The Thin End

Celebrities can spread false news like a virus a new study shows.  During the COVID-19 pandemic, misinformation about symptoms, vaccines and infections rates has been rife. New research published in Online Social Networks and Media investigated the authors, content and propagation of this 'infodemic'. Using data from over 92 professional fact-checking organizations between January and July 2020, researchers analyzed 1,500 false or partially false tweets that spread misinformation about the COVID-19 pandemic.  Celebrities are a major source of false information, as they are more likely to be liked and shared by many followers.  The results revealed that false claims spread faster than partially false claims and are generally focused on discrediting other information. The research found that brands (either organizations or celebrities) were involved in 70 per cent of the false information claims either through liking or retweeting false information. The study even identifie...

The Thin End has referred to the 'hidden' health cost of the COVID pandemic in previous articles.  Clearing the decks to prevent the National Health Service being overwhelmed meant that others had their diagnosis and treatment put on hold.  What the government should do now is to learn the lesson to build resilience into the system.  Else, we are saving the lives of those directly affected by a pandemic while allowing the health and lives of others to be lost.  This has been particularly evident in cancer services.  It is challenging to see the real ethics of that choice.  Sacrificing Peter to save Paul is not the best approach.   On the contrary, it had all the hallmarks of a panic response.  NHS England has now prioritised cancer services, but an analysis produced this month by The Institute for Public Policy Research (IPPR) says that the UK government must now use the opportunity of restarting cancer services in the NHS to "build back better." ...

The upsurge in COVID-19 cases in Spain serves as a timely reminder that we are not out of the woods. The UK government acted swiftly to impose a two week quarantine period for people arriving from Spain. The latest advice from the Foreign and Commonwealth Office (FCO) states that travellers returning to England, Scotland, Wales, or Northern Ireland from anywhere in Spain after July 26 needed to self-isolate for 14 days. It would be wrong to consider that the problem is a Spanish one. It isn't. As the Prime Minister acknowledges, there are signs of a second wave across Europe. We can hope that with speedy action it can be contained. Certainly,  we need to be vigilant and ready to act decisively in the UK. The test, track and treat are vital in ensuring a speedy and effective response. The Thin End COVID lockdown diary is out now on Kindle.  " It became clear from the beginning of the COVID Pandemic that many countries were ill-prepared for the task. This was undoubtedly tru...

The UK government incompetency has cost lives.   So many voters invested their hopes in Prime Minister Boris Johnson.  That hope has been cruelly dashed.  It will take time for this to impact in opinion polls, although the first signs of shifting public opinion are there. The Leader of the Labour party, Keir Starmer, now offers a different style of leadership.  The contrast is stark.  The rambling, incoherent dishonesty of Boris Johnson, or the clear, inciteful, yet compassionate approach of Sir Keir.   The one evokes doubt and uncertainty; the other, confidence in an ability to deliver. Faithfully doing as they were advised, UK citizens have been suckered into a strategy to protect, not the NHS, but the Tory government. Thousands of lives have been lost in so doing.  That is the tragedy. So many voters put their trust in Mr Johnson as the Prime Minister to deliver Brexit.  However, it is now apparent, he had little else to offer.  Of c...

The Leader of the Opposition, Keir Starmer, was right to question the Prime Minister on Care Home deaths. Our loved ones in care homes should have been kept safe.  A new report today finds that the number of people dying from COVID-19 in care homes is double the figure given by the government. The government's advice up to 13th March was that there were unlikely to be infections in care homes. This conclusion could not have been based on scientific advice.  What logic were they applying? There is no reasoning in science why a virus would behave differently because it is in a care home! A virus has no idea it is in a care home! Did they think older people were immune if they were in care homes? The government was slow to understand the problem we faced, slow to act, and still refuses to publish the advice it receives. The consequence in our care homes has been catastrophic. The government should come out of its self-congratulatory mode and start listening. The j...

Test, track and treat must be an essential ingredient coming out of COVID-19 lockdown.  This was acknowledged by the British Prime Minister, Boris Johnson, in his statement to the House of Commons today spelling out a little more detail of the strategy moving forward.  With more testing, it will be possible to predict at a more localised level in the community where infections will spread and target both community testing and more social interventions on high-risk areas in the future.  This might then prevents further national lockdown in response to any rebound of the virus.  The Prime Minister rightly refers to the R-value in informing strategy. It represents the rate of infection - or how many people can be infected by another.  At the outset, this was above 3, and anything above one means a dramatic increase in infections and deaths.  The Prime Minister also, on that basis, is right that there might be a need for differences in approach in di...

Following the PMs address this Sunday.  I have found no need to alter my earlier assumption that "the government strategy is to not have a strategy." I have come to the conclusion that the government doesn't have a strategy for easing lockdown and we, the public, are going to make it up as we go along. So, I hope you all have the appropriate skills to consider the risks. Why did the Prime Minister not make a statement earlier? He has added only confusion, where once we had clarity.  They are attempting to come out of lockdown by stealth, without testing, so we have no idea where the virus is. We have, instead, a vague ambition to increase testing. Meanwhile we will all be at risk if people are going out more and going back to work. The message was that we should stay at home and socially distance to 'save the NHS'. The truth of that is that it wasn't about saving lives, which is why initially the figures we were given didn't include deaths in care homes...

In a major survey of frontline NHS doctors since the Coronavirus crisis began, over 16,000 UK doctors1 have responded to a BMA survey, answering questions on PPE provision, their well-being and drug shortages. The survey shows that overall, nearly half the doctors say they had to source their own Personal Protective Equipment, PPE,  for personal or departmental use, or they have relied upon donations. Breaking it down by profession, the majority, at 55%, are GPs with 38% being hospital doctors. Dr Chaand Nagpaul, BMA Council Chair said: “In what is the biggest survey of frontline NHS staff during this crisis, thousands of doctors have told the BMA that they have had to personally buy PPE for themselves or their department or rely on donations. 55% of GPs told us they sourced their own PPE or relied on donations and 38% of hospital doctors." While it shows how resourceful doctors have been and how much support there has been from the general public in providing ...

He is back. UK Prime Minister, Boris Johnson, is back at the helm following his illness with COVID-19. At the media conference this evening, he seemed to have much of his old bounce. He had at least some good news. The UK is now turning the corner in its struggle with COVID-19. The curve of deaths appears now in a downward direction. The UK has passed its peak of COVID-19 deaths, and this is all good news. We now have a better idea of the numbers of COVID-19 deaths because we are no longer merely counting those in hospitals. Testing has undoubtedly gone up, even if it hasn't reached the target of 100,000 set by the Health Secretary. The emphasis is now turning to reduce collateral deaths (from cancer, heart disease, etc.) due to patients not accessing vital health care. We still don't know how many may die as a result of this. This needs more effort and should be a key factor now and in coming out of lockdown. It would be wrong to sacrifice cancer patients and others. After...

The UK government won't tell us who sits on the body advising them on how to deal with the COVID-19 pandemic. It isn't surprising because what we do now know is that it lacks critical expertise in virology, immunology. This lack of expertise certainly shows at the daily media briefings, which seem more to do with putting a government spin on stories than revealing what is happening. To the greatest extent, we are being kept in the dark. Take today, for example. The Health Secretary Matt Hancock came up with this shockingly misleading statement. He told us that “The UK has already gone past the number of tests per day for instance that they carry out in South Korea, we’re approaching the levels that Germany undertakes" This just is not the case by any reading of the statistics. The UK’s daily testing average over the past week has been just shy of 23,000 tests a day. Germany has been carrying out 450,000 tests a week, according to its foreign minis...

The virus vector for COVID-19 pandemic is a novel zoonotic coronavirus,  SARS-CoV-2,  most likely originating from bats.  One problem in combating the virus is that we know so little about it.  We don't know, for example, whether any immunity developed in humans will last, or how long it will last.  Nor do we know to what extent it jumps from species to species.  Is it possible that our livestock, or our domestic pets,  will become infected?   Whether SARS-CoV-2 can also infect other animal species is being investigated by various research institutes worldwide. The Friedrich-Loeffler-Institut (FLI) started infection studies in pigs, chickens, fruit bats, and ferrets several weeks ago.  First results show that fruit bats and ferrets are susceptible to SARS-CoV-2 infection, whereas pigs and chickens are not. The susceptibility of ferrets in particular is an important finding, as they could be used as model animals for human infection...

While the UK Government is not doing enough, our doctors and nurses are struggling at the frontline. Some are losing their lives to COVID-19. Instead of addressing the issues, the government are asking doctors and nurses to use personal protective clothing in ways that are considered dangerous. The Royal College of Surgeons has issued a statement saying that doctors should not be coerced into putting their lives at risk. Meanwhile, doctors and nurses are being gagged from speaking out about the shortages. Responding to criticism that Prime Minister Boris Johnson missed five emergency COBRA meetings, the Education Secretary said at the press conference today, Sunday: "This is a whole government effort. We are doing everything that is required, everything that is needed." Well, what is needed is PPE and testing, among other things, and on both these fronts the government is failing to do everything required. Our doctors and nurses are being asked to put their lives at f...

Doctors should not be coerced into risking their lives if there is a shortage of PPE, says the Royal College of Surgeons in response to the new PHE guidelines on PPE. Instead of addressing the dangerous shortage of PPE, the guidelines are being changed to enable levels of protection to be reduced. This is unacceptable. Professor Neil Mortensen, President-elect of the RCS, said: “We are deeply disturbed by this latest change to PPE guidance, which was issued without consulting expert medical bodies. After weeks of working with PHE and our sister medical royal colleges to get the PPE guidance right, this risks confusion and variation in practice across the country." It is utterly disgraceful that the new guidelines have been introduced without consultation of health care representative bodies.   Professor Mortensen continues:  “The new guidance implies that, even in the operating theatre, surgeons and their teams may not require proper PPE. This is simply unac...

As we move to the 'surge stage' in the coming weeks of COVID-19 deaths in the UK, we do need to get more detailed information on deaths outside hospitals. This week the Office for National Statistics reported the highest total number of deaths since ONS weekly death reporting began in 2005.  That gives us some idea of what the underreporting of COVID-19 deaths might be. It is extremely difficult to be sure.  One question is to what extent the virus is the cause of deaths that would not have happened without an infection, and to what extent it is hastening deaths that would have occurred in any event.   The provisional number of deaths registered in England and Wales in the week ending 3 April 2020 (Week 14) was 16,387; this represents an increase of 5,246 deaths registered compared with the previous week (Week 13) and 6,082 more than the five-year average.   COVID-19 was mentioned in 21.2% of all deaths registered in that week - a significant ...

Reports today that the UK government have decided not to go ahead with the plan to get ventilators manufactured by Formula 1 teams like Renault and Red Bull. Ventilation of the lungs isn't like filling a balloon with air. The use of PEEP, positive end-expiratory pressure, isn't how the lungs function usually.  Inflation of our lungs occurs by developing a negative pressure in the thorax by contracting the diaphragm and raising the muscles between our ribs. This both keeps the air sacs (alveoli) open and inflates them, producing airflow. It is the negative pressure compared to the air surrounding us that pulls air into the lungs.  The air moves down the pressure gradient.  Applying a pressure inside the air sacs can cause damage t o the delicate lining leading to pulmonary oedema and worsening hypoxemia that can prolong mechanical ventilation, this can then lead to multi-system organ dysfunction, and increased mortality.  Not all COVID-19 patien...

The UK government has now published its plan for Personal Protective Equipment) for frontline health workers. The plan incorporates 3 strands for guidance, distribution and future supply.  It seems to follow the kind of line adopted by the Health Secretary when he urged doctors and nurses to treat PPE as a 'precious resource' and not to misuse it.   This wasn't well-received by bodies representing the various strands of Health Care workers, not least the Royal College of Nurses.  The plan instead restates the obvious.   1) guidance: being clear who needs PPE and when, and who does not, based on UK clinical expertise and WHO standards. This will ensure workers on the frontline are able to do their jobs safely, while making sure PPE is only used when clinically necessary and isn’t wasted or stockpiled 2) distribution: making sure those who need PPE can get it and at the right time. The government will ensure those who need critical PPE receive...

If health care resources and staff are stretched to the limit, difficult life or death choices must be made.  Who to treat? That will be the question. At ordinary times decisions might be made based on whether treatment will do more harm than good.  It might even be the patient who decides.  End of life decisions are more often like that.  Will further treatment help? But these are not regular times. The British Medical Association guidance on pandemics says "In dangerous pandemics the ethical balance of all doctors and health care workers must shift towards the utilitarian objective of equitable concern for all – while maintaining respect for all as ‘ends in themselves’." If resources are spent on saving the life of one person at the expense of many others, how then is that balance to be made? One thing is sure.  Our actions are also part of this ethical mix.  Our efforts will determine whether or not the anticipated surge in those requiri...

Scientists across the globe are searching for a vaccine against the virus that causes COVID-19.  Let's applaud them too. A vaccine for the COVID-19 virus is still said to be 'a long way off' with best estimates being early next year.    The first potential vaccine entered clinical trials on 16th March 2020.  Vaccines cannot be conjured with a magic wand. Ordinarily, vaccines can take up to ten years to produce. The first Ebola vaccine took five years, and that was considered fast. The imperative is now to find a COVID-19 vaccine a lot faster.   Teams across the world a working flat out developing and testing possible agents. One reason it usually takes so long is what is termed the attrition rate - that is, the number of potential vaccines that don't make it through trials. The failures could be hundreds.  Safety and effectiveness are of paramount importance, and that means rigorous testing. The production of a vaccine isn't what we see in t...

There is some good news on the horizon.  The government might meet its target of 100,000 tests for COVID-19 by the end of the month. Testing is vital to bringing us all out of lockdown, getting people back to work, and gradually returning to normality. The US company producing the tests here in the UK has ramped up the facilities for its manufacture.  But initially, the tests will be for the antigen, indicating whether someone has got the virus.  We also need to test for the presence of antibodies, showing whether someone has had the infection and has developed an immunity. Meeting the testing target offers hope that the lockdown can be released gradually, perhaps first, with those who have recovered from the virus. Slowly, people can get back to work, getting the economy moving once again and critically enabling key health workers to return to the frontline. One thing the lockdown has demonstrated is just who our key workers really are.  The many we...

It is said that COVID-19 doesn't discriminate. This isn't strictly true. If you live in poor housing conditions and overcrowding you are more likely to be affected by the virus. More than a quarter of a million households in the UK are living in overcrowded private rented housing. 300,000 households are squeezed into inadequate social housing. People living in poor housing are more likely to have underlying respiratory conditions, more likely to find social distancing difficult. It will be more difficult to maintain hygiene levels. More overcrowding means greater stress and mental health issues. Little of the problem of overcrowding is being addressed by the government, and there is little to no help being offered to help these families cope with the COVID-19 lockdown. Poor housing conditions and overcrowding has increased over the last decade as the most vulnerable have been affected by austerity.  This is why we have said before that austerity kills.  It increa...