Elliot Colburn: The nationwide roll out of HIV transmission prevention drug PrEP is a life-changing government policy

15 Oct

Elliot Colburn is the MP for Carshalton and Wallington

While London Assembly member Andrew Boff was finishing his make-up ahead of LGBT+ Conservatives Lip Sync on the eve of our first virtual conference, Jo Churchill, the Public Health Minister, was Tweeting a life-changing government policy.

Not Boris Johnson’s announcement to make the UK world leader in green energy, or Rishi Sunak’s pledge to “protect the public finances”. In fact this might not be even in the same league for the population at large but for the LGBT community in particular – and many others including Black Africans, those of South or Central American heritage and many women across the country – this will be immediate and life changing: the nationwide roll out of the HIV transmission prevention drug PrEP.

On the eve of Conservative conference, Churchill confirmed not only what money would be available to local councillors to create new appointments at sexual health clinics to get people on PrEP – but that the money had been paid and is in their bank accounts. This £11.2 million of ring-fenced grant means already stretched GUM clinics can meet with would-be beneficiaries, run tests and change lives. Welcoming the news, Richard Angell of Terrence Higgins Trust called it a “watershed” moment.

For those who don’t know, pre-exposure prophylaxis, commonly known as PrEP, is a drug taken by HIV-negative people that reduces the risk of contracting HIV. When taken correctly it is nearly 100 per cent effective.

This is not to be confused with PEP, post-exposure prophylaxis, that is to be taken ideally within 24 hours, but no longer than 72 hours after the body has come into contact with HIV. The former is like the pill, the latter the morning after pill. Both prevent harm and heartache, both save individuals, the community and NHS considerable amounts of money. It’s good for the head and the heart.

Churchill’s news is a huge breakthrough – and a team effort. HIV and community groups across the country have highlighted the benefits of PrEP for five years or more – Terrence Higgins Trust, National AIDS Trust, Prepster and iwantPrEPnow deserve special mention.

In 2016 my colleague Mike Freer wrote for ConservativeHome making the case for a trial and eventual roll out (the trial ends this month and the roll out is concurrent) – he also laudably took on the bigotry in the debate at that time. LGBT+ Conservatives has raised this at every level in the party under the leadership of Colm Howard-Lloyd.

But the game changer was Matt Hancock. In January 2019, he told the Elton John AIDS Foundation that the Government would end HIV transmissions by 2030 – a huge commitment and no small challenge. So much had followed since. More places on the PrEP trial, Secretary of State support for the HIV Commission – founded by but independent of Terrence Higgins Trust, NAT and EJAF and due to report on World AIDS Day 2020 – to chart a way to reach this noble ambition. Now this – PrEP on the NHS.

This is something every Conservative can be proud of. Preventing harm – and illnesses – is best for our voters and the public purse. Being responsible for bringing to an end in England a five-decade long epidemic is something worth being in government for. Showing we are here to improve everyone’s lives. Gay and bisexual men arguably have most to gain but so do Black Africans, women and trans people.

Now the roll out will not be overnight – the kind of transformation will take weeks to implement, but there is no reason to not get in touch with your local clinic, just be kind and remember any delays are not their fault. Covid-19 is still stretching the NHS in all kinds of directions.

While this news is a milestone – the job is not completed yet. Not everyone wants to go to a STI clinic – campaigners want GPs, maternity units, gender clinics, even pharmacies to be able to prescribe PrEP. This would be welcome. There will need to be more funds made available to local authorities – Terrence Higgins Trust, NAT and London Councils have called for £16 million per year for the rest of the parliament. The HIV Commission will, I am sure, provide further guidance.

During the unparalleled Covid times, it feels strange to say there are things we can celebrate – our Government rolling out PrEP is definitely one.

Had Boff been Lip Syncing in person at that iconic LGBT+ Conservatives event he would have raised a glass to this massive leap forward. Instead we have to share a socially distanced pat on the back. Politics is ultimately about change not who gets the credit – but know this, it is yet another thing to be proud a Conservative government has achieved.

Bernard Jenkin: The threat of the virus to the NHS hasn’t gone away. How it could overwhelm hospitals – and intensive care.

13 Oct

Bernard Jenkin MP is Chair of the Liaison Committee, and MP for Harwich and North Essex.

The spring lockdown was necessary to avoid the NHS being overwhelmed by hundreds of thousands of seriously ill people. Today, infection rates are rising again.  So again, we must ask the question: what hospital capacity is required to keep pace with rates of infection?

Today, there is far more data, better understanding of the virus, and better treatments, so we no longer need to entertain the most apocalyptic predictions. Nevertheless, the figures are stark.

It is medical consensus that it takes an average of seven to ten days for someone infected with Coronavirus to develop severe symptoms which require hospitalisation. This affects a smaller proportion now, but ONS data suggests it is still significant.

In the week up to the 1st of October, 16,000 people per day were infected with coronavirus in England.  Hospitalisation data for this specific this specific period is still emerging, but already, seven to ten days later, the Government’s daily Coronavirus updates suggest that between 500 and 600 new hospitalisations are taking place daily in England.

This suggests that some three to four per cent of those newly infected with coronavirus will require hospitalisation. This is lower than earlier in the year (which was up to three times higher).

However, the epidemic is currently most prevalent among young adults.  They are far less likely to require hospitalisation.  This is the case in my own county, Essex, but low case rates are now doubling every ten days, as the virus spreads up the age range.  So rising case rates will lead to rising hospitalisations.

Intensive care units will also come under pressure.  Estimates from the spring suggest that up to 17 per cent of those in hospital with cthe Coronavirus required a move to the ICU.  Perhaps that will be lower too.  Let’s assume it will be only 10 per cent (and that optimism makes the sums easier).

The length of hospital stays also matters.  Those infected with Coronavirus can expect a length of stay in hospital of between five and 15 days, depending upon from where the data is drawn.

Here, a consensus has yet to emerge.  (The paucity of studies from outside China and the pandemic’s continuation means that medics are still feeling their way.)  In his presentation on Monday, Jonathan Van Tam, the Deputy Chief Medical Officer, showed a graphic with a range of nine to nineteen days: taking the middle point of that gives an average stay of 14 days. Similar evidence suggests that eight days is also the approximate length of stay for patients in ICU beds.

England has approximately 140,000 hospital beds, and 4,100 adult ICU beds. For this part of the year, we would expect around 85 per cent of beds to be full, which gives ‘spare’ capacity in England of around 20,000 hospital beds.

So what do all this statistical estimates mean, when asking how much hospital capacity will be needed if there is serious Coronavirus spread throughout the UK?

Let’s assume that we let the virus spread, so that, over the next three months, an additional quarter of the population of England becomes infected with coronavirus – an additional 14 million people. This is equivalent to just under five million infections per month, or 156,000 infections per day. 3.5 per cent of five million would become sick enough require hospitalisation.  That is equivalent to 5,500 daily hospitalisations.

We have to date ignored two factors which make things seem better than they would be. First, there would not be a flat rate of infections at 156,000 per day over three months. Instead, the daily infection rate would follow the familiar (and far more disastrous) bell-curve.

Second, we are assuming that the population which falls sick is relatively young and healthy, as now, and that we can protect the vulnerable.  Experience in this second wave already suggests this is most unlikely.

But let’s look again at what would be necessary to manage 5,500 daily hospitalisations. We know that hospitalisations last, on average, for 14 days. This means that we would need 77,000 extra beds on top of what we now have. So in addition to the 20,000 spare hospital beds that we currently have, we would need to find another 57,000 – equivalent to just over 16 new London-sized Nightingale hospitals.

In this (flat) scenario, these hospitals, as well as every hospital in the country, would have to be run at 100 per cent capacity, each and every single day for three months.

We have also assumed that we can perfectly match hospital capacity to the location of infection hotspots, which is not the experience.  Images we have seen of packed hospital corridors in Lombardy or New York demonstrate this task is very difficult, if not impossible.

For ICU capacity, the numbers are even more stark. If one in ten of those requiring hospitalisation require being moved to the ICU, then 5,500 daily hospitalisations becomes 550 daily ICU admissions. At an average length of stay of eight days, England alone would require 4,400 ICU beds, more than the entire capacity of ICU beds in the country.

And if the epidemic spreads to older and more vulnerable people, this shortage would become yet more acute.  In Essex, the NHS is not planning to stop doing anything but Coronavirus.  The aim is to keep the NHS open for as much normal business as possible, but there would be no possibility of achieving that in the scenario above.

This is the maths which is driving the conversation in government around the need for new Covid restrictions. If test and trace was working better, perhaps we would have been better able to keep the number of cases down.

But absent massive test and trace capacity, the Government has no option but to consider the second round of Covid restrictions to get us through this winter.

The reality of this virus is that it is not like ‘flu; something you get once and gives you immunity.  It is also very hard, perhaps impossible, to find a permanent vaccine.  There never was a vaccine for AIDS or for SARS (another coronavirus).

Time and science will improve the resilience of people, society and the economy.  We certainly should not plan to have varying degrees of lockdown every six or twelve months.  The Government should set up a long term strategic group, away from the daily pressures of Whitehall, to draft a strategic White Paper, Living with Coronavirus, which sets out how we can best manage Covid-19 while keeping the economy open.