Boris Johnson will be judged on the next four weeks. That prospect should frighten him. 

“Small wonder, then, that while ministers have been on a loop promising to “ramp up” testing, those tasked with making that happen have been tripping over their feet. Note the government’s own animal health agency, which says it could have been running 40,000 human tests a week and has been eager to help, but couldn’t get a straight answer out of Public Health England (PHE). First in touch with PHE back in January, its capacity still remains untapped.”

Boris Johnson and his government are on probation, watched by a public whose mood could turn rapidly and brutally. For now, and on paper, Johnson has the people with him: his poll ratings have surged north of 50%, a feat last managed by a Tory government at the height of the Falklands war nearly 40 years ago. But the wisest heads in Downing Street will not be turned by those numbers. They know that there’s always a “rally around the flag” effect at moments of extreme crisis: when citizens are frightened, they want to believe their leaders have got things under control. That’s why incumbents around the world, even useless and immoral ones such as Donald Trump, have enjoyed an initial corona bounce in their ratings, almost regardless of their actions. At the start of the Iran hostage crisis in 1979 Jimmy Carter saw his approval numbers leap from 32% to 61% – only for him to crash to defeat a year later. Johnson will know that one day, and perhaps quite soon, he, too, will be judged.

He can point to some concrete achievements. The opening today of what is a giant field hospital in east London’s ExCeL centre, constructed within nine days, is the prime example. Those who drooled with totalitarian envy at China’s ability to throw up a hospital in Wuhan within a week were adamant that a western democracy like Britain could never match that accomplishment, and they have been proved wrong. Rishi Sunak’s promise that the state will pay 80% of workers’ wages has won plaudits around the world, even if the chancellor has had to return repeatedly to his economic rescue package, tweaking it to catch those groups he left behind first time around. And the government has imposed a national lockdown that has been largely observed, one that might even see a flattening of the infection curve in the next week or so.

All that, though, has to be set against a record that does not inspire confidence, but saps it. It consists of a series of decisions that, for now, the British public has been prepared to forgive, granting its leaders the benefit of the doubt, but which it may eventually find indefensible. Their combined effect can be seen in a single image, a graph with the power to terrify. It shows that the UK death toll is currently higher than Italy’s at the same stage, reinforced by another showing that by this stage of the outbreak Italy had begun to flatten its curve while in Britain the line keeps rising, the number of deaths doubling every three days.

Start with Johnson’s initial reaction to this menace. Recall the smirking insouciance with which he boasted that he continued to shake hands, even when he met people he knew to be infected with the virus. If Britain emerges from this crisis with a higher death rate than comparable countries, that is a Johnson moment that will come to haunt him.

That complacency was formalised in the government’s flirtation with the notion of herd immunity, an approach that some ministers still try to deny was ever policy but which was spelled out explicitly by the chief scientific adviser as recently as 13 March. To be sure, Johnson U-turned on that, ditching mitigation for all-out suppression when he announced the national lockdown 10 days later, prompted in part by seeing Italy engulfed by the virus. But Britons might not wait for the inevitable public inquiry to wonder at the time lost chasing what proved to be a fantasy and to ask how those precious days might have been used instead to prepare for what was coming.

For that time could have been devoted to testing, the failing on which this government is likely to be judged most harshly. On Thursday, health secretary Matt Hancock sought to offer an explanation for why Britain so conspicuously lags behind the likes of Germany in this area: Britain does not have the diagnostic industry the Germans have built up over 70 years, he said. But that cannot excuse what has been a litany of mixed messages, crossed wires and broken promises.

Even now, there remains confusion about whether the government accepts the centrality of testing to combating this threat. It was not three weeks ago that the head of the World Health Organization made the case in words of one syllable. The way to fight Covid-19 was “test, test, test”. Yet a matter of hours before Hancock spoke, and even as the prime minister was calling testing the key that would “unlock the coronavirus puzzle,” the deputy chief medical officer, Jonathan Van-Tam, was on TV arguing that testing was “a bit of a side issue,” compared with slowing the rate of new infections via physical distancing.

Small wonder, then, that while ministers have been on a loop promising to “ramp up” testing, those tasked with making that happen have been tripping over their feet. Note the government’s own animal health agency, which says it could have been running 40,000 human tests a week and has been eager to help, but couldn’t get a straight answer out of Public Health England (PHE). First in touch with PHE back in January, its capacity still remains untapped.

That seems to fit with reports that PHE has been too controlling and centralising, standing in the way of the Dunkirk effort urged by Nobel prize-winning scientist Sir Paul Nurse, in which hundreds of the UK’s smaller labs would play the role of 1940’s little boats, doing their bit to test, test, test. There has been confusion – ministers say there’s a shortage of key chemicals called “reagents”, the chemical industry says there’s no shortage – and there has been failure, best captured by the sight of those much-vaunted drive-through testing facilities, in Chessington, North Greenwich or Wembley, standing unused and echoingly empty. Note too the baffling decision that only 15% of NHS staff could be tested, a limit that was lifted this week.

When the time comes, the government might try to blame the civil servants and the bureaucrats and, no doubt, there will be plenty of blame to go around. But the government has power – more of it now than at any time since the war – and its duty was to bend the bureaucracy to its will. Hancock wants to convey that he’s doing that, promising 100,000 tests a day by the end of the month. But even if meeting that target proves possible, and details are scant, it could come too late, given that those same ministers are warning that the tidal wave will be crashing on our shores very soon.

Sadly, the failings on testing do not stand alone. There has been the scandalous failure to equip doctors and nurses with the protective kit they need. When hospitals are turning to suppliers of medical fetish gear for essential masks and scrubs, you know something has gone badly wrong. The same can be said of watching a Trump administration official mock the UK for having so few ventilators, or of the evidence that our government chose to stand aside from a Europe-wide effort to source those life-saving machines, apparently because to take part would smack of betraying Brexit.

For now, the British public are being patient, but their patience will not be infinite. Hancock will have to make good on that promise of 100,000 tests by the end of this month; the curve will have to flatten. At stake over the next four weeks will be the lives of many citizens of this nation – and the life of this government.

 

Exeter’s Westpoint Arena set to be temporary coronavirus emergency hospital

A new NHS Nightingale hospital is being set up at Exeter’s Westpoint Arena to treat COVID-19 patients from across Devon and Cornwall, Devon Live understands.

Colleen Smith  www.devonlive.com

It is believed work is ongoing at Westpoint Arena, on the outskirts of Exeter near Clyst St Mary, ahead of an official announcement.

It is understood that work has begun on the Devon and Cornwall NHS Nightingale hospital which will have around 400 beds.

Westpoint – the site for the annual Devon County Show – is the largest exhibition and entertainment venue in the South West with an indoor venue for up to 7,500 people. It is located near Exeter Airport.

It is not yet known if the area will include a temporary morgue similar to the one recently set up in Kingskerswell.

The NHS last night confirmed that new Nightingale hospitals are being built in Bristol and Harrogate. The Government say NHS Hospitals across the country have already freed up more than 33,000 beds, the equivalent of 50 new hospitals, and there are 8,000 extra beds in the private sector.

But the Nightingales are on standby in case these are not enough to cope.

The military helped to set up London’s Nightingale hospital, which so far has 500 beds in place with space for another 3,500.

Staff from across the NHS will be working there, including student nurses, medical students who have started work early and former doctors, nurses and other staff who have come out of retirement.

Similar hospitals are also due to open at Birmingham’s National Exhibition Centre and Manchester’s Central Complex.

A 4,000-bed facility is being opened at London’s ExCel centre. In Bristol, 1,000 beds will be available at the University of the West of England…….

A nearby hotel – the Hampton by Hilton at Exeter Airport – has been converted to accommodate discharged hospital patients awaiting care home placements.

The hotel was closed on Tuesday March 24 following the lockdown to reduce the spread of Covid-19.

Devon County Council confirmed the hotel is being utilised to help ease the pressure on local hospitals and care homes who are attempting to cope with an increase in demand on its services.

 

Britain’s coronavirus testing scandal: a timeline of mixed messages

It’s like watching a slow motion car crash, except we are passengers in the car – Owl

Three weeks ago, the World Health Organization told countries battling Covid-19 to “test, test, test” for the virus. Since then, the UK government has been accused of issuing mixed messages, of over-promising and under-delivering – the UK’s daily testing rate has only just passed 10,000.

Pamela Duncan  www.theguardian.com

11 March: Tests to be expanded

The health secretary, Matt Hancock, insists the government is “rolling out a big expansion of testing” but declines to give a specific timetable. NHS England says there are plans to increase coronavirus testing to 10,000. The UK-wide death toll stands at eight – 1,215 people have been tested for coronavirus in the UK.

12 March: Tests to be restricted

The UK moves from the “contain” to the “delay” phase of its plan to tackle coronavirus. Boris Johnson announces that health workers will no longer test people for the virus in their homes, but will continue to test people already in hospitals.

16 March: WHO says ‘test, test, test’

The WHO urges countries to “test, test, test”. 3,826 people have been tested for coronavirus in the UK.

18 March: ‘Test 25,000 a day’ – but no timetable

Boris Johnson announces the ambition of carrying out 25,000 tests a day, but provides no detail. 5,779 tests are carried out that day.

19 March: ‘Antibody tests coming soon’ – but no timetable

The prime minister says mass testing to see if people have already contracted the virus, and are probably therefore immune, will take place relatively soon, which he says would be a game-changer. The UK death toll from coronavirus stands at 144.

24 March: ‘UK has 3.5m antibody tests’ – but no timetable

Matt Hancock announces the government has bought 3.5m antibody tests, which can determine if someone has had coronavirus. He repeats that general testing will be ramped up, but with no timeframe for deployment. 6,491 tests are performed.

25 March: ‘UK aiming for 250,000 tests a day’ – but no timetable

Johnson tells the daily Downing Street press conference: “We are going up from 5,000 to 10,000 tests per day, to 25,000, hopefully very soon up to 250,000 per day.” 6,583 tests are carried out.

25 March: ‘Antibody tests within days’ – then denied

Earlier that day, Prof Sharon Peacock, the director of the national infection service at PHE, says mass antibody testing in the UK will be possible within days. The government later takes a more cautious line, saying the tests will not be available so quickly.

27 March: ‘Dramatic increase planned’ – but no timetable

Michael Gove announces that a “new alliance” of businesses, research institutes and universities will boost antigen testing capacity (which checks if someone has the virus) for frontline workers. He says hundreds of people will receive the tests over the weekend and that there will be a “dramatic” increase in testing the following week.

31 March: ‘Testing hampered by chemical shortage’

Only 8,240 people are tested on this day. Gove says the availability of certain chemicals is limiting the ability to rapidly increase testing capacity.

1 April – Ministers admit only 0.4% of NHS staff have been tested

Despite its 27 March announcement, Downing Street confirms that only 2,000 people out of 500,000 frontline NHS England workers had been tested for coronavirus so far. Public Health England’s Prof Yvonne Doyle appears to confirm that the UK’s strategy is now to increase testing for the virus in the general population. A total of 9,793 tests are carried out.

2 April: Government sets new target – and admits 3.5m antibody tests don’t work

Testing passes 10,000 a day for the first time since the start of the crisis, with 10,215 carried out. Hancock sets a new government target of 100,000 tests a day by the end of April – including both antibody and antigen tests. He says the UK wants to buy 17.5m antibody tests, “subject to them working”, and that early tests had been “poor”. None of the 3.5m tests bought by the government – and announced on 24 March – have been found to work so far.

3 April: 100,000 target clarified

Hancock tells broadcasters that the prime minister’s 25 March commitment to get to 250,000 tests a day “still stands”, but that he wanted to “put a very clear timeline” on the goal to get to 100,000 by the end of the month. He says it is “frustrating” that the first antibody tests have not worked. The prime minister’s spokesman is forced to clarify that the 100,000 target is for England only.

 

Health secretary says coronavirus peak remarks ‘over interpreted’

The historic claim is that it will “all be over by Christmas” – have we heard that one yet? – Owl

Kate Proctor  www.theguardian.com

The health secretary urgently sought to play down his suggestion that the peak number of deaths caused by coronavirus could fall as early as Easter Sunday – claiming his remarks had been “over interpreted”.

Matt Hancock began his media appearances on Friday by saying it was “perfectly possible” the peak of the disease could arrive in nine days’ time.

His comment led to confusion hours later at the daily Downing Street press conference as the government’s deputy chief medical officer, Jonathan Van-Tam, asked when the epidemic was expected to peak, said: “We don’t know the answer to that yet.”

Van-Tam said it was “too soon to say” when the peak would hit, appearing to contradict the health secretary.

“It will partly depend upon how well those social distancing measures are adhered to by every one of us,” he said. “I hope it will be soon. We’re going to watch very carefully to see when we’ve hit the peak and when we’re starting to turn it, but we will not take any premature actions.”

Easter Sunday falls on 12 April this year, and Hancock had earlier said he would not steer people away from anticipating that date as the peak in the number of fatalities in the UK, though there was still uncertainty around it.

He clarified his remarks during the Downing Street press conference on Friday evening after being asked again by Sky News when he thought the peak would fall. “The truth is that we don’t know,” he said.

He claimed his remarks had been over interpreted and he had been clear that the government could not give a definitive answer in his earlier interviews.

He said: “Actually, there’s a reason we don’t know, and that’s because it depends on how people act, and this is why the absolute central message, the most important message that anybody can take away from this press conference or the entirety of the government’s messaging and how we feel, is that you’ve got to stay at home.”

The first minister of Scotland, Nicola Sturgeon, said Hancock’s 12 April suggestion did not feel accurate considering the evidence she had assessed. She said: “I want to be very clear that nothing I have seen gives me any basis whatsoever for predicting the virus will peak as early as a week’s time here in Scotland.”

Her chief medical officer, Dr Catherine Calderwood, stressed: “I have not been able to find that the peak will be as soon as we’re hearing in the media today. Now is not the time to think that perhaps it will all be over soon.”

Several government ministers have come under fire for giving mixed messages to the public, including the transport secretary, Grant Shapps, who incorrectly said people should only go shopping for food once a week, which was later corrected by No 10.

Michael Gove also stepped in to explain that daily exercise should be a walk or run close to home after people had interpreted the government’s rule as allowing them to travel further afield.

The prime minister has also been criticised for talking about plans for up to 250,000 tests a day. The health secretary confirmed the immediate aim was 100,000 tests a day by the end of April.

 

My ICU is three times capacity. And still the coronavirus tide keeps coming 

I am angry.

I am angry that NHS Nightingale will come too late. Intensive care units are becoming overloaded across the London region.

Anonymous • The writer is an NHS respiratory consultant who works across a number of hospitals

www.theguardian.com 

Our own is now ventilating almost three times the number it was designed for, spilling out across adjacent wards and operating theatres on scavenged ventilators and skeleton staffing.

Still the tide keeps coming. We are keeping sicker and sicker patients on the wards just because there is no capacity to ventilate them.

We are becoming stricter and stricter about who we are able to offer ventilation to; soon many of our own staff would not meet the criteria.

These conversations become harder and having them so many times per day is exhausting. The Nightingale is opening at least one week too late.

The upcoming weekend terrifies me.

I am angry that for the last week I have almost certainly had Covid-19 myself. I am lucky, of course, but because we have hardly any testing for staff and I did not have a fever or continuous cough, I was cleared as safe to continue working without a test. Who knows whether I was safe or not?

The tiredness has been crippling and I have crawled straight into bed after 14 hour days. I am feeling a bit better now but have profound anosmia that has robbed me of any ability to taste my food. But at least I am OK.

I am angry that so many of my colleagues are sick.

Some departments, my own included, have over half our staff off. We have – apart from a few exceptions – not run out of protective equipment, but it doesn’t seem to matter. People are sickening anyway. My worry is that some will get seriously ill, and some will die. Some already have.

In a callous, brutal way, I can only hope they are not people I know. I don’t think I could stomach that.

I am angry that we have had to go cap in hand to larger partners, in effect begging for equity in staffing.

Most teaching hospitals have an army of university-affiliated doctors doing research, or super-specialist clinics, or complex surgeries, and each have pulled these doctors into their own hospitals now that these activities have been cancelled.

This includes hospitals without emergency departments, which fully staff empty wards until they receive patients referred on a case-by-case basis from other hospitals.

Contrast this with a smaller hospital, already full before the crisis began, with no pool of additional resource to call on for a sudden unexpected shift to 24/7 working. There have been direct refusals to share staff and the unfairness takes my breath away.

Surely the only sensible answer is to convene a regional panel to fairly allocate staffing between hospitals based on need; once again the lack of high-level leadership lets us down.

I am angry that I cannot switch off. At home, at work, in the car, this is all there is now. Everything else seems trivial, monochrome, unimportant by comparison.

To my shame this has started to include me and my family. How can I care about my kids’ birthdays or my parents’ loneliness when people are dying unnecessarily?

How do I enjoy a day off at home when I’m still expected to dial in to two, three calls and there are constant WhatsApp messages and emails for advice and urgent decisions? I worry how long I can sustain this for.

Most of all, though, I am angry that despite all of our preparations we will be overwhelmed through no fault of our own. We prepared well. We were responsive, organised, calm, ready. What we have achieved already is truly remarkable. Now, though, we will just be yet another hospital with patients being treated in corridors, exhausted staff, insufficient ventilators and people dying because we can’t treat them properly.

 

What cost the lockdown? They helped economies in 1918, study suggests

Despite the fact that we don’t yet have the Covid-19 epidemic under control (we may just about have a more or less constant, but not yet a reducing, infection rate).  Debate has started on exit strategies and herd immunity.

Owl thinks it might be wise to watch and see what happens in other nations, further down the path. It also might be wise to wait until we get a fully functioning testing system which will be an essential prerequisite.

However, here is some interesting historical research.

Tom Whipple, Science Editor  www.thetimes.co.uk 

Seattle could see the pandemic coming as, to the east, town after town fell. When Spanish flu at last hit the Pacific coast the city was ready. Theatres, saloons, churches and schools were shuttered for five months.

In Saint Paul, Minnesota, the response was different. Worried, perhaps, about the economic effects, the town dithered and reopened after a month. Years later, as Seattle boomed, its economy was still suffering.

Economists believe that the 1918 flu pandemic could offer us a parable. For those countries weighing up the economic cost of intervention versus the lives saved, it is part of growing evidence that suggests the two are not mutually exclusive.

The study, by researchers from the Federal Reserve Bank of New York and the Massachusetts Institute of Technology, compared the severity of measures taken a century ago by 43 cities and the subsequent recovery. Their analysis of employment, manufacturing and bank losses implied that the economic costs alone of stopping a pandemic might be less then those of not stopping it.

Although the work has a caveat that Spanish flu had a higher death toll than coronavirus, and killed more people of working age, it is just one of a number of similar analyses being brought out to help governments.

Economists at Chicago University have used standard measures of the monetary value of a life to conclude that, assuming models of the pandemic were correct, the cost in US deaths of not stopping it would be equivalent to $8 trillion, or $60,000 per household.

Anna Scherbina, of Brandeis University in the US, has considered other trade-offs in an unchecked pandemic, factoring in medical costs and days of work lost to illness. With a total estimated bill equivalent to 43 per cent of US GDP, she concluded that it would be some time before the cure was worse than the illness.

The lessons should be an encouragement to governments to hold firm, she said, at least for now. “The economic costs of a lockdown are immediate and clearly visible to all, in a form of shuttered businesses, lower paychecks, lost jobs, etc,” she said. The benefits of a lockdown, however, are “not as obvious to the public”. According to her model, however, she calculated those benefits would run out and it would not be economically advantageous to maintain a lockdown until a vaccine was found.

Jonathan Portes, of King’s College, London, said that the uncertainties in what we know about the virus makes it hard for policymakers. While there is agreement on the economic merits of the present response, the same is not true in the longer term.

“Right now, there’s no trade-off between health and wealth,” he said. “Later, however, when the initial pandemic is firmly under control and we are thinking about how and when to lift restrictions, we may face difficult decisions on how to balance health risks and restarting the economy.”

Ultimately, said Julia Steinberger, from Leeds University, what matters may not be money, but how the money is directed. Last week a paper was published arguing that a long-term economic contraction of more than 6.4 per cent would cause more cumulative loss of life than the virus itself.

She has recently published research, however, suggesting that the GDP of a nation and its life expectancy is not so closely linked. Instead, she argues, the correlation between the two is our choice.

“A lot of things matter in the economy that are not measured in GDP,” Ms Steinberger said. “The UK has a highly-educated workforce, physical infrastructure, technology. All these things don’t leave the country just because GDP is going down.”

To get through this crisis, she said, “we need to protect essentials — basic goods like food, transport, housing. We need to keep focused on what we can do for each other.”