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Someone Please Tell Mr. Hancock and the Department of Health About ‘Cohorting’

by Dr David Livermore
4 December 2023 9:00 AM

The Great and Good are busy trying to justify instructing the discharge of elderly patients, of uncertain Covid status, from hospitals to care homes. The result, back in March 2020, was to seed multiple care homes with Covid. The virus was then spread by staff who worked shifts for multiple sites. Care home residents account for around 45,000, or 20%, of all U.K. deaths attributed to Covid, rising to between a third and a half of those in the first wave.

Jenny Harries, then one of Chris Whitty’s Deputy CMOs and now Chief Executive of the UKHSA, e-mailed in March 2020, “The reality will be we need to discharge COVID-19 positive patients into residential care settings.” She perfectly understood the implications, last week telling the Covid Inquiry that it “sounded awful” and adding that she had been taking “a very, very high-level view”.

Matt Hancock further informed the Inquiry “The only choice is between bad options… I have gone over and over in my head the decisions that we took… Every decision was a choice between difficult options, and nobody has yet brought to me a solution to this problem that even with hindsight (my italics) would have resulted in more lives saved. If there is one, I want to know about it because it’s crucial that we learn these lessons for the future.”

What is remarkable about all this is that there was an obvious way to mitigate the problem. It’s what Sunetra Gupta, in Saturday’s Telegraph called “fever hospitals”, and what I’d call ‘cohorting’. Put simply, you take over a few care homes and you send all the possibly infected discharges there, instead of scattering them hither and thither. It’s not perfect – some uninfected discharges find themselves together with a high concentration of the infected, increasing their risk. But it’s a damned site less bad than seeding scores of sites. What’s more, you can ensure that these few sites are served by dedicated staff who aren’t also working elsewhere.

It’s basic infection control, and it’s hard to think that no one proposed it…

That said, it is just about possible, because the Department of Health has form:

From 1997 to 2011, I ran the Antibiotic Resistance Laboratory for the then Health Protection Agency (HPA), which is the UKHSA under its previous moniker but one. Any hospital that encountered unusually resistant bacteria could send them to my team for confirmation of their own results, advice on what antibiotic to use and investigation of the bug’s resistance mechanisms. We watched to see if similar resistance types were cropping-up at multiple hospitals, indicating an emerging national public health issue. Colleagues in the adjacent Hospital Infection Laboratory performed DNA fingerprinting, identifying whether new resistance types were spreading across different hospitals.

In Spring 2011, I was surprised to receive Acinetobacter and Klebsiella (genera of bacteria) from a dozen intensive care units in the same week with similar resistance patterns – but very unusual ones for the U.K. DNA fingerprinting confirmed clusters of isolates belonging to the same strains from the different ICUs. It was bizarre for something like that to arise out of the blue; multi-site problems usually build slowly and progressively.

Usefully, a couple of submission forms noted “Patient transfer from Libya”. Most other patients had Arabic names too, so we phoned around the hospitals and discovered that these too were “Patient transfer from Libya,” or were in a nearby bed to “Patient transfer from Libya.”

We gathered that the Department of Health, in its compassionate wisdom, had imported war casualties from Libya and distributed them across NHS sites, “so as not to overload a single ICU”. Other European countries had taken Libyan war casualties too, and reported similar clusters of resistant bacteria, as here, here and here. 

I did my best to create a stink, raising the topic at the Government’s Antimicrobial Resistance, Prescribing and Healthcare Infections Advisory Committee. I could never find out exactly who was responsible for distributing the patients, nor what hospitals (in North Africa or Malta?) they’d passed through before reaching the U.K. Nevertheless, I felt confident that I’d created enough noise, and that the message had filtered back. 

I was wrong. Later in 2011, I moved from the HPA to the University of East Anglia but, until 2018, retained a day and a half each week subcontracted to my old lab at the HPA, now PHE. I was no longer Lab Director but still chaired the Clinical Meeting, reviewing the week’s submissions. And, one week late in 2015, we had unusually-resistant Klebsiella, Acinetobacter and Pseudomonas from multiple burns units. 

Once again, bacteria of the same species were similar to one another but very different from our domestic problem strains. Several Pseudomonas had a very exotic antibiotic-destroying enzyme called VEB-1 and shared a DNA fingerprint. And, this time, the local microbiologists were phoning to complain, telling us that their burns units had been instructed, with minimal notice, to accept compassionate transfers from a fire in Bucharest, coming to the U.K. for skin-grafting.

These patients had already spent many days in a Romanian burns’ unit, where their wounds had acquired an unpleasant microflora. Which was then introduced, not to one U.K. burns unit, but to several. Burns units are notorious for the spread of infection and great care is taken to prevent this. Yet, in contravention of all good practice, there was no pre-transfer screening, and no microbiology notes for the transferred patients. Worse, some patients were too unwell for grafting, meaning that their transfers were pointless, only adding to their suffering.

In each of these cases it is to the credit of the individual NHS physicians, nurses and infection control teams that they prevented, or limited, the spread of the bacteria imported to their units. There were some cross infections, but no major local or national outbreak. Malta was less fortunate: Klebsiella with OXA-48 – an enzyme that destroys the most powerful penicillin-related antibiotics (‘carbapenems’) – was imported with Libyan war casualties and thereafter swiftly became endemic across the island nation.

Each time, just as with the discharge of Covid cases, the same risks were negligently run. Possibly-infected patients were distributed to multiple sites, creating a much greater risk than if the transfers were concentrated to a few well-prepared sites. For the Libyan and Romanian stories you can support the humane intent whilst deploring the haphazard execution. In the case of Covid it is likely that the virus likely would have found the care home patients eventually anyway, but cohorting would have minimised the early deaths.

First do no harm. Will the Department of Health ever learn about ‘cohorting’? And tell Matt Hancock?

Dr. David Livermore is a retired Professor of Medical Microbiology at the University of East Anglia.

Tags: Care homesCovidCovid InfectionsDepartment of HealthMatt HancockPolicy Failure

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22 Comments
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Dinger64
Dinger64
1 year ago

It used to be pleurisy or consumption (TB)!
old people die! It’s just a fact of life, we all have it coming! We used to understand this and accept it, but now, apparently, political excuses say it must not happen! Poppycock!

Last edited 1 year ago by Hardliner
55
-2
Ron Smith
Ron Smith
1 year ago
Reply to  Dinger64

Unless you are un Canada and ask for a Stairlift!

11
0
Mark Thornton
Mark Thornton
1 year ago

There is an Elite Group that control all the functions of State
whether politicians or civil servants
its probably always been this way
But it hasn’t been a problem as up to now they have had acceptable competence
Now they are just hopeless
Nothing demonstrates this more clearly than the COVID Inquiry
The same Elite marking its own homework
The tragedy is we have all the expertise eg Livermore, Heneghan, Gupta etc in spades
But they are sidelined.

97
0
Dinger64
Dinger64
1 year ago
Reply to  Mark Thornton

“The same Elite marking its own homework”

spot f-ing-on!

52
0
A Y M
A Y M
1 year ago
Reply to  Mark Thornton

It could be construed in this statement from that puppet Harries:

”that it “sounded awful” and adding that she had been taking “a very, very high-level view”.”

20
-3
Ron Smith
Ron Smith
1 year ago
Reply to  Mark Thornton

Nobody has explained why Simon Dolan’s Supreme Court challenge was thrown out twice!

14
0
wokeman
wokeman
1 year ago

They wanted ppl to die because it was obvious COVID wasn’t half as deadly as claimed from the Diamond Princess Cruise ship. Therefore spreading amongst the elderly in care homes was a key component of their plan. Otherwise mortality data would have no excess in it at all, and there was no tool to engender fear for the mass take up of their clot shot without “excess deaths”.

Last edited 1 year ago by wokeman
77
0
A Y M
A Y M
1 year ago
Reply to  wokeman

Deaths in the same cohort skyrocketed again in the “second wave” of Jan and Feb 2021, right when the poor old buggers were getting almost forcibly jabbed with the bioweapon.

Attributed to Covid, of course.

41
-3
Dinger64
Dinger64
1 year ago
Reply to  wokeman

I remember the news pictures of all those graves dug by the hundreds in Brazil, all empty! I wonder if they where ever used or just dug?

16
0
Ron Smith
Ron Smith
1 year ago
Reply to  wokeman

And those ‘Pathways’ end of life protocols with Morphine & Medazolam (that was made illegal when called Liverpool Pathways, just changed the name) would’ve added to that wave.

24
0
Jane G
Jane G
1 year ago

Are there any medically qualified people at all in the Dept of Health?

Even the most basic understanding of infections and their spread would indicate that the equivalent of ‘fever hospitals’ was what was required. I was under the mistaken assumption that that was what the Nightingales were for. (And if there was ever a monument to incompetence, they were it!)

With all the money thrown at the NHS, why is absolutely everything done on the cheap? Maybe it’s just high profile things that get the funding; ‘our’NHS is all fur coat and no knickers.

I recall once in the NHS a band 3 admin clerk telling our band 8 head of dept that we couldn’t order copier paper until the next month. This meant we weren’t able to send out appointment letters. Absolutely barmy. (Most of our patients didn’t have mobiles to send texts to and the phones were in constant use for other matters)

47
-1
Stuart
Stuart
1 year ago

At the risk of repeating myself, I attach a BMJ article 13 May 2020 which refers to “Staggering number” of extra deaths in community is not explained by covid-19. 20,000 old people who were in hospital because they were ill and needed treatment and were thrown out by the NHS without a second thought to die.

I cannot think of an appropriate comment…love to all

BMJ Article
45
0
Ron Smith
Ron Smith
1 year ago
Reply to  Stuart

Yup throw sick people out to make was for more sick people!

9
0
allanplaskett
allanplaskett
1 year ago

‘The Great and Good are busy trying to justify instructing the discharge of elderly patients, of uncertain Covid status, from hospitals to care homes. The result, back in March 2020, was to seed multiple care homes with Covid.’

Dr Livermore should confer with Prof Carl Heneghan, who has not recanted his statement that care-home deaths in England peaked in the first week of April-20, a week before supposed infection seeded by returning NHS patients could have taken effect.

A better chance of understanding the Spring-20 ‘Gompertz curve’ surge in excess deaths lies in examining the Euromomo graphs and asking why some countries had no surge in deaths at that time at all. The prime example is Germany, which is contiguous with the Netherlands, a country that had a similar spate of excess deaths in April and May 20 as the UK.

Was sarscvov2 the first acute respiratory virus in history to observe frontiers?

I think it is more likely that precariously age-frail people in Germany were not deserted to die of thirst and want and did not have air-tubes forced violently down their throats. Nor were they put on pathway regimens of passage-easing opiates.

The crucial common factor appears to be the bulk pre-ordering by national health authorities of the executioner’s drug midazolam.

Last edited 1 year ago by allanplaskett
24
0
Ron Smith
Ron Smith
1 year ago
Reply to  allanplaskett

And where was the mass order of antidotes for Medazolam!

4
0
CGW
CGW
1 year ago
Reply to  allanplaskett

I researched at the time data from various government websites (not the Netherlands, though) and these data clearly show that there were no excess (i.e. unusually high numbers of) deaths in the February/March/April 2020 timeframe in Germany, Austria, Romania and Slovenia, whereas there were clear peaks in England&Wales, France, Italy and Spain. I simply compared 2020 mortality data with available data from 5 earlier years.

In other words, the virus did stop at borders or (more sensibly) there was no virus, only government and associated health service reactions.

Germany cancelled 908,000 hospital operations, including 52,000 cancer operations, after Merkel’s announcement of a pandemic, and locked down twice, resulting in excessive deaths from November 2020 onwards.

3
0
JXB
JXB
1 year ago

Prime Directive of contagion control: DO NOT mix infectious/possibly infected people with non-infected people.

Instead quarantine them together and attending staff in a place(s) of isolation and keep them there until they have all died, recovered or show no signs/symptoms of infection and are outside the incubation period.

This was known for over a century.

Last edited 1 year ago by JXB
27
0
Monro
Monro
1 year ago

I found this rather dispiriting article written 30 March 2020

‘Patients in an early operable stage of cancer were sent home untreated; expectant mothers were refused admission for what were likely to be difficult and dangerous confinements; children in plaster of paris were deprived of the care they needed; bedridden patients—the arthritic, the diabetic and heart cases—were discharged to the care of relations, heedless of the fact that these relations might now have evacuated, leaving the house empty; highly contagious tuberculosis patients were sent to crowded homes with young children, perhaps to die, perhaps to infect their families.’

‘No proper records were kept to show what happened to those people discharged in this way.’

‘…..access for any other medical needs was drastically reduced: “In addition, therefore, to the sick who were sent home, some of whom were ‘wholly unfit people’ and should not have been discharged, there was the problem of existing waiting lists at voluntary hospitals……..’

‘….more beds were made available in voluntary hospitals than the Government had expected, and all of these were to be paid for – whether they were utilised or not. Voluntary hospital bosses in particular were more than happy to take the money for doing nothing, but keeping so many beds empty meant the hidden waiting list for a hospital bed more than doubled.’

‘ casualties treated in hospitals from beginning to end was roughly forty percent less than the number of sick people turned out of hospitals in about two days in……………

……………September 1939.”

The Lowdown 30 March 2020

No progress made in health crisis management planning in this country in the intervening sixty years.

What are all these useless overweight NHS back office admin staff doing?

Pathetic…….

Last edited 1 year ago by Monro
29
0
Ron Smith
Ron Smith
1 year ago

And now we have the contaminated blood scandal from 40 years ago…..some guy on BBC Radio 4 whose daughter died through infected blood….”I think they did that on purpose as a testbed when they were warned not to, they are all corrupted by big pharma”…That is the only time i heard someone criticise BF on the BBC….So is the 2021 and ongoing scandal only going so see the light of day in 40 years? That’s what Andrew Bridgen thinks.

21
0
186NO
186NO
1 year ago
Reply to  Ron Smith

Yes , when all the bad actors have departed stage left and can no longer be pursued – it will be the day of all days to bury bad news.

7
0
JayBee
JayBee
1 year ago

This important article c/should have saved the British taxpayer the embarrassing spectacle of the Covid inquiry and its £200+mln lawyers grift cost.
The only justifiable and efficient action that should have been and should ever be taken and the only medical lesson to be learned from the ‘pandemic’.

14
0
wryobserver
wryobserver
1 year ago

Hancock says “The only choice is between bad options… I have gone over and over in my head the decisions that we took… Every decision was a choice between difficult options, and nobody has yet brought to me a solution to this problem that even with hindsight (my italics) would have resulted in more lives saved. If there is one, I want to know about it because it’s crucial that we learn these lessons for the future.”

in April/May2020 I submitted my solution to the CMO, CSO and Hancock which even without hindsight would have saved thousands of lives; I have estimated up to 25,000. It was ignored. That it might have been lost in the email deluge that the Daily Sceptic recorded was routinely junked is irrelevant, as I sent a hard copy to the DoH addressed to Hancock personally.

Perhaps then the Department can dig it out and send it to him, or maybe I shall do it myself. Maybe I am Nobody… pity though.

10
0

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