Category Archives: COVID-19

Jeremy Corbyn wrote a long letter to Boris Johnson on 31st March.
As well as wishing him a speedy recovery, Jeremy made some strong points about aspects of the current crisis, and asked for immediate action on:

  • Full PPE now for Health and social Care workers
  • Test Test Test
  • Expand Social Care
  • Enforce Social-distancing and Protection
  • Bolster Support for Workers
  • Lead a Global Reponse

(the 4  pages of the letter are attached)

Posted by Jean Smith on behalf of SHA member Diane Jones.

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Unite national officer for health Colenzo Jarrett-Thorpe said: “At this time of national emergency caused by the coronavirus pandemic, it is right that the legal protections covering whistleblowers in the NHS are highlighted.
“Unite, which has 100,000 members in the health service, will be monitoring the situation very closely in the weeks ahead and will give maximum support to any member who may face disciplinary procedures as a result of raising legitimate concerns, for example, the lack of personal protective equipment (PPE).
“The current legislation protecting whistleblowers has been further underpinned by the NHS Staff Council statement of 28 February and the English Social Partnership Forum statement on 1 April.
“Any NHS worker that suspects they are being victimised for whistleblowing should contact their ‘freedom to speak up’ guardian which every trust in England should have in place. If they are a union member, they should contact their workplace representative or local union office.
“There have been anecdotal stories on social media that some NHS bosses may have been clamping down on those wishing to expose failings in the system and improve the well-being of patients. If we discover concrete evidence that this is happening, we will act immediately to support our members.”

The NHS Staff Council statement of 28 February 2020

https://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-reward/NHS-Staff-Council—Guidance-for-Covid-19-Feb-20.pdf?la=en&hash=70C909DA995280B9FAE4BF6AF291F4340890445C&hash=70C909DA995280B9FAE4BF6AF291F4340890445C

English Social Partnership Forum Joint Statement on Industrial relation – 1 April 2020

https://www.socialpartnershipforum.org/media/166314/SPF-Covid-19-statement-final-and-formatted.pdf

Protection for whistleblowers in the UK is provided under the Public Interest Disclosure Act 1998 (PIDA).The PIDA protects employees and workers who blow the whistle about wrongdoing.

For more information please contact Unite senior communications officer Shaun Noble

Email: shaun.noble@unitetheunion.org

Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.
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PROTECT ALL FRONTLINE HEALTHCARE WORKERS

31/03/2020 cllralanhall BlogPress Leave a comment

Personal Protective Equipment, known as PPE is in demand. There are reports that there is a shortage in hospitals and care facilities.

The Daily Mirror reports that hospitals listed as having shortages include Rotherham General Hospital, Bristol Children’s Hospital, Hillingdon Hospital in Uxbridge, Royal Devon and Exeter Hospital and at St Thomas, Lewisham and two other unnamed hospitals in London.

“The correct PPE must be made available at every site that might require it. This is vital in order to protect our patients but also to protect the lives of the life-savers.”
DAUK’s Dr Natalie Ashburner in @DailyMirror @nashburner#COVID19 #testNHSstaffhttps://t.co/Mhd2UISZeF

— The Doctors’ Association UK (@TheDA_UK) March 19, 2020

The view from the NHS frontline is explained here:

https://youtu.be/WphmagWsCUI

Dr Samantha Batt-Rawden, an intensive care doctor and president of the Doctors’ Association UK, told Nick Ferrari that more doctors will die unless they get proper equipment.

In a further twist, healthcare workers who raise their concerns are facing being “gagged”. Helen O’Connor, GMB says in The Guardian “It is scandalous that hospital staff speaking out publicly face being sacked by ruthless NHS bosses

who do not want failings in their leadership to be exposed. Suppression of information is not just a matter of democracy, it is now a major public health issue.”

The Local Government Association has sent a letter to the Secretary of State for Health, Matt Hancock MP. It says that there is an urgent need for Government to move faster in making PPE available for the adult social care sector. Sufficient supplies that are of acceptable quality are needed immediately. Councils and their provider partners also need concrete assurances about ongoing supplies for the days and weeks ahead.

Councillor Alan Hall has written to the Director of Public Health for Lewisham seeking reassurances for both hospital and social care staff locally. The full letter is below:

Catherine Mbema
Director of Public Health – Lewisham

Dear Catherine,

I have been informed that the lack of Personal Protective Equipment for cleaning staff at Lewisham Hospital is a real concern. Trade Unions say that there is a shortage of supply and that staff are very worried. It has been described as “a total nightmare”.

As the Public Health Lead across Lewisham, I would be very grateful if you could raise the shortage of supply with the NHS and the Hospital and reassure us that PPE will be available.

Whilst I write, personal carers have reported shortages and inadequacies nationally. Can an assurance that all Lewisham Council and NHS staff have been provided with effective PPE?

May I take this opportunity to thank you and your team for all the incredible work that has been placed upon you. I have always campaigned against Public Health cuts and the short sightedness of this is surely been borne out now.

Kind regards,

Alan

Cllr Alan Hall

In an article on the United Nation’s website, there is a chilling message:

“COVID-19 will not be the last dangerous microbe we see. The heroism, dedication and selflessness of medical staff allow the rest of us a degree of reassurance that we will overcome this virus.

We must give these health workers all the support they need to do their jobs, be safe and stay alive. We will need them when the next pandemic strikes.”

Please help: NHS Staff need adequate PPE now https://t.co/XLsLDNaz5g via @socialisthealth

— Alan Hall (@alan_ha11) April 1, 2020

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Britain’s charities and voluntary organisations urgently require a financial support package from government so they can play their part in the coronavirus fight  and help some of the most vulnerable affected by the pandemic.
The call came from Unite, Britain and Ireland’s largest union, today (Tuesday 31 March), which represents tens of thousands of not for profit workers, as charities experience a dramatic slump in funding at a time when demand for their services, from housing to mental health, is soaring because of the virus.
Unite has joined forces with the National Council for Voluntary Organisations (NCVO) in calling for emergency funding for the sector. The NCVO has estimated that the sector could lose £4.3bn in income over the next three months.
Unite national officer for the community, youth and not for profit sector Siobhan Endean said: “Our members are keen to play their part in combating the coronavirus which will impact on some of the most vulnerable in society. Demand for charities’ services, from housing to mental health, has greatly increased.
“The voluntary sector is facing a crisis in funding, while meeting an unprecedented demand to support our communities. Our members are working incredibly long hours, with a lack of personal protective equipment and under immense pressure.
“We need urgent action from the government to ensure that the voluntary and not for profit sector and those employed in it are protected amidst the current crisis we find ourselves in.
“That’s why Unite has joined forces with the NCVO to call for a comprehensive financial package to underpin the sector at this extraordinary time.
“Government has rightly identified our members as ‘key workers’ and that’s why chancellor Rishi Sunak must unveil specific measures to assist the sector as a matter of urgency.”
Unite and the NCVO are making these key demands:
  • Emergency Mobilisation funding for frontline charities and volunteers supporting the response to the coronavirus crisis in the UK and globally through grants with a swift application process.
  • A ‘stabilisation fund’ for all charities to help them stay afloat, pay staff and continue operating during the course of the pandemic which would be  administered through the National Lottery.
  • Confirmation that charities should be eligible for similar business interruption measures announced by the chancellor for businesses and access to government rescue schemes.

Unite senior communications officer Shaun Noble

 

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Health visitors and community nurses going into the homes of families with children and babies urgently require personal protective equipment (PPE), Unite, Britain and Ireland’s largest union, said today (Tuesday 31 March).
Unite also wants PPE to go to the thousands of staff working in social care settings, such as care homes, who feel forgotten by ministers.
Unite assistant general secretary Gail Cartmail said: “Health visitors and community nurses need PPE equipment today as they offer high-level professional advice on home visits to the parents of tomorrow’s generation of adults.”
Unite, which embraces the Community Practitioners’ and Health Visitors’ Association (CPHVA), has joined the chorus of frustration from unions and professional organisations over the slow roll-out of PPE to NHS staff.
Unite assistant general secretary Gail Cartmail said: “The government needs to provide urgently an immediate, adequate and free-flowing supply of PPE to the hospital and community sectors of the NHS.
“And ministers should not ignore the forgotten army of thousands of dedicated workers employed in social care settings, who are often low-paid.
“We urge a redoubled effort by ministers to cut through the logistics’ logjams and get this equipment to the frontline where our brave doctors, nurses and other healthcare professionals are risking their health to save others.
“It is sometimes forgotten that health visitors and community nurses are out there every day visiting parents in their homes offering excellent advice on new born babies and young children.
“And while it is generally accepted that children are relatively immune from Covid-19, they or their parents may unwittingly have picked up the virus.
“The health visitor and community nurse role is particularly important now as parents are, quite rightly, extra anxious about their own health and that of their children.
“The least we can do is to see that the community nurse workforce has the right protective equipment.”
Unite lead professional officer for health visiting Obi Amadi said: “Our community practitioner members are working really hard to provide services in the community. In many areas, they have been struggling to keep themselves and those they are visiting safe because of the lack of PPE.  There is also a reported lack of hand sanitisers.
“The health and care staff working in the community play a vitally important  role, but feel they have not had access to enough PPE, nor been sufficiently recognised for their tireless below-the radar efforts at this time of national emergency.”

 

Unite senior communications officer Shaun Noble

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The Socialist Health Association (SHA) published its first two Blogs on the COVID-19 pandemic on the 17th March and 24th March 2020. A lot has happened over the past week and we will address some of these developments from our political perspective.

  1. A global crisis

The pandemic continues to spread around the world and we are seeing that while Europe remains a global hotspot the epicentre is now shifting to North America. It remains to be seen how the Trump administration ‘handles’ the situation but global leadership and best practice will not emanate from the White House and we will need to look to those progressive State and City level leaders in New York City and California for examples of political leadership in a crisis.

The astonishing successes in tackling the pandemic seen in the Far East should still be sources of practical evidence of good practice. Despite the concerns about transparency in the Chinese system it remains an extraordinary achievement to have controlled the spread from the centre of Wuhan (population 11m) to be contained within Hubei Province (population 58m). A bit like London and the rest of the UK! The 1.4bn population of China have so far been exposed to relatively minimal spread. Some of the urban populations in China are huge such as Shanghai’s 24m people and the density and housing would be vulnerable to the spread of C-19. Our government talk of ‘contain’ and ‘delay’ and ‘suppress’ the coronavirus – well there is much to learn from Asia.

Whenever we see TV footage of the Chinese control measures, staff in public places are gowned, have masks and/or goggles and gloves. Clearly there is no shortage of PPE in China! Frequently you see officials challenging people in the streets and checking temperatures with the thermal imaging meters. Of course these screening measures are imprecise and the scientific evidence to support them is thin but we were told in the UK that the two key questions were – have you got a fever or a dry cough? We know that many people are symptomless when they first contract the virus and can be infectious but this does not rule out basic questions such as these delivered by lay workers to protect others in the streets/shops/surgeries/workplaces? People who have symptoms of a cough or fever are referred to diagnostic pods for advice and further testing. This does seem to be good public health control and is also used at airports and seaports, which have been pretty absent in the UK.

Test, test, test was the refrain from WHO leader Dr Tedros A. G. and one of the countries that has shown success in controlling the spread of C-19 is democratic capitalist South Korea where the population of 52m has had 9,583 confirmed cases with only 152 deaths by the 29th March. They have led the world in PCR testing for the presence of the virus with an estimated 316,000 tests done by 20th March. Germany is close behind with 167,000 tests done and the UK trails behind at 64,000 by the 19th March. It is basic communicable disease control methodology to identify probable cases by the history (symptoms/signs) and then have a test to confirm the case. If positive then there is contact tracing and cases are quarantined. It is still not clear why the PCR testing capacity was not scaled up in the UK during the time between the middle of January when the RNA code of COVID-19 was shared worldwide and March when demand for testing and containment accelerated. This is one of the key questions for the enquiry after the pandemic is over.  The relative lack of testing capacity has made the control measures here more difficult. The cases recorded here have, since abandoning the contain phase, been those presenting to hospitals rather than measuring the incidence in the community.

Attention is now moving towards rolling out the second test – the ‘have you had it?’ antibody test. This will not help in the early stages of the illness but will help confirm that people have actually had C-19 and will in most cases have immunity to the virus. This will give more confidence for NHS and Social Care and other essential workers to return confidently to their workplaces. This is in the evaluation stage but should be available soon and hopefully will not be held up. Getting scarce NHS and Social care workers, and other essential workers back to work is extremely important as is protecting them at work from contracting infections.

The pandemic is gradually spreading to India and down the African continent too. This will expose more at risk populations living on the edge economically, often in poor and unsanitary housing. We know that infection control measures will be difficult to undertake and the health services remain relatively weak in LMICs. As ever, social determinants of health and wellbeing will emerge as factors and the mortality will reflect the global inequalities we already know about.

So it was good to learn on the 25th March that the G7 countries have stated their support for the UN and WHO and committed some resources to help tackle the pandemic. The UK has offered £240m which if mirrored by other G7 countries will not get very far towards the WHO target of £71 billion for the immediate public health response and priority research. Lets hope that sufficient resources will flow but sadly the richest country in the world (USA) has had a recent track record of disinvesting from global organisations such as the UN and WHO.

As in the previous Blogs we support the research into novel treatments and the development of a vaccine but not to let that divert us from trying to delay the spread of the virus across our country by enforcing the stay at home and lockdown measures. We should continue to apply basic public health control measures, even within households, of isolating symptomatic people, strengthening hand washing and hygiene measures.

We also welcome the action that has been taken by some Local Authorities to provide accommodation for the homeless and rootless and also providing them with food and places to stay during the day, which reduces spread amongst this very vulnerable population. Lets make some of these initiatives set the pattern for tackling this issue in the post pandemic age.

 

  1. 2. The NHS and Social Care

The NHS has been ramping up their preparedness and we welcome the use of private facilities as part of the national response although we prefer that this is seen as requisitioning and not a favourable commercial contract for the private sector. We also welcome the creation of the emergency Nightingale Hospitals built in Conference centres and sports stadia in London, Birmingham, Manchester, Glasgow, Belfast and Cardiff . These new beds will be purpose built for COVID-19 caseloads but we note that they will need to be staffed by trained nurses and doctors. These new beds must be seen alongside the closure of an estimated 33,000 beds since 2008/9, which has weakened the NHS resilience and made the UK one of the European countries with the lowest beds/1000 population. For example Eurostat data for 2017 identifies ‘curative beds/100K population’ and shows that Germany had 601, France 309, Italy 262, Spain 242 and the UK 211. It is no surprise then that we see intensive care patients being airlifted from Italy and France to Germany. Germany’s testing control measures and its hospital bed capacity is part of the explanation for them appearing more in control of the situation with currently a comparatively low death rate.

We have seen a massive shift in the way that GP services are provided and how GPs and patients are adapting to telephone and videoconferencing. GPs are also playing a vital role in advising and supporting those receiving community care and have long term conditions. These vulnerable patients will be well known to their primary care teams and reliant on being able to get advice. It goes without saying that out of hospital care will be vital during the time when local acute hospitals are stressed with redesigning services to deal with acutely ill COVID-19 patients.

In terms of overall preparedness one does wonder whether the NHS was more prepared for Brexit than a pandemic!

The social and residential care sector in the UK will be a vital player as the pandemic rolls out with its particular risk for older people. The dynamic between social care and the NHS will be important as the NHS struggles and the transfer/admitting/discharge criteria change. Already the NICE guidance on criteria for intensive care has identified frailty explicitly as an issue to assess suitability to admit a patient.

As with other key services social and residential care staffing will be a challenge as recruitment and retention issues increase and staff stay off work to self isolate. The guidance on personal protective equipment (PPE) is being actively reviewed and both NHS and Social Care staff in the Community must be provided with appropriate protective equipment to match the cases that they are assessing in the community or actually caring for. This will become more important for primary care clinicians as well as social care staff asked to look after acute COVID-19 patients or those discharged for hospitals.

 

  1. Jobs and income

Clearly the pandemic has driven a coach and horses through the economy. The Chancellor’s proposals have been helpful and the proposals for the self -employed has moved a long way toward providing some security for this sector. The gig economy however is more difficult and the benefit system has been shown to be inadequate as a place to go for this group of workers. The SHA still feels that there is an opportunity to trial universal basic income as a mechanism to provide all citizens with assurance of having enough income for their health and wellbeing.

There are also concerns that without close Parliamentary scrutiny there are risks that the Tory government will award contracts to their people and the State revenues will be subject to fraudulent claims from off shore companies and global players who have been able over the years to duck paying tax. The SHA has always viewed a progressive tax system to be the route to funding necessary services and that tax dodging should be rooted out.

There may be a case now for a form of  Parliamentary scrutiny so Labour Shadow Ministers have sight of the details around awarding such huge amounts of public money to companies run by the Bransons and Dysons of this world. There is a positive movement underway shown by the selfless work of health and social care services and other essential workers. It is also exhibited by the clapping applause last Thursday and the 750,000 volunteers.

There should be an opportunity as we come out of this crisis to lay the foundations for a different type of society in the same way that after WW2 the incoming Labour party brought in such great reforms as creating the NHS and introducing State Education.

 

On behalf of the Officers and the Vice-Chairs of the SHA.

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COVID-19 and the NHS – “a national scandal”, comments the Lancet.

“The gravity of that scandal has yet to be understood.” Reports Richard Horton in the Lancet 28 March 2020 :

“When this is all over, the NHS England board should resign in their entirety.” So wrote one National Health Service (NHS) health worker last weekend. The scale of anger and frustration is unprecedented, and coronavirus disease 2019 (COVID-19) is the cause. The UK Government’s Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn’t follow WHO’s advice to “test, test, test” every suspected case. They didn’t isolate and quarantine. They didn’t contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The UK now has a new plan—Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come.”

Please read the full article here. You can download the pdf at this link.
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The Socialist Health Association (SHA) published its first Blog on the COVID-19 pandemic last week (Blog 1 – 17th March 2020). A lot has happened over the past week and we will address some of these developments using the lens of socialism and health.

  1. Global crisis

This is a pandemic, which first showed its potential in Wuhan in China in early December 2019. The Chinese government were reluctant to disclose the SARS- like virus to the WHO and wider world to start with and we heard about the courageous whistle blower Dr Li Wenliang, an ophthalmologist in Wuhan, who was denounced and subsequently died from the virus. The Chinese government recognised the risk of a new SARS like virus and called in the WHO and announced the situation to the wider world on the 31st December 2019.

The starter pistols went off in China and their neighbouring countries and the risk of a global pandemic was communicated worldwide. The WHO embedded expert staff in China to train staff, guide the control measures and validate findings. Dr Li Wenliang who had contracted the virus, sadly died in early February and has now been exonerated by the State. Thanks to the Chinese authorities and their clinical and public health staff we have been able to learn about their control measures and the clinical findings and outcomes in scientific publications. This is a major achievement for science and evidence for public health control measures but….

Countries in the Far East had been sensitised by the original SARS-CoV outbreak, which originated in China in November 2002. The Chinese government at that time had been defensive and had not involved the WHO early enough or with sufficient openness. The virus spread to Hong Kong and then to many countries showing the ease of transmission particularly via air travel. The SARS pandemic was thankfully relatively limited leading to global spread but ‘only’ 8,000 confirmed cases and 774 deaths. This new Coronavirus COVID-19 has been met by robust public health control measures in South Korea, Taiwan, Hong Kong, Japan and Singapore. They have all shown that with early and extensive controls on travel, testing, isolating and quarantining that you can limit the spread and the subsequent toll on health services and fatalities. You will notice the widespread use of checkpoints where people are asked about contact with cases, any symptoms eg dry cough and then testing their temperature at arms length. All this is undertaken by non healthcare staff. Likely cases are referred on to diagnostic pods. In the West we do not seem to have put much focus on this at a population level – identifying possible cases, testing them and isolating positives.

To look at the global data the WHO and the John Hopkins University websites are good. For a coherent analysis globally the Tomas Peoyu’s review  ‘Coronavirus: The Hammer and the dance’ is a good independent source as is the game changing Imperial College groups review paper for the UK Scientific Advisory Group for Emergencies (SAGE). This was published in full by the Observer newspaper on the 23rd March. That China, with a population of 1.4bn people, have controlled the epidemic with 81,000 cases and 3,260 deaths is an extraordinary achievement. Deaths from COVID-19 in Italy now exceed this total.

The take away message is that we should have acted sooner following the New Year’s Eve news from Wuhan and learned and acted on the lessons of the successful public health control measures undertaken in China and the Far East countries, who are not all authoritarian Communist countries! Public Health is global and instead of Trump referring to the ‘Chinese’ virus he and our government should have acted earlier and more systematically than we have seen.

Europe is the new epicentre of the spread and Italy, Spain and France particularly badly affected at this point in time. The health services in Italy have been better staffed than the NHS in terms of doctors/1000 population (Italy 4 v UK 2.8) as well as ITU hospital beds/100,000 (Italy 12.5 v UK 6.6). As we said in Blog 1 governments cannot conjure up medical specialists and nurses at whim so we will suffer from historically low medical staffing. The limited investment in ITU capacity, despite the 2009 H1N1 pandemic which showed the weakness in our system, is going to harm us. It was great to see NHS Wales stopping elective surgical admissions early on and getting on with training staff and creating new high dependency beds in their hospitals. In England elective surgery is due to cease in mid April! We need to ramp up our surge capacity as we have maybe 2 weeks at best before the big wave hits us. The UK government must lift their heads from the computer model and take note of best practice from other countries and implement lockdown and ramp up HDU/ITU capacity.

In Blog 1 we mentioned that global health inequalities will continue to manifest themselves as the pandemic plays out and spare a thought for the Syrian refugee camps, people in Gaza, war torn Yemen and Sub Saharan Africa as the virus spreads down the African continent. Use gloves, wash your hands and self isolate in a shanty town? So let us not forget the Low Middle Income Countries (LMICs) with their weak health systems, low economic level, weak infrastructure and poor governance. International banking organisations, UNHCR, UNICEF, WHO and national government aid organisations such as DFID need to be resourced and activated to reach out to these countries and their people.

  1. The public health system

We are lucky to have an established public health system in the UK and it is responding well to this crisis. However we can detect the impact of the last 10 years of Tory Party austerity which has underfunded the public health specialist services such as Public Health England (PHE) and the equivalents in the devolved nations, public health in local government and public health embedded in laboratories and the NHS. PHE has been a world leader in developing the PCR test on nasal and throat samples as well as developing/testing the novel antibody blood test to demonstrate an immune response to the virus. The jury is out as to what has led to the lack of capacity for testing for C-19 as the UK, while undertaking a moderate number of tests, has not been able to sustain community based testing to help guide decisions about quarantining key workers and get intelligence about the level of community spread. Compare our rates of testing with South Korea!

We are lucky to have an infectious disease public health trained CMO leading the UK wide response who has had experience working in Africa. Decisions made at COBRA and announced by the Prime Minister are not simply based ‘on the science’ and no doubt there have been arguments on both sides. The CSO reports that SAGE has been subject to heated debate as you would expect but the message about herd immunity and stating to the Select Committee that 20,000 excess deaths was at this stage thought to be a good result was misjudged. The hand of Dominic Cummings is also emerging as an influencer on how Downing Street responds. Remember at present China with its 1.4bn population has reported 3,260 deaths. They used classic public health methods of identifying cases and isolating them and stopping community transmission as much as possible. Herd immunity and precision timing of control measures has not been used.

The public must remain focused on basic hygiene measures – self isolating, washing of hands, social distancing and not be misled about how fast a vaccine can be developed, clinically tested and manufactured at scale. Similarly hopes/expectations should not be placed on novel treatments although research and trials do need supporting. The CSO, who comes from a background in Big Pharma research, must be seen to reflect the advice of SAGE in an objective way and resist the many difficult political and business pressures that surround the process. His experience with GSK should mean that he knows about the timescales for bringing a novel vaccine or new drugs safely to market.

  1. Local government and social care

Local government (LAs) has been subject to year on year cuts and cost constraints since 2010, which have undermined their capability for the role now expected of them. The budget did not address this fundamental issue and we fully expect that in the crisis, central government will pass on the majority of local actions agreed at COBRA to them. During the national and international crisis LAs must be provided with the financial resources they need to build community hubs to support care in the community during this difficult time. The government need to support social care.

COVID-19 is particularly dangerous to our older population and those with underlying health conditions. This means that the government needs to work energetically with the social care sector to ensure that the public health control measures are applied effectively but sensitively to this vulnerable population. The health protection measures which have been announced is an understandable attempt to protect vulnerable people but it will require community mobilisation to support these folk.

Contingency plans need to be in place to support care and nursing homes when cases are identified and to ensure that they can call on medical and specialist nursing advice to manage cases who are judged not to require hospitalisation. They will also need to be prepared to take back people able to be discharged from acute hospital care to maintain capacity in the acute sector.

Apart from older people in need there are also many people with long term conditions needing home based support services, which will become stressed during this crisis. There will be nursing and care staff sickness and already fragile support systems are at risk. As the retail sector starts to shut down and there is competition for scarce resources we need to be building in supply pathways for community based people with health and social care needs. Primary health care will need to find smart ways of providing medical and nursing support.

  1. The NHS

In January and February when the gravity of the COVID pandemic was manifesting itself many of us were struck by the confident assertion that the NHS was well prepared. We know that the emergency plans will have been dusted down and the stockpile warehouses checked out. However, it now seems that there have not been the stress tests that you might have expected such as the supply and distribution of PPE equipment to both hospitals and community settings. The planning for COVID-19 testing also seems to have badly underestimated the need and we have been denied more accurate measures of community spread as well as the confirmation or otherwise of a definite case of COVID-19. This deficiency risks scarce NHS staff being quarantined at home for non COVID-19 symptoms.

The 2009 H1N1 flu pandemic highlighted the need for critical care networks and more capacity in ITU provision with clear plans for surge capacity creating High Dependency Units (HDUs) including ability to use ventilators. The step-up and step-down facilities need bed capacity and adequate staffing. In addition, there is a need for clarity on referral pathways and ambulance transfer capability for those requiring even more specialised care such as Extracorporeal Membrane Oxygenation (ECMO). The short window we now have needs to be used to sort some of these systems out and sadly the supply of critical equipment such as ventilators has not been addressed over the past 2 months. The Prime Minister at this point calls on F1 manufacturers to step in – we wasted 2 months.

News of the private sector being drawn into the whole system is obviously good for adding beds, staff and equipment. The contracts need to be scrutinised in a more competent way than the Brexit cross channel ferries due diligence was, to ensure that the State and financially starved NHS is not disadvantaged. We prefer to see these changes as requisitioning private hospitals and contractors into the NHS. 

  1. Maintaining people’s standard of living

We consider that the Chancellor has made some major steps toward ensuring that workers have some guarantees of sufficient income to maintain their health and wellbeing during this crisis. Clearly more work needs to be done to demonstrate that the self-employed and those on zero hours contracts are not more disadvantaged. The spotlight has shown that the levels of universal credit are quite inadequate to meet needs so now is the time to either introduce universal basic income or beef up the social security packages to provide a living wage. We also need to ensure that the homeless and rootless, those on the streets with chronic mental illness or substance misuse are catered for and we welcome the news that Sadiq Khan has requisitioned some hotels to provide hostel space. It has been good to see that the Trade Unions and TUC have been drawn into negotiations rather than ignored.

In political terms we saw in 2008 that the State could nationalise high street banks. Now we see that the State can go much further and take over the commanding heights of the economy! Imagine if these announcements had been made, not by Rishi Sunak, but by John McDonnell! The media would have been in meltdown about the socialist take over!

  1. Conclusion

At this stage of the pandemic we note with regret that the UK government did not act sooner to prepare for what is coming both in terms of public health measures as well as preparing the NHS and Local Government. It seems to the SHA that the government is playing catch up rather than being on the front foot. Many of the decisions have been rather late but we welcome the commitment to support the public health system, listen to independent voices in the scientific world through SAGE and to invest in the NHS. The country as a whole recognises the serious danger we are in and will help orchestrate the support and solidarity in the NHS and wider community. Perhaps a government of national unity should be created as we hear much of the WW2 experience. We need to have trust in the government to ensure that the people themselves benefit from these huge investment decisions.

24th March 2020

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All hospital car parking charges for NHS staff in England should be abolished this week as they combat the coronavirus, Unite, Britain and Ireland’s largest union, said today (Monday 23 March).
Unite, which has 100,000 members in the health service, said that NHS trusts in England were charging employees an estimated £50-to-£200 a month for the privilege of parking at their place of work.
Unite contacted shadow Labour health and social care secretary Jon Ashworth this afternoon asking him to raise the issue of abolition of the parking charges for NHS staff for the duration of the coronavirus emergency with his Conservative counterpart Matthew Hancock.
Unite said such a move, ideally this week, would remove the additional worry for NHS staff concerned about travelling on restricted public transport networks.
Unite national officer for health Colenzo Jarrett-Thorpe said: “It is a long-standing Unite policy that NHS staff should not be charged to park their cars for coming to work to look after the sick, injured and vulnerable.
“This is even more important and relevant, given that NHS staff are already risking their lives round the clock to save those suffering from COVID-19.
“We have been in touch with Labour’s shadow health and social care secretary Jon Ashworth this afternoon asking him to raise this with his counterpart Matthew Hancock as a matter of urgency.  
“NHS staff don’t need the additional worry of parking, especially when there are restrictions on public transport and it is safer in these times to drive to work than risk infection on trains and buses. 
“Many NHS staff are not well-paid and the fact that NHS trusts in England  are charging them £50-£200-a-month to park in normal times is wrong – in this exceptional period of national emergency, it is doubly so.”
Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.
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I sent this letter to the Scottish First Minister and health spokesperson with the PQs attached and and copied it to Welsh First Minister and Health spokesperson.

21 March 2020

Dear Nicola and Jean,

I am writing as a public health physician who is increasingly concerned about the apparent failure to implement fundamental public health measures to address the COVID-19 outbreak – specifically, community contact tracing and testing – and about what seems to be one of the knock-on effects of this failure, namely the blanket closure of schools.   

Tracing and testing of contacts, isolation and quarantine are the classic tools and approaches in public health to infectious diseases. According to the WHO, they have been painstakingly adopted in China in response to the COVID-19 outbreak, with a high percentage of identified close contacts completing medical observation; and they have been strongly recommended by the WHO for other countries.

In England, there are a lack of data – contact tracing appears to have been adopted only initially. According to modelling conducted by the authors of one of the papers published by the government yesterday, ‘The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19) (Keeling et al.) they expect that it would enable the outbreak to be contained :
“Aggregating across all individuals and under the optimistic assumption that all the contact tracing can be performed rapidly, we expect contact tracing to reduce the basic reproductive ratio from 3.11 to 0.21 – enabling the outbreak to be contained (figure 2). Rapid and effective contact tracing can therefore be highly effective in the early control of COVID-19, but places substantial demands on the local public-health authorities.”

The basic reproductive ratio, R0, is a standard epidemiological construct for understanding the epidemic potential of an infection; the higher the ratio, the more difficult it will be to control its spread. Ideally, R0 should be 0. If R0 is less than 1, an infected person will transmit the infection to less than one other person, and so the epidemic potential is critically reduced. On the basis of this modelling, if contact tracing is not being rigorously conducted now, the possibility of critically reducing the epidemic would be missed. The Keeling paper when taken together with the New York academics Shen et al  critique  raises serious questions about the validity of  Prof Fergusson’s  model (whose apocalyptic numbers were was used by the Westminster government to justify its approach.)  

I am truly concerned that contact tracing, testing, quarantine and isolation have not been exhaustively carried out before taking the blanket decision to close all schools. I have sent the opposition spokespeople for health at Westminster some suggested PQs that my colleague Peter Roderick and I have drafted, which I attach.

It is important to note that many areas in Scotland and elsewhere have a low number of cases and so at this stage by taking an area approach to vigorous and meticulous contact tracing and testing it should be possible to contain the disease – in Singapore, the BBC reports that the army has been called in to help with this. This would in time, with other measures, allow local areas on a school-by-school basis to safely consider reopening – and uphold each child’s right to education.

One of the major differences in this outbreak is that the outbreak is being managed centrally rather than being coordinated centrally, with insufficient foot soldiers on the ground. In England local authorities and Directors of Public Health cannot tailor responses to the local situation and are subject to central policy decisions. My colleagues in public health in local authorities say they have received very little information. This, combined with the devastating cuts to community-based communicable disease control and the changes wrought by the HSC Act 2012 which carved out public health from health services in England and then further fragmented communicable disease control by removing it to PHE have created a perfect storm.

I urge the Scottish government immediately to institute a massive centrally-coordinated, locally-based contact tracing and testing programme; and to discuss with local authorities, health boards, trade unions, public health and communicable disease control experts, schools and colleges and universities how this tried-and-tested classic approach would, with other measures, enable the blanket school closure decision to be modified in favour of a locally-based strategy.    

Scotland has been a pioneer for public health measures –it is important to reassert its expertise.
 
Yours sincerely,
Allyson Pollock

Professor Allyson Pollock, Professor of Public Health, Faculty of Medical Sciences, Newcastle University



Suggested draft PQs to the Secretary of State for Health and Social Care on contact tracing and testing

Summary

Contact tracing, testing of contacts and isolation are the classic tools and approaches in public health to infectious diseases. They have been adopted in China in response to the COVID-19 outbreak, and have been strongly recommended by the WHO. In England, there is a lack of data – contact tracing appears to have been adopted only initially, whilst the authors of one of the scientific papers published by the government today state that they expect that it would enable the outbreak to be contained.  

China

In February 2020, 25 experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, the US and WHO undertook a 9-day Joint Mission on COVID-19 to China.
It stated the following on contact testing:

“China has a policy of meticulous case and contact identification for COVID-19. For example, in Wuhan more than 1800 teams of epidemiologists, with a minimum of 5 people/team, are tracing tens of thousands of contacts a day. Contact follow up is painstaking, with a high percentage of identified close contacts completing medical observation. Between 1% and 5% of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location.

For example:
• As of 17 February, in Shenzhen City, among 2842 identified close contacts, 2842 (100%) were traced and 2240 (72%) have completed medical observation. Among the close contacts, 88 (2.8%) were found to be infected with COVID-19.

• As of 17 February, in Sichuan Province, among 25493 identified close contacts, 25347 (99%) were traced and 23178 (91%) have completed medical observation. Among the close contacts, 0.9% were found to be infected with COVID-19.

• As of 20 February, in Guangdong Province, among 9939 identified close contacts, 9939 (100%) were traced and 7765 (78%) have completed medical observation. Among the close contacts, 479 (4.8%) were found to be infected with COVID-19” (pp.8/9).

During the second stage of the outbreak, “[m]easures were taken to ensure that all cases were treated, and close contacts were isolated and put under medical observation” (page 15).

It is not clear from the report whether all contacts were tested, though they were apparently quarantined. Contacts have been both tested and quarantined in Singapore, where the army has been called in to help with tracing, according to the BBC.

In considering next steps for other countries, the report states (emphases added):
“3. Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts,and an exceptionally high degree of population understanding and acceptance of these measures.

Achieving the high quality of implementation needed to be successful with such measures requires an unusual and unprecedented speed of decision-making by top leaders, operational thoroughness by public health systems, and engagement of society.

Given the damage that can be caused by uncontrolled, community-level transmission of this virus, such an approach is warranted to save lives and to gain the weeks and months needed for the testing of therapeutics and vaccine development. Furthermore, as the majority of new cases outside of China are currently occurring in high and middle income countries, a rigorous commitment to slowing transmission in such settings with non-pharmaceutical measures is vital to achieving a second line of defense to protect low income countries that have weaker health systems and coping capacities. The time that can be gained through the full application of these measures – even if just days or weeks – can be invaluable in ultimately reducing COVID-19 illness and deaths. This is apparent in the huge increase in knowledge, approaches and even tools that has taken place in just the 7 weeks since this virus was discovered through the rapid scientific work that has been done in China.”

The mission recommended countries outside China with imported cases and/or outbreaks of COVID-19 to “[p]rioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts” (page 21).
England

Blogs by PHE CEO (Duncan Selbie) and PHE’s Deputy Director, National Infections Service (Nick Phin) in mid-February state that contact tracing was being undertaken:
“PHE now has a very extensive and complex contact tracing operation underway with health protection teams around the country diligently talking to people that might have been in close contact with carriers of the virus to assess their risk, provide advice and ultimately prevent further spread.”
“So far in the UK we’ve seen a small number of novel coronavirus cases.  At the moment we undertake contact tracing to prevent the infection spreading further. Contact tracing is a fundamental part of outbreak control that’s used by public health professionals around the world.”

There was no statement that those traced would be tested, isolated or quarantined, and apparently this would be done only if the contact developed symptoms:
“When we get in touch with a contact we provide them with advice on what to do if they become unwell or develop certain symptoms.  This way they can speak to the right health expert, so that the right advice can be given and right action taken.
If we believe a contact is at higher risk of infection they may be asked to self-isolate, remaining in their home and staying away from work, school or public places and we contact them daily until they can be given the all-clear.
If the person being monitored does develop symptoms, we would test them and provide them with specialist care if they have the novel coronavirus.”
There is also an implication in Nick Phin’s blog that as more cases develop, less contact tracing might be undertaken (emphasis added):
“Our experts have considerable experience at using contact tracing to prevent and contain outbreaks and to keep the public safe.

However, it does involve a lot of resources so as part of our comprehensive approach to tackling novel coronavirus in the UK, we’re putting extra resources into our contact tracing efforts. If the virus becomes established in the UK then we mayneed to move to a different phase of the response which focuses less on containment – but we are a long way off that.”

Concern has been expressed about the UK’s approach to contact tracing and testing – see, for example,  Martin Hibberd, professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine, quoted in The Guardian on 12/3/20 as saying that “the UK’s response ‘has clearly not been sufficient’. He and other experts called for much more extensive testing and tracing of the contacts of those diagnosed with Covid-19”.

The government published today the scientific evidence supporting its COVID-19 response. According to modelling conducted by the authors of one of the papers published, entitled ‘The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19) (Keeling et al.) :
“Aggregating across all individuals and under the optimistic assumption that all the contact tracing can be performed rapidly, we expect contact tracing to reduce the basic reproductive ratio from 3.11 to 0.21 – enabling the outbreak to be contained (figure 2). Rapid and effective contact tracing can therefore be highly effective in the early control of COVID-19, but places substantial demands on the local public-health authorities.”

The basic reproductive ratio basic reproductive ratio, R0, is a standard epidemiological construct for understanding the epidemic potential of an infection; the higher the ratio, the more difficult it will be to control its spread. Ideally, R0 should be 0. If R0 is less than 1, an infected person will transmit the infection to less than one other person, and so the epidemic potential is critically reduced. On basis of this modelling, if contact tracing is not being rigorously conducted now, the possibility of critically reducing the epidemic would be missed.  

We have not been able to find any data on contact tracing, the testing of contacts, isolation or quarantine in any part of the UK, and have not been able to find any PQs on the subject so far (despite the hundreds already tabled).

Draft PQs (1) and (2) below are therefore aimed at obtaining those data for England.

Draft PQ (3) directly addresses the government’s response to the expectation of the Keeling et al. paper published today.

Draft PQ (4) has been prompted by personal knowledge and conversations with other public health professionals, and concern that public health expertise in infectious diseases and in disease control more generally has been disappearing in local areas. 

Draft PQ (5) is wider than testing of contacts, but cost may very well be a factor that might have contributed to a lack of testing, and so we have suggested framing the question more broadly.

Draft PQs


(1) To ask the Secretary of State for Health and Social Care if he will specify, by local authority area, the contact tracing that is currently underway in England in relation to those who have been, or are suspected as having been, infected or contaminated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including (a) the number of personnel carrying out such tracing and (b) the number of close contacts (i) identified and (ii) traced.

(2) To ask the Secretary of State for Health and Social Care if he will specify, by local authority area, the number and percentage of close contacts of those who have been, or are suspected as having been, infected or contaminated with the severe acute respiratory syndrome coronavirus  2 (SARS-CoV-2), who (a) are undergoing testing (b) have tested positive and (c) have been isolated or quarantined.

(3) To ask the Secretary of State for Health and Social Care whether he is ensuring rapid and effective contact tracing in relation to COVID-19, in light of the authors of the Keeling et al. study entitled ‘The Efficacy of Contact Tracing for the Containment of the 2019 Novel Coronavirus (COVID-19) published by the government on 20thMarch 2020, stating that “we expect contract tracing to reduce the basic reproductive ratio from 3.11 to 0.21 – enabling the outbreak to be contained”; and if not, why not.

(4) To ask the Secretary of State for Health and Social Care if he will publish the latest data for the numbers of (a) consultants in communicable disease control and (b) community infection control nurses, and c) their location by local authority area.

(5) To ask the Secretary of State for Health and Social Care if he will specify (a) the public bodies and/or (b) the companies which are carrying out the tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and explain the sensitivity and specificity of each test and their cost .
 
Allyson Pollock, Professor of Public Health, Newcastle University
Peter Roderick, Principal Research Associate, Newcastle University
20/3/20

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We have now launched another collaborative petition with the people at Change and have support from Health Campaigns Together and Socialist Health Association. 

It is likely other campaigns will support too in the next few days. Here is the link 

Change.org/NHS4all

Please sign and share widely. Please not only post on your own social media networks (though this is vital) but please include in your local group newsletters and prominently on your local group facebook and twitter pages – it might even be an idea to pin the post to the top of your timelines or facebook walls.

Also please take the time to write an email to your colleagues, fellow campaigners and friends asking them to sign too…

We’ve put together a model email for you to use here so it won’t take you long, it reads: 

 

“Dear ____

Keep Our NHS Public is helping launch a new petition putting six key demands to the government around its response to the Coronavirus pandemic. These demands cover a cross-section of our campaigning priorities, applied to the current moment of crisis  click here to read in full!

In the current climate, this petition could become absolutely huge, so we definitely need to get out the gate fast with sharing it. Please sign your name and share the petition to all possible contacts! SIGN HERE

On Twitter, we’re using the hashtags #NHS4All, #6Demands, #Covid-19, #SafetyFirst, #Coronavirus with #NHS4All as the main one.

Best”

 

Remember our last petition with Change received 1.3 million signatures and helped the organisation widen its reach, recruit unprecedented numbers and raise much-needed funds – so the bigger this is the better for all of us. And in this moment of isolation and likely imminent lockdown – it’s time at last to embrace, social media and digital campaigning!

Good luck and thank you from all the team.

In Solidarity

Tom Griffiths

Keep Our NHS Public

Campaigns Officer

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Fire and rescue service personnel must receive priority testing and vaccination for coronavirus, the Fire Brigades Union (FBU) has said after some brigades reported losing hundreds of staff to self-isolation.

In a letter to ministers in Westminster and the devolved administrations in Scotland, Wales and Northern Ireland, the FBU has said that without testing, firefighters and control staff could be self-isolating unnecessarily, when they could be on hand to protect the public.

The union also says that testing could help reduce the risk of frontline staff transmitting the infection to vulnerable members of the public.

London Fire Brigade has at least 280 personnel in isolation, 5% of its overall staff; West Midlands Fire Service, which covers Birmingham, has 105 staff in self-isolation, 5.5%; Scottish Fire and Rescue Service has 285 staff in isolation, 3.75%; Essex County Fire and Rescue Service has 61 staff in isolation or 4%.

Fire and rescue services across the UK are operating with 11,500 fewer firefighters than in 2010, and, unless services are able to test their employees, they could face dangerous shortages.

Matt Wrack, FBU general secretary, said:

“In this time of national crisis, every emergency service worker has an important role to play. The NHS is an obvious priority, but any testing regime needs to address all key public services.

“Without proper testing, the number of fire and rescue personnel available could drop to dangerously low levels. Fires and other non-virus related emergency incidents won’t wait for this crisis to subside and ministers need to consider that carefully.

“It is vital for public safety that firefighters and control staff, like their colleagues in the NHS, receive priority testing and, once available, vaccination.

“We’re pushing for measures to limit our members’ exposure to the virus, but some interaction with the public cannot be avoided and ministers need to manage that risk.”

While the FBU has called for firefighters to cease all non-essential, non-emergency interactions with the public, they will continue to come into contact in emergency situations, placing them at greater risk of infection.

Emergency fire control staff handle 999 calls and provide vital fire survival guidance for areas of up to 5 million people from a single room. Should one member of staff contract the virus, the emergency call infrastructure for an entire region could be at risk.

Media contact

Joe Karp-Sawey, FBU communications officer

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