Winter

No, Chris Whitty. Omicron is Not a Really Serious Threat

We’re publishing another guest post by our in-house doctor, formerly a senior NHS panjandrum, this one looking at the latest hospital data. Turns out, staff absences are the reason London hospitals are under pressure, not a surge in Covid admissions due to the Omicron variant.

How quickly things change. The Daily Sceptic has asked me to provide a brief update on the unfolding situation after the Christmas weekend. Less than two weeks ago at the Downing Street press conference, Professor Chris Whitty said “by the time we get to Christmas I expect the majority of people going to hospital to be Omicron cases”. In response to a journalist’s question about Omicron, he said: “This is a really serious threat. How big we don’t know but everything we do know is bad.”

So, how bad is it?

Hospital admissions are rising, but not necessarily due to Omicron, according to Chris Hopson, the CEO of NHS providers.

Talking to chief executives this morning, the sense is that admissions are rising but not precipitately so. What’s particularly interesting is how many chief executives are talking about the number of asymptomatic patients being admitted to hospital for other reasons and then testing positive for Covid.

Trusts are not, at the moment, reporting large numbers of patients with Covid type respiratory problems needing critical care or massively increased use of oxygen, both of which we saw in January’s Delta variant peak.

Leaked NHS Report Claims London Hospitals “Likely to Be Overwhelmed” Within Three Weeks. We’ve Heard That Before

An internal NHS report leaked to the Health Service Journal claims that hospitals and ambulances in London are “likely to become overwhelmed due to rising Covid demand in the next two to three weeks”.

This is despite the fact that, as NHS Providers Chief Chris Hopson points out: “The overall numbers remain relatively low compared to the January 2021 peak – 1,819 Covid patients currently in London versus 7,917 on January 18th 2021.”

Let’s bear in mind also that last winter an internal NHS briefing, again leaked to the Health Service Journal, claimed that under the “best” scenario London would have a shortfall of 1,515 general and acute beds by January 19th. Yet the briefing also stated London has 15,600 general and acute beds, which is almost double what turned out to be the peak Covid winter occupancy of 7,917 beds on January 18th.

Nationally, at the winter peak on January 18th there were 8,696 unoccupied beds, 26,902 beds occupied by Covid patients and 50,204 beds occupied by non-Covid patients.

It’s also worth remembering that the NHS has a beds crisis every winter, as this selection of Guardian headlines illustrates. (See also the image at the top of headlines from the 2017-18 winter crisis.)

Dominic Raab Refuses to Rule Out Imposing Further Restrictions before Christmas Day

Although Dominic Raab has insisted that Brits will experience a “much better Christmas than last year”, he also mentioned that there are no “hard, fast guarantees” that additional Covid restrictions won’t arrive before Christmas Day. Meanwhile, Government advisers have said that “significant action” needs to be taken to curb the spread of the Omicron variant and save the NHS from “real collapse”. Sky News has more.

Raab told Kay Burley: “I think we will have a much better Christmas than last year because of the vaccination level – both the overall vaccination level and particularly the impact of the booster campaign.

“People will need to be careful and cautious.

“But I do think, again subject to the data – and it’s always under review – that we’re in a better position to enjoy Christmas with loved ones this year.”

Asked if more restrictions would be imposed between now and Christmas Day, Raab said: “I just can’t make hard, fast guarantees.”

Twelve people infected with Omicron have died – Raab said 104 people with the variant are in hospital.

He added he did not anticipate parliament being recalled to vote on new restrictions before Christmas.

The Cabinet Minister said there was a time lag in the data and “we don’t yet know the severity” of the Omicron variant, adding that “it comes through day-by-day”.

He said regardless of modelling by scientific advisers, the government would “test the data in real-time against real cases”.

Professor Ravi Gupta, a member of NERVTAG which advises the Government on the threat posed by new and emerging respiratory viruses, said “significant” action needs to be taken to tackle the growing number of Covid cases.

He said: “It is of serious concern. We have an escalating number of cases that really has reached levels that we haven’t seen before in terms of the rate of increase.

“The action that’s needed really is going to be quite significant.”

Dr. Gupta added: “The sheer numbers that are going to be infected because of the increased transmissibility of this virus is going to potentially overwhelm our health service.

“So that’s a really critical situation that we’re facing.”

Worth reading in full.

Will the U.K. Face a Winter Covid Surge?

I’m slightly surprised to be writing this post as to my mind the answer is obvious – of course the U.K. will face a winter Covid surge. It’s winter. That’s what happens in winter; the dominant respiratory virus surges and, most years, taxes the capacity of the health service. The only question is how big it will be – unusually large like 2020-21, or unusually small like 2019-2020 before Covid hit? It’s worth remembering that more people died in England and Wales per head of population in 2008 (once adjusted for age etc.) and every year prior to it than died in 2020 or 2021, many of them succumbing during the winter flu season, as the chart below from the Institute and Faculty of Actuaries shows. In other words, there’s a winter surge in deaths-by-virus every year, and I see no reason why 2021-22 will be any different.

Standardised mortality rates (SMRs) in England and Wales

As I see it, the only realistic way there would not be a Covid surge on some scale is if another influenza-like virus takes over, which seems unlikely right now as flu is almost nowhere to be seen.

Nonetheless, I am writing this post, and that’s because some people seem to think that this year it’s not going to happen. Dr Sebastian Rushworth argues that places hit hard already, such as Sweden, New York and Lombardy, have developed enough immunity to avoid “another big wave” altogether. Andrew Lilico in the Telegraph maintains that owing to “infection saturation” and vaccine third doses, “for us, the Covid crisis is over”. Even the usual doom-mongers at SAGE are predicting a decline in hospitalisations and deaths in December, according to new modelling released on Friday. A decline in flu-like hospitalisations and deaths in December? Whoever heard of such a thing?

I freely admit that the winter surge may, because of acquired immunity, be relatively small in places like the U.K. which have already faced widespread exposure. Perhaps that’s all that Sebastian Rushworth and Andrew Lilico mean, and in which case our positions are not so far apart. But will it really be a non-event, as SAGE at least appears to be implying, so that Covid deaths decline during the winter and don’t put any further pressure on the health service?

Scottish Government Considers Extending Vaccine Passports to Cafes and Pubs

John Swinney, the SNP Deputy First Minister, has admitted that the Scottish Government is considering widening the use of its vaccine passport scheme, so that it encompasses more leisure venues including pubs, cafes, cinemas and theatres in an attempt to thwart a Christmas surge in Covid cases. At the moment, only those wishing to enter a nightclub or large venue need to provide proof that they are double vaccinated. The Telegraph has the story.

Swinney also said ministers were looking at extending the use of face masks and clamping down on workers heading back to the office, ahead of a formal review of restrictions that will be unveiled next week.

In the clearest signal yet that the Scottish Government will introduce a winter clampdown, he told MSPs that the options would be discussed with business leaders in the coming days.

Swinney argued that tightening up such “baseline protective measures” was the best way to “head off any prospect of future lockdowns”.

Although he admitted that the number of people hospitalised with Covid had declined by almost 20% over the past week, he argued previous trends suggested “the spread of the virus could, very quickly, increase again during the coming weeks, perhaps over the Christmas period”.

But Paul Waterson, Spokesman for the Scottish Licenced Trade Association, said vaccine passports could spell the “death knell” for lucrative Christmas parties. Many pubs have been relying on them for a boost to their incomes after more than a year of turmoil.

Dr. Liz Cameron, Chief Executive of the Scottish Chambers of Commerce, warned that extending vaccine passports would be a “massive backwards step” at a “pivotal moment” in the country’s Covid recovery. Leon Thompson, Executive Director of the trade body UKHospitality Scotland, said: “The extension of this poorly conceived and badly executed policy has the potential to destroy many businesses that are already struggling.”

Douglas Ross, the Scottish Tory leader, highlighted the Deputy First Minister’s testimony to a Holyrood inquiry last week, in which he admitted there was no evidence to show vaccine passports had reduced the spread of Covid.

Mr Swinney argued it was impossible to prove a specific restriction caused a decline in Covid rates but Ross said: “It’s a mind-boggling way to make policy. They’re inventing it on the hoof.”

The Deputy First Minister disclosed that he and his colleagues were considering whether to allow people who have not been double vaccinated to access affected premises if they instead provide proof of a negative test.

But he was challenged over how premises such as cafes would be expected to enforce a vaccine passport scheme when they do not have staff at their entrances.

Since the start of October, adults have had to prove they are double vaccinated to enter nightclubs and other late-night venues with music and dancing, or attend large events such as football matches and concerts.

Worth reading in full.

Matt Hancock Demands That Mandatory Vaccination for NHS Staff Must Arrive before Winter

hancock.jpg

The former Health Secretary has declared that NHS workers must be coerced into having both doses of a Covid vaccine before the onset of winter, while criticising unvaccinated staff for dismissing “all the scientific and clinical advice”. However, the current Health Secretary Sajid Javid wishes to delay the implementation of mandatory vaccinations for NHS employees until April of next year to avoid a severe staffing shortage over the Christmas period. The MailOnline has more.

Hancock, who quit in June after breaching his own social distancing rules by kissing a married colleague, said the move would act as another “tool to save lives” during what is projected to be a harsh winter for the health service.

He also scorned NHS staff who are still not vaccinated and don’t have a valid medical reason, warning that it was their “moral duty” and that they had “ignored all the scientific and clinical advice”.

Ministers have for weeks been considering whether to make Covid jabs compulsory within the health service after pushing through the requirement for care home workers in the summer. 

But last week the Health Secretary Sajid Javid appeared to push back the inoculation deadline until April amid warnings from NHS bosses that introducing a ‘no jab, no job’ policy now could leave hospitals understaffed at a crucial period.

Writing in the the Telegraph, Hancock, who was Health Secretary for three years, warned ministers against delaying compulsory vaccinations for the sector into the new year.

He said: “having looked at all the evidence, I am now convinced we must require vaccination for everyone who works not just in social care but the NHS, and get it in place as fast as possible… so as we prepare to a face a difficult winter, let’s use all the tools we have to save lives. 

Imagine the cancer patient, already battling another deadly disease, being cared for by a nurse. Who can put their hand on their heart and say they’d be happy to tell that patient their nurse could have the vaccine, but has chosen against all scientific and clinical advice to ignore it.”

Hancock said doctors and nurses had a “moral duty” to get the Covid vaccine to protect their patients.

A SAGE adviser said today it was a “general standard of hygiene” for anyone in a frontline role in contact with vulnerable patients to be double vaccinated against Covid. But they stopped short of calling for jabs to be made compulsory, saying this should only be done as a “last resort”. 

NHS England figures show only a small minority of NHS staff are still to get two doses of the vaccine, with more than nine in 10 doctors and nurses having already received both jabs. Health chiefs warned yesterday that hospitals are already at peak winter levels of bed occupancy despite it being early in the season. 

All care home workers will be required to have had two doses of the Covid vaccine from Thursday or lose their jobs, under a policy brought in while Hancock was Health Secretary. 

But the Government’s own figures suggest this will lead to some 40,000 care home workers losing their jobs in the already understaffed sector. This could lead to the closure of up to 500 homes, putting extra pressure on hospitals which will be unable to discharge patients well enough to be taken off the wards.

Worth reading in full.

Jonathan Van-Tam Declares That Too Many Think the Pandemic Is Over

Worried about rising case rates, Jonathan Van-Tam, the Deputy Chief Medical Officer, has told members of the public to receive their booster shots and wear masks, while also commenting that too many think that the pandemic is already over. The Mirror has more.

He warned the every day actions of Brits will be crucial in determining how bad the pandemic gets.

Britain has had among the worst infection rates in Europe over the past month, and few restrictions to stop the spread of Covid.

So far the Government has resisted calls to launch its ‘Plan B’, which would see a return to home working and mandatory face mask wearing.

“The rates are still very high at the moment”, Professor Van-Tam told BBC Breakfast and BBC Radio 5 Live.

“They are higher than in most of Europe. And we are running quite hot – I think that’s the right expression.

“And, of course, it’s of concern to scientists that we are running this hot this early in the autumn season.

“And so, from that perspective, I’m afraid it’s caution, followed by caution, and we need to watch these data very carefully indeed over the next days and weeks.”

He added: “Too many people believe that this pandemic is now over. I personally feel there are some hard months to come in the winter and it is not over.

“The caution that people take or don’t take in terms of interacting with each other: that is going to be a big determinant in what happens between now and the darkest months of the winter”.

Despite a recent 10% dip in weekly cases, the UK remains at the top of the European charts when it comes to daily Covid infections.

Worth reading in full.

Mandatory Vaccination For NHS Workers Would Lead to A Winter Staffing Crisis, Warns NHS Providers Chief

Chris Hopson, the Chief Executive of NHS Providers has sent a warning that the NHS could suffer severe staff shortages this winter if mandatory vaccination for NHS staff comes into effect. Approximately 10% of all NHS workers haven’t received two doses of a Covid vaccine, which encompasses roughly 120,000 members of staff, with Hopson saying that any vaccine mandate should be delayed until April to avoid any serious problems over the next few months. The Telegraph has the story.

Latest NHS figures show that 90% of staff have been double-jabbed. However, about 120,000 workers are not – and at some trusts, including major hospitals in London and Birmingham, uptake is as low as 80%.

Barts Health NHS Trust, Birmingham and Solihull Mental Health Foundation Trust, North Middlesex University Hospital NHS Trust, Barnet, Enfield and Haringey Mental Health NHS Trust and Sandwell and West Birmingham Hospitals NHS Trust all have an uptake of 80% or less, according to NHS figures for the week ending October 14th. 

Sajid Javid, the Health Secretary, last week said he is “leaning towards” making jabs compulsory for frontline health workers.

But on Monday Chris Hopson, Chief Executive of NHS Providers, which represents hospitals, said that if the Government was to press ahead, it should delay until April to ensure the NHS can get through the “very, very difficult winter”…

Hopson said around two thirds of NHS leaders backed mandatory jabs, but one third objected. 

He told BBC Breakfast: “If we lose very large numbers of unvaccinated staff, particularly over the winter period, then that also constitutes a risk to patient safety and quality of care.

“We know – and the Chief Medical Officer has said this really clearly – that we’ve got a very, very difficult winter coming up and we know the NHS is going to be absolutely at full stretch.

“So it makes sense to set the deadline once that winter period has passed”.

Worth reading in full.

As the Autumn Covid Surge Declines, is SAGE Right to Predict No Winter Epidemic?

As reported daily infections fall once again, giving a temporary reprieve from calls for social restrictions to be re-imposed, the new ONS Infection Survey data published today shows record levels of prevalence in the country in the two weeks ending October 22nd.

One in 50 people in England or 2% of the population are estimated to have had coronavirus during that fortnight. In Wales it was around 2.5% or one in 40.

Importantly, this recent epidemic is almost exclusively in children, especially those aged 11-16, and to a lesser extent in their parents (aged 35-49). Prevalence in primary school children rose to around 4.1% by October 22nd while in secondary school children it was 9.1% or one in 11.

Since then reported infections in children have begun to fall, leading some experts to declare that, with an estimated 75% of the cohort now having been infected, “England has seen the peak of cases in children“.

Modelling for the Government is now predicting a persisting slump in infections going into the winter, with some estimates envisaging as few as 5,000 daily reported infections by Christmas.

This puts me in the unexpected position of being more pessimistic than SAGE, as I would be frankly amazed if there was no winter surge in Covid infections. We’ve seen before how SAGE models seem not to take sufficient account of seasonality, and this may be another example of that.

SAGE Modelling Predicts That Covid Cases Will Slump Even Without ‘Plan B’

Recent SAGE modelling has predicted that the rate of Covid infections will soon fall, even without the imposition of new restrictions, such as ‘Plan B’ measures which include vaccine passports and mandatory mask wearing. The booster vaccine roll out and an increase in natural immunity within children have been given as reasons for this decline in the number of Covid cases, with the modelling calculated at a time when the Covid case rate is already beginning to flatline. The MailOnline has the story.

While the figures are only based on a few days’ data, they are in line with some of the more optimistic projections from No10′ [sic] scientific advisory panel SAGE.

Modelling by the London School of Hygiene and Tropical Medicine for SAGE had cases dropping from next month without any additional restrictions, to as low as 5,000 per day through winter.

Scientists said that a combination of booster vaccines, growing natural immunity in children and a reduction in classroom mixing during the October half-term break would drag cases down. 

SAGE has previously been criticised for overegging the scale of the country’s outbreak, but Dr. Simon Clarke, from the University of Reading, said it looked like this time they “had a high chance of being right.”

But the Microbiologist told MailOnline: “Just as people criticised the shortcomings of pessimistic models we have to apply the same scepticism to such optimistic ones. But the team at LSHTM are very good at what they do.”

Professor Paul Hunter, an Epidemiologist at the University of East Anglia, said he “trusted” the LSHTM model, adding: “Over the next few weeks, we should start seeing a substantial fall in cases followed by hospitalisations.”

But not all scientists advising the Government agree, with many on SAGE publicly lobbying for masks, working from home and vaccine passports to safeguard against rising cases in winter. 

Downing St. was forced to defend its decision not to revert to ‘Plan B’ today after leaked Government documents showed the contingency plans could cost the economy £18billion this winter. The estimate for the damage from reverting to working from home and face masks was produced by the Treasury and Cabinet Office.

A separate paper from the Culture Department has raised concerns vaccine passports could be ‘counter-productive’ and drive people to poorly ventilated pubs.

Worth reading in full.