December 30 2020

The anxiously awaited MHRA approval of the Oxford Astra Zenica vaccine came first thing this morning. As Matt Hancock announced it you could see the delight on his face. I am sure you will all join me in thanking all those who have made this happen in amazingly quick time with all the safety tests completed. Particular congratulations to one regular reader of this report who has been personally very involved in the work.

A further interesting announcement today was that the second dose could be delayed for up to 12 weeks instead of just 3 weeks like the other 2 available vaccines. The UK has ordered an initial 100 million doses. This means that more people can be given their first dose, which is now thought to give good protection from 2 weeks with the second dose to come much later than planned. This will enable more to have some protection quicker than anticipated.

At the PM’s briefing tonight, JVT warned us not to try and compare in forensic detail the different vaccines. You cannot compare like with like when you start with slightly different definitions of illness between them. The point being it makes no difference which one you have. Please have the first one you are offered.

Today’s figures tell their own story. 344,775 tests were done in the last 24 hours, and 50,023 cases were found positive yesterday. The rate is 353.7 per 100k, a rise of 20% in the last 7day average figure.

981 deaths have been reported in the last 24 hours. This may well be a bit increased because of the holiday effect. Germany reported just over 1,000 deaths in 24 hours, record highs for both countries in the second wave.

On the 28th December, 23,771 patients were in hospital with Covid with 1,847 on a mechanical ventilator. Both these figures show considerable growth in the last week.

Gavin Williamson reported his plans for education, it remains his priority to keep schools and universities functioning but in view of the present circumstances a number of changes are necessary. Most primary school children will return to school on January 4th including the vulnerable and children of key workers. In a few areas which will be listed on the Gov.UK web site they will delay until 18th January. In secondary school, those in examination years will now return on 11th January and the remaining years in secondary school will return on 18th January. There will be more remote learning and a further role out of devices to help their learning on line.

Universities are to stagger returns with medical students and others on essentially practical courses starting first. All children and students will get at least 2 rapid tests as they return to school. It may be the first time younger children meet a soldier. It will need careful handling.

There have been Tier changes have been announced tonight. With another 20 million of us now added to Tier 4, it means 78% of us are under the most strict rules. Most of the Midlands and Northern England except Yorkshire are now in Tier 4 from midnight tonight. You can find the full list of places that are now in Tier 4 on the Government web site. Most of the rest of the country is in Tier 3 with very few places left in Tiers 1 and 2. These arrangements may well be tightened in the next few weeks as they are kept under regular review, it is too early to see the effects of Christmas day mixing . It is vital now we all stay at home in our households tomorrow night. It is still possible we will see a Tier 5 with curfews and restricted travel. It’s in all our hands. If we do not stay apart this will be the inevitable outcome in a few weeks time.

I note reports from Los Angeles that there is such a shortage of pine wood that undertakers have been unable to make coffins. There are reports of funerals going ahead before the ordered coffin is available.

Many of you may have heard Dr Tom Dolphin , now a consultant anaesthetist , speaking very clearly about the issues in the NHS. Many of you helped start his training in the Greenbelt Field Hospital all those years ago.

I received this hospital update today and have permission to share some of it “ The hospital emailed all its specialist nurses on Saturday informing us we were expected to do all the online training for vaccinations over the weekend. There was about 3 hours of work covering vaccine history, the workings of the immune system, anaphylaxis, storage, admin and legal issues. Nothing we did not already know about, except the specifics of the new vaccine. We were also told we are expected to volunteer extra ward shifts because staffing is critical. They have reduced the number of “safe “ staffing for some wards which means I could work a shift with 30 patients and only 3 staff. Cancer has not been cancelled officially but we are told our priorities must change. All clinics are back on the telephone, this means I have not even met some of my 200 patient case load. Our hospital now has 124 Covid patients with 9 fully ventilated. Our senior consultant is trying to work whilst having chemotherapy himself. About a third of our nursing team have retired, left or died since March, and one is struggling to stay mobile with MS. I am just not sure I can do my day job, additional palliative care, ward shifts and vaccinations. The only way is to start at 6am rather than 8am and just keep going. It’s just as well I have a great family to look after me, but I do wonder how long it will be before a nurse looses her registration because of an oversight or a fatigue induced error.”

Essex declared a major incident today because of excess pressure and lack of staff.

I have been thinking about priorities today and I wonder if this needs rethinking. With the arrival of significant amounts of vaccine and the news a second dose could be delayed for 12 weeks . Could or should we reprioritise it. I do not think we would disagree that NHS staff and Home Care staff with regular patient contact should be the priority group and including those in laboratories working with infected specimens. Who should come next is more difficult. I am beginning to think that if education is so important that university students should be next, together with their teachers, followed by secondary school pupils and their staff , then primary school pupils and their staff. Children and to a lesser extent students, find social distancing difficult if not impossible. They are our future. Keep them safe and the education continuing then our future is much more secure. After students and children we can go back to the age bands already prepared, together with other key workers. Most senior citizens can comply more easily with isolation. Many other adults are able to work at home and stay apart.

This is clearly controversial but we have 50 million doses to play with and another batch to come. What do you think? We are in a constantly changing situation. Education needs preserving, some are better at isolation than others. It would get NHS staff back to work quickly if they do not have to self isolate or stay at home to care for young children.

Let me know what you think about this I have not yet seen it debated anywhere. There is a lot to talk about. There is probably not a right or wrong. The only wrong will be to go out celebrating tomorrow, that will be a criminal offence. Large fines will be in order. Meanwhile a Boris said tonight the tunnel has been shortened , the light has got brighter.

Thank you to Oxford and Astra Zenica.

Stay safe everyone.

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