Living on Plague Island

As the Covid Inquiry is about to begin module 4 hearings, and nearly two weeks into 2025, the NHS, is as predicted, overwhelmed with patients suffering from flu and other viruses and illnesses. As well as truly distressing stories from the front line this has brought the usual flurry of misinformed pieces spouting the benefits of hand washing, for example, as well as the usual airing of the argument that ‘immunity debt’ is at the root of our ills. This short blog discusses some of the issues.

A and E Departments overwhelmed

Hospitals up and down the country are currently coping with what is sometimes referred to as unprecedented demand which on occasions is described as worse than at the height of the pandemic. Today’s edition of the Guardian is an example focusing on the pressures on paramedics and the resulting huge volume of missed 999 calls, in part due to long delays in handing over patients to hospitals. Multiple hospitals have reported critical incidents and one hospital in North London has gone as far as advertising for a ‘corridor nurse’ to care for the large number of patients being held on trolleys in corridors without privacy, toilet facilities, oxygen or an electricity supply.

Media Commentary

Much of the commentary from the media has been ill informed and it feels like they are almost shrugging their shoulders presenting these unprecedented scenes as the new winter normal, whilst the right wing media and tried to blame the new labour government and others have blamed the situation on the crisis in social care

At the same time, some, though not all of the commentary in the i. newspaper has been good in the sense that they have tried to get underneath the issues and go beyond describing the immediate situation. On 4 January the i. published an article which focused on the problems faced by clinically vulnerable people – for example:

Sarah, told The i Paper her 21-year-old son, who has Duchenne muscular dystrophy, has recently had Covid twice in six weeks and been hospitalised.She is one many parents anxious and fearful over the wave of viruses hitting the NHS this winter. 

Support group, Clinically Vulnerable Families, carried out a snap survey among its members. Of the 550 who responded to the survey, 88 per cent of respondents revealed they had delayed or cancelled medical appointments due to the risk of airborne infections.‘

Lara Wong, founder of Clinically Vulnerable Families, said: “Clinically Vulnerable Families is deeply concerned about the inadequate infection prevention and control measures in healthcare settings as hospitals grapple with the so-called ‘quad-demic.’

“We have heard numerous reports of hospitals banning visitors instead of implementing effective airborne infection control measures – such as the use of close-fitting FFP2/FFP3 masks and improved ventilation standards to ensure vulnerable patients receive uncontaminated air.‘

And today the i. published an article containing insights from a retired infection control nurse – see top caption above.

“I think it is understandable that people are terrified of going into hospital at the moment. I wouldn’t want to go into hospital in the current situation.”

Dr Curran, who is a doctor of nursing and has a masters of public health and diploma in infection control, says one of the problems is that all these viruses – including norovirus – are in the air, but some people mistakenly believe it all stems around hand washing.‘

Lara Wong, founder of support group Clinically Vulnerable Families, … said: “Safe healthcare should be a basic expectation.“Just as you wouldn’t want to feed your loved ones from dirty plates or put them to bed in soiled sheets, the air we breathe in healthcare settings also needs to be clean, as it carries viruses and bacteria.

“Hospitals are full of vulnerable people and the Covid Inquiry has highlighted that the air in healthcare is not clean enough.

“This allows preventable infections like flu, Covid and pneumonia to spread, costing lives and prolonging hospital stays.‘

Alas not everything from the i. has been positive. Towards the end of last week they ran a story blaming the crisis on that old chestnut ‘immunity debt’.

This theory has been discredited – see my blog on the subject from 2023, but it does not stop certain scientists and journalists continuing to wheel it out. I sent a letter of complaint to the i. which is self explanatory but they have not published it or even acknowledged it:

Clare Wilson argues that ‘immunity debt’ caused by lockdowns is the most likely reason behind the recent surge in infections such as flu, RSV and HMPV.  The obvious alternative explanation is that Covid-19 infections weaken the immune system and cause people to be ill more often, but she dismisses this by saying that if people’s immune systems had been damaged nb. we have hard evidence to support this) we would expect other illnesses like RSV, flu etc to worsen each year. We are hampered by the cut backs in the amount of data being collected to prove or disprove trends conclusively, but many experts argue that this is indeed happening. Witness A and E departments across the country that resemble war zones at present. 

It seems incredible nearly five years on from the first lockdown and three and a half years from so called ‘freedom day’ that people are still clinging to this idea of ‘immunity debt’. It is of course obvious why governments like the idea. It means they don’t need to invest in the kind of infection prevention and control measures that so many of the witnesses to the Covid Inquiry last Autumn called for.

What I don’t understand is why a respected paper as the i. would argue the case. It is ironic that you ran a picture of an ill baby at the top of the article. How do you explain this baby being ill because of ‘immunity debt’ when she wasn’t born during lockdowns? 

Gillian R Smith

Infection prevention and control procedures in healthcare

In the midst of all of this chaos in hospitals one might hope to see serious infection control measures being put in place. It does appear that this is happening in some places that have reintroduced a requirement of wear a face covering. Alas this does not specify the quality of mask to be worn despite the obvious desirability of wearing a FFP2 minimum standard of mask. In other places little seems to be done to control the spread of circulating viruses beyond recommending hand washing which as we have seen will do very little to control the spread.

But even if hospitals are not introducing IPC procedures to deal with the unprecedented demand one would surely expect them to be more tolerant of clinically vulnerable patients who try to protect themselves? Whilst we don’t have quantitative data on this question, we do have at least one really bad example from the last week where this has not been the case.

The case below involves a CVF member I know well who suffers multiple problems, including a serious chronic obstructive pulmonary condition. If they caught Covid or flu they would probably end up in A and E costing the NHS thousands of pounds. However, none of this was acknowledged by a senior consultant who simply ridiculed them. This is sadly, all too common.

Concluding Comments

Clearly we need to press on in trying to fight these battles but from tomorrow the focus also needs to be on the return of the Covid Inquiry. Vaccines and therapeutics are a potentially important weapon against the spread of viruses which have fallen down the agenda in recent years. This is a key focus of module 4. The CVF group is once again a core participant and founder and head Lara Wong will be appearing before the inquiry on Thursday.

It is unlikely that I will be publishing anything on here for the next few weeks but I will return in February. I sincerely hope that the situation in the NHS will have improved by then.

Gillian Smith

13 January 2025