Really? Is it? Or is this all going to go horribly wrong…?
What has been said?
So, yesterday the UK Government made the announcement that they are going ahead with their plans to relax the mandatory Covid-19 rules across the country. Clearly Boris didn’t read my earlier blog about R numbers suggesting that a “one-size-fits-all” approach is a bad idea… oh well.
As of the 19th July it will no longer be a legal requirement to:
- Wear a face mask on public transport or in shops – it will be down to “personal choice”, but how do we choose when we are told we should be wearing a mask to protect others? If we are not wearing a mask will people have a go at us because we are being socially irresponsible, or will people get aggressive if someone vulnerable asks them to wear a mask to help protect them? It seems like a recipe for social unrest to me.
- Meet with no more than 6 people in your home (rule of six) – I suspect with the England football matches, this one went out the window weeks ago, I think everyone either forgot about this when we could meet out of doors, or they just gave up on it anyway.
- Work from home wherever possible – I think this will be irrelevant as it will be down to employers most of the time to decide what they want their staff to do
- The number of people who can attend a wedding or funeral
- Table only service at restaurants and pubs (meaning nightclubs can now reopen)
- The number of people who can visit relatives in care homes
- Large scale events which previously needed Covid-19 safe certificates
- Tapping into your favourite restaurant or bar… those of us who CAN live without a smart phone have already passed this one!
- School bubbles –these will go as currently there are about 280,000 children off school isolating because their “bubble burst” making them a Covid-19 contact, replacing bubbles with daily testing.
- Travel restrictions – it is unclear what will happen with this one, and even more uncertain if any other countries will actually want anyone to visit from the UK when we currently have 27,334 new cases a day! Our case numbers are higher than Germany (392), Italy (480), France (796), Greece (999), Portugal (1483)… in fact only Spain has more than us, and not by much, with 32,607 cases!
- Self-isolation if a contact – if someone has been double vaccinated (or is under 18 years old), they will no longer need to self-isolate, instead they will have to be tested multiple times but can otherwise go about their normal daily routine. But how is this going to actually be monitored or even work?
We clearly have a lot of capacity left for lateral flow tests! But these announcements are great news, right… aren’t they? Errrrm, I’m not so sure….
What is the current situation in the UK?
I believe the UK is on a knifes edge where Covid-19 is concerned. There are about 28,000 new cases every day; case numbers are back up to the worst levels we saw in the 1st wave of infections last year.
The thing that has changed since the beginning of the year is that numbers of cases no longer directly reflect the numbers of people being admitted to hospital or dying. But before we naively believe the Government saying everything will be fine let’s just look carefully at the figures.
The current estimates for admission to hospital and mortality rate for Covid-19 in the UK are estimated admission rates of 1 in 60 and a mortality rate of 1 in 1,000. This is great and a long way down from the figures of about 1 in 10 admissions and 1 in 100 mortality, BUT IT IS NOT ZERO! And the Government are predicting that by the 19th July there will be 50,000 new cases per day, and this could even go up to 100,000 cases per day in August or September when all the new changes are in place. What the heck?!
Let’s do some maths here. If we have 50,000 new cases per day and 1 in 60 are admitted, then we will be admitting about a 1,000 people a day with Covid-19. On top of this 50 of those people a day will die. If we get up to 100,000 cases a day, we will have 2,000 admissions and 100 deaths a day. The current average length of stay in hospital with Covid-19 is 7 days which means that at 2,000 admissions per day, there will be 14,000 patients with Covid-19 in UK hospitals at any one time. That’s 14,000 less beds to try and catch up in the horrendous waiting lists, 14,000 people requiring extra infection control precautions (which won’t be available for the “normal” infections such as MRSA or Clostridium difficile), 14,000 patients who could infect healthcare workers who then are at worst at risk of getting sick, and at best not being able to work for 10 days, etc.
Patients don’t have to be really sick to bring the NHS to its knees, they just have to require extra care for which there isn’t capacity.
And what about the normal winter pressures? What about the risk of a bad Flu year because influenza didn’t circulate last year to top up our immunity? Influenza itself could result in 1,000s of extra patients in hospital requiring care and infection control precautions.
General Practice will likely get a hammering even if most patients with Covid-19 aren’t being admitted as these patients are likely to try to see their GP when they are feeling a bit under the weather or have the symptoms of long-covid.
And we will need to ramp up testing to be able to detect all of these extra cases… the list goes on and on….
And another thing…
So, if that wasn’t enough there is another thing that worries me about the relaxing of restrictions, and that is the risk of vaccine failure due to virus mutation.
Viruses can only mutate during reproduction inside their hosts cells. In the case of SARS CoV2 that means that mutation can only occur in anyone infected, be it someone really sick in hospital, or someone asymptomatic sitting in the pub watching football cheering on their favourite team and showering their mates with the virus. The virus doesn’t care how sick you are!
The more people infected, the more opportunities for the virus to mutate, the higher the risk that one of these mutants will be able to bypass our “vaccine induced immunity” and guess what… we’ll be back at square one again. Do we really want that? It would be a disaster.
Now it may not happen. SARS CoV2 may never mutate enough to get around the vaccines, and yes Pfizer and AstraZeneca et al tell us they can reformulate their vaccines within about 6 weeks… but it takes months and months to get those vaccines into people’s arms… and then the virus could mutate again… and again… and again…. Why give it the opportunity?
I have said it before, and I’ll say it again, if you want to reduce the risk of SARS CoV2 escaping vaccine induced protection then you need to bring rates down first and then vaccinate whilst the rates remain low. But that is not what we are doing. We’re letting rates go up whilst we vaccinate. Let’s just hope we get away with it.
So, what do you think?
Okay, it is clear I am not in favour of what the UK Government is planning to do on the 19th July. Yes, I want to stop having to wear face masks, they damage my skin, they are uncomfortable and itchy, and they have probably passed plastic bags in terms of environmental pollution. But I really think this is, yet again, too fast. Case numbers are already high, and even though the rates of admission and mortality are much lower than before they are still high enough to cause serious damage to the health service.
So, I am left wondering has this really been thought through properly? Is this really “based on science” or is it based on popular politics? Am I the only one thinking, ”new health secretary; new messaging”… Sajid Javid seems to be the new poster boy spokesperson; he is everywhere! I’m not so sure, I don’t quite believe the “World is safe, we’re in the semi-finals, all is right with Brexit” view….
What I would do…
- Stop announcing things in advance, it just means people go ahead with that change immediately
- Keep face masks in public indoor areas, including transport, supermarkets, venues, shopping malls and unfortunately hospitals
- Remove track and trace, there is limited evidence it ever really worked!
- Get symptomatic people to self-isolate, increase “sick pay” to cover the full 10 days
- Use the lateral flow test correctly to identify negative results… do not trust them for positive results, these should be confirmed by PCR
- Keep international travel restrictions, just because you have been fully vaccinated you can still “carry” the virus.
- Keep quarantine, travel is not essential, if you go – “pay the consequence”, we accept long check in times, so why not quarantine? Quarantine should just become an accepted part of the travel process
- Daily test school kids, send positives home; get rid of their face masks in the classroom, get rid of bubbles!
- Daily test healthcare workers and visiting relatives who might spread infection to the vulnerable and send positives home
Essentially ring fence or protect the vulnerable and allow the rest of the population to act more freely…. I might have mentioned that before too, oh well!