1/ Lots of debate as to why ~40,000 vulnerable people died of Covid in care homes in England and Wales and who was to blame. Yet the road to this particular tragedy is well documented. A thread...
2/ First, it's important to note the cull of care home residents is a failure on the gov's OWN terms. As detailed below, Whitehall never planned to stop a new virus. But it was, from 2017, supposed to have plans in place to protect care homes
3/ How do we know there was supposed to be a plan? Because it is one of the key recommendations to have come out of Excercise Cygnus, the 2016 dry run for a pandemic. In short, Whitehall ordered itself to produce a plan for care homes assets.publishing.service.gov.uk/government/upl…
4/ Here's the backstory. During Cygnus, the NHS quickly became overwhelmed. The then health sec Jeremy Hunt refused to decide who should and should not receive care, describing a request to turn off 4,000 ventilators as "morally repugnant" telegraph.co.uk/global-health/…
5/ After Mr Hunt downed tools, responsibility for triage in Cygnus was passed to the NHS during the exercise. It does not say exactly what then happened, but it is clear hospitals were emptied, care-homes were overwhelmed and bodies quickly piled up. Sound familiar?
6/ Mr Hunt says that his decision therefore exposed flaws in the system led to "extensive and important" reform. But given that a third of Covid deaths occurred in care homes over the last year this is clearly nonsense
7. So what happened? The report on Cygnus (kept secret until the @Telegraph and others forced its release last yr) made a number of important recommendations. Chief among them were ....
8/ First, it ordered the production of a "population triage" plan for use in a pandemic. It should define the “triggers” for implementation and (given the Hunt problem) a “proposal for who would make the decision to move to population-based triage and in what circumstances”.
9/ Second, the report asked that a proper "surge" plan be drawn up given that the version rapidly bodged together during Cygnus did not work out too well. Central to this was to be "a rapid discharge protocol" for moving hospital patients from hospital into the community...
10/ Third, the report called for a single body to be set up to coordinate everything in the event of a pandemic. This was to prevent exactly the sort of leaderless chaos described by @Dominic2306 last week. It was to be called "a pandemic concept of operations"...
11/ Mr Hunt and his successor Matt Hancock had THREE full yrs to put these and other recommendations in place before Covid stuck in Dec 2019. Remember these were not radical east Asian suppression plans, just mitigations to take the edge off Whitehall's agreed let-it-rip policy..
12/ Were they implemented? Were they ****. The DH continues to claims otherwise but relies on a technocratic definition. Crucially, neither the population triage or surge plan has seen the light of day despite ongoing legal efforts to unearth them
13/ There are also two cultural problems relating to DH/PHE here: first, it has no real concept of what a detailed *plan* means and secondly, it has a long-standing cynicism/prejudice about the private care sector which it sees as a dumping ground....
14/ On the later, consider this quote I was given from a PHE employee in April: "Most hospitals in the UK are full of people who are clinically well. This is what clogs up the system. Typically they sit around clogging up hospital beds until they die, get MRSA and die....
15/ ".... or go to a care home to die. All we did is, well, stiff broom and all that".

Even last week, Dr Jenny Harries was trying to shift the blame to care home staff despite 25,000 patients being discharged into homes when there were plenty of single-occupancy units free
16/ But Whitehall's problem with plans (as opposed to strategy) is most serious. Oxbridge PPE types (from which its so-called "fast stream" is recruited) will do anything to avoid getting their hands dirty with the nitty-gritty of planning and delivery...
17/ Yet the report on Cygnus recognised this and ordered that proper "tactical level plans" be drawn up for the care sector - three years ago
18/ So when @Dominic2306 alleged last week there were "no plans" he was undoubtedly right. What he may not have twigged is that his interrogator - Jeremy Hunt - was as culpable as Matt Hancock for their absence
19/ There is more here on the vital lessons from Excercise Cygnus that the Government ignored - free to read telegraph.co.uk/global-health/…

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More from @PaulNuki

25 May
1/ Gosh, I see tomorrow's Commons spectacular is to be co-chaired by Jeremy Hunt. This is odd because in the field of pandemic planning (which he ran between 2012-2018) he is best styled as not so much as grand inquisitor but *chief defendant* ...
2/ Mr Hunt is huge on the "everything-would-have-been fine-if-it-had-been-flu" defence. This after all was the title of our plan - the UK Influenza Pandemic Preparedness Strategy 2011....
assets.publishing.service.gov.uk/government/upl…
3/ But this is tosh. It's no defence at all and it is important to understand why.
First, influenza comes in a huge range of different forms. It can be fast or slow, mild or devastating. This is true of seasonal flu but especially so for pandemic varieties ...
Read 8 tweets
24 May
1/ There's a lot of balls circulating about the UK's pandemic response and specifically *herd immunity*. Yet most of it is fully documented. Here's a thread pulling together some of the key points...
2/ Did the UK have a herd immunity strategy? YES, it was always the default. We had no other plan. The idea of suppressing the virus via lockdown etc was made up on the hop in late March when it became clear the NHS would be overwhelmed. Everyone knows that.
3/ Why did we not have a suppression plan? This is more interesting and the answer is that the DH/PHE/Cab Office explicitly rejected the idea when it reviewed the nation's pandemic strategy in 2010/11 assets.publishing.service.gov.uk/government/upl…
Read 17 tweets
22 Apr
BREAKING: New data on UK variants out from PHE....

1/ South African up 70 on last week, as results of surge testing in London start to come through...
2/ India up 55 to 132 total. Rapid growth, albeit from a low base...
3/ P1 from Brazil up 20 to 60
Read 4 tweets
18 Apr
Revealed: Why Britain’s regulator missed the link between the AstraZeneca jab and rare blood clots telegraph.co.uk/global-health/…
2/ We confirmed the first three cases of CVST+H happened in Jan and Feb. Two life-changing events and one death. The first Yellow Card came in, say the MHRA, on 8 Feb - the day the vax launched in Europe. Why were these and other early signals missed?
3/ We identified three reasons. First, the "sensitivity" of the algorithms/processes used by MHRA were lower than in parts of Europe. We tracked against background rates, while others turned the sensitivity dial up to 11... Image
Read 9 tweets
10 Mar
1/5 I find the debate over aerosol transmission very odd. It's perfectly clear respiratory viruses spread that way in part at least, and has been for years. It raises some important questions for Western science ...

ncbi.nlm.nih.gov/pmc/articles/P…
2/ First, why the reluctance to accept what is so clearly evidenced? My guess is that like so much necessary but avoided pandemic planning, it's all about resources and long established (but incorrect) professional group think ...
3/ If you accept respiratory viruses can spread via aerosols, you need to rethink the design of countless systems, buildings and public health protocols. It's a huge job which disrupts everything. It's therefore one we would prefer to avoid, or "park" in the language of PHE...
Read 5 tweets
8 Mar
1/4 Tony Blair intervened to save the Windsors after Diana's death. Boris (for it is he) must try to do the same today. The family's fragile legitimately rests on it representing the *entire* nation and the skin colour bile utterly undermines that...
2/ The deep outrage and offence it has, and will continue, to cause should not be underestimated. There will be lame attempts to pass it off as one Phil's bad 'jokes' but it won't wash... telegraph.co.uk/news/2021/03/0…
3/ Meghan offered this get out of jail card: "There's the family, and then there's the people that are running the institution, those are two separate things and it's important to be able to compartmentalise that because the Queen, for example, has always been wonderful to me."
Read 4 tweets

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