The vaccine roll out accelerates. But testing still remains a vital part of the Government’s strategy.

13 Jan

Now that vaccines are being administered across the UK at astonishing speed, with approximately 2.8 million doses given so far, it’s easy to believe the light at the end of the tunnel is here in the global battle with Coronavirus.

Ideally, it is. The best case scenario is that the vaccine quickly protects everyone who needs it, while reducing the virus’s transmission in the population. 

Even better would be if the vaccine provides long-lasting immunity, as opposed to people having to get inoculated on a regular basis (creating a health risk and huge logistical challenge, especially if the virus mutates and new vaccines are needed).

While we find out these details – and we should have some answers over the next few months – there’s been less talk about NHS Test and Trace, and mass testing, the systems the Government has spent enormous sums on to keep the virus at bay while there’s no vaccine.

Paradoxically, as the vaccine roll out gets under way, NHS Test and Trace has become stricter, updating its definition of “close contact” so that users have to log more details of who they’ve been within two metres of.

Not least because the system has been quietly improving, with a record figure of 493,573 contacts identified in the week ending December 30 – up from 407,685 the previous week. In short, this will lead to an increase in the number of people who need to self-isolate.

The Government is also devoting huge resources to mass testing, with Matt Hancock announcing on Sunday morning a programme of “lateral flow” devices to help detect asymptomatic cases. 

A total of 317 English local authorities will be able to deliver this, with the army deployed to Bolton to help next week. Pilot schemes are also being used by businesses, such as John Lewis and others in manufacturing, retail and food.

While these systems aren’t perfect – there are still lots of criticisms around their capabilities – the point is that they’re being developed and improved, in spite of the vaccine, which is celebrated as our get out option. So why is this the case?

The first explanation is simply that the Government needs every resource possible right now to fight the mutant variant of Coronavirus. Chris Whitty, England’s Chief Medical Officer, has warned that we’re about to go into the worst weeks for the NHS, so it’s no wonder that we’re readying multiple systems.

Then there are more depressing long-term considerations, such as whether the vaccine runs into trouble. Perhaps immunity does not last as long as we thought it would, or a new strain of the virus comes along for which there is no vaccine yet, and so forth. This is when Plan B, C, D, E and a whole alphabet of other options becomes vital.

Worse still, there could be another pandemic in the future. That’s why the Government can better justify spending eye-watering sums on this infrastructure, which we may be grateful for later.

The difficulty with all this is that the Government has had to build testing infrastructure while we’re in a pandemic, as opposed to before, so it has discovered flaws in its systems in the worst possible way, perhaps part of why test and trace has cost £22 billion.

No doubt there will eventually be questions about why it – along with many other governments – lacked preparedness in this area, unlike South Korea and Taiwan, who had contact tracing in place. Yes they built their systems in response to MERS and SARS, respectively, but the signs were there to the international community that this infrastructure was worth considering.

Either way, the focus on testing isn’t going away any time soon.

London’s Nightingale hospital comes off “standby” mode – as these sites face their biggest test yet

12 Jan

In recent months, the Government has been forced to defend itself over the Nightingale hospitals, the medical sites it set up in the spring to support the NHS through the Coronavirus crisis, which have been noticeably empty, and sometimes deactivated, across the pandemic.

While their emptiness should be a good thing, many have wondered – more so now that the NHS is under huge strain and with the emergence of the new Coronavirus variant – why this extra support has not been used much, if at all.

It is estimated that the Government spent £200 million in total on seven sites in England, but the most publicised Nightingale hospital (in London’s ExCel) closed a month after treating 57 patients. Inevitably there were questions about whether this was a good use of resources.

When Matt Hancock was grilled on this matter in December last year he said that these hospitals were never intended as the first port of call, and were in fact “there in case they’re needed.” Stephen Powis, NHS England Medical Director, has echoed this sentiment, calling them “our insurance policy, there as our last resort.”

So it is troubling that today the London Nightingale field hospital has been opened up again, albeit as a “rehab unit” to treat those recovering from Covid and other conditions.

The Nightingale in Exeter has been off “standby” mode since November, when it started taking patients from the Royal Devon and Exeter NHS Foundation Trust.

Nightingale hospitals in Manchester, Bristol and Harrogate have also been used for non-Covid patients.

And Northern Ireland is seeing a similar rise in demand, where the Nightingale Hospital in Belfast is being prepared for use as intensive care patients increase.

That being said, across all Nightingale hospitals there is no consistent snapshot of how they’ve been used, as so much is determined by the nature of the virus and how it spreads across the country.

At the other end of the spectrum is Sunderland’s Nightingale Hospital, a 460-bed facility, which has not treated a single patient and does not expect to as of yet.

It’s a similar story in Wales, where the health authorities decided to dismantle its 2,000-bed field hospital which was created at the beginning of the pandemic, instead moving to smaller sites, which are designed to support existing hospitals.

In England, however, the signs are there that this infrastructure will be more relied upon, particularly given the dire warnings from Chris Whitty, England’s Chief Medical Officer, about the challenges over the coming weeks as the NHS battles a much more transmittable version of the virus.

One of the biggest challenges ahead will be whether the Nightingales have enough staff to support the upscaled infrastructure. NHS professionals have complained that there simply aren’t enough nurses and doctors for them. Hancock has previously said the Government “built more capacity within the NHS” to cope with growing cases, but how this translates to reliance on the Nightingale hospitals remains to be seen. Tragically, the next few weeks are likely to be their crucial test.

Ryan Bourne: Ministers must speed up the pace of vaccination. Here are some ways of doing so.

6 Jan

Ryan Bourne is Chair in Public Understanding of Economics at the Cato Institute.

Back in May 2020, I wrote that a high-efficacy vaccine was the biggest economic stimulus available to us. Removing whatever barriers existed to its approval and rollout, so accelerating the end of the pandemic, was worth billions of pounds per week in GDP and hundreds of lives. Stock market reactions last year implied vaccines were potentially worth 5-15 per cent of global wealth. But it’s now clear there’s a need for even greater urgency in getting the UK vaccinated.

The disease outlook is grim. As of Sunday, the number of people hospitalised with Covid-19 in England was 32 percent higher than its April peak, with new daily admissions above those seen last Spring. In the South East, the number of Covid-19 patients in hospital is near double the 2020 peak. Chris Whitty explained yesterday how case curves are trending upwards in other regions. Given recent trends and mobility data less responsive so far than to lockdown one, things will get worse before they get better.

So a national lockdown was perhaps inevitable. To judge by Twitter, people were gearing up to revive their pro- and anti-lockdown talking points beforehand. But the armchair cost-benefit analysis from Spring 2020, or even November, is no longer valid. First, because we have vaccines already being rolled out that will, at the very least, mitigate against Covid’s worst effects. Second, because the new mutation appears more highly transmissible in the face of given suppression measures. Both realities strengthen the case for reducing interactions now. Both increase the urgency for rapid vaccination.

The benefits of measures that reduce transmission of the disease are more certain with vaccines available. Lockdown sceptics had a point when they said at least some “lives saved” from government mandates last year were deaths deferred until the next wave. Now, with only 20 million full vaccination courses required to inject demographic groups making up 97 per cent of cumulative deaths so far, avoiding infections today means avoiding Covid-19 deaths forever. That makes the case for breaking up social networks all the stronger, including through closing schools (evidence suggests children are seeding the virus into households).

The high transmissibility of the new strain supports this action. A more rapidly spreading virus increases the risk of “overshooting” ICU capacity. Such is the speed of spread (one in 50 people had the virus last week), each day of societal delay in reducing the transmission rate below one accelerates the crunch. So quickly are we becoming infected, herd immunity may even come this year. The choice before us is whether we achieve it through the route strewn with significant deaths and bad illnesses, or via a path where injections eliminate almost all severe cases.

It feels almost lame to say it—as if nobody ever thought of it—but both the public health and economic consequences suggest we must do everything possible to speed up the vaccination process. We are in a straight race between vaccinations and the virus, and I fear even Boris Johnson’s revised timetable is too slow.

In an ideal world, with plentiful vaccines, logistics ready, and vaccines preventing transmission, the best path to herd immunity would be to vaccinate high transmitters first in a geographically concentrated way. However, we do not know whether the vaccines actually reduce transmission yet, and Chris Whitty contends that there will be supply shortages for months. If that is true, prioritising those at highest personal risk, as the government is doing, makes sense.

The UK regulator was admirably swift in vaccine approval. But doses available have been revised down massively since November and it’s not obvious why things aren’t moving faster. Reported vaccinations in week two (through 27 December) were not even half the number of those in week 1. Sure, this was Christmas week, but why not have longer working hours on other days to compensate? With a spreading virus, delay costs lives. Oxford/AstraZeneca’s vaccine was approved last Wednesday. It was not rolled out until Monday. Why? The virus doesn’t take time off to celebrate New Year’s Eve and a bank holiday.

Yesterday, Johnson said that 1.3 million vaccinations had now been undertaken. That’s only around 350,000 in the past eight days – nowhere near fast enough given the balance of costs and benefits. By mid-February, he hopes that 13.4 million first doses will be achieved. That requires two million per week from now until then. Yet even that seems tardy given the costs of lockdowns.

We must be pulling every lever here. Constraints to early roll-outs should have been foreseen. And if there are unforeseen roadblocks, economists would advise that raising the price you are willing to pay encourages supply. If, as reported elsewhere, a lack of vials is really the problem, what incentives are being given to ensure manufacturers work round the clock, seven days per week? Making the activity more profitable increases the willingness to pay overtime, train new workers, and run machines hot. If not vials, identify the production or staffing bottleneck and apply the same logic.

Eliminating barriers to vaccinator volunteers is a no brainer. So it’s heartening that the government is “reviewing” red tape that says vaccinators must be diversity, terrorism, and fire-safety trained. But financial incentives could help too. The NHS is giving GPs an extra £10 for every care home resident they vaccinate this month, which makes sense given 36 per cent of deaths have been in homes. Yet what about financial inducements for extended hours, weekend work, and more?

This would not only help in getting more vaccinations delivered, but potentially space them out a bit too. So prevalent is the virus right now, hordes of people packed into waiting rooms could lead to infections even prior to vaccines being administered. Is anyone establishing drive-through or outdoor sites, as seen in Israel?

Nor can we afford wasted vaccines. The zero out-of-pocket price means no penalty for people or providers for missed shots. With the possibility of vaccines wasted or appointments missed, GPs, hospital workers, and (hopefully) pharmacies should have the decentralised authority to administer them to “ineligible” individuals without the threats of repercussions to avoid waste. A vaccine dose to someone is better than no one. Let’s not sacrifice lives on the altar of “fairness.”

The Government’s “first doses first” policy shows that Ministers understand inoculating more people sooner is essential, even with a potential efficacy trade-off. But this strategy only helps in the medium-term if the supply is ramped up. The economy and the public health effort require getting the manufacture, logistics, and physical delivery expanded in the swiftest time possible. It’s not easy, but the language from government sometimes treats the stated constraints fatalistically, rather than seeing them as an economic problem that prices, incentives, and regulations could affect.

Belgium hasn’t “flattened the curve” – and should not be used to justify UK curfews

11 Sep

During the Government’s press conference on Wednesday, Chris Whitty explained that the latest lockdown rules, which mean it’s now illegal for over six people to socialise indoors or outdoors from Monday, had been inspired by Belgium.

On July 29, the country introduced similar guidelines, reducing the number of people who are allowed to socialise together from 15 to five, as well as enforcing a 10pm national curfew (which, depressingly, has been applied to bars and restaurants in Bolton – and could be extended to other parts of the UK).

Speaking about Belgium, Whitty said it had been a “clear indication that if you act rapidly and decisively when these changes (rises in cases) are happening, there is a reasonable or good chance of bringing the rates back down under control”.

Newspapers were quick to praise the country. The Daily Mail suggested that it had been “able to curtail a second wave of coronavirus”, and The Evening Standard even referred to Belgium as a “success“.

On the other hand, Spain and France, which have both seen cases rise rapidly, have been portrayed unfavourably. In the press conference, Whitty used this dramatic graph (below) to highlight their situation.

The conclusion is clear: the UK now needs to “act decisively” – aka apply similar measures to Belgium’s – to save it from a similar fate.

Matt Hancock, too, echoed Whitty’s sentiments. “If you look at what’s happened in Belgium, they saw an increase and then they’ve brought it down, whereas in France and Spain that just hasn’t happened”, he said.

Yet, in the last few days the idea that Belgium is a “success” look rather dubious (to say the least).

Indeed, as The Brussels Times points out, the country has recorded a rapid rise in the number of new Coronavirus infections. According to the latest figures by Sciensano (the Belgian institute for health), an average of 547.4 people per day tested positive for Covid-19 in the country during the last week, with new infections per day rising by 22 per cent over the seven-day period (from September 1 to 7).

It’s the sixth day in the row that the average number of new confirmed Covid-19 infections in Belgium has risen again.

Furthermore, while the Government’s graph was plotted from the European Centre for Disease Prevention and Control, others look less flattering. Take the site Worldometer, as an alternative source, which released these yesterday:

Although it’s worth pointing out that Belgium did experience a slight dip in the number of new infections in August, the trend clearly hasn’t been sustained as people return to work and school. And on a more contentious note, it’s not obvious whether the dip was due to the interventions (limiting parties to five and curfews) or something else. There is still much that we do not know about the virus, and why it moves through countries at different rates.

Another question to ask is what hospitalisations look like in all this; from September 4 to 10, there has been an average of 22 new hospital admissions per day in Belgium – an increase on the previous week (15.7). Compared to cases, these figures are relatively low, and another reminder that scientists still don’t understand how cases translate to hospitalisations and deaths (partly because no one knows what cases were at the beginning of the outbreak).

Already there’s been talk of whether Britain could copy Belgium more in its approach, with a troubling YouGov poll showing that 62 per cent of the public would support a 10pm to 5am curfew.

But any moves must be made on more clear-cut data. By all indications, the latest figures are not that.