Tag: Covid-19

Categories
Testing

UK “Rapid Turnaround” Covid-19 Tests

Here’s another extract from Boris Johnson’s Covid-19 “lockdown 2” briefing on October 31st:

I am optimistic that this will feel very different and better by the spring

It is not just that we have ever better medicine and therapies, and the realistic hope of a vaccine in the first quarter of next year

We now have the immediate prospect of using many millions of cheap, reliable and above all rapid turnaround tests

Tests that you can use yourself to tell whether or not you are infectious and get the result within ten to 15 minutes

And we know from trial across the country in schools and hospitals that we can use these tests not just to locate infectious people but to drive down the disease

And so over the next few days and weeks, we plan a steady but massive expansion in the deployment of these quick turnaround tests

Applying them in an ever-growing number of situations

From helping women to have their partners with them in labour wards when they’re giving birth to testing whole towns and even whole cities

The army has been brought in to work on the logistics and the programme will begin in a matter of days

Working with local communities, local government, public health directors and organisations of all kinds to help people discover whether or not they are infectious, and then immediately to get them to self-isolate and to stop the spread

The precise nature of all these “cheap, reliable and above all rapid turnaround tests” is rather vague though. Presumably Boris has his “Operation Moonshot” in mind?

Shortly after the initial Moonshot revelations in September the BMJ had this to say:

The documents talk about “buying large scale capabilities” from partners such as the drug company GSK to “build a large scale testing organisation.” However, under “potential partners for increasing laboratory capacity” the documents list only the company AstraZeneca. Under logistics and warehousing, the documents list potential partners as Boots, Sainsbury’s, DHL, Kuehne+Nagel, G4S, and Serco. Under workforce are listed universities, the Society of Microbiologists, and the British Society of Immunology.

Alongside mainly commercial partnerships, the documents also state that a number of new tests and technologies would need to be used, including some that do not yet exist.

“Delivering testing at the scale and level of ambition set by the prime minister is likely to mean developing, validating, procuring, and operationalising testing technology that currently does not exist,” the plans state. Lower sensitivity testing for “screening/enabling purposes” could also be used, with polymerase chain reaction (PCR) testing then used to “confirm positive results or in situations where accuracy is needed for highest risk individuals.”

Testing technology listed in the documents includes qrt-PCR, Endpoint PCR, LAMP, LamPORE, lateral flow antigen test, and whole genome sequencing. Two of these tests—lateral flow antigen tests and LAMP—are listed as having a “lower sensitivity” of between 80% and 100%.

I cannot help but wonder how development of those “tests that do not yet exist” is coming along? According to the Financial Times today:

As England prepares to enter its second national lockdown on Thursday, the government’s Operation Moonshot plan to deliver a mass population testing programme is back under the spotlight. According to documents reviewed by the Financial Times, the Department of Health has awarded contracts worth at least £1bn to companies providing rapid testing. Many of the technologies relating to these contracts will feed into the Liverpool trial, in which everyone living or working in the city will be eligible for a test from Friday. The strategy will hinge on new lateral flow tests, which give results in 20 minutes and can be performed on a throat or a saliva sample, as well as conventional swab tests and loop-mediated isothermal amplification (LAMP) technology.

The pilot is expected to last about two weeks, with tests being deployed by the army, and could allow teachers, pupils and hospital staff to be tested weekly. But scientists have raised concerns over the accuracy of some of the lateral flow tests being used, which are prone to missing cases of active infection. Meanwhile, delays in assessing technologies produced in the UK have led to frustration over government contracts being awarded to overseas companies.

The government has signed at least 10 contracts with companies based in the UK, US and China, totalling more than £1bn, for rapid testing technology and logistics, according to publicly available contracts on the EU public procurement site, Ted, and information shared with the non-profit legal firm the Good Law Project.

Categories
News

England’s Covid-19 Lockdown Redux

My apologies for the rather more than brief hiatus in this series of articles. One reason is that on June 18th The Guardian reported that:

The government has been forced to abandon a centralised coronavirus contact-tracing app after spending three months and millions of pounds on technology that experts had repeatedly warned would not work.

In an embarrassing U-turn, Matt Hancock said the NHS would switch to an alternative designed by the US tech companies Apple and Google, which is months away from being ready.

Another reason is that I am currently sat at my keyboard on Burrator Ward at Derriford Hospital in Plymouth, where I am recovering from a non trivial triple coronary artery bypass operation, and have just washed my hands in accordance with the instructions in the unisex toilets:

There are other reasons too, but for now let’s continue with the latest news from the Downing Street propaganda machine:

Amongst a variety of other words uttered during yesterday evening’s press conference Boris Johnson had this to say:

Even in the South West, where incidence was so low, and still is so low, it is now clear that current projections mean they will run out of hospital capacity in a matter of weeks unless we act.

And let me explain why the overrunning of the NHS would be a medical and moral disaster beyond the raw loss of life

Because the huge exponential growth in the number of patients – by no means all of them elderly, by the way – would mean that doctors and nurses would be forced to choose which patients to treat

Who would get oxygen and who wouldn’t

Who would live and who would die,

And doctors and nurses would be forced to choose between saving covid patients and non-covid patients

And the sheer weight of covid demand would mean depriving tens of thousands, if not hundreds of thousands, if not millions, of non-covid patients of the care they need

It is crucial to grasp this that the general threat to public health comes not from focusing too much on covid, but from not focusing enough, from failing to get it under control.

I am told that it is quite normal to experience a wide range of emotions when recovering from a major operation.

This morning I awoke in a howling rage. My blood pressure is currently 134/82.

[Edit – November 6th]

A video update from Ann James, Chief Executive of University Hospitals Plymouth NHS Trust:

Our [Covid-19] numbers are beginning to rise, and they’re rising quite quickly. So at a really important time, a critical time, we set out what our next steps are to make sure that we can keep everyone safe and supported during what I know is another really difficult time for everyone.

We have already needed to make some changes to the hospital. We’ve had to change the use of some of our wards as we increasingly care for a growing number of Covid patients, and we’re looking to change some of our other services.

Categories
News

When was the first UK coronavirus case?

Over recent days the mainstream media have been vying with each other to reveal the identity of the United Kingdom’s Covid-19 “patient zero”.

According to The Guardian on June 1st:

In the UK, the first confirmed cases of coronavirus came on 31 January when two Chinese nationals staying in a hotel in York tested positive. But as the crisis has rolled on, and the virus’s range of distinctive symptoms become more widely known, many – some in letters to the Guardian – have asked themselves if they or their loved ones could have had it earlier.

The article reports that:

A day before the first confirmed fatality from coronavirus outside mainland China was reported on 2 February this year, the death of the influential guitarist and musician Andy Gill was announced. The 64-year-old, who fronted the post-punk band Gang of Four, died of pneumonia after two weeks in St Thomas’ hospital in London.

The trajectory of Gill’s illness, which took medics looking after him in January by surprise, is now familiar – sudden deterioration, low oxygen levels and organ failure. He had fallen sick after his band returned from a trip to China in late November.

Then on June 8th The Sunday Times published an article by their chief foreign correspondent, Christina Lamb describing her own Covid-19 like symptoms in early January and reporting that:

“Thousands of people have emailed me with classic Covid symptoms from late December and January,” said Professor Tim Spector, a leading epidemiologist at King’s College London, who runs the Covid-19 Symptom Study app to which 3.8 million people have signed up.

“Either there was another virus behaving in a similar way which has since disappeared or these were early cases.”

If so, why was it not reflected in a spike in hospital admissions or deaths? “That’s the medical mystery,” said Spector.

There were, he said, possible explanations. “People who got it were young and healthy and didn’t transfer it to the elderly, obese and so on. Many of those early cases were skiers coming back from holidays. Or the virus was in some way different and didn’t have that final stage which attacks the immune system.

Christina points out that:

Officially, the first case involving a Briton was Steve Walsh, 53, a businessman from Hove… On February 6 he was diagnosed and transferred to Guy’s Hospital in London.

Before suggesting that:

It now seems likely that Walsh was not the UK’s “patient zero”. A month earlier, Susannah Ford… had fallen ill after flying back from a skiing holiday in Austria. [She] became ill on January 6, two days after her return from a new year trip.

Ford had spent a week in the resort of Obergurgl, near the Italian border, with her husband and two teenage daughters, flying back into Gatwick on January 4. She was the only one in the family who fell ill and assumed it was something she had picked up on an earlier trip to Trinidad.

Last week Ford paid for a test that shows whether the patient’s blood contains the antibodies that form when a person successfully fights off the disease. It came back positive, confirming that she had had Covid-19, although not when.“I’m convinced it’s when I was ill in January,” she said. “I can’t prove it was then but I haven’t been ill since or come into contact with people with it.”

Is there any advance on early January? Not as far as I am aware in the UK, but there have been several reports that European athletes who attended the Military World Games in Wuhan, China in October 2019 fell ill with symptoms resembling those of Covid-19.

According to an article in The Times on May 8th:

A French athlete who fell ill after competing in Wuhan in October says she has been told by doctors that Covid-19 was the likely cause of her ailment.The claim by Élodie Clouvel, an Olympic silver-winning pentathlete, has bolstered speculation that the coronavirus may have been present in the Chinese city several weeks before it was declared and then carried around the world by those who had taken part in an international competition there.

However according to the Global Times on February 24th:

A Wuhan hospital clarified the clinical diagnoses of five foreign athletes at the 7th CISM Military World Games held in Wuhan, Central China’s Hubei Province in October 2019, saying that they contracted malaria and were not infected by the novel coronavirus.

And what of the science? According to a paper published in “Infection, Genetics and Evolution” in early May:

We observe an estimated time to the Most Recent Common Ancestor, which corresponds to the start of the COVID-19 epidemic, of 6 October 2019–11 December 2019 (95% CIs). These dates for the start of the epidemic are in broad agreement with previous estimates performed on smaller subsets of the COVID-19 genomic data using various computational methods.

It seems that it’s not beyond the bounds of possibility that several athletes brought the SARS-CoV-2 virus to Europe from Wuhan in late October 2019.

Categories
News

UK “Covid-19 Hypoxia” Trial Announced

According to an article by Emily Morgan on the ITV News web site:

A month ago Robert Peston and I highlighted the worrying condition known as ‘happy hypoxia’ which has been affecting thousands of coronavirus patients.

It has become apparent over the course of the pandemic that some patients appear absolutely fine and apparently not in distress but have oxygen levels so low they would normally be unconsciousness or even dead.

We highlighted it because medics raised the alarm that many people were getting to hospital too late and should be brought in much sooner.

We’d noticed the mention of what we called ‘Covid-19 hypoxia’ in the medical literature rather more than a month ago, which was one of the reasons why in the middle of April we applied to Innovate UK, the UK’s innovation agency, for R&D funding to develop a “Covid-19 eHealth Data Acquisition Unit:

Today we are delighted to be able to announce that our application has been successful! We’ll be making a formal announcement in the near future, but getting back to Emily’s article for now:

NHS England told me exclusively they were looking at changing guidelines for 111 call handlers and they were looking at giving patients devices that could monitor their oxygen levels at home.

For the families of those who have died it was a small victory.

Today the NHS has made good its pledge to look at it.

A pilot is now underway in 11 hospital trusts where some Covid-19 patients and at risk patients are being given oximeters.

A “pulse oximeter” is one of the sensors we will be connecting to the “domestic” version of our Covid-19 data acquisition unit, which will use “Artificial Intelligence”, or perhaps more accurately “Machine Learning”, to infer the state of a person’s health from the information it receives from its assorted inputs.

Emily continues:

These are really simple devices which clip on your finger and give you a quick and easy reading of oxygen levels in your blood.

The results are pinged via an App back to doctors who can keep an eye on them.

It’s so simple and so clever that Dr Andy Barlow from Watford General Hospital says it will absolutely save lives.

Here’s a picture of one such “life saving” device:

A picture of our very own Covid-19 eHealth data acquisition unit will be available in due course!

Categories
News

UK Excess Deaths Due to Covid-19 Hypoxia?

The UK’s Office For National Statistics has just released a report which “Examines death registrations not involving coronavirus (COVID-19), to understand the apparent increase in deaths”. It nonetheless suggests that a significant number of the UK’s recent “excess deaths” that make no mention of Covid-19 on the death certificate might well have been caused by the SARS-CoV-2 virus. In section 5 concerning “Deaths due to dementia and Alzheimer disease” the ONS point out that:

The sudden rise in deaths due to dementia and Alzheimer disease is so sharp that it is implausible that the full increase observed could have happened by chance. The absence of large rises in deaths due to this cause that mention conditions that could exhibit similar symptoms to COVID-19 suggests that if COVID-19 is involved in the increase in deaths due to dementia and Alzheimer disease, the usual symptoms of COVID-19 were not apparent. This could fit with recent clinical observations, where atypical hypoxia has been observed in some COVID-19 patients. In someone with advanced dementia and Alzheimer disease, the symptoms of COVID-19 might be difficult to distinguish from their underlying illness, especially with the possibility of communication difficulties.

The terms “Covid-19 Hypoxia” and “silent hypoxia” have been used in the medical literature for quite some time, amongst other things to suggest that “overuse of intubation” for Covid-19 patients should be addressed.

We await further news on the attribution of UK deaths to the many effects of the SARS-Cov-2 virus with interest.

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

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
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!