Tag Archives: care home visits

How the pandemic tempts us into insults and sports metaphors

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Britain has approved the first Covid vaccine, thereby starting a robust exchange of insults with a random sampling of other countries, and in case that didn’t bring enough joy to the world, setting off another round of the sort of chaos that allows us to recognize Boris Johnson’s government even when we’re blindfolded in the woods on a moonless night. 

I look at each day’s news with a mixture of dread and glee.

The insult exchange

It started with Gavin Williamson, the education secretary, who you might think (being the education secretary and all) would know better but, hey, silly you.

Williamson went on the radio and said Britain was the first country to approve the vaccine because “we’ve got the very best people in this country and we’ve obviously got the best medical regulator, much better than the French have, much better than the Belgians have, much better than the Americans have.

“That doesn’t surprise me at all, because we’re a much better country than every single one of them.”

Several winces later, Conservative peer Michael Forsyth (his friends and family call him Lord Forsyth; you can call him Mikey) tweeted, “Frankly, [that’s]  just unseemly.” 

European Commission spokesperson Eric Mamer pointed vaguely in the direction of the high road and said, “This is not a football competition.”

 

Irrelevant photo: erigeron

Anthony Fauci, on the other hand,  ignored all of that, but he was critical of how quick Britain was to approve the vaccine, saying the UK hadn’t reviewed it “as carefully” as US health regulators.

The next day he backtracked, saying, “I have a great deal of confidence in what the UK does both scientifically and from a regulator standpoint” and on top of that, “I did not mean to imply any sloppiness.”

The difference in speed is because the US regulator often goes back to the raw test data while both UK and European Union regulators work from the reports the companies assemble. 

A few people have commented not that the slower approval process would be any safer but that people might have more confidence that it was safe. It could be a valid point, but where’s the fun in that?

 

The Brexit connection

Unable to see a flap going on and not jump into the middle of it, prominent Brexiteers in the government waded in and claimed that Brexit was the reason Britain had been able to approve the vaccine so quickly. 

“Prominent Brexiteers” describes pretty much the whole government, but this was only a couple of them, Matt Hancock and Jacob Rees-Mogg. Their quotes, sadly, are as boring as they’ve turned out to be inaccurate, so we’ll skip them, but you can follow the link if you want all the Ts dotted and the Is crossed.

The inaccuracy, though? EU law allows individual countries to distribute a vaccine in an emergency. They don’t have to wait for the European Medicines Agency to approve it. In fact, since Britain’s in a transition period until the end of the year, we’re still running on EU law and yes, that’s what we’ve done.

 

The chaos

Having approved the vaccine so quickly, we’re kind of like the kid who snatched the first potato out of the oven. Yes, he made sure he got the big one, and yes he gets to boast to everyone else about that, but he might’ve been smart to grab a potholder first. It would only have taken a few seconds.

In other words, as far as I can tell, from my vantage point on the couch, we’re having trouble figuring out what to do with the vaccine now that we have it. Because it all happened so fast and we haven’t exactly been (I know this’ll surprise you) planning for it. 

I seem to remember some loose talk, oh, maybe last week sometime, about frontline staff being a top priority for the vaccine, although I don’t remember hearing a definition of frontline staff. There was equally loose talk about NHS staff being at the top of the list. Whether those two were the same thing or not is anyone’s guess. 

During the first lockdown, we were all governmentally cranked up to respect the underpaid people who kept the buses and trains running, the stores stocked, the cash registers registering, the packages delivered, the food produced, and the cabs zipping around our towns. They put their lives on the line, we were reminded, and if they didn’t get the pay they deserve and need, they did at least get a bit of recognition.

Now that a vaccine’s imminent, are they still frontline staff? 

Well, um, it doesn’t look like it.

The government’s circulated (and the newspapers have duly published) a priority list with nine categories, starting with care home residents and the people who take care of them and working its way down to people over fifty. The list has some oddities, including putting frontline medical (and only medical) staff in the second category instead of the first and not bringing in the clinically vulnerable until the fourth category, where they keep company with the over-seventies. The Black and minority ethnic people (it’s a category in Britain, however vague it may seem to me as a foreigner) who are statistically at higher risk are mentioned nowhere. It also leaves out teachers and people who work in public transportation and food processing and retail the many other jobs that put people at risk. You know, all those people we appreciated so much the first time around and have now forgotten.

Then, after the list had been circulated, it somehow looked like care home residents and their carers might have to wait, because the vaccine has to be stored at the temperature of dry ice and you can’t just toss it in your back seat and drive it to the nearest care home. But hospital inpatients and outpatients who are over eighty might just skip to the top of the list because they’re easy to find. 

I have a picture of NHS staff running down hospital corridors vaccinating any random person who looks old enough. Whether they’ll find them again when it’s time for their booster shot is a whole different problem. But we have weeks  before we have to solve that one.

What we do know is that the first batch of the vaccine has arrived in the UK and that it will be distributed to hubs–places selected because they have the equipment to keep it cold enough. 

How many doses do we have? 

Um. Dunno. The business secretary, Alok Sharma, said that by next week, when vaccinations are supposed to start, the government’s “absolutely confident” that it will have 800,000 of them. 

I wasn’t worried until I saw that “absolutely confident.” 

Are they going to divide those 800,000 doses so they cover 400,000 people at two doses each? Or is the plan is to give one each to 800,000 people and trust that the second dose will be available when it’s needed? More doses are expected before the end of the year, but Sharma couldn’t say how many and NHS Providers said the UK would have to assume that more doses might not arrive “for some time.”

Sober-sounding voices on the radio advise us not to try to book a vaccination. The NHS will contact people to let them know their vaccination category is open and tell them how to register. But the NHS generally communicates with patients by letter. You know letters? Those paper things that appear in your mailbox or fall through a slot in your door? They take time to write, to print, to seal into envelopes, to move from wherever they started to wherever they’re going.

In theory, the vaccination program begins on Tuesday.

Independent of all this, I’ve read that it may be April before everyone in the nine at-risk categories is vaccinated. 

 

Mass testing

In the meantime, we have lots of twenty-minute Covid tests, which are also called lateral flow tests, in case it makes your life better to know that. They were supposed to be game changing, but the government’s announced so many game changers since the start of the pandemic that I’m not sure if I’m supposed to be running around with a tennis racket or a pool cue. 

The tests were rolled out on a mass scale in Liverpool, which has a high infection rate, and Dr. Angela Raffle, a consultant in public health and an honorary senior lecturer at the University of Bristol, said, “The infection rate in Liverpool has come down no quicker than in many other places that haven’t got mass testing and we haven’t yet seen a proper evaluation report from Liverpool.”

I read elsewhere else that mass testing alone isn’t a solution. You have to do something useful with the results if testing’s going to bring down the infection rate, and we seem to have missed that part of the plan. Possibly because it involves different sports equipment, which is stuck in the government’s Warehouse of Sports Metaphors. We filed forms that will let us get our hands on it long ago, but they’re still waiting for approval.

The NHS test and trace program, which is the key to doing something useful with the test results, usually hits the headlines because it misses some absurd percentage of people (4 out of 10 a month ago, which is–holy shit–almost half), but recently it improved its contact rate. 

How’d it do it? 

It changed the way it reports its data. I’d love to give you a link on that, but I heard that on the radio and I can’t find the right combination of words to coax the information out of Lord Google. But it was the BBC, and whatever complaints everyone from all sides has about, it isn’t known for making up its facts.

The rapid tests are also being used to allow relatives to visit people in care homes and do what I’m old enough to remember once seemed natural: hug them. But because the rapid tests miss some problematic percentage of infections, the BBC writes that “there has . . . been concern in some parts of the care home sector over the use of the tests, with homes in Greater Manchester reportedly urged not to use them to allow visits.” 

Some homes report not having received tests, in spite of a government announcement that everything was in place and reunions were possible. Others say they have the tests but not the training to use them

And there I have to leave you. A masked delivery driver is at the door and I hope he’s brought my sports metaphor delivery. 

He’s not on the list of priorities for a vaccination and he’s working on a zero-hours contract.

The problems with mass Covid testing

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Britain started a £100 billion Covid testing program, Operation Moonshot, which is supposed to catch asymptomatic cases so people can quarantine themselves instead of transmitting the disease and life can return to normal. The plan is to screen millions of asymptomatic people every week, and it’s being tried out in Liverpool as I type. 

Which sounds great, but Dr. Angela Raffle, a consultant to the UK national screening programmes, said, “It worries me that ministers . . . can wake up one morning saying let’s spend £100 billioin on this and not have it scrutinised–it would be like building a Channel tunnel without asking civil engineers to look at the plans. . . . This seemed to me to be the most unethical proposal for use of public funds or for screening that I’d ever seen.”

Other than that, though, it’s a good plan.

Irrelevant photo: apple blossoms–a photo I stole from last spring. 

The program relies on the Innova lateral flow test, which when it’s used by research nurses catches 76.8% of positive cases. When it’s used in the real world by what the article I read called “self-trained staff,” though, it picks up only 57% of positive cases. And Jon Deeks, professor of biostatistics, said people aren’t being told that they still might be carrying the disease, so if they test negative they feel safe to do–well, whatever they haven’t felt safe to do. Visit granny in the nursing home or tear off their masks and run through twelve supermarkets breathing heavily on staff and fellow shoppers. 

Nursing homes in three counties, including mine, are trying out rapid tests to allow visitors in. The publicity I’ve seen doesn’t mention the possibility of false negatives. It’s all how great it is that granny got a visitor. And up to a point it is great. I’m sure granny was pleased. I also hope it doesn’t end up killing her.

The good news is that the test doesn’t generate a lot of false positives. 

Italy was the first country to use mass testing–they used antigen tests–to control the virus, and it seemed to be working, which encouraged other countries to try it, including Britain. Italy’s now in its second wave of Covid. It went from  500 cases a day in August to more than 35,000.

So what went wrong?

Andrea Crisanti of the University of Padua says the tests were used the wrong way and that using them to protect vulnerable people in care homes was “absolutely criminal,” because of the infected people they miss–the false negatives.

The tests they used are 80% to 90% accurate and give both false negatives and false positives, but they’re quick and they’re cheap. If they’re used, say, before people catch a train, they could reduce travelers’ exposure. But they wouldn’t eliminate it because, again, they don’t catch every case.

Crisanti said, “If your objective is to screen a community to know if transmission is there, fine.” But the quick tests, he said, need to be backed up with the more accurate but slower PCR tests, along with stay-at-home orders.

There doesn’t seem to have been–or to be–any strategy for what to do with the information beyond simply boosting the number of tests.

In an article about how antigen tests were used in the US, the website ProPublica writes that “When health care workers in Nevada and Vermont reported false positives [from the tests], HHS [that’s Health and Human Services, a federal agency] defended the tests and threatened Nevada with unspecified sanctions until state officials agreed to continue using them in nursing homes. It took several more weeks for the U.S. Food and Drug Administration to issue an alert . . . that confirmed what Nevada had experienced: Antigen tests were prone to giving false positives.”

In nursing homes, false positives are as dangerous as false negatives. A person who tests positive will be moved in with other people who test positive. If the test gives out some false positives, healthy people will be exposed to Covid, making the test a self-fulfilling prophecy.

The tests HHS recommended are meant for people with Covid symptoms, and when they’re used that way they produce virtually no false positives and catch 84% to 97%  of positive samples in a lab test. But a study–like many Covid studies, it hasn’t been peer reviewed yet–found them catching only 32% of positives in people without symptoms.

Still, HHS is recommending them for use on nursing home residents without symptoms and suggesting repeated tests to reduce false negatives. An October survey found that a third of nursing homes hadn’t touched the antigen tests they’d been given. They didn’t trust them, they didn’t have the staff time, and the paperwork and reporting requirements were more than they wanted to deal with.

Dr. Rebecca Lee Smith, an epidemiology at the University of Illinois, said, “It’s how you use the tests, not just how many tests you have.” If you have a million tests, is it better to test a million people once, or test half a million people who are at high risk twice, or test essential workers five or 10 times? 

If anyone has an answer to that question, I haven’t seen it in print yet.

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Earlier this week I introduced the game Where’d the Money Go? and missed some of the more outrageous examples of where the money’s gone. I plead extenuating circumstances, because a National Audit Office report hadn’t hit the news yet. So let’s make up for my lapse. 

Sorry. I do try to sneak some good news into these posts. Some weeks, it’s like fighting gravity.

Early in the pandemic, in an effort to get protective gear for the health and social care systems, the government set up a high priority contracting channel for businesses that were recommended by ministers’ offices, lords, politicians, or officials. Oddly enough, those lords and politicians seem to all have ties to the ruling party, the Conservatives.

The rule of the playground is that we don’t share.

Their bids that went through that channel were ten times more likely to be successful than the bids that went through ordinary channels. One source said their pitches were automatically treated as credible. The documentation is–

Quick, someone, what’s a shoddier word than shoddy? Paperwork documenting why a particular supplier was chosen is sometimes missing. Contracts were sometimes drawn up after the work had been started. 

The person who recommended the company to the priority channel is documented less than half the time. No rules for how the priority channel should operate seem to have been written.

This was in the first six months of the pandemic, when £18 billion was spent on Covid-related contracts.

Liz David-Barrett, a professor of governance and integrity (that’s what she studies–I’m not commenting on her personal qualities), said that firms recommended in this way are usually treated as higher risk rather than lower.  

In a related story, although I can’t say what channel this contract went through, Gabriel Gonzales Andersson made £21 million for wandering through a deal between the UK government and an American jewellery designer, Michael Saiger, to procure protective gloves and gowns from China. 

According to the BBC, Gonzales Andersson was paid to find a manufacturer for deals that had already been arranged.

If you can figure out what happened between the two, you’re doing better than I am, but they’re both in court in Florida–suing each other, I think, although I can’t swear to that. Saiger had several follow-up contracts, and the gear he was supposed to supply was delayed, possibly because the relationship between the two men fell apart.

One more example before I stop: Lord Feldman, a former chair of the Conservative Party, and a managing director of the lobbying firm Tulchan Communications, acted as an unpaid advisor on Covid. 

Tulchan is also called a public relations firm; flip a coin if you care.

After the firm Oxford Nanopore signed a £28 million contract with the Department of Health, and also after Feldman stepped down as an unpaid advisor, Nanopore hired Tulchan. The health secretary, Matt Hancock, happens to have met with both Feldman and Oxford Nanopore before the contract was signed. I have no idea what they talked about. Movies, probably. Pornography. Gummi bears. Surely not whose money would end up in whose pockets. I wasn’t there. That’s how the gummi bears came into it. 

Tulchan says Oxford Nanopore was already in discussions with the Department of Health before the meetings, so everything’s fine.

Nanopore later picked up another £100 million in contracts.

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The British Medical Association has gone public with advice on how to lift the current lockdown. The approach last time was, “Wheeee, that’s over. Go out, have fun, spend money. Don’t work from home. The economy needs you.”

That was followed by a faint, “And, oh, do be careful, okay? Wash your hands or something.” 

Which is one of several reasons that we’re now in a second lockdown. 

What the BMA advises includes giving local public health teams more of the test and trace budget, along with more oversight of the program; limiting socializing to two households instead of six people; keeping the local tiered lockdown system that imposes varying restrictions depending on an area’s level of infection but banning travel between areas in different tiers; encouraging people to work from home if they can; and replacing guidance about how to keep workplaces and public areas safe with rules about how to keep workplaces etc. safe. The theory goes that rules are enforceable and might be taken more seriously.

Dr. Chaand Nagpaul, the BMA’s chair of council, said, “The big question in practical terms is can we reopen hospitality venues–pubs and restaurants–in the run-up to Christmas and still avoid infection levels increasing?

“I suspect we can’t, but the decision may be made to do so anyhow on the basis that any increase will be slow and may be able to be counteracted later.”

Because what the hell, it’s Christmas. What do a few extra deaths matter?

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If I haven’t managed to be funny this time–and I’m pretty sure I haven’t–I’ll try to do better next time. It’s not that this stuff isn’t funny, in a demented sort of way. But it takes time to find the humor and I want to get this posted before the next wave on insanity breaks over us. 

Stay well. It’s dangerous out there.