April 2020

April 1

That was a most interesting discussion following the observation that a higher percentage of men are both catching and dying of Covid 19 than women. Whether you are a geneticist, a microbiologist, feminist or misogynist you came up with almost all the possible explanations, I have little else to add. Once this is all over, research will benefit from a better understanding of immunity and auto immune disease. In the mean time what ever your sex build up a strong immunity stay at home, stay safe and if you are a dog don’t get neutered!

One alarming message from tonight’s briefing was the indication that car use had begun to increase in the last few days. We must not relax this at all. If you make journeys that are not essential you threaten the lives of the rest of us. Please STAY AT HOME. I am not concerned about the slight increases in the numbers of new cases there are bound to be daily fluctuations linked to the completeness or otherwise of the data collected every day. The overall figures suggest we are at the beginning of the plateau we are all waiting for. We will know in a weeks time. The rise in the daily death rate is statistically speaking only to be expected. The way the data is collected has changed and is more accurate. It also reflects conditions here before the “lockdown” started a week or so ago. It may continue to rise for the next week but hopefully not at the same rate. I mentioned yesterday the dangers of trying to compare different countries and the number of cases. I have today been trying to find a set of figures to reflect the death rate per million population in each country. The figures I found were about 48 hrs old. In the UK we have 35 per million of the population compared with 53/million in Belgium and 206/million in Italy. The other figure I enjoyed was that globally 22,130 have recovered in the last 24 hours. I cannot find reliable figures for the UK today but we all know there are many . Another exciting development is the start of a randomised controlled trial of an antiviral drug called Remdesivir on affected patients this week both in the UK and in Omaha in the USA. This antiviral drug was first available about 10 years ago and was used to treat both Ebola and the Marburg virus. Watch this development carefully. Why did the media not ask questions about this today? They remain obsessed with testing. Testing is coming, we know there have been hiccups with it and everyone is doing their best to sort it out. There is light at the end of the tunnel. We will get to the end of this tunnel if we all stay at home, only going out if essential and maintain social distancing. Washing your hands may save your life as well as mine.

April 2

Sorry to be a bit late posting this tonight, I realise some of you are waiting patiently. I have been involved with a meeting of the World Association of Emergency and Disaster Medicine. WADEM . I have also had an email telling me I am temporarily back with a Licence to practice medicine. Seems like my retirement is over! I await to see what they will want me to do.At first sight today’s figures from the Government briefing are a little disappointing in that the number of new cases and deaths have gone up but closer scrutiny suggests they are what we still expect. The key figure is the rate of increase and that is holding steady. I remain quite confident that we will begin to be on the plateau of the curve by this time next week. The figures from Italy suggest they have got to the curve. There is a lot of other good news to share. Addenbrooks hospital has started using a reusable testing kit which only takes 90 minutes to get the result. Bancroft school, a public school in Woodford where I was in practice have developed and made excellent face shields in their design and technology dept. They have gone into production today. Matt Hancock seems fully recovered and did an excellent briefing tonight dealing positively with the testing issues. He made it very clear that we must not risk using any tests which give false results. One such test now available has an unacceptable number of errors and will not be used. A wrong result is much worse than no result. Community surveillance at Porton Down is about to start and these prevalence tests will be of enormous value in planning how we get out of all this.Another most generous gesture from Matt Hancock was the writing off all NHS depts, some 13 billion pounds that have accumulated in almost every trust for at least the last 20 years.I was told off by a teacher for not using paragraphs in my notes so I have tried to use them tonight . People often do not read what they write, a classic example of this was a message I received today. In all innocence it read. “Please do not forget to spread the clap to the NHS. “They certainly deserve a good clap but not the clap which would be hard to spread if remaining 2 metres apart. Let me know if there is any specific issue you would like me to cover. In the mean time stay at home keep well apart and follow all the rules. Stay safe , we are on track to get through this but only if we keep playing by the rules with no cheating.

April 3

Stay at home. This is not a request its an instruction. These were the final words today from Matt Hancock. It cannot be stressed enough we are into the critical phase of this epidemic. It may be a lovely spring weekend but please do not be tempted to bend the rules. We must all stay at home. The daily statistics continue to rise along the predicted path. Remember the surge of new cases reflects the situation a week ago when the incubation period for these cases began. From the mass of figures available, some contradictory, one good figure emerges — 18,327 more people are reported as having recovered across the world, the highest daily figure yet.The erection and equipping of the Nightingale hospital at the ExCel centre in just 9 days is truly mind blowing. Remember how we thought the efforts in China to build a similar hospital was amazing. By reconfiguring the beds in all our hospitals another 2500 critical care beds are now available and as of tonight about 2000 of these beds are empty, This does not count the new beds at the Nightingale hospital. This means we are no where near the capacity of our expanded NHS. The peak is still to come, our corporate strategy is working but it will not work if anyone relaxes the stay at home rule and stays 2 metres apart.Clinical trials of possible treatments are ready to go and patients are being recruited. Please encourage those affected to agree to the trials on offer. One such trial already has more than 900 recruits. The more volunteers the quicker we will see results. One drug has been around for years and has previously been used to treat malaria. Another trial involves drugs used to treat HIV cases.The expert tonight was prof. Jonathan Van Tan. He was a local boy to Boston and many remember him as a school boy here. The Boston community are rightly proud of his achievements. He reminded us all that we are all on the same side in this war. We all fight it together. I know one of the hardest things to do for some is to stay at home. You must do this, we need a lot less on the streets.I still await news of what sort of health care I am to be involved in. Help me stay safe, by you staying at home.

April 4

Well another challenge tonight, a power cut just as the daily briefing was beginning. Lasted 30 minutes and was due to some local HT power cable being knocked down. Its back now, so here goes.The sun is out but we are not out. Unless you have an allowed reason to be out I do hope every one could sign up to this. I suggest you ask the teenagers and young adults in your family and friends and see if they can sign up to this. We MUST keep up the pressure to stay at home unless absolutely necessary.The daily figures continue on the expected path but the rate of new cases is still rising but only at a small rate. it does look like the plateau is forming but is still to early to be absolutely sure. The rising death rate is still a tragedy but reflects the new cases of a week ago, we will see that begin to fall in a week or so. the rate of rise is reducing so more encouragement there.We do not know national discharge rates for those fully recovered but I was very encouraged to hear of 88 people discharged well from one hospital in London yesterday. It would help if all hospitals released these figuresMany of you know the NEC in Birmingham if only for Crufts. Try to imagine it with 2000 beds in by the end of next week. The number of ventilators now available should mean we will manage this now. There is still spare capacity.Those of you trying to manage home teaching might like to use graphs for a lesson or two. Those studying A level maths or statistics could perhaps teach you as well as younger children. There is so much data available now.The culture of wearing masks in china and neighbouring countries including Singapore is well known. For many years we have seen masks being worn to protect from traffic pollution and fog. It is very much a cultural phenomena. Research coming from Hong Kong and referred to by Jonathan Van Tan yesterday clearly shows a mask does NOT protect you from catching the virus and it MAY increase your chances. Masks protect others from your germs but if you have the virus you should not be on the streets. There is extreme pressure from some groups to wear them but for once, and perhaps the only time, I agree with Donald Trump and will not wear one in the street. Many people have not been shown how to wear one properly.Beverley Cuddy from Our Dogs made it very clear on the radio today that some dogs are worried by people wearing masks. She insisted that dogs in a public area MUST be kept on a lead. If they run off and get lost, you will not be allowed to organise search parties to find them. With the fine weather, what about making sure your garden fences are all in good order and your dogs cannot escape if running free at home.I received a picture of a cat today with a caption “they castrated me to make me stay at home”. I hope it does not come to that! We will have a rise in the human birth rate when this is all over.I live in the country, surrounded by worried farmers who will not get the seasonal workers needed each year from Eastern Europe. If you fancy working on a farm, the war time Land Army is being started again. Whenever you can buy local farm produce to help support them.So stay safe, stay at home and we can each and everyone of us save lives if we do this, continue to wash hands and stay 2 metres apart.

April 5

With all our day to day lives in turmoil it has been all to easy to forget that today is Palm Sunday and the beginning of Holy Week. I found it uplifting to listen to the virtual service from All Souls Langham Place in London, a church I often attended when a student. Holy Week is a time of solemn contemplation culminating in the Resurrection and all the hope that it brings. We are still in very serious times in our battle with Covid but we can look forward to it all being over and our hopes for years to come fulfilled..Persevere and follow the rules was the message from today’s briefing. I realise I am very fortunate with a large house and garden. I would find it much more difficult if I was in a family of 5 with small children in a two roomed flat in a crowded city.The figures today are as were expected. Remember now testing is confirming cases that were previously only suspect and not counted. This contributes to the higher number of confirmed cases. The number of new deaths continues to be very high but does show a small drop compared with yesterday. We must remember not to take too much from single day figures. We need to see a trend. I think we can take a little cautious comfort from these figures if, and only if, we continue to stay at home.Figures from Spain shows the daily death rate dropping for the second day running and in Italy there are encouraging trends. Remember we are following them about a week behind.There is encouraging news for NHS workers in Scotland. Their testing facilities are open at the Glasgow airport carpark, The testing will mean those well and testing negative can return to work. On the other hand some are asymptomatic and testing positive. This means they go home to quarantine and increases the number of reported cases.Find out about the new status checker released as an app. Pease use it as it will make it easier for the epidemiologists to help work out the behaviour of this new disease and will help with manging our recovery phase in due course.How long this lasts is entirely dependent on you and me following the rules. I am sure even tighter rules on exercise and dog walking are not far off if we don’t listen or try to cheat.One way to combat this whilst stuck at home is to write a diary. Get the children and the grand parents to do it as well. Try to be reflective about its effect on your life. Create a family history file that future generations can refer to. Think how fascinating it would be if we could read about daily life in the 1918 Spanish flu epidemic. There will be further pandemics in the future; lets help future generations learn the lessons of history so they don’t repeat our mistakes.So stay apart, stay at home, make your garden lovely if you are able and above all persevere. Just as with the story of Easter there is hope for the world so we will see light at the end of this tunnel. Don’t forget to listen to our Queen tonight at 8pm. She has been an inspiration to our country for 70 years.

April 6

Are you all in good spirits? One of my aims with these daily sit, reps (situation reports) has been to maintain morale. I am delighted out PM has tweeted to day that he is in good spirits. It would seem at last that the vast majority of people have got the message about staying at home and there is some evidence that there is an effect on the pandemic. We are nearing the peak but even a small amount of relaxation of the rules will wreck all the good work. Delaying the peak by a week could cause thousands of deaths so you know the rules which remain : Stay at home, Protect the NHS and Save lives.There is cautious optimism about the statistics today, but we need great care in interpreting them as we have seen falls on Monday figures before. In normal times there is always a rise in hospital admissions on a Monday. The rate of rise in the death rate has fallen and the number of daily admissions is stabilising. I am sure the peak is not far away. in Spain the death rate has dropped 4 days in a row.I am most alarmed by those who have been taken in by the 5G hoax. I understand some 5G masts have been attacked and put out of action. These people are putting all our lives at risk. If you see lunatics doing this please diall 999 and call the police urgently. Your doctors , the Emergency Services and many others rely on this system to save lives. It must be stopped.Another worrying but predictable development is the reported 25% rise in the number of requests for help with domestic violence. Many people at risk are trapped at home with abusive partners. Please make contact regularly with any you know who are at risk from a violent partner. Lets all think twice before we have “a domestic” with our partners . We must count to ten and think before we act.The ramping up of the NHS is incredible. I am amazed just how much has been done. I believe we now have enough resources for the worst case scenario, there are enough critical beds now for all who might need them. At the briefing today the media were pushing to have an outline exit strategy explained. In my view it would be totally inappropriate to discuss this whilst still trying to maintain the social distancing policy and the demand to stay at home. The exit plans are being worked on. There will be many strands to this but the order of implementation and the time lines still depend entirely on reaching the peak soon and maintaining a plateau.. We will win this, we must be patient; there is light at the end of the tunnel and it is getting brighter.As always I will try to answer your questions. Stay safe and be in good spirit.

April 7

I am becoming increasingly concerned about the ideas going round at the moment that the fever associated with covid 19 infection is helpful and is the way to kill off the virus. It is being said that you should not therefore take medication to lower your temperature as you will make the disease last longer. This is a myth resulting from an over simplification of the complex reactions. leading to a fever, and then a false extrapolation from there.I will try to explain this simply , if you want even more detail you will need to consult a modern textbook by reputable authors on immunophysiology.When we are infected by a virus, the body starts a complex process where the white blood cells known as macrophages start to attack the virus particles and produce a substance called interleukin 1 . This substance is known as a pyrogen (one which raises the temperature) Interleukin 1 signals to other blood cells known as lymphocytes specifically the helper T cells. These set about destroying the virus.Because interleukin 1 is a pyrogen it circulates in the blood at a higher level than normal. It finds its way to the brain , in particular the hypothalamus where it binds to receptors. It is the hypothalamus that normally maintains our temperature at a very steady state (37C or for Americans 98.4F) There can be about half a degree variation throughout the day in a well person.So the rise in temperature is an external sign that the internal mechanisms are working. A rise of a few degrees in body temperature does not kill the virus. You would need to bring it to boiling point to do that ! A rise in temperature in our bodies is essentially an unwanted side effect of an infection. there are other causes of a pyrexia other than viral infections. The Mayo Clinic has an excellent guide about how to manage fevers and this was posted by someone here yesterday.A high temperature of above 39C can in itself be dangerous and must be reduced using an antipyretic drug like a form of Paracetamol (Tylenol like products in the USA). we sometimes have to take quite drastic action to prevent brain damage, rigors and convulsions, using tepid sponging and cool fans and intravenous paracetamol. You will be aware of children having febrile convulsions from teething or a common cold.Please help dispel this false idea by demonstrating the theory is wrong. Please feel free to share

I wrote last night’s notes about the daily briefing before the news that our Prime Minister had been admitted to hospital and later to the Intensive Care Unit. I am sure that whatever your political persuasions you will join with me in wishing him a speedy and full recovery in short order. It is encouraging that he is not requiring any ventilatory support. To paraphrase George Orwell in Animal Farm “All men are vulnerable and some are more vulnerable than others”. We must continue with extra vigilance to stay at home and socially isolated for the foreseeable future. Be prepared for at least another 3 weeks before any relaxion of the rules could even be considered.The death figures today are the highest daily figure yet. We have to be careful how we interpret this figure, because the day before had showed a lower than anticipated rise and there will be day today fluctuations. Over all it does look as if the curve is beginning to flatten, if it had continued increasing at the same rate as last week it could have been as high as 1400/day now. Similarly the rate of increase of daily hospital admissions is beginning to suggest the peak is getting closer. We must not relax in any way, but can afford a bit of optimism on what otherwise has been a sad day for many of us.Keeping the numbers down and delaying them has worked. We have more than adequate capacity in the NHS to cope now providing we look after the staff by following the rules.We hear tonight there are now 8 testing drive-through sites that are operational. Testing rates are increasing daily. The new NHS army is beginning its work . You may have heard about shielding. If you are part of the 1.5 million who are in the top tier you may have received or will receive in the next day or so, a letter telling you to stay at home and stay isolated because you are in the most vulnerable in the community. Having immuno- suppressant therapy or chemotherapy for example. The NHS army will do your shopping, collect drugs, walk the dog etc. The middle tier or the vulnerable, are those with underlying problems aged 70 or above. I am one of these, there are some 16 million of us . The third tier is everyone else. The rules remain the same for everyone, there are no exemptions except those allowed. So despite our concerns for Boris we can take comfort in that we are following closely behind Spain and Italy in our progress through the pandemic. I hear lots of innovative ideas to relieve boredom and reduce stress, keep them up and keep sharing good ideas.

April 8

Well despite the depressing death figure for today those famous green shoots are still visible and growing slowly. The vast majority are complying with our rules and the graphs confirm this. The chancellor tells us the Government will do everything it takes to beat this pandemic. Are each and everyone of us equally committed to do what it takes.?This means ALL of us .I have continually reminded you that the death rate will be the last figure to fall but the graphs do show an overall steadying of the rate of hospital admissions and the rate of ITU admissions are settling down. The tragic death rate will go above 10,000 but no where near the 250,000 that were seen in the 1918 epidemic An important message today was about being kind to one another. I have been impressed by and grateful for the number of welfare enquiries I have had. Please keep up the kindness, send an Easter message to old friends and distant family. There was very significant and generous help to charities announced today which will enable them to keep going with their vital work within our health and social care systemsWe are not ready for easing of any of the restrictions yet but they will come soon, and perhaps even quicker if we stay at home.I am beginning to need a haircut as many of you will be. There is no chance of that in the near future. Undertakers have a dark sense of humour like the emergency services. I was amused by a message saying if I wanted to have my hair cut, my nails trimmed or a facial that undertakers were still working. To have an appointment with them all I have to do is ignore the social distancing and go out and about. I do not want my hair cut by the undertaker, so will be staying at homeLets all play our part and do what it takes for we all depend on one another.

April 9

The message tonight is please deny this virus the chance to kill more people. We are not done yet, we must keep going. We must keep going the extra mile by staying at home over the whole of the Easter weekend and all next week.Social distancing is working, it stops transmission of the virus. I cannot stress enough how important this is. We are stopping the number of confirmed cases going sky high. The day to day numbers are still fluctuating up and down a bit, but the curve is clearly flattening.If you look at the number of patients admitted to critical care, the numbers were doubling every 3 days a few weeks ago. Now it is taking 6 or more days to double. This is really good news. There are enough critical care beds now available to the NHS. They can cope now and there is still room for non Covid 19 patients such as the multiply injured and those with severe heart attacks.In the community it is also not doubling for more than 6 days.When I worked in hospital I remember laughing at a letter to a patient in the ICU addressed to the Impressive Care Unit. I am most impressed by all my health care colleagues working in this field. I have also heard it called the Expensive Care Unit. Of course it is expensive but the NHS can have all the money it needs our Government assures us. It is good news that the PM is holding up and still in good spirits. We must send a message to him that we all are doing our best to stay in good spirits as well.So the green shoots are growing, the light at the end of the tunnel is brighter. Please do not ruin it all now. Do not leave your home this holiday without an absolute necessity within the rules. We are all in this together, so lets all be team players.

April 10

This morning I have been searching through the newspaper archives for England in 1918. The papers were full of advertisments and testimonials for the benefit of Venos cough medicine in treating Spanish influenza that was rife in England and much of the world. I certainly remember being forced to take it as a child, being told that the worse it tasted the quicker it worked. The newspapers of the day tended to report the local scene rather than the national pictures but schools and businesses were closed, large numbers of dead were piling up waiting to be buried and what was left of our army were drafted in to help. The local Medical Officer of Health was the expert. It would seem that the epidemic moved from town to town across the country. Transport was much more limited and the epidemic only moved slowly. If you are bored look at the national library archives or Findmypast . You will glad you live in the 21st century compared to then.

Today, being Good Friday, is the time when Christians all over the world reflect on the ultimate sacrifice made for us all. Many others are making enormous sacrifices by continuing to work under enormous pressures to keep the NHS, Social Care and other vital industries functioning normally. For the rest us, all that is being asked, by way of a sacrifice, is give up your holiday weekend and stay at home. A very small price to pay that the rest of us can survive. So stay at home and save lives.Our National effort to save lives is working, please do not relax in any way. Nearly 20,000 remain in hospital, the daily death rate is fluctuating up and down but the rate is not rising significantly. I have repeatedly said this would happen and I expect it to be much the same for the next two weeks. It really is good news. It follows two weeks behind the flattening of the rate of new cases. Testing is now taking off at pace and it would seem we will reach that target of 100,000 by the end of April. Three mega laboratories are now working, with another scheduled at Cambridge in next few days. There are many other laboratories coming forward with the required expertise. They are being repurposed rapidly. There are now 15 drive through testing stations so that there is sufficient capacity to test all NHS staff. Again this is excellent news.There has been a lot of discussion about personal protective equipment, PPE, and I have written about the correct use of this several times already. The government have published a plan which has 3 parts . Firstly a guide as to when and how to wear it. Importantly it says when you do not need to wear it. We must not waste the kit. It must be used and reused when appropriate. Wasting it by wearing it wrongly and when not necessary, is madness. There is clear science now to show that generally wearing it when out and about is not necessary. Much better to use the 2 metre social distancing rule. Remember also a front door is much more effective than a mask.Secondly, distribution has been a problem but a new giant network is up and running, thanks to a massive effort involving the armed forces to get all the kit to the right places, 742 million pieces of equipment are now out there. Deliveries are ramped up to each Trust every 24 hours now.Thirdly, future supplies are being secured. Buying it abroad has been difficult as some countries would not allow export. We are now manufacturing vast quantities here in the UK. Many companies have volunteered to repurpose their factories and production is going full speed ahead. The government still want to know of anyone able to make a contribution to the production of the required PPE. The graphs shown by Prof Van Tam are much as I expect. The dangerous phase is not over. Relaxation of our efforts now will be catastrophic. If we all make a sacrifice, whether its our freedom to roam, or working 18 hour days in essential work, it will mean the light at the end of the tunnel can glow brighter.

April 11

Well the furore about the use of PPE continues. I have seen many pieces of video showing staff are not using it correctly. This may be especially true of staff not used to having to wear it. In normal circumstances we need to change PPE between patients we treat, as we endeavour to prevent cross contamination of patients as well as protecting ourselves from the patients. In the current situation, all the patients have the same infection so there is absolutely no need to change PPE when we move to the next patient. Yes of course we should wash hands but that can be done with gloves on. Gloves need to be changed if they are torn and masks need to be changed when they get wet. Visors, goggles, hats etc do not need to be changed until the end of a shift. I do wish people would not bash others for misunderstandings. I think we need to spell out very clearly that we cannot afford to waste equipment, there is now enough to go round if it is used both wisely and correctly.

April 11

Well the furore about the use of PPE continues. I have seen many pieces of video showing staff are not using it correctly. This may be especially true of staff not used to having to wear it. In normal circumstances we need to change PPE between patients we treat, as we endeavour to prevent cross contamination of patients as well as protecting ourselves from the patients. In the current situation, all the patients have the same infection so there is absolutely no need to change PPE when we move to the next patient. Yes of course we should wash hands but that can be done with gloves on. Gloves need to be changed if they are torn and masks need to be changed when they get wet. Visors, goggles, hats etc do not need to be changed until the end of a shift. I do wish people would not bash others for misunderstandings. I think we need to spell out very clearly that we cannot afford to waste equipment, there is now enough to go round if it is used both wisely and correctly.

The briefing tonight was from our Home Secretary and once again she reminded us our Government is following the strategic plan to do the right thing at the right time, guided by the science. The right thing for this weekend is to stay at home to save lives.The Home Secretary is, amongst other things, responsible for our police service, which is the envy of the world with its gentle and soft but firm approach to crime. Criminality is adapting to this crisis in the same way as the rest of us. We were assured that the police were still out there at work dealing with cyber crime, bullying , violence, fraud, theft and many other issues. They are not staying at home and will come quickly if we need them.The almost inevitable consequence of families being confined to home is the rise in domestic violence. There has been a 120% increase in domestic abuse cases handled by one charity. Our homes should be a safe haven for all of us. The police reminded us of a new service. If you need urgent help and protection as a result of domestic violence please dial 999 and if you cannot talk safely then dial 55 when they answer. It tells them you cannot talk and need immediate help, they will come.Remember we are all in this together and we must be kind. If you know adults or children at risk of domestic violence please stay in touch and be there for them.I must admit to getting a little uptight with the media pressures about both PPE and the exit strategy. They endlessly repeat the same questions and the politicians skilfully deal with them with a straight bat. I discussed the PPE issue earlier today and my views have not changed. I do wonder if there is a place for retired health service staff who have used PPE regularly to play a part in training care staff and others not used to wearing it.There are many aspects to developing a safe exit strategy which avoids the risks of a second peak of cases. Both vaccine use, and effective drugs will influence. There are possible promising results from a new antiviral drug called Remdesivir. Far to early to tell yet but you heard it here first!Please continue to be supportive and kind, we do not need people slamming one another when discussing these topics. Its sometimes better to ignore than to go on the attack. We are getting there, by all looking out for one another. Todays figures have us all on the right track, a good result from staying at home. Keep it up please.

April 12

A very blessed Easter to you all, on a day the like of which none of us have ever experienced. Today of all days we can always rely on our wonderful Queen to inspire us. In her Easter message she says clearly “Easter has not been cancelled we need it more than ever.” We have had a glance at what a personal sacrifice can mean so that others can live. Easter is a time of light and we must share that light freely and positively.Tonight’s briefing began with a sombre recognition that our total deaths have risen above 10,000, followed quickly by graphs which continue to show a flattening of the curves in the other graphs we are used to. Remember not to make too much of one day’s figures, they tend to be lower at weekends, but the drop in the number of deaths per day is heartening.The second objective with flattening the curve was to delay the peak of cases for the NHS to cope with. We were told that tonight that 2,295 spare critical care beds are available, which is 150 more than yesterday. If people start to go out we will quickly fill them all up and have patients on the floor in corridors as we have seen in other countries. Please continue to stay at home. we will get through this but we must all continue our great efforts and sacrifices.I hope you will all try to get the new APP and log in to help with future contact tracing. It is reassuring that every death of a member of staff will be individually reviewed with the thoroughness that the NHS investigates any untoward event or critical incident so we can identify what if anything could or should have been done differently to avoid that death.I have the impression that many of you both enjoy and look forward to my interpretation of the days events. If this is so I am very happy to continue trying to be objective and focussing on progress and good news. I go out of my way not to be aggressive or slam those I do not agree with. I am determined to shield you all from my stress, from false news and from others who want to blame every one else. The bright light of Easter we all need is still there at the end of the tunnel and is getting brighter. If the few who want to complain or not cooperate, or demand masks when they do not need them would kindly go and post elsewhere, I would be very grateful.So stay home, protect the NHS save all our lives and try to have the best possible day. Look forward to the day when PPE stands for Post Pandemic Extravaganza . It is coming.

April 13

Following your very clear steer that these postings are of interest and value to you, I am happy to continue with them. A big thank you to you all for sacrificing your holiday to stay at home, by doing so you have saved lives. I believe we can confidently say we have reached the plateau in the curve we have talked about for some weeks. We shall now see these figures go up and down for a couple of weeks before the downward trend is seen.Remember in all pandemics the figures rise quickly but go down slowly and the hospital death rate lags behind by a couple of weeks. Deaths outside hospital will be collated by the Office for National Statistics and in the fullness of time they will be most accurate. There can be quite a long delay between the death certificate being written by the doctor and a member of the family going through the death registration process. I was interested to notice that of the 667 deaths in hospital in England recorded by 5pm yesterday only 118 actually occurred yesterday. The rest occurred on days between 1st April and the 11th April. This clearly all illustrates the difficulty of full accurate figures being available daily.The issue of masks has become an issue again following rather outspoken comments by Dr David Nabarro of the WHO. The science that our government is quite clear about is that their use by everyone in the community is questionable. It is not just a question of availability it is also about customs. I will be very happy to change my mind if there is clear scientific evidence to say I should, but I do not intend to wear one like a child sucks on a comfort blanket. If I was showing symptoms I would stay at home. I should not go out, but if I did I would wear a mask to prevent droplets from my cough going anywhere near you. If I was just beginning the illness I would have no symptoms but on the other hand would not have a cough producing infected droplets either.All patients with the disease should wear a mask all the time wherever they are indoors. Dead bodies should also continue to wear one until properly bagged ready for disposal. Our scientists are reviewing the origins of the WHO advice and assessing the placebo effect. I will do my best to keep you up to date.Are you aware of the significance of R 0? Reproduction naught is the figure which reflects the rate at which each case can infect others. At its worst each case can cause at least two to three others this is recorded as R2 or R3. Thanks to your brilliant efforts at staying at home and social distancing we have reduced it to R1 so less than one new case follows each case and hopefully to below that to R0More good news is about NHS capacity which is now plentiful. The Manchester Nightingale Hospital is ready to go. SAGE, the expert advisors, will meet tomorrow. I anticipate their advice will be more of the same and no relaxing of the rules. They report to the Government who have to make decisions about extensions on Thursday. We must resist all pressure to relax too soon. I am personally concerned about other countries relaxing to soon only to see a second wave. We have heard very little about Russia and how they are coping. There are quite worrying figures tonight, but how accurately they reflect the true situation, who knows? We do know we are winning: the plan is working keep it up, stay at home, stay apart by 2 metres and don’t waste PPE by wearing it wrongly or when unnecessary.

April 14

We have been somewhat bombarded by statistics tonight, which frankly does not help us in understanding them because it is so difficult to compare like with like. I would much rather concentrate on the people these figure represent. There is no doubt that patient’s lives in our thousands of care homes are quite grim at present. Many patients and staff being very distressed. To try and understand this lets try to look behind the scenes.We live in an aging community. Many, many more live to get that telegram from the queen than ever have before. It follows that more and more people need care in a residential setting. We call them by a variety of different names, including terms like residential homes, nursing homes and care homes. The vast majority will have significant health conditions long before Corovid 19 arrived. Common conditions will include, Heart Failure, Ischaemic heart Disease, Diabetes, Strokes, Cancers, Dementia and mobility issues. Many patients live in the care home setting for months or even years and it is in effect their home. If they contract the Covid virus it is not at all surprising so many succumb to it. In the past is has happened with local seasonal flu epidemics and in the years I was in practice it was not at all unusual to lose 5-10 patients from influenza each winter in any one care home.Many patients did not want to be transferred to hospital when they became ill and wanted to spend the end of their days in their home, with carers they knew. We know there are sufficient beds in our expanded NHS hospitals but such patients very frequently decline to go in.Turning now to the problem of recording deaths in care homes and in the community. Just how much does the addition of Corovid infection to their other list of serious conditions contribute to their death? How can doctors assess this when writing death certificates ? What other factors are there ? Is their pressure in some places not to include the virus on a death certificate? This can be a real nightmare for GPs and others who take the issue of death certificates very seriously. How can it be standardised?I hope this back ground helps you to understand why the NHS is struggling to find a uniform way of reporting deaths in total across the country. Every county in the world has similar problems and no two can be compared like for like.It is encouraging that the hospital admissions have fallen by about 2% all across the UK now and not just London. There is always a great effort to prevent hospital cross infections with every case carefully looked at for lessons to learn. This was very true with the concerns over MRSA infections and is still very much the case with Covid,More about masks another time but remember your front door is the best mask. Social distancing is working you MUST continue with this. Please ignore or delete aggressive emails and messages, protect your mental health and remember if you see or read something you do not think sounds right it probably is not. Keep safe everyone.

April 15

It certainly seems as though we are winning the battle to keep the NHS going and maintain sufficient capacity for everybody who needs a hospital bed. 19,521 people are in hospital today with Corovid 19 and there are 2657 critical care beds available now for anyone who needs one. There has been a 5% reduction in the number of patients in London in hospital and 2% across the whole country. This is continuing the plateau and early downward trend in the figures we have watched in the last few days.Our shared sacrifices are working, so far the targets are all being met.The pressures on care homes in the community are now to be our focus. Although guidance to them was first available in February, many seem to be close to being overwhelmed. There are many distressing stories. There is a new plan to support Care homes. All patients being discharged from hospital to a Care home will be tested before discharge. All symptomatic staff and patients will be tested. There needs to be detailed local plans for more efficient isolation and barrier nursing, as each home will have a different geography. It would seem that the problems with PPE are nearly overcome. There are still issues about how and when to use which equipment, and when its not required. A big push on training is required.I know of many people who are distressed at not being able to visit and say goodbye to loved ones in Care homes . I am delighted that efforts are to be made to ensure this can happen safely. This will go a long way to relieve a great deal of psychological stress. The right to say goodbye will be welcomed by everybody.A new Carer’s Emblem to include carers as well as NHS workers is also welcome. We must all recognise the key role they play and it is to be hoped that those who wear it will be recognised and supported by the community.Although crime has substantially dropped overall there has been a significant rise in antisocial behaviour, which was expected in the warmer days. We must continue to try and be creative in our ways of managing the predominantly young men, who need other things to engage them.A while ago now I commented that the claims that patients who were taking ibuprofen might be more prone to infection and to having a more serious infection. I am please to say that an Expert Working Group published their report yesterday and concluded there was insufficient evidence to support this idea and recommended its use is continued, along with similar non steroidal anti inflammatory drugs (NSAIDS). They play an important part in treating arthritic and rheumatic pain and with fevers in children.A slighly disturbing message is coming from my Accident and Emergency friends. They tell me people are leaving things too long before going to A and E with conditions like Heart Attacks, Asthma, and even appendicitis. it is understandable that you will be concerned but you will be kept apart from Covid patients and there is room for you. You will still get the help you need. Please look after your self and get the timely help you need. In the meantime stay safe, stay at home, and stay 2 metres apart. we know this really is working well now.Get ready to clap the remarkable 99 year old Captain Tom Moore as he completes 100 laps of his garden on his zimmer frame. He set out to raise £100 and has now raised over £8 million for the NHS. I understand he is going to keep walking!

April 16

A great deal to try to digest and understand tonight as we learn we must continue our near lockdown conditions until at least the 7th of May. I recognise how very fortunate I am to be in a large house in a large garden in a rural area. I have no small children to entertain or school at home and am only 10 minutes in the car to a large Tescos which can provide all the essentials I am likely to need. I so wish I could be of practical help to those stuck with children in small high rise flats.So both SAGE and COBRA have met today and advised the Cabinet we should remain in the lockdown because the policy of doing the right thing at the right time is working and lives are being saved, There has been a further 3% fall in the numbers in hospital today.Five issues were considered in making this decision. 1) We must continue to protect the ability of the NHS to cope, this is going well at present. 2) We must see a sustained and a consistent reduction in the daily death rate. We are still some 7-10 days from this being true. 3) We must see a sustained reduction in the daily rate of new infections. It looks as though this is just beginning. 4) All PPE must be in place everywhere. We are getting there slowly. 5) We must not relax any restrictions which could risk a second wave of infections so that we would have to start all over again. This is still a significant issue.There is good news about the newly designed ventilators worked on by Formula One, Fords of Dagenham and others, they have been approved for use and will become available next week.Particularly relevant to this area is the arrival of fruit pickers from Romania . Without their help much of this season’s crop would go to waste. British people do not want the work. They will be well looked after in caravan camps and will be isolated for 7-10 days before working. We are delighted they were prepared to come.It is clear that this virus has a predisposition for the elderly, and for those with pre-existing conditions. What is not clear is why men seem much more prone to it, there are lots of theories but no clear proof. What is also emerging is a disproportionate number of black and other ethnic minorities being affected. We have no idea why this is. I have noticed this amongst the names of NHS and Care staff dying who have been named recently. There is to be a detailed review of these trends to see what can be done to understand this and avoid it.Death statistics continue to be a problem. When is it a natural death and when and how much if any does incidental Covid 19 virus infection contribute to the death? We must now compare figures with the same time a year ago. The number of deaths from Heart failure and Cancer would be about the same. It is the excess number which is due to the virus.You will have heard a lot about R and the R number. You are all used to opening your mouth and saying AAH! when being examined. Doctors will be celebrating, the R number in the community is now thought to be below 1. This means the number of cases will drop.Do not give up now. The good news is we are winning. Keep playing your part. Stay at home. Stay safe, Use the NHS when you need it, its there for you its free and they have the capacity to care for you. If you do not have Covid symptoms you will be kept apart from those who do. You can still save lives including your own.

April 17

Positive progress tonight, those green shoots are growing and the Easter light at the end of the tunnel is glowing brighter. We just have to keep going, to stay good humoured, and to continuing being kind to one another. We greatly assist this by staying at home and respecting the two metre rule.I hear encouraging news from the London Ambulance Service where I still have many friends. Their response times for emergency calls has come back to normal in the last 24 hours for the first time for some weeks. The number of patients in hospital with Covid 19 continues to drop particularly in London. All the efforts now are directed at continuing the plateau we have regularly talked about. It is encouraging to think it is beginning to go down now we must not relax now as a second wave of cases would be devastating and push deaths sky high again.hospital that some staff are ready and waiting for you. Do not be afraid of going to hospital. You will be triaged away from covid 19 patients. Do not risk your life, do not ignore cardiac chest pain or the pain of appendicitis.The furlough scheme for those unable to work has been extended until the end of June. All the efforts now are directed at continuing the plateau we have regularly talked about. It is encouraging to see it is begining to go down. We must not relax now as a second wave of cases would be devastating and push deaths sky high again.I continue to be worried about scaremongering. We have heard talk to day of having up to 40,000 deaths in the UK. This is most unlikely providing we prevent a second wave and by continuing what we are doing we should be able to stop this. The models worked on by the scientists predicted a worse case scenario of 250,000 deaths and a best case scenario of 20,000. We are much closer to the bottom end of the range.A lot of good news about vaccines tonight with the establishment of a special vaccine task force, we need lots of top units working on different vaccines. There are not quick results in this work and many different approaches are required. It is said you have to back many different horses then one will be a winner. There is also to be a vaccine innovation centre based at Harwell. We are working with others across the world, There are no certainties yet, but I am confident a vaccine will emerge in record time.Deaths of colleagues and friends are beginning to affect all of us. I learnt today of the death of a colleague from my student days. I have had a difference of opinion today with a friend. but that is all ok We are polite and respectful, its all right to disagree. If I asked you all how to boil an egg we would have many different ideas.If you work for the NHS you should by now have had your test, I believe there is considerable capacity now in the system. I suspect the problem for many of you is the need to travel to a centre perhaps up to an hour away, then wait in a queue and drive home again. I would not want to lose 2 hours of my time after a 12-14 hour shift. We must campaign for the tests to be in place at your place at work.A final question I would like to pose. Some good many years ago now the Health Service separated Medical Care and Nursing from Social Care. The social care sector was privatised largely and all our geriatric wards and hospitals disappeared. Look through that important instrument called a retrospectoscope; was that a good idea ?So stay safe, stay at home, look after your mental health. use your front door as a mask and be very kind to one another.

April 18

Because its a weekend there seems to be slightly less to report tonight which must be a good thing. I think however, we must absolutely continue to follow all the guidelines with no relaxation of the rules what so ever.We learnt more of the funding provided to our Local Authorities to ensure vital services such as refuse collection are continued. More funding to Adult and Children Social Services to ensure services such as safeguarding and domestic violence are enhanced. The vast majority of our country’s rough sleepers, almost 90%, have been offered accommodation.Shielding of the most vulnerable is progressing well and in most areas the local authorities backed by charities and volunteers are distributing thousands of carrier bags of essentials on a regular basis. Social Care Grants for those falling through the other financial support systems are being stepped up to ensure everyone has access to some financial support when needed.It was good to hear some recognition of the extra hardships experienced by those with children and no gardens. On humanitarian grounds, to prevent mental health problems, the Councils have been told to keep local parks open for children to walk and play in. They must not congregate however and should remain in their family/ household group and keep well apart from other groups. Please do not abuse this relaxation of the rules or you will lose it. It is recognised that with this horrendous loss of life it is important for people to mourn at the grave of a loved one and lay flowers. There is another slight relaxation of the rules to allow us all to visit graves of loved ones in our household groups, again please do not abuse this or it will be withdrawn.You all know of this remarkable veteran Captain Tom Moore, he is a Yorkshireman and I understand he is to be the guest of honour at the opening of the Harrogate Nightingale Hospital.The statistics continue to show the progress we are making. There is spare capacity in our hospitals. I was horrified to see film of the position in Moscow with ambulance queues several hundred yards long and taking up to 9 hours to off load their patients. This could have been us if we had not done the right things at the right time. And if we let a second peak happen it could still overwhelm us.I notice a couple of weeks ago the seemingly disproportionate number of Black And Minority Ethnic (BAME) people seriously ill and dying of Covid19. This seems a very complex multifactorial problem. Some detailed work has been commissioned to try and understand this and to find any possible actions to remedy it.The issues of PPE rumbles on with incriminations. When I first was involved in contingency planning we had what was know as the Civil Defence reserve stock. It was held in vast warehouses all over the country and had every conceivable item of equipment you could ever imagine needing to survive for 3 months. When this is all settled down perhaps this should all be reconsidered?Ventilators remain in the news. There are more available now than are required. I am interested in the new CPAP masks that are being used. It is also interesting that the method of proning while ventilating patients has been a successful last resort. There is a good bit of video on the net from France demonstrating its use and explaining the theory. My medical friends may find that interesting and if you know a lot about it because you have used it please comment about it after these notes.Stay safe, stay at home, save lives, use PPE if you need it, save it for others if you don’t.

April 19

Tonight’s briefing was lead by our Secretary of State for Education so not surprisingly schools and education played a big part.Tonight saw the smallest increase in the number of daily deaths for 2 weeks. It stands at 596. We must beware of getting too excited by this as its a Sunday with some incomplete reporting and tomorrow’s figure is likely to rise again. There is now early evidence that the death figures may just be beginning to plateau. The Oak National Academy opens on line tomorrow. This will provide high quality on line educational resources in the form of videos to all ages of school children. It would appear that a large number of pupils do not have access to i-pads or laptops at home. A considerable sum of money is being provided to help the poorest children keep in touch with their teachers and one another. Where necessary access to the internet will be facilitated by the provision of 4g routers to homes without one.Our Children are our future. We heard a clear apology that their education is being interrupted at the present time. There was a genuine promise to do all that can be done to minimise disruption. Special mention was made of vulnerable children, those with special educational needs, and challenging behaviour. There is concern about children in care at present with a promise that no child will leave care at present, the supportive work for these children will continue until the crisis is over. Special praise was offered to the Care workers and Social workers for all the extra efforts being made for these vulnerable children. Significant extra funding is being given to the NSPCC to maintain and strengthen the Child Line services and the adult support services at a time when the lockdown is causing a significant rise in domestic violence.There are no immediate plans to open schools again and equally no plans to keep schools open during the normal summer holidays.There is still a great deal of confusion about PPE. How and when to wear it. When it’s not needed and which bits of equipment are needed for which procedures. All staff who think they need PPE should read the latest guidance as it applies to them. Take the example of gowns. In some settings when wearing scrubs and an apron, gowns are not required, There are other settings where the same gown can be worn for a whole session with only the apron changed between patients. There are other clinical settings where full gowning is required for a procedure and then it can be discarded. Staff have got to consider what background PPE do they need and what do they need specifically for the next procedure. Most gowns can be washed and reused, most masks are single use. Undertakers have a requirement for PPE that is often forgotten. It goes without saying that at anytime if PPE becomes heavily soiled or dirty it should be possible to change it for fresh. As Dr Harries said tonight we all need some sensible grownup discussion about just how and when which equipment is to be worn.The Local Resilience Forums established in the wake of the Civil Contingency legislation a few years ago have been resurrected to manage and control the distribution of PPE in the community particularly to GP surgeries and Care homes but also the individual patients being cared for at home.So all of us must continue what we have started and we can now see early success in our efforts. We must not give up now, stay at home, stay apart. For the sake of our children we must keep going and strive hard to minimise the disruption to their education. Whilst stuck at home try some distance learning yourselves there is a great deal out there to try.Thank you for your continued interest in this daily summary.

April 20

Today’s briefing continues to confirm we are on the right track to meet that objective of protecting the NHS and saving lives. For the first time I believe more patients with Covid19 have been discharged rather than admitted to our hospitals in the last 24 hours. The number of in hospital deaths continues to fall each day. The measures we are taking are the right ones. We must just stick with it.The difficulties with collecting death figures has been highlighted many times. But it is worth looking at these figures from England released today. Of the 429 deaths in hospital added and counted for the first time today, 85 of them actually occurred on 19th April, and 210 on the 18th April. 53 more occurred on the 19th April and 77 on various days between 1st April and the 16th April. So you will seen that some of these deaths are taking up to 3 weeks to reach the daily official figures. In many cases it’s due to the involvement of a Coroner and the inevitable delays this brings. Collating deaths in the Community are even more complex.Whenever the news is generally encouraging we find the media will ignore that and try to find reasons to attack the politicians and scientists. It is beginning to be a bit tedious. I assure you that everybody is doing their absolute best to get this country through this crisis with the minimal loss of life. It does morale no good at all to highlight the deaths per day figure without also saying it has fallen every day in the last week and the lowest for nearly 3 weeks.There is no doubt we have a problem with PPE. It is a global problem and every country is scrambling to purchase it. Very precise new guidance has been issued to ensure the right equipment is used in the situation it is required. In the natural desire to be super safe some people are using far higher levels than required. In many care home situations gowns are not required if good disposable aprons are used. I have seen people out shopping in full face respirators, which is way over the top. We have all seen masks left over chins whilst resting or even singing! Be very clear the advice about PPE has not been down graded to cover the deficit, it has been clarified so that the right kit is used at the right time and none is wasted.The chancellor was reassuring as well about the financial payments for staff on furlough which began to role out today. We are so lucky to be in the UK, many smaller economies cannot afford to support their workers in the same way.The lockdown arrangements must continue, I only see good messages from todays briefing; please try to ignore scaremongering and false messages about the disease. We can look down the tunnel, its going to get better. We must go on doing the right thing, we must avoid a second wave of infections at all costs.There is to be a trial treatment using plasma from affected patients being given to those affected by the disease. This is known as convalescent serum and has been used effectively with some other diseases. It remains to be seen if it can help.We are all doing well, just keep going, be kind, be supportive and keep going by staying at home, unless out for an allowed reason. Wear the right PPE, ignore criticisms and maintain your mental health.

April 21

The NHS is still open for business. There are nearly 3000 critical care beds available today with an ample supply of all types of ventilation devices. If you need to be in hospital for a non-covid condition please feel safe enough to go for help. We must not add to the death rates by refusing to go to hospital when you need it. The numbers of patient with Covid 19 in hospital on any one day is stable and in London numbers are falling. The rest of the country will follow in a week or so. By staying at home and staying 2 metres apart you are making this work. Please keep going.All this good news does not interest the media who continue to quote misleading statistics and try to trip up the politicians and scientists leading our battle to beat this virus. Everyone is committed to working together yet it does not seem to be the case at times. With the death statistics in such a muddle I am going to say very little; we cannot compare like for like. No two countries collect them the same way. We are in the middle of a pandemic so its not surprising we are having the highest number of deaths for twenty years, I would not have expected less. Just remember the rate of deaths are stabilising and probably dropping but two week behind the plateau of cases. Ignore the hype and remember that the death rate is responding to our efforts to save lives.You must just keep going.SAGE has today discussed the problem of masks and the confusion about whether or not there is any benefit in well asymptomatic individuals wearing them outside the home for instance when shopping etc. We await their wise guidance. Massive efforts 24 hours a day continue to try and build up stocks and ensure everyone who needs them has the right access. There is no doubt that the stockpiles of a few years ago have been run down. In the fullness of time a full review of stockpiling should take place.The drive through centres now have enough capacity to test any key workers that need a test to ensure they are negative and can go to work. There are 27 centres now available and more still to come on line. One of the reasons that they are not being fully used is the distances some people have had to travel to be tested. This gap in the provision has been plugged by providing a postal service and bringing testing to the places of work. If you are entitled to a test under the rules please arrange to have one now.Dental treatment has been particularly affected because the use of a dental drill produces an aerosol of fine particles which could contain the virus in great numbers. For dentists to do this work they need the highest level of PPE. I understand well over 200 urgent care centres are available to do this treatment in an emergency. Please do your best to look after your teeth at the moment and avoid the total misery of toothache.Th opening of the Harrogate Nightingale unit was opened virtually today with Captain Tom Moore as guest of honour. Our Prime Minister has spoken to Trump and said thank you for the good wishes he had sent him. They also discussed trade agreements for the future. The Queen has celebrated her birthday with a minimum of fussTurn off the News when you have heard enough, it can affect you in ways you do not expect, keep active, write and phone old friends and acquaintances. Stay positive, stay at home, by all means think of the light at the end of the tunnel and even begin to think about a party at the end of all this. For now we must avoid a second wave at all costs. We must do as we are told and keep going.

April 22

Tonight’s briefing introduced a new face in the form of Sir Nicolas Carter, The Chief of the Defence Staff. He outlined the amazing work the armed forces have been doing in the last 25 days. I first became aware of the potential abilities of the armed forces quite early in my work in the emergency planning community. It is covered by legislation known as Military Aid to the Civil Community or the Civil Authorities or Civil Powers. these are often referred to as MAC-C , MAC-A or MAC-P.The Military have built all the Nightingale hospitals, created acres and acres of warehouses, assisted with the removal of the dead in multiagency teams, working in the front lines and in mobile pop up centres. Their ability with skills in command and control have been invaluable as they have organised so much in the background responses to the crisis.The bottom line is that we are doing well, we must not relax, the risk of a second peak of cases would be catastrophic. We must continue to stay at home and continue to prevent the spread. The figures do show that we are progressing exactly as we planned, the plateau is showing early signs of a down turn. The death rate is still dreadfully high, but is very much as was predicted and the actual numbers are at a plateau. The rate of daily increase is much slower now .Media headlines with new leaked data from a CQC (Care Quality Commission) report still not published is said to show that the number of deaths in care homes has doubled in 5 days with over 1000 reported deaths. This is tragic when you look at the individual names but it should not alarm us statistically. When an epidemic is out of control the figures double every 2 days, that is truly catastrophic and was seen in Italy at the beginning. When it doubles in 5 days the whole situation is coming under control. I feel we should be pleased with this, it could be so very much worse. The media just do not seem to understand this. We know our most vulnerable members of our society live in care homes and that is why the number of deaths is so high.The first trial of a vaccine on a human will probably start tomorrow. Many other trials are close behind. Success rates are not high in vaccine trials and often many are required to find one that works. This is key work, if we are very lucky we might have one that works; it may be 4 months, but a year or two is the more likely.With tests, we have to be sure of their accuracy. It would seem we have done some tests on a few NHS staff which have failed quality control. We have made this public and people are being retested. We have no knowledge of the quality control of testing in other countries. We must be wary of results that are not close to our results. This could account for discrepancies. Reports of the use of convalescent plasma in treating a couple of patients are interesting. This is a technique where blood plasma is collected from a patient who has had the infection and would therefore contain antibodies and then transfuse it into a sick patient with the disease. The theory is, the antibodies start to attack the virus and the patient gets better. This is not a new technique I remember a doctor I trained with who caught Lassa fever in Nigeria and was successfully treated with this method in Vom Nigeria. I decided to do a bit of research on this and was surprised to find it had been used back in 1918 to treat Spanish flu. Scarlet fever in the 1920s was treated the same way and up to about 1970 severe whooping cough was sometimes treated this way. More recently Ebola infections as well. The reported results are quite varied and the technique is rarely used today.I have realised that for the non scientists amongst my readers I have introduced some jargon. This is a non exhaustive list of some of the words I hope you have some understanding of now. When, or if you are bored, you might like to test yourself. The words are: Epidemic, Pandemic, R number, Prevalence, Incidence, Herd immunity, Viral load, Antibodies, Antigens, Double Blind Controlled trials, Randomised trials, Exponential curve, Linear curve, Peak, Plateau, Asymptomatic, immune, susceptible, Bias, Shedding. Also some abbreviations COBRA, SAGE, ONS, WHO. OBR. SARS. MERSHave fun with those, please ask if you do not understand any of the terms. Keep on with the good job you are all doing, we are coming through this slowly but surely. Those green shoots are going to need watering soon if it does not rain. The light is brighter; Stay safe. stay at home. stay 2 metres apart. You all are well aware of the rules we have gone far too far to give up now.

April 23

The focus of todays briefing was looking ahead to what are the next steps in beating this virus. It seems generally accepted now that we have achieved the objective of protecting the NHS. The bed occupancy rates are falling. The other charts, we are used to, have flattened and there are signs of a drop. Remember we have always said the death rate will be the last to fall.It is also very clear this will not be over in a few weeks and life is not going to come back to normal until next year. The new normal is unlikely to be the same as we have been used to.The new catch words are Test, Track and Trace. You will hear a lot of these in the next few months.Testing is progressing well now with daily capacity greater than daily demand. A graph shown today illustrates the exponential growth of test availability and is slightly ahead. From tomorrow any key worker or a close relative of a key worker can have a free test to determine whether or not they are affected by the virus. There are more testing stations, the military have established mobile pop up centres, satellite testing stations can be established at care homes. Anyone can order a test through their line manager or themselves on line. The test will be posted to you and then you have to post it back.Have you signed up to use the App about your symptoms of Covid yet ? Please do so. A great deal of work is rapidly being done to modify this App to allow tracking and to alert you if you have had close contact with someone positive. Tracking the virus is a key part of our united efforts to control the pandemic.Contract tracing is about to begin on an enormous scale, by using the App mentioned above. 18,000 new workers are being recruited including 3000 clinicians to process the enormous amount of data.Your part is to absolutely continue with social distancing and staying out of the way of other people by staying at home with the front door firmly shut. The closed door does much more to protect you than wearing a mask does. It would seem we are to continue to follow the science and not recommend well people without a cough or other symptoms to wear a mask when out shopping. I am personally pleased our political leaders have not given into pressure from others.Blood testing to detect antibodies is still not really quite good enough to use widely. New and better tests are in the pipeline and if they work well will be easy to scale up. The double blind study from Oxford started today with two people immunised . One had the new Covid 19 vaccine and the other was give the meningitis vaccine. Neither of the two patients nor the staff treating them are aware which one they have been given. If this trial proves effective and that remains to be seen we may see a vaccine ready for general use in the autumn.There is evidence tonight of cases of Covid 19 cases in the USA a least a month before they were acknowledged. I am sure some were in the UK as well. We must not rely in the absolute accuracy of any countries’ data. Finally 25,000 of us will receive a letter in the next few days asking you to take part in the biggest health survey ever. This is another bit you can do. Play your part in this survey, eventually it will involve 300,000 people.To our Muslim friends and neighbours a very special thank you for forgoing all the social activities involved in the festivals of Ramadan and Ede. We recognise how important this is for you.To every one else its still keep going stay safe protect the NHS and stay at home.

April 24

Over the last 8 weeks I have heard about and researched scores of different ideas about the treatment and prevention of Covid 19. None come anywhere near as ridiculous and dangerous as the method allegedly proposed by President Trump in the USA by injecting a disinfectant like Dettol or Lysol. This is almost certainly going to cause rapid death associated with considerable pain vomiting and seizures. I do not believe anyone reading my daily reports could possibly be so daft as to do this.Let me use that scenario to illustrate the issues of death certifications we have been talking about. Let us consider a middle aged man with a rather unstable mental health who begins to worry he has caught Covid 19. He is already rather over weight and takes regular tablets for high blood pressure. His cough is getting him down and he remembers the slogan that…….” kills all known germs” He decides to take a 10ml dose of intravenous disinfectant. Within 15 minutes he is dramatically ill, vomiting, uncontrolled bowel and bladder emptying, thrashing around in agony, followed by seizures and death. By the time a doctor arrives all he can do is confirm the death. The doctor sees the disinfectant with the syringe and needle beside it. Members of the family tell the doctor their version of what has happened. In the UK the doctor has a duty to report any suspicious death to the coroner. Normally an inquest may follow. Was this death an accident, misadventure or suicide. Was the person who told him to do this in any way culpable. Aiding and abetting suicide is a crime and could be seen as manslaughter or worse.When it comes to writing the death certificate some weeks later what should be recorded? The possible Covid infection, the hypertension, disinfectant poisoning, or seizures. The doctor has considerable discretion and will clearly influence the statistics and it takes some weeks for the death record to be officially recorded.Back to the briefing, the statistics continue to progress satisfactorily. The death are still high as expected but the rate of new deaths is steady and perhaps beginning to fall. The number admitted to hospital in London has dropped by 10% in a week. there is plenty of capacity in the NHS. We must not relax, the fear of a second peak is very real. With another fine weekend forecast we must stay at home. I cannot stress how crucial this is, we would waste all the efforts we have made and would have to begin the battle all over again.It was good not to hear about gowns and masks tonight but the issues of testing still rumble on. It is clear there is a mismatch between the available capacity for testing and those managing to get tested. Opening it up to all key workers and their families in England is an important step. Remember you can only have a test in this scheme if you are isolating because you might have the disease. It is not a free for all.We heard a lot about financial support to the freight industry, particularly the ferries between the UK , France, Ireland and our islands. There are important trilateral agreements to maintain essential ferries with the freight deliveries. This freight is often essential medical supplies. Also announced tonight was a trial of delivering medical supplies to the Newport Hospital on the Isle of Wight using a drone. This has prove successful elsewhere in remote and rural parts of the world. Many transport facilities from highways England and British rail are being repurposed to maintain essential supplies.The Government have started a major piece of work to try and investigate the apparent increased numbers of the Black and Ethnic minorities in the fatalities being recorded. I tried to investigate this and rapidly discovered how complex it was. It is not clear how ethnicity is determined and recorded in the first place. Region by region there are widespread variations in the distribution in the community. with London boroughs the numbers of white people resident varies from 87% to 49% across the capital. If you we look at junior doctors as many of 45% are from BAME. they come for training in junior posts and return home. Our nursing and care assistants also have a higher than average number of BAME who day after today support our NHS. We would never cope on a normal day without them. Our retired and very elderly people still tend to have a higher number of white people.I understand Stephen Lawrence’s mother has been appointed to assist Keir Starmer to look into this. I wish her the best of luck; it’s a minefield with many confounding factors.So only use the disinfectant to clean surfaces and floors, keep it away from children, the mentally unstable and presidential megalomaniacs! This weekend especially, try and lower the use of private vehicles, please stay at home, stay apart and keep washing those hands with soap.

April 25

A very sad milestone passed today as our hospital deaths for Covid 19 reached 20,000. The daily graphs and statistics are exactly as has been predicted, with the plateau effect clear but with daily fluctuations of the actual figures due to reporting of new deaths not accurately reflecting the date of death. Especially encouraging is the continuing drop, each day now, of the number of patients in hospital.”Where have all our patients gone?” is a cry being increasingly heard from the green areas of A and E departments (green mean they are free of Covid 19). It is most important that if you have problems with chest pain, bleeding from the gut, strokes , gall bladder and kidney problems you must continue to seek help as you have in the past. You must use 111, your GP, the Ambulance service or go direct to the A and E department. My medical colleagues are getting increasingly concerned that by not presenting when you should you are putting your life at risk as an unintended consequence. Do not be frightened if you need medical help, please ask for it. Fast diagnosis and treatment can be crucial.Law and order was the main theme in the briefing tonight led by the Home Secretary. We must not allow criminals to take advantage of the circumstances we are now living in. Criminals are ready and adaptable to find new ways of causing misery. Whilst crimes like shoplifting and burglary have fallen others like speeding and domestic violence have risen. Police have reported a small minority of drivers are using our empty roads as a racetrack. One vehicle was caught at over 150mph on the M1 and another doing in excess of 80mph in a 30mph limit!We were reminded about the work of the National Crime Agency working round the clock to keep us safe. The most sophisticated of criminals are still hard at work. The NCA reports considerable success in very large finds of class A drugs. This included a large batch of class A drugs hidden in a consignment of masks coming through the Channel Tunnel. It is in everybody’s’ interest that cyber crime is minimised. This is another area where the NCA are working night and day behind the scenes to keep us and our money safe. Such criminals are amoral, corrupt and exploitative.We can all play a part to protect one another, particularly the vulnerable and elderly who may be using the internet without the sensible safeguards we should all be using. Spend some time tidying your computer, make sure you have installed the latest software and antivirus software. Ensure back up and defragging and other maintenance tasks are happening regularly. Finally check for strong passwords and if you have not changed them recently do so. You no longer have the excuse you have no time to do it.With many children working much more on line, talk to them, tell them of the cyber dangers. Warn them not to open suspicious emails and attachments. Tell them, people they do not know, asking to be friends, are perhaps not going to be friends. Tell them never to buy drugs or covid treatment kits on line. They are highly likely to be fake. Our exceptional Emergency Services are doing a fantastic job trying to keep our country safe. You must all play your part in this. The effects of the lockdown affect all of us, it is fostering a spirit of national unity so we must not allow frustrations to break through we are not out of danger yet. Please Continue to stay at home this weekend, stay 2 metres apart . Cooperate with Test Track and Trace . The song on my mind today has the line “We will overcome.” We will indeed and you can all help that time come soon.

April 26

Sunday statistics are always a little difficult to interpret and each week we see a Sunday dip in the number of deaths. We certainly can see that this week with only 413 deaths in UK hospitals reported. The lowest for some time. Remember that is does not really reflect the number of deaths on Sunday, its the number of patients whose paperwork is completed and the data filed. We can however rejoice in the overall stability and slight drop in deaths and the considerable continuous drop of the number of Covid patients requiring critical care. There is plenty of capacity now if we need it.The Environment Secretary reported on the food situation and reassured us that food supplies in supermarkets are back to normal after the early panic buying. I have not been shopping since last Tuesday when there was still no flour about anywhere. I will be going again on Tuesday with my rather vulnerable step son. He is doing well coping with the stress of not being able to go out for a meal with me. We will see if flour is back on the shelves.I have wondered about normal contingency planning. We have always maintained food in a food cupboard and a freezer to feed us for about 10 days in an emergency be it floods, being snowed in or too ill to go out. How much are you able to keep in reserve? I realise without much space or no freezer it is difficult. Part of my recovery plan will be to review and restock our domestic food supplies. It is also gratifying to learn that after the rather high 20% absence rate in the food industry workforce due to self isolating, with testing, this has been reduced to only a little more than 6%. A big thank you to all of those keeping us from going hungry.I am always happy to deal with personal questions about this pandemic and more and more are asking me. Thank you. One common question is about immunity and I thought it worth while trying to explain it to everyone. Covid 19 is caused by a brand new virus that we know very little about. We can believe it will work like similar viruses but it is by no means certain. It will need careful observation of cases over some period of time to be sure it is going to do what we expect. We need to be sure there is unlikely to be a great mutation. We need to find a vaccine that works and that is extraordinarily difficult. We then need to know how long it works and whether there are other unexpected complications many years later.For the vast majority of diseases once you have it you develop immunity to being re-infected. We have to be sure this is true for Covid 19. We may lose immunity overtime. We do get repeated common cold infections. The same will be true of vaccines, how long will it last for and will we need regular boosters? Remember the childhood disease measles, many younger readers may never have seen a case thanks to a very high rate of immunity. To start with one jab was thought to give lifelong immunity, but the science showed that teenagers required a booster. Typhoid vaccine only lasts for 3 years and cholera only 6 months. seasonal flu only lasts about a year and we need a jab every autumn. And we all remember the tetanus jabs. Over the next few years the answers about all these questions will be apparent. We also need to assess how common it is to be able to spread the virus before the test becomes positive. There is beginning to be evidence that this is an issue. Politicians cannot answer the media questions because the scientists cannot easily get answers without detailed research over the next few years. Please be patient as we try to resolve these questions. If we make a false assumption it will all go terribly wrong. Lets us all hope and pray the immunity lasts for years, and an effective safe vaccine that can protect us all is produced quickly. Prof Neil Ferguson from Imperial College has warned that if we relax lockdown too soon we will have a death toll of over 100,000.News from South Africa that they have a very small death rate I find incredible to believe. Rural South Africa could not diagnose and manage the HIV epidemic, I have seen the levels of care there. Please be very cautious in interpreting figures from other countries; we cannot get our own right yet!The regular graphs shown tonight showed a slight but worrying trend to use vehicles more. I know its getting tough, we must not relax the lockdown, You must stay at home and socially isolate. The weather forecast suggests rain is coming this week; that might keep more of us at home whilst at the same time watering those green shoots at the end of our tunnel, stick together – United we win. Divided we fall. Please go on being kind to one another.

April 27

Boris is Back. We are at the moment of maximum risk. With these messages still ringing in my ears it was Matt Hancock presenting tonight’s briefing. He continued to stress the absolute requirement to continue the lockdown for the moment. It would be an absolute disaster to have a second wave of Covid 19. The Action Plan with the 5 criteria is working we must be patient when many around us are becoming frustrated by the slowness. Recovery is on track but be assured this is a long term process.The figures today remember have to be viewed cautiously, they are usually lower because they are incomplete on Mondays after a weekend. The actual number of in hospital deaths processed today was 360. This is the lowest number documented for some weeks. Hospital admission rates also continue to fall, and more and more critical care beds are becoming available.Because of the spare capacity now available, some non emergency work, previously postponed, can now slowly begin again. This will be on a local level according to the local capacity. This is a side effect of our efficient care of the NHS capacity rather than any relaxation of lockdown.I have mentioned the process known as plasmaphoresis before. This is a process where some plasma is taken from a victim of Covid about 4 weeks after they recover. Their plasma is rich in antibodies which will attack the covid virus. This plasma is then infused into a patient sick with Covid. The infused antibodies attack the virus and hopefully the patient recovers quicker than expected. After only 10 patients the results look encouraging with all 10 quickly recovering.Antigen testing continues to be more available than being taken up. It’s becoming a bit of a political football. I shall be glad to get to May whether or not the 100,000 target is reached. There are still no promising signs of a reliable antibody test.One of the things I enjoy each evening is watching and learning from the Government Ministers and their advisors as they take media questions. I have been on several training courses about this over the years having found myself as spokesman at major incidents etc. I was taught how to remain patient, to look out for bait and to refuse to take it and never speculate, sticking only to facts. Without exception we see first class handling of the media every day.The parting message remains as always; stay at home, be patient, be kind, we are getting there. We will do it united and with a common purpose. Please keep apart for a while longer as this is what is working.

April 28

A very solemn moment as the UK stood silent at 11 am to remember our key workers who have died in this epidemic. We will remember them was the familiar message echoed by millions across the country.The deaths in care homes continue to make the headlines, but great confusion persists in interpreting the numbers. With the media and others frankly not understanding the statistics. It is planned to release a daily new set of figures which should hopefully bring some clarity.One headline that has made a big issue, is the number of deaths in Care Homes that had tripled in two weeks. The tragedy and sorrow of every death is keenly felt but in the early stages of a pandemic the deaths will rise exponentially, like the number of new cases do, and can double every 2-3 days . So within a week it could have quadrupled. Rather than frightening us it would have been better to have illustrated that it could have been much worse were it not for the great efforts of so many of us.Continuing with statistics, as was to be expected the number of new reported deaths was higher than the last few days at 633 in hospital. The overall smoothed graph is beginning to show a drop in these figures. The number of patients in hospital with Covid 19 is continuing to fall and has done so every day since Easter. There are plenty of available beds in hospital should you or I need one and we should not hesitate to present for treatment.The issue of testing seems to be well under control now with predictions that the target can be met. The rules about who can be tested have been greatly relaxed from tomorrow. Any one in a care home or hospital can be tested now whether or not they have symptoms , and anyone over 65 with symptoms.I strongly recommend testing if you fit into one of the new categories. There are many more drive through centres and 25,000 home tests per day.There have been some changes in the rules about the saving and reusing of drugs prescribed for a patient in a care home and the re-prescribing the spare drugs for another patient who needs them. This has been a very expensive waste of drugs for many years.There are still no drugs available to effectively treat Covid 19 but there are at least 6 different clinical trials in progress at present. 8000 people have been recruited and about 4000 more patients are needed to volunteer for these treatment trials. Most of the drugs being used have been available to treat other conditions for some years.There is a worrying report in The Independent about 700 deaths in Iran after taking a fake remedy for Covid 19 which was methyl alcohol ! I have not been able to verify the accuracy of this report but if true is a terrible example of the risks of fake remedies.The issue of masks continues to rumble on with increasing clamour for rules to be tightened. I have followed the debates and the scientific evidence very carefully. I personally support the view that the evidence of their effectiveness when worn outside in the street and on transport is insufficient to justify any change. Most members of the public will not wear them properly, they will tend to irritate the face and untrained people tend to keep touching the masks, which will increase the risk of hand spread. I fear it may bring a false sense of security to those wearing them. The masks only prevents the wearer giving it to others. We know that street crime is often committed by those using balaclavas so the attacker cannot be identified. They are banned in many shops. Wearing a mask could easily be used to become anonymous when attempting smash and grab type crimes.Rather than go out wearing an uncomfortable ill fitting mask you have paid a fortune for. Please just stay at home, and keep the social distancing rules. For the sake of all those we remembered today we owe it to them to keep going. We dare not relax too early, a second wave of cases will be catastrophic.

April 29

The news of the birth of a baby should cheer up almost everyone. It’s great news for our prime Minister and his fiancée. No matter what our political allegiances no one can deny the ups and downs both of them have experienced in the last couple of months.This is apparently only the 4th time a serving Prime Minister has ever had a baby whilst in office. Can you name the other 3?The figures for deaths still cause great confusion. The latest figure released lists all deaths in hospitals, care homes, their own home and other places for patients with a positive test for Covid 19. It gives the number whose paperwork has been completed and stands at over 26,000.These figures are still not reflecting the true figures and it will take a long time (well over a year) before we can make a comparison of excess deaths day by day compared to previous years. Only then will we see the true impact of this virus.The briefing tonight otherwise, was quite a repetition of last nights briefing. We know we have to meet all 5 tests and we cannot claim to have met them all yet. We are getting there, we absolutely must not relax now we remain at a critical point in our corporate efforts to come through this. There is a suggestion that there is a slight, but persisting, extra use of motor cars; probably bending the rule to only go out when absolutely essential. We must all think carefully before we go in the car. We need to see that usage drops back to the level at the end of March.We must not risk the consequences of a second wave. I cannot stress this enough. I have been looking at the problem of second waves in the USA during the 1918 Spanish flu pandemic. New York largely prevented a second wave by prolonging the lockdown. Whereas cities like San Francisco lifted the lockdown early and had a large second wave, losing thousands more lives.Germany is lifting a lot of restrictions and there is a strong suggestion that there is a beginning of a second peak and so a further lockdown may be necessary. We should watch this carefully as well as watch other countries who give in to media and political pressure and relax too early. Over 1.3 million people have now been repatriated to the UK from all over the world. These include 19,000 who were trapped on cruise ships . There were enormous logistic problems getting them all home but we are told they are all home now.We are reassured that the PPE logistics are slowly being resolved. One such confounding figure that caused confusion was a consignment of PPE gloves. They were counted individually and not in pairs as most of us would expect. Only half the expected numbers were available. I do not think I know any one handed colleagues! There was also a hiccup with hospices that are largely run as charities and so fall outside the NHS remit for provision of PPE. This is being addressed urgently.The birth of a new baby is cause for celebration. We too can see a future now we are winning this war. Please continue to look after one another, nurture one another by keeping the 2 M apart. Keep washing your hands . Those green shoots have been well watered today and are now thriving BUT ONLY IF we keep going and follow the plan science gives us.

April 30

The Prime Minister chaired today’s briefing and was clearly pleased to announce; ” We are passed the peak.”. This will hopefully mean we are over the worse but is a long haul ahead and we must not risk all the progress we have made and risk a flare up with a second wave of cases.I have written a lot about the R number in the last few weeks so I hope you all understand that we MUST keep it below 1. This is the only way we will continue to see a reduction in the number of new cases and associated deaths. The value of the R number is varying around the country with some places higher than others. Many of the steps we have to take to reduce the lockdown will tend, as a side effect, to increase the R number. If more people are using public transport to get to work we will risk a rise in this R number and if it gets above 1 then the pandemic could recur.This is why this is such a critical moment in our journey to recovery. Our government want to progress very cautiously and they promise a detailed road map to recovery to be published next week.We must all remain determined to overcome all the challenges, and as Boris said by throwing heart, soul and everything at it.This means staying at home and staying two metres apart, if out in the street shopping or going to essential work. Despite all the difficulties, over 81,000 new tests were done yesterday and when today’s figures are announced tomorrow I am sure we will be very close, and perhaps just exceeding, that 100,000 a day target.Work progresses well on developing a vaccine and an exciting partnership between Oxford University and the drug company Astra Zenica on a not for profit basis has been announced to continue the development.A couple of weeks ago I commented on the use of a drug that had been used to treat Ebola virus. There are verbal reports which suggest the trial in the USA is showing some benefit. A trial in China has apparently been stopped due to lack of patients. I will want to see a peer reviewed written publication of the results before I get excited about them, but it is a further step forward.A big thank you to everyone who is taking part in any of the many trials associated with Covid. The patients of today are helping to save the lives of those in the future.The issue of masks was briefly mentioned tonight . There may be a suggestion that masks could be worn in public if it gives extra confidence to the wearer as part of a phased return to work. There may be some psychological benefits.As we move forward, we need maximum cross party agreement, we must follow all the science, we must continually add to our knowledge. We know the 5 tests we can overcome the logistic problems with PPE. we can look forward to considering our economy and recovery. We can review schools and how we start to get them back to normal. We must review the work places and how to get the workforce back to work safely and at the same time continue to suppress the disease.Yes we have reached the peak, we have climbed an enormous mountain but the path down is very treacherous. So please every one keep going . Stay determined, We will overcome.

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