[Ru]

Probably worth reading the analysis I linked to earlier, this actually seems to  show that if anything that 'frontline covid' staff are less impacted than other NHS staff:

...

What is likely is that these groups of healthcare staff are rigorous about use of personal protective equipment and the associated practices known to reduce risk.'

I get that, but point being made was that the need for PPE was overhyped. This suggests the opposite.

[ctodd]

Apologies if this has already come up (its a long+++ thread to read!)

I work in the NHS, patient-facing.

PPE is also important in protecting the patient e.g. wearing masks (most common PPE used by all). Anecdotally this is mostly what myself / colleagues are now most concerned about.

Again very much anecdote from my own workplace, but the feeling that nursing/residential homes (again, apologies if this has already come up) are now a bigger issue. In contrast to NHS hospitals etc - little if any provision of any kind of PPE and the systems that come with this (cold vs. hot areas, specific cold vs. hot staff members etc), are resulting in seemingly adverse consequences.

[Offwidth]

Probably worth reading the analysis I linked to earlier, this actually seems to  show that if anything that 'frontline covid' staff are less impacted than other NHS staff:

It doesn't surprise me at all, its perfectly consistent with the analysis from China and Italy and Korea. With proper PPE, risks to those looking after patients with covid in ITU are low (in most countries there are no deaths from ITU staff and where PPE isn't limited there are some countries with no healthworker deaths at all). Without PPE, dealing with covid patients is carnage (China's first weeks compared to when the state retained control). In this context the true fronline staff are those dealing with patients or in care where infection is likely there, but not tested for, and when proper PPE is inadvertantly not being used if they are positive (as per the sad case of Dr Tun).

https://www.theguardian.com/society/2020/apr/23/emails-reveal-doctors-plea-for-ppe-before-covid-19-death-dr-peter-tun.

Conversely, the absence of certain workforce groups among those who have died, while welcome, is also notable. Anaesthetists, intensive care doctors and by association nurses and physiotherapists who work in similar settings are believed to be among the highest risk groups of all healthcare workers.

This is because both caring for the sickest patients with covid-19 and undertaking airway management (so-called aerosol generating procedures) are associated with high risk of viral exposure and transmission. It is therefore notable that all of these groups are completely absent from the data set.

Yep, so those staff are being protected, and too many hospitals feel they need to ration elsewhere to protect supply. Do a search and there are numerous cases of healthcare staff complaining and a few threatening legal action for no PPE on standard 'non covid' wards where patients may or may not have covid and despite complaints there have been no tests.

Again, the reason for this is not known and data on infections and serious illnesses are important to consider as well as fatalities, but these data also are currently lacking. What is likely is that these groups of healthcare staff are rigorous about use of personal protective equipment and the associated practices known to reduce risk.'

I'd say it is known very well, but the extent not determined, like lots of things about this virus.

I have got an axe to grind here as I'm very concerned about the government response in some key areas, and I think too many people are focussing on the wrong risks- as important as that data analysis is later, it won't save more people now: better precautionary actions are needed.  The biggest government mistakes were failing to secure proper testing and PPE supply earlier and being oblivious to the 'hidden' risks now. The virologists have said from the start the most infectious patients with the highest viral load are those who are just falling seriously ill.. so by the time you know you need better PPE it's too late. There is also lots of anecdotal evidence (and clear scientific evidence on most other viral infections)  that a high infecting dose of such a load (high load patient coughing in someones face) is much more dangerous than the average covid infection (so more young healthcare workers will die without proper PPE, as per China). With the 'no covid' wards and care homes it's not just the risk to the health worker, it's also the risk of spread to the patient/caree next in line.

Recognising a subtle risk apparently not evident to most is important to me, as not doing so will cause many unnecessary deaths, will seriously weaken the NHS, and as I have relatives and friends of all ages in the at risk group. As per my previous discussion with Ru I can't provide the scientific papers (waiting that later analysis) and I may even be wrong but most evidence seems to stack up in my favour and precaution based on sensible assumption is the correct action. If I'm right serious errors are being made. I'll take being called a bellend (or worse) any number of times if it makes a few more people think.

These discussions remind me of the early government obession with modelling: too little attention being paid to those who fought past viral outbreaks. They are well intentioned but a dangerous distraction if they imply PPE is not needed as much as thought.  The correct PPE is vital for anyone working where the virus may be present.

[tomtom]

Agree with above on PPE - but at the root is testing.

If we knew which areas of hospitals and which care homes were most at risk (geographically - and within institutions) via testing - then you’d know where to priorities our limited supplies (chances are they’d be limited in some way however much had been stockpiled etc.. by now).

Testing also informs parameter values in models, allows validation/verification and continual updating/refining. I really get the impression we’ve been using ‘best professional judgement’ (which is industry speak for guessing) up to and including now.

It should underpin all the decisions we took.

But we pretty much stopped a month ago.

[ali k]

The expected bellendry from you Offwidth. It isn't my opinion - it's an analysis of the facts published by HSJ 2 days ago.

Pete I don’t know if you’re aware but your tone when you engage with Offwidth is completely different from any other person on this forum, even when they’re making the same argument as him. MrJR even messed up some numbers countering your points and you engaged constructively. If Offwidth had done that you’d have eviscerated him.

[Offwidth]

I do wish Pete would engage more constructively for the sake of the forum but I'd rather he doesn't do that at the expense of speaking his mind. I long ago realised it's human nature to build a narrative and stick to it, than to acknowledge errors and change and I've made similar mistakes myself despite having much fewer excuses than most.

[petejh]

Will reply properly later but what on earth is my supposed ‘narrative’ regarding the story about PPE? Other than: ‘what does the evidence say?’
I don’t stick to dogmatic views about anything to do with this pandemic - I form my views based on what the (imperfect) evidence suggests and I change my mind according to what updated evidence suggests, not what the papers focus on, or because something’s the flavour of the moment on here (which is often based on what the papers are currently saying)

It’s ironic in the extreme to be lectured on narrative bias by Offwidth 

[Offwidth]

The narrative point I was making was in reply to what AliK commented on.

[stone]

I wonder if SAGE is really just someone in the background shouting "push on" and "fuck it, just do it", a bit like Loskott from Dosage 2?

That's Cummings isn't it  https://www.nytimes.com/2020/04/23/world/europe/uk-coronavirus-sage-secret.html

[stone]

I wonder if SAGE is really just someone in the background shouting "push on" and "fuck it, just do it", a bit like Loskott from Dosage 2?

That's Cummings isn't it  https://www.nytimes.com/2020/04/23/world/europe/uk-coronavirus-sage-secret.html

Sorry I put the wrong link. The one with Cummings is https://www.theguardian.com/world/2020/apr/24/revealed-dominic-cummings-on-secret-scientific-advisory-group-for-covid-19

[Will Hunt]

BREAKING: Chief Adviser involved in advising.

[Oldmanmatt]

BREAKING: Chief Adviser involved in advising.

SAGE is supposed to be independent of political influence and consist of scientists and experts.
He wasn’t supposed to be there, that’s why the people who were, have leaked it.
Do you not think some things should be independent of party politics?

[Nigel]

BREAKING: Chief Adviser involved in advising.

Quick reply to this, agreeing with OMM.  Its SAGE, with an "S". Not simply AGE. If Cummings has a "S"cientific qualification which qualifies him to be there and to contribute then lets hear about it? In fact we know he doesn't. Of course he is well within his rights to advise ministers on the political ramifications of any scientific advice, but only after SAGE has spoken impartially. If he was there simply as an observer OK, but he is said to have contributed. On the face of it that seems wrong. There's following the science, and guiding the science...

[galpinos]

Pete,

I’ve not time to read the whole paper but but it control for age and co-morbities? It seems to say the mortality rate for the health workers is consistent with the mortality rate of the general population but the deaths in the general population have (I believe) mostly been people near/past retirement age or with co-morbities. So comparing the health worker deaths with the general population does not appear a like for like comparison.

[galpinos]

BREAKING: Chief Adviser involved in advising.

I was all ready to be appalled at this but the fact the PMs most senior advisor has always been present at SAGE meetings undermines my outrage.

I’m not sure we can be that upset just because it’s normally some advisor we’ve never heard of and this time it’s Cummings.

[Nigel]

Well latest report is that he was just an observer, which seems fine. That contradicts what I read yesterday though! So there is definitely some political briefing and counter-briefing going on here.

[petejh]

Pete,

I’ve not time to read the whole paper but but it control for age and co-morbities? It seems to say the mortality rate for the health workers is consistent with the mortality rate of the general population but the deaths in the general population have (I believe) mostly been people near/past retirement age or with co-morbities. So comparing the health worker deaths with the general population does not appear a like for like comparison.

The report compares covid deaths among the 98% of NHS staff of age group 18-65, with covid deaths in general population of age group 18-65.

If you examine the figures of who's actually contracting and dying of covid among NHS staff, you can reach some interesting conclusions, such as an FFP3 mask by itself is not effective protection from contracting covid but a visor and a mask with more stringent hyenie controls is. Because according to the stats no ICU staff have died.
If you compare this idea with what the WHO says about general public wearing masks, they say: ''World Health Organization (WHO) guidelines state that while masks can help prevent people from passing on coronavirus, they are inadequate protection on their own from contracting it.''

Then, you can take the data that NHS excess mortality is among staff outside ICU's and perhaps even outside 'hot' areas(?) where just an FFP3 nad apron/gloves is used (again a ?), and apply that concept to everyone else in the general population workforce who are being asked to go to work among people outside their household.
From that my hunch is that the risk of dying from covid is not greater in NHS staff outside of covid ICU or 'hot areas of hospitals than it is among all kinds workers in the general population who are engaging with people outside their household. See the TfL death rates for driver for example, which are higher by far.

I'm looking at this from the point of view of someone responsible for sending small teams of people back to work to carry out tasks where it is impossible for them to socially distance within the team, and also very likely to come into contact with other people from outside their household during the course of their day. I feel I'm pressured from clients and within my group to resume work, and I feel conflicted about having to do this and I want to understand the risk as best I can if I'm asking people to leave home and come and do work for us.
But instead, so much of the focus about risk to workforce seems to be on the risk for group of workers (NHS) which the data so far doesn't correlate with the level of focus. This I think has lead to a blindspot in thinking seriously about what the level of risk is to everyone else.

I'm rambling but basically trying to say the focus should be on ALL people in work not some people, and the thinking should follow the data not the newspapers. Because the newspapers (and posters here who follow the newspapers) have political agendas, some posters much more so than others.. 

[tomtom]

Well latest report is that he was just an observer, which seems fine. That contradicts what I read yesterday though! So there is definitely some political briefing and counter-briefing going on here.

So - if you were in a meeting hoping to discuss things candidly about what to advise regarding CV19 and Cummings was at the back of the room - would you be unaffected?

When we have a staff meeting and the dean (or other senior management figure) comes along to just observe and see how we all are there is a very different dynamic.

I can see that if ANOther anonymous civil servant came along to take notes then that’s not such an issue - but Dom? He’s got a rep... and I expect even if he sat at the back of the room looking disinterested playing candy crush on his phone / it’d still influence whAt was said.

[Nigel]

Pete,

I’ve not time to read the whole paper but but it control for age and co-morbities? It seems to say the mortality rate for the health workers is consistent with the mortality rate of the general population but the deaths in the general population have (I believe) mostly been people near/past retirement age or with co-morbities. So comparing the health worker deaths with the general population does not appear a like for like comparison.

Just catching up with the past couple of pages but was going to make a similar point. No, the study doesn't control for those things. This has the obvious deficiency that the 8% of NHS deaths of under 30's, and 26% of deaths in 31-50 range, may be vastly different to the same age bands in the general population if those gen. pop. deaths are skewed more towards the upper end of the 18-65 range as we might expect. A "proper" study realistically would have controlled this, but this was not a "proper" study (by the author's own admission) due to lack of data. The author makes the following clarification in the comments beneath the main article:

For those commenting on the weakness of the basic data - yes we agree. The options were to do our best with this data, openly acknowledging its limitations or to simply ignore the topic... we chose the former.

We've taken a look at age bands comparing our dataset and national data for mortality. Certainly the deaths in the heath and social care workers we identified were in a younger cohort. The population our cases are drawn from (working age population, who are healthy enough to work, in one sector) will inevitably differ from the wider population so this finding is not surprising.

As the overall mortality amongst the people we studied and the whole population is not hugely different - and we'd expect it to be lower in a healthier, younger population - it is reasonable to assume that the data are consistent with an increased mortality in the group we studied. Apologies for not highlighting that earlier.

Taking this anlysis further is challenging and may be stretching the data further than it merits. For real comparison we'd need to kow the mortality figures, by age group, in workers in non-NHS settings and I don't think that is available.

Main conclusion: we need a natonal registry, proper data and analysis by those with access to all the relevant comparative data.

I've highlighted one of the author's conclusions there. Bit naughty of me I admit, as if you read the whole thing dispassionately their ultimate l point is that this is very much a very basic overview sketch of the situation and more data is needed. Not surprising given that the methodology was to remotely collate only media reported deaths of NHS workers, hence it is necessarily incomplete and also represents an absolute lower bound on NHS worker deaths (hence is a "best case" scenario for NHS).

It is possible to point out other gaps in the info - e.g. time factor (i.e. are deaths skewed to earlier / later in pandemic, or consistent throughout, and compare to PPE provision over time). Also it only concentrates on deaths. It would be equally interesting to know about infections - given we accept that NHS workers are a younger cohort then they are more likely to recover (not die), but are they more likely to contract Covid 19? if so by what multiplier, and what is the spread across work roles etc. This sort of study would offer info about PPE and transmission risk in healthcare settings. But as the author said, the data does not exist.

In the interests of balance, Pete you could have made your back of fag packet calcs support your thesis more strongly if you had removed the 8 NHS worker deaths in the 70+ age bracket.

Anyway, I don't want to labour that study. Overall on PPE, if we are in any way "following the science" as a country then by all means downgrade the PPE, but only after the science is available. Until then we should be ideally be going way over the top if possible. I would not be unhappy to find retrospectively this was indeed the case, but waiting a year or two and letting the chips fall where they may does not seem sensible.

[petejh]

edit, double post.

[ali k]

BREAKING: Chief Adviser involved in advising.

But that’s the whole point isn’t it? Cummings is a political adviser. He has absolutely no relevant qualification or indeed mandate to be involved in these discussions. There’s been a huge emphasis during the press briefings put on the fact they are “following the science every step of the way”, as if there’s a single clear and logical strategy to follow that emerges from ‘the science’. But that’s not the case. There’s a range of competing disciplines and agendas which come into play when deciding on the strategy to follow, one of which is clearly political. Even if he’s just been an observer in the scientific discussions I’m uncomfortable with that fact because it adds a degree of political pressure to what should otherwise be a completely independent and open forum during the meetings. How do we know there hasn’t been a nudge in this or that direction when the judgement is finely balanced already? Or members holding back on raising politically sensitive arguments because he’s at the back of the room? There’s also the question as to what degree Cummings is then filtering the information before he presents his political advice to Johnson or Raab.

They’ve also made great play of being open and honest with the public. You can’t argue that if you don’t release the data, modelling, SAGE reports, or even who’s on the SAGE panel into the public domain all the way through this. Or to what capacity a political adviser has been involved in the supposedly independent discussions. Other than just saying “he was only observing, nothing to see here”.

[teestub]

So - if you were in a meeting hoping to discuss things candidly about what to advise regarding CV19 and Cummings was at the back of the room - would you be unaffected?

Totally, he doesn’t seem like the sort of person that could observe quietly for more than about 10 seconds, unless he’s sat in the corner with a muzzle on 😂

Any arguments about him needing to be there to communicate the SCIENCE in plain English seem to be daft, when you have the CMO and CSO there.

[danm]

It does sound awfully like the old days of Stalin, where you'd have a parallel power structure consisting of political commissars ensuring that decisions made by professionals fitted in with state doctrines. One way of making sure that the science which is followed is the "right" kind of science. I do hope I'm entirely wrong about this, but given Cummings penchant for quoting dystopian sci-fi as though it was an operational plan...

[Will Hunt]

Good grief, move along, move along. It was a throwaway comment aimed at the Guardian which seems to hear Cummings' name and immediately begin to froth itself into an apoplectic ecstasy of outrage.

[ali k]

...the fact the PMs most senior advisor has always been present at SAGE meetings undermines my outrage.

That’s the government’s line, but it is not the truth. As stated by the previous chief scientific adviser David King.