for the government’s top scientific advisers to feel creeping unease about the virus. The WHO had declared the coronavirus a global emergency just the previous day, and scientists at the London School of Hygiene and Tropical Medicine had confirmed to [Professor Chris] Whitty in a private meeting of the Nervtag advisory committee on respiratory illness that the virus’s infectivity could be as bad as Ferguson’s worst estimate several days earlier.

It sounds as though Boris Johnson had his eye firmly fixed on just one ball. Juggling two was beyond him. “Get Brexit Done” now belatedly reads “Stay Home, Save Lives” on his Twitter feed:

Please do read the entire article, but for now let us skip to the conclusion of the Sunday Times cautionary tale of staggering incompetence in high places?

A Downing Street spokesman said: “Our response has ensured that the NHS has been given all the support it needs to ensure everyone requiring treatment has received it, as well as providing protection to businesses and reassurance to workers. The prime minister has been at the helm of the response to this, providing leadership during this hugely challenging period for the whole nation.”

Merely business as usual in the age of “Fake News” and “Truth Decay“.

[Edit – April 20th]

Last night the Department of Health and Social Care “tweeted” a response to the Sunday Times article:

Clicking through to the DoH blog we read:

A Government spokesman said: ‘This article contains a series of falsehoods and errors and actively misrepresents the enormous amount of work which was going on in government at the earliest stages of the Coronavirus outbreak.’

‘This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided at all times by the best scientific advice.

‘The Government has been working day and night to battle against coronavirus, delivering a strategy designed at all times to protect our NHS and save lives.

‘Our response has ensured that the NHS has been given all the support it needs to ensure everyone requiring treatment has received it, as well as providing protection to businesses and reassurance to workers.

‘The Prime Minister has been at the helm of the response to this, providing leadership during this hugely challenging period for the whole nation.’

Followed by a long list of rebuttals of specific points in the Sunday Times article. How about this one for starters?

Claim –  ‘This was despite the publication that day of an alarming study by Chinese doctors in the medical journal The Lancet. It assessed the lethal potential of the virus, for the first time suggesting it was comparable to the 1918 Spanish flu pandemic, which killed up to 50 million people.’

Response –  The editor of the Lancet, on exactly the same day – 23 January – called for “caution” and accused the media of ‘escalating anxiety by talking of a ‘killer virus’ and ‘growing fears’. He wrote: ‘In truth, from what we currently know, 2019-nCoV has moderate transmissibility and relatively low pathogenicity. There is no reason to foster panic with exaggerated language.’ The Sunday Times is suggesting that there was a scientific consensus around the fact that this was going to be a pandemic – that is plainly untrue.

Here’s one interpretation of these events:

Will Michael Gove shortly become our next Prime Minister?

Categories
News

Wearing face masks in the community

Hopefully we’ve made our own views on this topic clear by now, but what does the science say about the pros and cons of “the average person in the street” wearing a mask in public? Here’s an extract from a new paper in The Lancet entitled “Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity“:

The WHO ha[s] not yet recommended mass use of masks for healthy individuals in the community (mass masking) as a way to prevent infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in its interim guidance of April 6, Public Health England (PHE) has made a similar recommendation.

By contrast, the US Centers for Disease Control and Prevention (CDC) now advises the wearing of cloth masks in public and many countries, such as Canada, South Korea, and the Czech Republic, require or advise their citizens to wear masks in public places.

An evidence review and analysis have supported mass masking in this pandemic. There are suggestions that WHO and PHE are revisiting the question.

People often wear masks to protect themselves, but we suggest a stronger public health rationale is source control to protect others from respiratory droplets. This approach is important because of possible asymptomatic transmissions of SARS-CoV-2.

Authorities such as WHO and PHE have hitherto not recommended mass masking because they suggest there is no evidence that this approach prevents infection with respiratory viruses including SARS-CoV-2. Previous research on the use of masks in non-health-care settings had predominantly focused on the protection of the wearers and was related to influenza or influenza-like illness. These studies were not designed to evaluate mass masking in whole communities.

The authors go on to address that failing of previous studies:

Absence of evidence of effectiveness from clinical trials on mass masking should not be equated with evidence of ineffectiveness. There are mechanistic reasons for covering the mouth to reduce respiratory droplet transmission and, indeed, cough etiquette is based on these considerations and not on evidence from clinical trials. Evidence on non-pharmaceutical public health measures including use of masks to mitigate the risk and impact of pandemic influenza was reviewed by a workshop convened by WHO in 2019; the workshop concluded that although there was no evidence from trials of effectiveness in reducing transmission, “there is mechanistic plausibility for the potential effectiveness of this measure”, and it recommended that in a severe influenza pandemic use of masks in public should be considered. Dismissing a low-cost intervention such as mass masking as ineffective because there is no evidence of effectiveness in clinical trials is in our view potentially harmful.

Mass masking is underpinned by basic public health principles that might not have been adequately appreciated by authorities or the public. First, controlling harms at source (masking) is at least as important as mitigation (handwashing). The population benefits of mass masking can also be conceptualised as a so-called prevention paradox—ie, interventions that bring moderate benefits to individuals but have large population benefits. Seatbelt wearing is one such example. Additionally, use of masks in the community will only bring meaningful reduction of the effective reproduction number if masks are worn by most people—akin to herd immunity after vaccination. Finally, masking can be compared to safe driving: other road users and pedestrians benefit from safe driving and if all drive carefully, the risk of road traffic crashes is reduced.

So there you have it. Mask up if you’re out and about in public. You know it makes sense!