Cowper's Cut 198: 2022's testing times, as infections and acute admissions rise
“I don't think hospitalisations will rise”.
Conservative MP Andrew Bridgen, on Sky News
Happy New Year to all 'Cowper's Cut' readers: may 2022 be good to you and yours.
Mathematics is beautifully apolitical.
As such, it is immune to motivated reasoning and student union debating society rhetoric alike. It gives a total of zero fucks about the associated hot takes, culture wars or rhetorical-theological clever-cleverness.
This means that it is the worst nightmare of clown-show PM Boris Johnson, who used his New Year’s message to claim, “we’ve met the target to offer the chance to get a COVID-19 booster to every eligible adult”.
Ahem.
‘Offer the chance to’ is the inoperative phrase here. (BBC Newsnight’s economics editor Ben Chu’s thread on the original promise and what’s been actually delivered is a good read.)
The booster rollout has been pretty impressive, and will hopefully keep more people safe from serious illness or death, but an offer is not a jab.
More pertinently, there’s been a worrying lack of curiosity throughout both Government and health and care system leadership about the reasons why the vaccination programme went so badly off the boil last summer.
The need for boosters was clear well before we found out about Omicron in late November, but the UK vaccination programme was lacking the key sense of urgency in both public and professional spheres for several months before that.
So – back to mathematics. The Government has taken the decision to err on the side of minimalism regarding restrictions. The UK's exponential growth in Covid19 infections has, thus far, been mercifully unmatched by the need for the sharply rising number of people hospitalised to need to be mechanically ventilated.
But the mathematics of this exponential growth in infections have hit the workforce hard: the Sunday Times’ Shaun Lintern and Gabriel Pogrund note that almost 10% of the workforce were off sick on New Year’s Eve. Of those 110,000, nearly half – 50,000 – were absent due to Covid19.
Lintern and Pogrund report that “in London, the centre of the Omicron surge, Covid absences account for 51 per cent of the total: 7,255 staff, including 3,340 nurses and 622 doctors. In the Midlands regions, 43 per cent of staff were off sick because of Covid, including 3,639 nurses and 419 doctors”.
Where rhetoric goes to die
The PM also claimed that “our position this December the 31st is incomparably better than last year”.
Mmmmmm. If not mmmmmmmm. Comparing this year-end to 2020’s year-end is definitive proof that it is not “incomparably” anything.
The People's PM also bullshitted that “we’ve secured the fastest vaccine rollout anywhere in Europe last year by avoiding sluggish EU processes”. As he ought to know, health is a shared competence within the EU, and the lie is given since all of the Vaccines Taskforce’s crucial procurement work took place while the UK was still in the EU.
Mathematics (again)
More mathematics can be found from Professor Adam Oliver; the latest report on Coivd19 in critical care from the Intensive Care National Audit and Research Centre; data analyst and modeller James Ward; the latest modelling from Warwick University (yet to be peer-reviewed); the Covid Actuaries Response Group; data modeller Colin Angus; HSJ’s Alastair McLellan and Dave West on hospitalisation numbers; the latest ONS data showing that 1 in 25 people in England had Covid19; NHS England hospital activity data.
Some of this data will, of course, have lags and imperfections due to Christmas and New Year holidays.
But all of it points to ongoing rises in Covid 19 infections.
Which might possibly be manageable, as London intensive care consultant Rupert Pearse’s NYE sitrep update suggests, but …
Not so much Test And Trace, more ‘trace a test’
The pre-Christmas public announcements from ministers (prime and sub-prime) focused on individual caution and regular testing, before a late segue into mentions of ventilation and meeting outdoors wherever possible.
The slight problem that arose here was about the lack of availability of testing.
With £37 billion budgeted to be spent on Test And Trace, you’d really think they’d sorted this one, wouldn't you?
And you'd be wrong.
Indeed, SOS Sajid Javid talked about having to “constrain” the system of supply over the coming fortnight, which includes the period of the return of schools. And thanks to the splendid Nick Timmins (via the Institute For Government), we remember what happened with schools transmission a year ago.
Data expert Ankur Banerjee explained the causes of UK’s parlous testing availability situation in this enlightening Twitter thread. The key issue is that “all of the distribution is being handled by a single company which will be closed for 7-8+ days around Christmas and New Years' Eve, and therefore shortages will persist … overall, there's only approx. 1.25mn Covid LFD test packs that will even be processed at the distributor. (There are ~27.8mn households in the UK.)
”Given that the Govt/NHS should have known back in the beginning of December that their distributor was planning to close down for a significant portion of the holidays when there would be high demand, it's pretty shambolic that they didn't have backup distribution plans in place”.
Ooops.
Big, big ooops.
And what’s worse, highly predictable ooops.
Banurjee also picks up on why pharmacies (a principal pillar of test distribution) have only been able to order one carton of tests per day. It’s a reason, sure: just not a good one. UK pharmacies called the situation ‘a huge problem’.
Then there was the UK Health Security Agency’s confused communications over the correct self-isolation period if infected. Nor did that help much.
January infections in the post; The Saj in the Mail
As the January infections are well and truly in the Christmas post, where’s Secretary Of State For Health But Social Care Sajid ‘The Saj’ Javid when you need him?
In the Mail, of course, where The Saj announces that "over Christmas, we saw how regular tests can give us the confidence to see loved ones and live our lives".
Ahem.
Not if we couldn't, you know, actually get tests.
More entertainment was on its way, as The Saj boasted that “we’re boosting bed capacity too, including through new Nightingale surge hubs within hospital grounds”. (Yes, ‘surge hubs’ does sound better than ‘tents in car parks’, doesn't it?)
If ostentatious handwashing has been the hygiene theatre of Covid19 (what with the limited evidence of fomite spread), then Nightingales (be they maxi- or mini-) have been its pandemic pantomime.
Mr Shit, may I introduce Miss Fan?
It is all starting to kick off, as spotted by Shaun Lintern. He tweets that United Lincolnshire Hospitals Trust has declared a 'critical incident' over "extreme and unprecedented" staff shortages. ULHT says it is "unable to maintain safe staffing levels", leading to "compromised care" across its sites.
ULHT might be the first NHS organisation of 2022 to declare this state of emergency, but it seems unlikely that they will be the last.
The small matter of a workforce crisis
Interviewed for Politico’s end-of-year London Playbook, Health Select Committee chair Jeremy Hunt predicted that NHS workforce issues will get “increasingly severe” next year, causing unprecedented stress on hospitals and GP surgeries, with “extremely concerning implications for care quality and safety in 2022”.
The Alan comeback
When Mark Borkowski is picking up the embers of your comeback as some kind of lesson about something, as he has done for The People’s Partridge, it’s clearly all going terribly well.
The renaissance of the political coldsore that is Hancockmania will doubtless be virally undampened by the revelation that both Alan and his advisor/lover Gina Coladangelo were at the famous Downing Street cheese-and-wine-meeting garden party. A-ha!
Cronyvirus and coronamillions update
This week, the former newspaper and Boris Johnson fanzine the Telegraph made itself look even more ridiculous than usual with this bizarre piece claiming that Government-promised UK testing contracts for rapid diagnostics were scuppered for reasons unknown, but implied to be the legal actions of the Good Law Project.
This article looks like total bullshit. It is far more likely that those tests didn't actually work. There are valid criticisms of Test And Trace, but they did tend to ensure that the diagnostic tests they bought really worked.
It is, moreover, somewhere way beyond implausible that our nationalist-populist Government would have failed to award contracts to British manufacturers if that had been at all possible. I mean, thanks to the Good Law Project, we know that they specified that Alan’s pub landlord Alex Bourne got a contract (despite Alan’s atrocious attempts to deny this).
As Good Law Project boss Jolyon Maugham QC tweeted, “The Telegraph says Government scrapped plans for UK made LFTs in early 2021 and blames Good Law Project for the national shortage. But Government's press release says they were buying UK made LFTs from Surescreen in Sept 2021! And that Surescreen were the first to get accredited!”
If they want to set up effective 'hit' jobs on the Good Law Project, the Government will need to put in a little more effort than this. They’re certainly not willing to put in the effort to release everybody’s favourite noble Baroness Dido Harding of Winscombe’s diary of meetings with potential Test And Trace suppliers during her tenure of that organisation, as the Mirror revealed.
The Telegraph also gave us a smile this week with its ‘investigation’ of Deloitte’s role in Test And Trace. This piece is, to say the least, rigour-free.
Other important things
Would appear here.
Recommended and required reading
In some good news, UCLH has opened its proton beam therapy service, as the Sunday Times reports, bringing UK provision up to two sites.
The New Year’s Honours list features many names from the fight against the pandemic.
Anaesthetist and intensivist Dr Tim Cook’s thread on hospital-acquired Covid19 infections is likely to become a topical read. Likewise engineer Barry Hunt’s, offering an engineering perspective to infection prevention and control in healthcare. And equally, epidemiologist Deepti Gurdusani’s thread on the ludicrous charge of scientists and modellers being ‘pro-lockdown’.
Interesting BMJ Leader piece on NHS organisational rhetoric and its distance from reality.
Likewise, a fine piece in the Journal of Paramedic Practice on ‘Point-of-care testing by paramedics using a portable laboratory: an evaluation‘
The Mail has a piece on the new CHPI report about private providers who did rather well out of the furlough scheme.