UK-Preparing for a challenging winter 2020/21, 2020, Academy of Medical Sciences, Holgate

[Esther12]

First two posts copied from
Coronavirus - worldwide spread and control
For general discussion of the UK response to Covid-19, please post on that thread

Four urgent changes Boris Johnson needs to make to prevent major COVID-19 death toll in winter

http://www.msn.com/en-gb/health/med...-death-toll-in-winter/ar-BB16Jepy?ocid=ASUDHP

That report was from Holgate:

At the request of the Government Office for Science, the Academy of Medical Sciences established in June 2020 an Expert Advisory Group chaired by Professor Stephen Holgate CBE FMedSci to inform...

https://acmedsci.ac.uk/file-download/51353957

During the upcoming winter, the NHS will need to provide ongoing care for those who have had COVID-19 infection and who are suffering from post-viral sequelae. Although there is a paucity of data to accurately estimate the extent of post-COVID-19 sequelae, post-viral syndromes are well documented following other viral infections including severe acute respiratory syndrome (SARS), Chikungunya and Ebola. SARS resulted in chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome.192 Chikungunya leaves 20% of patients with post-viral chronic inflammatory joint disease.193 Ebola resulted in 70% of survivors suffering from musculoskeletal pain.194,195,196,197 About 80% had major limitations in mobility, cognition and vision one year after discharge. Each of these post-viral syndromes have their own set of symptoms – and COVID-19 will probably be different again. In addition, data from the COVID Symptom Study suggest that while most people recover from COVID-19 within two weeks, one in ten people may still have symptoms after three weeks, and some may suffer for months.198,199

Some post-COVID symptoms may have multiple possible aetiologies – particularly mental health, cognitive impairment, chronic pain and chronic fatigue – which will benefit from a multidisciplinary approach for diagnosis, treatment and long-term management to avoid long-term disability.

OT, but this was of interest to me:

Those from BAME backgrounds (especially younger people) tended not to be aware of the disproportionate impact the disease has on these groups. As a whole, this group were less interested in talking about the disease as having an ethnicity-based element – they would rather think about socio-economic drivers, for instance the high numbers of people from ethnic minorities working as lower-paid frontline workers such as taxi drivers, bus drivers and nurses.

This too:

Trust and communications

Scientists were considered a trustworthy source of information but there was a tendency to associate leading scientists with politicians. There was a common perception that a single scientific truth exists around the pandemic and that scientists are the ones promoting and defending it, while politicians are more focussed on protecting the economy. But those who were more interested in the pandemic and knew more about it were also more likely to question the mortality and infection figures, wondering whether they are being massaged or underreported. Among this group, those who distrusted the government transferred this distrust to the scientists leading the response, whose position was seen to be politicised.

Conversely, trust in politicians was lower. Some acknowledged a difficult trade-off between protecting people and the economy (and were unable to suggest an answer) but there was criticism of the government’s handling of the outbreak and its communications, which were felt to have become more complicated since the early days of the pandemic. Those who had been following the pandemic more closely were able to name multiple instances where they felt the government had manipulated figures or not been straightforward in talking to the public.

The groups expressed confusion about the current guidelines, being unsure about how to act under many of the new, less absolute, social distancing measures. Coming shortly ahead of the planned opening of many shops and restaurants in England on the 4th July, there was also a view that many of the newly-opening places would not follow the rules. Some demanded greater clarity on the scientific rationale behind each of the steps that have been taken in the opening up – what the impact of each step was expected to be and the thought process behind permitting it.

The 'expert advisory group' included Matthew Hotopf.

Claire Bithell, who did a lot of the worst Science Media Centre spin, also played a role as Head of Communications at the Academy of Medical Sciences

 

[Jonathan Edwards]

Four urgent changes Boris Johnson needs to make to prevent major COVID-19 death toll in winter

http://www.msn.com/en-gb/health/med...-death-toll-in-winter/ar-BB16Jepy?ocid=ASUDHP

This looks to me like a complete lame duck. The four proposals are the basic minimum that nobody even needs to be told about. What we need are some real changes. For instance sending all Covid19 cases to dedicated fever hospitals not ordinary hospitals. Enforced quarantine. Shutting down air traffic. Like the sorts of things they do in New Zealand and Australia. All these establishment cronies are equally culpable. In comparison to Independent SAGE it is little better than a whitewash.

 

[Hutan]

Given Professor Holgate's position as Chair of the CMRC and his role as chair of the Expert Advisory Committee that authored this document, I thought the excerpts @Esther12 posted were particularly interesting.

During the upcoming winter, the NHS will need to provide ongoing care for those who have had COVID-19 infection and who are suffering from post-viral sequelae. Although there is a paucity of data to accurately estimate the extent of post-COVID-19 sequelae, post-viral syndromes are well documented following other viral infections including severe acute respiratory syndrome (SARS), Chikungunya and Ebola. SARS resulted in chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome.192 Chikungunya leaves 20% of patients with post-viral chronic inflammatory joint disease.193 Ebola resulted in 70% of survivors suffering from musculoskeletal pain.194,195,196,197 About 80% had major limitations in mobility, cognition and vision one year after discharge. Each of these post-viral syndromes have their own set of symptoms – and COVID-19 will probably be different again. In addition, data from the COVID Symptom Study suggest that while most people recover from COVID-19 within two weeks, one in ten people may still have symptoms after three weeks, and some may suffer for months.

It's good to see post-viral sequelae getting a mention. However, the discussion slides from post-viral sequelae, which may well have differences depending on the virus, e.g. lung damage in Covid-19, to post-viral syndromes. There is emphasis on how different each of the post-viral syndromes are and a downplaying of how long they last. For example:

SARS resulted in chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome

gives the reader no accurate idea of the high proportion of people affected with, or the long-term nature and severity of, the post-viral consequences of that coronavirus infection.

Ebola resulted in 70% of survivors suffering from musculoskeletal pain.194,195,196,197 About 80% had major limitations in mobility, cognition and vision one year after discharge.

This fails to mention fatigue, which has been documented as a very debilitating symptom of post-Ebola syndrome.

Some post-COVID symptoms may have multiple possible aetiologies – particularly mental health, cognitive impairment, chronic pain and chronic fatigue – which will benefit from a multidisciplinary approach for diagnosis, treatment and long-term management to avoid long-term disability.

While this is potentially true e.g. in terms of PTSD, it is very liable to mis-interpretation. It certainly opens the door for 'chronic fatigue' following Covid-19 to be labelled as psychological in origin. I know Professor Holgate was just the Chair, but given his long association with ME/CFS, he must be aware of the harm statements like that can do. This document was a chance to protect the many people developing post-covid-19 syndrome from hasty labelling with psychological diagnoses and treatment with GET. I haven't read the whole document but, given Esther12's quotes, I'm assuming that opportunity was missed.

 

[Hutan]

Those from BAME backgrounds (especially younger people) tended not to be aware of the disproportionate impact the disease has on these groups. As a whole, this group were less interested in talking about the disease as having an ethnicity-based element – they would rather think about socio-economic drivers, for instance the high numbers of people from ethnic minorities working as lower-paid frontline workers such as taxi drivers, bus drivers and nurses.

I found that interesting too, Esther12.

This statement is based on this investigation:

Between 30 June and 2 July we spoke to 36 people in the groups covering the general public, vulnerable people required to “shield” and those from Black and minority ethnic backgrounds.

36 people, covering the general public, vulnerable people and people from Black and minority ethnic backgrounds spoken to over three days. That's not a very big sample for drawing conclusions about what people from BAME backgrounds, 'especially younger people', think. There's also, to me, a disapproving tone in the comment about what this small sample thought.