On Thursday 3rd December, a live public Q & A was held via Zoom to launch the interim report on the findings of the All-Party Parliamentary Group (APPG) on Coronavirus, with March for Change. The APPG was formed to examine the UK response to the pandemic, to assess the impact of the pandemic and inform suggestions for future policy. The panel for the session consisted of Dr Mike Galsworthy (Co-founder of Scientists for EU, Chair), Caroline Lucas MP (Green), Dr Philippa Whitford MP (SNP, Shadow Secretary of State for Health and Social Care) and Professor Martin McKee (Professor of European Public Health, London School of Hygiene and Tropical Medicine).
The session opened with an overview of the enquiries conducted by the APPG, which included speaking to 65 witnesses, 30+ hours of public evidence sessions via social media and the processing of almost 3,000 evidence submissions. The panel then outlined how the findings related to the previously announced March for Change Covid-Secure UK exit strategy, a proposed three step plan (Control; Suppress; Eliminate) for moving forward from the measures used in the fight against coronavirus to date.
Ms Lucas introduced the first set of findings; those relevant to the first stage of the proposed plan: Control. She outlined the problems with the existing UK “NHS Test and Trace” system since its inception which consistently failed to meet targets repeatedly set by the government. On the evidence gathered by the APPG, she said it was clear that existing, local public health teams were better placed to provide an efficient system than the private companies given the responsibility by the Government. Another major issue she identified was the poor level of financial support available for those unable to work, and difficulties in accessing even that support. With the lowest levels of Statutory Sick Pay in the OECD, and limited, difficult access newer £500 isolation payment it was not surprising that compliance with self-isolation requests was so low, as people often simply could not afford to take time off work. She also described the existing system as relying too much on the arbitrary targets for tests conducted rather than results.
Ms Lucas made mention of interesting evidence by Syra Madad, organiser of a successful scheme in New York. This scheme was introduced after the initial lockdown which used local contact teams who knew their own neighbourhoods to carry out personal visits to contacts. They were also able to offer both financial support and practical support with issues like safe quarantine accommodation. This enabled of 90% compliance which far exceeded anything achieved in the UK to date. In the UK full self-isolation compliance was observed to be as low as 10%. Among other factors identified as needing improvement was turn-around time of test results.
Looking back to the period after the first lockdown, the panel agreed that time over the summer had been “squandered” rather than dealing with the issues. Prof McKee went on to point out that having got the infection rates well down at the end of the first lockdown, relaxation over the summer and Eat Out to Help out had set the scene for the second wave rather than the progress being built upon.
The next section of the overview was taken by Dr Whitford, who talked about the elements of the report relating to the second stage of the strategy: Suppress. She opened by remarking that where she came from in Ireland, there was a saying that if you wanted to get “there”, you “wouldn’t want to start from here”, but here we were regardless.
Dr Whitford spoke about the more effective use of local public health teams by all the devolved nations. She expressed disappointment that after a lot of progress in Scotland over the summer with no deaths for six weeks of people who had tested positive for the virus, too much of a relaxation being signalled from Westminster had effectively undone the work. She expressed concern about the planned relaxation this Christmas potentially coming at a very high cost.
The subject of the proposed Christmas relaxations was taken up by Prof McKee, saying that he too was very concerned. He suggested that we all wished to avoid the type of bounce-back that Canada had seen in infection numbers after their Thanksgiving celebrations in October, saying he didn’t want to see Dr Gabriel Scally’s oft-quoted line about hugging loved ones at Christmas and burying them in the New Year become a reality for UK families.
On the vaccination plans, Dr Whitford was keen to stress that we had a long way to go before enough of the population received vaccination to return life to normal, and she wanted clarity as to how the vaccinations were to be rolled out. Dr Galsworthy added to this that studies after the first wave had shown only about 5-10% of the population had antibodies meaning there is a long way to go to population immunity even now. Dr Whitford also expressed concern about the number of vaccine doses available initially; lack of information about further supply; and caution on the limited knowledge of its efficacy in reducing transmission.
Dr Whitford then expressed the group’s desire to see a comprehensive plan for a public information campaign in the light of the anti-vax campaigning already under way by a small, but very vocal, group. She expressed concern at the somewhat jingoistic tone from government in recent days and the Prime Minister’s tendency to over-promise and under-deliver, as well as his general reluctance to deal directly with bad news. Her final point was the need to stick to the guidance for the duration. Using WW2 as an example, she said it was unacceptable that people were deciding they had had enough. To decide not to bother to follow the guidance any more was no more an option now than deciding to use a torch during the blackout would have been during the Blitz. She stressed the need to work together to avoid tens of thousands more unnecessary deaths before the vaccinations take full effect, which would probably be early next summer.
Moving on to the third and final stage of the Covid-Secure UK strategy: Eliminate, Prof McKee explained that the aim was not global eradication of the virus as with smallpox in the past; that would be unrealistic. The aim of the strategy was the elimination of community transmission through the vaccination programme now that vaccines were becoming available. To Dr Galsworthy’s query about the duration of immunity, he acknowledged it is not yet certain how long it would last, but that he was optimistic based on other examples of which he was aware.
The first question was then brought forward from a member of the public attending online:
What is the response of the Government to the IPPG report, and what can we do?
Dr Whitford answered this first, saying that the report was only now being released. She mentioned that recent government rhetoric, in some instances, seemed to be in agreement with the report, for example with reference to decentralisation of the Test and Trace system. However, she believed that what she had seen happening recently suggested things were actually going backwards. The panel agreed that it would be useful for members of the public to contact their MPs and ask if the MP had read the report, ask for the MPs response and request their MP to nudge the Prime Minister.
The discussion returned to the subject of the importance of decentralisation of Test and Trace and the need to use local contact teams on the ground. Prof McKee suggested that Fr Brown’s fictional detective investigations were carried out in person for a reason, and that it would be unimaginable for him to be portrayed making the same sensitive enquiries over the telephone rather than travelling around on his bicycle to talk to people. Phone contact was simply not an effective contact tool when asking people to do something difficult like self-isolating. He made particular reference to the invaluable interpersonal skills in local sexual health teams who already carry out sensitive and effective contact tracing, skills it was felt were missing from the current system and could be utilised through local public health.
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The next question was from Liz in the online audience, asking if mass testing in Liverpool was useful.
Prof McKee pointed out that the rates in Liverpool had already been coming down when the testing started. He said the rapid tests were useful but significantly less accurate resulting in a trade-off and the key was the manner in which the tests were used citing the example of mass testing in Slovakia. He praised the Liverpool approach of targeted repeat testing but stressed the need for support to be available for anyone testing positive, saying that the Slovakian approach had used both strict enforcement and full support. Dr Whitford felt that the rapid testing was useful where a big outbreak had occurred but was concerned at false reassurance being given in the light of the tests’ low sensitivity. Several tests on consecutive days were the best way to use them.
Dr Galsworthy suggested the need for the public to consider not just the potential for death from the virus, but also the potential for developing the as yet little understood “long covid”. Dr Whitford spoke of the group’s shock at the number of people contacting them about the issue, having severe ongoing problems after relatively mild original illness. She said the narrative that young people had no cause to worry about the virus was dangerous; this is based on the number of young, previously active people, reporting the problem and that there would be enormous challenges to health services as a result of these ongoing complications from the virus. Ms Lucas suggested that because the issue was as yet poorly recognised or understood, people were also facing difficulty in accessing support from employers and from the benefit system. The panel agreed that the group’s session with a mixture of long covid sufferers and bereaved families had been extremely difficult for all concerned.
The next questioner asked Is a vaccine the only way out?
Dr Whitford’s immediate reply to this was “Yes”. She explained that the government had no interest in a border control approach when approached by the devolved nations jointly to request it be considered, and that there was no easy answer or magic wand. She was very sincerely hoping that the Prime Minister would not describe the vaccination programme as “world-beating” as she felt that would immediately doom the effort. Dr Galsworthy commented that the vaccine must not be seen as just something to get to first as if in a race, and that the public required reassurance that their safety came before national pride.
The next question was about the ingredients in the vaccine(s), how animals coped without vaccinations, and access to information before being asked to consent.
Prof McKee referred to the document now available for health professionals giving detailed information about the vaccine and recommended it to anyone that would like to see the information. He expressed confidence in the staff at the MHRA, the UK regulatory authority, saying that the stakes were high as they were now becoming independent of the European Medicines Agency and he did not believe they would risk mistakes by rushing the process unduly. In relation to animals and vaccines he pointed out that vaccinations are widely used in agricultural animals and pets, and that animals in the wild often simply succumbed. The panel then joined in giving examples from history of tragic human infectious disease outbreaks where vaccines were unavailable, including various measles epidemics, and the devastation caused by the arrival of the Conquistadors in the Americas.
The next question praised the report as extremely valuable but asked about its presentation to the Government.
The Chair, Dr Galsworthy, said that they were doing all they could. The panel joined in requesting that the public keep up pressure by whatever means possible: write, tweet and email MPs; contact the local Party offices; contact local papers; use social media etc. Keep pushing, they urged.
The final question was maybe the most topical of all from audience member Adam Ward: What can we do to enjoy Christmas safely?
The first answer jointly from Ms Lucas and Dr Whitford was “Ventilation!”, a risk mitigation they felt was not mentioned enough. Ms Lucas referred to Independent SAGE’s suggestions for celebrations and outdoor events and suggested wrapping up warmly and organising street parties, which would also help tackle some of the loneliness people will be feeling even more acutely this year. Discussion of outdoor winter events in other countries provoked references to the joys of Germany’s Christmas Markets. Returning to ventilation, Dr Whitford said a request had been made to remove tax on air purifiers and similar systems. She recommended opening windows as much as was bearable if households were gathering, possibly leaving a room with the windows open for a ventilation break and then closing them on return. She cautioned against giving elderly relatives hypothermia to protect them from Covid-19!
Dr Whitford also recommended that people carefully consider their plans, asking themselves whether taking advantage of all the flexibility offered was the right thing for their family in the circumstances, or whether maybe planning an Easter together might be preferable this year to putting people at risk. There was a suggestion to concentrate on maybe seeing someone at most risk of loneliness rather than having a full gathering. There was an example of just that from within the panel as Ms Lucas is planning to spend Christmas with her mother after the loss of her father this year, and there would be similar considerations for many families.
Following on from the German Christmas Markets example, Prof McKee suggested using the opportunity to revisit our own outdoor traditions such as the Mummers, and thinking about a new way of living and enjoying ourselves out in our communities, not isolating ourselves or others but enjoying it safely.
The final message from the panel was “Let’s get creative this Christmas!”
The session closed with thanks to March for Change, the APPG, all that had taken part and contributed over the duration of the enquiry, and all who had joined the session online.