As everyone (in the racing fraternity) celebrates the return of the Cheltenham Festival, Owl remembers how the 2020 festival is credited with being the first super spreading event as Boris Johnson dithered and delayed over imposing any lockdown. This followed Johnson skipping the first five Cobra meetings. 

In 2020 The Cheltenham Festival began on 10 March. On 12 March Johnson asked people with a cough or a temperature to stay at home, and said this: “I must level with you, I must level with the British public. Many more families are going to lose loved ones before their time.” This was known as the “Delay” phase or in Johnson’s terms “Squashing the Sombrero”.

Lockdown was finally announced on 23 March.

Had we not been ultimately “saved” by science we certainly wouldn’t have been saved by him.

Ironically, the 2022 Festival is being held as Covid surges again and when, from April fool’s day, Johnson’s libertarian government goes “full ostrich” on testing as we ‘Learn to live with this virus’.

How concerning is it that Covid infections are rising in the UK?

Nicola Davis www.theguardian.com 

Covid infection levels in the UK on are on the rise once more. We take a look at the current situation, and what the future might hold.

What is the Covid situation in the UK?

According to the latest figures from the Office for National Statistics, based on swabs from randomly selected households, infection levels are rising in the UK. In the week ending 5 March, about one in 25 people in the community in England had Covid, with the figures even higher in Scotland and Northern Ireland, where they were one in 18 and one in 13 respectively. In Wales the latest figure was 1 in 30.

Why are infections rising?

Experts say there are likely to be many factors at play, including the relaxation of Covid measures, changes in people’s behaviour – such as increased socialisation and reduced mask-wearing – the rise of the BA.2 Omicron variant, which appears to be more transmissible than the earlier BA.1 Omicron variant, school half terms, and possible waning of immunity conferred by booster jabs.

However, it is difficult to unpick which is having the biggest impact, and this may differ around the UK.

Does this mean more hospitalisations and deaths?

Sadly, yes. While Covid vaccinations have weakened the link between infections and serious outcomes, they have not broken it. Hospitalisations are already rising in the UK, although it is difficult to unpick how many are directly because of Covid.

Dr David Strain, senior clinical lecturer at the University of Exeter medical school, said the length of stay for patients was also increasing.

“This is likely to represent a difference in disease course of BA.2 compared to BA.1,” he said. “The increased transmissibility of BA.2 is causing a higher number of patients and staff contracting it even after very brief contact,” he added, which is having an impact on staffing levels.

The impact on deaths will take a little longer to become clear, given the lag between people becoming sick and their condition deteriorating.

How much pressure is the NHS under because of this latest resurgence of Covid?

The number of people with Covid in hospital across the UK rose from 10,500 on 26 February to 11,944 on 10 March, in line with rising infections. However, just 254 of them are on mechanical ventilation, reflecting Omicron’s less serious impact than Delta and fact that eight out of 10 adults have had a Covid booster vaccine. Intensive care doctors say that many Covid inpatients are partly or wholly unvaccinated.

The UK health secretary, Sajid Javid, has said that the rising numbers were “expected” and are “not something that’s of particular concern”. However, Chris Hopson, chief executive of English hospitals body NHS Providers, has warned that “while it is positive that the overall number in hospital remains low compared to previous waves, rising admissions can have knock-on effects for patient care”.

How worried are the experts?

The mood appears to be one of unease rather than alarm. Speaking in a personal capacity, Prof Cath Noakes, an expert in environmental engineering for buildings at the University of Leeds and a member of Sage, said the current situation was not unexpected.

“It was always predicted that as restrictions are removed that cases would rise,” she said. “But as this happened at a time when cases were already very high it will have more of an impact both on the pressure on the NHS and the disruption to schools and business from the very high numbers of people who are off sick.”

Noakes added it was very important to keep a close eye on hospitalisations and cases among older people, given outcomes for this group could be far more serious.

“With the prevalence at least one in 25 and higher in some parts of the UK, the chance of infection is really high and the reduction in testing and lack of requirement to isolate mean that there may be far more infectious people who are still interacting in the community than before,” she said.

One concern raised by experts is that public behaviour was still a long way from what it was pre-pandemic, meaning there is potential for a further rise in infections.

“I’m expecting cases to go up and down and maybe up again as the balance between increased mixing, immunity following vaccination and infection, and waning immunity shifts, and as the next variant emerges,” said Prof Tim Colbourn of University College London, adding cases could be in the range of 30,000 to 100,000 a day for the foreseeable future.

“Hospitalisations and deaths should stay relatively low because of protection via vaccination, drugs and prior infection, and this should apply to new variants too as it has done for previous variants,” Colbourn said, noting excess mortality had been negative since the start of 2022.

What is happening elsewhere in the world?

The UK is not alone in seeing a rise in infections. An increase has also occurred in Germany and the Netherlands, among other countries in Europe, while China has recently reinstated lockdowns in certain hotspots to try to tackle a surge related to the Omicron variant, with Hong Kong warning its hospitals were being overwhelmed.

Why is Hong Kong so hard hit?

The main reason appears to be low rates of vaccination among older age groups. Recent government data suggests just over 55% of those aged 80 and over have had one dose, with just over 36% having had two and far fewer having had three. In addition, a zero Covid approach means there is little natural immunity in the population.

“There are indications that hesitancy is high and actual access to vaccines appear to be an issue,” said Dr Michael Head is a senior research fellow in global health at the University of Southampton.

Noakes said a similar situation was unlikely to occur in the UK in the short term.

“But it serves as a reminder that this virus is still a killer among an unvaccinated population and that the milder effects that we are experiencing in the UK are almost certainly due to our high levels of vaccination coverage,” she said.

Two new support programmes have been launched by Devon County Council – one catering for those looking to start a new business or social enterprise in Devon, and another to help existing businesses to grow.

[Owl is confused. At least one of these help packages is being offered by Devon County Council through a support package already part of our Heart of the South West (HotSW) Local Enterprise Partnership. Are we doubling up on bureaucracy, doubling up on announcing “new money” or is HotSW ineffectual? – Owl]

Lewis Clarke www.devonlive.com

Devon Get Started has been established to help anyone aged 25 and over in the county to get their ideas off the ground. Start-ups or social enterprises in their first six months who are facing continuity challenges, are also eligible for support.

For businesses that are already up and running, the County Council is offering help through Thrive Devon which aims to support SME productivity and competitiveness, helping businesses to grow, create jobs and reach new markets.

Devon Get Started focuses on support prior to start-up, aiming to build confidence, managing start-up costs, and covering any skills gaps.

An assessment will help participants in the scheme through the various stages of business planning to discover their strengths, identify their goals and highlight opportunities as well as potential barriers to growth. It will also define what tools might be needed to implement their vision.

Led by qualified business coaches and advisors, the initiative offers a mix of workshops, peer support activities and one-to-one support.

– Workshops will help participants learn how to identify their resources, how to avoid common mistakes, and how to manage, organise, run, market, finance and grow a new business.

– Business advisors can offer one-to-one support on creating a sustainable business plan, accessing funding, and creating partnerships. They will also organise a follow up session after six months to overcome any issues which may arise in launching new products, breaking into new markets (both in the UK and abroad), developing a growth strategy, improving productivity and increasing profitability.

The programme is suitable for businesses operating in almost all industry sectors and will specifically aims to reach individuals in Devon within sectors hardest hit by COVID-19 such as tourism, hospitality, retail, food and drink. Support will be offered across the Devon County Council area, especially in the priority areas of West Devon, Torridge, Teignbridge and Mid Devon.

Thrive Devon will offer a free diagnostic and training service, with tailor-made support that will enable businesses to improve and grow, including specialist workshops on topics such as digital skills, finance, marketing, HR and business planning.

The programme works alongside the European Regional Development (ERDF) Thrive support and is available to Devon SMEs who may not be eligible to receive help under the ERDF funded programme.

Both Devon Get Started and Thrive Devon will continue until March 2023 and they are part of a wider package of support being delivered through Devon’s £6 million recovery programme, aiming to provide help and support in four key areas: small and medium enterprises, employment and skills, the green recovery and the hardest hit towns and communities.

Councillor Rufus Gilbert, Devon County Council Cabinet Member for Economic Recovery and Skills, said: “All potential entrepreneurs face different challenges before setting out on their self-employed journey and the Devon Get Started scheme can help address those challenges by creating a supportive and motivational environment. We want to enable everyone who takes part in Devon Get Started to be able to turn their idea into a successful and sustainable enterprise or business.

“Thrive Devon provides a great opportunity for existing businesses to improve and grow. The tailored backing offered through the scheme will help signpost businesses to the most relevant support, advice and training.”

For more information about Devon Get Started and to enrol, visit Devon-Get-Started.

To find out more about Thrive Devon and to enrol go to https://www.heartofswgrowthhub.co.uk/business-support-programmes/thrive/

Almost 800 medical graduates could be denied the chance to train as doctors in the NHS this year, despite the health service’s crippling shortage of medics.

Denis Campbell www.theguardian.com 

A total of 791 medical undergraduates who have applied to start training as junior doctors at the start of August have been told there are no places for them – the highest number ever.

The risk that young would-be doctors may not be allocated to start their training at a hospital in the UK has sparked concern among the medical students affected, as well as medical organisations.

Pressure is growing for action to close the gap between the number of training places available across the NHS and the number of graduates seeking one, so medical talent is not wasted and hospitals hire as many fresh recruits as they can to help tackle the widespread lack of medics.

Doctors are worried that the mismatch between demand for and supply of training places will lead to the NHS missing out on medics it sorely needs and that some of those denied a place will either go to work abroad instead or give up medicine altogether. The most recent official figures showed that the NHS in England is short of almost 8,200 doctors.

Dr Dustyn Saint, a GP in Norfolk, tweeted the health secretary, Sajid Javid, about the situation, saying: “Sajid Javid sort this out! You know how much general practice needs these people in a few years, standing by and doing nothing is inexcusable.”

Another doctor said: “It’s bonkers that 800 would-be doctors could be denied training places at a time when the NHS in England is short of 8,200 doctors.”

Half (393) the 791 will soon graduate from UK medical schools while the other half (398) are “eligibility applicants” – those with a medical degree from an overseas medical school who are entitled to work in the UK or who graduated from a British medical school before August 2020.

The UK Foundation Programme (UKFPO) ensures that aspirant doctors who have just graduated from medical school are able to start foundation one training, the bottom rung of the ladder that leads to medics becoming fully qualified. Training usually starts in the August after graduation.

But the UKFPO has warned that the foundation programme is “over-subscribed” to a record level this year, raising the prospect that some of the 791 may not be allocated a training slot.

While it has already filled 8,209 foundation training places, the 791 who have missed out so far have been put on a reserve list.

The UKFPO, which is run by Health Education England (HEE), has told them that: “We would like to reassure the applicants on our reserve list, who may be feeling anxious, that we are currently working very hard to find additional places for everyone who needs one.”

It works with the health departments in the four home nations to ensure that the NHS has as many new trainee doctors as they need and works with them to increase numbers if necessary.

The 791 is the largest number of applicants on record that the UKFPO has not placed by this stage of the year. In 2017 only 25 graduates were in that position, though that number has risen sharply in recent years and by last year had risen to 494.

HEE has blamed the situation on a record number of applicants and promised “pastoral support” to medical graduates on the reserve list, many of whom are anxious about their futures.

“There have been record numbers of applicants for the 2022 foundation programme. Although the statutory medical education bodies have increased the number of foundation posts available, we recognise that 791 students have been placed on the reserve list,” said Prof Liz Hughes, HEE’s deputy medical director.

It has sought to reassure graduates without a training place that they will get one somewhere in the UK by August. Places will be freed because historically about 7% of applicants withdraw between applying and starting their F1 training, it said.

The British Medical Association has voiced concern about the large number of unallocated medics. “Now we have a situation where a record number are left with unnecessary uncertainty about where they are headed this August,” said Khadija Meghrawi, the co-chair of its medical students committee. “In a time where student mental health is declining, this additional source of uncertainty and stress is particularly unfair.”

Prof Martin Marshall, the chair of the Royal College of GPs, said: “It is important we get to the bottom of why this has happened and address it as soon as possible. It’s encouraging that we have so many people completing medical school and wanting to continue their training. This needs to be matched by capacity in foundation training schemes.”

Azeem Majeed, a professor of primary care and public health at Imperial College London, said: “It’s essential that workforce planning in the NHS is adequate, given that there are shortages of many health professionals, including doctors. This means having enough foundation posts for newly qualified doctors.

“It’s likely that most of the 791 people without foundation doctor posts will eventually be allocated one but it does create undue stress for them and they may be allocated a role in a part of England where it may be difficult for them to work due to family reasons.”

Lateral flow tests could cost care home visitors £73 a month, a leading UK charity has said, as it renewed calls to keep the devices free in such settings.

Nicola Davis www.theguardian.com 

The government has previously announced that free testing for the general public will end from 1 April, and that this will include care home visitors.

However, charities have warned the shift away from free tests could place a heavy financial burden on those visiting care homes, where testing is still advised.

Boots has announced it will offer the devices at £2.50 for one or £12 for a pack of five, or £17 for a pack of four with the extra option to send results to the UK Health Security Agency (UKHSA).

James White, the head of public affairs and campaigns at the Alzheimer’s Society, said the proposed charge on lateral flow tests for visitors to care homes was a cruel tax on care.

“Over the past two years, we’ve consistently heard many tragic stories from families struggling to visit their loved ones in care homes. For many people with dementia, this isolation has led to a significant deterioration in their condition and mental health,” he said.

“With infection rates rising once again, the government must provide free lateral flow tests for all visitors to care homes so that families are not put in an agonising position where they are forced to ration visits, leaving people with dementia once again isolated and alone.”

Dr Sam Royston, the director of policy and research at Marie Curie, which runs hospices, also raised concerns.

“Without the provision of free testing, many people living with a terminal illness and their families will face additional costs at a time when we know people are often struggling. This extra cost would put further strain and pressure on people’s lives at a time when their basic living costs are already rising exponentially due to the high cost of living and energy,” he said.

“For those who can’t afford the extra financial burden of paying for testing, this could lead to more people facing further social isolation towards the end of life.”

The Alzheimer’s Society is running a petition to keep testing free for care home visitors – which has been signed by more than 7,000 people – with the charity suggesting there are a number of options to do so, including providing tests to care homes or sending weekly tests to essential caregivers.

Caroline Abrahams, Age UK’s charity director, said: “No one should have to pay out of their own pocket for tests in circumstances where the expert advice is clear that testing remains an important safeguard against Covid,” she said.

“If care home visitors are going to continue to be asked to keep testing to protect their loved ones, it would be completely unacceptable to expect them to pay.”

The concerns come as data from the Office for National Statistics (ONS) suggests infection levels in the UK are on the rise once more, with the proportion of those over 70 who had Covid in the most recent week the highest since the ONS survey began.

The Department of Health and Social Care currently advises that testing for visitors to care homes should continue, in line with the wider care home testing regime.

However the Guardian understands measures around testing as well as infection, prevention and control measures – including for care home visiting – are currently under review. The DHSC has said further details are to be set out by 1 April.

The DHSC is also soon expected to announce which at-risk groups will be eligible for free symptomatic testing. At present, it is thought this will include people over 80 or with compromised immune systems, as well as NHS and social care staff.

A DHSC spokesperson said: “As set out in the government’s Living With Covid plan, the approach to managing Covid-19 in adult social care services will continue to evolve in the coming months. We will continue to focus on providing care for those that need it and supporting people who are most vulnerable to Covid-19.”

More than a thousand NHS staff in Devon are currently off work due to “Covid-related problems,” a health boss has revealed.

Ollie Heptinstall, Local Democracy Reporter sidmouth.nub.news 

Dr Paul Johnson, clinical chair of the NHS Devon Clinical Commissioning Group, warned a recent increase in Covid cases across the county is having an impact on the health service.

However, addressing a monthly Team Devon meeting of local leaders, he said it was not leading to an increase in the number of people seriously ill with the virus.

“We’re seeing a significant increase in the number of people who are testing positive for covid and the number of staff who are testing positive and having to absent themselves,” Dr Johnson said.

“So, what that means is that we have fewer staff available. And at the moment, there are over a thousand staff in the NHS in Devon who are off because of Covid-related problems.

He added: “On top of that, we are having to have people in cohorted wards [a ward where people with the same infection are put] because they test positive [for] Covid, and that means often they’ve come into hospital with something separate and so they are not on the specialist ward that they should be on.

“Rather, they’re on that general ward and it does mean that giving them specialist nursing and medical input becomes more difficult. It also means the number of beds that we have available is reduced because of infection contacts.”

“And lastly, it means that many people are delayed in their ability to be discharged, particularly if they need a care package or into a care home because they’re testing positive.”

Few patients need intensive care

The meeting was told that despite the number of people in hospital with Covid rising to more than 230, very few of them need intensive care.

“At the height of the pandemic, it was about 10 per cent needing intensive care, whereas at the moment we only have four in our intensive care units,” Dr Johnson said.

“So, the good news is that this particular variant doesn’t seem to be having the impact [in making people seriously ill] and it’s also testament to the effectiveness of the booster vaccine and the number of people within Devon who have actually got that booster.”

Despite the end of legal Covid restrictions, the public is still being asked to wear masks, keep hands clean and to maintain distancing in healthcare settings.

People are also expected not to attend hospital, for visiting or for outpatients’ appointments, if they have symptoms of an infection – whether Covid or not. Visiting may also be in a timed slot to control numbers.