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    Unite national officer for health Colenzo Jarrett-Thorpe said: “Pressures on our ambulance members are unprecedented with the profession not currently being given the correct guidance as to whom they should take to hospital.
    “They are also not being given the correct level of personal protective equipment (PPE) if they suspect a patient has Covid-19.  Ambulance workers are putting their health, perhaps their lives, at risk, by not receiving the correct PPE and also by not receiving the correct fit test training to wear the PPE. 
    “On top of this, the lack of testing remains a stark and very serious issue – there are not enough tests to ensure ambulance staff are tested within the five-day window for testing.”
    “Unite is urgently calling for ambulance workers to be given clear guidance regarding triaging which patients should be taken to hospital and more action on PPE which needs to be supplied to paramedics, so they are able to do their essential duties.
    “Paramedics are terrified of making the wrong call and being sanctioned for this.
    “I think the public’s patience with ministers is wearing very thin as they continue to say that there is enough PPE in the system, when there are numerous reports from frontline staff that this is simply not the case.
    “It is humbling to see social media posts which show some NHS and social care staff risking their lives as they go to care for patients with coronavirus. The situation is even more dire in social care settings, as care staff do their utmost for the elderly with inadequate protective kit.
    “Unite has thousands of members who are part of the healthcare science workforce. These talented staff need to be engaged to provide the test that is required to ensure 100,000 people can be tested a day. 
    “Unite has over 100,000 members in the health and social care services and we will not rest until we ensure that all health and social care workers are secure in their individual roles in keeping us all safe and well – we are campaigning for that goal 24/7.
    “If these objectives are not met and NHS staff continue not to be protected, reluctantly NHS and social care staff could legitimately and lawfully decline to put themselves in further danger and risk of injury at work. Unite will defend NHS and social care staff.”

    Unite senior communications officer Shaun Noble

    Comments Off on Unite statement on coronavirus – and its impact on paramedics and other NHS workers and social care staff

    BUYING BEDS FROM PRIVATE HEALTHCARE PROVIDERS

    Can the minister explain why the Government has chosen to buy beds from private healthcare providers rather than requisitioning private hospitals and staff as the Spanish Government has done?

    The Centre for Health and Public Information (CHPI) has demonstrated that the government’s deal to purchase their entire capacity in return for covering their “operating costs, overheads, use of assets, rent and interest” is in effect a bailout for private hospitals. https://chpi.org.uk/blog/who-benefits-from-the-nhss-bailout-of-private-hospitals/

    Based on the accounts (2017 or 2018) of their operating companies, four of the largest private hospital providers (Spire, BMI, Nuffield, Ramsay) have an average gearing (total debt / equity) of over 300%. This means that they are heavily reliant on debt to finance their businesses, and are therefore potentially vulnerable to a prolonged period of low or non-existent demand.

    Without the deal, private healthcare providers would face the same fate as other industries who are experiencing a significant drop off in demand due to the virus. Crucially it also represents a bailout for the landlords and lenders of the private hospitals whose investments would also be at risk if the hospitals were unable to honour their payments.

    Why is the Government acting to protect private healthcare providers, and the profits of their investors, rather than taking the alternative approach of requisitioning private hospitals and their staff to support the NHS?


    What payments will the government have to make for requisitioned private health care capacity?


    Can the government provide assurances that the contracts signed for ventilators from known Tory backers like Dysons and JHB are of the required standard to enable gradual re-establishment of breathing?

    CARE AND NURSING HOME RESIDENTS

    Are you confident that all care and nursing home residents who are symptomatic are being tested for COVID-19?


    Why there is a difference in priority for the NHS and Care sector?

    Please supply any figures of death rates and infection rates as incidence and prevalence.  It should surely be easy for every care home retirement village and other institutions to collect daily stats and report regionally.

    How can you ensure that Trusts, NHS charities and local authorities work together to provide a system coordinated response?


    PUBLIC HEALTH ADVICE

    Why does the Government advise 7 days isolation for those who are symptomatic for COVID-19 while the WHO advice, followed in most of Europe is to isolate for 14 days?

    CONTACT TESTING, TRACING AND NUMBERS

    • What is the best estimate of the proportion of the population who have had Covid-19?
    • What is this estimate based on?
    • Is there any community surveillance for Covid-19 taking place? If so what are the details? What are the results?
    • How much contact tracing is done for patients who have been diagnosed as having Covid-19?
    • What role will contact tracing play in managing the easing of the current public health measures?
    •  What steps is the government taking to have a robust tracing capacity in place as we emerge from the current public health measures?
    • What criteria will be government use in terms of R0, new cases, patient deaths, herd immunity, contact tracing capacity etc to inform any decision to ease current public health measures?
    • How many of the NHS and care staff who have died in this epidemic are from overseas?

    The figures now emerging for the deaths of those working in the NHS cover the very substantial numbers of outsourced workers, a cohort that the public just don’t know about. Aside from being cheaper and allowing corporates to cream off a profit, these workers are treated as second class employees, with worse conditions, oppressive supervision, abysmal support and non-existent occupational health. Aside from low pay and the insecurity of zero hours contracts there are countless ways in which they are coerced to “just get on with it”, risking serious harm.

    The DHSC is undercounting numbers of health workers infected, can the government give assurances that they will provide accurate figures and include out sourced agency and locum staff?

    Hospitals have been asset-stripped for years by outsourcers, PFI partners and management and IT consultants, and Lansley’s Health and Social Care Act has undermined the structural coherence of the NHS. The malign results of this we now see with hospitals struggling against collapse with the untold sacrifices of heroic staff. And even here, the government (Matt Hancock) has consistently under stated the numbers of deaths of NHS staff: on Friday he said the number was 19 when it was 31 and he repeated the 19 figure on Saturday when it was in the 40s and in the public domain. Can we be assured that Mr Hancock will provide accurate figures and strive to remain on top of his brief?

    We know the numbers of front line workers losing their lives to Covid is now in excess of 40  – why has the government not acknowledged this nor yet apologised for their gross mishandling of PPE supplies.


    The finger-prick antibody tests that Hancock has ordered are widely regarded as unreliable with low sensitivity and specificity. Can we be assured that this is not the case?


    With respect to testing – why has the government wasted millions on a test which quickly proved not to be reliable. Who sanctioned this?


    What are the step changes to increase current testing capacity to 100,000 by the end of the month?  When will each new site come on stream and how much capacity will be added – and then say what actually happened – on a weekly basis?

    What really is the approach to testing front line staff? Pretending to test all front line staff is pointless as someone who is negative today could be positive tomorrow – so this would mean testing everyone everyday which would need significantly more capacity than planned. Are they testing staff who are currently self isolating and not at work and those who become symptomatic?

    What is their approach to testing care home residences and staff? Initially this should focus on those home with assumed cases and needs to be done in a consistent way

    FUTURE FUNDING

    We are pleased to hear of the Prime Minister’s recovery, and noting his praise for the dedication and commitment of NHS staff, will he now reinstate the NHS as the preferred provider when work is commissioned?

    Given the inability of local Public Health teams to provide an adequate local response to the epidemic given recent cuts and reorganisation, will be now ensure the reinstatement of Public Health powers and budgets?


    Public support for the NHS has never been higher, arguably because the population understands better than this and the previous Tory government how vital it is to national life. Will the government undertake to reinstate the NHS on its former footing as a National health service, and undertake to spend the same proportion of GDP on it as comparable countries?

    COMMUNITY SERVICES

    There is likely to be a wave of people being discharged from hospitals who remain very ill. Given the shortfall in GP and District Nurse numbers, how does the SoS expect that these patients will be adequately supported?

    Is now the time to commit to a significant increase in District Nurse numbers with upskilling to enable more people to remain at home post-Covid with GP support?

    PPE

    PHE has continually prevaricated about the spec – and in comparison to other countries still falls short, yet even that is still proving impossible to obtain for too main frontline workers, both in hospitals and in the community. We know the supply chain in England in particular is flawed because the Cabinet Office brought in an a ‘middle man’ without any experience of handling PPE or the manufacturing industry. Cabinet Office must be told they should be stood down with immediate effect from their role in England and allow industry to liaise directly with hospital Trusts, primary care bodies and care organisations for fast track targeted purchasing to unblock this ASAP.

    Why has the government persisted in shipping PPE/ventilators equipment from abroad  –  some of it substandard or out of date  – when we have received skilled offers from such as GTech in Worcester offering 30k ventilators ( not CPAPs) and the British textiles manufacturing industry being continually blocked from their significant capacity to provide PPE  – some of which is now going abroad in frustration?

    Tough Questions

    1 Comment

    News From The Frontline 13.04.20.

    By Vivien Walsh

    1. How the government lies with statistics.

    BBC news has reported 737 new coronavirus-related hospital deaths in a 24 hour period making the total so far 10,612. In a different report the BBC said that the real figure must be over 1000.

    These Department for Health and Social Care (DHSC) records do not give figures for deaths outside hospital, for example in care homes, nursing homes or people’s own homes. They are only reports for England, not Scotland or Wales or Northern Ireland. And they are only cases where COVID-19 is recorded as the primary cause of death. Some clinicians might record respiratory or renal failure or pneumonia as the primary cause of death, and may or may not include COVID-19 as a secondary cause.

    In any case these statistics only give deaths where the virus has been cited as the primary, not secondary, cause. In many cases a test for the virus may not have been done. It takes more than 48 hours to get the results from a test. No bereaved family wants to wait longer than necessary to make funeral arrangements. There are always understandable pressures to get a death certificate issued, and the death registered as quickly as possible.

    In addition, now that so many care homes are in the private sector and not only concerned about their reputations but under competitive pressure to attract patients, there may be concern to minimise the number of deaths recorded as being caused by COVID-19 for fear of losing potential paying clients.

    The number of deaths of people in their own homes include those who under other circumstances would have been in hospital, but have heeded advice from the government, from their GP practices, from NHS 111, from hospital A & E departments and countless ads on all media, to “stay home”.

    1. Massaging data

    We have been hearing about absolute numbers of deaths on the news, both here and for comparison in different countries. But age-standardised rates, which take account of demographic differences between populations, are better for international comparisons. Using information taking age profiles into account, from China, which had the earliest attack from the virus, and information about UK age profiles, The Lancet published a calculation that UK death rates from Covid-19 were 0.66% overall, but 7.8% for over 80s, and only 0.0016% for children under 10, when they adjusted their figures for the number of people in each age group of a population.

    One of our informants, a doctor, suggests that when the pandemic is over, the results from the UK and USA will be worse than in those countries that introduced protective measures more rapidly and whose health services were better funded and prepared. “That’s why Number 10 is blaming civil servants for duff advice, NHS-England for PPE shortages, the public for not staying home, and NHS staff for wasting PPE (which they now call “a precious resource)”.

    The USA is the only economically advanced country not to have a national health service available to the whole population. Britain’s NHS when properly resourced and as it was originally established, was still much more efficient in terms of what is provided relative to £ spent, per head of population, because the other national health services are funded by insurance systems, which has to be claimed back.

    1. They knew what would happen!

    But the Government failed to publish an early warning, let alone prepare for Covid-19. Exercise Cygnus was a pandemic drill involving all Government Departments that concluded in Oct 2016, three and a half years ago, but the Government suppressed its findings. These were that the NHS would be plunged into crisis if Britain were infected with a deadly disease. It predicted there would not be enough beds (especially in intensive care), not enough staff, not enough of the necessary equipment, and not even enough space in mortuaries or then cemetaries for the dead, following years of Tory cuts and financial “squeeze”. And the country would be plunged into economic crisis from the acute recession, and social crisis as a result of coping with so many deaths.

    Last week Jon Ashworth (shadow Health Minister) called on Ministers to publish the results of this drill. But we must do more. We need to scale-up our campaigns throughout the Labour Movement and in society generally, to immediately increase spending on the NHS for the long term, to implement Labour’s policy to re-nationalise all the many sections of the NHS that have been privatised, and to convince everyone who stayed home last Dec 12th (or voted Tory) to vote Labour in future.

    1 Comment

    SHA COVID-19

    Blog 5  

    12th April

    The Socialist Health Association (SHA) has published its weekly Blogs on the COVID-19 pandemic since the 17thMarch 2020. This provides a narrative of political and health issues over the past 5 weeks.

    A lot has happened over the past week and we will address some of these developments from our socialist health perspective.

    1. Situation update

    So far in our Blogs we have drawn attention to how the UK has been to slow to respond to the pandemic threat since the warnings from Wuhan started at the end of December 2019 and were confirmed in mid January 2020. This was despite the fact that an infectious disease pandemic ranks No 1 in the UK government risk register and we knew that this was a Sars like virus.

    The Tory government had not paid attention to the various simulation exercises that have been done over the past few years most notably Exercise Cygnus in 2016, during Jeremy Hunt’s time as SoS for Health. The exercise simulated ‘swan flu’ and showed that there was a serious risk that the NHS would be overwhelmed with lack of PPE and insufficient ITU beds. Recommendations to increase stockpiles were ignored in a time of austerity and PPE equipment such as face visors were evidently deemed too difficult to store. It is interesting to note that many of the facemasks have a use by date from before that time. Even as far back as the Swine flu pandemic in 2009 the relatively small number of ITU beds has not been addressed and we have seen how relatively low the NHS acute bed numbers, as well as the ITU beds/1000 population are comparatively. The government have it seems been more interested in preparing for Brexit at the end of January than for a real pandemic threat. Instead of building up stockpiles of ventilators and other equipment the government have had to turn in emergency to their friends such as Dyson and JCB but it is no surprise that delivery takes time as medical equipment needs testing and tough quality assurance.

    We have also pointed to the laisser faire approach to this pandemic even after it became a global threat. The scientific advisory group ‘modellers’ had by late February warned the government that the country faced the possibility of suffering 500,000 deaths from Covid-19. So at this time we knew that this was a virulent virus that was easily transmitted person to person and if not suppressed would spread within communities rapidly and seek to move out to new areas. The religious community in South Korea was a clear case of transmission from Wuhan and rapid spread within a religious community in Daegu. In mid February this was traced back to Patient 31 by their effective contact tracing and testing protocol. South Korea, to their credit, stamped on the virus and did not allow it to spread and has only had just over 200 deaths within its population of 52m who continue to enjoy freedoms outside lockdown.

    As the virus began to spread we saw countries closing their borders and screening people arriving from air or sea. New Zealand and Australia are examples of this tough policy and they have managed to keep the virus from penetrating the country at scale. New Zealand has had four deaths and Australia 60 by 12th April. The UK note is also surrounded by sea and with Ireland is a separate landmass from Europe but we have not introduced any significant border health checks at any time.

    In Europe we all watched with mouths open when health services in Lombardy were overwhelmed and people who had been on skiing holidays had already returned to the UK and started to spread the virus here. What actions did the Border Forces take? How actively did we follow up reports of fever and cough in returning travellers? Do we even now check peoples travel history and report symptoms on return to the UK? Our death rates now are moving to exceed Italian and Spanish rates and compete to be the worse in Europe.

    Some of the success of countries such as Germany and Denmark has been closing their borders and undertaking health checks, testing and advising quarantining/isolation if needed. Denmark closed the border on 13th March (final day of the UK Cheltenham Gold Cup meeting in the UK) and a few days later closed schools, universities and banned gatherings of more than 10 people. Denmark which, is a small country of only 5.6m, has had 273 deaths by the 11th April. Scotland in comparison with a population of 5.5m has already had 566 deaths. Denmark is now considering loosening the lockdown requirements whereas Scotland still fears new spread.

    However frightening Covid-19 virus is in terms of its effects on people it is a virus, susceptible to soap and water and unable to spread between human beings unless spread by aerosol or droplets by coughs and sneezes or hand to face contamination. Basic communicable disease methodologies work – hence the WHO advice to test, trace and treat by isolation. No need to rely exclusively on mathematical models but tried and tested methods of infectious disease control measures. We hear very little of the most basic ‘tests’ namely asking people about their contact history and what symptoms they have. In the early days of this pandemic we had all heard about the cardinal symptoms and signs of Dry Cough and Fever. In the current situation that is enough for classification as a possible if not probable case. This then needs follow up with an antigen PCR test to confirm. Tracing other contacts and testing them and all contacts need to be isolated/quarantined. We realise that we have missed the boat now but should acknowledge that this is basic public health methodology in use for decades but not used here even at the start of the epidemic spread in the UK. Public Health trainees were often told – use more shoe leather than computer software when involved in outbreak management. The UK seems to be bemused by other countries testing temperatures with thermal imaging meters or checking if people have stayed in isolation as advised. God forbid people wearing face masks either!

    In earlier blogs we have also referred to the reluctance to learn from policies in countries that have been successful in suppressing the pandemic. Take facemasks, which are used widely in Asian countries, who have had success in controlling spread. It just seems to make sense (have face validity) that a virus transmitted from nose and throat to others would be hindered in person to person spread if everyone was wearing a face mask. A recent review by the respected evidence based group in Oxford recommends the precautionary principle in a time like this. The CDC in the US is recommending the use of facemask too especially as we look to reducing lockdown rules. Rather than say we need a randomised control trial – just do it! Of course in the UK it is almost impossible to buy quality facemasks, hand sanitiser gel or often latex gloves!

    The situation we find ourselves in is that PPE seems to be rationed and sadly there remain reports from NHS and social care clinical staff that they cannot get proper PPE supplies. Again we see TV reports of other countries in the world where many essential workers –non health care providers have access to PPE equipment which reassures them and is symbolic to others about the risk of cross contamination. Our bus drivers and other public facing non-NHS public servants have been exposed to risk.

    The government has struggled with scaling up the logistics and thanks to the Armed Forces supplies are getting through. However Public Health England (PHE) who were fast off the blocks once the Chinese Government shared the genome of Covid-19 have been unable to seriously scale up the PCR testing capacity. It remains to be seen whether the 100,000 tests by the end of April will be delivered. It is said by management consultants – ‘Never promise more than you can deliver’. It is also recommended; ‘don’t stretch the truth’. We have sadly seen this transgressed by Matt Hancock promising the ramping up of testing, supply of PPE. His boast of purchasing 3.5m antibody tests before they have been shown to be valid is embarassing. Reminds us of the Brexit Ferry contract from a company that had never managed a Cross Channel Ferry service.

    The vaccine is of course much more important than the antibody test and we applaud the progress that researchers have made but do caution that we should not promise more than can be delivered. A safe and effective vaccine requires safety and effectiveness trials and this all takes time.

    1. Inequalities and risk factors

    One of the striking findings of this pandemic is the susceptibility of Black and Minority Ethnic (BAME) groups to the virus. It has been striking that the first group of doctors who have given their lives to the virus have been Black or South Asian heritage. Some of the areas where the NHS has had pressures are also areas with relatively high Asian populations (Brent, Luton, West Midlands). This risk factor will of course have social, economic and cultural determinants alongside some biological factors such as a higher risk of diabetes and cardiovascular disease. There are very few health conditions where socio-economic factors do not affect incidence and prevalence. The two hospital porters from Oxford who died recently of Covid-19, were out sourced workers, both of Filipino heritage and like doctors and nurses exposed to risk at work. Their NHS fellow workers allegedly offered to share PPE in the early stages of the pandemic!

    We are familiar with the social gradient of disease and death. So it is no surprise that in the USA we are also seeing African American citizens are losing their lives disproportionately. For example in Michigan 15% of the population is black, but account for 40% of the deaths. Chicago has a 30%  African American population and this group have a 70% death rate. These ratios are also reflected in Louisiana in the deepsouth, especially New Orleans, where the Mardi Gras celebrations continued regardless of the pandemic.

    These global health inequalities will also be mirrored in Africa when the virus moves down that continent. Think of our discourse about the dearth of PPE and medical equipment such as ventilators. In the Central African Republic of the Congo (CARC) with its 5m population it is estimated that they have 3 ventilators. On the international market prices have responded to demand. Costs of a ventilator on the market have jumped from $9000 to $20,000 over the past few weeks. The CARC‘s GDP/capita is $1.3 per day with very poor health infrastructure.

    It is good to hear that the British Government has donated Aid to the UN and WHO to support Low and Middle Income Countries combat the pandemic. It is in all our interest that these countries and their people weather the storm. One World and Planetary Health – we are all mutually dependent.

    1. 3. Political Leadership

    One of the issues that has emerged through the experience so far with this public health emergency is the quality of political leaders. We have already drawn attention to Denmark with Mette Frederiksen who is a woman and the country’s youngest–ever PM. Last week we referred to Angele Merkel’s clear leadership in Germany, which is doing extremely well so far in controlling Covid-19. Think too of Jacinda Ardern the Labour Prime Minister in New Zealand who in her short time as PM has had to deal with three different emergencies – the Mosque massacre, the Whakaari/White Island volcanic eruption and now the Covid-19 pandemic.  She has provided exemplary leadership by going hard and going early. She placed the country in total lockdown on the 25th March and softened the blow by using a slogan – ‘be kind’. Epidemiologists have praised her ‘brilliant, decisive and humane leadership which has seen New Zealand achieve a remarkably efficient implementation of the elimination strategy. Of course the country will still be susceptible to Covid-19 but the health protection measures have worked so far and unlike the UK will not have such high death rates/population.

    1. A great science policy failure?

    Richard Horton, Editor of the Lancet, has said that the global response to Sars-CoV-2 is the greatest scientific policy failure in a generation. The signals were clear. Hendra in 1994, Nipah in 1998, Sars in 2003, Mers in 2012 and Ebola in 2014; were all caused by viruses that originated in animal hosts and crossed over into humans. Covid-19 is caused by a variant of the same coronavirus that caused Sars. The US Institute of Medicine (IOM) in 2004 concluded that; “the rapid containment of Sars is a success in public health, but also a warning. If Sars recurs health systems worldwide will be put under extreme pressure and continued vigilance is vital”

    The IOM report quoted Goethe:

    Knowing is not enough; we must apply.

    Willing is not enough; we must do”

    Sadly we have known about this threat since Sars emerged in 2003 and we have undertaken simulation/emergency planning exercises as recently as 2016 which tested resilience for ‘swan flu’. However it looks like we did know but we did not act.

    13.4.2020

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

    2 Comments
    1. On PPE. From a Greater Manchester doctor working on a respiratory ward, unofficially renamed by staff the “Coronavirus Ward”, about protective equipment:

    “It’s not so much whether there’s enough, it’s what’s being brought in is really poor quality and advice about what constitutes PPE  is changing daily. Loads of my colleagues have already tested positive…… that’s one good thing my hospital is really on it with testing staff.”

    1. From a Unison rep in NHS Greater Manchester:

    “I am worried about members with diabetes, especially type 1. First of all they were listed in the ‘at risk’ group, not quite as at risk as the ‘vulnerable’ group, but who should still not be asked to work. Now they are being asked to go in. The responsibility has been put on them to observe the recommendations. They are sent on to wards where it is impossible to keep a 2m distance from patients, and PPE is still a problem.”

    And “there are not enough tests for the virus. But it would be possible to identify people with symptoms, and teams could be recruited to monitor symptoms and track contacts. However this is not happening.”

    1. Care workers are also on the Frontline. From a care worker in Scotland who visits patients in their homes. She was very upset because she was not allowed to shop at the time reserved for NHS staff “because she had the wrong uniform”. She has been working double shifts for a month, and will be doing so until July, and at the same time doing shopping for some of her patients, elderly people unable to get out of the house and whose adult children live too far away to help. This has been made more difficult by not being treated as a frontline worker, especially as there are limited occasions when she can do shopping, given her extra workload. She points out she is risking her life and those of her family members, but not being treated as “frontline”.

     

    1. Terror of the Unknown. From another Greater Manchester doctor, a retired consultant: “I have been retraining, but will be back at work full time on Monday. The main thing I noticed last week was the atmosphere of fear amongst the staff. Our hospital are pretty organised, it seems to me, with training and equipment, but not unexpectedly, there is terror of the unknown.”

     

    1. Ventilators and Tory Donors. Andrew Raynor of MEC Medical submitted an application to help the government on 16th March, but “nothing” happened. They are a worldwide supplier of oxygen therapy, suction, flow meters, electric suction, regulators and more. Raynor said the government had, instead, “ploughed loads of money into big consortiums to try and make a cheap, makeshift ventilator”. He did not have a problem with the government wanting to make a cheaper ventilator, but pointed out that his firm was already a ventilator manufacturer, and could “upscale quicker”.

    Instead, on 26 March, the BBC reported that the government had ordered 10,000 ventilators from the vacuum cleaner firm Dyson, which has no experience making the ventilators required. Dyson, working with medical technology firm, The Technology Partnership, has “hundreds of engineers working round the clock to design the ventilators from scratch.” The BBC commented that even if a suitable prototype was produced as a result, it still had to get regulatory approval, and move to production on a significant scale.

    As an anaesthetist commented to us: “simple ventilators allow you to dial in the tidal volume (the amount of air moved into or out of the lungs during each ventilation cycle), the respiratory rate” and the concentration of oxygen being breathed in. The ventilators deliver all the breaths and can be used during surgery or for transferring patients.” That is, for short term ventilation.

    But after several days on these ventilators, usually necessary for Covid-19 patients, “people develop wasting and loss of condition in the muscles responsible for breathing in. This means that patients need to be supported during this time, but support can be gradually reduced as they begin to recover muscle strength and can take progressively larger breaths. “They usually also need a temporary tracheostomy to reduce the amount of dead space, enabling lighter sedation and more effective breathing.”

    However, the Dyson ventilators are very basic and do not allow for weaning of the ventilator. “But he’ll make a lot of money, get a peerage, and make it look like Matt Hancock is doing something.”

    In contrast, “modern Intensive Care Unit ventilators are expensive and take ages to produce. Hancock just wanted a soundbite and a photo-opportunity. He passed over offers from established manufacturers to award contracts to big name companies like JCB and Dyson, with no experience of ventilator production, but owned by Tory donors.”

    Our informant compares the finger-prick antibody tests that Hancock has ordered. “They are totally unreliable, with low sensitivity and specificity, but home testing makes for a good, eye-catching headline, even if it’s a waste of time and money. Hancock is a joke; he is surrounded by sycophants and yes-men at the DHSC.”

    Obviously the production of much-needed ventilators is welcome. But the Government’s choice of manufacturers raises major questions about whether it has prioritised its friends and donors, rather than the specification of the ventilators needed.

    Blog from Vivien Walsh

    Comments Off on News From the Frontline

    Fire and rescue personnel will fit face masks for frontline NHS and clinical care staff and deliver medical supplies to hospitals and care facilities during the coronavirus outbreak after an agreement was made by the Fire Brigades Union (FBU) with fire chiefs and national employers.

    Under the agreement [NOTE 1] specially-trained and experienced fire and rescue personnel will fit protective masks to frontline NHS and clinical care staff working with patients infected with COVID-19.

    Firefighters will now also be able to begin delivering much needed personal protective equipment (PPE) and medical supplies to overstretched NHS hospitals and care facilities.

    These two new areas of work agreed extend the previous agreement reached at the end of March which allows firefighters to be able to begin driving ambulances, delivering medicine and food to vulnerable people, and assist in the movement of bodies.

    The Health and Safety Executive (HSE) recently gave a strong warning [NOTE 2] that the incorrect fitting of a protective face mask can increase the risk of COVID-19 infection and ‘lead to immediate or long-term ill-health or can even put the RPE [Respiratory Protective Equipment] wearer’s life in danger.’ Firefighters have been wearing respiratory masks for decades and the specialist trainers are certified to undertake the face-fit testing.

    During a face fit testing, the ‘tester’ must ensure that the RPE is clean and functioning and that the seal with the wearer’s face is tight and can prevent hazardous substances getting into an individual’s airways. [NOTE 3]

    Under the new areas of work, the agreement states that the facemask fitting practitioner and the candidate must not come into skin-to-skin contact or be in close proximity to the exhaled breath of the other without suitable protection.

    Under the agreement, firefighters could also be expected to assist in the delivery of PPE to the social care sector which has reported critical shortages of essential equipment. For those delivering PPE and medical supplies, delivery locations must be established that limit the risk of cross-infection.

    The update to the agreements will now see firefighters able to carry out:

    • Face Fitting for masks to be used by frontline NHS and clinical care staff working with COVID-19 patients
    • Delivery of PPE and other medical supplies to NHS and care facilities
    • Delivery of essential items like food and medicines to vulnerable people
    • Drive ambulances and assist ambulance staff
    • Move dead bodies, should the outbreak cause mass casualties

    Firefighters will continue responding to core emergencies, such as fires and road traffic collisions, but under the updated agreement can now provide further additional services specifically related to COVID19. The agreement states that core responsibilities must be maintained throughout the crisis.

    Any activities taking place at a local level must be risk assessed with fire and rescue personnel being given any necessary additional training and the appropriate PPE.

    The additional work taken on by firefighters will be temporary to tackle the COVID-19 pandemic. Initially in place for two months, the agreement can be extended or shortened if agreed between all parties.

    There are around 48,000 firefighters and control emergency staff in the UK.

    Matt Wrack, FBU General Secretary, said:

    “This public health crisis will require all of us to do our bit to get through it, and firefighters rightly want to play as much of a part as they can.

    “We are already driving ambulances, delivering food and medicine to the vulnerable and moving dead bodies, and the new work will see fire and rescue personnel use their expertise to fit protective masks and get vital PPE and medical supplies to NHS colleagues on the frontline.

    “The coming weeks and months will be a huge challenge for all services, not least for fire and rescue services who must continue to respond to emergencies whilst supporting the response to coronavirus. For that reason, testing for the disease must be made available to fire and rescue staff, so that as many healthy firefighters can be kept on the frontline as possible.”

    Joe Karp-Sawey, FBU communications officer

    Note 1 – Updated full Tripartite agreement: https://www.fbu.org.uk/sites/default/files/attachments/2020%20apr%2009%20-%20tripartite%20agreement.pdf

    Note 2 – HSE guidance on fit testing of masks https://www.hse.gov.uk/news/face-mask-ppe-rpe-coronavirus.htm

    Note 3 – Under the Control of Hazardous Substances Hazardous to Health (COSHH) Regulations, ‘respiratory equipment at work’ guidance, proper face-fit testing of Respiratory Protective Equipment (RPE), such as the widely used FFP3 respirators worn by health and care staff, must take place. Firefighters trained in this area will now be able to offer their support to NHS and care colleagues COSHH Regulations, ‘respiratory equipment at work’ – https://www.hse.gov.uk/pUbns/priced/hsg53.pdf

    Note 4 – The FBU called for the priority testing of firefighters and emergency control room staff on 20 March – https://www.fbu.org.uk/news/2020/03/20/covid-19-fire-and-rescue-services-lose-hundreds-firefighters-self-isolation-union

    The Fire Brigades Union (FBU) is the professional and democratic voice of firefighters and other workers within fire and rescue services across the UK. The general secretary is Matt Wrack

    The FBU is on Twitter: @fbunational and Facebook: facebook.com/FireBrigadesUnion1918

    For national spokespeople contact the press office via the details above. For local and regional spokespeople, please contact officials directly. You can find contact details for each region via this webpage: www.fbu.org.uk/contacts

    FBU press office
    press@fbu.org,uk

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    The Socialist Health Association (SHA) published its first three Blogs on the COVID-19 pandemic weekly since the 17thMarch 2020. A lot has happened over the past week and we will address some of these developments from our ‘politics and health’ perspective.

    1. The global crisis

    The pandemic continues to spread around the world and we are seeing that while Europe remains a global hotspot the new epicentre has now shifted to North America.

    New York Governor Cuomo is showing some visible leadership and filling some of the space that the President should be in. It was always the case that the private health system in the USA would not be able to present a joined up emergency response and primary care has never been strong either in the States. The CDC in Atlanta has, like the UK public health system, been starved of funds during Trump’s Presidency but more alarmingly their advice has been ridiculed and ignored. Compare this to when the USA public health system, under President Obama, supported the international effort to control the Ebola outbreak in West Africa?

    President Trumps best friend Mr Modi has declared a 3 week lockdown across India and in the process condemned millions of migrant workers to walk without adequate food or water hundreds of kilometres back to their rural villages. These dreadful scenes include police spraying them with disinfectant and stories of pushing wheelchair bound people 25 miles each day. Such news reports are matched only by the sealing off of ghettos areas in big cities such as Mumbai and Kolkata. Looking at how these people in dire poverty live without adequate housing, drinking water, food and sanitation is heartrending. Consider our government’s guidance on staying at home, washing hands and social distancing makes the prospect of widespread community spread, illness and death in these slums an absolute certainty. Let us hope that Modi’s BNP party do not further  fuel anti Muslim feeling in these poor and excluded communities.

    So Africa will be next and looking at Lagos with a population of 21 million with a large shanty town and Kinshasa in DRC at 11 million there will be vulnerable populations with inadequate sanitation and housing for the virus to spread exponentially. African economies are characterised by local markets which like India are very crowded, in narrow streets where people struggle against various motor and animal vehicles as well as packed buses and taxis. The WHO and UN as well as the IMF/World Bank need to urgently do what they can to help African governments mitigate the worst consequences of the pandemic, which includes harmful longterm economic impacts. Many African countries remember have over the last 5-10 years enjoyed solid growth in their GDPs.

    The pandemic will harm the poor more than the rich and although as Michael Marmot noted recently – at the beginning of a pandemic both prince and pauper are infected but over time the social conditions that the poorer populations are living and working in will mean that they suffer most. Securing income to live on for the many and somewhere to shelter for the homeless will be an urgent part of our pandemic response.

    1. The European picture

    So what can we learn about how the pandemic is affecting Europe? The first thing to note is of course that Italy and Spain are and have been suffering badly with high numbers of confirmed cases and deaths reported. In parts of the country both their hospital systems have been overwhelmed with health care staff succumbing to the infections and overall death rates being high. The pictures of patients on corridor floors and overcrowded trolleys is distressing as are the reports of nursing homes left to their own devices exposing staff and residents to mortal danger. We do need to ensure that mutual aid is respected in the UK to avoid NHS hospitals becoming overwhelmed as this is dangerous and hugely demoralising.

    Why is Germany apparently riding the storm better than their southern neighbours? The simple answer seems to be that they were better prepared than we are and have sufficient testing capability across the country, have a sound public health system at a national and federal level, sufficient numbers of hospital beds and ITU capacity, and supplies of PPE/ventilators to handle the load. There seems to be a better link between the national government and the federal institutions able to undertake public health action locally. There have been criticisms in the UK of the lack of coherent leadership at regional public health in England who are linked into the NHS and local authorities. The devolved system of national governments gets more coherence via the CMO roles at UK level and their links to First Ministers of devolved government.

    Recent reports show that Germany with 97,000 confirmed cases has had 1,478 deaths compared to the UK’s 48,000 confirmed cases and 4,932 deaths (18 deaths/million population compared to the UK 65 deaths/million at this point in the pandemic). Compare these rates to Italy and Spain who have been ahead of us in terms of epidemic spread at 259 deaths/million and France at 117 deaths per million.

    We have raised questions in earlier Blogs about the preparedness of the UK for a pandemic and the constraints on testing capacity, the shortage of adequate PPE for frontline staff and the inadequate supply of acute hospital beds (Germany 601 beds/100,000 and UK 211 beds/100,000) never mind ITU staffing and beds. We obviously commend the rapid building of the Nightingale Hospitals, which will be able to receive ventilated patients thus relieving local hospitals. We are pleased to hear too that the Abu Dhabi based owners of the Excel centre are withdrawing their charge of £2-3m per month for the venue, which would have been empty during the pandemic. We also commend the NHS for its preparation by increasing ITU capacity and redirecting staff usually working in other specialties. Let us investigate how the private hospitals are charging the NHS for access to their beds and facilities – our position has always been – requisitioned in a national emergency.

    The private hospital sector in the UK will be protected through the pandemic unlike other businesses. Large players such as Circle Health and BMI have been making a loss in 2018/9 amounting to £12m for BMI and Circle’s £14m. During the pandemic they faced economic disaster as their Middle East customers and the NHS elective care referrals ceased. These private health care companies are controlled by US health insurance companies and private equity funds. Another large group, Spire hospitals, lost £24m in 2018. Spire’s share price jumped 15% on Matt Hancock’s announcement! The Wellington and Portland Hospital, owned by US group HCA, lost £74m last year and will also be pleased to have access to taxpayers’ money. It remains to be seen under ‘open book accounting’ how the expenditure will be audited. Note that the best paid executives at Circle, BMI, Spire and HCA earned £377,000, £452,000, £615,000 and £711,000 respectively according to Private Eye sources!

    1. The UK

    The NHS has been making huge efforts to be as prepared as possible for the potential tsunami of COVID-19 cases. With the lockdown A&E departments have been relatively quiet and with elective care suspended and no visiting for inpatients many hospitals outside of London/Birmingham/Newport have been eerily quiet. Healthcare staff have been trained up to undertake different roles in anticipation of patients being admitted who require respiratory support – this seems to be the main serious impact of Covid-19. Let’s not forget however that heart attacks, strokes and childbirth will continue to occur, as will the treatment requirements of cancer patients.

    In previous blogs we have referred to the care sector and how important they are in managing the pandemic. The recent guidance on PPE has clarified some of the queries and enabled more staff to feel more protected than before. However the supply of PPE to front line staff remains patchy and with the death toll rising of healthcare workers the government must ensure that supplies are readily available for community nurses and care workers as well as social care staff in the residential and care home sector.

    While it is absolutely necessary to be transparent about the evidence of benefit from ventilation we do not think it humane or ethical to have strict age-based criteria for decisions to admit to acute hospitals for assessment. Frailty criteria published by NICE, for suitability for ventilation are of course necessary but the reports of people being coerced to sign Do Not Resuscitate (DNR) advanced directives is very dangerous and will lead to the perception that older and disabled people are being denied hospital treatment. Residential and Nursing Homes will also feel that they are being left to manage very ill residents who are on an end of life pathway without adequate resources and safeguards for staff. The same feeling will apply if domiciliary patients are transferred to nursing homes with a Covid diagnosis in large numbers. This is a very sensitive policy area, which needs careful consideration and an investment in resources to mirror that provided to NHS hospitals and the new Nightingales. There have already been examples of nursing homes having to deal with a relatively large number of residents with Covid-19.

    1. Looking forward

    The pandemic will sadly spread across the UK from its hot spots in London, the West Midlands and Gwent. The government is being held to account for its failures in preparation – perhaps more attention to Brexit than Pandemic planning! The slow response has been noted, the lack of scaling up of testing and the poor logistics on PPE stand out in the story so far.

    We still sense a racial/culture hostility to widespread use of masks yet many Asian countries that have controlled the spread have used them widely. We look forward to the WHO reviewing the evidence. The virus is transmitted from and to the nose and throat, so it does seem that there is a case that face masks have a role to play. However facemasks have not been available in the UK for weeks and have in a sense been rationed to health and social care staff!

    As we have pointed out even without the widespread use of facemasks Germany has shown us the benefit of sound preparation, supplies and capacity in their health system and we need to learn that lesson from our European partner. Austria is already planning its exit from lockdown. There has also been clear political leadership in Germany without chopping and changing with promises announced almost daily as we have seen here.

    The exit plan needs to be addressed and in the same way that we have not treated London as our Wuhan we do need to nuance our policies to match regional/metropolitan differences in where the pandemic has occurred and the readiness to relax the lockdown based on testing evidence of community immunity, protected populations and overall resilience.

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

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    The current crisis has brought to our attention the state of the food industry, from agriculture to supermarket. Tim Lang, Professor of Food Policy at London City University, published Feeding Britain last week[1]. He says that although Britain is not actually at war, we are nevertheless, in practice, facing a food challenge on a wartime scale.

    When there was no panic-buying, as we have at the moment, supermarket shelves were usually full. But that hid a highly fragile just-in-time supply chain, with British agriculture only producing about half of what we consume[2]. On top of that, methods of production are not only damaging the environment but human health as well. There is a massive gap in access to food between rich and poor, reflecting differences in wealth and income. Michael Gove, when Secretary of State for Environment, Food and Rural Affairs (DEFRA), said he was going to introduce a national food strategy, but the January 2020 Agriculture Bill contained hardly any mention of food.

    In the current coronavirus epidemic, the irresponsible scare-mongering of the media has clearly played a major part in emptying the shelves in supermarkets, and in addition to food shortages there has evidently been panic-buying of surface cleaners, soap and toilet rolls. There has been an upsurge in community support for the elderly, sick and disabled unable to leave their homes; but at the same time we must consider the threat of rising social tensions over shortages and availability of food and other necessities. Those with the most precarious incomes, dependent on benefits and zero-hours contracts, or with no entitlement to unemployment or sick pay, will be the worst affected. It will be other consumers who are blamed, rather than the Government which has been so slow to respond and done so much less that it could and should have done. During World War II shortages led not only to rationing but also looting and crime, despite the “Spirit of the Blitz”.

    Even without coronavirus (or brexit), the underlying problem is the small number of big firms that dominate the food retail sector: Lang points out that eight firms control 90% of food supply, of which Tesco has about 30% of the retail market. Price has been the dominant form of competition, so that farmers get only 5-6% of the value of the food we buy. A tiny 2.8% of cultivable land in Britain is used for fruit and vegetables. We import food we could grow, and most of what we do grow feeds animals or is used to make processed foods. It is a habit that dates from Britain’s past dependence on an Empire.

    Of particular interest to the NHS and to the SHA is Lang’s point that “food is the biggest driver of NHS spending as a result of obesity, diabetes and heart disease”. Even food which appears cheap has often created enormous and unsustainable costs elsewhere. A long-term solution is necessary, and not just a response to the current crisis.

    Tim Lang proposes that we need a “Food Resilience and Sustainability Act with legally-binding targets”; food procurement contracts based on “national nutritional guidelines”; an “audit of food production” in the UK; and a doubling of the budget for public health “from £2.5bn to 5bn” out of “the £130bn health budget”. He says that the coronavirus is reminding us “of the value of state institutions”. “We need to think about where our food comes from and move from a ‘me’ food culture to a ’we’ food culture”.

    Vivien Walsh

     

    [1] Tim Lang, Feeding Britain, Penguin books, 2020.

    [2] Jay Rayner, “Diet, Health, Inequality: why Britain’s food supply system doesn’t work” interview with Tim Lang, The Guardian, 22.03.2020.

     

     

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    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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    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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    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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