covid-19


Covid-19


Below are my thoughts from the start of the Covid-19 Pandemic early in 2020 and what has been happening, and more accurately, not happening, in England and Wales. I start with a summary. An index of real time comments then follows.


I write this with little pleasure. I only hope that someone out there is learning from our mistakes.


I do want to say something before continuing. One thing has become clear. Covid-19 is transmitted primarily where there is close person-to-person contact, particualry in enclosed environments and/or where people are not wearing masks.Our personal responsibility is therefore clear, irrespective of what Governments might be telling us. AVOID UNNECESSARY PERSON-TO-PERSON CONTACT WITH PEOPLE OUTSIDE OF YOUR OWN HOUSEHOLD. And when it is unavoidable,wear your mask and keep social distancing. It's tough, but that is in the end the only way to contain it and drive infection down until hopefully the vaccines do it for us. We cannot wait, though, we do not need more unnecessary deaths between now and the vaccines making a real difference.


There is now a huge problem with the people who get infected and do not have symptoms:

a) because they unwittingly spread the virus. But as importantly,

b) they are still likely to have physical damage from the virus that may only show itself in years ahead.


What is utterly incompetent is the total lack of public health messaging highlighting this. I feel sure the people crowding on to the beaches simply think, well, I'm young and fit and if I get it I won't have many symptoms. And they may not. But lack of symptoms does not equate to lack of longer term damage. The Government is failing us with its lack of public health messaging.


Sadly much of what I have been saying has come true. We eased the lock down too soon. We didn't allow time to monitor the effects of each stage of easing restrictions in order to truly understand the impact. More belowin a  piece entitled Deja Vu.


As for the summer debacle over exam results, please look at my piece below entitled A Pandemic Plan for Education in the UK written on the 19th June. 


I suggested below in Welcome to the Second Wave: Not the Same as the First Wave, is that we are now in the second wave in some countries, whilst others sadly are still drowning under the first wave, but the second wave has characteristics that are different. Well there was no recognition that the second wave had begun and now it is clear things are worsening fast.  I offer my further thoughts on what is currently as we enter the last week of September. Once Again,  Too Little Too Late.


Also we now need to publish an R number by age group because without doubt young adults now have an R number well above 1 which I highlight in Infections Rise in Young Adults - A Perfect Storm. It seems that we have got ourselves into a situation where, to misquote St Paul: Eat, drink and be merry, for tomorrow grandma dies. We seem to want to preserve freedom to party, socialise, eat out at any cost, the greatest cost being the lives of those most vulnerable to covid-19.


I have brought my thoughts up to date with Vaccination: The End of the Beginning? We still wait to hear whether the vaccines simply block symptoms, or whether they stop people being infected and infectious. (We now know they don't stop transmission - 29 January 2021).


I have  added The Promise of Normality: Don't be Fooled, Sadly Things Go From Bad to Worse and Vaccination Objectives: The Need for Clarity


War on Covid: Battleground Transmission is where the focus has to be and should have been from the start. I just so wish there had been greater co-ordination of vaccine development from WHO, and clearer vaccine planning nationally so we could have avoided what seems to be turning into a mix and match, pick and mix muddle as to who gets which vaccine and when, and what they get as the second jab.


March 25th 2021. The vaccine roll out in the UK is in full swing. Sadly that is not case in many parts of the world. I have made some comments below in Vaccines: An answer to some things, but not yet for everything.


Vaccine Passports are now being trialled. I can see the point but there is a glaringly obvious problem. The vaccines are not 100% effective against catching Covid, My thoughts below in Vaccine Passports: Yes, but no, but...

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Contents


  • Vaccine Passports: Yes, but no, but...
  • Vaccines: An answer to some things, but not yet for everything, 25th March 2021

  • War on Covid: Battleground Transmission, 12th January 2021

  • Vaccination Objectives: The Need for Clarity, 10th January 2021

  • Sadly Things Go From Bad to Worse, 7th January 2021

  • The Promise of Normailty: Don't Be Fooled, 1st January 2021

  • Vaccination: The End of the Beginning? - 6th December 2020

  • Lockdown Revisited, 8th November 2020

  • Delayed Action and the Need for Common Sense, 15th October 2020
  • Once Again, Too Little Too Late, 25th September 2020
  • DejaVu, 18th September 2020
  • Infections Rise in Young Adults - A Perfect Storm, 6th September 2020
  • Welcome to the Second Wave: Not the Same as the First Wave. 20th August 2020
  • Infection Rates up - Hospital admissions down. Why? 14th August 2020
  • A Summary, 4th Ausgust 2020
  • More of the Usual - What have we learned? Nothing? Less than Nothing? 25th July 2020
  • Death Rate - Infection Rate: Likely changes with the easing of the lockdown, 8th July 2020
  • Asymptomatic carriers, the hidden but increasingly significant risk factor, 5th July 2020
  • Whack-a-mole - sums it up somehow, 30th June 2020
  • Local lockdown - Secrecy Kills, 30th June 2020
  • Some Further Thoughts on the R number, 30th June 2020
  • Overseas Holidays, 27th June 2020
  • Civil Liberties – Civil Responsibilities, 26th June 2020
  • A Pandemic Plan for Education in the UK, 19th June 2020
  • Reducing the Pandemic Alert Level - Too Soon, 19th June 2020
  • Easing the Lockdown too quickly - A Case of Unlawful Indirect Discrimination?, 11th June 2020
  • At Risk Groups – Some Thoughts, 9th June 2020
  • Easing the lock down too soon on a high infection rate, 2nd June 2020
  • Reflections on the R number and back to School, 16th May 2020
  • What a Mess,  11th May 2020
  • Where is the co-ordinated Government Pandemic Risk Register?  1st May 2020
  • Easing the Lock Down – An Overview Risk Analysis,  28th April 2020
  • Relaxing the lockdown and minimising risk,  16th April 2020
  • A Risk Management Perspective on Covid-19 spread,  6th April 2020
  • How we got to where we are with Covid-19, 14th March 2020


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Vaccine Passports: Yes, but no, but...

Richard Bryant-Hefferies 

4th April 2021


Well thr debate has moved on to vaccine passports. I can see the sense in them, it is a way to have some degree of control over transmission risk. However, there is a glaringly obvious problem with this.  The vaccines are n not 100% effective against catching Covid. For the under 65s it seems that with some vaccines there's  only  70% effiveness  against symptomatic Covid.  And there is no mention of effectiveness against asymptomatic Covid. 


So where does that leave vaccine passports?  


There are questions to be answered because what we essentially have will be those under 65 who are most out and about as lock down is eased relying on vaccine passports when one in three approximately of those having the AZ vaccine will not be protected and could receive and transmit Covid. None of the vaccines are 100% effective against symptomatic covid as I understand it, I just don't have figures to hand for the under 65s. Plus there are those who are vaccinated but are asymptomatic carriers. What the data on this group is I have no idea.


Three people go into a bar with their vaccine passports. Two have protection against symptomatic covid, one doesn't and has mild Covid.  The bar person has been vaccinated but is asymptomatic.  No antibody testing to inform vaccine effectiveness.  Am I missing something? 


Whilst I hear people say repeatedly it is OK if covid is passed around amongst younger people who will not get deadly symptoms,  this utterly misses another crucial point.  Long covid.  Age does not seem to be a barrier to this. 


*****


Vaccines: An answer to some things, but not yet for everything

Richard Bryant-Jefferies

25th March 2021


I haven't said anything for some time. The vaccines are rolling out in the UK apace. Sadly in many parts of the world this is not happening. No global co-ordination. Very sad.


People seem unable to wait to get out there and get back to so-called normal. Wanting to travel, go on holidays, head to the shops, the pub, anywhere that is not in the home. You would think it was all over when of course it certainly isn't. OK, so in the UK older people have now had some vaccine protection, but people under 50 are still awaiting their jabs. They are going to be at heightened risk of catching it as things ease. Again I think it is too soon, but that's been the pattern throughout: lock down too late, open up too soon. OK, so younger people are less likely to die from covid, but they are likely to have long-term lealth complications which we have yet to fully grasp. 


The reality is that the future remains uncertain, and we have to learn to live with this. It's not easy, but we simply cannot rush things. It is not the time to start travelling overseas. Why sportspeople are being allowed to do this is beyond me. We have to remember, the vaccine reduces infection risk, but it does not remove it. Only human behaviour can do this.


We have got to learn from what has happened. Mistakes were made, we know this, we all should know this. They have to be identified and acknowledged, as do the things that went well. Sadly I have little faith that this will happen. 


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War on Covid: Battleground Transmission

Richard Bryant-Jefferies

12th January 2021


I still think we need to be more virus centred in our actions. War on covid should be on the posters because that is what it is. The battleground is transmission, not death rates. Containing transmission is the priority. It always has been but the government did not grasp this, did not prioritise this. All strategies have to be transmission targeted. That is the only answer and yes that means a lot of hardship. But unless you reduce transmission you cannot reduce the risk of more damaging mutations.


When it was getting under control they sent us out to eat, to shop, to the beach.


Yes there will be people worse affected due to health or economic situations. Society is unequal. There has never been an equal society in the history of humanity except perhaps amongst smaller indigenous groups, perhaps.

We have to do what we can to divert resources to those most in need. Of course we do. But if we prioritise the economy over containing transmission we will have more problems in the future and am ever increasing risk of even more deadly mutations.


Well that's what I think and no doubt there will be a howl of protests that it is not fair and I want my normal back. Well the reality is it isn't fair, pandemics aren't fair, and you can kiss goodbye to your normal for many months and very likely longer.


We are not at the beginning of the end. At best we are still at the end of the beginning.


Sorry, but the bottom line as I keep saying is transmission.


I despair and do not know what it will take to get it through so many thick skulls that they have to take responsibility for not putting themselves and others at risk.


The vaccines are not a silver bullet, they save lives but we cannot be sure on their impact on transmission as this is unproven. Vaccinated or not we still have to social distance, wear masks, etc.


Oh and people need to grow up and stop thinking the rules are something to get round like schoolchildren trying to outwit the teacher. It might be fun for children, but for grown-ups it is just plain stupid.



*****


Vaccination Objectives: The Need for Clarity

Richard Bryant-Jefferies

10th January 2021

 

Let me state clearly at the outset that I am fully supportive of vaccination against covid-19. We have to do what we can to minimise the impact the virus has on people’s health, and reduce the spread of the virus. The problem we face, though, is that these are two different objectives requiring different priorities, something that comes to the fore when we consider vaccination.


So far the vaccine focus appears to be very much upon minimising the impact the virus has on people’s health. Hence we have vaccines being developed across the world that have been trialled against people catching the virus.

What has not been trialled is if you contract the virus after you have been vaccinated, whether during the period in which the body’s immune system is fighting the virus (a period of time we are not clear on) or even after the person is infectious and could transmit the virus on to others.


This distinction is important because at the end of the day it is NOT reducing the impact on human health that will stop the virus. What will stop it is reducing transmission and therefore the risk of a mutation amongst the many that occur which will prove itself to be resilient to the first generation of vaccines.


Without clarity as to whether vaccines stop transmission, we are left with the physical behaviours that include lockdown, mask wearing, hand washing, social distancing, to contain transmission as the main actions to contain transmission.


I would humbly suggest that we need to put in place greater emphasis in vaccine development on the blocking transmission aspect.


In addition we also need strong public service messaging that reminds people that even once vaccinated, they have to continue with the physical containment behaviours highlighted above. My fear is that too many people see vaccination as a magic bullet. It isn’t. It’s a start. It is not the end. And from what I have seen of human behaviour there are just too many people out there with very little sense of collective responsibility who cannot wait for any opportunity to get out there, mix with others, and try and return to what they consider normality.


*****


Sadly Things Go From Bad to Worse

Richard Bryant-Jefferies

7th January 2021

 

Sadly the spiralling infection rate is no surprise. Government has lost control of the virus five times now and counting:

Delaying the first lockdown
Relaxing the first lockdown too quickly
Delaying the second lockdown
Relaxing the second lockdown too quickly
Opening up household contacts for Christmas

 

Unfortunately I expect the current lock down will be eased too quickly. Unless someone somewhere has learned something from the mistakes past and present.

 

At least we have finally had one example of forward planning, the first, cancelling school exams. But as for opening schools for one day and then closing them, sorry that is incompetence beyond belief.

At the start of the pandemic there were mistakes, then there was incompetence. It rapidly became negligence. What do we call it now?

Meanwhile the cohort of politicians so vociferously wanting lockdowns delayed or not happen have gone quiet. Let us hope they stay that way. 

 

Death rates

Looking at hospital admissions against deaths and allowing a four week time lag, we seem to have about a 50% death rate in hospitals. Better than 10 months ago. But not sure how much better. Are the new treatments saving lives or sadly just delaying deaths?

 

Vaccine roll out

Meanwhile at least we have the vaccine roll out. I am waiting to hear how high street pharmacies are going to be covid secure for delivering vaccinations. Can't see it. Queues will be massive.

 

As for the elderly accessing vaccine centres. Elderly people living alone with no transport, what provision is there for them? They cannot get in cars and taxis with people from other households. Not all have local support bubbles in place.

 

Still no confirmation from experts that the vaccines will definitely block asymptomatic transmission. I have heard this raised twice as a concern on two BBC health programmes.

 


*****


The Promise of Normality: Don't Be Fooled

Richard Bryant-Jefferies

1st January 2021


The government has been consistent. No forward thinking, no risk assessments, no planning. A series of stumbling reactions with an eye on popularity ratings, and extremists within their own party not wanting lockdowns..


Teenagers at school was always a major risk area. Any basic risk analysis would highlight this. There had to be testing in place, had to be.


So we continue to muddle along. Clearly no forward planning for worst case scenarios. No oven ready plans for different scenarios. And now we have a more transmittable variant.


How do vaccines that suppress symptoms but are not proven to stop transmission going to get us to normal? Until we get a vaccine that blocks transmission it will still be with us. So the economy will continue to go downwards. Politicians can promise what they like but whatever happens next is going to be dominated by debt whether we like it or not. That will be the new normal.


I worry that we are focussed so much on vaccines that block systems (good for reducing the death rate) but which are not proven to block transmossion. Are we heading for a lot of asymptomatic carriers? Could the wrong kind of mutation of the spike protein mean our vaccines ill be ineffective. What is sure the vaccines don't stop you being infective. So masks, social distancing etc will still be required even after vaccination. Where is the public health messaging about this?


We hear promises of mormality by Easter. No. No. No. We have to get real. This is going to be a long haul. So forget the grand visions. It is going to be about climbing our way out of where we are, slowly and painfully.

We should now be establishing state funded food banks. It is going to be tough so we have to get the basics right.



*****



Vaccination: The End of the Beginning?

Richard Bryant-Jefferies

6th December 2020


So here we are in England waiting for the batches of covid vaccine to arrive and to be distributed. I hope there is a robustly thought through plan for how they are to reach people, particularly as it seems the most vulnerable are to be targeted, many of whom are older people who may not be able to travel easily to distant vaccination sites. It has to be planned for.


I hope that the vaccines are effective. Yes I am concerned at the rush. However, I want to make it clear that I have no interest in the many conspiracy theories that are being publicised across social media. I am Pro vaccination.


I am also Pro being informed. I would like to know if the vaccines are designed to block infection, or simply to block symptoms. If the latter, will I be left infectious to others if I catch the virus? This does not seem to be getting any attention.


With older people who are most vulnerable likely to be among the earliest recipients of the vaccine, I worry about the unknown impacts that it may have given this group are those most likely to be receiving a large cocktail of different medications. The many drug cocktail permutations cannot have been covered in the trials. So there is risk. As there is also risk from not having the vaccine. 


I would like to have had more comparative data between the vaccines. In an ideal world the trials would have been given a set of criteria by WHO so we could have been able to make comparisons between data sets. 


I would also like to be sure that the spike protein in the covid virus is not too similar to any other proteins our body produces and needs. Perhaps the trials have shown there is no risk with this. Again, no information seems forthcoming. I would like to know.


I understand the rush. I wish we could have had a bit more rush back in March when we delayed lock downs. And again in the autumn when we again delayed lock downs. 


I hope the vaccine is effective, but in the meantime we have come out of lock down on a very high level of infection, too high in my opinion. I think we will be back in lock down in February. 


I think relaxing social contact for Christmas is plain daft. For the virus this is an opportunity. We do not need to give it this kind of opportunity. It must think Christmas is coming. 


Let us hope that the vaccines herald the beginning of the end for the virus, though the consequences will remain with us for many years to come. It is therefore probably more accurate to say that the the vaccine herald the end of the beginning, the beginning of a long process in dealing with the impact Covid 19 has had and will have on all of.


To say it is the beginning of the end is wrong and creates a false perspective. It is an ivory tower perspective. What we have now Is the end of the beginning.

We have a long way ahead of us:


Long covid
Loss of loved ones
Loss of jobs
Loss of businesses
Lost of accommodation
Mental health issues
Loss of schooling
State of the national economy


No this is not the beginning of the end for many many people who are now facing a long road of coping with the terrible effects of the virus.


****


Lockdown Revisited

Richard Bryant-Jefferies

8th November 2020



We are back in a national lockdown. It was delayed of course. Six weeks earlier and maybe it might have had an impact and avoided so many recent deaths as the virus regained control. If the regonal tiered system had been introduced earlier, immediately after the last lockdown was being eased, perhaps that might have made the difference. We will never know. We are where we are. The tiered system was not given long enough because of the delay in introducing it. And it probably didn't have the robust track, trace and isolate system needed to make it work.


What next? I expect we will have a national lock down every 3 months to contain it after it spreads after each lockdown easing going forward, if the tiered system does not work. 


As I I have said so many times before, it is about managing risk. Too many people didn't back in the summer, encouraged by the government. So we have to take responsibility for manageingour own risk, risk to ourselves and risks to others. 


As for Christmas, all I can see is that it is going to be an opportunity for the virus to spread once more, so be ready for another national lockdown towards the end of February 2021 at the very latest.



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Delayed Action and the Need for Common Sense

Richard Bryant-Hefferies

15th October 2020



The pandemic has now got a grip again. I called for targetted restrictions and lockdowns, but these were not forthcoming. We have seen delay and now it is out of control in many cities across the country. How many times do we have to get it wrong before we get something right? I despair.


Localised lockdowns should have been implemented weeks ago.The ones that were weren't robust enough. Now it is likely that they will have far less effect when implemented on such high infection rates.


The infection level has to come down, and for this to occur the transmission rate has to be reduced. Most of the transmission is human to human contact. The idea of a short sharp national 'circuit breaker' lock down has appeal, it makes sense. It needs to be tried, not just for now but, if it works, for the future. It may be something that has to be activated routinely until a vaccine is found.


But it could have been avoided if local lockdowns had been implemented robustly. For this to work peiople had to understand the logic and reasoning behind it. Muddled messaging and lack of involvement of local people and agencies did not help. 


We are where we are. We face an unrelenting virus. We give it opoortunity to spread and it will spread as sure as night follows day. 


Meanwhile after how many months of the pandemic we still await to see any kind of robust risk matrix to help us all understand exactly where the transmissions risks are. So we draw our own conclusions. It should be simple and it should require straightforward common sense.


  1. Keep your distance from people.
  2. Wear protection such as face masks.
  3. Wash hands regularly.
  4. Wash clothes where you have been in risky environments.
  5. Avoid gatherings and places where there are lots of people.


Keep well. Keep safe. 


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Once Again, Too Little Too Late

Richard Bryant-Jefferies

25th September 2020


So here we go again. Once more the numbers of people infected by covid-19 are rising significantly and hospital admissions and deaths are sadly also on the rise. Once again hesitant Government action has let it get hold.


Factors getting us to where we are now

The thing with covid-19 is that it is relentless. We have to match this if we are to have any success in containing it ahead of a vaccine in our tenacity to contain it. For at the moment that is the best we can hope for as we await a vaccine. But are the vaccine trials including elderly people, those with health conditions putting them at risk and those exposed to high viral load? At least they are including BAME people.


The Government eased restrictions too quickly without proper impact monitoring. Social distance messaging got muddled, if not totally lost. In effect we let loose a socialising wave which was really a freedom to take risks. Many bought into this, far too many, and mainly younger people who continue to be oblivious to the fact that whilst they might not have symptoms now, there is damage to their bodies that may very well have serious consequences for them in the years to come. Infection hot spots emerged.


Meanwhile families and friends were getting together once more with it seems like that for the continued need for social distancing and the management of risk. It has spread within homes and between households.


The issue I have and is that when I visit an elderly relative in another part of the country, on returning home where a family member has health issues and is at risk, I would like a covid test just in case in spite of being careful I have picked it up. But I can't. I don't have symptoms. I believe it is utterly ludicrous that people who know they have been in situations where there has been an element of risk cannot get a test. I know testing is a shambles, but this should also have been factored in.


Schools returned as did colleges and universities, adding to the perfect storm I have mentioned in a previous piece. Yet there is no focus being placed on the health risk to children who whilst they might be asymptomatic or have low grade symptoms, nevertheless may be experiencing some degree of organ damage or the effects of sticky blood that is going to be a far greater risk to their well being in the future than missing a few months of formal schooling.


And as for being asked to feel sorry for students who can't party away their university nights, don't get me started... Lockdowns were clearly foreseeable. You don't need much intelligence to know this and to prepare for it. Meanwhile what of all the other young people, leaving school with little hope of a job in the short term. Not much focus on them.  And, lest we forget, it was onl 80  years ago young people were being sent up in spitfires. Let's have some perspective please.


Attitudes, lock downs and restrictions

So we have local lock downs and restrictions, but have they really worked? Are people still prepared to change their lifestyles for the common good? 


People need a sense that those telling us what is good for us are in it with us. The Cummings affair totally undermined this. From that moment on we knew there was one rule for some and a different rule for the rest of us. We still believe this to be the case. A lot of vital goodwill has been lost. 


What also undermines people willingness to make sacrifices is the fact that we know we are not getting the whole truth from politicians. Numbers and statistics are not always what they seem. We have seen this again and again in relation to death rates, infection rates, track and trace, testing, PPE provision. The list goes on. For goodness sake we need the truth, not the version of the truth that they want us to hear. 


So local lock downs will continue, and generally at the moment the virus shows signs of being out of control. Too late. The virus is opportunistic. Partly closing the stable door will never contain it. Plus if you are going to contain it, contain it where it is. We needed generational restrictions weeks ago to stop it spreading further from younger adults. We do generational lock downs. Elderly people were subject to this for months. They got on with it. All credit to them.


The next six months

Things will probably get worse. We don't have enough widespread containment measures. Local actions are reactions to evidence of the virus getting out of control. They need to be proactive. The thresholds for restrictive measures have to be lowered. 


The state will become even more in debt, though I am not too sure exactly to whom we are indebted. 


The economy will struggle. What a sanitised way of putting it. It means the following:

  • People will lose their jobs
  • People will lose their businesses
  • People will lose their homes
  • People will lose their lives


The truth is we are at war with this virus. Like an invasion force it exploits our weaknesses, which include:

  • Muddled messaging
  • Massaged facts and statistics
  • An apparent unwillingness to sacrifice our social lives
  • Reactive not Proactive responses


We were told it was ok to

  • meet in groups outside and to form household bubbles
  • go to schools, colleges and universities
  • eat out and drink out
  • get back to the workplace


For those of us who remember the Top Cat cartoon, we were in effect encouraged to "mingle, mingle, mingle".


Meanwhile look at the House of Commons whilst these messages were in force, MPs distancing from each other like someone has got the plague. Do as we say, not as we do. And not a mask in sight.


If we are to come through the next six months with limited damage we have to feel we are in this together. The government, the country needs our goodwill. They will not get this from TV messages, but from their actions and how restrictions are applied, equally and based on facts that are true and not massaged.


We don't want false hopes and put in the sky moonshots, we need the truth, we have needed it from the start, we still do. And a little bit of acknowledgement of what has gone wrong and some apologies would also help.



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Deja Vu

Richard Bryant-Jefferies

18th September 2020


Sadly we are now in the grip of a second wave. Comments I have been making have rung true. We eased the lockdown too soon. We didn't monitor the effects of each easing before the next in order to ascertain the effect. We lost the social distancing message. We encouraged people to get out and socialise, probably mostly younger adults acted on this. We opened up workplaces, schools, universities at once. 


Then there is Track and Trace and Testing. Oh dear. It was clear that as the infections increased and as people needed to know their status with schools, work etc opening up, the demand would go through the roof. 


Now we seem back where we started, looking at the possibility of if not a national lock down, certainly very large regional lock downs. Yes we have seen last week how giving advance notice of restrictions ahead of a sunny weekend just encouraged some to get out and party while they still could. Now the Government have done exactly the same thing again. I shake my head at the sheer incompetence of it.


Will we do anything different this time around?

  • Health services have a greater understanding of what they are up against. But no messages of Save the NHS are being broadcast this time around.
  • There is perhaps more protection for care homes, but there are still issue with the testing and the availability of PPE in places.
  • There is unclear messaging as to exactly what symptoms children have, even though research has shown there are some difference from adults.
  • No public service broadcasting on the long term health effects of covid-19, even for the asymptomatically infected.
  • With testing overwhelmed there is now no hope whatsoever that those who should have been able to access a test based on having been in a risky environment though asymptomatic will ever be able to access tests.
  • Are we really on top of people coming in and out of the country, something we completely lost the plot on last time around?


Like many of the older generations, I take a risk management perspective. I do not go out unless necessary. I avoid places where there are too many people in close proximity to each other. I get the bulk of my food delivered. We are in a different world requiring more personal responsibility. 


However, we also need a Government that shows responsibility and accountability as well, that can be honest in their reporting of what is happening. I would like hope for the future, but I much prefer truth in the present


One simple observation: we are told it is OK to get out and socialise, sit around a table and eat and drink, get together in groups of 6. So why are our MPs sitting so far apart in the House of Commons? 


Deja Vu, we are where we were, you would hope more informed than before. But I am not so sure. We are still muddling through, reacting to events. 


You want to contain a virus, then contain it where it is. It was focused in young adults a couple of weeks or so back, but we didn't undertake a generational lockdown. So now it is spreading to other more vulnerable age groups. 


I would like to be optimistic, but I am not. I wish you well and hope you stay safe. It won't be easy.



*****

 

Infections Rise in Young Adults - A Perfect Storm?

Richard Bryant-Jefferies

6th September 2020


It is clear from infection rate data that  increasing rates are occurring for people in the 20-29 and 30-39 age groups. We should therefore be thinking about the R number by age band because for these groups it is now well above 1. Those most at risk of the deadly effects of covid-19 must keep their distance from these age groups. 


The R figure by age band is not being published. Why? It is crucial information that is needed to manage the current spread of covid-19.


The situation is compounded by the return of students to universities, not just the movement of young adults within the UK, but also coming in from overseas. How are they going to quarantine within communal accommodation?


All the focus seems to be on tourists, but students are a significant group feeding heightened risk into the age band that is most actively spreading the infection.


As for social distancing amongst children and young people outside of school, that seems non existent. I saw 10 young people sitting crammed into a bus shelter only yesterday waiting for the bus home, none of them wearing masks. 


The situation is further compounded by the fact that asymptomatic carriers and spreaders remain under the testing radar, a group that may be more prevalent in the age groups that currently have the highest R number.


In addition, it is the young adults who are most likely to have children who are now heading back into schools.


The socialising of young adults, the re-opening of universities to students, and the re-opening of schools, threatens to make this the perfect storm.


We have to have publicised data on infection rates by age band, we have to see the R number for these age groups, and we have to have effective strategies for shielding those most at risk from those most actively spreading covid-19. Both government and the media are currently failing us.



*****


Welcome to the Second Wave: Not the Same as the First Wave

Richard Bryant-Jefferies

20th August 2020


I think that a very dangerous and misleading assumption has been made by the nations that locked down and then eased the lock down, and who are now seeing infection rates rising, quite significantly and steeply in some places. The assumption is this, that the second wave will have the characteristics of the first wave. I think that our problem now is that this is wrong.


The most significant characteristic of the first wave was the death rate. It was very high. Care homes were at the mercy of the virus, as were health workers who did not have the right protective equipment, and transport workers who had no protective equipment. People who were mostly at risk were still out and about, not yet realising the full scope of the risk that they faced.


Now we have a different situation. People have been locked down and have now re-emerged on to the streets and into social and retail settings. Infections rates are rising. Deaths are not.


It seems reasonable to conclude that the virus is now primarily spreading amongst adults under say 40 with little or no underlying health issues that can make covid-19 a deadly virus. These are the people more out and about. Older people and those who have been shielding are remaining cautious, venturing out in ways that minimise risk to themselves.


Yet because the death rate is not increasing, no-one wants to talk of what is happening as a second wave. 


Let us take the wave analogy. You can have the tsunami that is a wall of water towering above you. But you can also have the tsunami that seems little more than a wave a few feet above the normal, but it keeps coming pushing on and taking out everything that is fragile in its path. I would suggest that the latter is analogous to the second wave that is affecting many countries now who eased their lockdowns too soon.


If I am correct, then we need risk management that fits with the nature of the second wave. Those at risk of death or serious health effects must remain shielded or shielding. Those less at risk will have to be back to work, to keep the economy functioning.


Schools will re-open, but for children who have parents or carers at risk, they may need to remain at home.


The interface between those at risk (BAME/elderly/health compromised people) and those less so but who are more likely to be carrying the virus has got to be managed. I hope for everyone's sake that it will be. But so far I see little sign of this.



*****



Infection rates up - Hospital admissions down. Why?

Richard Bryant-Jefferies

14th August 2020


We are seeing infection rates increasing, but hospital admissions have reduced. What is going on? 


Well it would seem that those amongst whom the infection rate is increasing are those who are younger, with less underlying health issues. These are also the people who are out and about more, exposing themselves to opportunity to pass the virus around. 


Meanwhile the older people and those with underlying health conditions are continuing to be wary, holding back from joining the exodus from houses to the shops, beaches, restaurants, pubs, etc. They are more likely not to be putting themselves at risk.


So, what can we learn from this? One thing stands out. Local lockdowns may perhaps need to be targetted towards those who are within at risk groups. In fact the one-size fits all national lockdown may have been an over-reaction. Perhaps that could have been targetted only at those most at risk, which would have allowed the economy not to go info freefall.


The problem with this, however, is that healthier and younger people may not have the life-threatening symptoms to the same degree, but are they getting the damage that is being evidenced to vital organs which may mean significant health problems in the future? 


We are still on a very steep learning curve. Perhaps in a strange way the healthier people are renderring a servcie to those who are at risk by developing a level of herd immunity that will in time constrain the spread of the virus more generally across the population. Maybe. Who knows? 


What I do know is that as someone who is over 60, and who is shielding, I am one of those not heading out except where necessary, and am taking precautions to reduce risk at every turn. 



****


A Summary

Richard Bryant-Jefferies

4th August 2020


From the off we did not take a risk management approach. We left the gate open. We let too many infection points in. We had no credible joined up cross ministry plan. We had no identified responsible coordination. We delayed getting testing established. We abandoned track and trace and quarantine. We delayed lock down. We didn't protect the elderly, we exposed them to risk. We eased lock down on too high an infection rate. We got muddled and reactive messages from the government.


But for me the one underlying factor that lies behind it all is the the government simply had no grasp whatsoever of the meaning of risk and risk management. There was no cross ministry risk register used to identify risk areas, mitigating actions, responsible individuals and time scales. Had there been and had the obvious risks been addressed we would very likely be in much less of a mess than we are in now.


Government economic actions whilst seemingly laudable had one fatal flaw, it wasn't thought through. It was assumed it would be a short stop gap measure. That was never realistic given the nature of the virus.


So now the government has a stark choice of their own making. Bankrupt the economy literally with a further lock down, or keep things open for business and let rip the virus. This is the position they have put us in, aided by foolish human behaviour thinking everything is heading back to normal encouraged by daft upbeat government messaging. Closing down the economy has proven to be merely a delaying tactic. As social contact increases whether through leisure, work, travel or education, the infection rate climbs. The all or nothing approach has not worked. Whether targetted lock down is the answer, time will tell. Has it been sufficiently modelled to inform decision making? Probably not. 


We have sadly trodden not a middle way between protecting the population's health and keeping economic activity alive, but rather a muddle way. The virus is a long term matter, it is not going away any time soon. The need to avoid unnecessary social contact of any kind remains necessary, and will continue to be so. But we have confusion. Street parties of less than a hundred are dispersed by police. Meanwhille our beaches are packed with thousands and are allowed to happen without any intervention. This is NOT consistent. It is confusing. 


Incompetence or negligence, that surely is the question?


****



More of the Usual - What have we learned? Nothing? Less than Nothing?

Richard Bryant-Jefferies

25th July 2020


So, here we are, lockdown is easing rapidly. Social distancing is now a thing of the past. People are finally getting over there issues about wearing masks and people are thinking things are on their way back to normal.


Infection rates will sadly go up because you only have to walk down the street to see how few people are interested in social distancing. The government's confused messages have left people thinking it is all ok. Yes the infection rate is down, but the virus is out there and it is looking for opportunities to spread. We are giving it those opportunities. 


We are encouraged to have hope. But I don't want any kind of hope. I certainly don't want false hope. I want reality and truth so that I can make informed choices as to what areas of my life involve risk that I can manage, and the areas where the risk is too high.Trust people with reliable information has been required right from the start. What have we learned?  Nothing? Or less than nothing?


Covid-19 cases are rising in many areas of Europe.. We are once again flying people in and out with little in the way of quarantine. Deja vu. What have we learned?  Nothing? Or less than nothing?


The Prime Minister has now acknowledged that there was not enough understanding of asymptomatic carriers spreading the virus back in March. Why, then, are covid-19 tests not freely available today to anyone who thinks they could be an asymptomatic carrier? Nothing is joined up. What have we learned? Nothing? Or less than nothing?


I give an example. I visit an elderly relative in a part of the country where infection rates are higher. I return home to my family where a person is immunocompromised. It would make sense for me to have a test, just to be sure I am ok and do not need to maintain a period of social distancing in the home. But I cannot get a test on the current guidelies. I have to have symptoms.


So, to conclude, the asymptomatic carriers will continue to carry and spread the virus, whether in our homes and high streets, or on planes and in hotels and other social venues. Yes the economy is starting to fire itself back up, but for how long? We must have hope. Hope in what? Hope that somehow the virus will disappear? It won't. It's with us until we find an effective vaccine. And even then, it will still be out there, adapting no doubt to survive as we all do. The question is whether humanity can adapt itself to survive. Or will it be business as usual. Will we have learned something, nothing, or less than nothing?


****


Death Rate - Infection Rate: Likely changes with the easing of the lockdown

Richard Bryant-Jefferies

8th July 2020


It seems to me that with the easing of the lockdown we are likely to see an increase in the infection rate. However, there is a chance that the death rate may not increase in parallel.


The reasons for this are that the people most likely to be out and about, and in risky environments are probably younger people who have less or no underlying health conditions. Whilst they may be more at risk of becoming infected, they are less likely to suffer serious health consequences and death.


In contrast, older people and those who have underlying health conditions are less likely to be out and about and are much more likely to be cautious in taking risks. This is the group most at risk of serious health effects from the virus and death, so their caution may well protect them.


The net effect of these above will be a rising in overall infections but a continued and possible lowering of the death rate. 


What is concerning is that this does not seem to be taken account of in relation to the Government easing shielding restrictions which could mean the infections start to reach those with underlying health conditions.


****


Asymptomatic carriers, the hidden but increasingly significant

risk factor

Richard Bryant-Jefferies

5th July 2020


The aspect of covid-19 infection that is not getting the focus required and which probably provides the main risk that cannot really be managed post lockdown in the UK, is the importance of the asymptomatic carriers. They go under all the radars. They are probably the reason why the general infection level isn't reducing as much as is expected. The number of asymptomatic carriers is simply not known.


In addition, because this is the most obvious problem area, I am surprised more research isn't going into this group. Just how infectious are they? What factors are contributing to their not being symptomatic?


It is a weakness that access to testing is still based on you having symptoms. It is simply not good enough. Why is it not getting media attention?


****


Whack-a-mole - sums it up somehow

Richard Bryant-Jefferies

30th June 2020


So the great Goverment strategy for dealing with outbreaks of the virus is... whack-a-mole.


Whack a mole sums up the Government approach. React React React. How do you deal with moles? Get into the tunnels, cut off their movement, shut down how they travel from A to B, contain the infestation and get rid of them there. Like we didn't with the virus, we didn't close down its transmission routes at the start, we let it in, we didn't have proper quarantine, and we finally locked down too late and let the infection rate get too high. Yup, whack a mole strategy really does reflect government incompetence.



****


Local Lockdown - Secrecy Kills

Richard Bryant-Jefferies

30th June 2020


Meanwhile we in the UK we are easing the lockdown on a high infection rate. Social distancing seems to have got lost as I experience our streets. Leicester, a city in central England, is locking down because of a sudden increase in infections. We are not being given any detail on who and why there has been an infection spike. Secrecy helps no-one. How will anyone else learn if we are not told? How will anyone act to stop it occuring somewhere else? Utter foolishness.



****


Some further thoughts on the R number

Richard Bryant-Jefferies

30th June 2020


R is meaningless unless you take the number of infections into account. If you have say 50,000 infections at any one time them R=1 will perpetuate that level of infections. At 1,000 then that number is perpetuated. We have a high level of infections in the UK  due to delay and inaction at the start and that is at the root of our problem.


We were told by ONS in early June we had an infection level of 33,000. At R=1 and maintained across a year, based on the 14 day infection cycle, that is about 850,000 new infections. It will be worse if we get a second wave. This is why it is serious, and why we do not need more pathways for the virus to spread to increase the infection level.


Holiday destinations will have high infections rates once people start to pour into them. The R number will increases and they will become hot spots for infections. Our rush to UK beaches or to take foreign holidays is just plain stupid and is going to put all of us at risk.


I fear the worst because I see very little to encourage me to think otherwise. We let it get hold,we let it in in a big way, and we were slow to react. For me Taiwan is the example of how to respond. 24 million people,7 deaths. Their healthcare response including their protection of healthcare staff appears exemplary, all that we and so many other countries simply did not have in place.



***


Overseas holidays

Richard Bryant-Jefferies

27th June 2020


I haven't written anything until now on the topic of people now deemed OK to go on holiday abroad, and return. I am still trying to take in the utter stupidity of this decision. This is where we began. This is what probably kicked it off because we were slow to seal our borders, we didn't properly monitor people coming in, we didn't get on top of track and trace and we had only minimal quarantine options in place.


We hear that the countries we will be able to fly to have lower infection rates and R numbers than us. So why do they want us over there? However, that is not the point I want to make.


I would suggest that it is not unreasonable to think that tourist hotels, cafes, beaches, shops in a given country are likely to have higher infection rates and R numbers than the rest of that country overall. They are going to be infection hotspots. So to compare that country's infection rate and R number to ours is meangingless and, even worse, dangerously foolish.. 


In addition to that you have the likelihood that airports and planes will also carry a heightened infection risk. Have airlines got on top of deep cleaning between flights and the way air is circulated around the plane? Flying overseas now for a non-essential reason, for example a holiday is, in my view, plain daft. 


And if, say, you go to Spain, you are mixing with tourists from all over Europe. Tell me, how is track and trace going to help anyone across countries? Is someone who gets home to Germany and develops symptoms going to be able to have their holiday movements tracked so an English person they sat with at a table can be picked up as having risk? Of course not. With movement back to European travel you would need a pan-European track and trace, and that should have been thought of from the start.


****


Civil Liberties – Civil Responsibilities

Richard Bryant-Jefferies

26th June 2020

 

Well it seems that easing the lockdown madness is upon us. The Government have told people they can travel any distance to sunbathe, and so people are, by the thousands and more. Wasn’t it foreseeable, that when the hot weather arrives, people would be flocking to the beaches?


In addition there is the on-going muddle and dither over the 2 metre social distancing rule which, quite frankly, has left us all confused.


So here we are with people wanting their civil liberties, wanting to street party, go to the beach, basically do what they want, but no recognition of civil responsibility. I am not sorry to say that civil responsibility must, of necessity, trump civil liberty. What we are witnessing now is civil irresponsibility, and it is stretching the police who are not geared up to in effect contain what amounts to mass insurrection. Coastal populations have a right to be protected from risk, particularly if that risk stems from the unlawful activity of ignoring social distancing.


So what happens next?


Well, the people who are on furlough or on benefits who are choosing to flout the law, should they still receive these benefits? You want Government to support you and your liberty, then you need to show some responsibility in return. Number plate recognition could be used to help identify the law breakers. Yes, there goes civil liberty, but you have to protect people from civil irresponsibility which affects their civil liberty - their right for the state to take action to protect them from what remains a deadly virus.


The police are stretched and it won’t take much more for the army to be brought out. If nothing changes, expect this very soon. There will be tanks blocking main routes to the coast. We could be heading for localised curfews. Things may well get very difficult, and we must not lose sight of the three causes:


  • The Government giving muddled messages on social distancing
  • The Government encouraging people to the beaches and to have social contact outside
  • The unwillingness of people to accept they still have a civil responsibility to not just stay alert (which is not strong enough), but to act in ways that contain the spread of the virus


What will be the effect of what is happening? The virus very likely will spread. There is no reason why it shouldn’t. We still have a high infection rate which does not take account of the asymptomatic carriers across the country.


I can only speak for myself. I feel more at risk now than I have done since the start of the virus. Lockdown contained it. Social distancing was being respected. It felt relatively safe to get some shopping. It doesn’t any more. Few people where masks. Social distancing is not being respected.  Too many people are in confined spaces. Just because the recorded infection rate has reduced and the R rate is around 1, does not make it safe. There are far too many unrecorded carriers of the virus.


Anyone reading my blog over recent weeks will know I take a risk management view of the virus and how to respond to it. To me the risk is now as high as it has ever been. The lid is off the bottle. The virus genie is back out and it feeds off human to human interactions. It has a lot to feed on.


I hope you stay safe. My sense though is that it is about to become much more difficult to do so.



****


A Pandemic Plan for Education in the UK

Richard Bryant-Jefferies

19th June 2020

 

Listening today to school Heads frustrations at the lack of direction and planning as to how schools will deal with the effects of the Pandemic on education provision, it makes you wonder how difficult some kind of plan would be to formulate.


Clearly many are waiting for Government direction and decision-making so that they can move forward in a consistent way to make their own plans for the year ahead.


So what is needed? First of all there has to be an acceptance that over a term of education has been lost and has to be caught up in some way. However this undertaking has to be consistent both across the country, and across educational providers for different ages. The two have to be joined up to stand any chance of effectiveness. This is simple common sense. The education of children and young people of all ages is important.


Secondly, once caught up, there has to be a revised timing for children moving on to new schools, colleges, universities and Further Education provision. Again there has to be consistency and joined up thinking and planning.

In addition, educators need time to plan ahead so any revised timing must be made as soon as possible, in other words now, so the management processes required can be brought into action.


So, taking the above into account, here is an overview plan.


  1. Announce that the Autumn term will cater specifically for the lessons that would/should have been provided during the Spring and Summer terms that have been lost to many.
  2. All end of school year exams from June/July 2020 to be moved to December 2020.
  3. Intakes to new schools. Colleges, Universities and Further Education will be cancelled for September 2020 and moved to January 2021.
  4. Spring and Summer 2021 terms will be extended into the Summer of 2021 to allow more time to address the syllabus which is needing to be compressed into a shorter period than usual.


No doubt there will be challenges, there always is with change, but given the creativity that we have in abundance within our educational providers, it does not seem beyond their ability to organise all of this. But it needs Government direction and support, it needs clarity and consistency, it needs a joined up approach. Most of all, It needs to be set in motion now.



****



Reducing the Pandemic Alert Level - Too Soon

Richard Bryant-Jefferies

19th June 2020


So the alert level is reduced from 4 to 3. Sounds typical. Don't wait to see if reducing the lockdown triggers an infection spike first.


We are in what we used to call in the met office a suckers gap. The rain has stopped. We think it is over, we all rush out but there's another bank of cloud on its way. 


No. I don't trust the government or its advice. We still have a significant infection rate. Any increased death rate from easing the lockdown has yet to work through. 


If the infection rate has dropped in two weeks time then maybe I'll start to believe. Until then stay safe,stay locked down and go out for essential reasons only.


Oh, and if you want to get the children safely back into school, how about clear plastic superhero visors? 


****


Easing the Lockdown too quickly - A Case of Unlawful Indirect Discrimination?

Richard Bryant-Jefferies

11th June 2020


I find myself wondering about the legality of the hasty easing of the lockdown.


You could argue that relaxing the lock down where the risk of increased infection spread and death is a clear and present danger is unlawful indirect discrimination under the UK Equality Act 2010 by age, race, gender and disability. Older people, BAME people, men, and people with disabling health conditions will be disprortionately and most adversely affected by this action.


I leave it for others more knowledgeable on this topic to decide whether there is a need for at the very least public debate on this point, or a legel action to clarify where the public stand on this Government action.



*****


At Risk Groups – Some Thoughts

Richard Bryant-Jefferies

10th June 2020

 

It is clear that certain groups of people in the UK are more susceptible to the most damaging health effects of Covid-19. Dialogue and research continues so that a fuller understanding can be gained of the complexities and causes linked to this. I have some observations to share.

 

Age

 

It is clear that a person’s age is a major factor in determining the impact of Covid-19. However, the point is rarely made that this could well simply be linked to underlying health issues rather than age per se. As we get older many of the organs of the body lose some degree of their functionality, even though there may not be a specifically identified disease. It seems reasonable to me to suggest that the age related deaths that are occurring may be more to do with these underlying health impairments than the simplistic categorisation of age that is all that seems to be focussed on.

 

Black, Asian and Minority Ethnic (BAME) People

 

Claims are being made that the higher death rates amongst BAME people is due to some race-related genetic characteristic. Yet so far nothing seems to have been identified. Indeed, the notion of race in this regard seems to me to be inappropriate. With so much genetic mixing over the centuries, what do we actually mean by a racial genetic identity?

 

It seems much more likely that the underlying factor is underlying health conditions. Why should BAME people be more at risk in this regard? Poverty, deprivation, poor health and social care linked to experienced racism are all factors impacting on health. In addition there may be lifestyle choices related to diet that perhaps are a factor.

 

Are we seeing high death rates within Asian and African countries? Is the Bangladeshe person equally at risk in Bangladesh as they are in, say, London? This needs looking at. But it is complex. Poverty and deprivation are also a feature in a number of Asian countries. Whilst in AfricaI understand the median age in 19 years old, so the age factor may be crucial making the comparisons with non-African countries difficult.

 

I have worked in the NHS within the field of equality and diversity. I have seen the annual staff and service user surveys analysed by ethnic group. Yes, racism is present and experienced. How this has affected the current treatment of BAME staff and service users in the context of Covid-19 remains to be clarified.

 

Racism is complex. As for the BAME peoples’ covid-19 death rate, we need to know the ethnicity of the person sending the BAME person to the front line, or providing the health care. Racism often is White to BAME, but it isn't always. It's complex, Asian to Black, Caribbean to African, White European to White Lebanese. In addition, caste and tribal identities can all play a role. Add religious identity, gender, disability, age and sexual orientation and you start finding problematic experiences and outcomes are amplified even further.

 

I do not have an answer. But we do need clarification. We need not just the statistics, we need to hear the voices, the actual experiences of BAME people. That is where we will find the truth and where we should begin looking for answers.



*****



Easing the lock down too soon on a high infection rate

Richard Bryant-Jefferies

2 June 2020


The early easing of the lock down, driven in part by the Cummings debacle, means we will reach up to R=1, we probably already are in some parts of the country. 

 

What this means is that the number of people infected will infect the same number of people by two weeks’ time. We are told we have around 50,000 people currently infected in the UK, so at this level over a year with R=1, 1.3 million people will be infected.  The current death rate is about 4-5,000 people every two weeks. That means 104,000-130,000 covid-19 related deaths over the coming 12 month period if nothing changes. It will be higher if easing the lock down too soon triggers a higher R value which in all likelihood it will if it hasn't already.

 

We are easing the lock down off too high a level of infection. Someone must surely be flagging this up to No 10?  You have to consider the R number in relation to the infection level. You just have to. No one is talking about this.

 

You have to have local planning and actions. You have to have local R rate and infection level monitoring. I know we have track and trace but with these numbers it is going to be overwhelmed.

 

Why do they persist in this one size fits all easing of the lock down? It makes no sense.

 

The Prime Minister tells us we can start to see our grandchildren again. No we can't. They are starting going back to school. They are being exposed to possibly bringing the virus back home. How can shielded or vulnerable grandparents risk seeing them? No joined up thinking again.

 

The sad fact is that as I have mentioned in earlier posts, we locked down too late, and now it seems everyone is rushing to ease it too soon.

 

 *****



Reflections on the R number and back to School

Richard Bryant-Jefferies

16th May 2020



So now we have an easing of a lockdown driven by dodgy data. A national R number is meaningless. You need localised numbers to identify whether it is time to ease the lock down n a particular region, and to then be able to manage the local risks that are pertinent to the population.


You need to take account of localised at risk population numbers. Some areas will be at greater risk of the impact of spreading the virus: areas of poverty and deprivation; areas with high BAME populations; areas with higher infection rates, are some examples.


School openings are not going to be responsive to area risks, all we have is the usual one size fits all response. You have to look at local infection rates and at risk populations in local areas. No thought. No risk planning..Added tio which schools are a very diffucult setting to arange social distancing. There is also no reliable data on the impact of children in sporeading the virus.


You need risk managers involved in identifying risk and safeguarding actions. They have been silent.


This government clearly has no idea when it comes to risk management. 



*****


What a Mess

Richard Bryant-Jefferies

11th May 2020


There has been no planning. No risk management. No risk registers. No safeguarding actions identified. Did the government initiate a cross ministries Pandemic Risk Register back at the end of February in order to identify pressure points, needs, safeguarding actions, designated responsibilities? Or did the government just stumbled along with no structure in place to respond on a coordinated way? I suspect the latter because for one thing care homes would have immediately been identified as a high risk and actions would have been identified to minimise it.


Any risk analysis back in February would have shown it to be the most vulnerable to covid-19, elderly people with underlying health conditions. Meanwhile covid-19 was getting into the visual system. So what does the government/NHS do? Move elderly people out of hospitals into care homes, which had at that time already locked themselves down to family visits, without testing them for covid-19. Can you actually comprehend anything so utterly stupid?


Time for the virus to incubate, 3-14 days. Time for the government to incubate a good idea and put it into action (self isolating or stopping people entering the country, wear masks, provide tests, provide enough protective equipment, realise public transport is a problem) about 2 months. That is why we are in trouble and why I have no faith in the government handling the easing of the lock down. I suspect again there is no coordinated risk process of place with identified safeguarding actions of things get worse.


If we lived in an ideal world, relaxing the lock down would be coordinated by WHO, with different countries piloting different areas to see what is safe.

If we lived in an ideal country, relaxing the lock down would be coordinated by government with different geographical areas piloting specific relaxations: open primary schools in Kent, open garden centres in Devon, open DIY centres in Leeds, open public parking in public spaces in Cotswolds.


Common sense tells us what spreads the virus, contact with people. You minimise that and you minimise the spread. Increase contact and you increase the spread. It is not rocket science, it is common sense.


And now we have the latest guidance with regard to meeting people in open spaces. Am I the only one confused? It seems that we can meet with one person from another household outside  in a park, which is supposedly safer than my garden. Why not in a garden if you are fortunate enough to have one and you keep your distance?). But is that one person per day, or can we have a succession of persons dropping in for a chat throughout the day? Has my one person got to be the same person for my wife, or can we each have visits from our own person? At different times or at the same time? Once a day or a succession of persons throughout the day.


What shambolic advice. I am left thinking we can have a visit from one friend or family member once a day, or a succession of friends and family members, one at a time, throughout the day.


And what is so utterly scandalous is we have a political system where we can't do anything about what our elected government does for four or five years. We are stuck with them, lying about testing numbers and evading responsibility for the mess we are in when it is plain for all to see that they didn't have a clue right from the start with their mythical containment phase whilst flying people in with the virus, no testing or checking, no quarantine. The only saving grace are the good people who are making huge sacrifices and taking enormous risks to provide care and essential services, and in spite of government failings.

The heart of this country lies with its people, not with our blundering government.


Oh and don't go back to work on public transport until you see conservative MPs doing it. Perhaps they should be piloting what is safe. When the MPs return to work then maybe that will be the sign that all is OK. Whilst they avoid Westminster like the plague there is a whiff of hypocricy methinks. Let them lead the charge back into the workplace.


*****



Where is the co-ordinated Government Pandemic Risk Register?

Richard Bryant-Jefferies

1st May 2020


There should have been risk analysis undertaken by Government in February. All ministries should have been tasked with producing Risk Registers to be coordinated by No. 10. Risk Registers are commonplace in large organisations. We centrainly had one where I worked for many years in the NHS. It was updated an monitored routine.


It would appear that at Governmental and Ministerial level nothing happened. This was the root of our problem.


With no identified high risk areas, there could be no early action planning. No identified responsibilities, time lines and monitoring. Systems were simply not set up. The Government policy appeared to be stumble along assuming all will be well because. 


Well all was not well, in fact it has become an unmitigated distaster. Many people in the country right at the start could see the need for planning and action. But what we had instead has been a series of reactive actions.That is never an effective way of managing anything. 


Because systems were not and very likely are not still n place, the the easing of the lock down is likely to again be a reactive proces, rather than something where high risks are identified and actions identified to respond ahead of time.


It is all very sad, very scandalous and very incompetent.


**** 



Easing the Lock Down – An Overview Risk Analysis

Richard Bryant-Jefferies

28th April 2020

 

Throughout the Covid-19 outbreak there has been little or no reference made to Risk Assessment and Risk Analysis. Had this been undertaken earlier in the year much of what has occurred I believe could have been significantly minimised. I have written about this elsewhere (www.richardbj.co.uk/blog/covid-19.html).


Now we have to consider the notion of easing the lock down. This requires its own Risk Analysis.  It has two components:


  1. Health Risk stemming from easing the lockdown
  2. Economic Risk from not easing the lockdown

 

Risk analysis involves scoring the risk of something happening and the effect of it’s occurrence. So the risk of covid-19 spreading and the effect of that spread. Each are scored on a scale 1-5 with 1 lowest and 5 highest. The scores are multiplied to get a risk score.

 

 

  1. Health Risk stemming from easing the lock down


The consideration needs to be made as to which areas of the lock down can be eased with minimal impact on health risk. It seems reasonable to take the view that those areas where there are lots of close contact are the areas where lock down should not be eased. Three areas are considered below, there will be others.


Reopening businesses


 So whilst there may be a case for certain businesses re-opening, those where people are in close contact are not those to be eased first, such as barbers, nail parlours, restaurants and other social settings. These are high risk environments. So the risk of covid-19 spreading in such environments is high, probably 4. It would not be 5, the highest score has to be kept for NHS and care home settings. The proximity of people with the possibility of a person carrying the infection is high, particularly where we have poor levels of testing for people to know whether they are asymptomatic or pre-symptomatic carriers. The risk stemming from contracting the virus is also high. Not everyone dies, of course, but the risk is there. So it might be reasonable to score the effect as 4, and higher for vulnerable at risk groups.


Businesses that are in large spaces may be less of a risk for spreading the virus if social distancing can be maintained. However, open plan offices where there are no barriers between people could pose a higher risk than office spaces where people are more partitioned off from each other.

Smaller shops and business may be a higher risk because social distancing may be more difficult to achieve.


Re-opening schools


It was an issue whether to close schools, and now the issue is whether it is safe to re-open. From a health perspective the risk remains the same as it was when they were closed. We have not tested enough to know who is carrying the virus into schools which by their nature cannot maintain social distancing. Teachers and school staff are therefore put at risk, as are the families of children who may take the virus home. So re-opening schools from a health perspective must carry high risk, again 4 for the risk of spreading, possibly even 5 for the lack of social distancing, and 5 the effect of that spreading. So a 25 total makes a very high risk.

 

Family visits


Allowing members of families to visit each other has been given significant importance within the lock down. Where people had been out and in contact with others or in environments where infection was likely, this made sense. And where people continue to need to go out to shop there is risk if they then visit family members who are in self-isolation. So the risk has not changed. However, where people have self-isolated for 2 weeks, are not going out shopping etc but are having deliveries, then they are not at risk to others and in these cases a relaxing of the lock down would seem reasonable. Their risk of having the virus is much lower and so their risk of spreading is much lower, maybe 2 or 3. The risk from the spread though remains high in particular if they are visiting vulnerable relatives, but the score is likely to not be above 15, so a much more manageable risk.

 

     2. Economic Risk from not easing the lockdown


The risks to the economy of not easing the lock down relate to people keeping their jobs, businesses managing to survive, reducing the risks to health and well-being of people who not only lose their jobs but also their homes. Government has sought to minimise some of these with financial support, but businesses can only remain inactive for so long. Not easing the lock down risks the national and individual economies stagnating and bring the problems highlighted above.


Re-opening business is to some degree reliant on schools being reopened to release parents to go to work. So you have a very clear balance to strike between risk to health and risk to economy when it comes to school reopening.

Re-opening businesses also means more travel and for many people that means public transport. This was very likely a major factor in the spread of covid-19. It would be again is large numbers of people are packed on to buses and trains to attend work. The risk to health is high, and the risk of triggering a second lock down is clear.


Mass gathering of any kind have to be well down the list of what is safe to return to with an easing of the lock down. Not only are they unlikely to be able to maintain social distancing, but there are travel issues that risk the spread of the virus.

 

     3.Testing


The need for testing so those with immunity can be identified as fit to travel to work, fit to attend school, fit to visit relatives is vitally important. In fact reducing the risk from an easing of the lockdown is largely dependent on two things: maintaining social distancing and the provision of widespread testing. The first as we have seen is possible in some settings, but less so in others. The second is being addressed but the capacity is well short of what is needed to ease the lock down significantly enough to start getting the economy moving again. It would require all working people to be tested, and we are a long way from this.

 

     4. Conclusion


We cannot rush into an easing of the lock down without thinking it through, weighing up the risks, and putting in places measures to address identified heightened risk where it is identified. It cannot be done on a whim, or for political reasons. Countries are easing different areas but there does not seem to be any clear and consistent rationale as to what is happening. I can only hope that Governments will take seriously the need to undertake Risk Analysis of the lock down easing options and to take a measured and informed, step-by-step approach with constant monitoring to ensure if covid-19 spread increases then lock down actions can be put in places once again.



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Covid-19 - Relaxing the lockdown and minimising risk

Richard Bryant-Jefferies

16th April 2020


t is important to talk about and plan for relaxing the lock down but it is something that we are not anywhere near implementing, and certainly not before the May bank holidays.


To relax the lockdown you have to be clear for whom it can be relaxed. There are four groups of people across the country:


1.. Those who have had the virus and have immunity - though it seems there may be a question of how much immunity having its is giving you

2. Those who currently have the virus and are infectious, some of whom are presymptomatic or asymptomatic

3. Those who haven't had the virus but are not in an at risk group
4. Those who haven't had virus and are in an at risk group.


Reasonably it is those in group 1.who have some immunity who should be the first to be released from the lock down. But without mass testing, who are they? 


Can we take the risk with the other groups? You can't release those in grouop 2. who are infectious from the lock down. But again without mass testing and so many asymptomatic carriers, how can we know who they are?


Clearly those in groups 3 and 4 are those most at risk from the esaing of the lockdown.


Mass Testing


Mass testing of 100,000 a day is nowhere near enough. That's only 3 million a month. We are talking about much more than that if we are to get those who are immune identified and back to work. We have a population of nearly 70 million. A million a day is the probably impossible testing rate that is needed.


We are nowhere near having the information needed to start relaxing the lock down. Any risk assessment on this happening in the next few weeks would tell you that the risk of triggering it off again is very high.


Identifying and managing risk


Any published Government Strategy must include a robust risk analyisis. 


Even if you relaxed the lock down but sought to maintain social distancing, people will be traveling once again and public transport will be a high risk setting if you haven't had the mass testing to identify those with immunity. And let's not forget that those who are immune can still carry it and deposit it on surfaces.


We could quickly be back to square one.


So it has to be a staged and slow process with robust monitoring at every step. But the key remains testing. Only that will give us the information needed to have any hope of a planned and relatively safe relaxation of the lock down. And at the moment we are no where near the capacity required for this, and do not appear to have plans to test to that capacity.


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A Risk Management Perspective on Covid-19 spread

Richard Bryant-Jefferies

6th April 2020

 

From the start of the covid-19 spread it would appear that little analysis was undertaken from a risk management perspective. Risk management input would have provided a very different response to the one we have seen, demonstrating a different set of priorities with potentially different outcomes.

At the beginning of February 2020 it was clear that there was a very contagious virus which, if not contained, was going to spread fast. We knew this from what was happening in China. At that point we needed to undertake a risk analysis of the virus reaching our shores and the impact it would have in order to identify and prioritise actions.


A simple risk analysis model considers two variables:

  1. The likelihood of something occurring
  2. The negative effect of that something


On a scale of 1-5 with 5 being the highest, you measure likelihood and the negative effect, you then multiply them together to find the risk and impact of that something occurring. Anything over 16 is definitely in need of being addressed immediately.


1. The likelihood of something occurring


In February we needed to consider the likelihood of Covid-19 reaching our shores. At that time we had no international travel restrictions, we had a half term holiday coming up, and we had no significant systems in place for testing people coming into the country. Planes were not routinely deep cleaned and were travelling across different routes around the world optimising the opportunity for spread.


The thinking at the time was to test for symptoms. There was no erring on the side of caution that the pre-symptomatic could spread it, or that there was a high level of asymptomatic infection.


We knew from China that the virus was highly contagious. It was out there and from a risk perspective it was reasonable to infer that it would get here. There was no reason why it wouldn’t, there were no barriers in place and there was a lot of international travel about to take place during the half term break. It was therefore not unreasonable to assign a risk factor of 5 to the likelihood of Covid-19 reaching us.


2. The negative effect of that something

 

The something occurring is, of course, the spread of Covid-19 and the impact that it has on human health. We knew it was contagious. We knew it was killing people, particularly but not only, the elderly and those with underlying health issues. It was clear that if it arrived without some kind of robust containment, the effects would be disastrous. We knew that to contain you had to have control of its entry and you had to delay its entry. Delay first, then you give yourself a chance to contain. So it is reasonable to assign a risk score of 4 to the impact of Covid-19 on people’s health. Not 5 as that would be reserved for something that would kill everyone.

 

3. Risk score and effects

 

So multiplying the two together would have given us a risk score of 5x4=20.  That should have necessitated immediate action.

 

Step 1. Actions to block or delay it coming into the country

Step 2. Containment of where it gets through

 

We did not act. Therefore we could not contain. We are living the effects.

 

Had we acted immediately we might have blocked, delayed and then contained the virus, buying us time to find a vaccine. It would have involved a lengthy ban on international travel, but it was feasible and in terms of the human cost, worth a try. But because of our inaction we took this option off the table.

 

We left ourselves with the second option which was let it in, then try and contain it in order to delay it overloading the health service. The lockdown was aimed at delaying the spread, particularly to the vulnerable. It seems to be having that effect. At the same time having let it in we are also allowing herd immunity to become our main weapon in containing it into the future.

 

4. The Future

 

Relaxing the lockdown is now being considered for some point. It has to be planned. It has to be step by step. The risk of opening up a further spread of the virus is clear.

 

Relaxing it too soon and we will have a spread risk of 5 again, and the same risk of 4 as to the effect of the virus on health. We will in effect be back to where we started. We cannot allow this to happen. We have to learn from our mistake.

 

So we have to err on the side of caution and lockdown as long as we can, certainly until after the second May Bank holiday when people will be tempted to travel around the country. And when it is lifted it has to be strictly controlled. We have to have the testing in place to know:

 

  1. who has the antibodies and is immune,
  2. who is currently infected
  3. who has not had the virus and is therefore at risk of getting it.

     

    The relaxing of the lockdown will have different meanings for different people. We had to have a virtually one size fits all approach because it was out of control and we didn’t have any way of knowing who was in which of the above three groups. But we can be more selective if we take the different risk factors for these three groups.

     

    We have to keep the borders controlled for longer. We do not need more virus brought in, we have let enough in and we have seen the effect. And of course we don’t want to be taking it ourselves out into the world.

     

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    How we got to where we are with Covid-19

    Richard Bryant-Jefferies

    14th March 2020


    This is perhaps a good time to reflect upon the actions and the inations that have brought us to the current situation of covid-19 being out of control within the UK.


    From the start it was clear from the rapid increase in cases and deaths in Wuhan that covid-19 was infectious and could be deadly, particularly to certain at risk groups. As it escaped beyond China’s borders it was obvious that it was going to travel wherever people were travelling. But we did nothing other than offer people with symptoms coming into the country to get tested. Were planes being deep cleaned routinely? Are they now? We did not grasp that this was not a case for symptom management, but risk management.


    So we continued to fly people into the country carrying covid-19. Some we quarantined en masse. We had no idea whether asymptomatic carriers were infectious, but we ignored the risk that they might be. The genie was out of the bottle and we were flying bottles in with the stoppers already out. It was inevitable that passenger flights would have to stop, but we delayed.


    There was no coherent plan until very recently. Contain and delay. I shake my head. The plan was back to front. We did not delay the spread of covid-19 into the UK, and now it was beyond containment. Had we stopped flights and ferries, had we not only tested symptoms but quarantined those in contact on flights, we might have delayed its spread. The numbers might have been such that containment could have worked. But not now.


    The Government tells us we have to wash hands with soap. Yes. But what of washing our faces with soap straightaway afterwards because our faces are also exposed to airborne droplets?


    Psychologists tell the government not to postpone large gathering and events, not to encourage blanket self-isolation and lock-downs because people cannot cope with this. Where is their data? Where is the scientific basis for not trusting the people to do the right thing? When was the last pandemic that they are drawing their data from? We’ve still ended up cancelling or postponing events. If we had done it earlier we might have delayed the spread to give containment a chance.


    Stockpiling is pilloried, but if you want people to self-isolate you have to stockpile. The more you reduce your need to go out to the big supermarkets, the more you minimise the risk of being infected or infecting others.


    So here we are today with covid-19 out of control. The British people are not trusted to be able to cope. The NHS, already overworked, does not have the staff, equipment and space to cope. And the ones who will suffer the most are the elderly and the ill, the most vulnerable.


    I heard an ‘expert’ saying on the radio how people were now being encouraged not to phone 111, but go online. The most vulnerable elderly are the group most likely not to have online access, and are the age group that don’t want to trouble people, or think there is always someone in more need than themselves. They do not need a barrier to seeking help.


    The litmus test of a good Government is how their actions and inactions impact on those most vulnerable in our society.


    I expect a vote of no confidence in Parliament in the not too distant future.


    *****