Thursday, September 23

The evidence is clear: there was no excuse for Hancock’s nursing home strategy | William Hanage


TThe UK has suffered some of the worst consequences of the pandemic among developed nations, both in terms of deaths and economic disruption. But instead of learning from its mistakes, all the evidence suggests that the British government is trying to rewrite history as the pandemic continues.

When Health Secretary Matt Hancock appeared in front of MPs last week to answer questions about the government’s early handling of the virus, part of the questioning focused on the devastation the virus had been allowed to cause in nursing homes between residents and staff.

While it is really difficult to pick the worst failure of the UK pandemic response, this has to be a contender. The numbers have not yet been fully cataloged and may never be fully known, because the evidence was so sparse at the beginning of the pandemic, but the Office for National Statistics estimates 42,000 Nursing home residents in England and Wales have died from Covid. This result was completely predictable in the absence of significant infection control.

Nursing homes are an example of what epidemiologists call a “congregated setting.” They are places where people meet in small groups, making many contacts and with little capacity for distancing, guaranteeing the virus a captive audience. Other examples include prisons and cruise ships.

We care a lot about Respiratory viruses in residences, because they are lethal. During the early days of the pandemic in China, scientists indicated that older people were especially vulnerable to the virus. As a result of these two events, well known in January and February 2020, nursing homes were a disaster waiting to happen. However, until mid-April last year, UK hospitals were discharging patients from nursing homes without needing to be tested for Covid first, giving God knows how many introductions, outbreaks and deaths.

Hancock has claimed that only 1.6% of nursing home outbreaks were planted in hospitals, citing research from Public Health England (PHE). But the research in question is biased by the fact that tests are needed to detect an outbreak, and evidence was in short supply during the most severe period of the spring 2020 surge. You can’t find something if you don’t look for it. No one claims that all of the outbreaks occurred via this route, but it was a known way that the virus could reach vulnerable populations and no steps were taken to stop it. In fact, the same PHE research states that “most of these outbreaks in potentially hospital-seeded nursing homes were identified between March and mid-April 2020, and none identified from late July to September, where some recent cases have emerged,” which suggests that once testing was finally mandatory for discharge from hospitals to nursing homes in mid-April, it was helpful in preventing outbreaks.

Before mid-April, testing was also limited to people with symptoms, which was disastrous given the potential for inadvertent transmission from currently asymptomatic people. Hancock claimed that asymptomatic transmission was not appreciated at the time decisions were being made, but that is nonsense. The minutes of the Sage meeting held on January 28 focus on the issue, rightly so because this was one of the most important questions that would have determined what was needed to control the outbreak. The record states: “There is limited evidence of asymptomatic transmission, but early indications imply something is happening. “Did Hancock read this? If so, why didn’t he acknowledge that the consequences for the most vulnerable in his care would be catastrophic?

As it happens, a more reasonable explanation for the download policy is offered, but if anything, it’s even less reflected in early virus handling. The recent experience of the pandemic in north of Italy had made it clear that a serious increase in infections was heading towards the NHS, and planning for that meant that beds needed to be freed up. This surge was the consequence of delaying the close until after a big wave had become unavoidable. Hancock claims that having taken action earlier would have meant “invalidate scientific consensus“Which Stephen Reicher, a member of the independent Scientific Pandemic Insights Group on Behaviors (SPI-B), described as” just plain untrue. “

When it comes to consensus, I can’t claim to know the minds of all the experts at the time, but I do know that I was a long way from being alone during February and March 2020 in my great concern for the UK, which was increasing. With each passing day of inaction. As revealed in text messages between the prime minister and Dominic Cummings, the former adviser in March warned of the seriousness of the situation facing nursing homes and drew attention to the delay in implementing the tests.

Taken together, this collection of excuses unwittingly reveals the mindset that led to the abysmal UK pandemic response throughout 2020. Whenever scientists got the message “We don’t know exactly how bad it is, but it could well be really bad and you must act accordingly, “the political response was,” So you mean it might not be so bad, “and avoid making difficult decisions. Uncertainty is not a reason for inaction, and unpleasant realities cannot be subordinated to hopeful fantasies. when it comes to a pandemic.

Among those realities is the Delta variant, which just delayed England’s promised reopening on June 21. Even with the successful launch of the vaccine, in which the UK has excelled, the reopening was always expected to lead to more cases, more hospitalizations and more deaths. The question is how much vaccination mitigates those worst results, and if you are comfortable with that price, because people will still get sick and die, only fewer. Brilliant and urgent work by PHE scientists has shown that the Delta variant is more transmissible, with some limited ability to evade vaccination, and is more dangerous. The most recent reports suggest that infection with Delta is about twice as likely to land you in the hospital, especially if you are not vaccinated.

Setting a deadline for the end of a pandemic in advance is the very definition of offering an unnecessary hostage to fortune. I am hopeful that vaccination will limit the damage resulting from Delta in the UK, even as I am desperately anxious for those parts of the world that are not fortunate enough to have easy access to vaccines.

Epidemiologists will be the first to admit that managing a pandemic is extremely difficult. But the UK has not just made a few mistakes here and there: there has been a persistent and pathological pattern, exemplified by Hancock, of serious mistakes from which nothing is learned and which are soon repeated. As a result, the country is waking up to another false dawn. About 130,000 have already lost their lives so far. They deserved better. The country too.




www.theguardian.com

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