Tag: Public Health

When and how should we relax Covid-19 lockdown restrictions in the UK?

There is increasing discussion about how and when we should relax Covid-19 lockdown restrictions in the UK. My view is that we should be guided by data on case numbers, hospitalisations and deaths; and lift restrictions cautiously. In recent weeks, we have seen positive progress on case numbers with the daily number of people with positive Covid-10 tests falling from a peak over 50,000 per day earlier in the year to under 15,000 per day more recently. Hospitalisations and deaths are also falling but will lag behind the decrease in case numbers.

There are reasons to be positive about the future. Vaccination numbers are increasing daily with over 15M people now vaccinated against Covid-19, and administration of second vaccine doses due to start soon, as well as extension of vaccination to younger age groups. We are on target to offer a Covid-19 vaccine to all adults by later in 2021. However, we have seen lower vaccination rates in some groups, such as people from ethnic minorities, and it is essential to work with communities to overcome this vaccine hesitancy.

Another reason for optimism is that a large number of people also have some natural immunity to Covid-19 because of previous infection. Last year’s experience also shows that there is a seasonal effect on case numbers. Hence, we can be optimistic about seeing a decline in Covid-19 case numbers in the summer. We need though to avoid lifting restrictions too quickly and should do so in a gradual manner starting with opening up schools, and then opening up other sectors of the economy and society to avoid an increase in cases, hospitalisations and deaths in the Spring.

Finally, we need to be fully prepared for a potential increase in Covid-19 cases in the Autumn and Winter. This means ensuring that a high proportion of adults have had two doses of vaccine, and that we have a fully functional test and trace system in place by then. We are also likely to need continuing restrictions on overseas travel and travel to the UK; as well as planning for “booster” doses of vaccines to protect against newer and more infectious strains of SARS-CoV-2.

My Medical and Public Health Wish List for 2021

2020 was a difficult year for many people all over the world (if only we had the benefit 20-20 hindsight at the start of the year). Here is a list of 10 developments I would like to see in 2021.

1. A much better government response to the Covid-19 pandemic with interventions introduced at the right time and correct scale.
2. A rapid rollout of the Covid-19 vaccination programme so that target groups such as older people, those with long-term health problems, NHS staff and other key workers such as teachers and people working in high-risk occupations can be protected.
3. Awareness that the Covid-19 pandemic must be ended globally, not just in richer countries, and ensuring that people across the globe have access to the vaccines that will be introduced in 2021.
4. Better government policies to address key health challenges and risk factors for poor health such as poor diets, lack of exercise, and obesity; along with the wider determinants of health such as housing, education, poverty, and employment.
5. Greater support for our schools and teachers who have been outstanding in 2020 in trying to keep children educated during the midst of a global pandemic.
6. Respect for science and a reduction in the anti-science conspiracy theories that are some common on social media and in everyday conversations.
7. Greater support and recognition of the role played by primary care in ensuring good access to healthcare and improved health outcomes globally.
8. A positive relationship with our European neighbours and with the European Union.
9. An adequate replacement for the ERASMUS programme so that or students can benefit from the social, cultural and education opportunities that placements at universities in other European countries can bring.
10. An improvement in the IT systems that staff working in the NHS have to use. Poor IT leads to high levels of stress among NHS staff, and wastes valuable time and money that could be used to better effect elsewhere.

This is just a small list. Let me know what’s on your wish list for 2021.

How to cut Christmas Day coronavirus risk – from presents to games and dinner

In a Daily Mirror article published on Christmas Eve, Matt Roper and I discuss ways to stay safe this Christmas when the UK is in the midst of a pandemic, with Covid-19 cases rising across the country. The key action is to minimise mixing indoors with people from other households. Think carefully before you socialise, particularly if this will be with people at higher risk of death and complications from Covid-19, such as the elderly and those with long term health problems.

How often should we wash or sanitise our hands?

You should aim to get into a routine for handwashing. I would recommend handwashing around every two hours during the daytime. You should also wash your hands before and after any activity that might increase the risk of infection, such as handling food or when you have been in contact with other people. Using soap and water is fine, and there is no need to use expensive hand sanitiser unless soap and water are not readily available.

Should we keep the windows open? What if it gets too cold?

The risk of infection is substantially higher in poorly ventilated, indoor spaces. Good ventilation helps ensure that any virus that is in the air is dispersed more quickly, thereby reducing the risk of infection, if you are indoors with people who are not from your household. If you are not able to keep the room at a reasonable temperature whilst also maintaining good ventilation, you should consider whether it is safe for you to meet indoors with people from other households.

How long should relatives stay for? (i.e., just a few hours, overnight, a few days? Does it really matter how long?)

Whether people can stay with you depends on the local rules for your area. In England, mixing with people from other households is not allowed indoors if your live in a Tier 3 or Tier 4 area, except on Christmas Day (but not in Tier 4 areas). Most person-to-person transmission of Covid-19 takes places within households. Hence, where visits are allowed, these should be kept to a minimum period and overnight stays should be avoided. The longer you spend indoors with other people and the more people you mix with, the greater is the risk of transmission of infection.

What about Christmas presents/cards? Should they be wiped down first?

The risk of infection from handling presents and cards will not be great, but it is still a good idea to wipe them down first and leave them for a few hours before opening them. Remember to wash your hands after handling objects that have been touched by other people.

How close can we get? (i.e., should we hug, sit on the same sofa, be together in the kitchen etc…)

Direct physical contact with other people through, for example, hugging or shaking hands, increases the likelihood that the Coronavirus (SARS-CoV-2) will transfer between people and will therefore increase the risk of infection. Wherever possible, social distancing should be maintained (two metres ideally, one metre as an absolute minimum). In practice, this will be difficult for many people indoors, which is why indoor mixing with people from other households increases the risk of infection. Do not meet people from other households if you have any symptoms of a possible Covid-19 infection or if you are within 10 days of contact with somebody who has had an infection.

Is it better for younger family members to visit older ones, or for older ones to come to see younger ones?

It doesn’t really matter which way around the visit is; any mixing of people from different households will increase the risk of infection. Choose the location where you can maintain the best infection control measures; for example, a house with larger rooms and good ventilation rather than a small flat. Remember to follow the local rules on household mixing for your area; and practise good infection control, such as social distancing and regular hand-washing. Meeting outdoors is always safter than meeting indoors as any virus that is in the air will disperse much more quickly.

Are there any Christmas tradition we shouldn’t do? (i.e., Mistletoe, charades, board games, carol singing…?)

It’s best to avoid handling objects that have been touched by other people. Activities such as singing indoors have also been shown to increase the risk of infection as they are what are known as “aerosol generating”. Although Christmas is a special time and an important part of our social fabric, special precautions are needed this year and for the first few months of 2021. We need to maintain these measures until such time as the NHS Covid-19 vaccination programme starts to protect us and bring infection rates down.

How should the seating for people from different households be arranged for Christmas dinner?

People from different households should ideally maintain adequate social distancing wherever possible. Good ventilation helps to disperse any virus in the air more quickly.

Which is the safest way to serve the food? (i.e., Plated up in the kitchen rather than served from the table etc?).

It’s better to plate food in the kitchen rather than from the table or using shared platters. If food is served from a table, it is more likely to become contaminated.

Is there any kind of food we shouldn’t have? (Shared bowls of nuts, buffet style food, too much alcohol etc?)

Shared dining has been shown to increase the risk of infection. Hence, shared food such as bowls of nuts or buffet style food is best-avoided as handling food by many people will increase the risk of infection (not just for Coronavirus but also for gastroenteritis). Avoid drinking too much and remain aware of your surroundings and of other people around you.

What extra hygiene measures should be taken?

The best measure you can take is to meet outdoors where the risk of infection is much lower than indoors. If meeting indoors, ensure that surfaces are cleaned, ventilation is good, and anyone who is unwell or has had recent contact with someone with a Covid-19 infection stays at home and does not mix with other people. Take particular care with hygiene in higher risk areas such as kitchens and bathrooms. If you are in a high-risk group for a more severe Covid-19 illness or death, you need to take additional precautions and consider whether it is safe for you to meet people from other households indoors. You will eventually be offered a Covid-19 vaccine and once vaccine coverage in the population is high, we will see a decline in infection rates, making it safer for everyone to start to resume normal social activities.

London and South-East England Move to Tier 4 Restrictions

After a period from mid to late November in which the number of people with a positive Covid-19 test in the UK declined, in recent weeks we have unfortunately seen a rise in Covid-19 cases, with over 28,000 cases reported in the UK on 18 December. This rise in case numbers has been particularly high in parts of London and South-East England, leading today to these areas being placed into a new Tier 4 Level. Infection rates are also increasing in other parts of the UK, such as Wales, leading to increased pressure on the NHS.

Despite the enthusiasm and optimism generated by the Covid-19 vaccination programme, the number of people being vaccinated is well-below the level needed to start to reduce infection rates in the community. Without a very rapid escalation in the Covid-19 vaccination programme, which in turn depends on further vaccines being licensed for use in the UK and very quickly obtaining a much large supply of vaccines than we have available now, it will be sometime (perhaps several months, depending on vaccine availability) before enough people in England and elsewhere in the UK are vaccinated to have an impact on Covid-19 infection rates.

Our current crisis will require mass vaccination on a speed and scale we have not seen before in the UK. This needs to target older people, those with long-term health problems, and key workers in the first instance (NHS staff, care workers, and teachers for example); before moving on to other groups.

For the time being, it’s essential that people follow the local Covid-19 rules for the area where they live. In particular, mixing indoors with people from other households should be avoided as the risk of infection in substantially higher in crowded, indoor spaces where ventilation is poor.

Everyone should be mindful of older friends, relatives, and social contacts; and those with long-term medical problems. These groups are at the highest risk of serious illness and death if they contract Covid-19; and anybody in one of these groups should be very cautious in their interactions indoors with people not from their immediate household.

Although everyone wants to enjoy Christmas, it’s essential that infection control measures and local Covid-19 rules are followed during the holidays to protect yourself and others, and to relieve pressure on the NHS. Please also attend for your Covid-19 vaccination when you are invited. Achieving a high vaccine coverage rapidly is our best way to bring the Covid-19 pandemic under control.

Changes in Covid-19 Tiers in England

After a period from Mid-November onwards in which the number of people with a positive Covid-19 test in the UK declined, in recent days we have unfortunately seen a rise in Covid-19 cases, with over 25,000 cases reported in the UK on 16 December. This rise in case numbers has been particularly high in parts of London and South-East England, leading to more areas of England being placed in Tier 3.

Despite the enthusiasm and optimism generated by the Covid-19 vaccination programme, the number of people being vaccinated is well-below the level needed to start to reduce infection rates in the community. Without a very rapid escalation in the Covid-19 vaccination programme, which in turn depends on very quickly obtaining a much large supply of vaccines than we have available now, it will be sometime (perhaps several months, depending on vaccine availability) before enough people in England and elsewhere in the UK are vaccinated to have an impact on Covid-19 infection rates.

For the time being, therefore, it’s essential that people follow the local Covid-19 rules for the area where they live. In particular, mixing indoors with people from other households should be avoided as the risk of infection in substantially higher in crowded, indoor spaces where ventilation is poor.

Everyone should be mindful of older friends, relatives and social contacts; and those with long-term medical problems. These groups are at the highest risk of serious illness and death if they contract Covid-19 and should be very cautious in their interactions indoors with people not from their immediate household.

Although everyone wants to enjoy Christmas, it’s essential that infection control measures and local Covid-19 rules are followed during the holidays to protect yourself and others, and to relieve pressure on the NHS.

Was the government right to announce an easing of Covid-19 restrictions during Christmas?

  1. Was the government right to announce an easing of Covid-19 restrictions during Christmas?

When the current lockdown in England ends, it’s likely the government will introduce a new system of tiered restrictions. My view is that these restrictions should remain in place through the Christmas and New Year period, based on the local community infection rate. Easing the restrictions too quickly risks undoing all the gains we have made during the lockdown. Greater social mixing indoors over the Christmas and New Year holidays will inevitably lead to an increase in Covid-19 infections.

 

  1. Could allowing mixing of households actually mean people will die as a result?

Most person to person transmission of Covid-19 infection occurs within households. This is the rationale for the government’s policy of stopping different households from mixing with each other indoors. Allowing mixing of households indoors will inevitably lead to an increase in infections, which would be very serious for more vulnerable people, such as the elderly and those with major medical problems, who are at greatest risk of serious illness and death if they contract Covid-19.

 

  1. Won’t locking down during January make up for the Christmas easing?

We need sustainable measures to control Covid-19 rather than “stop-start” measures.

 

  1. Isn’t Christmas too important for people’s mental health and well-being to deny them the chance to celebrate it as normal?

Christmas is a very important part of our social fabric. We need to think how we can allow people to celebrate without risking their health and the health of more vulnerable people.

 

  1. Can’t we trust people to still be responsible and limit contact with their elderly relatives even if restrictions are eased?

Most people will be mindful about the health of elderly relatives and will take precautions to prevent them from falling ill even if restrictions are eased.

 

  1. If restrictions stay in place, won’t there be more risk of people rebelling against the rules and wilfully disobeying them?

There is a risk of that some people won’t follow the rules but the vast majority of people will be sensible and follow the local restrictions that are in place. With positive news about developments in vaccines, we may be able to live much more normally from around Easter onwards. It’s important we retain our discipline and follow rules for these next few months until sufficient people have been vaccinated against Covid-19, allowing a degree of “herd immunity” to develop, which will lead to lower infection rates.

 

  1. Would there be any risks involved in opening up churches for Christmas services?

Any indoor mixing poses risks and activities such as singing in indoor spaces have been shown to lead to increased risks of infection. It may be possible though to open churches in some parts of England where local infection rates are low and where good infection control measures – such as physical distancing and restricting the numbers who can enter a church – are followed.

 

  1. Won’t elderly people be getting vaccinated before Christmas anyway?

Although we have had positive news about vaccines recently, no vaccine is yet currently licensed for use in the UK. Assuming a vaccine can be rapidly licensed and is available for use from December onwards, we won’t have enough doses of the vaccines to have a major impact on the pandemic in 2020. All the current vaccines we have heard about require two doses a few weeks apart. It’s only when a large proportion of people have been fully immunised with two doses of vaccine will we see the effect of vaccination and this is likely to take a few months to achieve.

 

  1. Even if they allow us to have a big family Christmas, should we?

I would be cautious about large, indoor Christmas events – particularly if you have elderly relatives or relatives with serious medical problems.

 

  1. I want my whole family together at Christmas. What can I do to reduce the risks? (Should we self-isolate 2 weeks before? Take the kids out of school earlier etc. Is there anything we can do inside the house to reduce risk?)

Self-isolation can help but does not entirely eliminate the risk of infection. It’s not a good idea to disrupt children’s education by taking them out of school. Actions to reduce the risk indoors include avoiding overcrowding so that physical distancing can be maintained, ensuring that ventilation is good as the risk of infection is much higher in poorly ventilated spaces, and practising good hygiene, such as regular handwashing.

 

  1. Should we still get together for Christmas if the households have to travel from different parts of the UK to meet up?

It’s better to “stay local” if you can for Christmas. Once a vaccination programme is in place, this will allow a return to a more normal society; resulting in a much better Christmas experience for everyone next year in 2021.

Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?

Our new paper published in the Journal of the Royal Society of Medicine discusses excess mortality during the Covid-19 pandemic. The scale of the COVID-19 pandemic has forced policy-makers to operate with limited evidence for the relative success of different control measures.  Excess mortality is one key outcome measure. The highest excess mortality per million population is seen in Spain, followed by England and Wales. The majority of these excess deaths are caused by COVID-19, but a significant proportion are not directly related to COVID-19. In measuring the impact of COVID-19, mortality is however only one of many important outcomes. Even in ‘mild’ cases not requiring hospitalisation, symptoms can be long-lasting, and heart and lung complications are common, affecting quality of life and ability to work. Beyond the effects on health, the pandemic has disrupted all aspects of society – many countries have experienced record economic recessions, while school closures affect children’s educational attainment.