Covid: the things they don’t tell us as the shutdown looms

Lockdown 2.0 is on the way, and ministers say they have been left with no choice if lives are to be saved and that the NHS will not be overwhelmed.

It appears to be an open and closed case. But as MPs prepare to vote on the blockade, a number of questions remain to be answered.

It has been suggested that one of the benefits of the lockdown is that it will provide time to fix England’s NHS test and trace system.

It is routine for you to fail to meet your goals of reaching people who test positive and then obtaining and contacting your close contacts to ask them to isolate themselves.

But solving that is easier said than done.

Municipalities are now being encouraged to create their own local contact tracing teams to try to improve the scope of service.

About a third have something going, but most are up front with skeletal teams and IT struggles.

Public health directors are frustrated that they were only given money to do this when the second wave began, rather than at the beginning of the year, when infection rates were lower and it would have been easier to rack up.

What’s more, very few people seem to be isolated. Research suggests that fewer than one in five are fully doing so.

The government is now providing help: those with low incomes receive maintenance payments of £ 500. But that, some say, is not enough.

“The government just doesn’t understand the difficulties people face in terms of lost income and job insecurity,” says an executive director who has had in-depth negotiations with the government on the issue.

“We’re doing all this work to try to reach them, but then don’t help them isolate themselves. What’s the point?”

The government presents detailed statistics on Covid. They show that more than 9,000 patients are currently in hospitals in England.

But what they don’t tell us is exactly how full the hospitals are.

Covid patients occupy less than one in 10 beds.

So far, both the NHS England and the Department of Health and Welfare have refused to disclose the number of beds available once patients being treated at the hospital for other conditions are taken into account.

The figures obtained by the Health Service Journal, which according to the BBC are correct, suggest that just over 80% of the beds are occupied.

That’s actually a bit lower than last winter, reflecting the fact that despite efforts to do more non-Covid work like cancer care and routine surgery, the numbers they remain well below pre-pandemic levels.

Provides a bit of leeway, but not a lot. In fact, those areas like Manchester and Liverpool that have seen a significant proportion of admissions are close to being full.

But there are several options for the NHS to increase capacity. One is to start canceling treatments that are not urgent, and some hospitals have already started doing so.

The other is to use the Nightingale field hospitals. The Northwest has begun accepting non-Covid patients to ease pressure on hospitals in that region.

Could the others unfold? Possibly, although unions have wondered where staff are going to come from to care for patients.

But regardless of that, it is virtually impossible to assess how acute the pressures are.

NHS leaders are due to hold a press conference on Wednesday, which may shed some light on the issue.

We know that the virus has killed a disproportionate number of people who are elderly or have an underlying health condition.

However, as the second wave took off, the number of nursing home-related outbreaks began to rise, while one in five of the “new hospital cases” are actually people believed to have contracted the virus in the United States. hospital.

This is a source of frustration for many experts.

Research shows that three-quarters of deaths in the first wave came from just the 5% of the population considered to be most at risk, according to the Oxford University model.

This 5% will include people who are in nursing homes and those who are sick enough to be in the hospital for other conditions.

Professor Mark Woolhouse, an infectious disease expert at the University of Edinburgh, says he cannot understand why more isn’t being done alongside the social distancing rules that already exist to protect these groups.

It is believed that it could “make a significant difference” in the number of deaths. “It is inconceivable that we are not doing more.”

What can be done? A number of different suggestions have been presented to the government.

These include supporting multigenerational households by offering free hotel accommodation, boosting the nursing home workforce so that staff do not have to work in multiple households, facilitating the spread of infections, and providing more testing to hospital staff. and also to those who have care responsibilities.

One of the most alarming graphs presented by the government when it announced the latest lockdown on Saturday looked at a variety of scenarios for the number of deaths expected in England.

The worst projection suggested that deaths could reach 4,000 per day, as the graph below shows.

But now it turns out that the projection was out of date.

It was based on figures from early October, which show that by now there should be 1,000 deaths a day. The current average is a quarter of that number.

What’s more, the Public Health England and Cambridge University team that produced it have published reports based on the most recently available data.

Questioned by MPs on Tuesday, Chief Science Advisor Sir Patrick Vallance said he apologized if that caused confusion.

Meanwhile, none of the scenarios took into account the regional restrictions that the government has imposed since mid-October.

The MPs lobbied the UK’s top medical adviser, Professor Chris Whitty, on the matter. He argued that while there were some signs that the restrictions were beginning to have an impact, it would not be enough to reduce infections sufficiently.

But others question this. Professor Carl Heneghan, director of the Center for Evidence-Based Medicine at the University of Oxford, says he is concerned about the use of clearly outdated models.

He says making such predictions is notoriously difficult and any forecast “beyond two weeks” comes with a large margin of error.

He believes there are some signs that the rise in hospital cases is starting to slow down and I would like to see time allowed for it to develop.

Government policy development is usually accompanied by a comprehensive evaluation, which compares the benefit of doing something and balances it against the cost.

When the UK first entered the blockade, this was not done.

And that seems to have been repeated again despite warnings about the indirect cost of confinement, from mental health issues and people delaying seeking help for other health conditions, to financial consequences.

Though Sir Graham Brady, chairman of the 1922 Conservative MPs Committee, has challenged the prime minister to publish the assessment if one is available before MPs vote later.

However, the government says it is making attempts to minimize the consequences, pointing to the extension of leave payments so that employers can claim up to 80% of staff salaries.

And he has gone out of his way to emphasize that the NHS is still there for health issues unrelated to Covid. In fact, it says that without the lockdown, other services would have to be cut due to the increase in Covid cases.

But the fear is that confinement will act as a deterrent for those seeking care, while isolation and work worries will increase mental health problems.

University College London psychiatrist Professor Sonia Johnson is concerned that there is “little specific attention to the costs of confinement for the most marginalized and excluded” in society.

The risk is that the cure is worse than the disease, and some believe that we are not modeling this properly to help solve it ahead of time if it is.