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
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!