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.
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.
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.
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:
Why does the government need to check identity with TransUnion of people applying for home tests when they’ve been given all details including NI number ? Sinister pic.twitter.com/fzrkKIi4BE
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:
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.
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.”