A comprehensive guide to holding safer conferences and meetings, for trade unions and other organisations. We are delighted to have worked with the Hazards Campaign to develop this guide, which provides easy to follow and implement advice on reducing risks of infection at in-person meetings.
Download link just below document
DiU were joined by a number of organisations on our demonstration to demand protection from airborne transmission for all HCWs. We also received a number of messages of support, including from Diane Abbott MP, the Hazards Campaign, Every Doctor, Prof Trish Greenhalgh, Unite health branch in Nottinghamshire and Prof Raymond Agius. Photos of the protest appear below followed by the messages of support.
Statement from Janet Newsham, Chair of UK Hazards Campaign
The hazards campaign supports those organising and campaigning for justice and safety at work.
UK Hazards Campaign and all its supporters send solidarity greeting to the Doctors in Unite demonstration taking place outside the Dept of Health in London at the same time as our protest outside the HSE in Bootle in the North West England. We agree that the HSE has a legal duty to ensure safe working conditions for all workers, in our hospitals and clinics and across businesses and industry.
Throughout the pandemic, the HSE has failed to ensure that employers in all settings are controlling the infection risks to their staff through their duty to provide suitable and sufficient risk assessments.
They have reacted too late leaving hundreds of thousands of workers infected, thousands left with long-covid and some have sadly died. We know that PPE is the last resort in the defence from an airborne disease and that before it is considered all other safety measure must be put in place to remove the risks, however if PPE is necessary then we expect high quality respirator face masks at a precautionary standard are provided.
We accuse the HSE of being complicit with Government in not ensuring that workers have been provided with these, including in high risk health and social care settings.
Employers, enforcement authorities and the government are responsibility for thousands of needless deaths of workers all over the country by failing to ensure proper air quality in the workplace.
The UK Hazards Campaign will remember all those who have died but we will continue to fight like hell for the living!
We wish you every success on Tuesday and look forward to continue working together in the future. Airborne protection NOW for all workers!
Janet Newsham – Chair of UK Hazards Campaign
Statement by Dr Julia Grace-Patterson, Chief Executive, Every Doctor
16 months after the World Health Organisation declared COVID-19 a global pandemic, and where are we? Still trying to get NHS workers the protection they need to stay safe.
Those early months of the pandemic were chaotic. Some NHS staff were given out-of-date PPE, others had none at all. Thousands of health and social care workers were left at risk; and carried this risk to their patients and their families.
Over a year on, 1,500 health and social care workers have died from COVID-19. At least 122,000 more are suffering from long COVID. And yet NHS workers are still waiting.
This government claims to ‘follow the science’. Well the ‘science’ now is very clear. COVID-19 is an airborne virus. And FFP3 respirator masks are the safest PPE we can give healthcare workers. And by protecting NHS workers, we not only protect these individuals; we also protect their families and loved ones, and their patients too.
All health and social care staff should have access to them – no exceptions, no excuses.
We heard horrifying stories from our community of frontline doctors last year about makeshift PPE. Of staff in GP surgeries and hospitals having to craft their own gowns and masks out of bin bags and sanitary towels, or having to rely on generous donations from local businesses.
Where was the government?
Awarding PPE contracts to companies that were completely unfit, without any transparency or competition, and some of whom had no experience at all in supplying medical equipment.
Alongside Good Law Project, we took the government to court over these shoddy PPE deals. We’re still waiting to hear the verdict, but for EveryDoctor these cases weren’t so much about the judicial outcome itself, but to recognise the sacrifices every one of our colleagues have made in the last year.
One legal victory is never going to solve everything. Our fight to Protect NHS workers is far from over. After 18 months fighting this virus, NHS workers still don’t have the protection they need.
We know that COVID-19 is an airborne virus. But right now the majority of frontline health and social workers are still not being given respirator masks. Government guidelines are still recommending basic surgical masks for the majority of workers.
No amount of clapping or empty words can take away the fears our NHS colleagues still feel when being forced to work in unsafe environments. No one should be forced to work like this, but especially not those who have given their all to care for us throughout this pandemic.
That’s why we’re proud to support this protest today.
Dr. Julia Patterson
Chief Executive, EveryDoctor
Statement from Diane Abbott MP
“I am sorry I cannot be here with you today. But I want to say firstly thank you for all you and your colleagues do and have done throughout this pandemic.
But I am sorry you have been asked to do it. It is the government’s responsibility that you came into this pandemic completely understaffed and underpaid. It was the government which didn’t provide PPE, including the saintly Jeremy Hunt as Health Secretary. It was also the government which has allowed so many of you to become ill and die as a result of this virus.
It didn’t have to be this way. In New Zealand and China currently have 40 cases between them, and have had no deaths in months. ZeroCovid is possible. None of this needed to happen.
If £37bn can be wasted on a useless Test & Trace system, why can’t you get a 15% pay rise? If money can be found for renewing Trident, why can’t you all have proper PPE? And if the government is hiring consultants on £1,000 a day, why can’t they hire more doctors and NHS workers? If the NHS vaccine programme is great, why are they intent on privatising the NHS?
Instead, they let Black and Asian people die in huge numbers, while demonising their communities and denying that racism exists.
They must be challenged. They must be opposed, so I am glad that you are doing this today.”
Statement from Trish Greenhalgh, doctor and Professor of Primary Care Health Sciences, University of Oxford
This is a shortened version of a video statement by Prof Greenhalgh, which can be seen here https://www.dropbox.com/t/hutkC5mWxinVbx1b
“At the beginning of the pandemic we thought the virus was spread by large droplets and from surfaces. We now know, beyond any real doubt, that the virus is airborne, and that makes it that much harder to protect against it. But it also means that this old classification of aerosol generating procedures, for which you would be given higher grade protection, doesn’t really apply. Because anybody who is look after somebody who has got Covid or might have Covid, really needs to be protected with a level of PPE which protects them against airborne infection, which means a higher grade respirator mask in particular, together with other precautions.
I’ve been working with the Royal College of Nursing, Unite the Union, and many other health and care unions and we’ve been trying to get the rules changed to protect health and care workers, many hundreds of whom have already died from Covid-19. We shouldn’t be putting our front-line key health workers at this risk.
Please support the demonstration organised by Doctors in Unite outside the Dept of Health on 27th July, if you feel strongly about this issue, as I do. Lets hope this is a successful protest and that it changes policy, so that front-line workers are better protected.
Thanks very much and good luck to all the protestors on the day.”
Statement from Jon Dale, Unite Nottinghamshire Health branch
Unite Nottinghamshire Health branch congratulates Doctors in Unite for organising this demonstration. We send our solidarity and full support in the campaign for safe workplaces for all.
NHS workers should decide what PPE is required – not government ministers or cash-strapped management. Safe workplaces need enough workers to do the job – not a skeleton staff working exhaustingly long hours.
The campaign for proper PPE is linked to the campaign for a fully funded 15% pay rise. With united trade union action and solidarity, NHS workers can win and inspire all workers to fight for workplace safety and decent pay.
Statement from Professor Raymond Agius, doctor and Emeritus Professor Occupational and Environmental Medicine
Prof Agius has worked tirelessly to publicise the failure of the government and the HSE to protect people in the workplace from Covid-19
“Sorry I can’t join you in London. Because of my age and gender, I don’t fancy travelling from Manchester by train and then on the tube, especially since the ex-mayor of London has decided to grant the ‘freedom’ of the city to the SARS-CoV-2 virus.
However, I have been looking after the health at work of health care workers since 1986 and have been campaigning since March 2020 for them to be provided with FFP3 and other protection against Covid, since #COVIDisAirborne.
So what you are doing today has my wholehearted support.
At the start of the pandemic it was thought that spread of coronavirus was through large droplets travelling over a relatively short distance or by fomites contaminating hands and mucous membranes. The danger of aerosol spread was recognised, but thought to be limited to ‘aerosol generating procedures’ (AGP) such as intubation. For this reason, high grade face masks (FFP3 or N95) were only recommended for staff exposed to AGP (1).
The denial of aerosol transmission of virus (2) always sat uncomfortably with the acceptance that so called AGP represented a risk. It is now known that aerosols are generated by talking, shouting, singing, coughing and sneezing and are an important form of viral transmission. Official Infection Prevention and Control (IPC) guidance  is now seriously lacking on the issue of AGPs: several studies    indicate that many of the “classic” AGPs (like intubation) produce little in the way of aerosols and that an actively coughing patient may be much more infectious than those undergoing various AGPs. Moreover, patients with Covid-19 requiring AGPs are likely to be sicker and later on in their illness course, and will therefore produce much less aerosolised virus than patients who have just become symptomatic, when infectiousness is known to be at its greatest.
In fact, coronavirus can be spread over large distances, for example in food processing plants (7) or in restaurant settings. Studies in health workers of SARS-CoV-2 antibody status (signifying past infection) (8) strongly suggest that high level PPE (including high grade masks) is effective in preventing infection, and that use of surgical type fluid resistant masks is inadequate in situations where staff are in close contact with symptomatic patients such as on hospital wards.
In addition, ventilation in enclosed and crowded workspaces is clearly an important risk factor in spread, yet there is little specific advice to manage this risk other than keeping windows open. This is a particular concern in workplaces and schools where maintaining social distancing is difficult; currently the highest rate of new infection is among secondary school children. The fact that a recent update of official IPC guidance does not mention aerosol spread at all (outside of AGPs) is inexplicable, given that this was after Public Health England recognised this route of transmission over two month ago. This puts tens of thousands of health and social care workers at potential risk in hospitals, primary care settings and in care homes, as well as the patients they care for.
The pandemic is far from over, with more than 600 health and care workers already having died, and an overall death toll in the UK equivalent to one international airplane crash killing all passengers every day for nine months. Although vaccine development gives some cause for hope, important unknowns remain how many people will receive/accept vaccination and how long this process will take, whether vaccination will prevent transmission and therefore achieve herd immunity, and how long protection might last. There is therefore every reason to hone non-pharmacological interventions in order to reduce further loss of life. We therefore call upon PHE and the Department of Health and Social Care to recognise an urgent need to update guidelines on COVID-19 prevention and control in the light of what is now known about aerosol transmission. This should include upgrading type of masks worn (9) and advice on how to maintain and monitor effective ventilation.
Evidence shows that those of BAME origin are amongst those at highest risk of infection and death from COVID 19. People of BAME origin often work in low paid employment in jobs where it is not possible to work at home such as cleaners, carers and bus drivers. These are also jobs which put workers in close, protracted contact with the public. Doctors in Unite believe that when a safe vaccine against COVID 19 becomes available that those in such high risk roles should be prioritised to receive it and they should be recognised as front-line staff.
In the NHS, it is usual for low paid jobs to be contracted out to private corporations and these outsourced workers, for example in NHS domestic services and portering, do not get treated on a par with directly employed staff. While it has been shown that clinical staff in intensive care units have been well protected against Covid 19 with high quality risk assessment, PPE, air purification and more, other front line clinical workers, especially outsourced BAME workers, have had high mortality.
In addition, public facing workers of BAME origin often live in overcrowded, multi-generational households. Potential exposure to COVID 19 at work not only puts them at risk, but their extended families.
Doctors in Unite believes that these high risk, front-line workers should be among those at the front of the queue to receive a safe COVID 19 vaccine, and applauds the International Workers of Great Britain for their groundbreaking court victory over health-and-safety protection for workers in the gig economy.
See article here on IWGB’s court victory here: https://morningstaronline.co.uk/article/b/union-hails-groundbreaking-court-victory-over-access-to-ppe-for-gig-economy-workers
Doctors in Unite sent the letter below to Professor Allyson Pollock and colleagues, in support of their letter to Liverpool MPs questioning the rationale for mass testing of the people of Liverpool. A link to their letter, and a BMJ blogpost by Dr Angela Raffle, Consultant in Public Health appears below our letter.
9th November 2020
To: Allyson Pollock, Professor of Public Health, Newcastle University; Anthony J. Brooks, Professor of Genomics and Bioinformatics, Leicester University; Louisa Harding-Edgar, General Practitioner and Academic Fellow in General Practice, Glasgow University; Angela E. Raffle, Consultant in Public Health, Honorary Senior Lecturer in Public Health, Bristol Medical School Department of Population Health Sciences, University of Bristol; Stuart Hogarth, Lecturer, Department of Sociology, University of Cambridge.
CC: Dr Matt Ashton, Director of Public Health, Liverpool.
Dear Allyson, Prof Brooks, Dr Harding-Edgar, Dr Raffle and Dr Hogarth,
Doctors in Unite would like to support your letter expressing concerns about the mass testing for COVID 19 in Liverpool.
We are surprised that Dr Ashton, Director of Public Health for Liverpool is enthusiastic about the pilot and would be interested to hear his reasoning. If there is more detailed information which has led him to this conclusion, that we are not party to, we would be willing to reconsider our position in the light of any such evidence.
We believe that there is a place for testing of a sufficiently-sized random sample of individuals if it is to determine more accurately the prevalence of COVID 19 in society, in fact we called for this early on in the pandemic, it is in place nationally and could usefully be augmented to generate local results. However opening the testing to everybody detracts from the randomness of the sample, which becomes self-selected, and creates a significant issue of false negative test results which needs to be considered.
Mass testing with the aim of suppressing the virus, without adequate Test, Track, Trace, Isolate and Support is in our view unlikely to be successful. As you point out even a very small false positive rate will mean that people who are not infected will be told to self-isolate and there will be a larger number of these individuals and their families the more people who are tested. Without income protection many people are likely to decline to be involved.
We believe that the Westminster Government response to the COVID 19 pandemic has been appalling and that many lives have been unnecessarily lost. It is time for the Government to abandon their populist approach and to start to be led by the science.
Dr Jackie Applebee, Chair, Doctors in Unite
Letter to Liverpool MPs:
BMJ blogpost by Dr Angela Raffle
The media recently highlighted the fact that NHS England has announced:
“The NHS is set to radically overhaul the way MRI, CT and other diagnostic services are delivered for patients . . . . Community diagnostic hubs or ‘one stop shops’ should be created across the country, away from hospitals, so that patients can receive life-saving checks close to their homes. The centres could be set up in free space on the high street or retail parks.”
“The need for reform of NHS diagnostics was recognised in the Long Term Plan” – so begins the recent report by Professor Sir Mike Richards, ‘Diagnostics. Recovery and Renewal’.
The key recommendations are:
- Acute and elective diagnostics should be separated wherever possible to increase efficiency.
- Acute diagnostic services (for A&E and inpatient care) should be improved so that patients who require CT scanning or ultrasound from A&E can be imaged without delay. Inpatients needing CT or MRI should be able to be scanned on the day of request.
- Community diagnostic hubs should be established away from acute hospital sites and kept as clear of Covid-19 as possible.
- Diagnostic services should be organised so that as far as possible patients only have to attend once and, where appropriate, they should be tested for Covid-19 before diagnostic tests are undertaken.
- Community phlebotomy services should be improved, so that all patients can have blood samples taken close to their homes, at least six days a week, without needing to come to acute hospitals.
Motherhood and apple pie
On the surface of it, these are laudable aims that have been welcomed by hospital bosses. The COVID-19 pandemic has had a devastating effect on management of non-covid conditions with, for example, a 75% reduction in cancer referrals and a reduction in 210,000 imaging procedures each week. Before the pandemic there were 30,000 patients who had waited longer than 6 weeks for a diagnostic test, a figure that has now increased to 580,000. Urgent consideration must be given both to how the NHS is put back on its feet and how it addresses the huge backlog of problems as well as the ongoing pandemic. There is logic in separating acute and non-acute service provision into covid and covid free areas, and who could object to patients having convenient and rapid access to the best available technology? This does of course depend on many factors, not least having an efficient coronavirus testing system at some point in the future, but raises other crucial issues.
Where will the staff be found?
The plan as set out requires the recruitment of around 11,000 staff including 2000 radiologists, 500 Advanced Practitioner radiographers, 3,500 radiographers, 2,500 assistant practitioners, 2,670 administrative staff and 220 physicists. Bear in mind the current staffing crisis on the NHS, with around 140,000 vacancies across the board exacerbated by low pay and workplace stress. Cancer Research estimated that staff would need to double by 2027 to meet demand, with one in ten posts in diagnostics unfilled at the start of the pandemic. Furthermore, massive investment in equipment will be needed. The report points out that in relation to the 20 other countries making up the Organisation for Economic Cooperation and Development, the UK ranks bottom for CT and 3rd from last for MRI scanners. The Clinical Imaging Board claims that nearly 30 per cent of the UK’s MRI stock is at least ten years old, with no replacement plans for almost 40 per cent of systems more than seven years old.
All that’s left to find – money and staff
The last settlement for the NHS was £20.5 bn, which over a five year period amounted to an annual increase in budget of 3.4%. This did not include funding for training and employing the staff of the future. Most commentators thought a minimum 4% increase in funding was needed, and the Office for Budget Responsibility put the figure at 4.3% in order to meet increasing demand. COVID-19 has now blown all these estimates out of the water with the additional costs of restarting and sustaining the service, dealing with COVID-19 long term and developing and implementing a workforce transformation.
Private sector – the spectre lurking in the wings
In Simon Stevens’s letter to health care providers in July this year, he mandated:
“Ensuring that sufficient diagnostic capacity is in place in Covid19-secure environments, including through the use of independent sector facilities, and the development of Community Diagnostic Hubs and Rapid Diagnostic Centres”.
As pointed out in The Lowdown in a comment on diagnostic hubs:
“References . . . to high street and retail park sites are possibly of no real concern – perhaps they’re more about exploiting cheap-to-rent locations during the pandemic-driven economic recession than a push to link-up with high-profile brand sponsors – but the well-established presence of private sector interests operating in the diagnostic and pathology arena suggests there may be rich pickings on offer somewhere in the hub programme, if only until the backlog is cleared”.
In fact the privatisation of diagnostic and laboratory facilities is already well underway. There is no comfort here in Professor Richard’s report which even cites as a case study:
“The East Midlands Radiology Consortium (EMRAD) was launched in 2013 to create a common digital radiology system. Pioneering work led to the development of a Cloud-based image-sharing system through which the seven NHS trusts involved in the partnership could share diagnostic images, such as X-rays and scans. In 2018, EMRAD formed a partnership with two UK-based AI companies, Faculty and Kheiron Medical, to help develop and test AI tools in the breast cancer screening programme in the East Midlands.”
There is no mention of the fact that EMRAD paid £30m for the picture archiving and communication system from GE Healthcare but refused to pay full service costs until GE sorted out chronic problems causing a dangerous backlog of CT and MRI images.
Like many of the aspirational service developments contained within the Long Term Plan, ‘one stop shops’ could offer real value to patients. As the report by Professor Richards recognises:
“These new services will require major investment in facilities, equipment and workforce, alongside replacement of obsolete equipment. Training of additional highly skilled staff will take time but should start as soon as possible. International recruitment should be prioritized.”
This is no small ask and needs to be part of a generous new funding settlement for the NHS by government. This should be an investment in the NHS as a public service rather than a source of rich pickings for private companies.
This article was written by John Puntis for Keep Our NHS Public
We sent the following message today, 20 September 2020, to Independent SAGE:
|“Doctors in Unite fully endorse Independent SAGE’s emergency ten point plan to avoid a national lockdown. [The plan can be found here: https://www.independentsage.org/wp-content/uploads/2020/09/Emergency-Plan-PUBLISHED.pdf ]|
Experience from other countries such as Germany, South Korea and Japan has shown that if the correct measures are adopted the case rate of COVID 19 can be substantially reduced and unnecessary deaths prevented. Equally these proposals are not alien to the United Kingdom as virtually all of the recommendations are already policy in our devolved administrations.
However, despite governing one of the richest countries in the world, Boris Johnson and the Tory Party callously ignore what can be done and what needs to be done and instead throw billions of pounds at private sector providers such as Serco, Sitel and Deloitte whose national “test, trace, isolate and support” programme is demonstrably unfit for purpose, and is contributing to the current alarming rise in Covid-19 infection.
Doctors in Unite call on the Tory Government to take off their ideological blinkers and to listen to the experts and people on the front line, to give the NHS and Public Health the tools they need to crush the virus and to immediately adopt i-SAGE’s emergency ten point plan”
We did suggest an amendment to point 2 of the plan which says there should be “no return to workplaces until they are certified Covid-safe”. It is very difficult to make any indoor space completely Covid-safe and the Health and Safety Executive (HSE) has suffered swingeing cuts over the last decade to the point where it is unable to fulfil its statutory duties in the workplace. We suggest therefore that there should be no return to the workplace “until it has been fully risk-assessed”, which will allow for trade union and worker involvement in ensuring that workplaces are as safe a possible.
Dr Applebee proposed the motion by TOWER HAMLETS DIVISION of the BMA: That this meeting, in response to COVID 19, demands that government:
i) ensure that workers are not under pressure to attend work either for financial or workforce reasons while they are unwell or self-isolating and at risk of inadvertently passing on the disease;
ii) provide the equivalent of day-one statutory sick pay to those on zero hours contracts;
iii) allow the NHS to requisition private health care facilities to accommodate effective COVID-19 treatment and quarantine provision if needed;
iv) ensure workers are paid in full while they are unwell or self-isolating.
With respect to point iii)
The COVID 19 pandemic has surely blown the myth that private is good and public is bad.
We have heard repeatedly today how the NHS has stepped up to the plate to deal with the crisis, though years of an unprecedented funding squeeze has led to the collateral damage that Chaand (Dr Chaand Nagpaul, Chair of the Council of BMA) referred to earlier of those whose other health needs could not be met due to the lack of slack in the system.
On the other hand outsourcing to the likes of Deloitte and Serco has led not to the world beating test trace isolate and support system trumpeted by Boris Johnson, but a wholesale fiasco where people are having to drive miles to get a COVID test and where, despite the billions spent, the global multinationals cannot do as well with contact tracing as the very poor relation that are local public health departments.
Private hospitals were handed hundreds of millions back in March to increase capacity to deal with COVID 19 but they were largely unused, gifting a nice windfall to their shareholders at a time when their usual work had all but dried up.
Now they are likely to commissioned to help with the backlog of NHS care. Don’t get me wrong the backlog needs to be cleared, patients need their treatment, but the private sector should not be able to profit from this. They should be brought into the NHS family and their activity now should be offset against the money they were given in March. There must be value for public money spent.
The fact that the NHS had to shut down everything except dealing with COVID in March is a stark illustration of the chronic underfunding and that there has to be spare capacity inbuilt into the system to deal with crises. The extra money thrown at the system should have been thrown at the NHS not the private sector.
With respect to points i), ii) and iv):
If we are going to crush COVID, really get on top of it, we need people to be able to afford to stay at home and isolate if they are in contact with an index case. If there is enough money in the economy to subsidise eating out there is surely enough to guarantee that if someone is in quarantine that they are paid in full.
Many of the lowest paid, for example cleaners, refuse collectors and care workers, many of whom have looked after patients with COVID, often of precarious zero hours contracts, cannot work from home, and to make ends meet many of them have two jobs. They need to be reassured that they wont’ lose out financially if they stay off work otherwise they will have no choice but to go in and the virus will continue to spread.
Covid is with us but Government could do so much more to minimise it’s devastating impact.
The pandemic has surely underlined the huge value of publicly funded, publicly provided health service which is free at the point of delivery and the demonstrated the dedication of the staff who work within the NHS and Social Care.
As has been said today already, we have an opportunity to reshape the future, it’s up to us whether we grasp the nettle.
Please support this motion in all it’s parts.
The Motion was passed with overwhelming support from delegates
A review of where the UK is in its response to the Covid-19 pandemic
1. Policy failure
Richard Horton, editor of the prestigious medical journal ‘The Lancet’, described the management of COVID-19 as the “greatest science policy failure for a generation” in his book on the pandemic. Currently the numbers of newly diagnosed patients are steeply rising with many wondering if the government has completely lost its grip. So – four months after Johnson showed his remarkable grasp of the scientific narrative by declaring: “If this virus were a physical assailant, an unexpected and invisible mugger (which I can tell you from personal experience it is), then this is the moment when we have begun together to wrestle it to the floor” – where do things stand?
2. Increasing number of positive test results
In July, the lowest number of daily new positive tests recorded was 574; by 6th September 2020, this had risen alarmingly to nearly 3000 on each of two successive days, showing a sudden increase of around 50% just as schools were reopening and more workers being coaxed back into workplaces. Over the preceding few weeks, European countries such as France, Germany, Spain and the Netherlands had all seen a sharp rise in new cases, with 40% being in the younger age group. In the UK, the change in new diagnoses from predominantly elderly people to the young was even more apparent, with two thirds being in this demographic, including the steepest increase seen in 10 – 19 year olds accused of not observing social distancing.
Meanwhile those with symptoms were often being told they will have to drive long distances, sometimes over a hundred miles, just to get a test. For many, this is simply not feasible, while for those who do make such a journey there is the risk of spreading infection further. At the same time statisticians have started to model the effects of NHS winter pressure combined with a second peak of coronavirus and predict that more than 100 acute hospital trusts will be operating at or above full capacity. A survey by the Doctors’ Association UK found that over 1,000 doctors were planning to quit the NHS through disillusion with the government’s management of the pandemic and frustration over pay. Recent national demonstrations calling for pay rises suggest many other NHS staff share these concerns and are prepared to take action.
4. Coronavirus endemic in some cities
A new public health report leaked to the press highlighted that COVID-19 was entrenched in some northern cities, and that case numbers had never really fallen to low levels during initial lockdown. This situation was strongly associated with deprivation, poor and overcrowded accommodation and ethnicity. New cases diagnosed per 100,000 population/week varied widely round the country at 98 in Bolton (topping the league), 37 in Manchester, 29 in Leeds, and only 3 in Southampton. The implication was that local lockdown measures were not likely to be any more effective in suppressing new infections and that there was an urgent need for a new strategy including better and locally tailored responses. These should include effective ‘find, test, trace, isolate and support’ (FTTIS) systems under the control of local authorities, many of which are in despair over their poor funding, and the hopeless performance of national ‘test and trace’. Given over at huge cost to the private companies Serco and Sitel, these are still only successfully contacting 50% of contacts of known cases, a figure that, according to the official Scientific Advisory Group for Emergencies, should be at least 80%, with all these contacts then going into isolation.
5. Broader lessons
Other lessons to be learned relate to financial support for workers and isolation of those living in overcrowded housing. It is simply no good (i.e. it is ineffective as an infection control measure) to expect low paid workers often with little or no financial reserves to self isolate for two weeks with either no pay or derisory statutory sick pay – full pay must be given by employer or government. In addition, people in densely packed housing cannot effectively self isolate, and as in some other countries, need to be temporarily housed in suitable alternative accommodation. This might be reopened hotels, or the almost unused Nightingale hospitals for those with mild symptoms.
6. is london different
One question of interest is why figures have not jumped up in London where the number of new cases in different areas is between 6 and 18/100,000/week. Possible explanations are that London was initially hit very hard by COVID-19 and as a result people have remained more cautious. For example, many Londoners who are able to work from home have decided not to heed government advice to return to office buildings. Geographical disparities in numbers of cases probably also reflect the fact that in northern cities such as Bradford, Oldham, and Rochdale, there is a relatively higher proportion of the workforce in more public facing roles such as the National Health Service, taxi services, take away restaurants, etc. Antibody testing (carried out regularly on samples of the population) also indicates that something like 17.5% of Londoners have been infected compared with 5-7% in the rest of the country. Although this is far from ‘herd immunity’ (which would require about 70% of the population to have been infected) it may mean that rapid increases in numbers of infection is at least initially delayed.
7. Airborne spread
There is now considerable support for the idea that an infected person can spread the virus over long distances through the atmosphere, although at the early stage of the pandemic this notion was rejected (hence the 2 meter social distancing advocated as being safe). There is an increasing body of evidence confirming aerosol spread of virus, and this is well illustrated in food processing plants. Detailed investigation of the huge German meat factory outbreak showed spread of virus came from a single worker in the factory, with infection transmitted over 8 meters and more, and did not represent community acquired infection being brought in simultaneously by a large number of employees. The implication is that environmental conditions and effective ventilation are crucial to preventing spread of COVID-19, but unfortunately government guidelines as yet do not acknowledge this issue or provide appropriate guidance – a clear example of following far behind the science.
Government strategy is reliant on the development of effective treatments and a vaccine; this in part explains the half-hearted approach to contact tracing. Lessons learned in the pandemic have reduced the numbers of patients that die once admitted to hospital, and this relates to use of oxygen delivery via a tube in the nose rather than one in the windpipe requiring the patient to be paralysed with drugs and breathing performed by a ventilator machine. Studies have also shown that giving a powerful anti-inflammatory steroid drug improves survival. As the number of patients has fallen considerably, less pressured staff also have more time to give better quality care. There is no basis for the suggestion that coronavirus has become less virulent; if it were to mutate, there is also the possibility it may become more rather than less harmful. The most likely explanation for rising case numbers overall with little change in hospital admissions and deaths is the fact that new cases are now predominantly in younger, fit people, who are much less likely to develop severe disease.
A vaccine is being presented as a ‘silver bullet’ that is just around the corner, however this is not the right message to give. There are estimated to be 170 research teams working on developing a vaccine, and nine products have reached large scale trials. To frame vaccine development as some kind of race increases the risk that a vaccine which is not very effective or has serious side effects will be rushed into use and public trust destroyed as a consequence. This would be hugely damaging and illustrates the importance of good public health messaging and the imperative of not compromising on safety through political pressure to deliver or the thirst for company profit. More important to bear in mind, there has never been an effective vaccine against a coronavirus just as there has never been an effective vaccine developed against HIV.
10. Fairy tales and reality checks
The Westminster government continues to choose to stumble on through the pandemic in the hope that a vaccine or effective treatment will arrive like a knight in shining armour, effect a rescue and bring us back to what was once normality. There is precious little reason to think that this is a sound strategy. Its cavalier approach to managing this unprecedented health emergency has included closing down Public Health England on spurious grounds – likened to taking the wings off a malfunctioning aeroplane in mid-flight in order to ensure a safe landing. Basic demands from the public must continue to be for an effective FTTIS system, nationally coordinated but locally delivered and aimed at complete disease suppression; much improved testing, including local testing units and rapid turn around of results; investment in NHS infrastructure and ending the obsession with inefficient and expensive private contracts; honesty and transparency to win public trust and unite the young and old in a common purpose. Sadly, a conservative government characterised by antagonism to public services and one that prioritises business interests over public health is unlikely to be either self critical and learn from experience or to implement positive changes such as those outlined above. The price for wearing such ideological blinkers will be more suffering and more economic damage as COVID-19 once again inevitably spreads like wildfire through our communities. Perhaps it is only a massively increased death toll that will make it change course.