What I would like to hear from Boris Johnson today

It is likely that when the Prime Minister addresses the nation today, it will be to tell us that there is going to be an extension to the roadmap out of lockdown. Press speculation suggests this will be for another 4 weeks. The extension will primarily affect the entertainment and hospitality industry but even if you feel that you’ve already got back most of your own freedoms remember that the affect here is not just on people who want to go to a concert or a nightclub but on those who work in those sectors and from there on to the wider economy. Churches will also be affected as we will have to continue under current restrictions.

In the current context with cases of the Delta variant rising rapidly, the delay seems wise. June 21st was predicated on other variants of COVID being predominant so that the spread of the virus at this time should have been slower and one dose of the vaccine covering most of the adult population giving greater protection. So, I’ve been expecting a delay or compromises to the plan for a few weeks.

However, if Boris is going to make that announcement, then here are a few things I’m hoping he will also have to say today.

First, we need a clear rational for the decision. The government have said that they are following the data. So, we need to see which specific data is informing the decision and the assumptions behind it. In other words, we need to see a clear understanding of what is happening with hospitalisation, bed occupancy and ICU data. We need to know what the NHS are projecting that they can cope with.

Secondly, we need to know what the target is for second vaccines over the next few weeks.  This is crucial because it is the second dose that seems to be making the difference.  What percentage of the population fully vaccinated is needed to dampen down the cases and hospitalisations?

Thirdly, we need a little bit more detail about who is being hospitalised, when and for how long.  This will help us to check and challenge assumptions behind decisions.  If we are seeing younger, fitter people going into hospital earlier and staying shorter then that has two crucial implications meaning we can sustain a higher exit wave and enabling us to reduce the length of delay time. This is because first of all it would point to a shorter lag time and therefore to a smaller % of admissions and secondly it would mean that triage could be deployed to reduce hospital visits.

Fourthly, we need to see that the Government is using time wisely. Therefore, I would like to hear a bit more about their plans to protect the NHS in the future. There will be more variants to come, some of which might be even more effective at evading vaccine based immunity. There will also be other viruses and epidemics to face in the future.  The primary reason we were given for initial restrictions was to flatten the curve in order to shield the NHS. However as I said at the time, attempting to manage damage in order to queue/schedule people into hospital wasn’t the greatest way of dealing with things. Longer term we need a health service that is better able to respond to sudden surges in demand. I suspect that in such scenarios that will not require a high dependence on doctors and consultants. It will mean bed spaces, ICU and ventilator capacity and it will mean people to care for patients with a level of paramedical know how.  It seems to me that the crucial factors then are our ability to set up nightingale wards/hospitals coupled with the formation of a national health reserve similar to having an army reserve. This might be made up of former and retired medics, nurses, paramedics etc. We have spent 18 months protecting the NHS and now it’s time to get some answers on how we look after it for the long term.

Fifthly we need answers to show that the Government has learnt lessons from our experience with the Delta variant. It seemed obvious to most of us that India should have gone on the red list sooner and that once it did the measures should have been immediate. It also seemed obvious that if one town (Bolton) was experiencing a surge in cases then our surge testing response needed to go wider than the immediate area where cases first started to rise.  It also seems obvious to me that when time is of the essence then any variant under investigation is a variant of concern and you eed to respond quickly. You can’t spend weeks with people travelling freely spreading a variant whilst you decide whether or not it is more transmissible and more vaccine resistant.

Sixthly, a lot of these issues are pointing to one overlying point. We need an answer to the question, “how can we be confident that the final step will be irreversible?” We’ve had to rely on extreme measures this past 18 months to respond to a pandemic.  Lockdowns were never the instrument of choice.  So, what has the Government been doing to ensure that we won’t have to rely on this blunt instrument in the future and what are the implications for us?

I hope the PM will address some of these things, preferably today but if not then over the next few weeks so that we use the delay wisely.

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