{"id":17,"date":"2020-12-07T09:26:00","date_gmt":"2020-12-07T09:26:00","guid":{"rendered":""},"modified":"2021-03-24T09:23:46","modified_gmt":"2021-03-24T09:23:46","slug":"covid19-winter-update","status":"publish","type":"post","link":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/2020\/12\/07\/covid19-winter-update\/","title":{"rendered":"COVID19 winter update."},"content":{"rendered":"<p><span style=\"font-family: arial;\"><b>SUMMARY<\/b><\/span><\/p>\n<\/p>\n<ul style=\"text-align: left;\">\n<li><span style=\"font-family: arial;\"><b>December&#8217;s tiers are more strict than many expected<\/b><\/span><b style=\"font-family: arial;\">.<\/b><\/li>\n<\/ul>\n<ul style=\"text-align: left;\">\n<li><b style=\"font-family: arial;\">The &#8220;curve may have been flattening&#8221; before the lockdown began &#8211; why?<\/b><\/li>\n<\/ul>\n<ul style=\"text-align: left;\">\n<li><b style=\"font-family: arial;\">Do Lockdowns work? Yes!<\/b><\/li>\n<\/ul>\n<ul style=\"text-align: left;\">\n<li><b style=\"font-family: arial;\">Other factors affecting the pandemics behaviour.<\/b><\/li>\n<\/ul>\n<ul style=\"text-align: left;\">\n<li><b style=\"font-family: arial;\">Tiers bases on smaller areas and more tiers would help.<\/b><\/li>\n<\/ul>\n<ul style=\"text-align: left;\">\n<li><b style=\"font-family: arial;\">Mass testing has&nbsp;colossal&nbsp;costs for few benefits<\/b><\/li>\n<\/ul>\n<ul style=\"text-align: left;\">\n<li><b style=\"font-family: arial;\">The financial hardships will need new political thinking<\/b><\/li>\n<\/ul>\n<p><span style=\"font-family: arial;\"><b><br \/><\/b><\/span><\/p>\n<h3 style=\"text-align: left;\"><span style=\"font-family: arial;\">Introduction<\/span><\/h3>\n<p><span style=\"font-family: arial;\">So here we are again with a new set of restrictions which for 55 million people in the UK are about as severe as the lockdown in place since November 5th. After a month of Lockdown 2, many people were expecting to be rewarded with more ability to socialise and for economic activity to resume, but this has not materialised. Only Cornwall has escaped the top two tiers as the picture shows &#8211; expect lots of traffic west across the border for a night out with friends?<\/span><\/p>\n<table cellpadding=\"0\" cellspacing=\"0\" style=\"float: left;\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-va-kwHb4usw\/X8PlzPKBL5I\/AAAAAAAABCE\/uxEqIF1XCzsRqgyHLmfikhfxobPAzyXawCLcBGAsYHQ\/s620\/tiers.jpg\" style=\"clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"620\" data-original-width=\"615\" height=\"200\" src=\"https:\/\/1.bp.blogspot.com\/-va-kwHb4usw\/X8PlzPKBL5I\/AAAAAAAABCE\/uxEqIF1XCzsRqgyHLmfikhfxobPAzyXawCLcBGAsYHQ\/w198-h200\/tiers.jpg\" width=\"198\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\"><span style=\"font-family: arial;\"><b><i>UK tiers!<\/i><\/b><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-family: arial;\">For many it is disappointing that so many restrictions remain in place in so many areas where the R0 is less than 1 and also with the NHS coping at the moment after the early peak and localised problems in the North.<\/span><\/p>\n<p><span style=\"font-family: arial;\">This time there are more complaints with many&nbsp;Conservative&nbsp;MP&#8217;s rebelling as they find their leafy rural constituents lumped in with the more affected urban neighbours. The Labour Party and Green Party, MP Caroline Lucas have abstained, finding themselves in a position of acknowledging the need for further restrictions, though not able to vote for the governments way of imposing them.<\/span><\/p>\n<p><span style=\"font-family: arial;\">Personally, I had hoped the proposals did not get through parliament and that the Government then have to think again about how to proceed with restrictions and support. For many <a href=\"https:\/\/www.youtube.com\/watch?v=8x6eSZA90M4\" target=\"_blank\" rel=\"noopener\">online punters,<\/a> of course, restrictions have been a terrible infringement on our freedoms with little benefit. It seems to me that some clarity is needed.&nbsp;<\/span><\/p>\n<h3 style=\"text-align: left;\"><span style=\"font-family: arial;\">What the data shows<\/span><\/h3>\n<p><span style=\"font-family: arial;\">The governments own data shows that this winter curve, so far, looks smaller, though may ultimately be wider than the spring wave. There are reasons for this. First of course, are <\/span><span style=\"font-family: arial;\">the earlier local restrictions in the north<\/span><span style=\"font-family: arial;\">&nbsp;where the second wave was at its worst. So, the flattening of the curve started before Lockdown 2 from November the 5th, (arrow) and resulted from local action in the areas hardest hit &#8211; again crowded, polluted cities, in areas with more poverty and those who suffered less in the first wave.&nbsp;<\/span><span style=\"font-family: arial;\">.<\/span><\/p>\n<table align=\"center\" cellpadding=\"0\" cellspacing=\"0\" style=\"margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-knUrnW3o8Yc\/X8C0JDmz2pI\/AAAAAAAABBM\/EzCUfMPR2pI0BAPPHtu9bmEQDfNrl6gVQCLcBGAsYHQ\/s2048\/cases%2Bwith%2Barrow.png\" style=\"margin-left: auto; margin-right: auto;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"1266\" data-original-width=\"2048\" height=\"248\" src=\"https:\/\/1.bp.blogspot.com\/-knUrnW3o8Yc\/X8C0JDmz2pI\/AAAAAAAABBM\/EzCUfMPR2pI0BAPPHtu9bmEQDfNrl6gVQCLcBGAsYHQ\/w400-h248\/cases%2Bwith%2Barrow.png\" width=\"400\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\"><span style=\"font-family: arial;\"><b><i>Positive test trends<\/i><\/b><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-family: arial;\">After positive tests come hospital admissions, the most important measure when it comes to decision making. These can be expected to lag behind the trends for positive tests by a week or two and suggest that the restrictions have been effective.<\/span><\/p>\n<table align=\"center\" cellpadding=\"0\" cellspacing=\"0\" style=\"margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-Ln2kNk3vCgM\/X8CyydLUanI\/AAAAAAAABBA\/QHXkafmYnQofngVt3PFGhwTHt8xFzZVcgCLcBGAsYHQ\/s2048\/admissions%2Bwith%2Barrow.png\" style=\"margin-left: auto; margin-right: auto;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"1266\" data-original-width=\"2048\" height=\"248\" src=\"https:\/\/1.bp.blogspot.com\/-Ln2kNk3vCgM\/X8CyydLUanI\/AAAAAAAABBA\/QHXkafmYnQofngVt3PFGhwTHt8xFzZVcgCLcBGAsYHQ\/w400-h248\/admissions%2Bwith%2Barrow.png\" width=\"400\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\"><b><i><span style=\"font-family: arial;\">COVID19 Hospital admissions trends<\/span><\/i><\/b><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div><\/div>\n<p><span style=\"font-family: arial;\">In Plymouth, for example, at that point there were about 100 people with COVID19 in Derriford hospital &#8211; to the naysayers that might not seem like a huge number as the hospitals catchment area includes 400,000 people, but it means there are three wards full of people with a complex multi-system disease in addition to the normal winter pressures. &nbsp;<\/span><\/p>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">This time lockdown has not brought a reduction in A+E attendances and the hospitals are desperately tying to maintain normal services, so enormous pressures exist.<\/span><\/p>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Following the national pattern, cases are clustered in our crowded cities and less marked in the smaller Exeter and Torquay. I can imagine the incredible challenge this represents on the ground, particularly when&nbsp;<a href=\"https:\/\/www.devonlive.com\/news\/devon-news\/hospital-staff-coronavirus-cases-devon-4696705\" target=\"_blank\" rel=\"noopener\">staff absence<\/a>&nbsp;<\/span><span style=\"font-family: arial;\">due to positive testing and illness&nbsp;<\/span><span style=\"font-family: arial;\">is<\/span><span style=\"font-family: arial;\">&nbsp;as high as 20% in some hospitals.<\/span><\/div>\n<div>\n<h3 style=\"text-align: left;\"><span style=\"font-family: arial;\">More evidence &#8211; on one hand&#8230;..<\/span><\/h3>\n<div><span style=\"font-family: arial;\">The <a href=\"https:\/\/covid.joinzoe.com\/about\" target=\"_blank\" rel=\"noopener\">COVID Symptom tracker<\/a> at Imperial College is a trailblazer. This maps out viral activity in the community. They report numbers on the basis of self reporting of those with symptoms and a positive test and their numbers are in accord with ONS data.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">They too report an early flattening of the curve, with a peak before November. Again the arrow points to the introduction of Lockdown 2.<\/span><\/div>\n<div><span style=\"font-family: arial;\">&nbsp;<\/span><\/div>\n<div>\n<table align=\"center\" cellpadding=\"0\" cellspacing=\"0\" style=\"margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-36OOifgRVq0\/X8IMp2OIXiI\/AAAAAAAABBs\/4RXQi_IT6OgcHneU60xwwFngYi64TrOXwCLcBGAsYHQ\/s1069\/zoe4.png\" style=\"margin-left: auto; margin-right: auto;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"489\" data-original-width=\"1069\" height=\"183\" src=\"https:\/\/1.bp.blogspot.com\/-36OOifgRVq0\/X8IMp2OIXiI\/AAAAAAAABBs\/4RXQi_IT6OgcHneU60xwwFngYi64TrOXwCLcBGAsYHQ\/w400-h183\/zoe4.png\" width=\"400\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\"><b><span style=\"font-family: arial;\">COVID19 cases<\/span><\/b><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><\/p>\n<div style=\"clear: both; text-align: center;\"><\/div>\n<\/div>\n<div><span style=\"font-family: arial;\">Tim Spector, the lead scientist at the project, has put it this way&#8221;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\"><i><b>&#8220;I&#8217;m disappointed to see so many regions going into Tier 3 when the latest data suggests that symptomatic cases are continuing to fall. Our data shows that the UK R0 value is now below 1 at 0.9, mirroring ONS data, and probable reflects voluntary behaviour changes.&nbsp;Importantly&nbsp;the NHS continues to cope&nbsp;even&nbsp;with the addition of winter pressures. &nbsp;<\/b><\/i><\/span><\/div>\n<div><span style=\"font-family: arial;\"><i><b><br \/><\/b><\/i><\/span><\/div>\n<div><span style=\"font-family: arial;\"><i><b>These heavy restrictions may have greater costs to the public health than benefits. We need to consider more carefully the wider physical, social and mental health implications of excessive mandatory restrictions if they are not justified by the recent data&#8221;.<\/b><\/i><\/span><\/div>\n<div>\n<h3 style=\"text-align: left;\"><span style=\"font-family: arial;\">and on the other hand&#8230;&#8230;<\/span><\/h3>\n<div><span style=\"font-family: arial;\">Imperial is also conducting a random sample of positive PCR tests in 100,000 people in the community called REACT-1. This survery of swabs in the community reveals a similiar pattern of positivity over the time of the lockdown though with a very different conclusion:<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">They show that the lockdown has had a dramatic effect on the prevalence of COVID19.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><\/p>\n<div title=\"Page 2\">\n<div style=\"background-color: white;\">\n<div>\n<div>\n<p><span style=\"font-family: ArialMT;\"><b><i>&#8220;Three weeks into the second national lockdown in England there has been a ~30% proportionate reduction in prevalence overall, with greater reductions in the North. As a result, inter-regional heterogeneity (differences) has reduced, although average absolute prevalence remains high at ~1%. Continued monitoring of the epidemic in the community remains essential until prevalence is reliably suppressed to much lower levels, for example, through widespread vaccination&#8221;<\/i><\/b><\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div>\n<div style=\"clear: both; text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-n0UmeelgRPw\/X8TcdX_Kw9I\/AAAAAAAABCc\/NScF1rxsIh8wvQHUeKnTKpAIk4ek0h8LACLcBGAsYHQ\/s1259\/predict.png\" style=\"margin-left: 1em; margin-right: 1em;\"><img decoding=\"async\" border=\"0\" data-original-height=\"630\" data-original-width=\"1259\" src=\"https:\/\/1.bp.blogspot.com\/-n0UmeelgRPw\/X8TcdX_Kw9I\/AAAAAAAABCc\/NScF1rxsIh8wvQHUeKnTKpAIk4ek0h8LACLcBGAsYHQ\/s320\/predict.png\" width=\"320\" \/><\/a><\/div>\n<p><span style=\"font-family: arial;\">Interestingly, they do acknowledge that restrictions forcing people to stay at home adversely affects those in crowded houses where being shut indoors will lead to more cases. Measures to combat this, namely offering alternative accommodation for people who can&#8217;t effectively isolate at home have not been put into place.&nbsp;<\/span><\/div>\n<h3 style=\"text-align: left;\"><span style=\"font-family: arial;\">Does Lockdown work?<\/span><\/h3>\n<div><span style=\"font-family: arial;\">Of course it does, but I can see the arguments from both sides.&nbsp;<\/span><span style=\"font-family: arial;\">The most&nbsp;compelling&nbsp;evidence for the positive effects of lockdown include an increase in cases and infections in North America after Thanksgiving as well as the ongoing carnage in lockdown light USA. In reality, they are still in their first wave and experiencing record levels of infection and deaths from COVID19 with many hospitals <\/span><a href=\"https:\/\/www.statnews.com\/2020\/11\/19\/covid19-hospitals-in-half-the-states-facing-massive-staffing-shortage\/\" style=\"font-family: arial;\" target=\"_blank\" rel=\"noopener\">struggling to cope<\/a><span style=\"font-family: arial;\">.<\/span><\/div>\n<div><span style=\"font-family: arial;\">&nbsp;<\/span><\/div>\n<div>\n<table align=\"center\" cellpadding=\"0\" cellspacing=\"0\" style=\"margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-GQ6kl-DpUzg\/X8ycIITkxHI\/AAAAAAAABCs\/nCzjSPUbwAkCnaBrP8TUbpMJYzLgDQkUgCLcBGAsYHQ\/s2048\/usa.png\" style=\"margin-left: auto; margin-right: auto;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"1446\" data-original-width=\"2048\" height=\"283\" src=\"https:\/\/1.bp.blogspot.com\/-GQ6kl-DpUzg\/X8ycIITkxHI\/AAAAAAAABCs\/nCzjSPUbwAkCnaBrP8TUbpMJYzLgDQkUgCLcBGAsYHQ\/w400-h283\/usa.png\" width=\"400\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\"><span style=\"font-family: arial;\"><b><i>Lockdown light USA COVID deaths<\/i><\/b><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-family: arial;\">While there is more to this than restrictions: poor public health, world leading social inequality, terrible food and obesity, the sad upward march of COVID&nbsp;related&nbsp;deaths is truly Trumpian.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">But there are other factors too&#8230;..<\/span><\/div>\n<h3 style=\"text-align: left;\"><span style=\"font-family: arial;\">Why is this happening?<\/span><\/h3>\n<div><span style=\"font-family: arial;\"><b>Behaviour. <\/b>As Tim Spector says, personal behaviour makes a difference. Whatever we think of the tiers, we have pretty much all changed our behaviour in ways unthinkable a year ago. When local hospitals are filling up, many of us who can will make big changes in the way we behave and this will particularly apply to those who are vulnerable.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\">&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\">National restrictions add to this. <\/span><a href=\"https:\/\/royalsocietypublishing.org\/doi\/full\/10.1098\/rsif.2007.1197\" style=\"font-family: arial;\" target=\"_blank\" rel=\"noopener\">Social distancing<\/a><span style=\"font-family: arial;\">, the wearing of masks and hand washing make a difference to viral spread and have become the norm.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\"><b>Immunity. <\/b>Coupled with our changed behaviour, there is clearly&nbsp;immunity&nbsp;out there. This can be seen in the very low rates of recurrent infection and the lower rates in areas hit by the first wave. While levels of antibodies remain low, and fade with time, T Cell immunity is likely to be more common and longer lasting. The reason for the relatively low mortality rate compared to other epidemics, is the existence of pre-existing&nbsp;immunity&nbsp;to &nbsp;coronaviruses.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\"><b>Vitamin D.&nbsp;<\/b>I would love to think that vast numbers of people are supplementing with Vitamin D. Im sure some some are and this too will make a difference. Hard evidence of community uptake is difficult to come by and advice from our leaders is way behind the science. Lots of evidence is accumulating regarding the <a href=\"https:\/\/pmj.bmj.com\/content\/postgradmedj\/early\/2020\/11\/12\/postgradmedj-2020-139065.full.pdf\" target=\"_blank\" rel=\"noopener\">effectiveness of Vitamin D<\/a>, and we are missing the opportunity to correct this most modern of health problems in time for COVID19.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\"><b>Natural pandemic history. <\/b>The other thing of course, is the natural history of pandemics. We will only know this for COVID19 in a year or so when we look back at the now fluid graphs as they are frozen by time.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">So, what of the natural history of past global viral pandemics? The biggest one in the last century, was the 1918-20 H1N1 influenza A pandemic. This hit the world in three waves, the second bigger than the first, and was fuelled by movements of young men from all areas of the world to concentrated super-spreading military training camps. It it hypothesised that more deadly strains were selected out by the extraordinary circumstances of the war turning normal behaviour upside down in epidemiological terms.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Instead of the ill staying, and dying at home, those soldiers with mild cases were kept in action, relatively isolated at the front, while those who were ill were taken to field hospitals and then back home, spreading the disease during every phase of their journey.<\/span><\/div>\n<div><span style=\"font-family: arial;\">With little immunity from previous flu outbreaks, the 20-40 age group were particularly affected with truly terrible consequences for a world struggling to recover from war.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">The natural history of this illness can be seen from the graph below, from a <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3291398\/\" target=\"_blank\" rel=\"noopener\">review<\/a> published in &nbsp;2006.<\/span><\/div>\n<div>\n<table align=\"center\" cellpadding=\"0\" cellspacing=\"0\" style=\"margin-left: auto; margin-right: auto;\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-MUl3CJNHGII\/X8NbWTrwdII\/AAAAAAAABB4\/gQ1k_iiEoKoKxsQ1mXS4pCPPZGgPYRADACLcBGAsYHQ\/s600\/1918_spanish_flu_waves.gif\" style=\"margin-left: auto; margin-right: auto;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"308\" data-original-width=\"600\" height=\"205\" src=\"https:\/\/1.bp.blogspot.com\/-MUl3CJNHGII\/X8NbWTrwdII\/AAAAAAAABB4\/gQ1k_iiEoKoKxsQ1mXS4pCPPZGgPYRADACLcBGAsYHQ\/w400-h205\/1918_spanish_flu_waves.gif\" width=\"400\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\"><span style=\"font-family: arial;\"><b><i>1918 Influenza pandemic &nbsp;waves<\/i><\/b><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-family: arial;\">Of course, that pandemic was different, yet immunity&nbsp;built up and the pandemic ran its course, tragically leaving&nbsp;50 million dead behind it. By comparison, COVID19 is a milder infection, though at least 10 times worse than endemic flu strains, most of which have descended from the 1918 pandemic strain. COVID19 will come in waves, perhaps up to four, then fizzle out to join flu as a part of our year to year experience. To some degree this has to be what we are seeing right now. Hope that its severity will decline with time is right now, hope, not certainty.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Further, those who say we should maximise &#8216;freedom&#8217; at the expense of the &#8216;vulnerable&#8217; seem to fail to understand the dangers of overloading of a fragile, poorly prepared and understaffed NHS which can provide care for so many people and in so many ways not imaginable in those sad days after World War 1.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">However, with the costs mounting surely we could better balance the needs of the future with the present and allow more human and social activity. Perhaps based on more finely tuned, locally applied measures, and like in Scotland, a wider choice of tiers, and dare I say it again, a functioning way of providing specific advice to individuals with infection with testing and tracing.<\/span><\/div>\n<h3 style=\"text-align: left;\"><span style=\"font-family: arial;\">How could we do better?<\/span><\/h3>\n<div style=\"text-align: left;\"><span style=\"font-family: arial;\"><b>Taking Away Control &#8211;&nbsp;<\/b><\/span><b style=\"font-family: arial;\">Localism. <\/b><span style=\"font-family: arial;\">One complaint is that the county wide application of Tiers is too broad a brush. Our over-centralised approach is again reflected in restrictions applied to large areas containing very variable rates of infection. Power and control have been taken away from local councils and this politically driven phenomena is playing out with the pandemic. &nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Yet, local Authorities are better placed not only to decide on restrictions needed to keep hospitals functioning, but also to change levels on the basis of local outbreaks and hospital capacity.&nbsp;<\/span><span style=\"font-family: arial;\">That Boris feels that this would simply be too complicated for people to understand is a testament to the cobweb laden weakness of centralised diktat. Patronising is too weak a word for it.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Both lockdowns offered the opportunity to enhance testing and tracing and once again this has been sadly missed. Our testing and tracing system has morphed into a resource devouring incompetent monster. &nbsp;Mass testing comes to mind.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\"><b>Mass Testing??&nbsp;<\/b>The outcome from that chunk of the \u00a3500&nbsp;million&nbsp;spent on the Innova lateral flow tests used in the Liverpool experiment is that a few asymptomatic&nbsp;cases have been found who were less likely to be spreading the virus in any case.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Does it work?&nbsp;<a href=\"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/%22The%20Unherd%20is%20the%20pinnacle%20of%20journalistic%20anguish%20and%20confusion,%20and%20also%20a%20perfect%20example%20of%20the%20kind%20of%20media%20nobody%20needs%20any%20more.%20It%20makes%20some%20nods%20towards%20worthwhile%20things,%20like%20giving%20its%20journalists%20time%20to%20dig%20into%20stories,%20but%20there's%20no%20sign%20that%20they'll%20use%20it%20to%20come%20up%20with%20anything%20new%20or%20interesting.%20They%20say%20they%20want%20to%20present%20more%20than%20one%20side%20of%20an%20argument,%20but%20the%20whole%20thing%20comes%20across%20of%20a%20whiny%20rejection%20of%20a%20media%20landscape%20in%20which%20other%20people%20are%20talking%20over%20all%20their%20dreadfully%20important%20think-tanks\" target=\"_blank\" rel=\"noopener\">I and many others don&#8217;t think so<\/a>. The British leading the world? Innova is a odd creation: It is registered in liability-light Las Vegas, set up by an obscure investment unit in Hong Kong and makes the tests in China. As stated in the Private Eye, it is very good at lining pockets.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">The test is not without its flaws. There are few false positives (0.3%) but far more false negatives. The test missed 20% of people infected with the virus when performed by skilled staff, and surprisingly for a &#8220;simple&#8221; test, this increased to 40% for those self testing. So about half the COVID cases will slip through the big holes in this net.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div>\n<table cellpadding=\"0\" cellspacing=\"0\" style=\"float: left;\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-2uE8nHeko-w\/X8PtyanAYFI\/AAAAAAAABCQ\/tfsKA9ka76oL9Ene_t1NfXuBObJI5ox8gCLcBGAsYHQ\/s768\/mass%2Btesting.jpg\" style=\"clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;\"><span style=\"font-family: arial;\"><img decoding=\"async\" border=\"0\" data-original-height=\"432\" data-original-width=\"768\" src=\"https:\/\/1.bp.blogspot.com\/-2uE8nHeko-w\/X8PtyanAYFI\/AAAAAAAABCQ\/tfsKA9ka76oL9Ene_t1NfXuBObJI5ox8gCLcBGAsYHQ\/s320\/mass%2Btesting.jpg\" width=\"320\" \/><\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\"><span style=\"font-family: arial;\"><b><i>Testing (and spreading?) event in Liverpool<\/i><\/b><br \/><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"font-family: arial;\">Even the small false positive rate matters when the test is applied to large numbers of people, only a few of whom will be infected. For example, if 100,000 people are tested in an area with prevalence of infection of 400\/100,000, the test will give 630 positive results, though only 230 of them will have COVID19.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Like the other data above, the cases were already in decline before the army arrived to administer the tests. <a href=\"https:\/\/www.bmj.com\/content\/371\/bmj.m4436\" target=\"_blank\" rel=\"noopener\">Recent analysis shows the trial has failed<\/a>, and should be stopped.&nbsp;<\/span><span style=\"font-family: arial;\">Despite the financial resources and effort expended on weekly mass testing, Liverpool is still facing Tier 2 restrictions, so the benefits are hard to see.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Despite the lack of benefit there are plans to roll it out&nbsp;across the country, and this could cost a staggering \u00a3100 billion. This equates to \u00a33,500 for every household in the&nbsp;country. You don&#8217;t have to be an economist to gasp at the sums being delivered to the&nbsp;private&nbsp;sector without much evidence of an impact. Imagine how much more value these vast resources would have returned if invested in other sectors, for instance, restorative farming to repair the countryside or carbon capture to lead the world in sinking carbon.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Perhaps the technology would be better targeted at healthcare workers and possible students, but should really be subject to evaluation first &#8211; this must be particularly galling for the National Screening Committee, a body already set up and tasked to do this job, yet rather like primary care and local public health, not even asked. &nbsp;<\/span><\/div>\n<div><\/div>\n<div><span style=\"font-family: arial;\"><b>More tiers. <\/b>Following Scotland&#8217;s lead in having more Tiers &nbsp;to apply would also have helped. I suspect that would have been seen in Downing Street as following the SNP&#8217;s lead and thus politically unthinkable for this government. With the NHS app and technology the way it is, more flexibility of a larger number of tiers would have meant less restrictions in many areas.<\/span><\/div>\n<h3 style=\"text-align: left;\"><span style=\"font-family: arial;\">So do the costs outweigh benefits?<\/span><\/h3>\n<div><span style=\"font-family: arial;\">I admit that it&#8217;s no easy matter for politicians to plot a way out of this.&nbsp;<\/span><span style=\"font-family: arial;\">Rishi&nbsp;Sunak&#8217;s&nbsp;sunny days seem over now. Its one thing splashing the cash,&nbsp;inevitably&nbsp;popular, but another to work out how to pay it back. His recent&nbsp;financial&nbsp;statement hints at pain to come and delivers that pain now for key public sector workers already demoralised by a decade of frozen pay and worsening&nbsp;conditions.&nbsp;<\/span><\/div>\n<div>\n<table align=\"center\" cellpadding=\"0\" cellspacing=\"0\" style=\"float: left; margin-left: 1em; text-align: left;\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><a href=\"https:\/\/1.bp.blogspot.com\/-hVqk3AXKmKU\/X83ipxxgnPI\/AAAAAAAABC8\/G5DG0EmvCbYRIPZepEMjnpZ29vGBkrEHwCLcBGAsYHQ\/s530\/sunak.jpg\" style=\"clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;\"><img loading=\"lazy\" decoding=\"async\" border=\"0\" data-original-height=\"530\" data-original-width=\"474\" height=\"200\" src=\"https:\/\/1.bp.blogspot.com\/-hVqk3AXKmKU\/X83ipxxgnPI\/AAAAAAAABC8\/G5DG0EmvCbYRIPZepEMjnpZ29vGBkrEHwCLcBGAsYHQ\/w179-h200\/sunak.jpg\" width=\"179\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\"><span style=\"font-family: arial;\"><b>Jam today, <br \/>Toast tomorrow?<\/b><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div><span style=\"font-family: arial;\">Those costs include the haphazard and declining&nbsp;quality of the education of our children. <a href=\"https:\/\/www.eschoolnews.com\/2018\/02\/20\/taking-teacher-attrition\/\" target=\"_blank\" rel=\"noopener\">Teacher attrition<\/a> is likely to increase from its already unacceptable levels. Every year 20% of teachers leave the profession. This matters. Prevention children playing in the park matters and adults socialising too. Businesses and&nbsp;livelihoods&nbsp;will be sacrificed.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Another month, or months of restrictions will need to be accompanied by a&nbsp;financial&nbsp;package of support for small and medium enterprises which have long been recognised as central to our economy. One demonstration of how this has impacted them is how they have missed out on the recent rise in retail sales, most of which has gone on-line to Amazon, whose effects in economic terms is that of a giant wealth extracting parasite. Sadly,<a href=\"https:\/\/www.theguardian.com\/technology\/2020\/oct\/29\/amazon-profits-latest-earnings-report-third-quarter-pandemic\" target=\"_blank\" rel=\"noopener\"> their profits have tripled<\/a> during the pandemic.<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">If we are&nbsp;going&nbsp;to continue with what is called orthodox Conservatism the&nbsp;economic&nbsp;pain will outweigh the gain, many many times over. Perhaps the time has come for new thinking &#8211; a Universal Basic Income, for emergency &#8220;Quantitative Easing&#8221; to clear COVID19 related Government debts. Perhaps, for progressive taxation to ensure Government income covers something approaching the cost of its spending. Higher levels of public spending will require increased government income and more borrowing.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">Social inequality is simply&nbsp;not affordable. This pandemic is in many ways a social disease hitting the disadvantaged harder. Billions have been lost by those least able to afford it while the more well off have accumulated savings during the pandemic. Can alleviating poverty be achieved without addressing the global problem of undeserved wealth? I don&#8217;t think so.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">The time for a more significant green revolution&nbsp;which might prevent far more painful catastrophes coming our way in the next few years and decades. Progress remains too slow despite more <a href=\"https:\/\/www.theguardian.com\/environment\/2020\/nov\/17\/boris-johnson-announces-10-point-green-plan-with-250000-jobs\" target=\"_blank\" rel=\"noopener\">&#8220;world beating&#8221; headlines<\/a>.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">The bottom line is that we need to spend more on the public sector. However bitter a pill that might be for politicians brought up in the Thatcher mould of life without a society, it is an inevitable conclusion of the pandemic. Unless we get this investment in place in the next few years, the next few decades will bring changes which COVID19 demonstrates we are not ready for.&nbsp;<\/span><\/div>\n<div><\/div>\n<div><span style=\"font-family: arial;\">So there are benefits in lockdowns and lots of costs too. Once the vaccines are delivered and the&nbsp;restrictions&nbsp;lifted, then we will need to think hard about the new society. COVID19 has demonstrated the old one was broken.&nbsp;<\/span><\/div>\n<div><span style=\"font-family: arial;\"><br \/><\/span><\/div>\n<div><span style=\"font-family: arial;\">&nbsp;<\/span><\/div>\n<div>\n<div>\n<p><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>SUMMARY December&#8217;s tiers are more strict than many expected. The &#8220;curve may have been flattening&#8221;&hellip; <a href=\"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/2020\/12\/07\/covid19-winter-update\/\" class=\"more-link btn btn-link\">Read More&hellip; <span class=\"screen-reader-text\">Continue reading COVID19 winter update.<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":169,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"spay_email":"","footnotes":""},"categories":[3],"tags":[],"class_list":["post-17","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-covid19-updates"],"jetpack_featured_media_url":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-content\/uploads\/2020\/12\/tiers.jpg","_links":{"self":[{"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/posts\/17","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/comments?post=17"}],"version-history":[{"count":2,"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/posts\/17\/revisions"}],"predecessor-version":[{"id":638,"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/posts\/17\/revisions\/638"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/media\/169"}],"wp:attachment":[{"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/media?parent=17"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/categories?post=17"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drbannonsblog.aprendo.co.uk\/drbannonsblog_wp\/wp-json\/wp\/v2\/tags?post=17"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}