In mid-July, an Academy of Medical Sciences report urged the government to use the remainder of the summer to prepare for a second wave of coronavirus during the winter. Commissioned by the government’s chief scientific adviser, Sir Patrick Vallance, the 79-page study warned that a resurgence of the virus had the potential to kill up to 120,000 hospital patients in a worst-case scenario. The Guardian has examined the government’s response to five of the report’s main recommendations – and found significant shortcomings in nearly every case. Minimising transmission of coronavirus in the community, with a public information campaign for all, as well as advice tailored to individuals and communities at high risk. Earlier this month, the government announced it was launching a “hands, face, space” campaign to run across TV, radio, print, social and display advertising in England to prevent the spread of coronavirus indoors during the winter and to avoid a second peak. The slogan was originally launched by the prime minister in July, but was overshadowed by the “eat out to help out” campaign of the chancellor, Rishi Sunak. This month’s announcement did not contain any details on whether the campaign would contain tailored messaging – the lack of which has been highlighted by some as a contributory factor to recent local spikes. The academy’s report highlighted that factors such as education, income and ethnicity can affect exposure to public health messages. Prof Dame Anne Johnson, the vice-president of the academy and an author of the report, said: “We’ve had throughout the pandemic these sort of very generalised messages; we haven’t seen much of that more nuanced or more targeted or culturally competent [messaging].” She also said that with the recent rise in transmission in young people “it would be great to hear their voices on all this and how they feel. It will be working with them to get the right messages across that doesn’t put their lives on hold, but enables them to keep as safe as possible.” Guardian rating: 5/10 Reorganising health and social care staff and facilities to maintain Covid-19 and Covid-19-free zones, and ensure there is adequate PPE, testing and system-wide infection-control measures to minimise transmission in hospitals and care homes. PPE shortages blighted efforts to combat the first wave of coronavirus. The government says it has ordered 31bn items and PPE will be free for staff and residents in care homes. In theory, regular testing (retesting) for care homes in England, under which staff would be tested weekly and residents every 28 days, has been available since July – but Care England says this has not been delivered. The government has also provided £546m to the care sector to pay wages for staff self-isolating and to hire more staff to restrict movement between homes and therefore the spread of the virus over the winter. It has also promised a “dashboard” to monitor care home infections. Trusts have been using government funds to divide healthcare settings into “hot” and “cold” settings, as suggested in the report. But Prof Johnson said testing was crucial to other measures. “If we want to get on top of this backlog of people who are needing urgent care, then clearly you’ve got to make sure that they go in Covid negative for surgery, that the staff aren’t infected, and you’re not getting cross-infection,” she said. “That needs a really robust testing system to be in place, so all this does go back to both the testing system but also the way that we train and protect staff and make sure that they understand how to reduce transmission.” Testing problems have forced hundreds of physicians to take time off, according to the Doctors Association UK. Guardian rating: 3/10 Increasing capacity of the test, trace and isolate (TTI) programme to cope with the overlapping symptoms of Covid-19, flu and other winter infections. The academy’s report states: “TTI will only be effective if it is carried out quickly, accurately, is acceptable to the public, and encompasses a high proportion of symptomatic cases.” The most recent figures, for the week ending 9 September, show that 15,526 people were transferred to the contact tracing system in England, compared with 8,117 when test and trace launched at the end of May. At that time, the proportion of close contacts who were reached and asked to self-isolate in England was 91.1%; the latest figure was 73.9%, albeit up from 69.2% over the previous seven days. Testing problems have been rife recently and are expected to last for weeks. The latest test-and-trace figures say there is capacity for 2.5m tests in the UK a week; only 1.6m were processed in the most recent week for which data is available. Additionally, the proportion of in-person test results received within 24 hours in England was 33.3% – dropping to 14.3% when home test kits and satellite test centre figures are included – a far cry from Boris Johnson’s pledge to ensure all coronavirus test results were delivered within 24 hours by the end of June. During the winter flu peak, Prof Johnson said the number of people with symptoms could reach 500,000 – the same daily capacity for Covid tests the prime minister has pledge to deliver by the end of October, but which must be doubtful on current form. There have also been concerns a significant proportion of people are not self-isolating fully when they are supposed to. Guardian rating: 2/10 Establishing a comprehensive, near-real-time, population-wide surveillance system to monitor and manage a winter wave. Although it is not real-time, Prof Johnson praised Public Health England’s weekly Covid surveillance report which uses multiple sources to gauge incidence. The daily dashboard of cases relies on the testing regime, which has been experiencing major problems and is generally reserved for people with symptoms, limiting information on incidence.
Prof Johnson said: “We’ve got a much, much better idea now about the proportion of cases that were identified … PHE publishes data on age, ethnicity and area, which is a great help. So you’ve got more idea, and the data coming from outbreak investigations is better but, for example, it would be good to see much more information understanding where the transmission is going on. “So if you ask people: ‘Where do you think you’ve got the infection?’ Are they getting infected at home? Are they getting infected at work? Is it hospital-acquired infection and what are the risk factors? – you’ve got a lot more granularity. We’re beginning to get some of that but it would be good to have more detail, particularly on these very high-risk situations in hospitals and care homes and particular outbreaks.” She said it was clear more data was being collected but “it’s not easy to get it all collated together”. Guardian rating: 7/10 Guarding against the worst effects of flu with a concerted effort to get people at risk, and health and care workers, safely vaccinated. In late July, the government said it would offer a free flu jab to more than 30 million people, calling it the most comprehensive flu vaccination in UK history. It involves extending the NHS free vaccination programme to everyone over 50 (previously only over-65s were eligible), people shielding and those who live with them, plus children in their first year of secondary school. Last year 25 million were invited to participate in the programme, but only 15 million did so. Prof Johnson said: “Obviously they have taken that [recommendation] on board but again the proof is in the pudding. It will be important to see that … it’s being delivered in a timely way and that the uptake is high. Particularly in health and social care workers, you want to get [uptake] rates closer to 100%.” Guardian rating: Too early to tell