Category: #uk

A leaked email sent to medics has fuelled speculation that fresh Covid outbreaks will trigger the reopening of emergency hospitals built to increase NHS capacity during the first wave of infections.

According to Politico London Playbook, nurses who worked in the London Nightingale hospital during the early days of the pandemic have been sent a “hint, hint” reminder that their training remains valid. The report comes after the government announced 17,540 confirmed new cases on Thursday – an increase of more than 3,000 from the previous day’s tally.

England’s seven Nightingale hospitals currently remain on standby, “albeit in some cases repurposed or having been considered for alternative use”, says The Guardian.

London’s Nightingale hospital – based at the ExCeL conference centre in the east of the capital – “would be the largest intensive care unit in Europe if fully operational”, but treated a only small number of patients during the initial wave of infections, adds the newspaper.

Discussions are reportedly already under way about using Bristol’s dormant Nightingale hospital, at the University of the West of England’s Frenchay campus, to provide additional capacity for the city’s Eye Hospital. And councillors in Harrogate have called for the Nightingale facility there to be used as a flu vaccination centre in the run-up to winter.

Meanwhile, the Nightingale hospital in Birmingham “is being readied again to take patients at 48 hours’ notice, according to a hospital CEO in the city”, The Guardian reports. And the emergency hospital in Exeter is being used for a Covid-19 vaccine study.

Sunderland’s Nightingale Hospital, which was opened by TV presenters Ant and Dec in May, is also ready to be used in the event of “another surge of coronavirus”, says regional news site ChronicleLive.

The seventh hospital, in Washington, Sunderland, has not been used but will remain available as long as necessary, health authorities have said.

When the emergency medical centres were first set up, the government boasted about the swiftness of their response, with the London Nightingale hospital built in just nine days.

But a leaked document seen by The Telegraph back in April revealed that the London hospital was “turning away more coronavirus patients than it is treating”, owing to a lack of staff.

This week kicked off with more coronavirus chaos that left Downing Street under fire after a glitch in Britain’s tracking system saw the daily number of new cases appear to double overnight.

Boris Johnson and his ministers blamed “computer issues” for delays in reporting more than 15,000 cases recorded over the previous week, which was caused by data on people who tested positive exceeding the maximum size of files used in the system.

The Conservatives had more luck getting to grips with technology at their first virtual party conference, which wrapped up on Tuesday following a round of remote speeches from cabinet ministers, as well as a promise from Johnson to create a “post-war new Jerusalem” after the pandemic.

Over on the opposition benches, Keir Starmer’s battle with the Labour left continued, as the Unite union, the party’s biggest donor, announced it was cutting its funding by 10% amid frustrations with a perceived shift in the party’s direction.

To find out how closely you’ve been paying attention to the latest developments in both UK and global events, put your knowledge to the test with our Quiz of The Week:

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In the US, Donald Trump returned to the White House after three days in hospital for treatment for Covid-19, despite health experts warning that he was still potentially infectious. The second presidential debate is now in doubt, after Trump said he would not take part in a virtual head-to-head.

If his scheduled stand-off with Joe Biden is cancelled, voters will be left with extra time to mull over the vice-presidential debate, which saw Democratic nominee Kamala Harris lock horns with Mike Pence on issues including the administration’s coronavirus response, racism, health care and climate change.

Meanwhile, the World Health Organization (WHO) has warned that face masks may not protect against Covid-19 in wet or damp weather – a verdict that is unlikely to bother the mask-eschewing US president.

Former BBC journalist Allegra Stratton is in the media spotlight after landing what some commentators are calling “the worst job in politics” – fronting No. 10’s new daily televised press briefings.

Stratton has served as director of strategic communications for Chancellor Rishi Sunak since quitting broadcasting in July, but is now leaving the Treasury to become Boris Johnson’s most high-profile spokesperson.

The No. 10 newcomer has “impeccable Tory connections” and “bucketloads of broadcast experience – a must for what’s likely to be a difficult job”, says The Independent says. She is married to James Forsyth – who is political editor at The Spectator, which the prime minister used to edit – and Sunak was best man at their wedding.

Now aged 39, Stratton kicked off her journalistic career as a producer at the BBC after graduating from Cambridge University. Following a spell as political correspondent for The Guardian, she returned to the BBC as the political editor of Newsnight, and also put in a stint at ITV News.

Stratton is no stranger to being in the media spotlight either. As Newsnight editor, she was at the centre of an outcry over the alleged humiliation of single mother featured in a report about the government’s cuts to benefits. The programme later issued an apology after more than 50,000 people signed a petition.

Stratton was appointed to the Downing Street briefings role, currently being filled by Johnson’s official spokesperson James Slack, after “impressing” the PM with her performance at the Treasury, says HuffPost.

But the task facing her is a tricky one. A Labour adviser told The Guardian that it was an “awful job”, while the newspaper notes that Stratton “arrives at a moment when the government is besieged by restive backbenchers sceptical about Covid restrictions, and facing fierce criticism over the way they are being communicated”.

The high-profile nature of the role has also triggered criticism from the opposition benches, with Keir Starmer arguing that the appointment risks “unbalancing the political discourse”.

Kevin Marsh, professor of tropical medicine at the University of Oxford, and Moses Alobo, programme manager for Grand Challenges Africa at the African Academy of Sciences, explain the continent’s Covid-19 response.

As the threat of a Covid-19 pandemic emerged earlier this year, many felt a sense of apprehension about what would happen when it reached Africa.

Concerns over the combination of overstretched and underfunded health systems and the existing load of infectious and non-infectious diseases often led to it being talked about in apocalyptic terms.

However, it has not turned out quite that way. On September 29th, the world passed the one million reported deaths mark (the true figure will of course be higher). On the same day, the count for Africa was a cumulative total of 35,954.

Africa accounts for 17% of the global population but only 3.5% of the reported global Covid-19 deaths. All deaths are important, we should not discount apparently low numbers, and of course data collected over such a wide range of countries will be of variable quality, but the gap between predictions and what has actually happened is staggering.

There has been much discussion on what accounts for this.

As leads of the Covid-19 team in the African Academy of Sciences, we have followed the unfolding events and various explanations put forward. The emerging picture is that in many African countries, transmission has been higher but severity and mortality much lower than originally predicted based on experience in China and Europe.

We argue that Africa’s much younger population explains a very large part of the apparent difference. Some of the remaining gap is probably due to under reporting of events but there are a number of other plausible explanations. These range from climatic differences, pre-existing immunity, genetic factors and behavioural differences.

Given the enormous variability in conditions across a continent – with 55 member states – the exact contribution of any one factor in a particular environment is likely to vary. But the bottom line is that what appeared at first to be a mystery looks less puzzling as more and more research evidence emerges.

The importance of age

The most obvious factor for the low death rates is the population age structure. Across multiple countries the risk of dying of Covid-19 for those aged 80 years or more is around a hundred times that of people in their twenties.

This can best be appreciated with a specific example. As of September 30th, the UK had reported 41,980 Covid-19 specific deaths while Kenya, by contrast, had reported 691. The population of the UK is around 66 million with a median age of 40 compared with Kenya’s population of 51 million with a median age of 20 years.

Corrected for population size the death toll in Kenya would have been expected to be around 32,000. However if one also corrects for population structure (assumes that the age specific death rates in the UK apply to the population structure of Kenya), we would expect around 5,000 deaths.

There is still a big difference between 700 and 5,000; what might account for the remaining gap?

Other possible contributors

One possibility is the failure to identify and record deaths.

Kenya, as with most countries, initially had little testing capacity and specific death registration is challenging. However, Kenya quickly built up its testing capacity and the extra attention to finding deaths makes it unlikely that a gap of this size can be fully accounted for by missing information.

There has been no shortage of ideas for other factors that may be contributing.

A recent large multi-country study in Europe reported significant declines in mortality related to higher temperature and humidity. The authors hypothesised that this may be because the mechanisms by which our respiratory tracts clear virus work better in warmer more humid conditions. This means that people may be getting less virus particles into their system.

It should be noted however that a systematic review of global data – while confirming that warm and wet climates seemed to reduce the spread of Covid-19 – indicated that these variables alone could not explain most of the variability in disease transmission.

It’s important to remember that there’s considerable weather variability throughout Africa. Not all climates are warm or wet and, if they are, they may not stay that way throughout the year.

Other suggestions include the possibility of pre-existing protective immune responses due either to previous exposure to other pathogens or to BCG vaccination, a vaccine against tuberculosis provided at birth in most African countries.

A large analysis – which involved 55 countries, representing 63% of the world’s population – showed significant correlations between increasing BCG coverage at a young age and better outcomes of Covid-19.

Genetic factors may also be important. A recently described haplotype (group of genes) associated with increased risk of severity and present in 30% of south Asian genomes and 8% of Europeans is almost absent in Africa.

The role of these and other factors – such as potential differences in social structures or mobility – are subject to ongoing investigation.

More effective response

An important possibility is that public health response of African countries, prepared by previous experiences (such as outbreaks or epidemics) was simply more effective in limiting transmission than in other parts of the world.

However, in Kenya it’s estimated that the epidemic actually peaked in July with around 40% of the population in urban areas having been infected. A similar picture is emerging in other countries.

This implies that measures put in place had little effect on viral transmission per se, though it does raise the possibility that herd immunity is now playing a role in limiting further transmission.

At the same time there is another important possibility: the idea that viral load (the number of virus particles transmitted to a person) is a key determinant of severity. It has been suggested that masks reduce viral load and that their widespread wearing may limit the chances of developing severe disease.

While WHO recommends mask wearing, uptake has been variable and has been lower in many European countries, compared with many parts of Africa.

So is Africa in the clear? Well, obviously not. There is still plenty of virus around and we do not know what may happen as the interaction between the virus and humans evolves.

However, one thing that does seem clear is that the secondary effects of the pandemic will be Africa’s real Covid-19 challenge. These stem from the severe interruptions of social and economic activities as well as the potentially devastating effects of reduced delivery of services which protect millions of people, including routine vaccination as well as malaria, TB and HIV control programmes.

Research agendas

Major implications of the emerging picture include the need to re-evaluate African Covid-19 research agendas.

While many of the priorities originally identified may still hold, their relative importance is likely to have changed. The key point is to deal with the problems as they are now rather than as they were imagined to be six months ago.

The same thing applies for public health policy. Of course, basic measures such as hand washing remain essential (regardless of Covid-19) and wearing masks should be continued while there is any level of Covid-19 transmission. However, other measures with broader effects on society, especially restrictions on educational and economic activity, should be under continuous review.

A key point now is to increase surveillance and ensure that flexible responses are driven by high quality real time data.

Kevin Marsh, professor of tropical medicine at the University of Oxford, and Moses Alobo, programme manager for Grand Challenges Africa at the African Academy of Sciences.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Michel Barnier has warned European Union leaders against signing off on a “half-baked” Brexit deal at crunch talks next week.

Ahead of the summit in Brussels, the EU’s chief negotiator told a meeting of European ambassadors on Wednesday that any hint of compromise, especially on fishing rights, would weaken the bloc’s position, according to a leaked memo seen by The Times.

Barnier is encouraging European leaders to insist on further UK concessions and to resist Boris Johnson’s efforts to turn the summit into a negotiating deadline.

Government ministers and EU officials had hinted that the UK and EU were on the verge of a trade deal, but Barnier is insisting that negotiations will need to continue until the end of the month and wants next week’s summit to be limited to a “taking stock” of the talks, the leaked memo reveals.

The Daily Express suggests that by restricting the scope of the summit discussions, the EU’s negotiating chief “is hoping to distract over the compromises he has already made in talks with UK counterpart David Frost, or is planning to make”.

A diplomatic source told The Times that “Boris keeps saying that a deal is ‘oven ready’ but Barnier will not want to come to leaders with any half-baked detail, especially on fish”.

Fishing rights have become one of the greatest obstacles in the Brexit negotiations, with Brussels seeking to retain access to British waters as No. 10 attempts to scrap the old quotas and make such access conditional on successful annual negotiations.

The Financial Times reports that Brussels “is looking at how to compensate European fishermen that lose out from Brexit by handing them part of Britain’s old fishing rights in EU waters”.

As the row rumbles on, Barnier is due to meet the UK’s Frost for informal talks today.