UK Lockdown set to tighten

29th March 2020

Powis

Prof. Stephen Powis – urging against complacency

With the UK lockdown fully underway, and the further tightening of measures in prospect, the critical issue to address is the testing of health workers for COVID-19.  The NHS has had to deal with the crisis at a point when 10% of posts are vacant and many services sustained through the use of agency staff.  As a result of the crisis sickness levels in the NHS are already high, resulting in a shortage of medical staff, with many others self isolating with suspected symptoms.  Others are worried that they may be infected without showing symptoms, posing a potential risk to patients, colleagues and families. Widespread testing of NHS staff would help protect patients as well as allowing staff to return to the frontline faster.

The urgency of this strategy was underlined yesterday by national medical director of NHS England, Prof. Stephen Powis, at the daily Downing St press conference, that the UK “will have done very well” if deaths are kept below 20,000 in the current pandemic.  Given that deaths in the UK have just passed the 1,000 mark that represents only 5% of the potential death toll, even in a best case scenario.

At a cost of nearly £6m the government has taken the controversial decision to write to every UK household this week, in the form of a personal letter from Prime Minister, Boris Johnson, urging everyone to observe the lockdown measures currently in place, while reinforcing the social distancing and hand washing messages.

Debate has already started as to whether the letter is the best use of resources given the TV, radio and social media coverage of the stay home, save lives message.  Evidence suggests that in most instances behavioural change is taking place, with social distancing now being the norm in supermarket queues.  Amongst the minority where there is active resistance to the government measures people are unlikely to be persuaded by a letter from the Prime Minister.

The outpouring of public support for health workers, in the clap for carers initiative on Thursday and the rush of over 500,000 volunteers to provide support, has demonstrated the willingness of huge sections of the population to play their part in tackling the COVID-19 crisis.  This was swiftly followed by the embarrassment of Boris Johnson, testing positive with mild symptoms, Health Secretary, Matt Hancock, having to go into self isolation and Chief Medical Officer, Chris Whitty, temporarily withdrawing from the public stage for the same reasons.

Substitutes have had to deliver recent Downing St daily press briefings, with appropriate social distancing being observed, and reporters asking questions via video link.

With week one of the lockdown over there is every expectation that the coming seven days will see pressure upon the NHS increase significantly.  Of the 6,300 COVID-19 patients in hospital, as of last Friday, at least half are in London alone, which is expected to be the worst hit part of the UK over the next ten days.  Privately, many involved in local resilience are expressing the view that London is, to all intents and purposes ‘lost’, and measures to contain the virus have effectively been too little, too late.

While government measures to help the employed and self-employed during the week were welcomed, the period of uncertainty leading up to the announcements meant that many continued to travel to work on crowded tube trains and buses.  Without any certainty about income people felt they were being forced to choose between going to work and taking their chances with the virus.

Similar scenarios are playing out across major conurbations across the world, with New York and Tokyo continuing to report significant increases in cases and Mexico announcing a nationwide one month lockdown in an effort to contain the spread of the virus.

In the UK, ‘field hospital’ arrangements have been set up in London, with 4,000 additional beds, with Birmingham and Manchester expected to follow.  NHS guidance suggests that staff from across hospitals including non-nurses such as care assistants, therapists and pharmacists may be drafted in to assist with the care of patients, with intensive care nurses overseeing teams of carers across several patients.   Guidance also suggests that staff volunteering to work in field hospitals may need to be prepared “to live-in for the period the field hospital is open.”

In the context of a lack of high grade masks and inadequate levels of personal protective equipment, in an already under resourced NHS, capacity is soon going to be stretched beyond any reasonable limits.

Under resourcing and the creeping privatisation of the NHS have been starkly exposed by the present pandemic.  The symptoms though have been presenting for a long time.  The drama of current events is increasingly confirming that the long term cure for health provision in the UK is only possible with the planning, investment and organisation necessary under socialism.

 

 

Whatever it takes?

20th March 2020

BorisBriefing

Boris Johnson – a little less bluster, a little more action?

The COVID-19 coronavirus crisis is throwing up significant contradictions for capitalism.  In a system built upon competition, the only way to defeat COVID-19 is through co-operation.  In a system which prides itself upon being dedicated to the free market and privatisation, the only answer to COVID-19 is centralised control and state intervention.  In a system in which companies in the FTSE100 are happy to rake off enormous profits when times are good, they are desperate for a government bail out when times get tough.

Having been elected on the ‘Get Brexit Done’ mantra the Tories are now running with ‘Whatever it takes’ as the slogan in their efforts to tackle COVID-19.  Rishi Sunak, newly installed Chancellor of the Exchequer, last week revealed a budget that sought to provide a bail out for business, but expects workers at the sharp end to settle for little more than half a loaf, as the economic consequences of COVID-19 begin to bite.

Capitalism inevitably sheds labour in times of crisis but is in danger of shedding more labour even more quickly than the system can cope with, plunging into worldwide recession as a consequence.

In spite of this, Parliamentarians and the press alike are being are being very polite.  It is a national crisis and we must all pull together to get through, it’s no good indulging in a blame game, after all, who could have seen his coming?

Short term memory is a wonderful thing.  Bird flu? SARS anyone?  It was only a question of time before another viral attack was unleashed upon the world and building capacity to resist should have been a priority for some time now.

The reality is somewhat different.  Ten years of Tory enforced austerity has not only weakened the capacity of the NHS to deal with the medical consequences of the virus but has severely undermined the community infrastructure necessary to help support people through the crisis.

Local government services already at breaking point have limited capacity to adjust.  The zero-hour contract, low pay, gig economy, beloved of so many of the companies Sunak will bail out, gives millions of workers no security or protection at such a critical time.  Many will turn to local services for support and find that these too have been eroded over the past decade.

UK Prime Minister, Boris Johnson, has donned his populist cloak and claimed that, unlike the 2008 financial crash when the banks were bailed out, this time the people will be bailed out and not suffer unduly.  During the course of the same press briefing (19th March), Johnson also claimed that if we all pull together it will be possible to ‘turn the tide’ on COVID-19 within 12 weeks.

This seems to fly in the face of the assumptions made by the Imperial College London (ICL) report upon which the government is now making its planning assumptions.  The ICL report suggests that the mitigation approach, initially adopted by the government, would result in “hundreds of thousands of deaths” and overwhelm NHS intensive care units.  ICL models suggested 250,000 deaths in Britain based upon experience to date in the UK and Italy.

More effective, according to the ICL report is a strategy it terms suppression, now adopted by the government, which aims to reverse the epidemic growth altogether by reducing case numbers and keeping them down.  ICL suggest that,

“A minimum policy for effective suppression is therefore population wide social distancing combined with home isolation of cases and school and university closures.”

ICL claim that suppression policies would need to stay in place for at least five months and claim that, to avoid a spike when suppression is eased, restrictions in some form may need to be in place until an effective vaccine is available, which could be up to 18 months.

This is a far cry from the blustery optimism of Johnson’s turning the tide in 12 weeks rhetoric.

The UK has a total capacity of 5,000 intensive care unit beds in surge capacity mode.   In Italy, deaths increased when beds hit capacity and critical care was not available.  Estimates suggest that nearly 5% of people with COVID-19 will need to be hospitalised, a figure which increases into the older age range.  An estimated 70% of the over 80s who require hospitalisation will be likely to need critical care.

While the Tories cannot quite be accused of acting like Mexican president, Andres Manuel Lopez Obrador, who thinks he can defeat COVID-19 with lucky charms, including Catholic scapulars and a US 2 dollar bill, they still need to take more urgent action more quickly.

As ever, it is the poor and the elderly who are most at threat.  As ever, these people are the most reliant on public services which the Tories have consistently undermined.  As ever, these are the sections of the population which rely most on the NHS.

COVID-19 knows no boundaries, either of geography or class, but it is inevitably the case that those with the least resilience, both medically and financially, are at the sharp end of the social spectrum.  They will need more support than a few long terms loans to private business will provide.  They will need sick pay and their wages and housing costs covered in order to get through the crisis.

Whether the system can really be turned around to support the poor, the elderly and the unemployed, rather than the banks, the rich and the City of London, remains to be seen.  Johnson’s daily 5pm press briefings will continue to be monitored with interest.