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‘Extraordinary omission’: key findings in scathing UK Covid report

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‘Extraordinary omission’: key findings in scathing UK Covid report

The joint report by the Commons health and science committees on lessons to be learned from the UK’s response to Covid spans 150 pages and is divided into six themes. Here are the main findings from each.

Planning for a pandemic

The section on preparedness draws on concerns highlighted as far back as May 2020 and finds that the UK was confident of the extent of its pandemic planning despite most of it being “too narrowly and inflexibly” based on the idea of a flu-type outbreak.

The planning did not properly consider asymptomatic transmission or take into account earlier outbreaks that failed to reach pandemic level, such as the Sars virus affecting east Asian countries in 2002-04, or the Mers virus first identified in the Middle East in 2012, the report found.

Detailing various government exercises about hypothetical pandemics, it said an “over-reliance on pandemic influenza as the most important infectious disease threat clearly had consequences – it meant that the emphasis of detailed preparations was for what turned out to be the wrong type of disease”.

Perhaps the most vivid piece of evidence in this section came from Dame Sally Davies, England’s former chief medical officer, who blamed what she called “groupthink”. The report quoted her as saying: “Our infectious disease experts really did not believe that Sars, or another Sars, would get from Asia to us. It is a form of British exceptionalism.”

Lockdowns and their timing

Among the most fractious debates in the response to coronavirus has been over the timing of England’s lockdowns, both when the first one was imposed in March 2020 and apparent delays in putting in place another in the autumn and winter of that year.

On the first lockdown, the report is clear and condemnatory: factors including a lack of testing capacity and doubts over whether British people would accept a lockdown prompted scientists and politicians to adopt a “policy approach of fatalism”, which would seek to manage but not suppress the extent of an outbreak. While this was not an active decision to seek so-called herd immunity, it amounted to this in effect, the report said.

Following what the committees called “simultaneous epiphanies” by ministers and advisers about the catastrophic effects of this approach, a UK-wide lockdown was finally announced on 23 March. The report said: “It is now clear that this was the wrong policy, and that it led to a higher initial death toll than would have resulted from a more emphatic early policy.”

It adds, more damningly still: “As a result, decisions on lockdowns and social distancing during the early weeks of the pandemic – and the advice that led to them – rank as one of the most important public health failures the United Kingdom has ever experienced.”

The report was, however, more equivocal on whether the ministers should have imposed a “circuit breaker” lockdown in England in late October 2020, saying the emergence of the more transmissible Alpha, or Kent, variant could have prevented this being effective anyway, and that a circuit breaker in Wales did not prevent a winter lockdown.

Test, trace and isolate

The report’s most consistent and vehement condemnation came in this section, beginning with what it described as a hugely serious failure to even try to copy the rapid rollout of mass testing in places like South Korea.

Public Health England claimed to have studied and then rejected the South Korean approach but could provide no evidence for this, the report said, adding: “We must conclude that no formal evaluation took place, which amounts to an extraordinary and negligent omission.”

This meant testing in everywhere but hospitals was halted, and so new cases or contacts could not be tracked. “As a result the UK squandered a leading position in diagnostics and converted it into one of permanent crisis … The consequences of this initial failure were profound … For a country with a world-class expertise in data analysis, to face the biggest health crisis in 100 years with virtually no data to analyse was an almost unimaginable setback.”

While testing capacity was later increased hugely, the report noted that government rhetoric was still often notably more impressive that the reality. “Ministers began by promising the test and trace system would be ‘world-beating’ in May 2020 when the truth was that it was that it was a laggard,” it said of the system, which had a budget of £37bn.

The report also castigated the low numbers of people who complied with self-isolation rules, citing a lack of financial support and the continued requirement to self-isolate for 10 days, long after tests were freely available to show they did not have the virus. As well as the impact this delay had on the economy and people’s lives, the report said, “by providing a powerful disincentive to take a Covid test and to disclose all contacts, it seems likely that it will have also caused more infections and cost lives”.

Social care

More than 39,000 care home residents died with coronavirus between 10 April 2020 and 31 March 2021, with the report finding that ministers and the NHS “both failed adequately to recognise the significant risks to the social care sector at the beginning of the pandemic”.

The committees concludes: “The UK was not alone in suffering significant loss of life in care homes, but the tragic scale of loss was among the worst in Europe and could have been mitigated.”

Some of these failures were specific to the pandemic, the report said, including the decision to focus on freeing up NHS capacity and thus release many patients into care homes without Covid tests, and problems with a lack of personal protective equipment. Others, such as a shortage of staff and funding difficulties, were “illustrative of a longstanding failure to afford social care the same attention as the NHS”.

Wider health inequalities

The report stressed that “the experience of the Covid pandemic underlines the need for an urgent and long-term strategy to tackle health inequalities”, a point highlighted by politicians and experts during the pandemic.

It noted the particularly high toll of Covid on people from minority ethnic backgrounds and on people with learning disabilities. It said: “It is telling that the first 10 NHS staff to die from Covid-19 were from black, Asian and minority ethnic (BAME) backgrounds, and evidence has since confirmed that the impact of Covid-19 on this section of the workforce has been significant.

“While the NHS has made progress in recent years, the experience of people from BAME groups during the pandemic has made it clear that inequalities persist.”

Vaccines

While the report gives recommendations on lessons to be learned from the development, procurement and distribution of vaccines, these were mainly based around other areas of government learning from it – particularly the flexibility and speed of the vaccines taskforce headed by Kate Bingham. The Covid vaccine programme overall, the report said, “has been one of the most successful and effective initiatives in the history of UK science and public administration”.

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Health

Lagos to convert General Hospital to eye centre

The Lagos State Commissioner for Health, Prof. Akin Abayomi, says the state government will designate one of its general hospitals as a centre for ophthalmic specialty to improve care for patients with eye conditions.

Abayomi said this during the 4th Annual General Meeting and Scientific Conference of the Africa Retina Society on Thursday in Lagos.

The News Agency of Nigeria (NAN) reports that the event was themed, “Upscaling Retinal Services in a Resource-Constrained Economy.”

Abayomi said the centre would provide a world-class diagnostic, medical, surgical and ophthalmic services in Lagos and Nigeria.

He stressed that the state would prioritise eye health, noting that the state was working on developing screening capacity of all its primary healthcare facilities to detect eye diseases early.

“The conditions that affect the eyes very much reflect the conditions of the community in which you live. HIV, for example, was a major problem in South Africa, and I certainly experienced the impact of HIV on our day-to-day medicine and practice.

“Here in Nigeria, we have other things. We have hypertension, diabetes, sickle cell, and lots of trauma. These are the kinds of things that we see in our clinics here in Lagos and in Nigeria.

“We need to be able to understand how these prevailing conditions really affect us,” he said.

The commissioner further said that efforts are ongoing to promote eye screening, especially in schools, starting with the training of teachers to detect students exhibiting challenges with their vision.

He added that the state would leverage the social health insurance to screen, detect and treat eye diseases as patients presents at health facilities.

The commissioner further said the state would strengthen public awareness and understanding on eye health, especially glaucoma and visual acuity.

Abayomi disclosed that the state through its Ministry of Health had forged a partnership with the Chagoury Group
to develop a specialist eye hospital in Lagos to boost access to eye services.

He acknowledged that ophthalmology was equipment-intensive, stressing that government would pay attention to that and human resources to enable practitioners make appropriate diagnosis, and treatment to reverse medical tourism.

Earlier, Prof. Linda Visser, Head, Division of Ophthalmology Stellenbosch University, South Africa, called on policy makers to formulate policies that would integrate eye screening into diabetes care from the primary healthcare level, noting that cases of diabetic retinopathy was on the increase among Africans.

Diabetic retinopathy (DR) is a chronic progressive disease of the retinal capillaries (small blood vessels) associated with prolonged raised blood glucose levels in people with diabetes.

Visser cited data from International Diabetes Foundation that showed that 537 million adults aged 20 to 79 years are living with diabetes globally, a number that was predicted to reach 1.3 billion in 50 years.

“The high prevalence of type 2 diabetes continues to rise worldwide and is particularly rapid in low- and middle income countries.

“Most of these countries have limited availability and affordability of healthcare services for screening and treating diabetes-related complications, such as retinopathy, to prevent vision loss,”

According to her, all persons with diabetes are at risk of developing DR, however, those with poor blood glucose and blood pressure management and hyperlipidaemia are most at risk.

Visser, Past President, Vitreoretinal Society of South Africa, emphasised that early detection would lead to timely treatment of DR, which could prevent 95 per cent of vision impairment and blindness.

Also, Dr Asiwome Seneadza, Chairman, Africa Retina Society, said that the theme was timely and critical as efforts are made to navigate the complexities and challenges in delivering advanced retinal care across the continent.

Seneadza said, “That’s why we are advocating for improved diabetes care and regular retinal screening made available and accessible for every individual living with diabetes,” he said.

Similarly, Prof. Bassey Fiebai, Chairman, Vitreo Retinal Society of Nigeria, said the meeting was critical to proffering solutions to the challenge of offering standard retina care, improving outcomes and reducing visual loss from retina related disorders among low to medium income countries.

Fiebai said that the government plays a critical role in providing funding, training of personnel, provision of equipment to improve screening, detection and treatment of retinopathy disease.

The professor noted that retina specialists are few in Nigeria, placing the figure at about 100, stressing that it was inadequate to cater to the teeming population who require eye care.

“Right now in the country, we have just a little over 100 retina specialists. And we know that the population of Nigeria is about 230 million.

“So we’re looking at a situation in which one retina specialist is supposed to cater for 2.3 million people. How does anyone cope?” she queried.

NAN reports that the Annual General Meeting and Scientific Conference of the Africa Retina Society which began on June 26 to June 28, had participants from various African countries brainstorm on enhancing retinal care.

(NAN)

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Health

Cholera outbreak: Tinubu sets up presidential committee to oversee emergency operation centre

President Bola Tinubu has directed the setting up of a presidential committee to oversee the Cholera Emergency Operation Centre, operated by the National Centre For Disease Control.

The Minister of Health, Ali Pate, made this known on Tuesday after the Federal Executive Council meeting chaired by President Tinubu at the State House, Abuja.

He added that the committee’s effort is in addition to state government support to ensure Nigeria makes progress in reducing open defecation.

“The Council then approved a cabinet committee comprising the federal ministries of Health, Finance,Water Resources, Environment, Youth, Aviation, Education because some of our children will be returning to school . In addition to this, the state government, we will co-opt, so that Nigeria makes progress in reducing open defecation because cholera is a developmental issue that requires a multi-sectoral approach.

“The President directed that a cabinet committee be set up to oversee what the emergency operation centre led by NCDC is doing and for the resources to be provided complemented by the state government,” he said.

Pate further disclosed: “At the moment about 31 states have recorded 1528 cases and 53 deaths in Nigeria. That is what we are working through the Emergency Operation Centre that was activated by NCDC on Monday.

“Now we have a cholera outbreak and we discussed extensively in the Council in addition to a new emergence of Yellow Fever specifically in Bayelsa State.

“On cholera we are in the middle of the 7th pandemic globally which is decades in the making. In 2022, the world had almost 500,000 cases of cholera so it is not only peculiar to Nigeria. In 2023 almost 700,000 cases of cholera were reported by the World Health Organization.

“This year more than 200,000 cases have occurred in five regions of the World.”

He emphasised that a multi sectoral approach is required to tackle the outbreak .

“Resources were deployed to 21 states to help them respond to cholera. We are improving awareness of population, handwashing, hygiene sanitation, in addition to treatment with drugs, and intravenous fluids,” he added.

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Health

NCDC reports 1,598 cases of cholera across the country

The Nigeria Centre for Disease Control and Prevention, NCDC, has reported 1,598 suspected cases of cholera across 107 local government areas.

The cholera outbreak is characterised by a case fatality rate of 3.5 per cent, significantly higher than the national expected average of one per cent, underscoring the severity of the situation.

The Director-General of NCDC, Dr Jide Idris, disclosed this on Monday in Abuja while providing an update on the cholera epidemiological situation in Nigeria and ongoing prevention and response efforts at the national and sub-national levels.

Cholera is a severe diarrheal illness caused by the bacterium Vibrio cholerae. The disease remains a significant health challenge, especially in regions with inadequate sanitation and clean water access.

Understanding the transmission mechanism of cholera is crucial to curbing its spread and implementing effective prevention measures.

Idris said: “Government is deeply concerned about the rapid spread and higher-than-expected mortality rate, indicating a more lethal outbreak.”

He emphasised that the fatalities represented significant personal losses, including those of family members, spouses, parents and healthcare workers.

“This situation can be compounded as the rainy season intensifies,” he added.

He disclosed that Lagos State accounted for the highest number of deaths with 29, followed by Rivers with eight, Abia and Delta with four each, Katsina with three, Bayelsa with two and Kano, Nasarawa and Cross River with one each.

He added: “This alarming trend highlights the urgent need for coordinated response to prevent further escalation of the crisis. Sixteen states accounted for 90 per cent of the confirmed cases, with Lagos being the epicentre of the outbreak. Lagos State, having the highest number of cases, has received significant focus, with ongoing support and resources directed to manage the outbreak effectively.”

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