Richard North, 26/04/2020  

On 17 March, chief scientific adviser Vallance declared that less than 20,000 deaths in the UK from Covid-19 would be a "good outcome" in terms of "where we would hope to get to with this outbreak". But, with a further hospital 813 deaths reported yesterday, taking the UK reported total to 20,319, Vallance's "good outcome" will soon be a distant memory.

In fact, the 20K mark was passed some time ago – exactly when we will never know. But, as almost everyone must know by now, the published figure does not include deaths in care homes, hospices and in the community. And, on 17 April, one of the largest providers, Care England, suggested that care home fatalities had reached 7,500.

Even for care homes, that might be an under-estimate. In other parts of Europe, these institutions are estimated to account for half of all deaths from Covid-19. With other deaths in the community, outside the hospital system, that would put our total at over 40,000 already.

Given that the death rate in an epidemic usually follows a bell-shaped curve, and we may not even be at the halfway point, whatever we have now might be doubled before we are in the clear, and then only if cases don't take off once lockdown restrictions are lifted.

Elsewhere, we have the idiot savant, Delingpole, railing against the lockdown as always, but also hitting out at the Mail which, a week into April, was retailing the results of a study which indicated that the UK could be the worst coronavirus-hit nation in Europe with 66,000 deaths in the first wave of the epidemic.

And yet, with what we already know, we can surmise that over 60,000 deaths in the UK is a realistic proposition. And, at this stage, it would be unwise to presume that would be the full extent of an epidemic that could easily bounce back if lockdown restrictions are eased.

What makes this a distinct possibility is the way the epidemic has been handled so far, with hospitals having become reservoirs of infection, with staff becoming infected and freely circulating in the community, unwittingly reseeding the population and keeping the epidemic going. Add to that the way the hospitals have passed on infection to care homes, these too have become reservoirs with their staff members also reseeding the population.

As to how hospitals function in this way, it is pertinent to note that, in the 2008 edition of the Cabinet Office's National Risk Register, it was noted that, of the 2002-3 SARS outbreak, over 8,000 people had been affected, of whom over 750 had died. The majority of cases occurred among close family members associated with an initial case, and hospital workers who had cared for infected patients.

The vulnerability of hospital staff has thus been well established since we first encountered novel coronavirus respiratory infections and, if there was any doubt, one only has to see the detail of the structured measures that are required to protect hospital staff from infection.

Illustrated here is Cotugno Hospital in Italy, a specialist infectious diseases facility that now only treats Covid-19 patients, a facility designed for the purpose of dealing with infectious patients. The reporter here puts the hospital's success down to having the right kit but, in such operations, the design comes first. Only when that is right can the secondary, procedural measures hope to succeed.

In the necessarily less formal environment of a residential care home, staff have no realistic chance of avoiding either cross-infection between patients or themselves acquiring infection. And so one must question how it is that so many ended up having to take in infected patients, for which purpose they were so manifestly ill-equipped.

Here, for once, the Telegraph is doing a halfway decent job, almost behaving as if it was still a newspaper. With a headline declaring "Care homes' soaring death rate blamed on 'reckless' order to take back Covid-19 patients", it examines the events that gave rise to the current situation.

In particular, it highlights two "damning policy documents" published on 19 March and 2 April, in which officials told NHS hospitals to transfer any patients who no longer required hospital level treatment, and set out a blueprint for care homes to accept patients with Covid-19 or who had not even been tested.

The documents are indeed damning, the first on the two, dated 19 March 2020 effectively required the hospital service to turf out 15,000 patients to make room for the expected "surge" of Covid-19 patients, anticipating that about half of these would need support from health and/or social care.

The peremptory tone of the "discharge requirement" (for that is the document's title) is quite chilling. Hospitals are told that patients who meet the discharge criteria should be transferred from wards within one hour of decisions being made that they should leave, to designated discharge areas. It then says that discharge from hospital "should happen as soon after that as possible, normally within two hours".

As to the second document, dated 2 April 2020, this is headed: "Admission and Care of Residents during COVID-19 Incident in a Care Home". It makes the unrealistic and, bluntly, scurrilous assertion that patients with Covid-19, whether symptomatic or asymptomatic, can be safely cared for in a care home, on the basis of guidance set out in the document.

Apart from setting out a scale of PPE, which most care homes have been unable to obtain, it makes bland assertions such as: "Care home staff who come into contact with a Covid-19 patient while not wearing PPE can remain at work". This, it says, is because in most instances this will be a short-lived exposure, unlike exposure in a household setting that is ongoing.

Experience in UK hospitals, where there are numerous examples of uninfected patients being admitted, only for them to succumb to Covid-19, and the Chinese experience where the proportion of nosocomial infection in patients with Covid-19 was 44 percent, affecting not only patients but staff, mainly doctors and nurses, would tell anyone but the most cynical (or heartless) that the guidelines were completely unrealistic.

To give the Telegraph its due, in an editorial, it asks: "How does the Government explain its advice to care homes?" Is it possible, it ponders, that in the rush to reduce pressure on the NHS and increase capacity, decisions were taken that passed the risk on to care homes instead?

It seems, says the paper, that while attention has been focused on hospitals – where the number of dead has been more accurately recorded – there was a hidden spike of deaths in care homes, the timing of which might in fact coincide with this policy. If so, this is a shameless part of the coronavirus story that demands explanation.

And in yet another piece, the paper asserts that, "Care homes should be places of safety", pointing out in passing that health secretary Hancock has admitted that 15 care workers are known to have died in England – in addition to the 400 or so residents who might be dying per day.

Once again, therefore, we confront the imbecility of converting district general hospitals into Covid-19 treatment centres, having to come to terms with the realities of what that entails, while the so-called Nightingale Hospitals run on empty.

Additionally, we see a separate report that "two new waves of deaths are about to break over the NHS" as patients suffering life-threatening conditions are unable of unwilling to secure the treatment they need.

In response, we see the head of the NHS launch a major new drive to persuade the public to seek the urgent care and treatment they need. This is NHS chief executive Sir Simon Stevens, who claims that "NHS staff have worked hard to put in place measures allowing people to access care safely – such as splitting services into Covid and non-Covid". But the man deludes himself if he believes the measures can restore confidence in what has become what one of my readers dubbed, the National Homicide Service.

Unjustified or not, the fact is that policy decisions made by NHS and other health planners are killing people. And while these serial killers are at large, no one is safe.

comments powered by Disqus

Log in

Sign THA

The Many, Not the Few