Rachel Flowers, Croydon’s director of public health, last night issued a stark warning to the council that ending the coronavirus lockdown prematurely would be “most dangerous”.
Rachel Flowers: resolve to beat coronavirus
Flowers was addressing a “virtual” meeting of the council cabinet, in which she and Michael Bell, the chair of Croydon Health Services NHS Trust, delivered a detailed summary of where the borough stands after eight weeks of pandemic lockdown.
With Downing Street issuing contradictory messages about easing the lockdown and calling on the public to “be alert” to the deadly virus, Flowers was unequivocal when she spoke about the risks of a second or third wave of infections.
“This is the time we need to get the resolve,” Flowers said.
“We are at the most dangerous time in a pandemic,” she said, advising that the council, its staff and the Croydon public of the need to continue with the “stay at home” principle which appears to have reduced the number of people seeking medical assistance because of the virus, and slowing in the rate of people dying from the virus.
In the UK, more than 32,000 people who were confirmed as having coronavirus have died, while nearly a quarter of a million people have tested positive for covid-19. There appears to be a slowdown in the number of cases being reported, but for Flowers – who oversees an area which includes the largest number of care homes in London – it is too soon to be abandoning the core principles which have brought about such a downturn.
“We may have flattened the peak,” Bell said in his presentation, “but our response is not yet over.”
Mayday Hospital has reduced the number of covid-19 patients by 80% since three weeks ago
The risk of a second, or even third spike in the number of people becoming infected with covid-19, or dying from its effects, remains for as long as there is no vaccine or proven cure for the virus.
Bell reported that 900 people had been admitted to Mayday Hospital with covid-19 since the outbreak. Of those, 230 people who tested positive for the disease had died in hospital.
The hospital had increased its number of intensive care beds from 15 to 37 since the outbreak, and while three weeks ago there were 250 covid-19 patients in the hospital, by yesterday that number had reduced to 50, with only 15 of those requiring intensive care.
Bell related that Mayday had had no shortages of PPE – personal protective equipment – which he described as “a good success story”. Testing for the virus was now running seven days a week at the hospital, where the testing capacity is sufficient that they have been able to provide tests for local GPs and care home staff.
The Trust’s supplies of PPE are such that Bell advised that it is now making weekly deliveries of equipment to the borough’s 50 GP practices, and is collaborating with other care providers “to ensure all staff are well-protected”.
Bell also thanked local voluntary groups who had provided hospital staff with 1,000 meals every day.
Because of the lockdown, last night’s “virtual” gathering was the first cabinet meeting in Croydon since the end of February, and Jo Negrini, the council’s chief executive, used the occasion to try to rewrite history, or at least that part of recent events which reflects poorly on her and her judgement.
Jo Negrini: rewriting recent history
“I’d like to reassure members that we’ve been working very, very closely with care homes,” she said, as she claimed that the homes had received the PPE they required, stressing that “importantly, the right PPE”.
This, of course, contradicts accounts from care home workers who, at the beginning of the pandemic emergency were too often without any PPE, with some frontline staff being forced to adapt and adopt, some using Marigold rubber gloves and black bin bags in place of PPE as they went about their daily duties.
For all Negrini’s platitudes about what a good job she and her staff have done, her council issued three public appeals for PPE equipment, as well circulating internal emails, seen by Inside Croydon, which detailed the shortages. PPE stocks in Croydon were supplemented by donations from undertakers and school children.
In her written report to the council cabinet, Negrini had claimed that Croydon’s care homes were “responding well”. This would seem to be at odds with most interpretations: by May 4, 127 people had died from the virus in care homes in the borough.
Croydon has 123 care homes, half of which are specifically for older people; 20 of those homes had reported cases of residents with covid-19, according to Negrini. Negrini did not mention in her presentation how many care home staff in Croydon had contracted the virus.
Nor did Negrini mention the number of Croydon Council staff who had tested positive for covid-19, had been hospitalised because of the seriousness of the illness, or died. It had been reported last month that one member of council staff, Asha Walrond, had died from covid-19. Sources within the council suggest that at one point, 1 in 4 council staff were forced to self-isolate because they had symptoms.
Care homes are becoming the new coronavirus frontline
With reports from Mayday and other hospitals of declining demand for emergency assistance due to covid-19, the focus shifts towards the borough’s care homes and their many vulnerable residents, as they become the new coronavirus frontline.
Flowers is keenly aware that in the past few days, central government has effectively passed the buck for managing the pandemic crisis in care homes to local authority public health directors.
In a letter from MP Helen Whately, the care minister acknowledged that testing of care home residents and staff needs to be “more joined-up”.
Under the new approach announced by the thoroughly useless Whately, council public health directors, such as Flowers, will take lead responsibility for arranging the testing of all care home residents and staff, in discussion with directors of adult social services, local NHS bodies and regional directors of Public Health England.
As one public health professional described it today, “Effectively, the government is saying that they have failed to provide sufficient levels of testing, and now its the public health directors to decide how to ration it.”
By May 1, there had been 6,866 deaths attributed to covid-19 in care homes in England and Wales. As the Grauniad reported, “The health and social care secretary, Matt Hancock, offered on 28 April to test all residents and staff, but there has been widespread criticism of the availability and speed of checks.”
And the newspaper continued: “In her letter, sent on Thursday, Whately says there will ‘soon’ be capacity for 30,000 daily tests of care home residents and staff, adding: ‘This ambitious plan requires a close partnership with local leaders to help direct these efforts to where it is needed most’.”
The minister wrote that lead responsibility is being given to public health directors “to ensure that testing of staff and residents in care settings is more joined-up, and that available national capacity we are delivering is targeted to areas and care homes with the greatest need”.
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A major problem with the externalisation of care services has been the loss of local authority oversight and control. The Care Quality Commission, time and again, has been seen to be inadequate and toothless.
Covid-19 is a notifiable disease within the meaning of The Public Health (Control of Disease) Act 1984, updated 2010. This gives Croydon (and all authorities) sweeping powers. Given that Croydon has a plethora of Care Homes and Nursing Homes for elderly people and a multi-racial population, it makes it one of the more vulnerable communities, so why on earth hasn’t the response been far more urgent, comprehensive and thorough?
It needs to adopt MANDATORY public health powers for ALL care homes to require them to give staff paid time off to get tested and to ban the use of agency staff unless they deliver care to a specific location (I.e not travelling from Home to Home). Those on zero hours contracts need to be fairly compensated if they self-isolate, much as full-time staff do. ALL care Home residents need to be home tested and isolated in designated areas if positive. Just today we learn that nearer 30,000 people have died from the virus or virus related causes, the vast majority being older people.
ACTION cannot wait and I find much of what is said in this Inside Croydon article shows a huge lack of urgency, gravitas and conviction, as if the lives of the very old and of low-paid care staff do not matter.
When will our Council officials and politicians wake up to this?
“There appears to be a slowdown in the number of cases being reported”.
Speaking to a Croydon paramedic this morning, things are definitely “quieter”.
And the virus has had the benefit, if that’s quite the word, of stopping all the “silly” calls. As an aside, this chimes with the comments of another friend of mine – a 20-year served Croydon paramedic – who asserts that the London Ambulance Service would be well-resourced ordinarily, if it wasn’t for 50% of his calls being “time wasters”. It’s the wasteful consumption of capacity that causes the problems, in his view.
“The risk … remains for as long as there is no vaccine or proven cure for the virus”.
There hasn’t been a vaccine for a coronavirus yet, and it’s not as if they haven’t been trying for SARS and MERS, so there is no reason to expect one to come along now.
But understanding and management of the disease seems to be improving exponentially – remember the (global) rush for ventilators, which now appear to be injurious? – and will result in what you might call an ‘optimal’ (for which read, the lowest possible) fatality rate.
Ultimately, the current crisis will be seen, beyond personal tragedies, as a failure of imagination, in terms of planning, and of data. That applies internationally.
When the data is properly available worldwide (not that I would rely on the CCP for theirs), we might find that the most important number – the Infection Fatality Rate (IFR) (NOT Case Fatality Rate) – may not be dissimilar to flu.
That is not to diminish the disease – apparently it is horrible to have in its full-blown state, and a horrible way to go (much worse than flu) – but it will inform our future behaviours.
Unfortunately, the IFR is not usefully available, and won’t be for some time, if at all. That is a (structural) failure of Public Health England and (hush my mouth) the NHS regarding testing which will need addressing after this is done.
Other countries have done better, and it will be a difficult conversation here. For instance, Germany’s testing success appears to be a function of its health service being a public-private sector hybrid, and its engagement with commercial laboratories.
Can you imagine trying to have a grown-up discussion on a public-private sector hybrid model for the NHS ever – let alone at the moment?
As of reports yesterday, excess deaths exceed those of winter 2014-2015 by around 16%, yet it is held that the difference could be explained by people dying of other causes – heart attacks, cancers etc – that would have been avoided in an ordinary (flu) years.
So, as I say, if the IFR comes in anywhere near flu, regardless of how horrible this disease is on acquisition; then we may look forward to a better day.
I really, truly hope so.
Be well all.