ExCel U-turns on charging NHS for hospital site

The owner of London’s ExCel centre has performed a U-turn on charging the NHS to use the site as a hospital to treat coronavirus patients.

https://www.bbc.co.uk/news/business-52172007

ExCel chief executive Jeremy Rees said an initial agreement with the NHS to house the temporary Nightingale Hospital “included a contribution to some fixed costs”.

But he said: “We have since decided to cover the fixed costs ourselves.”

Mr Rees added that the ExCel had always been provided to the NHS rent-free.

The Sunday Times reported that the centre, which is owned by Abu Dhabi National Exhibitions Company (ADNEC), was charging the NHS between £2m and £3m in rent to use the east London site.

Humaid Matar Al Dhaheri, managing director and group chief executive of ADNEC, said: “To be clear, profit has always been the furthest thing from our minds.”

He added: “It is our firm commitment that we will not charge a penny for the use of our facilities, and we will provide the NHS with the operational and logistical support it needs for NHS Nightingale London.”

The field hospital can hold as many as 4,000 patients and is the first of a number of similar facilities planned for the UK.

 

Rees-Mogg firm accused of cashing in on coronavirus crisis

Government minister Jacob Rees-Mogg’s investment firm has been criticised for exploiting the coronavirus crisis after telling clients it provided a chance to make “super normal returns”.

Sarah Butler  www.theguardian.com 

Somerset Capital Management (SCM), which manages investments in emerging markets, told clients that the dive in stock market valuations around the world since the pandemic took hold had made “excellent entry points for investors”.

“Market dislocations of this magnitude happen rarely, perhaps once or twice in a generation, and have historically provided excellent entry points for investors,” SCM fund manager Mark Asquith wrote in a note to clients.

“History has shown us that super normal returns can be made during this type of environment.”

Rees-Mogg co-founded SCM and continues to hold a 15% stake in the business. He stepped back from day-to-day work at the firm when he became an MP in 2010 and quit his role as part-time adviser when he became a minister in 2019. He reportedly received a payout of about £1m from the business last year.

The firm said assets in Latin America, Europe, the Middle East and Asia were cheap following the recent heavy falls in global stock markets. Asquith noted that in the 12 months following the 2008 global financial crisis, the value of smaller companies in emerging markets rose more than 150%, with some Brazilian firms surging by about 500% within two years.

The company said it has recently taken advantage of the downturn to invest in Hapvida, a Brazilian medical insurer and hospital operator; Advantech, a firm behind technology used in China to monitor the temperatures of people in public places during the pandemic; and the South African pharmacy chain Clicks.

Keir Starmer, the new leader of the Labour party, said: “Nobody should be seeking to take advantage of this crisis. We should all be asking ourselves what we can do for our country and each other.”

The shadow chancellor, John McDonnell, said: “This attitude is about as sick as it comes. Profit seeking from people’s suffering is nearly as low as you can get. When we come through this we need a windfall tax on the profiteers.”

However, Jolyon Maugham, the campaigning lawyer who backed legal action against Brexit, described the criticism as “a bit silly”.

“No fan of Rees-Mogg, and of course super-profits must be properly taxed, but this is a bit silly. SCM wants to invest in bombed out share prices. This is actually a good thing as higher share prices will make it easier for those businesses to attract fresh capital and survive,” Maugham said on Twitter.

Oliver Crawley, a partner at SCM, said: “Our thoughts are with those suffering as a result of these tragic circumstances and we are full of admiration for the huge commitment so many are making to fight this pandemic.

“Our fund managers’ investment commentary is focused on the valuations currently seen in the emerging markets, not the appalling human cost of the virus, and we sincerely hope these comments are not misconstrued as being unsympathetic.”

 

A week of missed chances, blame games and a loss of confidence

Owl thought that the “Torygraph” might be an interesting place to get an inside story of the testing fiasco.

By Edward Malnick, Sunday Political Editor www.telegraph.co.uk

Ministers and Whitehall officials insist they want to avoid a “blame game” for the UK’s apparently under-powered efforts to carry out mass coronavirus testing to date. But the remarks that follow such claims tend to involve implicit or explicit criticism of Public Health England, the quango responsible for protecting the nation from health emergencies, such as pandemics.

A recent, official survey of PHE’s own staff found that confidence in the organisation’s leadership was lacking from within as well. Less than half (49 per cent) of the body’s employees, 81 per cent of whom took part in the survey, said they had confidence in the decisions of senior managers.

In Downing Street too, confidence appears to have been lacking in recent weeks both in the Department of Health and PHE, with an acknowledgement that more should have been done earlier to roll out mass-testing, particularly of NHS staff unable to work because they or members of their household had displayed Covid-19 symptoms. One claim repeated inside and outside of Whitehall is that PHE has failed to capitalise on offers of help from the private and academic sectors, to help increase its capacity.

Tom Shinner, the highly-regarded official previously in charge of no-deal planning, was drafted back to No 10 a fortnight ago, having left Whitehall last year to become chief operating officer of Entrepeneur First, a technology investment firm. But the week in which public focus turned to testing coincided with Boris Johnson, Matt Hancock, the Health Secretary, and Dominic Cummings, the Prime Minister’s chief adviser, all physically isolated from each other and the rest of the government machine, and suffering, with varying degrees, from Covid-19 symptoms. Mr Johnson, who still has a temperature, and Mr Cummings, both remain in isolation as they attempt to shake off the virus, although Mr Johnson has continued to chair daily meetings on the issue.

Now, Lord Bethell, the former managing director of the Ministry of Sound nightclub, has been appointed as the de facto minister for testing in the Department of Health. While Mr Hancock named Prof John Newton, the director of health improvement at PHE, as the senior official who would steer through the new plan to reach 100,000 tests per day by the end of this month, Lord Bethell will have ministerial oversight.

Dedicated teams in the Department of Health will now, among other tasks, be responsible for involving industry and universities in the Government’s efforts to ramp up the number of tests taking place.

A growing number of experts see mass testing, together with the tracing of anyone who has come into contact with those who have tested positive, as key to helping the UK out of its impasse, where lifting the current restrictions on the population would almost certainly cause an upsurge in infections and overwhelm the NHS.

On Saturday, Neil Ferguson, the Imperial College London professor upon whose modelling the Government has relied, said he was “hopeful” that some of the strict social distancing measures could be substituted with rapid access to testing and contact tracing in a few weeks’ time – once case numbers are lower.

A growing number of experts see mass testing as key to helping the UK out of its impasse Credit: PA

In an interview with BBC Radio 4’s Today programme, Prof Ferguson said that in January, when Covid-19 was discovered in the UK, “it wasn’t felt by PHE and others that we could ramp up testing fast enough for it to be an option then”.

When testing and contact tracing was rolled out the following month, it was focused on people returning from affected countries, rather than more widely across the population. An early detection policy, involving the isolation of all positive cases and those who have come into contact with patients, appears to have significantly helped to reduce the spread of Covid-19 in countries such as Singapore and South Korea, which learned lessons from the Sars outbreak in 2003.

In the UK, however, “we didn’t have the tests, as the epidemic took off, available to really roll it out on a national scale,” Prof Ferguson said.

Now, in early April, there not only remains a major shortfall in the the country’s capacity to test large sections of the population, but, as of Friday, only 5,000 of the health service’s 1.4 million staff had been tested, with many having to remain off work, without tests, because they live with family members or friends who have displayed symptoms in the last fortnight.

Some members of the cabinet are among those who are sceptical of Mr Hancock’s pledge to reach 100,000 tests by the end of this month. A previous announcement that the Government had purchased 3.5 million immunity home testing kits has so far failed to materialise, and there is a concern that ministers have previously rushed through major announcements without the evidence that they can be followed through.

On March 24, Mr Hancock said: “Of course it really matters for getting people back to work, so we have now bought 3.5 million antibody tests.

“That will allow people to see whether they have had the virus and are immune to it and then can get back to work.”

But on Thursday, the Department of Health and Social Care (DHSC) conceded that the Government had not actually bought the tests but had put agreements in place to allow them to buy 3.5 million kits from a number of manufacturers, provided they receive official approval.

“We have not yet bought any tests but we do have contracts agreed subject to testing,” a DHSC spokesman said. “We have secured small numbers with potential to get much larger orders.”

Mr Hancock’s new five-point plan to ramp up testing to 100,000 per day includes both swab testing, to see which patients have the virus, and rolling out antibody tests which would establish whether individuals have already had and recovered from the disease.

Under the plan, PHE is “leading” on plans to increase the number of tests of inpatients and the most critical workers from 13,000 to 25,000 per day by mid-April, using eight of its labs and 44 across the NHS. But the Department of Health, under Mr Hancock and Lord Bethell, is leading work on all forms of testing as well as ensuring the involvement of private and academic bodies in testing and supplying equipment.

The set-up appears to leave significant room for inter-governmental blame to arise again if the 100,000 tests-a-day target fails to materialise by the end of this month. But one Whitehall source insisted that with the return of Mr Hancock and Chris Whitty, the Chief Medical Officer, following week-long home isolations, “it feels like the grown-ups are back”.

 

Exercise outside the home could be banned

Exercise outside the home could be banned if people ignore coronavirus social distancing rules, the health secretary has warned. https://www.bbc.co.uk/news/uk-52172035

Matt Hancock told the BBC’s Andrew Marr that the government would “take action” if needed to control the virus.

It comes after reports of groups of people gathering in parks during sunny weather this weekend.

Meanwhile, a further 555 people have died with the virus in England, 12 more in Wales and seven in Northern Ireland.

Mr Hancock said: “If you don’t want us to have to take the step to ban exercise of all forms outside of your own home, then you’ve got to follow the rules.”

The health secretary said the vast majority were sticking to the guidelines, adding: “Let’s not have a minority spoil it for everybody.”

This message is not helped by local maverick politicians: 

 Cllr Stuart Hughes, cabinet member for highways management DCC recently said enforcement has been removed from many parking places including coastal and tourist destinations. 

And EDDC revealed a couple of weeks ago that its all day parking for £2 will continue, following an agreement by council leader Councillor Ben Ingham and assets portfolio holder Cllr Geoff Pook. (In order to encourage people to spend all day wandering around the towns of Exmouth, Sidmouth, Honiton, Seaton, Axminster, Ottery and Budleigh.)

Can we all speak with one voice?

 

Tensions rise over scientists at heart of lockdown policy

It turns out that there is a complex backstory to the science involved in “follow the science”.

It involves personality clashes (scientists are not immune) and perhaps the more important connection to perceived failures to control the Foot and Mouth epidemic in 2001 and Swine ‘flu in 2009. These involved members of the current team of scientists. Inquiries in both cases were conducted, concluding: 

“Modelling did not provide early answers,” it concluded. “The major difficulty with producing accurate models was the lack of a relatively accurate idea of the total number of cases . . . This is not to reject the use of models, but to understand their limitations: modellers are not ‘court astrologers’.”

The same failure to gather data in this pandemic is highly likely to be part of the public inquiry that must surely follow. The most vital data still missing is the proportion of people who have already been infected — a number that would instantly make the modelling far more reliable, including telling us when the lockdown might end.

Jonathan Leake, Science Editor  www.thetimes.co.uk 

The Royal Society is to create a network of disease modelling groups amid academic concern about the nation’s reliance on a single group of epidemiologists at Imperial College London whose predictions have dominated government policy, including the current lockdown.

It is to bring in modelling experts from fields as diverse as banking, astrophysics and the Met Office to build new mathematical representations of how the coronavirus epidemic is likely to spread across the UK — and how the lockdown can be ended.

The first public signs of academic tensions over Imperial’s domination of the debate came when Sunetra Gupta, professor of theoretical epidemiology at Oxford University, published a paper suggesting that some of Imperial’s key assumptions could be wrong.

Her decision to publish highlighted academic rivalries between the epidemiology groups at Oxford and Imperial. These date back two decades to when Gupta, then a junior researcher at Oxford, lodged a complaint against her head of department, Professor Sir Roy Anderson, which saw him leaving the university. He is now professor of infectious disease epidemiology at Imperial. Now other researchers have raised different concerns— saying Imperial’s modelling, while high quality, needs to be checked and replicated by others.

Mike Cates, who has succeeded Stephen Hawking as Lusasian professor of mathematics at Cambridge and is leading the Royal Society project, said his concerns were partly that the Imperial team, led by Professor Neil Ferguson, was overloaded with work, but also that its model was originally designed to tackle entirely different illnesses such as flu.

“The Imperial team are very good but these models were optimised for a different purpose which is influenza . . . everyone’s conscious of the fact that it has been rapidly converted from a different purpose and wasn’t originally designed for this type of virus and this type of transmission,” Cates said.

He added: “We need some alternative models because very big decisions are being made based on the [Imperial] models. And that doesn’t mean there’s anything wrong with the Imperial model. It’s just that you can’t have one model, which has in it every possible different set of assumptions.

“With only the one model you don’t know which bits of it you really can trust, and which bits of it are less reliable — because the assumptions in it may have been made years before, in the context of a different disease.”

Such concerns echo those previously raised by Gupta. She said in an interview: “I decided to publish and speak out because the response to this pandemic is having a huge effect on the lives of vulnerable people with a profound cost and it seems irresponsible that we should proceed without considering alternative models. Imperial has a long history of involvement with government and its epidemiological models can have huge importance and translational impact but it’s tricky to use them to forecast what’s going to happen. We need to also consider alternatives.”

Her comments may hint at personal tensions among academic disease modellers, numbering just a few hundred people who know each other and have often worked together — or competed for jobs and grants.

In some cases there is a lot of history. In 1999 Gupta was coming to the end of a five-year fellowship in Oxford’s zoology department and applied for a permanent post, winning the approval of six of the eight-strong selection panel.

One of those who opposed her application was Anderson, her boss at the time. He alleged to other panel members that Gupta, who had worked alongside him for many years, had only got the job because she was having a relationship with another member of the panel. This was untrue and Gupta lodged an official complaint. Anderson sent her a formal letter of retraction and apology. He quit Oxford — moving to Imperial with a team that included Ferguson.

Later, the Wellcome Trust’s Centre for the Epidemiology of Infectious Disease, one of Oxford’s most prestigious institutes, was quietly merged into the medical department.

Until those events Oxford had led the way in epidemiology. It was Anderson’s Oxford group, for example, which modelled the global spread of HIV in the 1980s — warning that it could claim millions of lives. “It was ridiculed by the public health community,” said Mark Woolhouse, professor of infectious disease epidemiology at Edinburgh, who was once a member of Anderson’s Oxford group. “But the Oxford model was right. It showed how mathematical models of diseases can offer insights that public health experts cannot.”

Policy-makers took note. Woolhouse was also working with Anderson when mad cow disease spread from cattle into humans in the 1980s and 1990s and the government asked Oxford to help calculate the scale of the infection. This led to the cull of 4.4 million cattle, which suppressed the disease.

By the time foot-and-mouth disease (FMD) struck in 2001, however, Anderson’s clash with Gupta had seen him move to Imperial. Ferguson, who had once worked closely with Gupta at Oxford, including co-authoring papers with her, left her behind and also moved to Imperial. Oxford was in effect sidelined and it was from Imperial that Ferguson and Anderson dominated the government response to foot and mouth.

That response, involving the slaughter of more than 11 million sheep and cattle at a cost of more than £8bn was based entirely on modelling and remains hugely controversial — with many believing the modellers got it wrong. They were modelling a fast-moving epidemic with little accurate data. A subsequent government inquiry was damning of the general approach and its conclusions may be relevant to the current crisis. It said: “The FMD epidemic in UK in 2001 was the first situation in which models were developed in the ‘heat’ of an epidemic and used to guide control policy . . . analyses of the field data, suggest that the culling policy may not have been necessary to control the epidemic, as was suggested by the models produced within the first month of the epidemic. If so it must be concluded that the models supporting this decision were inherently invalid.”

The Imperial modellers’ next big public challenge came eight years later when swine flu swept the world — fortunately killing few Britons because older people tended to be immune and younger ones were strong enough to fight it off. Britain was, however, left with 34 million doses of unused and expensive vaccines. Again there was an inquiry — which concluded that ministers had once again treated modellers as “astrologers”, asking them to provide detailed forecasts when they had too little data.

“Modelling did not provide early answers,” it concluded. “The major difficulty with producing accurate models was the lack of a relatively accurate idea of the total number of cases . . . This is not to reject the use of models, but to understand their limitations: modellers are not ‘court astrologers’.”

The same failure to gather data in this pandemic is highly likely to be part of the public inquiry that must surely follow. The most vital data still missing is the proportion of people who have already been infected — a number that would instantly make the modelling far more reliable, including telling us when the lockdown might end.

“If we had been testing I still think we would have ended up in some form of lockdown,” Ferguson said, “but it might have been a shorter period of time and maybe slightly less intense.”

In the absence of government testing data the modellers can only make predictions hedged with a high degree of uncertainty.

A paper published last week from a group at the London School of Hygiene and Tropical Medicine, led by Nick Davies, warned that lifting the lockdown after 12 weeks would be followed by a surge of cases with between 220,000 and 370,000 extra deaths.

On the other hand, it suggested, imposing repeated lockdowns off and on for the rest of the year, could reduce the number of deaths to 130,000 and perhaps as low as 54,000. All the numbers are bad — but they are also incredibly wide-ranging.

Other modellers have drawn similarly dire conclusions. One of them is Osnat Zaretsky of DataClue, a company that has helped Israel, which has seen only 40 deaths so far, draw up a response. He believes Britain’s modellers have grossly underestimated the pandemic and predicts that Britain will see 95,000 deaths by May 1, rising to 288,000 by late June.

“The numbers are extremely alarming —they are doubling every couple of days and this is what our projections are based on,” said Zaretsky, a UK-born Israeli whose research suggests that the UK is not even counting deaths accurately. “There seems to be a vacuum of reliable information in the UK. It’s apparent that many sick people or even ones that passed away showed Covid-19 symptoms but have never been tested. This creates a false sense that the curve and the spread is far lower than they really are. As soon as the UK ramps up testing we’ll see a sharp increase in diagnosed cases.”

 

Exit strategy – the debate starts with some strongly held views. Follow the science, but which one? 

Owl has extracted this summary of the alternative views being voiced from a wider ranging article. 

As mentioned before, Owl thinks it might be wise to watch and see what happens in other nations, further down the path. (The USA will be an interesting wild-card to follow).

It  might be wise to wait until we get a fully functioning testing system which will be an essential prerequisite as well. With a novel virus, collecting real data is essential to validate the models being used and track what is happening when policies are implemented. The models are all based on a raft of assumptions, including herd immunity which assumes significant immunity will be gained from infection. 

Finally, the government might be wise to be prepared to be adaptable in the face of changing circumstances. 

Michael Savage  www.theguardian.com 

…….Francois Balloux, professor of computational systems biology and the director of the University College London genetics institute, said: “I personally, cannot see any viable alternative to ensuring immunity builds up in the population, through infection or vaccination. What is critical is to minimise hospital overload, to ensure mortality is kept as low as possible. There was a window of opportunity earlier in the Covid-19 pandemic, where it could have been controlled. We missed it, for various reasons, ranging from lack of preparedness to complacency. We should analyse our failings in the future, but now is not the time for blame.”

A No 10 spokesperson responded: “As set out by the prime minister, we are working to a scientifically-led, step-by-step action plan – taking the right measures at the right time.”

However, there is now an open debate in Whitehall and the scientific community about the best route out of the lockdown measures, which government advisers have suggested may need to be in place until the end of May.

Professor Martin Hibberd, of the London School of Hygiene and Tropical Medicine, pointed to successful strategies employed in other countries. These have involved very large-scale testing and as much contact tracing as possible, to identify people with the virus. “This strategy was difficult to achieve at the beginning of the outbreak, because of logistic problems in testing at such a large scale and our lack of experience at large scale contact tracing,” Hibberd added. “However, we should now be able to overcome these problems.”

Mark Woolhouse at Edinburgh University highlighted three key strategies for dealing with the epidemic. “Once lockdown has driven down the virus to low enough levels in the community we can go back to chasing down individual cases. At the same time we build more ICU capacity in the NHS so we can relax the lockdown without the health service being overwhelmed. And thirdly, we place new emphasis in shielding the vulnerable.”

By contrast, John Edmunds, also of the London School of Hygiene and Tropical Medicine, argued that the only way to proceed was to continue with the lockdown policy for many months. “Testing on its own will not stop this epidemic,” he said. “If you want the NHS to cope then you will have to take extreme measures for a long time. There is no way out. We will have social distance for many months or hospitals will be overwhelmed. Mass testing, mass contact tracing and more technology are fine, but what we really need is a vaccine.”

 

Fears of second-home hordes bringing Covid-19 to holiday havens may have come true

The virus prevalence data used in this article has been collected by the Covid Symptom Tracker app (posted by Owl, on 26 March) which allows contributors to track their health. It is also being used by NHS staff to work out local infection rates.

This is an example of an inspired piece of lateral thinking – real science – collecting real data on how this unknown virus is spreading and putting it to use within weeks, rather than all the theorising being done by Public Health England – Owl

Rosamund Urwin and Tom Calver  www.thetimes.co.uk 

Britons who fled to their second homes at the start of the Covid-19 pandemic appear to have taken the virus with them.

Analysis by this newspaper has found that areas with high numbers of holiday homes, including the Lake District, Anglesey and the Cotswolds, now have above-average rates of the coronavirus infection.

People had been urged against travelling to second homes in case they spread the disease and put extra pressure on local hospital and ambulance services.

The virus prevalence data has been collected by the Covid Symptom Tracker app, which allows contributors to track their health. It is also being used by NHS staff to work out local infection rates.

About two million Britons are now using the app, most of whom are healthy. Researchers using this sample estimated that there are 1.9 million people in the UK aged between 20 and 69 who are infected with symptomatic Covid-19.

However, there is a risk that this overstates the extent of the disease, as those with symptoms are more likely to have downloaded the app.

South Lakeland, which includes much of the Lake District, has an infection rate of between 5% and 6%, according to the app. There are 3,866 second homes in the area, about 7% of dwellings, according to data from the Ministry of Housing, Communities and Local Government.

Between 5% and 6% of people on Anglesey, the island off the northwest coast of Wales, and in the Cotswolds are also now infected, according to the app. There are 2,112 second homes in Anglesey, about 7% of residences, and 1,714 second homes in the Cotswolds, about 4% of the total residences.

Professor Tim Spector, the lead researcher for the app, added that there are signs of this trend in other areas too. “It looks like the coasts are more infected than the inner parts of the UK down in Cornwall and Devon — that may be the Londoners’ second home part,” he said.

Nationally, about 4.9% of app users reported symptoms. However, this average is skewed by cities such as London, Glasgow and Birmingham which have become hotspots of the virus.

Both the police and councils have repeatedly told second home owners to stay away. Dafydd Llywelyn, the Plaid Cymru police and crime commissioner for Dyfed Powys, last month described the Covid-19 pandemic as a “national emergency, not a national holiday” and called for travel to a non-primary residence to be banned.

The app was developed by a team at King’s College London in association with the start-up Zoe Global, Guy’s and St Thomas’ NHS Foundation Trust and the NIHR Biomedical Research Centre.

The most commonly reported symptoms include fatigue, described by half of sufferers, and chest pain, a cough and shortness of breath, which were all recorded by more than a quarter of ill respondents. About a fifth reported a hoarse voice and the loss of taste and smell.