August 2020

3rd August

The Guardian (among others) reported that Sir Paul Nurse, the Nobel laureate and director of the Francis Crick Institute in London, widely regarded as one of the country’s top scientists, had called on the government to be more open about how its coronavirus decisions were made, or risk losing public trust.

He said that important decisions throughout the pandemic had been made in what appeared to be a “black box” of scientists, civil servants and politicians: “Decisions are too often shrouded in secrecy. They need challenge and we need processes to ensure that happens. If they are going to keep the trust of the nation, they need to make those discussions more public.”

Other senior researchers also raised concerns about how the lack of transparency had allowed ministers to claim their policies were driven by scientific evidence when that was open to question.

 

9th August

New Zealand marked 100 days free of any cases of COVID-19. Professor Michael Baker, an epidemiologist at the University of Otago in Dunedin, on the South Island, stated: “It was good science and great political leadership that made the difference. If you look at countries that have done well it is usually that combination.” New Zealand had a total of 24 deaths linked to the virus. Unfortunately, a few days later a small cluster of cases occurred in Auckland, the country’s largest city, believed to have been linked to imported goods in cold storage and resulting in 36 confirmed cases and the re-imposition of lockdown in the city and lesser restrictions in the rest of the country.

 

13th August

Chris Hopson, chief executive of NHS Providers, told the parliamentary cross-party panel on coronavirus that the government had been “asleep at the wheel” when dealing with the needs of social care during the pandemic. He said that while requests for more PPE at hospitals had been met rapidly, “that absolutely wasn’t the case for the social care sector”. [Appendix 8]

 

18th August

In a speech to Policy Exchange (a UK-based centre-right think tank, created in 2002 and based in London), the Health Secretary, Matt Hancock, announced the abolition of Public Health England (PHE) and said: “To give ourselves the best chance of beating this virus once and for all – and of spotting and being ready to respond to other health threats, now and in the future, we are creating a brand new organisation to provide a new approach to public health protection and resilience. My single biggest fear is a novel flu, or another major health alert, hitting us right now in the middle of this battle against coronavirus.”

The new organisation intended to pool expertise from PHE and the NHS’s test and trace network [which could hardly be rated a success]. It would be modelled on the Robert Koch Institute in Germany.

The staff of PHE heard this would happen from newspaper reports.

The King’s Fund (an independent think tank which is involved with work relating to the health system in England) said PHE had been found guilty without a trial and that it was unclear what problem the government was hoping to solve by scrapping it. Similarly, the Health Foundation (an independent charity committed to bringing about better health and health care for people in the UK) said that reorganising the nation’s public health agency in the middle of a pandemic was highly risky, and its justification, or the nature of the change, hadn’t been fully set out by the Department of Health and Social Care.

PHE was set up in 2012 as part of the Coalition government’s (but mainly Conservative) health reforms and was supposed to work on health protection and matters such as obesity. It had been subjected to sharp funding cuts while wider public health funding had been slashed by 22 per cent since 2015.

The question was raised: had England’s poor handling of the COVID-19 pandemic been PHE’s fault? The answer is it may have contributed to it but certainly can’t be blamed for it all. It looked more like an attempt to absolve government ministers of the responsibility.

Sir Jeremy Farrar, director of the Wellcome Trust and member of SAGE, accused the government of making “knee-jerk, short-term, reactive reforms” and said that the government’s actions were pre-empting an inevitable public inquiry. Others chipped in with severe criticisms, with senior doctors, hospital leaders and a number of public health experts accusing ministers of scapegoating Public Health England for their own failings over COVID-19.

Professor Gabriel Scally, president of the epidemiology and public health section of the Royal Society of Medicine and a member of the Independent SAGE group, said the decision to scrap PHE during the coronavirus pandemic was happening at “absolutely the worst time” and there was an urgent need for the government to develop a strategy for dealing with COVID-19. “Making major organisational changes to the pandemic response system in the absence of a strategic plan is foolhardy in the extreme,” he said.

 

19th August

Liam Smeeth, professor of clinical epidemiology at the London School of Hygiene & Tropical Medicine, called for “a swift, no-blame enquiry”. Writing in The Times, he said: “We need a rapid inquiry where people provide full, open, honest evidence, without fear of retribution.”

He wrote that there were many areas of the response to COVID-19 where Britain could have done better and there were lessons we could learn. He went on to list some of the areas, including: the lack of crucial data on viral activity in the community; not appreciating the speed of viral spread; lockdown introduced  weeks too late; care homes largely ignored until much too late.

“A public inquiry that reports in a year or two will be too late,” he said. “We will have missed this vital opportunity to learn.”

Sadly, there was no serious response to this somewhat naïve request.

• A retired epidemiologist had a letter published in The Times stating (in part): “Britain’s sorry history of controlling infectious diseases is well illustrated by the slow, bureaucratic and centralised response to the COVID-19 pandemic crisis, and in the past 50 years by the failure to control MRSA and Clostridium difficile in hospitals, the escape of the foot-and-mouth disease from the Pirbright research facility in 2007, the smallpox outbreak in Birmingham in 1978 – the last case of smallpox in the world – and the BSE crisis of the 1980s and 1990s.”

That same day Lord Turnberg wrote: “Our disastrous inability to deal with the COVID-19 crisis can be traced back to 2004 when the government decimated [sic] the nationwide network of public health laboratories overseen by the Public Health Laboratory Service. These were the laboratories responsible for detecting outbreaks of infectious diseases, detecting their sources and successfully eliminating them.”

 

20th August

“Why has the government had such a dismal record of dealing with the coronavirus pandemic?” The Spectator magazine asked. “Some think it was early complacency which delayed the imposition of lockdown. Others point to an ignorance about the role of care homes. But according to former Brexit secretary David Davis, at least one of the reasons is that ministers were just trying to be too good.

“In an interview with The Daily Telegraph, Mr Davis said the government was ‘not dealing with [coronavirus] terribly well’ and that ‘the arrogance of the British approach has cost us dear’ because ministers were so focused on becoming world-beating rather than just making sure their systems worked. He said: ‘We don’t need to be world-leading. We just need to be competent.’

“It's an interesting perspective,” The Spectator continued. “Davis thinks ministers genuinely aspired to have the best response to the virus, rather than just hoping that labelling sub-par policies ‘world-beating’ would somehow hoodwink the public into thinking they were much better than the reality.”

 

20th August

A report from the MBRRACE-UK Confidential Enquiry into Maternal Deaths, based at the University of Oxford, said that pregnant women and new mothers had died needlessly in lockdown after being denied intensive care beds or mental health services. The report, which looked into cases of 16 women who died between March and May 2020, noted that a “lack of intensive care beds was repeatedly documented” and it criticised access to “appropriate mental health care” during the pandemic.

The report entitled Saving Lives, Improving Mothers’ Care, said that eight died from COVID-19, six from respiratory complications of the virus and one from cerebral thrombotic complications. Two other women had contracted the infection but died from unrelated causes. Four died by suicide, including two who were still pregnant, and two were killed by their partners.

• This was but the first of many reports of health-care failures during the pandemic. It was eventually revealed that the number of cancer referrals fell by 70% in April, that there were hardly any follow-up appointments for people with long-term conditions and elective admissions to hospitals dropped by 75%.

 

21st August

Carl Heneghan, professor of evidence-based medicine at the University of Oxford and director of the Centre for Evidence-Based Medicine, and Tom Jefferson, a senior associate tutor and honorary research fellow at the Centre for Evidence-Based Medicine at the university, discussed what could be learned from Italy’s experiences with COVID-19, Italy having been the first country in Europe to impose severe restrictions, including lockdown, to bring the disease under control. On 11th March when Italy’s prime minister, Giuseppe Conte, announced the national lockdown, there had been 12,482 cases and 827 deaths.

The authors said that the lack of pandemic preparedness against a backdrop of media-fuelled hysteria due to the initial explosive nature of the European pandemic reflected the decisions taken. They argued that it was not the time to point fingers and blame politicians for making difficult decisions in times of unforeseen crisis but rather we should look at what has changed and ask whether another generalised or local lockdowns are justified by the current situation and how prepared we are for a future outbreak.

After eight weeks of restrictions, the lockdown in Italy was eased on 4th May. Italians emerged cautiously. In small numbers, Italians visited their relatives; factories and building sites opened, but schools and churches remained closed. Most were preoccupied with tasting the first bar-made coffee in months. By June, anxieties were easing: cases were down to only 200 a day. However, the social custom of embracing and shaking hands with friends, fundamental to the Italian way of life, had dissipated in a short period of time.

Through the summer “weak positives” cases (i.e. where only a small amount of the virus was detected) increased, but admissions and deaths continued to fall. It appeared that those who tested positive had fewer viruses in their bodies. In Lombardy, the proportion of weak positives was around 50 per cent of the total cases and the proportion was increasing. Admissions in the region were few and far between and deaths, thankfully, ever rarer.

 

22nd August

Professor Sir Mark Walport, a member of SAGE, said that coronavirus will be present forever – in some form or another – and people are almost certainly likely to need regular vaccinations against it, like flu. COVID-19, he said on Radio 4’s Today programme will never be eradicated by vaccination in the way smallpox was. He warned of the possibility of the virus getting out of control again but said more targeted measures could be used instead of a generic lockdown.

• The government said it was aiming to start testing four million people a day by February 2021 with the Health Secretary, Matt Hancock, announcing a “moonshot” goal of regular population-wide testing, It was reported that some senior civil servants had already described “Operation Moonshot” as “crazy”.

 

23rd August

It was reported that a cross-party group of MPs was launching legal action to force the government to reveal full details of contracts awarded for personal protective equipment. The group accused ministers of breaching transparency rules and demanded the immediate disclosure of the contracts, which were valued at more than £5 billion. [Appendix 8]

 

25th August

The Daily Mail reported that ministers were continuing to defy advice from SAGE on testing hospital patients for COVID-19 before they were discharged to avoid infected people “seeding” outbreaks in the community when they got home. The committee had raised concerns back in May and recommended a routine screening programme for all discharged patients. But only patients being discharged to care homes were being tested – a rule put in place in April after the row over patients taking COVID-19 into care homes during March. In mid-June SAGE called for the COVID-19 infection status of individuals to be “known at discharge”.

NHS England guidance said that all patients admitted to hospital should be tested to make sure they don’t carry the virus in, but they don’t always get swabbed again before they leave, the paper reported.

It emerged around this time that the Department for Health and Social Care did not require inspectors from the Care Quality Commission to be tested when entering a care home.

 

26th August

Letters to The Times indicated one of the more ridiculous aspects of the government’s test and trace system. A person from Ilfracombe in Devon had been told to go to Swansea for a test but this was topped by a correspondent from Cardiff who attempted to book a test there but was instead told to go to Inverness, a return journey of more than 1,100 miles. He declined the offer. A girl in Wimbledon was offered a test in Leicester, a city under lockdown. Many other people reported being allocated tests more than 100 miles from their homes. A few days later callers in London were being told there were no tests available in that city while testing centres in Twickenham, Heathrow and Greenwich were practically empty. But appointments could be made in Bradford for those who fancied a bit of a drive (which would probably have suited Dominic Cummings and his family – see entry for 26th March). So, not quite the world-beating service the PM promised would be in place by the beginning of June.

• It later emerged that a glitch in the system was sending people on long journeys for testing. On 9th September a father, whose own father had died from the disease, told ITV’s Good Morning Britain (a programme on which for many months government ministers refused to appear) that he had driven across the country – to his “nearest test centre” – for an appointment to get his two young children, who had been displaying symptoms, tested for coronavirus but had been turned away because the centre had run out of tests. He was even more upset that the Health Secretary, Matt Hancock – in one of his more extraordinary comments during the pandemic – had blamed the public for the lack of available tests, saying the shortage of tests was caused by people who didn’t have symptoms making inappropriate use of the system. The father branded the situation an “absolute shambles” and said that he had been left “incredibly upset” over Mr Hancock’s excuse. He added that he would log back onto the NHS website to try to find another test centre.

 

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