“Thanks to all those who continue to provide rapid feedback from their frontline experience. Also for the forensic questions you provide. You are helping the Labour Party challenge where needed”.

Brian Fisher ( SHA Chair )

EXPERIENCE FROM THE FRONTLINE 26 4 20

Social distancing at the Stanlow / Ellesmere Port petrochemicals plant is impossible as the staff need to work in pairs or larger teams to do their work, often one on top of another, that’s the nature of the work.  My contact thinks much of that work is un-necessary at this time, it is not just about securing the site etc.., but workers are threatened with losing their jobs if they don’t come in.  I have seen photographs of lunch or tea breaks during this emergency, with staff in high vis clothing sitting sardined together on benches at refectory type tables.

Even those with asthmatic conditions have been refused time out.  It looks to be completely irresponsible of management.  I understand similar situations are to be found at similar plants elsewhere in the country

Guide dog training has been stopped, so people waiting for a replacement dog or to have one for the first time cannot.  I know several elderly blind or partially sighted people in this situation who are now trapped at home, probably indefinitely.  They are aware that if they stop walking they may never start again as muscle tone and bone mass are soon lost without exercise

PPE

Masks for the public when going into public spaces. The govt appear frightened of this because of concerns that it will divert surgical masks away from hospitals. They are confounding PPE, expensive, scarce and required by carers to prevent their catching the virus, with simple face coverings, in cotton or linen, cheap, washable and effective at reducing onward transmission. Trisha Greenhalgh has done an excellent explainer that sets out the evidence on this:  https://www.fast.ai/2020/04/13/masks-summary/   It is endorsed as policy by the CDC   https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html

Sadiq Khan has also been ahead on this promoting cloth masks for the public on London transport.  There will need to be a lot of them – but textile companies are not selling many clothes and could churn out millions pretty quickly –  but they need to be asked. Govt thinks public not grown up enough to understand advice for cloth not surgical masks.  My view is that masking up in public will have to be an important component of any exit strategy – and they need to get on with it.


Locally I find from contacts that those who are doing care support in the homes do not seemingly have any kind of PPE at all which is not surprising but also alarming.

LA councillor

TESTING

We are waiting for ‘test test test’ but that is feeling as though it will be a very long wait.  While we are waiting we need to recruit and train an army of contact tracers.  This needs to start now, almost certainly through local authorities.


We shall have to do case detection syndromically if the necessary volume of testing is not available when transmission has fallen significantly through the lockdown, with whatever limited testing support is available. This will be easier as we leave the seasonal respiratory viruses behind.  It is not perfect, but perfection is not necessary, just reducing the transmission rate.


Given that TESTS are supposed to be the start of this action” chain “ it less than clear where this chain is supposed to start and how it will relate to any denominator population / geographical community. It is clear that Ag and Ab tests are not going to be available in local communities  through the 7500 GP practices in England in the foreseeable future .

So it looks like Govt expect the management of the pandemic, exit from lock down and the inevitable second pandemic wave to be done via:

  • our 50 mass drive in test centres – [ ie for that segment of the population which has cars ]  – so our understanding and contact tracing for spread will be the ill defined catchment areas of these test centres
  • and / or through home based test kits …..in which case it could be completely random / Brownian in shape / dynamics

How will home-based tests connect with the new army of contact tracers which is being recruited by PHE – and their “assault “ on the spread of the virus  in local communities but it seems essential to involve general practice in our response to  COVID . I suppose it depends on how important you believe community spread generated though care and nursing homes is at periods of high community transmission in which case Public Health England may get a grip with additional support.

It appears that there are currently no  plans nationally to use our unique infrastructure of 7500  general practices to do Covid 19 testing. In Birmingham during swine flu in 2009, GP consultations and reports provided public health / health protection agency with “ hot knowledge “ about new cases ;  did swab tests and  gave us insight into the geography of spread across the city during the containment phase.

Apparently Ribera Salud integrated health care model in Valencia Spain has been able to mobilise and use flexibly all health care staff [ public health , primary care and hospitals ] during this crisis.

 

QUESTIONS

Is the government prepared to cope with the wave of mental health problems which are about to hit us as we pass the peak? I work as a mentor of GPs and keep in touch with issues on the front line. I am actually more concerned about care workers who have not been trained in the same way as doctors and nurses. If doctors are struggling with what they are seeing, how will a care worker cope with the loss of their charges in the homes from this terrifyingly overwhelming illness? What support will be available for their mental health?

Have the 3 RAF aircrafts returned from Turkey with the PPE? Did the government lie / mislead the country last Friday? Can the government confirm when the order was placed? It’s been reported that the Turkish government say the order wasn’t placed until Sunday.

Can the Government confirm whether the story in the Telegraph today about a British firm exporting 750k pieces of PPE because the Government hadn’t got back to them is correct or not

Is there any country which has a reliable antibody test? 

What is the preparation for accelerating the implementation of the postponed electives, treatments etc. as we transition to “normal”? Also, how to research the status of people who have avoided presenting themselves to their GP or A&E? These need to be well managed.

Apparently 15,000 a day are flying into the country with little regulation while we are all self isolating at home. Not to mention the rich arriving at private airports. How can we not be restricting air traffic at this time?

What arrangements is the minister putting in place to strengthen local and regional public health management of continuing cases to prevent subsequent new waves of the epidemic? The containment phase was ended in Mid-March and  lockdown applied nationally, despite considerable variation of reported disease transmission regionally throughout the UK.

Posted by Jean Hardiman Smith on behalf of the Officers and Vice Chairs of the SHA.

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