Senior doctors from across Wales have written to the first minister calling on him to make using second homes illegal during the Covid-19 pandemic.

By Felicity Evans Political editor, Wales https://www.bbc.co.uk/news/uk-wales-politics-52055456

In the letter, the 15 clinicians warn non-essential travel to the homes is “highly likely” to increase the presence of coronavirus in rural areas.

Mark Drakeford has said ministers are considering strengthening regulations on people travelling to second homes.

On Monday, he said more details will be announced by the end of the week.

All non-essential travel, including to second homes, is illegal under the current rules.

But the doctors’ letter says second homes “facilitate non-essential movement into rural areas” placing “additional pressures on local health and emergency services”.

It express concern that existing rules are “insufficient” in protecting rural Wales against the dangers posed by tourism and holiday home use in the current public health emergency

The clinicians, who all lead health clusters in different parts of Wales, call on Mr Drakeford to do three things:

• Make second home use illegal until the risk posed by Covid-19 has abated, even when lockdown restrictions begin to ease in other areas of Wales and the UK, to prevent a “second peak”
• Prolong lockdown measures in rural tourist hotspot areas of Wales, specifically targeting non-essential travel to these areas
• Give Wales’ police forces the power to force those breaking the rules to return to their main home

The doctors say that without such action “we face a very real possibility of a second peak in areas such as north and west Wales” at the worst moment, when staff resilience is low and global supplies of personal protective equipment is depleted.

“We appreciate the economic value of tourism, but this cannot be at the cost of the health of our rural population.

“We hope that the Welsh Government will show the value of devolution by being prepared to act in a swift, innovative, agile and decisive manner to safeguard the people of Wales.”

“Let history show that the government of Wales acted when it mattered the most.”

Arfon assembly member Sian Gwenllian, who speaks for Plaid Cymru on local government, called on ministers to “listen to the clinicians and act quickly to protect local communities in Wales”.

“For weeks we have been calling for tougher measures to stop the few irresponsible individuals who have ignored travelling rules,” she said.

First Minister Mark Drakeford told the assembly on Wednesday his government receives weekly reports from chief constables across Wales on the enforcement of regulations.

“Let me be clear again, travelling to a second home is not an essential journey and police in Wales are and will stop people attempting to do so,” he said.

Earlier, one of the GPs who signed the letter, Dr Eilir Hughes, told BBC Wales: “As we understand it, second residence use isn’t specifically prohibited and the police are finding enforcement is difficult particularly once tourists have arrived at their second home.

“This must be strengthened.”

Is pressure mounting to include the whole of the 60+ “Oldies” generation in protective “cocoon” lockdown in any exit strategy ?

If it is, then there will be big implications for East Devon where nearly 40% (37%) of the population fall into this age group.

Katie Gibbons  www.thetimes.co.uk 

Millions of Britons in their sixties are at an increased risk of becoming severely ill or dying from coronavirus and should consider isolating like older people, experts warn.

The government advises that only people over the age of 70 or with underlying health conditions should isolate but research shows that people aged 60 to 69 are also at high risk of complications and death from Covid-19.

A paper highlighting the dangers faced by the 7.5 million people in the UK in that age group has led to questioning from the medical community as to why the government guidance does not adhere to World Health Organisation advice that they are at risk.

Azeem Majeed, head of the department of primary care at Imperial College London, said that while this group was at a lower risk of severe illness when compared with the over-70s the threat was still considerable.

Data on Covid-19 deaths worldwide shows that fatality rates for people aged 60 to 69 are 3.5 per cent in Italy and 3.6 per cent in China. Other countries, including Switzerland and France, encourage those aged 65 and older to stick to strict public health measures and isolate due to their increased risk of severe illness and death from the disease.

WHO and the United States Centre for Disease Control and Prevention class people over 60 and 65 respectively as being at highest risk.

In Britain the risk of death from coronavirus rises in each age group.

However, the paper, published in the Journal of the Royal Society of Medicine, highlights that 85 per cent of deaths from Covid-19 are in people over 65. In the UK about 52.8 per cent of those aged 65-74 have two or more conditions, making them more vulnerable.

“Patients requiring critical care, such as respiratory support, are usually older with a median age of 60 years,” the authors said, adding that increasing the threshold for isolation to the over-60s could reduce pressure on the NHS.

As people age their immune systems weaken. Older people are also more likely to have conditions such as heart disease or diabetes, which again can affect how their immune systems cope.

Professor Majeed, who co-authored the paper with colleagues and academics from Exeter University, said: “The UK’s policy is at variance with the World Health Organisation, which states that those above the age of 60 years are at the highest risk, requiring additional preventative measures.

“To reduce hospitalisations, intensive care admissions and death we recommend that those aged between 60 and 69 are particularly stringent when implementing public healh measures such as social distancing and personal hygiene.”

Andrew Freedman, a reader in infectious diseases at Cardiff University School of Medicine, said the study “raises the question of whether healthcare workers in that age group should be shielded from frontline care of patients with Covid-19” in light of the call for retired doctors and nurses to return to work.

James Gill, honorary clinical lecturer at Warwick Medical School, and locum GP, said: “If a person older than 60 is already furloughed from work, then there is no significant disadvantage to personally implementing a more stringent approach to social distancing and self-isolation.”

Nick Phin, deputy director of the National Infection Service at Public Health England, said: “England data shows that the groups most likely to die from Covid-19 are men and those over the age of 70. Sadly, two thirds of deaths have been men and 79 per cent of all deaths are among those aged 70 and over.”

“If ministers respond imaginatively to the coronavirus crisis, they will have a chance of reversing a decade of decline. They need to change tack. They must shed ideas of British exceptionalism that saw them waste chances to purchase kit and protective equipment on the global market, as well as harbour delusions that “herd immunity” was a way out of the pandemic. We must look to other nations to see what works, and copy it. At some point ideology will intervene – usually to the detriment of the country. 

….What the pandemic has taught us is that our health depends on each other. The fight against a virus is necessarily collective – and a creative government acting decisively needs to lead it.”

Editorial www.theguardian.com 

The health secretary, Matt Hancock, holds the Covid-19 press conference. ‘Ministers need to level with the public over the shortfalls and blockages,’ says our editorial. Photograph: Andrew Parsons/10 Downing Street/EPA

In the late 1980s, the biggest medical puzzle of the day was how to design an HIV vaccine. Dozens of well-funded laboratories were on the case and a solution seemed within the grasp of researchers. Thirty years on and there’s no HIV vaccine. This sobering fact ought to bring us up short. We want to believe that a treatment for Covid-19 is just around the corner. But we must steel ourselves that a vaccine, as the head of the Wellcome Trust warned, is not a given.

While no expense should be spared to find a vaccine, the UK government must also display the wherewithal to design an administrative system to support and enable the public to live with this threat. That means getting the basics right. So far the signs have not been good. In Britain, everywhere you look you see a state overstretched and driven by politicians’ panic rather than careful planning.

Compare this with democracies as different as Taiwan, Australia, Germany and South Korea. They have kept their death tolls low by using a combination of physical distancing, tight travel restrictions, mass testing and contact tracing. The spread of the disease has been mapped and programmes run to identify not just those who are sick but those they’ve been in contact with. What leaders in these countries have not done is make over-the-top claims that they are getting on top of a problem when it is plain they are not. The health secretary, Matt Hancock, said we’d have 100,000 tests a day by the end of the month. Mr Hancock is on course to miss his target by a large margin. In his defence, the prime minister had gilded the lily more extravagantly than he had.

There do not seem to be coordinated, sustained efforts by the government to ramp up capacity to meet the challenge posed by coronavirus. Test kits, reagents, swabs, personnel, personal protective equipment have all been identified as bottlenecks. The longer we take to get mass testing and contact tracing going, the longer Britain is stuck in lockdown. That is why Simon Clarke did little for public confidence when he said it was not his job – despite being the local government minister – to press council health workers into a contact tracing programme.

Ministers need to level with the public over the shortfalls and blockages. The NHS, the Department of Health and Social Care, and devolved administrations should be publishing what PPE is being distributed and how far this falls short of what is required by hospitals or by how much it exceeds their need. This is about being accountable, not a finger-pointing exercise. There should be no reason for doctors to wear ski goggles instead of masks, and nurses using cagoules rather than protective gowns. In Italy, healthcare workers experienced high rates of infection and death partly because of inadequate access to PPE. Here the death toll of such staff has risen past 100. Clarity needs to replace ambiguity when dealing with matters of life and death.

If ministers respond imaginatively to the coronavirus crisis, they will have a chance of reversing a decade of decline. They need to change tack. They must shed ideas of British exceptionalism that saw them waste chances to purchase kit and protective equipment on the global market, as well as harbour delusions that “herd immunity” was a way out of the pandemic. We must look to other nations to see what works, and copy it. At some point ideology will intervene – usually to the detriment of the country. Conservatives have done great damage by finding succour in Ronald Reagan’s wrong-headed declaration that “government is not the solution to our problem; government is the problem”. What the pandemic has taught us is that our health depends on each other. The fight against a virus is necessarily collective – and a creative government acting decisively needs to lead it.

Owl’s reading of the responses to this pandemic point to the critical need to contact trace and test, test, test. 

Although this is something we abandoned very early on (with disastrous consequences), it looks a racing certainty that it will have to be re-introduced as part of any exit strategy. Local authority environmental testing staff should have been involved at the outset, but weren’t.  It looks like the government is dithering yet again. “Not my responsibility” Gov, honest!

Simon Clarke says contact tracing is ‘not’ his responsibility

Alessandra Scotto di Santolo  www.express.co.uk

The Local Government Minister was confronted by BBC Radio 4’s Today Programme host Nick Robinson on the offer of help sent by environmental officers to councils across the country to cope with coronavirus testing. But as Mr Clarke refused to take responsibility for the issue, the BBC host blasted the Minister over the unhelpful bureaucracy stalling the Government’s coronavirus efforts.

Mr Robinson asked: “I want to ask you about something for which you do have direct responsibility. Testing, as you know, is pretty pointless without contact tracing afterwards.

“If somebody is found to have symptoms you really want to find out who they’ve been in touch with and to isolate them.

“Have you, as Local Government Minister, spoken to councils yet about using the 5000 council environmental officers who are used to this sort of contact tracing and using them in this endeavour?”

To which Mr Clarke replied: “That falls under the agents of the HFC – the future contact tracing – we haven’t taken responsibility for that role.

“Our focus is very much on financial offers for local authorities, on shielding for the extremely vulnerable, on making sure that our councils are resilient financially in the face of this crisis.

“So contact tracing doesn’t fall under my ministerial portfolio.”

At this point, the BBC host blasted: “But isn’t this a problem of silos once again.

“There are 5000 environmental workers who have, I’m told and their institute says, offered to help contact tracing. This is what they do. This is what they understand.

“Public Health England only have about a couple of hundreds, they have 5000 potentially.

“And what you’re saying to me is ‘well, it’s not my responsibility’.

“Nobody is taking up these offers of help, are they?”

A consignment of personal protective equipment being collected by the RAF from Turkey will be in the UK “in the next few days”, Mr Clarke also confirmed.

But asked whether it had left Turkey yet, he said: “I can’t speak to that, I’m afraid. All I know is it set off last night.

“It will be with us obviously in the UK in the next few days, which is the core priority.”

Mr Clarke said there is a “standing presumption” that the Government will do its utmost to buy PPE “wherever it can be sourced” and urged manufacturers to “reach out” to the Cabinet Office to log their ability to make equipment.

On testing, he said the Government is working to ensure more key workers are eligible to have the tests so “every possible slot is filled” but admitted it is an “enormous challenge”.

“We are doing our very best to make sure that we hit that target.”

The Tory Minister said it is “highly unfair” to suggest that the Government’s ambition to reach 100,000 tests by the end of the month is not “empirically grounded”.

“We are absolutely determined across the whole of the UK to hit this target,” he said.

“As I say, we are going to move from 26 current testing facilities to 50. That will in turn obviously bring those centres closer to more people and make it more viable to go there.

“We’re increasing the groups of key workers who can go and be tested.”

He added: “I really do think it is unfair to suggest that we have continued business as usual. It has not been. It has been an extraordinary response that has saved lives and saved jobs, and I think on both counts we’ve done a lot of good work which is standing us in good stead.”

Something is clearly wrong. Britain does not need Boris Johnson, but it needs a prime minister, and badly. Coronavirus promises are made and not fulfilled. Orders go out and are not delivered. The clothing industry in the UK apparently cannot mass-produce a simple medical gown or mask, and must turn to Turkey, China and volunteers with sewing machines and 3D printers for supplies.

Simon Jenkins is a Guardian columnist www.theguardian.com 

Ever since Tony Blair came to power, the British government has been what some observers call “Napoleonic”. The focus of authority was one person sitting on a sofa. In good times, it has worked. In a bad time, it has collapsed. At first, Johnson didn’t take Covid-19 seriously, then he changed his mind and his advisers – and put himself in charge. Then he got ill and vanished.

Since then, a stage army of second-rate ministers, with a media alternately cheering and jeering, seemed in thrall to one man, Neil Ferguson of Imperial College, whose record of modelling of past epidemics has been criticised.

Now, as countries across Europe feel their way to ending lockdown, Britain’s government refuses even to mention the phrase, let alone debate it. A public experiencing immense economic precariousness is considered unfit to be told anything, other than to obey orders of ludicrous joy-suppression. Sitting on a park bench is a police offence.

This week, the Europe-wide consensus on combating Covid-19 is starting to crumble. Death rates are plateauing, and at levels where national health services feel they can cope with a return to partial normality (as it appears can Britain’s). Shops and schools are cautiously reopening. Public spaces are refilling, within limits. In every country, every province, arguments are taking place, and what amounts to a great experiment is under way, with wildly unreliable statistics.

Not in Britain. No one is in charge. The health secretary, Matt Hancock, is a serial promiser rather than deliverer. He is like a signalman with his wires cut. The chancellor, Rishi Sunak, is clearly not senior enough to win the case for relaxation. The stand-in prime minister, Dominic Raab, intones slogans about “protecting the NHS”. A government that resorts to slogans has lost an argument.

There is now a serious functional disconnect between Whitehall on the one hand and the Covid-19 economy on the other. The failures revealed in the 2016 Cygnus report on pandemic preparedness were not acted upon. Sunak’s 80% loan scheme has not worked, because banks were told to shoulder 20% of the risk and many are naturally baling. It should have been 100%. The furlough subsidies are similarly mired in bureaucracy. Money should have been “printed” and paid into individual bank accounts, not to companies.

Most serious has been an apparent collapse in public health beyond the realm of the NHS. From the start of the outbreak, the focus of attention should have been on those already caring for the elderly. Yet for weeks, care homes and home carers were not mentioned and the progress of the virus for them was not monitored. Because they were not “our NHS”, they were not even our dead.

The NHS was showered with beds and praise, while its workers were left at home, untested. Local government, which everywhere else in Europe seems to be deeply involved this emergency, was simply ignored. Equipment was not supplied, money was not spent. Whitehall famously hates “local” – and it shows.

If Johnson really thinks the country is at war, then the enemy has walked all over him at first push. It is right that the nation should summon its spirits to boost the morale of medical and caring staff. Their morale is crucial to public confidence. But in this emergency, morale is a function of competent government. After Covid-19, never again can Britain boast to the world the quality of its healthcare.

Denmark and Poland are refusing to let companies registered in offshore tax havens seek financial aid from their coronavirus bailout packages.

Faye BrownTuesday 21 Apr 2020 metro.co.uk 

Denmark and Poland are refusing to let companies registered in offshore tax havens seek financial aid from their coronavirus bailout packages.

The Danish finance ministry extended its support scheme until July, but warned firms that have not paid domestic taxes would not be eligible for state aid.

‘Companies seeking compensation after the extension of the schemes must pay the tax to which they are liable under international agreements and national rules’, a translation of the statement said. 

‘Companies based on tax havens in accordance with EU guidelines cannot receive compensation, insofar as it is possible to cut them off under EU law and any other international obligations.’

Poland has attached similar conditions to its own bailout scheme. Prime Minister Mateusz Morawiecki said large companies wanting a chunk of a roughly £5 billion bailout fund must pay domestic business taxes.

‘Let’s end tax havens, which are the bane of modern economies’ he said.

Following the news of Denmark and Poland, there were calls for other countries, including the UK to follow suit.

Tax heavens are countries which have low or no business rates. Companies can register themselves at an address at these places while avoiding paying taxes in the countries they operate.

Last year, an investigation found the UK was the ‘biggest enabler of global corporate tax dodging’. An index published by the Tax Justice Network found that the UK has ‘single-handedly’ done the most to break down the global corporate tax system which loses an estimated $500bn (£395bn) to avoidance.

Famous heavens include Gibraltar, the Cayman Islands and the British Virgin Islands – where Sir Richard Branson lives.

The billionaire has faced criticism this week for appealing for taxpayer aid to save his airline Virgin Atlantic, rather than drawing on his huge wealth. Many pointed out that the entrepreneur has paid the exchequer no personal income tax since moving to the tax- free Necker Island 14 years ago.

Branson said he was asking for a taxpayer loan, not a handout. He has pledged his luxury island resort as collateral to help him secure the bailout, believed to be £500m.

And he hit back at criticism that he was a tax exile who did not deserve help, saying he and his wife ‘did not leave Britain for tax reasons but for our love of the beautiful British Virgin Islands and in particular Necker Island’.

But head of Tax Justice UK Robert Palmer, has urged the government not to cave into his request.

‘Companies that seek to dodge their obligations to broader society by cutting their tax bills shouldn’t expect to get bailed out when things go wrong’ he told Business Insider.

‘The UK government should seriously look at copying Denmark’s approach. Any bailout needs to come with conditions to ensure good business behaviour.’

Dozens of patients with Covid-19 have been turned away from the NHS Nightingale hospital in London because it has too few nurses to treat them, the Guardian can reveal.

Denis Campbell  www.theguardian.com 

The disclosure comes amid a growing belief among hospital management in the capital that the Nightingale, built to great acclaim over just nine days, was becoming a “white elephant”.

The hospital has been unable to admit about 50 people with the disease and needing “life or death” care since its first patient arrived at the site, in the ExCeL exhibition centre, in London’s Docklands, on 7 April. Thirty of these people were rejected because of a lack of staff.

The planned transfer of more than 30 patients from established London hospitals to the Nightingale was “cancelled due to staffing issues”, according to NHS documents seen by the Guardian. All the patients had been intubated and were on a ventilator because they were so unwell.

The revelation raises questions about the role and future of the hospital, which up until Monday had only treated 41 patients, despite being designed to include almost 4,000 beds.

That means that the hospital has rejected more patients, owing to a combination of understaffing and the patients’ health, than it has treated. Of those 41 patients, four have died, seven have been discharged to a less critical level of care, and the other 30 were still being cared for at the Nightingale.

The hospital is being obliged to reject people needing care because it cannot get enough of the nurses usually based in other hospitals to work there, staff at the new facility claimed.

One member of staff said: “There are plenty of people working here, including plenty of doctors. But there aren’t enough critical care nurses. They’re already working in other hospitals and being run ragged there. There aren’t spare people [specialist nurses] around to do this. That’s the problem. That leads to patients having to be rejected, because there aren’t enough critical care nurses.”

Almost 20 other patients have been rejected by the Nightingale on medical grounds, for example because they were “too unwell to transfer” or had had a tube inserted into their throat to help them breathe, or because they did not meet the new hospital’s strict clinical admission criteria.

The Nightingale, which was opened in a high-profile ceremony involving Prince Charles on 3 April, admitted its first patient on 7 April and rejected the planned transfer of a patients from another London hospital for the first time on 9 April.

NHS England decided to create the hospital because they feared that within weeks hospitals in the capital would have been overwhelmed by the numbers of people needing intensive care.

At the time the health secretary, Matt Hancock, said that the NHS was “preparing for the worst but hoping for the best”.

One senior intensive care doctor said: “The Nightingale is clearly not a hospital. It’s an emergency overflow facility to ventilate patients to stop them from dying when hospitals have run out of space.”

Sir David Sloman, head of the NHS in London, oversaw the project, in which the army was closely involved, and it was approved by Sir Simon Stevens, chief executive of NHS England, and the prime minister, Boris Johnson.

Sloman wrote to NHS heads in London last Friday asking them to provide about 200 doctors and nurses so that the Nightingale could be used for a growing number of patients needing critical care and help established hospitals resume operations and preparations for the winter ahead.

Despite this, the Nightingale’s inability to admit patients has left established London hospitals unable to relieve the pressure on their overcrowded intensive care units by transferring people suffering from the coronavirus.

That has had the biggest impact on Northwick Park hospital, north-west London, which had to declare a “critical incident” and temporarily shut its doors to new admissions last month as the impact of the coronavirus worsened. It has been unable to transfer more than 30 patients to the Nightingale since 9 April, with many of those planned switches “cancelled due to staffing issues”, the documents show.

The Royal Free hospital, in Camden, London, has also had to abandon plans to transfer about 15 patients from its ICU to the Nightingale. Again, that was often due to lack of staff. Other hospitals in the capital, including St Mary’s, the Royal London and North Middlesex, have also had transfers blocked.

The Nightingale is already under intense scrutiny amid disagreements among NHS leaders and senior doctors in the capital over its purpose and whether or not it is a good use of resources.

A senior official at a London trust said: “It’s a white elephant. When it was conceived a month ago we were facing the prospect of hospitals in London being overrun and mass burial sites like in New York. We thought that London would be Italy and there would be more patients needing level 3 intensive care treatment by this stage.

“But the expected doubling every three days in the number of patients needing to be admitted to ICU didn’t happen. London hospitals doubled, tripled and in some cases quadrupled the capacity of their ICUs, so still have spare capacity, which means the Nightingale hasn’t been needed.”

 ‘I accepted the very first patient’: one nurse’s first week at NHS Nightingale – video

Other NHS planners said it was better to over-prepare for the pandemic. A senior intensive care doctor said: “ It was a sensible project designed to stave off the type of situation we saw in Italy. It may have just been a matter of days and we would have been thankful it existed. Thankfully, good surge planning to massively increase critical care capacity in hospitals, and a last ditch redistribution effort to move patients from stressed small hospitals to larger hospitals with space, has meant that we have not needed this type of facility.”

Stevens echoed that view at the weekend, saying: “We have not yet had to make extensive use of the Nightingale London thanks to the hard work of NHS staff, who have freed up more than 30,000 existing hospital beds, and the public, who have played their part by staying at home and saving lives.”

An NHS London spokesperson said: “The most important point about staff at the Nightingale is that thanks to their care and expertise, patients in that hospital are being successfully treated, discharged and ultimately having their life saved.

“There remains spare capacity in the critical care network across the capital to look after all coronavirus patients and others who need our care, and while it is incredibly reassuring for both staff and patients to have backup capacity at the Nightingale to alleviate pressure on ICU departments where needed, patients can be transferred to other hospitals in the city if they are better placed to receive them at that time – as is always the case.”

A Department of Health and Social Care spokesperson said: “It is misleading to suggest coronavirus patients are being turned away from NHS Nightingale due to a shortage of staff.

“NHS Nightingale has been set up to treat patients if the NHS was overwhelmed but thanks to the great work of selfless NHS staff, there is spare capacity in existing London hospitals to treat all coronavirus patients there instead.”