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Getting closer to it – but still no real strategy in the UK covid-19 pandemic

A review of what has been said in the last few days about the coronavirus pandemic in the UK.

Testing

When testing should have take place

In March the World Health Organisation (WHO) was saying ‘test, test, test’. But on 12th March the UK stopped testing in the community and focussed the limited testing capacity on hospital patients.

Boris Johnson’s government failed to impose mass coronavirus testing after being told that COVID-19 was only a ‘moderate’ risk to the UK (1st April).

Senior advisers admit lack of investment in mass testing ‘may have been a mistake’ as they believed influenza was a bigger threat (2nd April).

At the House of Commons Health Select Committee meeting on 5th May, Sir Patrick Vallance, Chief Scientific Advisor to the Government, said he ‘would have liked testing ramped-up sooner’. [Ramped-up is one of the a new words we have come to recognise.]

Jenny Harries, Deputy Chief Medical Officer for England, at the same meeting, said the changes to the policy in early March was because of ‘ insufficient capacity’.

Mass testing earlier ‘would have been beneficial’ (5th May).

How often should care workers be tested?

Sam Monaghan, manager of a group of care homes, arguing for weekly tests on care home staff and resident, on 2nd May;

‘A member of the resident group was diagnosed with the virus and we know that the highest probability how that came into the home was through one of our members of staff. The difficulty is that none of the staff are showing any symptoms at all so it’s a bit like ‘Where’s Wally’ – but Wally’s taken his jumper off and so the manger’s looking across her staff group asking where has this thing come from?’

The numbers game and the current situation

Stephen Powis, NHS England National Director, 4th May;

‘Testing .. has ramped-up very quickly over the last week or so and we are now at a very high level of testing with over 100,00, a little bit of a dip at the weekend but we anticipate that that testing ability will continue to increase.’

On 6th May the Buffoon was saying the aim now was to get testing up to 200,000 per day by the end of May. But it’s probably as useful in defeating the virusas Hancock’s promise of 100,000 by the end of April – which, for some miraculous reason, has only been achieved on 30th April, numbers dropping into 70-80,000 since. But all the classic questions, Who, What, Where, When, Why, remain.

Who will be tested, just those who show symptoms or a wider, random, cross section of the population?

What will the tests be looking for, just if people are infected or as part of an overall strategy of tracking and tracing?

Where will the tests take place, taking the tests to the people or the people to the tests?

When will the testing be part of a strategy?

Why is nothing forward – not even the numbers. 200,000 by the end of May is too low and too long a period for such a minimal increase in testing in relation to the population in general?

A different type of testing

Professor John Newton, the Government’s testing co-ordinator, on 4th May;

‘There are at least two large commercial organisation who have good lab based tests we are currently evaluating. But also people are looking at ways of doing anti-body tests close to the person, the patient. There are a number of options there including a saliva test. And all of the options are looking quite promising and being evaluated.’

Where is testing going – and when?

Jeremy Hunt, Chair, House of Commons Health Select Committee, on Radio 4, World at One, 5th May

‘Everyone accepts that Germany and South Korea have really done a pretty good job. Korea didn’t report more than 9 deaths on any day during the whole course of the coronavirus crisis and are now saying that are getting no new domestic infections. I think the important thing for us is; have we learnt from what is happening in Korea and do we have the Korean strategy in place? I think what we heard this morning from Sir Patrick Vallance and Dr Harries is that that now really is our strategy and that’s the most important thing.’

[Best practice was known about weeks ago. Why, in Britain, is this still going to happen at some indeterminate time in the future?]

Q. To mimic South Korean strategy?

‘Yes, I mean they are are the ones who did this test, track and trace process, very tech centred, very innovative use of apps, backed up with contact tracing on the ground. And remember they had a worse challenge that we had, they’re closer to China, they had less notice than we had, they had a super-spreader who was part of a religious cult. So they had a real challenge to deal with but they did manage to contain the virus. This is what we are now planning to do starting with the Isle of Wight.’

[South Korea and China are amongst those countries that have embraced technology in a big way, much more than in Britain. Many people don’t have Smartphones, many of the Smartphones don’t have Bluetooth and in those countries where technology was used in this way it was followed by extensive testing on a one to one basis. No plans for that have been presented here in the UK.]

Q. Are we past the peak?

‘That’s what the government is saying and I’m sure that’s what their scientific advice is saying. And there’s a lot of gloom about the death figures and to have 11.500 more deaths than you would expect in one week in April is pretty depressing. But the very last question in the Select Committee Hearing to Sir Patrick Vallance, I thought, was, in a way, the most encouraging because I said to him that if we do the test, track and trace, if we observe the social distancing rules, on balance, do you think we can avoid a second wave, and that’s the thing all over the world people are worrying about, and he basically said, Yes. He was an optimist, he said he thought we could. So I think that they are confident we’re not just past the peak but if we implement all the policies that are now in train, we could avoid a second peak.’

Q. When do we get to the point of being able to ease the lock down? When can that system take over?

‘Well, I think we’re going to hear about that on Sunday. And we tried to shed some light on that today. What it appears is that the absolute rule is that the R, the reproductive – rate mustn’t go above 1. They still think we are between 0.6 and 0.9. But within that there’s a lot of variation. So Sir Patrick Vallance was saying that in the community the R rate is probably a lot lower, towards the lower end of the scale, but in hospitals and care homes it is still running higher. So that’s where the risk is that you can perhaps get community transmission down, because people are staying at home, but you have a re-introduction of the virus through an outbreak in care homes, for example. So that’s why I think it’s a very finely balanced judgement.’

Q. That’s where the app may become critical and as well as that human contract tracers will be important. As far as the app is concerned will you be downloading it?

‘Absolutely. I think all of us who have Smartphones should, when we’re asked to do so and I think it can play a very, very important role. But I don’t think they work for everyone. I think 40% of the population don’t have a Smartphone so there will need to be more traditional methods of contact tracing with them. But I do think it has a very important role to play.’

[The British Government recognises that technology will not solve all the problems but doesn’t have an infrastructure in place to deal with those shortcomings.]

Q. Have we been too slow? The SAGE documents were released this morning, under pressure, and the Government is becoming more transparent, except a lot of those documents have been redacted, some to the point of being useless. Were you surprised by the extent to which they had been redacted?

‘Well, there’s a tradition, obviously I was in the cabinet for nine years, and advice to ministers is kept confidential and that is very, very important because you need advice to be completely frank and people giving the advice need to be able to say exactly that they want to say without having an eye over the shoulder to what happens if the advice gets published. But there is something different when you have a crisis like a pandemic and the Governments says that at every stage ‘we are following the scientific advice’.

If they say ‘we’re following the scientific advice’ but they don’t publish the scientific advice then it’s very difficult for MP’s to hold them to account. That was one of the things I asked Sir Patrick Vallance about and I asked Matt Hancock to day in Health Questions, to whether he would consider publishing the SAGE advice that he’s receiving at the same time as he makes his decisions, so that we all have access to the scientific advice that the Government says it’s following.’

[But when will this ‘transparency’ show itself?]

Q. So it’s too slow and it’s too late?

‘Transparency is very important because that ‘s the way you keep the trust of the public. Also, it’s important because there is a lot of uncertainty in these recommendations because it’s a novel virus and I think it helps if the public understand that some recommendations are clear cut but other’s are finely balanced and it’s helpful for us to understand that as well.’

Experts and transparency

Some members of the Scientific Advisory Group for Emergencies (SAGE), are arguing for more transparency.

Sir Jeremy Farrar, formerly Director of the Welcome Trust and a member of SAGE, on 4th May;

‘Personally I would make the minutes transparently available after a certain time. I think transparency helps people to understand the uncertainty, the difficulty, the fact that actually science does have to change as the facts change. That is certainly sensible and logical. What we know today is very different to what we knew in February and March.’

Breaking the lock down

On news that Neil Ferguson, the senior advisor to the Government had broken the lock down by having his married lover coming around to his house – apart from the issue of breaking the lock down he obviously had no idea of the gutter press in this country who will be looking for any opportunity to undermine anyone if it helps to sell the paper – or get the name of the paper broadcast on other news media (it’s all about advertising).

Jo Hemmings, Behavioural Psychologist, 6th May;

‘What people are now doing, perfectly understandably, is creating their own version of what they believe to be acceptable. You also have people that were behaving in a pretty sensible way for a while, say when we weren’t going out having obvious public group gatherings. Now the situation is so muddled about what is going on a lot of people have been doing for the last few weeks, and will continue to do is ‘the it’s just me thing’.’

Danger of a second wave

On the chances of a ‘second wave’, Robert West, Health Psychologist at University College London, on 3rd May;

‘With the figure that we have at the moment it looks like, probably, around somewhere between 5% and 10% of the population have been infected. That leaves between 90% and 95% who have still not been infected. So the death rate we’ve got at the moment is with that 5% figure, so we have to be very, very cautious and very careful about how we view the lock down.’

Maria Van Kerkhove, World Health Organisation (WHO), on a second wave, on 4th May;

‘What we’re seeing in countries like Singapore is almost like a second wave. Essentially what it is actually outbreaks that are happening in shared dormitories. So the virus has found a place where it can take hold and can resurge again. So all countries must remain on alert for the possibility of additional transmissions.’

The app that will solve all our problems – or not?

There are a number of issues with the Smartphone app – produced by NHSX (together with an unspecified private company) – that will be tested on the Isle of Wight from 5th May;

the test itself,

• the Isle of Wight has fewer Smartphones than is the avaerage in the UK (older population)
• there has been a low incidence of infection to date
• the island is still on lock down so people won’t be going out of their homes much
• how effective will the test be?
• even if the results are ‘positive’ the app won’t be used throughout the UK until towards the end of March

the aspects of the app,

• still not sure if it will work if the app is not showing on the screen
• there’s the possibility of the app running the battery down
• still many people have questions and doubts of the reassurances about privacy

This is on top of the issues discussed in a previous post.

Dame Wendy Hall, Southampton University, Government advisor on technology, on 3rd May;

‘It won’t be storing huge amounts of data about us in central servers, that’s not the case. Almost all of it stays on the phone, it’s all encrypted and what they store is anonymous. There’s no absolute right answer to this but I’m pretty convinced the way the UK is going, for the moment, is the right thing to do.’

Professor Susan Michie, Director of the Centre of Behavioural Change at the University College London who is also on the government’s Behavioural Science Committee for Covid-19, on 5th May;

‘I’m slightly concerned that there hasn’t been enough consultation with the public and a lot of concerns have been raised by the public about the governance of it, the security and privacy of it, the private company that’s owning it and so whether or not the public will take the app in the number that’s needed is a question mark. I do hope the Government quickly gets the trust that’s absolutely needed.’

Robert Hannigan, former National Security Advisor and Director at the Government Communications Headquarters (GCHQ), the Radio 4 World at One, 5th May;

‘It’s very good that they have said so much about it, there has been a great deal of technical policy detail published by NHSX [the NHS digital section] in the last week about how they’re doing this and I think that’s a very sensible approach and it’s reassuring to anyone who’s concerned about the technical aspects and the privacy aspects. I think they’re doing really well. This is attempting something which has never really been tried before, to use the Bluetooth technology, on this scale right across the country. It’s unprecedented so fair play to them for moving at such speed and trying to get it up and running. I’m sure there will be lots of things that go wrong and they will be putting right but that’s always true with new technology.’

Q. Is it the right decision to go down their own centralised route and not the Apple/Google decentralised route is correct?

‘It’s a balance but I think the downside of the Apple/Google localised route is that it leaves Public Health England and the NHS with no information about the overall spread of the virus and where it is spreading and all things they need to make really important decisions about public health and about how we may be released from the lock down, which is, after all, the major point in this.

The privacy aspect, I don’t think there’s a huge difference. I think given the steps that the NHS have taken to protect privacy and the involvement of the Information Commissioner in all of this it’s sufficiently anonymous not to be a threat to individuals. All the app records is the first part of a postcode and the make of the phone and, of course, this is co-operating with Apple and Google in a sense that it’s using those two operating systems, albeit not with the model they preferred. But having said all that, of course, there will be a good debate about privacy. My own feeling is that this should be time limited, so at the end of the pandemic we need to pause this experiment and have a proper public debate and parliamentary debate about the use of these apps in the future.’

Q. Are you reassured on the security of the data?

‘Yes, obviously the question of a centralise model, for which we are going down, is that the data has to be kept in one place and then it’s a question of who has access to it and for what reason. They have been very clear that it will only be public health authorities or public health reasons, that it will not be linked to other data about people in their health system. There is a question about how this data is kept and when it is destroyed. It will be useful to academics in the future to tackle future pandemics so we shouldn’t suddenly chuck it out, but equally I think we should bring this experiment to a clear close at the end of the pandemic and review it and have a proper debate about it. The key is that it should not be made available to the private sector, to companies to advertise and everybody agrees that this must be severely limited to public health experts and local authorities.’

Q. Do you think that in the way it has been set up it will be impossible for external users to get to this date?

‘Yes I do because I’ve read a lot of detail about how they’re been doing it in the last few days. You can always construct some edge case for how somebody could subvert this and that’s true of any system you build but frankly the conspiracy theories that I’ve seen put out there are pretty far fetched and would require so much effort and would be almost impossible to scale up.’

Q. You will be very happily downloading it?

‘I will and I think it’s important that it shouldn’t be compulsory to downloaded but it is going to help all of us stop the spread of this virus which is affecting all of our families and help all of us to get out of the lock down. So it’s in our interests to download this. It will not keep any personal data about you and I’m satisfied that the very limited data it does have will be properly protected.’

Q. You say is shouldn’t be compulsory but you sound if it’s everyone’s duty to download this app?

‘It’s in everyone’s interest and so far everybody I know, who I meet, wants to stop the spread of this virus, wants to protect the NHS and wants to get out of lock down as quickly as possible and are really desperate for that. And this is a really helpful way of doing it. It isn’t a major solution, it’s only part of a system that really depends on testing and proper tracing. It won’t be perfect, there will be problems, there will be false positives but it’s definitely worth a try.’

If someone who is (or was) a part of the British intelligence ‘community’ likes the idea then that alone is reason to be suspicious. And why is there a former (and not a present) Director giving this interview. That’s a way for the State to distance itself from any comeback.

Contact tracing and the lock down

David Nabarro, World Health Organisation (WHO) Special Envoy for Covid-19, on getting contact tracing up and running, 1st May;

‘This is something that every government is having to make a choice and I understand that the contact tracing process is now well advanced. You don’t need to have 100% tracing in order to get the R number down. You certainly can release the lock down while you’re building up the case finding and contact tracing capacity. That’s what most other countries are doing. They don’t wait until things are absolutely ready.’

Professor Susan Michie, Director of the Centere of Behavioural Change at the University College London who is also on the government’s Behavioural Science Committee for Covid-19, on 3rd May;

‘The Government message has become a lot more complicated, partly because this will need to be a different message for different people. Some people will be asked to go back to work when they are not happy doing that, concerned that there won’t be enough social distancing, giving risks of bringing back infections to the household whilst others, who are wanting to get out of their houses, won’t be able to.’

Chances of dying from the covid-19

David Spiegelhalter, Professor of Statistics at Cambridge University, on Radio 4, the Today Programme, 1st May;

‘If you’ve got the virus your chance of dying is roughly about the same as you would have had this year anyway. And if you’re worried about dying this year you shouldn’t be so worried at getting the virus. But I think we do need to have some sort of campaign to encourage people who are at very low risk to actually get out and start living again, when we’re able to.’

Ending the lock down

Robert West, Professor of Health Psychology, University College London, on how we should get to the easing of the lock down on Radio 4, World at One, 1st May;

‘It’s going to be a very odd moment and people will react to it very differently. Some people will say, ‘well actually I don’t really want to because I feel frightened and others will be champing at the bit and perhaps take it too far. I think it’s really important to say that it won’t be juts an all or nothing, it will be a very graded thing and this is going to present some quite significant challenges, in the sense of how you communicate that.’

Q. What sort of challenges does the nuance present?

‘It’s hard enough to get the message across when you are saying thinks that are black and white like ‘Stay at home, protect the NHS, Save lives’. Even there you get exceptions with people saying, ‘well, actually, I realise one should do that but in my case it differs’. When you make a more nuanced message which is that you can go out more, there are certain things you can now do that you weren’t able to to do before you can imagine the problems that you’ve got with people interpreting that is all sorts of different ways. Ad that means that the politicians who are giving the messages are going to have to chose their wording very carefully because a single throwaway remark could be misinterpreted and cause all sorts of critical problems.’

Q. How do you solve that because you have to come down on one side or the other?

‘Yes, the way you handle it is that you, whatever message you put across, you make it very clear who it applies to, what the situations are and give specifics about the situations you are referring to and, as always, you give very clear reasons as to why that is the case and a very important part of that is that if you’ve got an easing of the lock down which applies to some group in society more than it does to others you can imagine that it’s going to start to create problems with a resentment in some cases and people saying, ‘well, why should they be allowed to do this and I can’t’.

Q. The Government says even talking about that is dangerous, do they have a point?

‘They have no choice. They have to talk about it because what people can very clearly see is movement in other countries and that when this Government is already saying, ‘well, we have turned the corner on this one’, they can’t just pretend that it’s business as usual. So they have no choice. They have to talk about it. So then we come to how do you talk about it. The key thing is to help people to realise that this is a very risky time, tight now. This is probably as risky as it has been on any part of this crisis. If we get this wrong then we will be back where we started, possibly even worse. So people have to know that whatever the easing of restrictions, they don’t go beyond it.’

More on covid pandemic 2020-2?