Tens of Thousands of Avoidable Deaths Due to The Government’s Callous Indifference to the effects of Covid 19

June 1 2020 heralded the official start of the easing of the lockdown that has been in place since 23rd March to try to contain the spread of Covid 19.

The current reality is that due to the Westminster Government’s repeatedly vague and confusing messaging, compounded by their unwavering support of the Prime Minister’s rule breaking Chief Advisor, Dominic Cummings, people are already relaxing social distancing.

We have now known about the threat from Covid 19 since January this year, and through the lens of the media watched it heading our way via Iran, Italy and other countries. The UK had more time than most to prepare, however this opportunity was squandered by the Westminster Government.

Instead of learning from the experience of other countries and making sure that key workers had sufficient personal protective equipment and that time honoured locally coordinated test, trace, isolate and support programmes were in place to contain the spread of the virus, Boris Johnson glibly announced that the UK’s strategy would be one of developing herd immunity (a form of indirect protection from disease that occurs when a large percentage of the population has become immune) and that we should prepare ourselves for our loved ones to die.

Soon after, Imperial College published modelling which showed the NHS would be overwhelmed by Covid cases if more stringent measures were not put in place.

The Government publicly abandoned their herd immunity strategy and the UK went into lockdown. Over two months later, following a shockingly high peak in early April, the daily death rate and reporting of new cases has declined significantly, but not enough to suppress the virus to a level that makes it safe to start to open up schools and businesses.

The much heralded national contact tracing scheme is beset with problems and unlikely to be up and running (let alone working well) before the end of June at the earliest. Meanwhile, local projects are being held back, starved of resources and undermined.

We must ask ourselves why our Government have careered from one position to another during the Covid 19 crisis, seemingly out of control and always on the back foot. They, like anyone else, can be forgiven for the odd mistake, but this has had the appearance of a complete shambles.  They have the more conservative of the best scientific minds at their disposal and experience from other countries which were beset by the virus before the UK to draw on.

So why has their response been so seemingly incompetent and why are they now insisting that it is safe to ease lockdown when the evidence suggests that this will trigger another viral surge? Could this be construed as akin to corporate manslaughter?

We believe that the Westminster Government has been forced by events to address the health of the public in this crisis but has done so through gritted teeth because it is at odds with their ideological programme of dismantling the welfare state. For them the crisis is also an opportunity to expose more public services to privatisation.  This is why they have so vigorously prevented NHS laboratories and local public health teams from expanding their services appropriately to meet the demands of the pandemic, instead choosing to  contract with Tory-contributing, multinational, outsourcing agencies like SERCO despite the fact that these companies’ incompetence and corruption in providing health care are well known.

Easing lockdown may “stimulate” the economy, but in the process thousands, if not tens of thousands of lives, especially those of the elderly, will be sacrificed as the virus surges again.

This is disgraceful and callous. Lives are far more important than profit.

We have said before that lockdown should not be eased until

  • Proper locally coordinated test, track, isolate and support systems are in place and shown to be working
  • There is financial support so workers do not lose income if they need to isolate
  •  There is adequate ongoing supply of appropriate PPE for all key workers

None of these things are yet adequately in place.

History shows that pandemics have lethal subsequent waves.

We believe that to end lockdown in the current circumstances will lead to huge numbers of avoidable deaths as the virus surges again. When these deaths occur the question must inevitably arise – ‘was this corporate manslaughter?’

There is no rationale to the behaviour of the Westminster Government other than to put profit before people – we demand a change in strategy to put the health of the people first.

Doctors in Unite 7 June 2020.

References:

  1. https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea68b5
  2. https://www.theguardian.com/world/2020/mar/12/uk-moves-to-delay-phase-of-coronavirus-plan
  3. Britain Drops Its Go-It-Alone Approach to Coronavirus – Own Matthews, Foreign Policy 17/03/20
  4. https://www.theguardian.com/commentisfree/2020/may/28/coronavirus-infection-rate-too-high-second-wave
  5. https://www.bbc.co.uk/news/health-52473523
  6. https://www.theguardian.com/commentisfree/2020/may/28/ppe-testing-contact-tracing-shambles-outsourcing-coronavirus
  7. https://www.bbc.co.uk/news/health-52284281
  8. https://doctorsinunite.com/2020/05/25/isolate-trace-and-support-is-the-only-safe-way-out-of-lockdown/
  9. https://doctorsinunite.com/2020/05/18/testing-times-require-radical-solutions/
  10. https://www.history.com/news/spanish-flu-second-wave-resurgence
  11. https://www.theguardian.com/world/2020/may/31/did-a-coronavirus-cause-the-pandemic-that-killed-queen-victorias-heir

‘Isolate, trace and support’ is the only safe way out of lockdown

Doctors in Unite believe that comprehensive, publicly coordinated and community based ‘isolate, trace and support’ procedures are vital for control of the COVID-19 pandemic as lockdown is eased.

To keep the frequency of new cases in the community manageable people must be supported to self isolate once they are identified as potentially infectious. To this end it is imperative that there is no loss of income for those who need to self isolate through having been in contact with an index case.

To control the spread of COVID-19 the government must commit to maintaining people’s income so that they are not compelled to work when they should be in isolation. The financial burden should not be directly placed on companies as many of them would simply walk away from the obligation, though of course, companies should contribute properly through corporation tax. 

We call on Unite and the Trade Union movement in general to support our demand and to actively lobby the government to ensure that it is met.

Public Health and Primary Care

In January 2019, Doctors in Unite issued proposals relating to public health and primary care. This document has now been revised.

In the light of COVID-19 the authors believe that if these proposals had been implemented before the pandemic struck then the UK would have been able to respond much more quickly to the need and would have been in a much stronger position to plan and deploy local responses.

The government has allocated significant resources into protecting the front line of the NHS at the level of hospital services, with particular investment in the building of Nightingale hospitals. However, it has put almost no additional resources into primary care or community services to deal with COVID-19.

We believe that strengthening primary care and community services as laid out in our paper would mitigate the effects of COVID-19 for five main reasons:

1. Those working in primary care should look after populations and communities as well as individuals and their families. Dual training and accreditation for GPs and nurses in public health and primary care is essential. Neighbourhood public health leads would co-ordinate appropriate local responses to a pandemic, for example, by supporting people at home with COVID-19, isolating them and contact tracing in ethnically and culturally appropriate ways.

2. Primary Care Networks of GP practices should be funded to provide care home and appropriate domiciliary care during the pandemic. Community organisations should be integrated with primary care, which during theCOVID-19 lockdown could deliver food, medicines and other essential items as well as provide support for isolation, loneliness and respond to mental health issues.

3. We support a social prescribing model, which in normal times encourages patients to go out, meet people, socialise and stay active; during a pandemic this is necessarily amended, and patients are asked to stay in and not meet people, but to still socialise, keep in touch with others and remain active.

4. We develop the idea of local democracy through Neighbourhood Health Committees which would organise appropriate medical, psychological and social care, led by public health leads working seamlessly with directors of public health who have authority and independence which has been devolved from central control.

5. We propose professionally independent public health advocacy so that the people can trust the advice and information they receive.

Read the full paper here

Testing times require radical solutions

We believe that the failure of the UK government to properly coordinate testing for COVID-19 has contributed to the UK suffering the highest death toll in Europe.

Countries that have had lower mortality adopted robust testing strategies early on.

Testing centres are not local to where most people live. A common stipulation is that they must be driven to. If someone is unwell or doesn’t own a car this makes the testing centres inaccessible.

Reliable testing is dependent on when, in the course of the illness, the test is taken. There is a false negative rate of around 30%. To be meaningful, testing must be frequently repeated.

Countries that were early adopters of the fundamental public health principles test, trace, isolate, support and integrate have had much lower mortality from COVID-19.

If lock down is to be relaxed and there is the possibility that schools may fully re-open, it is imperative that robust, locally run testing and contact tracing takes place. Failure to do this could let the virus tear through a community and cause another surge in cases and deaths, something that the NHS and social care services are ill equipped to cope with.

The danger in schools is not so much children becoming unwell, as the virus being shared and spread back into the community. Although schools have re-opened in Denmark, they were one of the first countries to close schools. On March 15th Denmark had no deaths from the virus and just 137 people in hospital for treatment.

The modelling in Denmark used to inform policy was based on the assumption that children spread the infection at the same rate as adults, and had no ability to social distance. The government’s openness and cooperation with the teaching unions led to a situation of mutual trust. Denmark and the UK are very different. While lessons should be learned, they must be the right lessons.

Contact tracing apps may have their place as part of a comprehensive testing policy. They cannot be relied upon on their own, and they should not involve the central holding of personal data.

The government and Public Health England failed to act in February while it was clear the pandemic was spreading globally. There was an opportunity to set up robust testing which was missed, even though local councils already have the infrastructure to test and contact trace – they already do this for tuberculosis, STIs and outbreaks of food poisoning.

Primary care services have adapted very quickly and risen to the challenges of COVID-19. Local GP ‘hot clinics’ could be used as testing sites. Many areas have set up home support services for those who are unwell, but not ill enough to warrant hospital admission.

Support workers deliver pulse oximeters to measure oxygen saturation levels and contact unwell people with a daily phone call. This could easily be adapted to test, trace, isolate, support and integrate.

Instead the government has turned to the likes of Serco to coordinate testing – judged on their past performance, Serco should not serve this crucial role.

We support the pilot lead by retired doctors in Sheffield and believe that, in the absence of a coherent plan from the government, local councils should invest in and roll out similar initiatives.

The infrastructure to test and analyse is available in NHS hospital laboratories – but the government has chosen not to use these in England. Instead, this is outsourced to private laboratories, which do not integrate with general practices as NHS hospital labs do. Test results are not communicated to GPs who could act on them to limit the local spread of coronavirus. A key public health resource is being squandered.

Awarding contracts to the private sector is familiar pattern by this government. It is an ideological strategy rather than one based on what is best for the public, when evidence suggests that outsourcing can lead to chaos and a loss of life. The government is using a public health crisis to accelerate an agenda of privatisation – in the context of the continuing talks of trade deals with the US where we are told, but do not believe, that the NHS is “off the table”.

We demand:

  • Locally coordinated and robust testing, tracing, isolation, support and integration.
  • The use of existing local authority infrastructure upscaled with the necessary government investment.
  • The use of NHS hospital labs for local testing and effective transmission of results to GPs.
  • Repeated testing due to high false negative rates.
  • The use of retired health workers to provide clinical support, and furloughed workers to help to administer the community systems.

Our exit from lockdown must be safe and sustainable

The UK has been in lockdown since March 23rd 2020 in an attempt to slow down the spread of COVID-19. Six weeks on the number of new cases per day has begun to decrease and the government and businesses are clamouring to restart the UK economy. We believe that people’s health should come before profit and that there should be no return to work until it is safe to do so.

The UK has the highest death toll from COVID-19 in Europe. Data does not support that it is yet safe to relax physical distancing.

We may have reached the peak, but there were still nearly five thousand new cases diagnosed on May 3rd. As access to testing has been so poor it is impossible to know how many other people in the community are infectious.

We cannot undertake any meaningful planning for an exit strategy from the current lockdown without an understanding of COVID-19’s prevalence and our current levels of immunity.

On April 2nd Health Secretary Matt Hancock promised to test 100,000 people daily by the end of the month. The government claims to have reached their target though there are allegations that the tally was artificially boosted.

Testing must be safe, freely available and reliable and must be accompanied by rigorous contact tracing.

True prevalence is proving hard to predict. Where one study suggests 75% of people infected may be asymptomatic, another reports a very low rate of current infection – less than 1% of the tested population.

The only way out of this is to gather data and learn the truth.

Epidemiological studies of appropriately sized, randomised cohorts repeated every few weeks would chart the progress of the disease.

Cuts to public health have made it virtually impossible to mount coordinated local responses to COVID-19 with testing, isolating and contact tracing. Restoring and updating local communicable disease control is an integral part of properly funded, publicly provided health and social care.

The lack of appropriate PPE is an ongoing problem in public facing jobs and this will only be exacerbated as more people return to work. Industry must be immediately repurposed to produce appropriate PPE in sufficient quantities.

If people are to return to work it must be safe for them to do so, including during their commute.  

Each workplace should undergo appropriate risk assessment to prevent unnecessary transmission of the virus. We do not believe that the government can be trusted to do this. Trade unions must have oversight. For example, it should be up to the education trade unions to determine whether it is safe to open schools and the criteria that will need to be met. Schools must not be seen by the government and businesses as convenient childcare to enable a kick-start to the economy. We support the NEU’s demands that schools should only be opened when it is safe to do so.

COVID-19 has highlighted the importance of a nationally coordinated, publicly provided health and social care service. The NHS has excelled itself in coping with the crisis whereas the largely privatised, for profit care home sector, which has no central coordination, has been tragically unable to prevent COVID-19 from taking a huge toll on its residents.

It is well known that there is a spike in morbidity and mortality from all causes when a pandemic hits and services focus on the crisis in hand. 

The private health sector must not be allowed to profit from this. The private sector should be requisitioned if they are needed to help to clear the backlog. Matt Hancock, Secretary of State for Health and Social Care promised that “we’ll give the NHS whatever it needs and we’ll do whatever it takes”. 

The NHS needs investment to deal in-house with the waiting lists inevitably generated by the crisis, and investment must be ongoing to preserve NHS resilience. One of the lessons from COVID-19, and most winter flu epidemics, is that the NHS cannot be run flat out all year round without headroom and spare capacity to cope with peaks in demand.

New infrastructure, such as software for arranging work rotas, is increasingly outsourced to the private sector. This is unnecessary and could easily be managed within the NHS.

Neither must health care be rationed to cope with the backlog. We reject the blanket use of the term ‘Procedures of Limited Clinical Value’. Patient care must be decided individually on clinical need and not restricted due to financial pressures.

Deprived populations have very high death rates. Society’s response to COVID-19 has disproportionately affected those from BAME communities, the poor and vulnerable.

The UK is one of the most unequal societies in the world. While the more affluent are able to isolate in comfortable homes with plenty of outside space the poorest often have to share beds and go without food – for them physical distancing is impossible. Many epidemiologists, including Sir Michael Marmot, have demonstrated that the more unequal a society is the less healthy it is for everyone, including the richest. Health Equity in England: The Marmot Review 10 Years On, published only two months ago by The Health Foundation, is a damning indictment of Government policy. 

Many other commentators suggest ways to redress the imbalance, but successive Tory governments have largely ignored them. If these measures had been introduced it would have been much easier to contain COVID 19. We demand that Marmot’s original recommendations to be fully implemented.

We believe that people’s health must not be sacrificed in the interests of profits. There should be no return to work until it is safe to do so. Ordinary people must not be made to pay for the crisis – there must be no return to austerity. The UK is a rich country and there is plenty of money in society to ensure that everyone’s needs are met. If the banks could be bailed out in 2008 the people can be supported properly now. A Green New Deal would help to provide a more sustainable economy and a Universal Basic Income would help orientate us towards a fairer society based on need not profit.

Before lock down ends there must be:

  • Freely available testing with contact tracing which is rigorously followed up, and the restoration and updating of local communicable disease control.
  • Frequent epidemiological studies of appropriately sized, randomised community cohorts to determine the prevalence of COVID-19. 
  • Sufficient supplies of appropriate PPE for all public facing workers.
  • Trade union oversight on the safety of return to a particular workplace, and trade union control of the safety aspects such as physical distancing.

Longer term there must be:

  • A sustainable, green economy based on need not profit, with no return to austerity.
  • No exploitation of the backlog in care by the private sector to boost their profits.
  • A comprehensive national health and social care service, publicly funded, publicly provided and free at the point of delivery for all in the UK with adequate investment and an end to outsourcing, privatisation and fragmentation.

Schools must not reopen without clear evidence and widespread agreement that this is safe

As a paediatrician, I share the grave concerns of nurse Ian Wilson who has two children at school in Lewisham and experience of working with covid-19 infected patients. In an open letter to Health Secretary Matt Hancock last week, he pleaded that we were not enrolled against our will in a giant experiment that could go tragically wrong, pointing out that forcing hundreds of people into small rooms in small buildings was self evidently nonsense during a pandemic (1). Nothing has changed since this letter was first published on the 20th April, other than some additional worrying scientific evidence from Germany supportive of keeping schools closed (2). This work has shown that children with mild symptoms have just as high viral loads as sick adults, considerably undermining the suggestion sometimes made that somehow children would be less infectious. It is now clear that you need neither symptoms nor coughing in order to spread disease if you are an asymptomatic carrier, since droplets are produced simply by talking (3).  In close proximity, pupils would not only spread infection among themselves and teachers, but also carry the virus home to family members and vulnerable relatives.

Terrible though it is for children not to be able to go to school, and with all the attendant risk of negative impact on current health and wellbeing as well as long term prospects, there should be no reopening of school unless it is absolutely safe to do so. Not only that, teaching staff through their union representatives must also agree it is safe, and the decision cannot be left to education secretary Gavin Williamson alone. Social distancing is clearly a concept that would not be grasped by young children, and schools are usually busy and crowded places with narrow corridors and other bottle necks herding pupils together. It is absolutely right for vulnerable children to be at school at the present time, when relatively low numbers can be managed safely. More attention needs to be given to ensuring that these children are actually at school as many appear to be staying away. There are now covid free hospitals where elective surgery is being performed and perhaps this points the way forward for educational establishments. It would clearly require intensive testing and monitoring. In the meantime, more thought should be given to helping children particularly from poor backgrounds to `access study materials, for example through the loan of computers. On line learning to support home teaching has made huge strides but can also be further refined and developed. Psychological support for children should also be made available through the NHS and delivered via the internet.

  1. https://www.theguardian.com/education/2020/apr/20/thousands-urge-uk-government-to-keep-schools-closed
  2. https://www.theguardian.com/world/2020/apr/30/coronavirus-scientists-caution-against-reopening-schools
  3. https://www.nejm.org/doi/full/10.1056/NEJMc2007800?query=TOC

John Puntis is Co-chair Keep Our NHS Public