Thread by @cv_cev

🚨Clinically Vulnerable Families - closing
** Shared in full**

Thanks to the @covidinquiryuk staff & team

"The vast majority of people who died [.] were Clinically Vulnerable [.] including people who caught Covid-19 in hospitals, which were supposed to be places of safety."

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"Most urgently, we need to make healthcare safe for Clinically Vulnerable people."

"And by making it safe for them - by improving ventilation and putting in place other protective measures - we make it safe for others too."

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🛡Shielding

CEV people are a diverse group with varied personal circumstances.

It provided a passport:
🏠 Right to work from home
💷 SSP entitlement
🚚 Food & medicine deliveries
💉 Priority vaccine access

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🛡Problems with shielding

Communications: disempowering
No information on how to reduce risks

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CMO NI recognised "The approach [.] did not fully think through the loss of agency and loss of control."

Individual vs household approach unrealistic and unworkable:
🏫Children in school
⛺️Family members sleeping in a tent
🧠Mental health impacts
👩‍🔬Experimental programme

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🛡Execution of shielding

Systems are not up to the challenge
- Delays
- People falling through the cracks

Data sharing is recognised as "a colossal challenge" by the DHSC's most senior civil servant.

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🛡Communications

💙 Communications let CEV people down
💜 Information is very important
💗 Wasn't regular enough
💙 Advice was incomplete
💜 Whitty & Vallance were only on the TV when asked. He tried to signpost information, but it "was clearly a hopeless way"

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Incomplete advice:

- Varying abilities to comply
- Lack of scientific rational
- Non Covid-19 treatments
- Steps to alleviate effects of shielding

Practical steps were needed to inform and empower people.

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Timing

⏸️ Shielding was paused too soon
🍲 'Eat Out the Help Out'
📈 Exponential growth after Lockdown 1

CEV (and CV) remained at risk.

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⛔️ Immunosuppressed and immunocompromised people were left behind.

Access to antivirals is problematic.
CVF💙💜💗 remain concerned that this issue could fall through the cracks of the inquiry.

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Transitional support after shielding
- Marked lack of support

Needed to bridge gap:
Shielding ➡️ enhanced protection programme
Enhanced protection programme ➡️ nothing

"Public given false confidence that the virus no longer posed a significant threat."

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Clinically Vulnerable (unshielded)

🚫 Not shielded
🚫 Not contacted
🚫 Not informed about their risks

Some didn't know until invited for vaccines

🚫 No employment protections
🚫 No help getting medications / food
🚫 No SSP

Prof Snooks "Almost arbitrary cut off"

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Next time...

We cannot rule out shielding

"The core focus in any future pandemic should be that it is the duty of government to protect those who are vulnerable."

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Data issues

QCovid algorithm needs to be faster

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💙Support Clinically Vulnerable people to support themselves
💜Engage with Clinically vulnerable people
💗Prompt access to antiviral treatments
💙Educate the public - end #MaskAbuse

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🐘 The elephant in the room

"You are more likely to catch Covid in hospital than in any other setting"
- Matt Hancock

Clinically Vulnerable people may stay safe in the community but they can't in healthcare.

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🦠🏵 Are healthcare acquired (nosocomial) infections inevitable, OR can we reduce them?

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Over 90% of Clinically Vulnerable people have delayed / cancelled medical appointments due to high Covid risks.

"it is [.] impossible for those at higher risk to comply with the [govt] guidance even today when [accessing] healthcare because the environment [.] is not safe."

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🌬 Covid Transmission

"Incorrect assumptions [.] led to a failure to adopt a sufficiently precautionary approach."

"The significant role of airborne transmission is beyond doubt."

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💨 Adequate ventilation 💨

Dr. Shin picked this as his
"Headline Recommendation".

"If [the NHS estate, particularly ventilation and isolation capacity] is not improved, we will face the next emergency with the same difficulties that we encountered this Covid pandemic."

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Whitty "We should take indoor ventilation a lot more seriously."

"No one has seriously challenged @CliveBeggs [.] that the HTM guidelines are not fit for purpose and in urgent need of reform."

NB/ HTMs guide the design & operation of healthcare building systems for safety.

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@CliveBeggs A strong recommendation is needed despite the cost.

"The cost of doing nothing will be much higher, especially when, WHEN and not IF there is another pandemic with a pathogen which spreads through the air."

💨 "In the meantime, HEPA filters are 'low hanging fruit'". 💨

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@CliveBeggs 🥊FRSM vs. FFP2/3 🥊

"CVF urges the inquiry to accept the common sense evidence of its own independent experts."

"We cannot wait for randomised control trails which probably will never come."

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@CliveBeggs "It is [.] inconsistent to do so, given that FFP3s are already recommended for high consequences infectious diseases and aerosol generating procedures."

Adam then explains the
🧀Swiss Cheese model🧀 (sadly no cheese) vs. the hierarchy of controls.

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@CliveBeggs Recommendations:

💙Information on masks
💜Training for HCWs so they don't tell Clinically Vulnerable patients to remove masks [unless medically necessary].
💗HCWs to wear a mask or test if requested
💙Routine testing
💜Monitor CO2
💗Staggered appointments
💙Less crowding

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@CliveBeggs In the longer term...

Research to remove barriers and allow effective RPE in practice.

😷Why can't we make masks more comfortable?
💬Why can't we improve communication?

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@CliveBeggs CVF💙💜💗 are calling for the inquiry to recommend:

1. Review all DNACPRs since start of the pandemic
2. Review of the notes of all CEV
3. Psychological support for all affected

Decision support tools should only be used in the context of an overall clinical assessment.

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@CliveBeggs ⚖️ Equality Act ⚖️

Clinical vulnerability is a newly recognised issue that causes serious detriments across society but is not protected under the law.

"That is why we are asking the inquiry to consider recommending changes to the Equality Act"

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