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BAME & Inequalities COVID-19 H&S at work HSE Transmission

BAME frontline workers should also get priority for Covid-19 vaccine

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

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COVID-19 Government Guidelines Testing Transmission TTIS

Mass testing in Liverpool – more questions than answers

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.

Best wishes

Dr Jackie Applebee, Chair, Doctors in Unite

Letter to Liverpool MPs:

https://allysonpollock.com/?page_id=3345

BMJ blogpost by Dr Angela Raffle

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COVID-19 DiU and Unite Government Policy H&S at work HSE Staying safe Transmission TUC H&S Workplace COVID

Doctors in Unite support Independent SAGE’s emergency 10-point plan to stop a national lockdown

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.

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Speech by Dr Jackie Applebee, Chair of Doctors in Unite to the BMA Annual Representative Meeting, 15 September 2020

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

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COVID-19 Defend the NHS Government Guidelines Government Policy Hospitals and IPC Masks PPE Privatisation Schools Social Care Testing Transmission TTIS Zero COVID and Government Strategy

COVID-19 update 7 September 2020 – still stumbling along

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.

3. Disillusionment

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.

8. Treatments

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.

9. Vaccine

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.

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THE ROLE OF AIRBORNE SPREAD IN FACTORY OUTBREAKS OF COVID-19

Workers and local communities are not to blame; responsibility lies with employers, regulatory agencies and government

Summary

It seems nearly every day there is another outbreak of Covid-19 in Britain’s factories, in the food processing industry, in the garment industry and elsewhere.  It is increasingly clear that working conditions in the factories are largely responsible for the outbreaks, in particular by means of airborne spread of Covid-19.  In contrast spread between workers outside the factory and in local communities plays only a small part.  The timing, circumstances and pattern of the outbreaks, points to them being typical “super-spreader events”, caused by airborne spread of the virus within the same enclosed indoor space of the factory, from one or two infected individuals to large numbers of other workers.  The actions of workers themselves play only a minor role in these outbreaks; the task before us is to urgently take measures to address the airborne route of spread, not only in factories but in all workplaces and schools, if we are to reduce outbreaks.   

The spread of Covid-19 in indoor spaces is extremely difficult to prevent entirely.  There is in reality no such thing as a “Covid-safe” workplace or school, unless transmission in the community is eliminated.  The rate of community transmission will determine what happens in our workplaces and schools and a national “Zero Covid” strategy is therefore essential.  We can make indoor spaces safer by hygiene measures, distancing, wearing masks and proper ventilation.  We should be spending as much time talking about ventilation as we do the other measures.  The Health and Safety Executive, the Food Standards Authority and other regulatory authorities have a crucial role in ensuring this is done properly; so far we have heard very little from them during the whole of the Covid-19 pandemic.

This briefing discusses airborne spread and the lessons we need to learn from super-spreading events which have occurred here and in other countries.  This is all the more urgent as we head into autumn and winter when we all move indoors to a much greater extent. 

Contents

  1. Airborne spread of Covid-19
  2. Greencore outbreak
  3. Tönnies meat packing plant study
  4. Preventive measures taken by Tönnies and lessons learned
  5. Growing evidence and consensus around aerosol spread
  6. Workers and local communities are being scapegoated for factory outbreaks caused by airborne spread
  7. Epidemiological studies
  8. A trade union programme
  9. Doctors in Unite
  10. References

1. Airborne spread of covid-19

The British Medical Journal published a leading article on 22 August on airborne spread of Covid-19  [1], which summarises what is now very convincing evidence for aerosol transmission through the air.  The article says that current official guidance, which says transmission occurs only through contact and droplet spread and that aerosols are produced only during so called “aerosol generating procedures” in hospitals, does not withstand scrutiny, and gets in the way of much needed measures to combat the virus.  The authors state, “Heavy breathing, coughing, talking, and singing all generate aerosols……This has important practical implications for infection control, the prevention of outbreaks and superspreading events, and for the new social behaviours that are being implemented in an effort to control the pandemic.”  

The article states that airborne spread is now the plausible cause of super-spreader events, and it seems very likely that several outbreaks here in the UK, for example Greencore in Northampton, the garment factories in Leicester, meat and poultry packing plants in Wales and West Yorkshire and Coupar Angus in Scotland have been just such events.  It is striking that according to press reports, in some of the outbreaks employers insist they have been fully implementing all recommended workplace safety measures. Greencore is a case in point: the company stated, “All of Greencore’s sites have wide-ranging social-distancing measures, stringent hygiene procedures and regular temperature checking in place”.  Yet nearly 300 people working there were still infected. 

2. Greencore outbreak

It is instructive to look at the Greencore outbreak in some detail, to ascertain how the virus spread.  It is unlikely that a large number workers breached handwashing and distancing measures at the factory all within a few days, especially as management says they are so careful.  It is also implausable that community transmission carried infection into the factory to such a large extent.  This would mean a large number of discrete, small outbreaks in the community all at the same time, and very many more cases in the community outside the factory, which does not appear to have happened.  In fact, the BBC reports [2] that “Testing data and analysis from the Joint Biosecurity Centre shows the spike is “almost solely down” to the outbreak at Moulton Park-based Greencore, which employs 2,100 people”.  The timing of the outbreak indicates instead a typical super-spreader event.  The graphs below demonstrate this clearly; one is of the Greencore outbreak: there was a low and steady number of cases in the Northampton area until mid-August when there was an abrupt jump in cases – over 200 within 3 days; a typical super-spreader pattern.  The second graph is of the super-spreading event in a call centre in Seoul in March 2020, and shows a similar pattern: 94 out of 216 employees working in an open plan office on the same floor became infected over a few days in this outbreak.

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Seoul call centre outbreak early March 2020 Source: Park et al, Emerging Infectious Diseases CDC https://wwwnc.cdc.gov/eid/article/26/8/20-1274-f1

We have appended below a press photograph of the Greencore factory floor: assuming this accurately portrays current working conditions, there are lots of people sharing the same, indoor space for many hours at a time each day.  We have no information about the ventilation in the factory, but food processing plants are usually kept cool for hygiene reasons, and colder temperatures favour the survival of the SARS-CoV-2 virus.  The ventilation often also involves recirculation of colder air in such plants, at least in part, rather than complete air changes with fresh outside air.  Even with several air changes per hour it seems that some live virus can still be present in the air indoors (see below).  And the direction of ventilation and air flow within the space is also important; it may carry the virus from an infected worker towards others. This is thought to have happened in the well documented restaurant outbreak in Guangzhou. [13]  

We do not know if the photograph reflects recent practise, but if so, the lack of mask wearing is striking. Greencore workers told the local press they were “terrified” of being required to work while they awaited test results for Covid-19, and were told it was up to them if they wanted to wear a face mask or not. [14]

3. Tönnies meat packing plant studyIt is helpful to look at a detailed study of a similar super-spreading event also in the food processing industry – at the Tönnies meat packing plant in Germany in June. [3 – not peer reviewed as yet]. The study analysed a range of possible factors involved in the outbreak, including the timing of infection events, spatial relationship between workers in the meat processing plant, climate and ventilation conditions, sharing of living quarters and transport, and performed full viral genome sequences (i.e. genetic fingerprinting) from virus recovered from PCR-confirmed SARS-CoV-2 cases. The viral sequencing established that spread was from a single index case within the factory to other workers, and not from multiple entry points by different workers bringing infection into the plant.  It also established that shared accommodation and transport did not play a material role in the outbreak.  Over a 3 day period, 29 workers out of 147 who worked the same shift as the index case became infected before the index case was quarantined.  60% of workers within an 8m radius of the index case became infected.  In addition, before the workers caught in the first outbreak were quarantined, they had had contact with others elsewhere in the factory, which led to a secondary outbreak leading to over 1500 workers becoming infected in the Tönnies factory overall.  This led to a lockdown of a large area in the North Rhine-Westphalia region in western Germany.

3. Tönnies meat packing plant study

It is helpful to look at a detailed study of a similar super-spreading event also in the food processing industry – at the Tönnies meat packing plant in Germany in June. [3 – not peer reviewed as yet]. The study analysed a range of possible factors involved in the outbreak, including the timing of infection events, spatial relationship between workers in the meat processing plant, climate and ventilation conditions, sharing of living quarters and transport, and performed full viral genome sequences (i.e. genetic fingerprinting) from virus recovered from PCR-confirmed SARS-CoV-2 cases. The viral sequencing established that spread was from a single index case within the factory to other workers, and not from multiple entry points by different workers bringing infection into the plant.  It also established that shared accommodation and transport did not play a material role in the outbreak.  Over a 3 day period, 29 workers out of 147 who worked the same shift as the index case became infected before the index case was quarantined.  60% of workers within an 8m radius of the index case became infected.  In addition, before the workers caught in the first outbreak were quarantined, they had had contact with others elsewhere in the factory, which led to a secondary outbreak leading to over 1500 workers becoming infected in the Tönnies factory overall.  This led to a lockdown of a large area in the North Rhine-Westphalia region in western Germany. 

The diagrams below are reproduced from the study and show:  A: the distance between the index case (B1) and spread to other workers; diagram B shows the relationship of distance to infection risk and diagram C shows that spread within the factory was the cause of the outbreak and not shared accommodation or car pools.  A full description of these findings is in the paper at reference [3].

It is worth quoting from this study at length:

“Aerosols are believed to be particularly important in cases where a single source transmits the virus toa large number of individuals, so-called super spreading events. Whereas droplets typically travel no farther than 2 m, aerosols can stay in the air for prolonged periods of time and may deliver infectious viral particles substantially beyond 2m distances, especially in indoor settings with low fresh air exchange rates. Factors such as temperature, humidity and air circulation are thought to significantly influence stability and transport of droplets and aerosols and consequently transmission efficiency.

Meat processing plants have recently emerged as hotspots of SARS-CoV-2 around the world. This is thought to result not only from operational practices (e.g. close proximity of workers in the production line combined with physically demanding work that promotes heavy breathing), but also from sharing of housing and transportation that may facilitate viral transmission. The requirement to operate at low temperature in an environment with low air exchange rates is another factor that may promote spread of the virus among workers.

Transmission occurred in a confined area of (the) meat processing plant in which air is constantly recirculated and cooled to 10°C. ……. Analyzing housing and commuting parameters, along with spatial and climate conditions in the work area, this study provides evidence that transmission occurred over a radius of at least 8 meters around the index case…… Physical work and relatively low fresh air exchange rates together with continuous re-circulation of cooled air may have favoured the transmission of SARS-CoV-2…

The universal point of potential contact among all cases was work in the early shift of the beef processing plant. The shift comprises 147 individuals, most of whom work at fixed positions in a conveyor-belt processing line……

….. while some secondary infections may have occurred within apartments, bedrooms or carpools, our collective data strongly suggest that the majority of transmissions occurred within the beef processing facility, with (index) case B1 being at the root of the cluster.

Our findings indicate that a physical distance of 2 meters does not suffice to prevent transmission in environmental conditions such as those studied here; additional measures such as improved ventilation and airflow, installation of filtering devices or use of high-quality face masks are required to reduce the infection risk in these environments.

Our findings suggest that the facilities’ environmental conditions, including low temperature, low air exchange rates, and constant air re-circularization, together with relatively close distance between workers and demanding physical work, created an unfavourable mix of factors promoting efficient aerosol transmission of SARS-CoV-2 particles.

It is very likely that these or similar factors are also responsible for current worldwide ongoing outbreaks in other meat or fish processing facilities. The recurrent emergence of such outbreaks suggests that employees in meat or fish processing facilities need to be frequently and systematically screened to prevent future SARSCoV-2 outbreaks. Furthermore, immediate action needs to be taken to quarantine all workers in a radius around an infected individual that may significantly extend beyond 2m.

In contrast to work-related exposure, shared apartments, bedrooms, or carpools appear not to have played a major role in the initial outbreak described in this study. Nevertheless, later viral transmission within shared living quarters or work rides very well may have been a confounding factor in context of the second, larger outbreak occurring one month after the first outbreak. Our genotyping results are fully compatible with the hypothesis that this second outbreak was seeded by cases related to the initial cluster.

The significance of this study is imminent for the meat and fish processing industry but might well reach beyond these industries, and points to the importance of air quality/flow in confined spaces to prevent future superspreading events

Common operational conditions in industrial meat processing plants promote the risk of SARS-CoV-2 superspreading events. Additional measures such as improved ventilation, optimized airflow management, installation of filtering or ultraviolet light devices or the use of high-quality face masks are required to reduce the infection risk in these environments.”

Community spread and spread among workers outside the factory have been pointed to as the cause of the Greencore outbreak.    This seems to be mere supposition rather than any evidence-based assessment for such spread.  The Tönnies study involved a similar group of workers, i.e. workers sharing accommodation and transport, and specifically looked at these issues and disproved them as the reason for the outbreak.  There is a lack of awareness and therefore no consideration of the role of indoor aerosol spread driving factory outbreaks, which perhaps explains why the press, public and even health experts look for possible explanations outside the factory gates.

4. Preventive measures taken by Tönnies and lessons learned

The study reports that the company took the following measures after the outbreak:

  • Hygiene regulations and one-way traffic in hallways were reinforced.
  • An internal multi-lingual information campaign was started to raise awareness for all staff of prevention and self-detection of early COVID-19 symptoms.
  • Temperature checks were set up to check all employees entering the building.
  • Workers were made aware of the availability of testing and were motivated to report any events where they see themselves being at risk. Staff were tested based on self-reported symptoms, possible contacts to other infected persons, returning to work after more than 96 hours absence from work, or possible work place contact with infected colleagues.
  • Work place assessments were performed to see if it was possible to extend distances between workers.
  • Simple one-layer face masks were made compulsory.
  • Regulations to prohibit rotation between working places were imposed.  (Shift workers were employed by an outsourcing company who had changed their workplaces according to demand by the employer.)
  • Measures in the canteen were imposed to reduce physical contact and to ensure that workers would spend their break times exclusively with workers from their own shift.
  • Implementation of the measures was audited within a month by unannounced inspections of the Occupational Health and Safety Experts of the competent authority. 

There are a number of important lessons from this study:

  • Airborne spread is particularly important in super-spreader events;
  • Aerosols can carry virus much further than 2m indoors;
  • Temperature, humidity and air circulation (fresh air exchange rates) significantly affect stability and transport of droplets and aerosols and therefore transmission;
  • Close proximity of workers on the production line doing physically demanding work and therefore breathing heavily also facilitate transmission. (Other studies have pointed to rapid “line speeds” as an additional contributing factor);
  • Early quarantine of possible contacts is essential to limit spread;
  • Shared accommodation and transport did not play a significant role in this outbreak; the common factor was working together on the factory floor under these conditions;
  • Improved ventilation and airflow, installation of filtering devices, and use of face masks are required to reduce the infection risk in these environments, and in other workplaces which have enclosed indoor spaces.
  • Large secondary outbreaks can occur from an initial outbreak in a factory.  Press reports indicated an increased number of cases in the surrounding community as well (but this may have been due to increased testing).
  • There is a need for surveillance testing in high risk environments like food processing plants, given the large number of super-spreading events which have occurred in them.
  • In addition to measures like hygiene, social distancing and temperature monitoring, multi-lingual information campaigns, compulsory face masks and rapid access to testing are important.
  • Inspection by regulatory authorities is important to ensure compliance.

While there have also been numerous outbreaks in the hospitality sector, especially linked to pubs, the workplace appears to have now become the frontline in the battle against Covid-19, both here and across the EU. [4]  [5] 

5. Growing evidence and consensus around aerosol spread

Aerosol scientists, mainly in the US but also in Australia and elsewhere, and here in the UK (e.g. Professor Catherine Noakes at the University of Leeds, who sits on SAGE), have been convinced for some time that aerosol spread is a major route of transmission.  In July, 239 scientists wrote to the World Health Organisation (WHO) asking it to recognise airborne spread and amend its guidance.  WHO did shift its previous rejection of the idea and said aerosol spread “cannot be ruled out”.  Since then there has been further evidence, including the successful culturing of live virus from the air up to 4.8m from infected patients in hospital rooms.  (A surprising and concerning finding was that the rooms had fairly good ventilation rates as well as UV light air sterilisation, but live virus was still able to be cultured from the air.)  [6]

Meanwhile official documents from SAGE have referred to aerosol transmission on a number of occasions, [7] [8] and some professional associations’ guidelines now include advice on the risks of aerosol spread; for example, the Primary Care Respiratory Society says that routine assessments of patients by means of spirometry should be avoided due to the risk of droplet and aerosol spread.  [9]

Aerosol spread is officially recognised in Germany and Japan and recently the French employment minister, Elisabeth Borne, stated that compulsory mask wearing from 31 August in France, “reflects a growing scientific consensus that the virus is transmitted not only in big drops projected when a person coughs or sneezes, but also in smaller ones suspended in the air breathed out by infected people that accumulates in enclosed spaces”. [10].  Nicola Sturgeon spoke of the risk of aerosol spread in schools in Scotland on 24 August, stating her government was considering face coverings for secondary school students in communal areas.  [11]

In the US a number of institutions are actively looking at ventilation requirements in indoor spaces, using CO2 monitors as a proxy measure for adequacy of ventilation, and the addition of portable air filters to make indoor spaces safer, including in schools and universities.  A clear and practical article on this from the University of Colorado is at reference [12]. 

6. Workers and local communities are being scapegoated for factory outbreaks caused by airborne spread

We have seen in Leicester and other areas of the Midlands, accusations that outbreaks in factories have been due to workers and/or local communities failing to observe social distancing measures.  There has been racist scapegoating of Asian communities, blaming them for local spikes in infection caused by factory outbreaks (in the Leicester garment factories for example), which very likely have involved airborne transmission.  We have seen a social media post about the Greencore workers saying, “I don’t feel bad for most of the staff. The Eastern Europeans never followed regulations like distancing and not mixing in large groups in lockdown in March onwards. They don’t care.”  The role of airborne spread needs to be understood, and communicated to all concerned during these outbreaks.  Ignorance of how Covid-19 spreads is leading to victim-blaming of people who become infected, when attention should be directed to employers, public health officials and government for solutions.

It is notable that in many of these large outbreaks, workers are poorly paid and are on insecure short-term contracts.  Many receive only Statutory Sick Pay; as a result they have had to rely on food banks, and some have lost their homes as they could not afford to pay rent.  All workers forced to take time off due to having Covid-19 or having been a close contact of an infected person should receive full pay while isolating.  Not doing so is inhumane, and is obviously also self-defeating, as some workers will go to work like those who were made to do so at Greencore while awaiting test results, and thereby compromise efforts to curtail the outbreaks.  The government’s recent derisory offer of £13 per day for workers having to isolate is clearly wholly inadequate. It has been described as “a slap in the face” by a Council leader, and also only applies to areas with already high infection rates.  This is clearly wrong, we want to prevent infection rates going up, not reacting when they have already become high.  A proactive, preventive approach is needed.

7. Epidemiological studies

We believe it would be also be very helpful if detailed epidemiological studies, like the one done in the Tonnes meat packing plant, could be conducted in future outbreaks here in the UK, to better understand and learn from them.  Hopefully some are being done but we have yet to see any of these.

8. A trade union programme

  • Employers must recognise airborne spread as a covid-19 risk and take action to assess and minimise risk.
  • Improved ventilation and airflow, installation of filtering devices, and use of face masks are required to reduce the infection risk in these environments, alongside other safety measures against Covid-19.
  • Trade union supervision and control of workplace safety.
  • Weekly surveillance testing on site of all workers, including management, in addition to easily accessible testing for anyone with symptoms or in contact with Covid-19.
  • All workers forced to take time off due to having Covid-19 or having been in contact with it should receive full pay while isolating.  No-one should have to work while awaiting test results for symptomatic or contact testing.

9. Doctors in Unite

We are a national doctors’ trade union within Unite the Union; our members include working and retired GPs and hospital doctors and dentists from a range of specialties, as well as public health doctors and non-medical public health specialists, from across the four nations of the UK.  We are party to the BMA negotiating machinery by virtue of an agreement with the BMA dating from 1950 and are the only medical trade union recognised in local government. We have been involved throughout the pandemic, both in our day jobs, and also raising issues around PPE, “Covid-safe” workplaces and campaigning on the critically important requirement for locally based ‘Find, Test, Trace, Isolate and Support’ services run by the DPH in each borough.

We will also continue to lobby for a change to official guidance around transmission of Covid-19, although with the abrupt axing of PHE this may be difficult.   

10. References

[1] https://www.bmj.com/content/370/bmj.m3206

[2] https://www.bbc.co.uk/news/uk-england-northamptonshire-53860426

[3] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3654517

[4] https://www.ecdc.europa.eu/en/publications-data/covid-19-clusters-and-outbreaks-occupational-settings-eueea-and-uk 

[5] https://www.thelocal.fr/20200803/office-not-parties-biggest-source-of-coronavirus-contagion-in-france 

[6] https://www.medrxiv.org/content/10.1101/2020.08.03.20167395v1

[7]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/887618/EMG_Environmental_transmission-_02052020__1_.pdf

[8]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/894961/6.6731_CO_Review_of_two_metre_Social_Distancing_Guidance_FINAL_v3_WEB_240620.pdf

[9] https://www.pcrs-uk.org/sites/pcrs-uk.org/files/Diagnosis%20of%20asthma%20and%20COPD%20during%20Covid.pdf

[10] https://www.theguardian.com/world/2020/aug/18/global-report-france-tightens-mask-rules-as-covid-cases-rise-europe

[11] https://www.theguardian.com/uk-news/2020/aug/24/seventeen-teachers-at-dundee-school-contract-covid-19

[12] https://theconversation.com/how-to-use-ventilation-and-air-filtration-to-prevent-the-spread-of-coronavirus-indoors-143732

[13] https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article#tnF1

[14] https://www.northantslive.news/news/northamptonshire-news/greencore-staff-lift-lid-fears-4443310?fbclid=IwAR3ZzlExqOP-JzOXanlJgmeQTr7zqmhomNfEtjdRm3bSCigTKRxfyioYxig

Categories
COVID-19 Zero COVID and Government Strategy

We need a Zero coid-19 strategy now: say over 200 health and social care workers

Over 200 health and social care workers, from across the entire spectrum of specialties and grades of staff have signed an open letter addressed to Boris Johnson, calling on him to set out a coherent strategy that will effectively tackle the Covid-19 pandemic in England.  They include professors, consultants, GPs, nurses, therapists, administration staff, theatre porters, paediatricians, psychiatrists and mental health nurses, obstetricians and midwives, haematologists, laboratory staff, radiologists, respiratory physicians; healthcare assistants, psychotherapists, administrators, chief executives, occupational therapists, pharmacists, immunological researchers, clinical directors, senior lecturers, social workers, palliative care specialists, speech and language therapists.

The letter states that slogans like “stay alert”, “control the virus” and “whac-a-mole” do not constitute a strategy.  Given the terrible cost of the pandemic, both in terms of lives lost and lasting damage to the economy, we call on you urgently to set out an explicit strategy in relation to Covid-19”.  The letter says there is a clear choice, between mitigation, i.e. accepting ongoing infections and deaths indefinitely until a vaccine or cure is found, or suppression, i.e. aiming to eliminate the virus.  The letter says that the latter course clearly represents the best strategy in terms of both public health and protecting the economy.

The letter goes on, “This means having a much more ambitious target of suppressing the number of new cases to zero as soon as possible, and keeping it there.  This requires continuing public health measures, such as maintaining social distancing, universal use of face masks in enclosed spaces, sensible travel restrictions, and setting up countrywide community based, efficient and rapid ‘find, test, trace, isolate and support’ infrastructure across the country, including at our borders.  If done effectively and comprehensively this would successfully suppress the virus in a matter of weeks, and then keep it there.”

Dr Jackie Applebee, Chair of Doctors in Unite, the group who organised the letter, said “We cannot continue to drift on this rudderless course any longer.  Flare ups like Leicester and in the meat and poultry packing plants show the dangers of this approach and if there are enough of these there will be a second wave, forcing us all back into lockdown.”  Independent SAGE have called for a “Zero Covid” strategy; it is perfectly possible to suppress the virus in England as they have done in Scotland, with the right approach. For that to happen though we need an effective test, trace, isolate and support service, based in the community and run by Directors of Public Health, not the ineffective privatised and separate service we have now.

We ask the government, yet again, what is your strategy?

You can read the original letter here:

https://doctorsinunite.com/2020/06/21/open-letter-to-the-prime-minister-about-the-uks-covid-19-strategy-from-nhs-and-social-care-workers/?fbclid=IwAR0cIjKXS54H4cEFZHnfOW3WWG_SGe72ZS13T9bgjCjeeq-yHzbYi6nigpM

Categories
BAME & Inequalities COVID-19 DiU and Unite Staying safe Transmission Workplace COVID

Doctors in Unite Statement: Government guidance on shop opening and return to work is unsafe

We believe easing of the lockdown, and the active encouragement to return to work, is premature and unsafe given the high rate of ongoing infection1, that the R0 value is very close to, and in some areas is above 1 and the test, trace and isolate system is months away from being properly functioning.  In addition, the return to work will disproportionately expose lower paid and BAME workers to increased risk of Covid-19 infection, the very groups who have already been hit so hard by this deadly disease.

The return to work however is being implemented by the government and indeed further plans are to be announced shortly, so it is important to look at the guidance.  There is separate guidance for schools which will not be discussed here, however the general principles will apply to schools too.

The government’s guidance for 8 sectors of the economy, “Working safely during coronavirus”2 gives us serious cause for concern.   It fails to take into account the way Covid-19 transmission occurs indoors, the time spent in enclosed spaces and the need to ensure proper ventilation.  The very high risk faced by BAME staff is not mentioned.  The guidance also downplays the importance of face coverings as well as weakening the 2m rule, making it advisory rather than a requirement.  There is frequent use of the phrase “whenever possible” throughout the guidance, creating uncertainty and allowing room for employers to choose whether or not to implement the provisions.  There is sensible advice in the guidance, such as the need to carry out a risk assessment of the workplace, on home working and on handwashing, use of sanitisers and cleaning and disinfection.  However these do not make up for the many deficiencies, which will result in people who work in offices, shops and other enclosed work places up and down the country, doing so in unsafe conditions and being exposed to Covid-19. 

Indoor transmission of Covid-19

Apart from early “super-spreader” events outdoors, transmission of Covid-19 is essentially an indoor phenomenon3, both through droplet spread and microdroplet aerosol spread4.  The 2m rule is of limited value: if people occupy the same enclosed space for any length of time, and ventilation does not meet required standards, aerosolised viral particles from an infected individual can spread through the available space and may be breathed in by anyone occupying that space.  A single cough can project over several metres, tens or even hundreds of millions of viral particles into the air5 and will contribute to the creation of an “aerosol rich environment” in an enclosed space.  The longer people occupy this space the greater the risk of inhaling sufficient viral load to get infected.  Even if strictly observed, the 2m rule will not offer sufficient protection in this situation. 

A number of studies have shown that enclosed indoor environments can result in high levels of transmission.6, 7, 8 They show one or two infected individuals can lead to a large number of other people being infected, even if they are several metres away from each other. 

Ventilation

The consideration of ventilation in the guidance is inadequate and vague, and fails to take into account the challenges of making indoor spaces safe from Covid-19. It does say face-to-face meetings should be held “outdoors or in well-ventilated rooms whenever possible.”  There is no mention of ventilation however in relation to workplaces and workstations, where large numbers of workers will spend most of their day.

Improving ventilation is mentioned in the government’s guidance for transport operators, as follows: “Organisations should consider how to increase ventilation and air flow. Where possible, transport operators and businesses should ensure that a fresh air supply is consistently flowing through vehicles, carriages, transport hubs and office buildings.”   Once more we see “where possible” and there is also a distinct lack of detail about the technical requirements for effective ventilation to eliminate this highly infectious new pathogen from public transport provision.  This will not lead to safe conditions for travel for the public.

Organisations with ventilation systems are advised to check them to see if they require servicing or adjustment “for example, so that they do not automatically reduce ventilation levels due to lower than normal occupancy levels.  Most air conditioning systems do not need adjustment, however where systems serve multiple buildings, or you are unsure, advice should be sought from your heating ventilation and air conditioning (HVAC) engineers or advisers.”  There is no technical guidance here about type of ventilation required, and issues like the number of air changes per hour etc.  And what of premises were there is no ventilation system?

The absence of guidance on ventilation is all the more surprising given the detailed advice on this from Public Health England: “Covid-19: Infection prevention and control guidance”.9 While this is written for health care settings and much of the detail is not applicable, the facts of known asymptomatic spread of Covid-19, the aerosol route of transmission of the virus, and the ongoing high level of community infection mean that all indoor spaces are a potential hazard.  The general principles of this guidance should therefore apply to all indoor spaces, but they do not appear to have been considered, apart from that stated above.

BAME staff

Nowhere in the guidance is the very high risk from Covid-19 for BAME people mentioned.  Death rates are 4 times as high for some BAME groups, yet section 2.1 in the guidance for shops, on “Protecting people who are at higher risk” makes no mention of this.  The risk of dying from Covid-19 for people with diabetes, (included in the “clinically vulnerable” group of the population requiring extra protection) is exceeded by that for people of a BAME background.  This cannot be right, and as long as serious risks like this are not addressed, the current high death rates will continue.

Social distancing

There is over-reliance in the guidance on the 2m rule to keep workers safe, and as we have said, throughout the guidance this is weakened by the phrase “where possible”.  Where 2m distancing is not possible employers should “manage transmission risk” by among other things, “using back-to-back or side-to-side working whenever possible”.  Sitting side-by-side or back-to-back will not prevent people from breathing in aerosolised virus, as the studies clearly demonstrate, and people do not rigidly stick to one head position, they move around and turn especially when speaking to those around them.  This weakening is consistent with the constant drip feeding in the media suggesting that the 2m rule is not really essential, compromising the social distancing message overall still further.

A recent study in the Lancet showed that reducing distances is associated with increased risk: infection risk doubles when the distance between people is halved from 2m to 1m10.

Face coverings

The government’s recent about turn on the wearing of face coverings is welcome, as belated as it is.  However, the advice on face coverings in the return to work guidance almost seems to be designed to put people off from wearing them: “There are some circumstances when wearing a face covering may be marginally beneficial as a precautionary measure.”  Again, this is reproduced throughout the guidance documents. 

We recognise there will be some areas and job roles, and for some individuals, where it is not practical or advisable, but face coverings should be worn everywhere in the workplace as a means of source control for transmission of Covid-19, unless there is a demonstrable reason not to do so.

Duration of time, activity levels and size of work space

These three further risk factors for indoor transmission are also not considered in official guidance.  The longer the time people spend together in an enclosed space the greater the risk of inhaling sufficient virus to become infected.  Similarly, the smaller the space the greater the risk.  In addition if people are highly active, for example through physical exertion leading to heavy breathing, or laughing or shouting, excretion of virus is significantly increased from infected individuals, adding to risk of infection in an enclosed spaces.

Conclusion

Official guidance on return to work is inadequate and will leave very many people exposed to risk of infection with Covid-19.  Making workplaces safe in the era of Covid-19 is nigh impossible given the scale of changes required with ongoing high levels of viral transmission in the country.  The only way to keep people safe at work is to drive down transmission to much lower levels and have in place a reliable and highly efficient test, trace, isolate and support system.  Current government plans are very risky and threaten to drive a second wave of the pandemic in the UK.

References

  1. Estimated to be 17,000 new infections per day by the MRC Biostatistics Unit on 5 June 2020. https://www.mrc-bsu.cam.ac.uk/now-casting/
  2. https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19
  3. https://www.medrxiv.org/content/10.1101/2020.04.04.20053058v1.full.pdf
  4. https://science.sciencemag.org/content/early/2020/05/27/science.abc6197
  5. https://www.pnas.org/content/early/2020/05/12/2006874117
  6. https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article#tnF1
  7. https://wwwnc.cdc.gov/eid/article/26/8/20-1274_article
  8. https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak
  9. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/886668/COVID-19_Infection_prevention_and_control_guidance_complete.pdf
  10. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931142-9

Doctors in Unite Statement, 10/06/2020

Categories
COVID-19 Defend the NHS Government Guidelines Privatisation Staying safe Transmission TTIS

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
Categories
COVID-19 DiU and Unite H&S at work Schools Staying safe Transmission

Schools should not take in more pupils on 1st June unless it is safe to do so

On the 7th May, Doctors in Unite expressed its full support for the National Education Union’s five tests before schools could take in more children and colleges re-open. In brief, these tests were:

  • Far lower numbers of COVID-19 cases
  • A national plan for social distancing
  • Testing, testing, testing
  • Whole school strategy for testing in the event of infection
  • Protection of the vulnerable

However, it is now expected that primary schools will accommodate many more pupils from the 1st June, although the prime minister has acknowledged that some will need more time for preparation. The government anticipates that England’s schools are likely to be fully reopened by September this year, while only year 10 and 12 – pupils in their first year of GCSE and A-level studies – will be able to meet their teachers from 15th June.

Although numbers of coronavirus patients are falling, on 28th May there were still 1,887 new cases recorded. One cause of considerable anxiety is that plans to reopen schools more widely have failed to address the increased risk to BAME pupils and staff. Early figures on COVID-19 showed that 35% of almost 2,000 patients in intensive care units were black or from another minority ethnic background, despite BAME people making up only 14% of the population.

On a positive note, there has been a huge and welcome rise in the number of teachers becoming union members, and many parents also remain concerned about safety and are skeptical of government reassurances. Two recent opinion polls showed that 60% of parents were not prepared to allow children back to school. Teachers have rightly been critical of the government for being fixated on a date rather than focusing on ‘how’ schools are to manage the return of pupils.

In fact, government thinking on schools is difficult to fathom not least because the scientific advice on which it is based is still not being made fully public. This issue prompted Sir David King, previously the Government’s Chief Scientific Advisor, to set up an independent Scientific Advisory Group on Emergencies. The Independent SAGE takes a refreshingly honest and open approach, welcoming critique and public discussion, and includes a broad range of scientific specialists. It’s second report is a model of clarity and deals with the question of schools.

The report begins by stating: “The issue of schools reopening during COVID-19 does not just have implications for pupils; it also has knock-on effects for adult staff, parents and the communities and locality from which pupils come from”. Schooling is absolutely essential for children, but must be balanced against the risk to themselves and others. The report also asserts: “We believe that decisions on school opening should be guided by evidence of low levels of COVID-19 infections in the community and the ability to rapidly respond to new infections through a local test, track and isolate strategy. There is no clear evidence that these conditions are met. Until they are it is not safe to open schools on June 1”.

Unfortunately ‘tracking and tracing’ systems are only just now becoming operational and there are likely to be many teething problems not least because of a very top down government approach and the involvement of the private sector. Local initiatives such as in Sheffield are providing both a model approach and important lessons, but have already demonstrated that simply asking contacts of cases if they would not mind self isolating for two weeks is unlikely to work unless the teams actually have the authority to insist. While the government is already thinking ahead to possible financial penalties for those who do not comply with a polite request, they would be better providing financial support at the level of wages rather than the derisory statutory sick pay that is a disincentive for people to stay at home.

There are many things that could be done to ensure children’s education is re-established by preparing school environments for social distancing, and providing better hand washing and toileting facilities. All schools are different and teachers have the necessary insights here. Local knowledge, including rates of infection is essential to inform decisions and some schools will be able to open to greater numbers of pupils more quickly than others. The role of local public health officials is also hugely important and is only now being acknowledged. The development of an effective ‘track and trace’ system is both essential for an easing of lockdown and clearly some weeks if not even months away.

The education unions have put out a joint statement to call for the Government to step back from the 1st June and to work with unions to create the conditions for a safe return to schools. The key elements are fully supported by Doctors in Unite and are as follows:

  • Safety and welfare of pupils and staff as the paramount principle
  • No increase in pupil numbers until full rollout of a national test and trace scheme
  • A national COVID-19 education taskforce with government, unions and education stakeholders to agree statutory guidance for safe reopening of schools
  • Consideration of the specific needs of vulnerable students and families facing economic disadvantage
  • Additional resources for enhanced school cleaning, PPE and risk assessments
  • Local autonomy to close schools where testing indicates clusters of new COVID-19 cases

Dr John Puntis is the co-chair of Keep Our NHS Public, and a member of Doctors in Unite