Friday 15 May 2020
It is difficult to understand body language when I look at a government politician, as they are well trained to avoid that degree of inspection. Yet if I had to take a stab at the Health Secretary’s thoughts this evening, throughout the 1700 hours Downing Street briefing, I would say he was sounding unsettled. As he spoke, a brief newsflash came across the screen, that scientific advisers had said the virus transmission rate had increased. Then came the R number, which had previously had a maximum value of 0.9. It had risen to a value of 1.0.
That means that one person will, on average, infect one other person. That is, the infection is simply stable. One out, one in. The MRC Biostatistics Unit in Cambridge has undertaken some fascinating work into the R value and has undertaken calculations for different parts of the country. Look at these:
- North East and Yorkshire 0.8
- South West 0.76
- North West 0.73
- East of England 0.71
- South East 0.71
- Midlands 0.68
- London 0.4
These are median values, not averages. Yet to me the trend is clear. The pandemic is getting worse if one looks at the country overall and, at a guess, I would judge that some form of lockdown will soon be reimposed. I am not surprised to see the change, as the nation is behaving like dafties. I can also understand the view that we might as well get on with it and allow those at risk to take their chances. If I could measure the R value inside a care home, I am certain it would be higher than the value outside. Perhaps it would be more logical to treat care homes separately, so I was pleased to hear at the government briefing, the pledge to pile more investment into the nation’s weak and vulnerable.
A clinical lead is to be appointed for every care home in the land, which is not before time and will be useful. There have apparently been 12,000 deaths in UK care homes since the pandemic began. This figure is based on death certificates that carry Covid-19 as a cause of death. There will be plenty who died but where Covid-19 remained unnamed, so 12,000 is a probable underestimate.
I appear to be getting nowhere fast with the NHS, which has been in touch once again to ask for another DBS. This is the Disclosure and Barring Service that checks I am not a mass murderer. Although I have already received my clearance, and am ready to start work with care homes, I did not put my middle name on the application as the form said it was inessential. I was wrong. The NHS compliance folk are in a state at my missing middle name, and I have to restart the whole clearance process. Passport, proof of address, driving licence, you name it. Perhaps the NHS is kindly saying that it simply does not want me.
With lockdown only partially lifted, it is interesting to see the other countries in the United Kingdom trying to assert their authority, with Scotland being particularly feisty. Their First Minister has said that Scotland, “needs to get some normality back” and that people, “can’t live like this forever.” That is exactly what Boris Johnson said a short while ago, but the First Minister cannot be seen to agree with the UK’s Prime Minister. How sad, when the Scots are such excellent people.
There is gloomy news emerging from the USA. A vaccine expert has said that the country will face its darkest winter this year. Rick Bright, who was a former top health official, has warned that the US’s window of opportunity to control the outbreak is closing. He is right, certainly in terms of the number of deaths. However, it is evident that there is much more to these pandemics than the number of fatalities. While many people are dying, a quarter of US workers are now claiming unemployment benefits. In addition, the state legislature in Michigan had to cancel a meeting after receiving death threats, accompanied by an armed protest from groups against lockdown measures. Livelihoods are disappearing fast. Meanwhile a bigwig Republican, Richard Burr, has had to resign thanks to an accusation of insider trading. We may think we have it bad in UK, but the USA, certainly in numerical terms, appears to have it worse.
The NHS is very good at muzzling its employees, while pretending it does not muzzle them at all. Some NHS managers have tried to stop doctors speaking publicly about shortages of PPE and a newsletter sent to one batch of staff has suggested subjects for Tweets. Apparently, these should include thanking staff for hard work, paying tribute to retired NHS returners and retweeting posts from the Trust. The last time I saw control of this extent was after the fall of Ceausescu in Romania in the mid-1980s, when the population was fully muzzled.
Image is very important to the NHS, so anything that might impact this, is looked at closely. There is a party line, largely one of NHS support, that medical staff are expected to follow. Deviate from that and you deviate at your peril. The Doctors’ Association UK (DAUK) has firm views on this, as it is clearly illogical to encourage whistle-blowing in one respect and make life intolerable for the whistle-blower on the other. When DAUK undertook a survey of its members recently, the respondents fell into these categories:
- 9% of respondents had been told not to raise concerns about Covid-19 or PPE via social media
- 6% of respondents had been told not to speak to the press about Covid-19 or PPE
- 2% of respondents who had offered opinions on social media had been challenged or disciplined
- 32% of respondents had experienced bullying around the issues of raising concerns about PPE
Doctors are now taking legal action to force the UK government to launch an independent inquiry into its failure to provide adequate PPE for NHS staff and other frontline care workers. A pre-action letter has been sent to the Department of Health and Social Care (DHSC) warning of this.
After an impressive delay, the NHS is trying to refocus on regular practice once more, in addition to managing the pandemic, while realising that the country may never be free of Covid-19. A new roadmap to safely bring back routine operations has been produced. This requires patients to self-isolate for 14 days before going into hospital and to be clear of any symptoms before being admitted. I suspect it will take a while before the public has regained the confidence to enter an NHS hospital at all. How the nation will police the requirement for patients to self-isolate for 14 days before hospital admission is anyone’s guess. This crisis has already shown that what people say and what they do are often completely different.
Testing is forever in the headlines, with a government obsession that they must undertake 100,000 tests each day. The Prime Minister’s statement many weeks ago, that he would like to see 250,000 tests daily, seems largely to have been forgotten. At long last, Public Health England has approved two antibody tests, which reveal whether someone has had Covid-19 in the past. One test is made by US-based Abbott. The company has produced an immunoglobulin G (IgG) analysis and has pledged five million tests each month, to start immediately. The test’s accuracy is said to be very close to 100%. A second test has also been approved, this time made by Swiss-based Roche. It is also said to have an accuracy of nearly 100%.
I am always suspicious of anything in medicine that claims 100% success, so look forward to the next whistle-blower stepping forward who can tell me the reality.