Lockdown weak, NHS in danger, where next?

With coronavirus case numbers still growing strongly (though perhaps slowing a little according to symptom tracking) and the NHS struggling to cope with the numbers of people needing hospitalisation already, driven by the much lower case numbers of 2 or 3 weeks ago, this is clearly the most dangerous time of the whole pandemic for any of us to contract the virus; there is every chance, wherever we live, that the NHS may not be able to give us the treatment we might need.

Acceleration of the vaccine programme is of course essential and the delay to second doses to give more people the protection of a first dose is a proportionate response to a crisis of this magnitude. But it will take until mid February to vaccinate (first dose) the most vulnerable 15 million people, accounting for 88% of deaths. So we should expect a big drop in pressure on the NHS by mid March. But that is 7 weeks away. For now, growth in the virus is adding pressure faster than vaccination can relieve it.

I’m not going to repeat the point that the government has been slow to act at every point to prevent exponential growth of the virus. But where we are now, we have a much stronger virus than last March/April and a much weaker lockdown. People are moving about more, more is open, more children are at school, etc, etc.

It is self-evident, as it has been for weeks, that restrictions need to be tougher than this. Schools have (kinda) closed, which is, rightly, the “last resort”, so what else is there?

Close more?

Nurseries? Coffee shops? Estate Agents? All reasonable. There was a major problem with funding nurseries last time they were closed except for key workers. But they could be funded for a few weeks.

Schools? Some schools are reporting 50% attendance due to the expanded definitions of key workers, including, for example university lecturers working from home. Helpful to have the children in school, yes. Essential? Perhaps not in every case. We need to take transmission more seriously than last April, not less.

Beef up “covid secure” standards for workplaces and public transport?

I asked a question about this to our Director of Public Health

I think the unspoken truth here is that ‘covid secure’ was always more spin than substance. Try to do these things but a nod and a wink if you can’t, we won’t close you down. I think it is time to take transmission in the workplace seriously and close down sites that can’t or won’t operate safely. And maybe mass testing will help here.

Social mixing?

A great unfairness of the pandemic, possibly as great as the economic unfairness, has been the somewhat arbitrary imposition of complete isolation on some people while other have human contact more or less as before, based on who you live with and how you work. Support bubbles gave some welcome relief.

But even now, you can take exercise with one other person, and the next time you take exercise it can be a different person, and the time after that a different person again. Perhaps extending the support bubble idea would be better than this, i.e. limit the total number of people you mix with. And if you live in a large household or have to mix at work, that spends your mixing budget. A much fairer way of limiting social mixing without leaving some people utterly alone.

I do believe such steps will be necessary for only a few weeks while we have very high numbers and before the most vulnerable are best protected with vaccines.

And maybe there is scope to adjust the vaccination programme again. Start a parallel programme of vaccinating people by occupation, according to the occupations of patients we see in the hospitals. (Some argue specifically for teachers, police, taxi drivers, etc, but let’s follow the evidence.) This would slow down vaccination of the most vulnerable but could save lives overall. It would mean asking some elderly people to shield a bit longer.

What we can’t do is just hope this crisis goes away.

* Joe Otten was the candidate for Sheffield Heeley in June 2017 and Doncaster North in December 2019 and is a councillor in Sheffield.

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29 Comments

  • Jenny Barnes 11th Jan '21 - 3:03pm

    With the slow rollout of the vaccine at half dose it’s likely that the virus will mutate to be vaccine resistant. Maybe the vaccines can be tweaked, but it’ll be 2022 at the earliest before anything like normality returns. Buckle up.

  • Peter Davies 11th Jan '21 - 3:29pm

    We tend to exist in several circles: domestic, work, social etc. and spreading occurs more when these circles overlap and they overlap more when they are larger. A family of seven might overlap with four workplaces, and three social circles. There is nothing we can do to reduce household size and we have squeezed social contact close to zero.

    Work is really the only area we can still improve. There seems to be no real mechanism by which you would expect employers to do more than they are forced to by a threat of closure (and this is done by sector so all their rivals will be closed down too). Go into any shop and you can see ways they could organise better at very little expense. I suspect the average factory is doing even less.

  • No, they shouldn’t be tightening the lockdown further as it means doubling down on a failing strategy (it’s almost inevitable that they will but wrong).

    The problem is that stringent lockdowns target behaviour which carries a low risk of transmission anyway e.g. people walking in a park. As you tighten further, the “return” gets less and less.

    If you try the nuclear option and your enemy doesn’t surrender what do you do then? More nukes or go for diplomacy?

  • Little Jackie Paper 11th Jan '21 - 4:54pm

    ‘And maybe there is scope to adjust the vaccination programme again.’

    This is an important point and a real coming issue and you are very right to raise this. The JCVI priority list is surely the list we would follow rigidly in the ideal world. Following it is utterly admirable. And yet, as in many walks of life, the great must not be the enemy of the good. For example there is this question of 24/7 vaccination. Admirable, but if we go down that road we need to recognise that in all probability a vaccine available at 3.00am on a cold February morning is not likely going to be administered to an 85 year old but to someone in a lower priority group. Is it unreasonable to ask an 85 year old to be vaccinated at 3am? Probably. A 65 year old? That’s debateable and it’s a debate we might need sooner than later.

    I don’t like the idea of doing this by occupation (and there is an unpleasant whiff of special pleading at the moment). However I do have to recognise that there is a trade off here between speed and priority – both of which are important and there probably isn’t a right or wrong answer here.

    So I think this is a really important argument – In my mind the absolute, absolute priority is the top 4 groups in the priority list, but from there we perhaps need to prepare ourselves for a flexibility that will likely be rough and ready at times.

    Worth adding here that the vaccination plan published to day is worth a read – it’s not a bad document. I do think that we need this more GP led for the priority groups, and these mass vaccination centres look to me more suited to the people who are lower priority. But all things considered that plan looked OK at first blush.

  • I prefer to rely on the strategies and scientific expertise of Professor Jason Leitch in Scotland and Professors Whitty and Van-Tam in England who, unlike the anti-lockdown ramblers, at least know what they’re talking about.

    A pity the Johnson government is so world beatingly incompetent at implemention. To quote David Lloyd George : “Too late in coming to this decision. Too late in starting with enterprises”.

  • Little Jackie Paper 11th Jan '21 - 5:05pm

    Joe Otten – ‘Vaccine resistant mutation is possible at any time, and more probable the slower you vaccinate.’

    Indeed. The key issue now is getting to 2m a week then getting it up from there. Presumably the constraint there is supply and what would make the biggest difference now is availability of one or more of the other vaccines in the portfolio. Looking online at least the Johnson & Johnson one looks like it will be next to report trial results with the UK having ordered 30m with an option to raise that to 52m. That to me looks like what will speed this up most.

  • John Marriott 11th Jan '21 - 5:08pm

    Perhaps I should declare an interest. At 77 I am scheduled to get my first shot by the end of next month. However, knowing my local GP practice, I will be surprised; but we live in hope.

    People are stressing about categories, strategies, logistics and doses. The problem as I see it is that we may not have enough doses on the way to get anywhere near the immunisation levels required to get on top of the pandemic in the short term. With that in mind I think I would be happy to let my second shot be given to someone else.

    And the lockdown. “What lockdown?” I hear you ask. Well, it certainly doesn’t feel the same as last March around here. Perhaps one ‘tweak’ might be to insist that face coverings be worn out of doors at all times. Or how about a post 9pm curfew for all but key workers? (That would mean we could still get our click and collect takeaways or do a bit of last minute grocery shopping).

    Let’s be honest, we will only be safe (or should that be safer?) when we get immunised and, even then, I personally can’t see us returning to the kind of flying anywhere, massing together indoors and outdoors etc that many considered what life should be all about before the virus struck. Being an antisocial S.O.B. I’ll drink to that!

  • Viruses mutate when they reproduce. They reproduce most when they are in an accommodating environment – i.e. inside the body of someone who has been infected. The longer someone is infected, the more virus reproduction takes place, and the more opportunities there are for mutation. Two things therefore need to happen – yes, we should vaccinate as many people as possible as quickly as possible to prevent/slow down the rate of new infections. But we should also be finding ways to reduce the duration of the infection, because that reduces the possibility of mutations. Finding more effective, faster cures is therefore not only in the interests of the patient, but is a key contributor to reducing the rate of virus mutation.

  • Would there be a great problem in insisting that people wear a face covering outside the house? This would represent a coming together of messaging and a practical reduction in risk. Obviously some people would need medical exemption but it is one of the easiest restriction to monitor.

  • Lorenzo Cherin 11th Jan '21 - 5:55pm

    Agree with every word of this Joe, a shame but nobody here in this party, was interested in my suggestions, a couple of weeks ago and before this so called lockdownhttps://theartsandhumanityscause.com/6571-2/

  • Helen Dudden 11th Jan '21 - 7:05pm

    If in the first place, the virus was controlled it would have been a better solution. Now with the muted virus, the chances are, it will mutate again.
    When I was young measles and chicken box were more common, it was wiser to try and contain the spread as both of these illnesses, could cause problems to other’s. Pregnant women, were one group with a few of these childhood diseases. So activities were restricted.
    To be fair it’s taken a while for the virus to grow this strong.
    Everyone, and I mean everyone, should be isolated when they cross the borders, it’s happened in other countries.
    Prevention is better than the cure. It’s not sure if after the vaccine, it can be spread. Actually with child vaccination, it does go through the child, and diapers/nappies should be handled with care.

  • Graham Jeffs 11th Jan '21 - 7:58pm

    Geoff Reid “would there be a great problem in insisting that people wear a face mask outside the house “?

    Yes. It’s all down to circumstances. If I’m near other people (shopping etc) then it’s common-sense to be cautious If I’m out in the countryside with acres to myself (and wife) wearing a mask becomes a bit anal. Might suit the Derbyshire Constabulary, but advances the war on COVID not one iota whilst bringing the whole approach ridicule in such circumstances

  • Much more effective, by several orders of magnitude, than wearing a facemask OUTDOORS would be to actually enforce and publicise the regulations as they are now. Such as:

    Enforcing facemask wearing within shops – not just breezing past the note on the door. If I attempted to brazenly walk out of the shop without paying for an item, I’m sure that I’d be ‘challenged with vigour’ by their security staff. The same should apply to enforcing government regulation designed to save lives. Individuals who choose not to should be banned from entry, unless they can PROVE they are medically exempt, much as I have to when collecting a prescription.

    A public information information campaign about mask wearing , and clarifying how they should be worn – NOT as chinstraps, or just covering the mouth, not nose.

    The wearing of masks is to protect others, by wearing a covering over the mouth and nose. Visors are increasingly worn instead – They do not qualify. This is from the government web site:

    “A face visor or shield may be worn in addition to a face covering but not instead of one. This is because face visors or shields do not adequately cover the nose and mouth”.

    Health service staff wear them IN ADDITION to face masks, to avoid getting a high dose of virus by being coughed on by infected patients that they need to get close to, they do nothing to protect others. The only people using just visors should be made to prove they have a medical exemption.

    I’m well aware that some people cannot wear a mask for medical reasons. I cant fail to be aware of that, from the constant repetition in my local Sainsburys and elsewhere. What I dont have is any faith whatsoever that those who don’t wear them ARE the medically exempt, rather than those who just cant be bothered, or are ‘covid-deniers’. The regulations as they are enforced now mean that the rest of us are protecting THEM, while they enjoy convenience and the protection of them by others.

    Regulation about not meeting others should apply IN shops as well as elsewhere. It is pointless to insist that people shouldn’t meet outdoors, suitably distanced – it will be of negligible risk, especially compared with when I frequently see groups (generally couples of my age and older) stopping to have a natter with other groups, well within 2 metres and blocking the isles of local supermarkets, causing others to have to squeeze past.

  • There are many people like me who are not leaving their homes at all until they get the vaccine. We took that decision before Christmas, some time before the new guidance was issued for people who are shielding. We were similarly stuck at home during the first lockdown, but since July had been enjoying a walk in the country most days and that’s what we miss most now. We would feel safer if everyone else was sticking to the rules, but while they don’t we can’t risk it.

  • @Mary

    ” We were similarly stuck at home during the first lockdown, but since July had been enjoying a walk in the country most days and that’s what we miss most now. We would feel safer if everyone else was sticking to the rules, but while they don’t we can’t risk it.”

    That’s what I find so upsetting about all this, if everyone stuck to the rules, we would all be able to enjoy some limited but vital freedom. We could all take a bit of pain, so we can all have a little joy. But there are far to many out there now who are not concerned about sharing these little freedoms.
    There are far to many with the attitude this virus does not affect them, so why should they give up any freedoms. They seem to be quite content for the at risk and vulnerable to be shut away and forgotten about like some shamed family member who is never spoken of again.
    That is not the kind of society that I was brought up in and it is certainly not the kind of society that I want to live in now. I’m only 45 🙂 but I do not recognise some of the attitudes of my own generation and I struggle to understand what has happened

  • Helen Dudden 12th Jan '21 - 8:39am

    Yesterday, it was reported that Boris Johnson was out on his bicycle several miles from London. It was also reported that he had been to Ashton Gate in Bristol, a new injection centre for the virus.
    A few days before, his fiancee had introduced her mother into the bubble at number 10.
    I think even in my simple terms, you can understand how problems can occur.
    Also, there have been further reports of children and adults being fished out of the bitterly cold English Channel. You could go back on the contacts, they have had. Most of the rescuers will have families. Personally, I find the subject of money making this way disgusting.
    The French were insistent with the lorry drivers, stuck for several days without proper facilities.
    By the way in Ireland, paper work is causing problems in the food chain.
    There is zoom meetings and skype.
    The Government also announced that the new centres for the injection will be within 10 miles, supposedly not crossing counties.
    I believe to overcome this infection we all must play our part.
    Priti Patel must now get to grips with the situation in the channel it’s been long enough. Human Beings deserve better treatment.

  • After posting my comment yesterday (there has been significant delay), I read news reports that Morrisons and Sainsbury’s were going to enforce the ‘masks must be worn’ rule in the their stores, and also that at least one police chief had stated that they wouldn’t be assisting with enforcement as, to paraphrase, ‘they have better things to do’ (like stopping coffee-drinking walkers and people travelling in their cars, presumably).

    This morning, I receive an email from the chief executive of Sainsburys telling me that ‘When shopping in our stores, you must wear a mask or visor unless you have a medical exemption’.

    My attempt to point out that this is still in contravention of government regulations is stymied by the fact that they only receive feedback via phone (hypothetically), facebook or twitter (both of which I’ve junked), NOT simple email. Therefore off to Morrisons for me. Instead of the the Tescos 300 yards away.

  • Graham Jeffs 12th Jan '21 - 11:28am

    I commented a couple of weeks ago that in the first lockdown the supermarkets locally were wiping down the baskets and trolleys. This then ceased. So we have had a material percentage of shoppers bowling into these shops without taking any precautions.

    Stupidity and selfishness combined. No wonder the hospitality sector is aggrieved!

  • Peter Davies 12th Jan '21 - 11:42am

    @Anthony_H A Visor is what you can wear if you have medical exemption from wearing a mask. It doesn’t have the same effect but it does stop direct transmission by coughs and sneezes.

  • @Peter Davies

    Well, not exactly. They don’t substitute for a mask in any way shape or form in the role of protecting others – sneezing is not a symptom of Covid-19, and they provide no protection for coughs at all, unless the coughed-upon are within an unrealistically close distance to the cougher. They don’t provide a seal – as it states in the government regulation.

    This is why they aren’t being prescribed as a medical necessity by the NHS, to patients. They are, however, available from amazon for a little over £2 each so that anyone who wants one can wear them, at a price little more than the cost of a face mask.

    I personally do not believe that everyone I see wearing them is doing so through medical necessity rather than personal convenience, and it would be a far more effective measure in reducing transmission than outdoor facemasks or wiping down trollies (from the scientific evidence available to me, there has only been ONE verified case of Covid transmission by indirect touching, as opposed to airborne).

    For those for which it IS a medical necessity, it would be appropriate for those to be given assured and subsidized delivery slots, rather than going to the shops in person.

    My interpretation of the Sainsburys communication is that they don’t want so upset the middle class otherwise well face-visor wearers frequenting their stores. Those that are unaware of their lack of compliance should be made aware using public information broadcasts, as I proposed in my original post.

    As a matter of fact, I’ll be wearing a face-visor AS WELL as a face-mask. AND disposable gloves, and apron, as part of my NHS volunteer role, that I will be returning to shortly after shielding for ten months due to my wife being ‘extremely vulnerable’ (I myself only class as ‘vulnerable’, and she’s better now).

  • Helen Dudden 12th Jan '21 - 4:28pm

    More than a 1,000 cancer patients in London, are awaiting cancer surgery, that is category 2. I don’t know anything about cancer treatment, but I’m informed, that’s a needing to level.
    I wear a visor for medical reasons, I’ve had eye surgery and my specialist felt it’s in my interest.
    I personally feel, it’s time the situation was got to grips with, there are some serious issues to be resolved.

  • @Helen

    The problem with those that require cancer surgery is, that means they will then need access to an ICU bed to recover.
    When these are all being used by Coronavirus patients, it means the NHS has to cancel elective surgery.
    It is an awful crisis situation that we are in.

    I keep hearing many people argue on other forums, that NHS hospitals are not at capacity because there are 170,000 beds in total, what they fail to remember is those hospital beds are made up of many departments, Paediatrics, Geriatrics, Gastrology, Oncology, Maternity to name just a few, all of these wards have to be kept covid free.
    Once a hospital’s ICU and acute medicine wards are full, they have reached capacity, regardless of the number of other beds on other wards that are available.

    We know hospitals are desperately trying to expand capacity by turning operating room and surgical wards into ICU units, but of course, this then means more elective surgery being cancelled as these operating rooms / wards have been repurposed.

    Then there is the issue with oxygen supply. Covid Patients need high levels of oxygen support in order to keep stats above 90% or they risk organ failure. That puts a huge pressure on the infrastructure to deliver that, Hospitals were simply not designed to be delivering those amount of oxygen support to so many patients at the same time, which of course results in even more elective surgery being cancelled.

    I really wish the CMO would do more to explain the situation in Hospitals and the logistics involved with dealing with so many patients needing Oxygen support and being isolated from the rest of the hospital. I think that it is this lack in communication and explanation by the government and its advisors that has resulted in too many people believing that there are 10s of thousands of beds still available in Hospitals and the crisis situation is being exaggerated

  • Paul Barker 12th Jan '21 - 5:35pm

    The point is that we are facing a Medical Emergency, we should be closing down all Work that isnt Vital in the short Term.

  • Helen Dudden 12th Jan '21 - 6:39pm

    They are not certain about the outcome of the injection.
    But if I remember correctly Johnson did say that some will die. Not specific.
    The private sector is another avenue. But all this is badly planned.
    Having received information, on the subject of court actions in certain circumstances. It was warned this could be a serious issue in the future.
    I also received information, that Ffizor are planning a meeting to discuss the future of cancer after covid.
    Most certainly, I will voice my opinion on the subject of cancer v covid.

  • George Thomas 13th Jan '21 - 10:19am

    Regarding virus mutation to the point of vaccine resistant, the greater risk seems to be from nations who for whatever reason aren’t going to be able to vaccinate widely in 2021? If there are going to be mutations they are more likely to happen in these areas so unless either i) USA/UK etc. start spreading vaccines around and/or ii) we close our borders based on vaccine roll-out we could end up with a similar need for lockdown in 2022.

  • James Fowler 13th Jan '21 - 2:58pm

    How about stopping thinking that pulling a lever here or making a tweak there is going to ‘solve’ this crisis.

    As has been reported elsewhere there have already been 64 changes to regulations/guidance in less than year. Few (if any?) people really understand them anymore. Worse still, as nobody knows what going to happen next it’s become entirely rational to make the most of what you’ve got.

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