This is part two of a blog on the result, the outcomes as
best we can measure at the moment of how our government has responded to the
developing Coronavirus pandemic. If you haven’t read the first part, this may
make little sense. By way of an introduction, I’m considering the outcome of
the decisions made against a very singular metric – how many people died in the
first 5 weeks of the crisis. More information on why has already been covered.
But before you go any further, there should be some warnings around limitations
of data. I have compared the UK as broadly comparable to 4 other countries on
this metric. But no two countries are identical, although they are all
developed European economies with similar social structures and demographics.
Additionally, I am using the best statistics available to me. These are not
perfect and in the future better understanding will come of the comparisons.
But that won’t be reported in the news.
Now I have
got that out of the way, what does the metric show us?
Country
|
Deaths
per 1,000 population in first 5 weeks
|
UK
|
0.38
|
Spain
|
0.37
|
France
|
0.29
|
Italy
|
0.26
|
Germany
|
0.05
|
On this
basis, the UK has had worse results than other European neighbours in dealing
with the virus. I have already looked at two areas that governments could
impact: Health service capacity and resilience; and speed and scope of social
distancing measures. In both cases, mistakes were made. Those mistakes have
almost certainly cost lives. But the other things I want to consider in this
blog were provision or Personal Protective Equipment (PPE) and testing
strategies for Coronavirus.
Provision
of Personal Protective Equipment
As
previously mentioned the UK had planned for an epidemic such as Coronavirus and
how our healthcare system would cope. It was called Exercise Cygnus and took
place in 2016. The results of the exercise have remained classified. However,
at the time some information did come out, via we must assume approved news,
from the Chief Medical Officer. They were stark warnings. In the event of a flu
pandemic the UK would be short of three things: ventilators, PPE and capacity
to dispose of bodies.
This led
to a lot of planning by NHS England. Top of that list was that NHS Trusts
needed to be better prepared. We needed more PPE. We needed more ventilators.
We needed a better way to properly look after those who died. In order to put
this in place the NHS needed something that was becoming increasingly short. It
needed the money to buy these things. No extra funding came from the
government. NHS chief executives were left with an obvious choice really. As
budgets became more and more restricted due to austerity and government set
targets were missed and services and trusts started to fail financially. Use the
budget you already have to try to keep services running now to the best of your
ability OR spend that budget on the possibility of a future pandemic. Which
would you do?
Coming
into this crisis we did not have enough PPE. This was because the Conservative
government of the day chose not to provide any more funding. Interestingly a
lot of media outlets sympathetic to the conservatives have tried to blame this
on NHS executives. I find this hard to swallow and incredibly low. What were
they meant to but it with? Hope and charm?
PPE is
incredibly important because, as Italy found out very swiftly, without doctors
and nurses you can have a surplus of ventilators but no-one to run them if they
too have caught Coronavirus. In this country we are rightly proud and
protective of our NHS. It is truly a shining example of socialism working. In
fact since the start of UK lockdown measures we have had a weekly round of
applause for our NHS workers. Everybody feels and knows it implicitly in this
country. We rely on and owe the NHS and its staff so much.
But this must include that we
owe keeping them safe where possible. Even for those who don’t believe in the
NHS it is a simple equation in a time of pandemic – fewer healthcare
professionals mean each of us is at greater risk. Therefore PPE to keep them
safe must be paramount. What did the government do when they knew more money
was needed to pay for PPE a WHOLE 3 YEARS AGO? Provided no additional funding.
Who have media outlets tried to blame? NHS executives. In June of last year a
governmental body again warned the government that there was no stockpile of
PPE and this left us open to the threat. The government again did nothing. We
should be rioting in the streets over this betrayal. Once it is safe to do so,
obviously.
What is just as heinous is the
handling of this shortage by the government of today. It may be the same party,
but you can possibly see the argument of “it was different ministers then”. As
soon as this happened our government should have done everything, and I mean
everything, in its power to source additional PPE. Surely at least they have
done that?
On March 25th, when
the howls of outrage were starting to really wing out and hit the politicians
in Westminster, Boris Johnson said this:
“On the personal protective equipment
the answer is by the end of this week.”
That is the sort of bold,
definitive promise that we all want to hear from our politicians. Measurable,
reassuring, no nonsense. More media coverage followed to reinforce this determination.
And by the way, this promise was not JUST that the NHS would have the PPE it
needed. This was a promise that care homes as well as the NHS would have all
the PPE needed to keep staff safe. In fact Matt Hancock was able to trumpet that
997 MILLION items of PPE had been handed out. Outstanding delivery.
Except, of course, that the
target wasn’t met. The truth is that a survey by the British Medical
Association (who know a thing or two about healthcare and PPE) on the 18th
April – 3 weeks later found that half of doctors working in high risk of
infection areas reported a shortage of PPE. The situation is far, far worse in
the overwhelmingly privatised care sector. The Royal College of Nurses has told
members that as a last resort if there is insufficient PPE they can refuse to
treat a patient. Just pause and think about that scenario.
And it is not as if getting
PPE right now is an easy thing. There is a worldwide shortage. Every country is
trying to source PPE of the right type. Well, every country except those who
planned in advance and built a stockpile when told to by medical experts,
obviously. We, along with other countries need billions of items of PPE. And
PPE covers a wide variety of items. It must be the right PPE for the right use.
What about the almost 1
billion items distributed? Well, it turns out that of those 1 billion items,
50% of them were surgical gloves. So that leaves 500 million items to cover
masks, gowns, eye protection etc. Oh, and the gloves were not pairs. They were
individual gloves. Now, unless Doctor Richard Kimble was on to something and
there are a fuck-load of one-armed men running around the NHS individual gloves
are a mis-counting by any standard. Still, ignoring that the Secretary of State
for Health tried to pull the wool over the eyes of the public on that particular
topic, there must be a reason we are doing so badly.
For many of us, we would
possibly focus on supply chain problems. 36 individual companies, many of whom
are specialist manufacturers of PPE, have complained that they have approached
the government but been ignored. This is not that surprising for people who
have had involvement with government procurement. The government didn’t sign up
to a European-wide initiative to buy PPE because, using the official language,
of a “communications error”. How much communication is involved? “Would you
like to join?”, “Yes please”. But as it turns out, if you believe the
government’s own line there is another culprit.
The focus for the Secretary of
State’s commentary on the shortage? That doctors and nurses are using too much
of it. Yes, that is right. It is not the fault of a government that failed to
stockpile despite being told twice to do so. It is not the fault of a supply
chain that everyone knows is failing in lots of places. It is the fault of the
same doctors and nurses who Conservative politicians are out on their doorsteps
applauding every Thursday night. The same NHS staff who have lost over 100
colleagues to Coronavirus. How many of those would still be alive with the
correct PPE?
Testing for Coronavirus
At a press conference in front
of the world’s press on the 16th March – 5 days before the UK went
in to lockdown – the Director General of the WHO made it clear. The most
important tool, in their view, to arrest the spread of the disease was:
“Our key message is: test,
test, test”.
Now, that is easier said than
done. For a start, that means that you have to have the capacity and capability
– including the right resources – to actually perform testing. Quite simply,
the UK had never needed to have that capacity before and was unprepared. It
would be easy to accept this as an obvious rationale for why we didn’t test more.
I am not a scientist or healthcare professional. I can’t tell you what
chemicals, equipment and laboratory space is needed to perform these tests. Not
many people are. Of course, this explanation falls down when you look at a very
close comparison.
Germany, who had cases around
the same time as the UK, were able to implement track and trace testing and
target community transmission. They were able to ramp up their testing from
none to 500,000 tests a week in the first two months. Not only that, but they
used a system of track and trace. Anybody who tested positive was isolated,
their contacts ascertained and isolated and tested. Any who were found positive
- their contacts ascertained and isolated and tested etc. etc. By focussing on
positive tests and then targeting outbreaks in this way Germany has managed to
have, based on the measure I have used, had far and away the best outcomes.
Similar results have been seen in other countries who have taken this approach.
South Korea is a good example – but they had suffered because of the MERS
outbreak a number of years ago. They had experience and new what to do. Germany
copied their approach. For some reason, we didn’t.
To put into context the
differences, by the time Germany had capacity for 70,000 tests a week, the UK
had increased capacity at the same time to 5,000 a day. Hardly comparable. Not only that, but on March 13th
the government made the decision to stop testing for Coronavirus outside of
hospitals. Consider that for a moment. At a crucial point in the battle, when
we had evidence to compare from different countries on which strategies worked
best, we chose to stop following the most effective one. In fact even the Chief
Scientific Officer, Deputy Chief Medical Officer and the Security Minister have
all accepted that this was a mistake and we could have had better outcomes if
we had ramped up testing much more quickly. The question that must be answered
then is why? Why didn’t we increase testing capacity when other European
countries were able to? Why did we stop track and trace when we did? Even Italy
– who were held out as an example of what not to do – had managed 2.2 million
tests by the end of April – 1.5 times what the UK had managed.
The Prime Minister himself
appeared to understand how important testing and testing capacity was when he
promised in early March (when testing was around 5,000 per day) that this would
be ramped up to 25,000 and then 250,000. Of course, he never gave a timeline
for this but this shows clear intent. Does this mean it was ineptitude rather
than ignorance that led to our woeful testing regime? I would hope that any
inquiry would look at that – but I wouldn’t hold your breath for an inquiry to
hold a Conservative government to account. If you are still able to hold your
breath that is.
Obviously, the government
would need to explain this. On March 31st the daily government press
briefing made it clear what the problem with increasing testing was. There was
a global lack of the chemical reagents needed to perform the tests. This was
hampering the UK effort. Which makes me wonder – why didn’t Germany have the
same problem? What had they done that we hadn’t? After all, they are only a
short hop over the North Sea (or Nordsee coming the other way). What did we
fail to do or what did they succeed in that we didn’t.
As the clamour and cry got
louder, and the original target from the Prime Minister was forgotten, a truly
unusual and remarkable thing happened. The government set a target for the
number of tests to be performed, with a deadline attached. The target was that
100,000 tests per day would be delivered by the end of April. This sort of
thing – a government giving a way to be held to account – seems like a novelty.
The politicians we have had for 30 years or more have been far too clever and
sneaky to do this. Was this finally some honest politics?
It would be refreshing to
think so. Unfortunately, I think this has been the very opposite. And at the
time, it must have seemed a very astute thing to do. Matt Hancock gave himself
28 days from the 2nd April to get the number of Covid19 tests up to
100,000 a day from 10,000 a day at the time. Increasing our testing ten-fold
over the space of a month. A definite and gargantuan effort that would be
admired when it was achieved, surely? Or does it raise more questions and hide
a multitude of sins? Firstly, why 100,000 tests a day? There is no scientific
basis for this, no magic limit we must pass as a country to get back in
control. Even that capacity would be only 20% of the testing capacity Germany
had mustered to get in control of the disease.
Why then? 100,000 a day from
10,000 a day. Amazing. Of course one of the other things that a statistic like
this and a target like this does is focus your mind. But to focus you on one
thing means that you are no longer focussed on other things. Even if they are
more important. This target meant that people no longer focussed on the number
of people tested IN TOTAL. Or on which groups got priority testing. That means
that the news isn’t reporting on the fact that by the 28th April the
UK had still only tested 763k people IN TOTAL compared to Germany’s 2,547k – or
one third as many. Or that we had carried out less tests than Italy, Spain and around
the same as France on 724k. So whilst we were focussing on tests per day, we
were still falling behind in total. One problem with this measure you might
argue is obvious – that those countries have different populations. Actually,
if anything, that makes it worse. If we rank order countries by number of tests
performed compared to population and add it to the table above:
|
Country
|
Deaths per 1,000 population in first 5 weeks
|
Tests per 1,000 population by 28th
April
|
|
Italy
|
0.26
|
30.6
|
|
Germany
|
0.05
|
29.1
|
|
Spain
|
0.37
|
28.9
|
|
UK
|
0.38
|
11.2
|
|
France
|
0.29
|
11.1
|
100,000 tests per day. It may
feel like a bold target. But just perhaps it was a clever distraction tool. Of
course the reason that politicians very rarely give such targets is simple – if
you miss it you might be held to account. But with 28 days surely we would
achieve it. According to the government we did. On the 30th April
and the 1st May the government proudly announced that we had
performed over 100,000 tests on each of those days. Well, kind of met it.
Because what the Department of Health and Social Care had to do, in order to
even meet the target for those two days was not only count tests actually
performed, but include tests sent out in the post to people.
Some might argue that this was
a reasonable measure. Certainly government ministers were willing to stand
behind these figures as evidence of meeting their target. I don’t believe the
vast majority of people see it that way. For most of us a test for a disease
does exactly that. It isn’t that you have received a test kit in the post. It
is that something has been carried out that will tell the person taking the
test whether they are infected or not. We don’t give qualifications to people
because they are in the exam hall. They must be tested. Once that target had
been set, there was no way that the government could miss it. No matter what,
they would find some way to be able to say they had. I expected to see queues
of military personnel that day lined up to be tested. Nice to know that the
government found a cheaper and easier way to lift the tests performed figure of
80,000 above their magical threshold.
Even if you are convinced that
the government met that target – it was for two days only. Since that point it
has failed for 5 consecutive days to repeat it. Quite simply, anyone who would
believe they hit that target and it had an impact has been conned. The language
of the latest announcements is all about the targets for testing “capacity”.
But having capacity and actually testing are not the same. I have the capacity
to reach a million readers. The fact that it is more like 300 is a much more telling
statistic. This is another broken target.
Looking at the metrics on
number of deaths, where does that leave the assessment of how we have done? It
isn’t great. We now have the highest death toll in Europe as of the 7th
May – even though other countries have tested more so should have higher
confirmed deaths than us. In fact we have the second highest death toll in the
world – behind the USA. Of course, that is if you accept that China is
reporting the correct figures. Even if they aren’t – that still makes us the 3rd
highest. With 1 & 2 having many multiple times our population. When you
look at the levers and controls our government had, and how they were deployed,
it isn’t hard to see why. Looking at this crisis it appears that at every step
the government have been more focussed on looking good rather than doing good.
We can only hope that they pay for that at the next election.
No comments:
Post a Comment