Gosh, deciding what to blog about this week has been hard; ECIC has given me a whole list! I don’t know about you but I’m starting to feel a little overwhelmed with the amount of Covid-19 we are seeing in the UK. I thought it would help me to just sit back and try and take stock of where we are up to and what it all means… maybe it will help you too…. I’ll tackle ECIC’s list another time…
The new variant
So, many countries are calling this the “UK variant”, and it is often the way that a new pathogen is named after the place it was first detected. Remember back in January when we were calling SARS CoV2 the “Wuhan Virus”? At the moment there isn’t any hard evidence to suggest that the UK variant definitely did originate in the UK but it is possible. What we can say is that the UK has probably the best systems in the World in place to spot this type of problem and identify the cause, especially in terms of genomic analysis. Often those that look for things find things, those that don’t say they haven’t got it!
Having warned the rest of the World that this new variant existed, and having everyone shut their doors to us, it turns out that so far 45 other countries already have this new variant. In the US there have been cases in Colorado in people who have not travelled outside of Colorado and who have no contact with any known cases, as well as other cases, all unrelated, in the states of California, Florida, Pennsylvania, New York and Georgia.
So, many countries are calling this the “UK variant”, and it is often the way that a new pathogen is named after the place it was first detected. Remember back in January when we were calling SARS CoV2 the “Wuhan Virus”? At the moment there isn’t any hard evidence to suggest that the UK variant definitely did originate in the UK but it is possible. What we can say is that the UK has probably the best systems in the World in place to spot this type of problem and identify the cause, especially in terms of genomic analysis. Often those that look for things find things, those that don’t say they haven’t got it!
Having warned the rest of the World that this new variant existed, and having everyone shut their doors to us, it turns out that so far 45 other countries already have this new variant. In the US there have been cases in Colorado in people who have not travelled outside of Colorado and who have no contact with any known cases, as well as other cases, all unrelated, in the states of California, Florida, Pennsylvania, New York and Georgia.
Click for larger image
After further work in the UK it appears the new variant was already circulating back in September, but it didn’t take off until December. This new variant is meant to be “more transmissible” but as there is little evidence for these claims I feel there are also other less “great sound bite” factors in play e.g. lack of cooperation with restrictions or environmental factors.
I suspect the spread of the new variant probably has more to do with “non-genetic” factors such as it originally arising or being introduced into a population that had inadequate restrictions in place to prevent spread. I think if we hadn’t responded so effectively in the first wave, we might have seen the same potential for “exponential transmission”, but in the first wave we got the R0 down, everyone then was talking about R0. If you remember the “second wave” coincided with the discovery of the “new variant” which started in the South East which was in Tier 2… and from my experience when we were in Tier 2 the local restrictions were not really being applied, in fact there wasn’t actually much “restricting” at all; the local area was as busy as normal! On top of that we came into winter when viruses transmit more effectively due to indoor crowding and decreased humidity facilitating greater droplet transmission. Think back to the summer when all the experts where saying they were worried about going from autumn into winter… they were right, everything did go wrong, it’s no surprise really!
So, case numbers have exploded and we’re now back in a National lockdown.
National lockdown and social restrictions
The Government have been talking about having to possibly impose even tighter restrictions on the UK population to get the massive surge of Covid-19 cases under control. It’s hard to see how much tighter they can be? Stay at home, schools closed to all bar essential worker’s children and only essential shops to open! But IS this really what is happening? Do we need tighter restrictions or is better compliance required?
I live on a road that should be pretty quiet, it doesn’t really go anywhere except to some open moorlands and woods (lovely I know!) and yet it is just as busy as before anyone had even heard of a coronavirus. There are lots of images from over the weekend of people mixing in parks, playing team sports and generally ignoring the current lockdown rules to “stay at home”.
Let’s turn this around and think of this a bit like herd immunity… stick with me! Herd immunity suggests that if enough of a population is immune to a disease then the disease cannot circulate; in the case of a lockdown if enough people stay at home they are not circulating and it therefore stops the virus circulating. If enough of the population do this, then the virus can’t spread from one family or individual to another, providing protection or “herd protection”. We can’t have the situation where everyone stays at home because “keyworkers” have to work (they are key after all), however if enough of the rest of the population do stay at home (and I mean in the home) then viral transmission will be interrupted, and case numbers will go down.
At the moment we just don’t have enough people following the stay at home rule and so case numbers are likely to continue to rise.
I wonder if this may be because of the over emphasis of the “good news story” vaccine message delivered in December by the Government and media channels. Just look at the holiday booking bonanza announced today, holiday bookings soar from the over 50s… “I’ve had my vaccine, now where’s my passport”, come on guys… really… your priority is a week in Spain!? Those working in the NHS would just like to be able to TAKE any of their annual leave!!! ALL our annual leave is cancelled; we can’t even have a week off to stay at home!!!
The vaccines
Whilst I do agree that a successful vaccine is the way out of this Covid-19 mess I do wonder if putting such a positive spin on the story back in December has led to a high degree of complacency in the population. I regularly overhear conversations which go along the lines of “I’m not worried about Covid-19 anymore because we have a vaccine now”. NOOOOOOOOOO…….!
Eventually we will have enough people vaccinated to limit the spread of Covid-19 BUT we are nowhere near that level yet. According to the Government nearly 1.5 million people have been vaccinated in the UK, that’s only about 2% of the population. You only have to look at the daily figures for new cases to realise that this has made ABSOLUTELY NO DIFFERENCE to the rate of transmission of SARS CoV2 yet. Remember a previous blog saying that to get immunity you need around 90% of the population vaccinated, that means 60 million people in the UK need to be vaccinated!
So, yes we have vaccines, and yes they are being given to people, but nowhere near enough to prevent transmission of SARS CoV2 and nowhere near enough to prevent anyone getting infected. The answer to preventing transmission (whether it is highly transmissible or just transmissible) is to comply with infection control precautions and stay away from other people. I heard a great quote that “the most effective thing to stop transmission is your front door”; basically STAY AT HOME. The other message we hear a lot of is “otherwise the NHS will be overwhelmed”… NEWS FLASH “the NHS is already overwhelmed” but we are not allowed to say this officially because it would cause pandemonium and there would be no toilet rolls on the shelves again! Just look at the USA, they are now triaging patients for “access into A&E” and who they’ll save the oxygen for! This is happening, this is real.
Hospital occupancy
The NHS is taking a hammering from Covid-19! Case numbers are a lot more than during the earlier peak in April 2020. The graph shows cases in hospital up until 4th January (the latest figures on the Department of Health website) when they were lower than they are now… now we have 50% more hospitalised patients with Covid-19 than in April 2020.
I suspect the spread of the new variant probably has more to do with “non-genetic” factors such as it originally arising or being introduced into a population that had inadequate restrictions in place to prevent spread. I think if we hadn’t responded so effectively in the first wave, we might have seen the same potential for “exponential transmission”, but in the first wave we got the R0 down, everyone then was talking about R0. If you remember the “second wave” coincided with the discovery of the “new variant” which started in the South East which was in Tier 2… and from my experience when we were in Tier 2 the local restrictions were not really being applied, in fact there wasn’t actually much “restricting” at all; the local area was as busy as normal! On top of that we came into winter when viruses transmit more effectively due to indoor crowding and decreased humidity facilitating greater droplet transmission. Think back to the summer when all the experts where saying they were worried about going from autumn into winter… they were right, everything did go wrong, it’s no surprise really!
So, case numbers have exploded and we’re now back in a National lockdown.
National lockdown and social restrictions
The Government have been talking about having to possibly impose even tighter restrictions on the UK population to get the massive surge of Covid-19 cases under control. It’s hard to see how much tighter they can be? Stay at home, schools closed to all bar essential worker’s children and only essential shops to open! But IS this really what is happening? Do we need tighter restrictions or is better compliance required?
I live on a road that should be pretty quiet, it doesn’t really go anywhere except to some open moorlands and woods (lovely I know!) and yet it is just as busy as before anyone had even heard of a coronavirus. There are lots of images from over the weekend of people mixing in parks, playing team sports and generally ignoring the current lockdown rules to “stay at home”.
Let’s turn this around and think of this a bit like herd immunity… stick with me! Herd immunity suggests that if enough of a population is immune to a disease then the disease cannot circulate; in the case of a lockdown if enough people stay at home they are not circulating and it therefore stops the virus circulating. If enough of the population do this, then the virus can’t spread from one family or individual to another, providing protection or “herd protection”. We can’t have the situation where everyone stays at home because “keyworkers” have to work (they are key after all), however if enough of the rest of the population do stay at home (and I mean in the home) then viral transmission will be interrupted, and case numbers will go down.
At the moment we just don’t have enough people following the stay at home rule and so case numbers are likely to continue to rise.
I wonder if this may be because of the over emphasis of the “good news story” vaccine message delivered in December by the Government and media channels. Just look at the holiday booking bonanza announced today, holiday bookings soar from the over 50s… “I’ve had my vaccine, now where’s my passport”, come on guys… really… your priority is a week in Spain!? Those working in the NHS would just like to be able to TAKE any of their annual leave!!! ALL our annual leave is cancelled; we can’t even have a week off to stay at home!!!
The vaccines
Whilst I do agree that a successful vaccine is the way out of this Covid-19 mess I do wonder if putting such a positive spin on the story back in December has led to a high degree of complacency in the population. I regularly overhear conversations which go along the lines of “I’m not worried about Covid-19 anymore because we have a vaccine now”. NOOOOOOOOOO…….!
Eventually we will have enough people vaccinated to limit the spread of Covid-19 BUT we are nowhere near that level yet. According to the Government nearly 1.5 million people have been vaccinated in the UK, that’s only about 2% of the population. You only have to look at the daily figures for new cases to realise that this has made ABSOLUTELY NO DIFFERENCE to the rate of transmission of SARS CoV2 yet. Remember a previous blog saying that to get immunity you need around 90% of the population vaccinated, that means 60 million people in the UK need to be vaccinated!
So, yes we have vaccines, and yes they are being given to people, but nowhere near enough to prevent transmission of SARS CoV2 and nowhere near enough to prevent anyone getting infected. The answer to preventing transmission (whether it is highly transmissible or just transmissible) is to comply with infection control precautions and stay away from other people. I heard a great quote that “the most effective thing to stop transmission is your front door”; basically STAY AT HOME. The other message we hear a lot of is “otherwise the NHS will be overwhelmed”… NEWS FLASH “the NHS is already overwhelmed” but we are not allowed to say this officially because it would cause pandemonium and there would be no toilet rolls on the shelves again! Just look at the USA, they are now triaging patients for “access into A&E” and who they’ll save the oxygen for! This is happening, this is real.
Hospital occupancy
The NHS is taking a hammering from Covid-19! Case numbers are a lot more than during the earlier peak in April 2020. The graph shows cases in hospital up until 4th January (the latest figures on the Department of Health website) when they were lower than they are now… now we have 50% more hospitalised patients with Covid-19 than in April 2020.
Click for larger image
It’s not just overall numbers that are the problem. Staff are tired… REALLY tired. Not just physically but mentally as well. Normally people come into hospital and we make them better, sometimes that doesn’t happen but in general we “win”, they come in sick, we look after them and get to know them and then they go home better and we get a box of chocolates (if we are lucky) that gives everyone a feel good factor for the job. Consider now, they come in sick, we look after them and get to know them and then they get worse, and we see their fright and pain, some don’t make it! There is very little “feel good factor” especially as their bed is quickly filled with the same scenario. I do wonder how many of us are going to burnout as a result of the Covid-19 pandemic; I think it will be a lot. There was a study published just recently that found “45% met the threshold for probable clinical significance on at least one of the following measures: severe depression (6%), PTSD (40%), severe anxiety (11%) or problem drinking (7%), and 13% reported frequent thoughts of being better off dead, or of hurting themselves in the past 2 weeks”. Yet in the same study over half (59%) reported “good well-being”, so surely we are actually just “deceiving” ourselves? Almost half of ITU staff are struggling to cope mentally and physically. I suspect many are holding on whilst the pandemic lasts so they don’t let their friends and colleagues down, but when cases start to drop how many will say “enough is enough”?
Whilst it’s hard to say it, I do wonder how many NHS staff feel let down when they see the pictures of people flaunting the lockdown rules whilst they’re working to the limit trying to treat people in hospital? How many in the NHS feel frustrated at yet more restrictions or cancellations of annual leave, bank holidays, and days off, when they see groups of people mixing and enjoying the nice weather in various parks around the country? OK, I’ll say it, I DO; I resent those people’s behaviour!
Oh, stop being so negative, we can now treat Covid-19
Well, in fact we still don’t have any particularly good treatments for Covid-19. The only things that really make much of a difference are steroids and possibly Tocilizumab, and then only in those with the severe inflammatory response and who are otherwise fit enough to survive long enough for the medicine to work. Many frail, and some not-so-frail, patients are still dying from this infection even with these “treatments”; there are about 700 Covid-19 related deaths a day in the UK at the moment (that’s the bed count of a large District General Hospital every day!) This is a bit less than during April, but it is still a lot and worrying when you consider the virus “killed off” many of the most vulnerable in the first wave, these deaths are those that might be considered “less vulnerable”. So we have some treatments but they’re not that good; we have a better option it’s called “prevention” and that is still better than cure.
So, we’re in a bit of a mess really. Covid-19 is causing havoc within the population and the NHS and there is so far no evidence that things are getting better. We have to start “flattening the curve” again and in my mind the only way this will happen is if people start to respect this infection again and start complying with the restrictions that prevent its spread.
And if all that fails, the NHS will have to rely on giving the “gift” of a cuppa coffee to a struggling colleague and eating chocolates; these seem the only sure way to hold up our struggling optimism… now where is my bag of Minstrels?
Whilst it’s hard to say it, I do wonder how many NHS staff feel let down when they see the pictures of people flaunting the lockdown rules whilst they’re working to the limit trying to treat people in hospital? How many in the NHS feel frustrated at yet more restrictions or cancellations of annual leave, bank holidays, and days off, when they see groups of people mixing and enjoying the nice weather in various parks around the country? OK, I’ll say it, I DO; I resent those people’s behaviour!
Oh, stop being so negative, we can now treat Covid-19
Well, in fact we still don’t have any particularly good treatments for Covid-19. The only things that really make much of a difference are steroids and possibly Tocilizumab, and then only in those with the severe inflammatory response and who are otherwise fit enough to survive long enough for the medicine to work. Many frail, and some not-so-frail, patients are still dying from this infection even with these “treatments”; there are about 700 Covid-19 related deaths a day in the UK at the moment (that’s the bed count of a large District General Hospital every day!) This is a bit less than during April, but it is still a lot and worrying when you consider the virus “killed off” many of the most vulnerable in the first wave, these deaths are those that might be considered “less vulnerable”. So we have some treatments but they’re not that good; we have a better option it’s called “prevention” and that is still better than cure.
So, we’re in a bit of a mess really. Covid-19 is causing havoc within the population and the NHS and there is so far no evidence that things are getting better. We have to start “flattening the curve” again and in my mind the only way this will happen is if people start to respect this infection again and start complying with the restrictions that prevent its spread.
And if all that fails, the NHS will have to rely on giving the “gift” of a cuppa coffee to a struggling colleague and eating chocolates; these seem the only sure way to hold up our struggling optimism… now where is my bag of Minstrels?
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