Coronavirus in the UK - news, lockdown and discussion

[elbows]

With that in mind I will drill down into case age data for England again around the middle of next week. In the meantime I may get round to creating and post a graph of my own towns positive cases by age since the overall numbers here suck, they've been heading back towards the level seen here in Nuneaton & Bedworth at the July peak.

In the meantime here is the official dashboard graph for my location to illustrate what I just said:

View attachment 291960

I drilled down into cases in Nuneaton & Bedworth and in addition to the huge spike in school aged cases, there has indeed been some spread into some other age groups.



I suppose I will repeat this exercise for the East Midlands region since the overall cases graph for that region is also showing things heading back to levels seen at the July peak.

 

[teuchter]

I guess the surprisingly green patches we currently see in north Kent are not unrelated to the outbreak they had there some time back?

 

[elbows]

Good to see the daily reported new cases dropping again, I suppose we can only hope that trend continues.

I know you tend to look at a different set of numbers to me, but I'd say the numbers have sucked since you posted that. I think todays numbers bothered some people on twitter since they are quite high for a Sunday.

 

[elbows]

I guess the surprisingly green patches we currently see in north Kent are not unrelated to the outbreak they had there some time back?

Maybe. I know I keep saying that modelling implied that areas which had bad waves in the past would be expected to be less severely affected in this wave, but I'd still be cautious about making this assumption in regards to individual locations at particular moments in time. I'd probably want to wait longer to see what happens next, and would ideally augment the picture with local knowledge.

 

[elbows]

I haven’t looked into the specificity of the specific LFTs being used, but couldn’t it be that they are picking up non-COVID coronaviruses, so of course the PCRs are negative:

High incidence of false-positive results of IgG antibody against SARS-CoV-2 with rapid immunochromatographic antibody test due to human common cold coronavirus infection

We experienced a 72-year-old man who developed laboratory-confirmed human coronavirus HKU1 pneumonia. PCR testing for SARS-CoV-2 from a nasopharyngeal…

www.sciencedirect.com

Coronavirus colds aren’t necessarily just going to be a runny nose or whatever, and could share many symptoms with mild COVID.

That link appears to refer to an antibody test, so not relevant.

I havent looked into that issue much but this came up on twitter:



And I found the following sentence in this document: https://www.ox.ac.uk/sites/files/ox...E Porton Down University of Oxford_final.pdf

All nine kits also passed cross-reactivity analyses against seasonal human coronaviruses.

 

[elbows]

Since the numbers sucked despite it being the weekend, I decided to look at cases by age for the whole of England rather than wait till later in the coming week. As usual these are positive cases by specimen date, with data fro the most recent days still incomplete.

I'm afraid we should expect hospitalisations in England to rise since last weeks positive case data included notable rises in older age groups.

 

[brogdale]

Simple but stark:

 

[lazythursday]

Maybe. I know I keep saying that modelling implied that areas which had bad waves in the past would be expected to be less severely affected in this wave, but I'd still be cautious about making this assumption in regards to individual locations at particular moments in time. I'd probably want to wait longer to see what happens next, and would ideally augment the picture with local knowledge.

It's interesting that it appears from the interactive map that case rates are relatively low in the central cores of most major cities, but much higher in the hinterlands.

 

[elbows]

I've not read the committee report yet, I've just seen some of the newspaper frontpage headlines about it ( Newspaper headlines: 'Damning' report into government Covid 'failings' ). And the following article which is by Nick Triggle, a person who deserves to be part of the evidence of failure in both March 2020 and September 2020 so I wont be taking his spin on it as the gospel.

As we should probably have expected, the committee could not fully avoid the obvious conclusion that herd immunity was very much part of the original plan A. Not surprising since later denials by government werent credible given they so clearly briefed journalists about that part of the plan A rationale during a crucial week in March just before that plan went in the incinerator. Even so, the report appears to have still done what it could to look charitably on this aspect.

Covid: UK's early response worst public health failure ever, MPs say

But the new report by MPs fails to reflect the views of bereaved relatives, campaigners say.

www.bbc.co.uk

Maybe I will pick through the detail of it in a dedicated thread, although I would have covered a bunch of the detail during or shortly after the events it describes anyway, so perhaps that exercise will be largely redundant at this point. Although maybe I can salvage some value from it if there are obvious weaknesses and incorrect conclusions drawn by this committee report, that it would be useful to detect now in the hope that the public inquiry can avoid some of those shortcomings.

If the Triggle article is accurate then one thing immediately leaps out to be as being inappropriate:

And the NHS and government were also credited with the way hospital intensive care capacity was increased to ensure the majority who needed hospital treatment received it.

Thats certainly an area where to this day I dont think uncomfortable truths about what I tend to described as 'protect the NHS, die at home' have been dwelt upon and acknowledged properly at all. But I'll have to check the committees wording for myself, since "the majority who needed it" could be weasel words designed to hide a multitude of sins.

Plus later in the Triggle article we have this bit:

For people with learning disabilities, not enough thought was given to how restrictions would have a detrimental impact on them - particularly in terms of accessing health care more generally. Do not resuscitate orders were also used inappropriately.

The motivation for using do not resuscitate orders inappropriately is surely as part of planning how to ration care, so I'm not in the mood to hear praise about care capacity. And there are many other aspects of the die at home thing that I've gone on about really quite recently so I wont repeat the rest of my thoughts on that again right now.

Triggle likely skates over much damning detail with this bit:

For ethnic minorities, there were a variety of factors, including possible biological reasons and increased exposure because of housing and working conditions.

Again I've not read everything for myself yet, but at least one newspaper front page today says "Black and Asian NHS staff at risk after white colleagues had preferential access to PPE".

 

[elbows]

Covid response ‘one of UK’s worst ever public health failures’

Early handling and belief in ‘herd immunity’ led to more deaths, Commons inquiry finds

www.theguardian.com

Decisions on lockdowns and social distancing during the early weeks of the pandemic – and the advice that led to them – “rank as one of the most important public health failures the United Kingdom has ever experienced”, the report concludes, stressing: “This happened despite the UK counting on some of the best expertise available anywhere in the world, and despite having an open, democratic system that allowed plentiful challenge.”

Perhaps it would have worked better, and could work better in future, if such inflated opinions of our capabilities and democratic strengths were cast aside for being delusional shite. During a crucial March week some elements of the press asked the right questions in press conferences in a way that probably helped and was a rare sign of 'plentiful challenge'. But in many other ways the press were more interested in doing their duty via puff pieces about how brilliant and trusted the likes of Whitty were, how we should trust their judgement and feel for them as they make the big decisions. Herd management to go with herd immunity. Beyond the media, I dont think other forms of opposition were well placed to actually have a better grip on the situation or to challenge the decisions being made. Would have to look to various individuals on various parts of the internet in the period leading up to mid-March to find signs of something more potentially useful, a resource the state was apparently not setup to take suitable heed of (or they could have just copied certain other countries homework but they didnt show any apparent appetite for doing that either).

Hannah Brady, of the Covid-19 Bereaved Families for Justice group, said the report found the deaths of 150,000 people were “redeemed” by the success of the vaccine rollout.

“The report … is laughable and more interested in political arguments about whether you can bring laptops to Cobra meetings than it is in the experiences of those who tragically lost parents, partners or children to Covid-19. This is an attempt to ignore and gaslight bereaved families, who will see it as a slap in the face,” she said.

There are aspects of the report which Im sure they are more than justified in criticising, and I believe that group are also pissed off that they didnt get to give evidence to the committee.

 

[William of Walworth]

And it's all very well just mentioning this at the end of your report, Triggle, but there's far too little emphasis put on this throwaway remark IMO :

There was a lack of priority attached to care homes too at the start of the pandemic.
The rapid discharge of people from hospital into care homes without adequate testing or isolation was a prime example of this.

(It was me who added the bolding, there).

 

[David Clapson]

They claimed to have analysed South Korea's experience but were not believed! Lying fucks. Failure to learn from the experience of other countries is endemic throughout government. Our masters always think they know best. We are falling further and further behind other countries in our values and standards. We are a shameful third-rate shower of shit. I wish I was Norwegian.

 

[maomao]

"Black and Asian NHS staff at risk after white colleagues had preferential access to PPE".

That's terrible, have you (or anyone else) got a source for this? I assume it was a distribution bias (ie. PPE going to areas with less ethnic minorities or to healthcare roles less likely to be ethnic minorities) rather than actually just giving them to white people.

 

[wtfftw]

That's terrible, have you (or anyone else) got a source for this? I assume it was a distribution bias (ie. PPE going to areas with less ethnic minorities or to healthcare roles less likely to be ethnic minorities) rather than actually just giving them to white people.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.rcem.ac.uk/docs/Policy/RCEM%2520PPE,%2520ethnic%2520minorities,%2520and%2520risk%2520in%2520EDs%2520during%2520the%2520pandemic.pdf&ved=2ahUKEwi8x_y8rMTzAhUpgf0HHcoNBOUQFnoECA4QAQ&usg=AOvVaw0aD5zXDrYTFzm363hc54Cx

I'm in a rush so I hope that works. It's a pdf link.

Basically. Training, access, risk assessment, fit. All fails.

 

[_Russ_]

New Covid variant could be to blame for positive lateral flow tests followed by negative PCR

Scientists are investigating a new strain as one theory behind the anomalies, which have occurred in the South West of England, but do not believe it is a serious concern

inews.co.uk

 

[elbows]

That's terrible, have you (or anyone else) got a source for this? I assume it was a distribution bias (ie. PPE going to areas with less ethnic minorities or to healthcare roles less likely to be ethnic minorities) rather than actually just giving them to white people.

I'm not reading the full report properly today but I've skimmed it and it includes stuff like:

21. However, existing social, economic and health inequalities were exacerbated by the pandemic and combined with possible biological factors contributed to unequal outcomes including unacceptably high death rates amongst people from Black, Asian and Minority Ethnic communities. Increased exposure to covid as a result of people’s housing and working conditions played a significant role. We also heard that Black, Asian and minority ethnic staff in the NHS, who are underrepresented in leadership and management roles, faced greater difficulty in accessing the appropriate and useable Personal Protective Equipment. The experience of the covid pandemic underlines the need for an urgent and long term strategy to tackle health inequalities and to address the working conditions which have put staff from Black, Asian and minority ethnic communities at greater risk.

306. Staff from Black, Asian and minority ethnic backgrounds are crucial to the NHS and care sectors, making up over one-fifth of the workforce and it is notable that the first ten NHS staff to die from covid-19 were from Black, Asian and minority ethnic backgrounds.457 There is some evidence that even within these frontline roles, ethnic minority staff were more exposed to covid-19 risk than their white colleagues. For example, the Health and Social Care Committee heard that in the first wave of the pandemic, frontline NHS staff from Black, Asian and minority ethnic backgrounds faced greater difficulty in accessing appropriate Personal Protective Equipment (PPE) that fitted correctly.458

307. Professor Kevin Fenton, Regional Director of Public Health England London, who co-authored Public Health England’s August 2020 report, Disparities in the risk and outcomes of COVID-19, stated that adequate protection for staff was an area they were “very concerned” about in their review:
Many BAME workers felt less empowered, less able to speak up and less able to express their concerns about PPE risk or any vulnerabilities they might have. That may have placed them at risk [...] staff felt less able to ask for PPE, or may have experienced what they felt was disproportionate distribution, utilisation or access to PPE as well.459

336. It is essential that in any future crisis, NHS staff from Black, Asian and minority ethnic backgrounds are included in emergency planning and decision-making structures. NHS England should accelerate efforts to ensure that NHS leadership in every trust, foundation trust and Clinical Commissioning Group is representative of the overall Black, Asian and ethnic minority workforce.

337. Leadership in NHS England and Improvement should also increase their engagement with Black, Asian and minority ethnic worker organisations and trade unions to ensure that Black, Asian and minority ethnic members of staff feel valued by the organisation, are involved in decision-making processes and feel able to speak up when they are not being protected.

338. It is unacceptable that staff from Black, Asian and minority ethnic communities did not have equal levels of access to appropriate and useable personal protective equipment as their white colleagues during the pandemic. The Government must learn from the initial shortage of appropriate PPE for these staff and set out a strategy to secure a supply chain of PPE that works for all staff in the NHS and care sectors.

https://committees.parliament.uk/publications/7497/documents/78688/default/

 

[elbows]

And in regards the second part of paragraph 306, the evidence reference 458 points to this, which I also havent had time to read properly:

https://committees.parliament.uk/oralevidence/383/html/

 

[_Russ_]

I have to say the whole minorities getting less access to PPE accusation is rather nebulous imo

 

[elbows]

Well one particular aspect is discussed in my previous link:

A related question is that, as we know with most forms of protection, if it does not fit correctly, it is next to useless. One frontline NHS worker said, “PPE is designed for a 6-foot-3 bloke built like a rugby player.” I have heard anecdotally from a number of sources that there is a problem fitting the FFP3 masks for certain ethnicities, such as east Asians in particular. Nurses like my mum, for example, struggle to try to get the FFP3 mask to fit and it has failed a number of times. What are we doing to ensure that our staff are properly protected with PPE, especially the female BAME workforce and pregnant workers?

You are absolutely right, Sarah, to identify that one of the consistent issues that is raised with our trust chief executives is that some of the different types of mask do not fit particular types of face. You are right to identify that that has been raised as an issue particularly for certain groups of black and ethnic minority staff. I had heard that east Asian nurses in particular were finding that some brands of mask did not fit in the right way. I have heard variants of your anecdote about some of it being built for 6-foot-3 rugby players.

 

[elbows]

Plus given that the PPE failings were numerous and the dysfunction existed on many levels, it is unsurprising that this resulted in situations where staff who felt able to challenge management stood a slightly better chance of getting the situation improved for them, hence the focus on management representation in the committee report. So questions like the following one came up in the aforementioned evidence, although satisfactory answers were lacking.

Taiwo Owatemi: My question is directed to Dr Dixon and Richard Murray. In a survey of over 2,000 BAME NHS staff, 50% stated that there was a culture of discrimination within the NHS. They felt that they were unable to speak up due to the lack of BAME representation in leadership roles. Currently, only 6% of NHS leadership positions are BAME staff. As the NHS plans for the long term, what practical steps are being taken to ensure that there is diversity in leadership positions across all professions?

Likely a broader issue lurks in regards managements fitness for purpose in terms of addressing the needs of all staff, regardless of ethnicity. But I dont expect committee reports to look at that properly because once you start picking at that, much of the way everything is ordered and managed in this country starts to get exposed as a crappy sham built on hideous priorities.

 

[elbows]

I probably wont have time to go through the whole thing and comment on all of it, so I'll just pick a few more areas for now.

Hospital infection control is a special area of interest of mine so I'll start with that. It gets a brief mention in a section that wonders why we didnt try to learn from the likes of South Korea. And then it comes up a fair bit later on:

55. Moreover, the Nuffield Trust also highlighted the impact of low levels of capital investment on the NHS’s ability to respond to the pandemic, particularly in terms of infection prevention and control:

The fact that the UK trails most other countries in capital investment means many parts of the NHS are working with outdated buildings, and will be challenged to take steps such as separate Covid and non-Covid wards which could allow expanded activity while maintaining infection control.92

This challenge was also highlighted in written evidence, including by the Healthcare Infection Society, who stated:

Ventilation, spacing and isolation facilities in most areas of hospitals were not compliant with recommendations in Health Building Notes (HBN) and Health Technical Memoranda (HTM). No practical solutions were available to address this.93

I expect thats also an issue during 'normal times' and probably contributes to the levels of influenza death we sometimes experience in this country.

56. These impediments to effective infection prevention and control made it more difficult for the NHS not only to see patients physically, but also led to widespread restrictions on people accompanying patients, like birth partners or, as we note elsewhere, advocates for people with learning disabilities.94 The Healthcare Infection Society also highlighted the issue of bed capacity and staff levels on infection prevention and control (IPC) grounds, not just the delivery of critical care:

Bed occupancy was chronically high with relatively low staffing ratios of qualified staff and an inadequate number of side rooms in most hospitals. These are undesirable in IPC terms. Not only are infections more likely to spread and be more difficult to control, but the deficiencies hinder the ability to respond to unusual IPC challenges.95

Which then leads on to a broader point about capacity:

57. Sir Simon Stevens summed up the broader issue of managing NHS capacity during a health crisis in his evidence to us in January 2021:

Should we try to build more resilience into public services rather than running everything to the optimum just-in-time efficiency? I think that is one of the big lessons from the pandemic. We talked a bit about it earlier in respect of extended supply chains versus domestic manufacturing capacity, but that is just one instance of the broader point, which is that resilience requires buffer, and buffer can look wasteful until the moment when it is not.96

Resulting recommendations include:

71. The experience of the demands placed on the NHS during the covid-19 pandemic should lead to a more explicit, and monitored, surge capacity being part of the long term organisation and funding of the NHS.

72. The NHS should develop and publish new protocols for infection prevention and control in pandemics covering staffing, bed capacity and physical infrastructure. In developing these protocols the NHS should consider the importance of maintaining access for people accompanying some patients such as advocates for people with learning disabilities and birthing partners.

73. Comprehensive analysis should be carried out to assess the safety of running the NHS with the limited latent capacity that it currently has, particularly in Intensive Care Units, critical care units and high dependency units.

 

[Teaboy]

Its more than a bit galling to read the front pages of the newspapers today. I know solid brass neck is standard amongst that lot but a lot of the national press were (and still are) some of the most vocal and visible opponents of lockdowns and policies designed to stop the spread of the virus. This is before we talk about all the rank stupidity around save Christmas / summer holidays which has no doubt influenced government policy in a very negative way.

Their own hands are also covered in blood to say the least.

 

[elbows]

Yes, although there are exceptions, and I still remember commenting during the first lockdown that journalists asking questions in the press conferences of the time were the first to display 'lockdown fatigue' and start to undermine things.

 

[elbows]

One of the other recommendations is that SAGE advice upon which ministers base their decisions should be published very quickly.

I've looked at the section dealing with the second wave. It concentrates on things like local lockdowns, crap test & trace system, muddled public messaging & rules, and lack of autumn circuit breaker. And ultimately it does the same thing that government and the official experts did at the time, hiding behind the Alpha(Kent) variant as an excuse for not understanding the situation and acting appropriately at the time.

As such it ends up downplaying the extent to which Johnson left himself with no scientific cover when making terrible decisions in the buildup to the second wave last year. Given that the report was quite happy to look at all the failings of SAGE etc at the start of the pandemic I am not impressed that they failed to highlight advice other than circuit-breakers in the months leading up to that period. So I will highlight just a couple of those aspects myself using SAGE minutes:

SAGE meeting 43, 23rd June 2020: https://assets.publishing.service.g...0561_Forty-third_SAGE_meeting_on_Covid-19.pdf

There may be a need to change measures at the end of the summer in order to be able to keep R below 1 whilst proceeding with the planned reopening of schools. Planning for safe full reopening should take place now and should take account of the health benefits of reopening schools as well as the educational benefits

SAGE meeting 46, 9th July 2020: https://assets.publishing.service.g...7/s0622-forty-sixth-sage-meeting-covid-19.pdf

It is important to ensure that there will be enough 'room' in terms of the epidemic to open schools in September.

SAGE meeting 51, 13th August 2020: https://assets.publishing.service.g...0696_Fifty-first_SAGE_meeting_on_Covid-19.pdf

SAGE again reiterated the public health benefits of keeping incidence as low as possible

By September 2020 SAGE minutes reflected that they were well aware of what was happening. The committee report seems to focus a fair bit on the limited benefits Wales gained from its circuit breaker, including that it did not prevent subsequent lockdowns from being necessary. But actually SAGE minutes from September 2020 are full of indications that far more than circuit breakers would be required, and they didnt massively overstate the benefits. eg:

SAGE meeting 57, 17th September 2020: https://assets.publishing.service.g...62_Fifty-seventh_SAGE_meeting_on_Covid-19.pdf

A 'circuit-breaker' type of approach, where more stringent restrictions are put in place for a shorter period could have additional impact. Modelling indicates that a two-week period of restrictions similar to those in force in late May could delay the epidemic by approximately four weeks, if the epidemic had a daily growth rate of 4% prior to this period.

During this period SAGE also repeatedly highlighted the need for financial and non-financial support were required to improve adherence to self-isolation.

 

[two sheds]

You mentioned starting a thread just on this? I think that's an excellent idea.

 

[elbows]

You mentioned starting a thread just on this? I think that's an excellent idea.

I decided I'm not doing it because I have no more time left to explore everything else in the report, and frankly the level of depth they operated at does not motivate me to do so.

Meanwhile and not for the first time in this pandemic, Vallance has been defending himself publicly. As usual theres a mix of stuff, some of which I completely agree with and some of which makes me groan.

Covid: Not my job to sugarcoat advice, Sir Patrick Vallance says

The chief scientific adviser says he does not just tell the government what it wants to hear.

www.bbc.co.uk

It may not be his job to sugarcoat things but like most people in such positions, part of the job involved staying on-message when delivering public briefings, and thats partly why he was a source of so much shit in the early months. He also attempts to mask early failings by couching it all in terms of evidence and evolving understanding. In reality thats only part of the picture of dismal failure, so on some levels thats just a crap excuse within easy reach of scientists. Precautionary principals are part of science too, and the initial response was entirely lacking in that dimension. Nor am I convinced that precautionary principals have since found their rightful place.

 

[BillRiver]

Perhaps plumbers should be trained in the classics so even if they do blow up your house they can distract you from your woes with some tales of ancient roman plumbing misadventures.

My dad worked at Barking College of Technology for 20+ years, teaching literature including Shakespeare to hundreds of local people including a great many workers from the Ford factory in nearby Dagenham. They were paid, by Ford, for their one day a week at college at the same rates as if they'd been at work.

Eta: and my maternal grandad and great-uncle were involved in (self organised, outside paid working hours) workers education amongst miners in Northumberland back in the day. They learnt Latin and studied poetry together, amongst other things.

It used to be normal, that sorta thing, according to my late grandad. For the men, at least.

 

[wemakeyousoundb]

One of the other recommendations is that SAGE advice upon which ministers base their decisions should be published very quickly.

Something suggested in the 2010 independent review of the 2009 influenza (paragraph 15, chapter 4) as I heard earlier today on the radio.
But no, the poor sods weren't to know

 

[elbows]

Something suggested in the 2010 independent review of the 2009 influenza (paragraph 15, chapter 4) as I heard earlier today on the radio.
But no, the poor sods weren't to know

In many ways that 2009 swine flu pandemic review was a bit pathetic and congratulatory, something made possible by the relatively low burden of that pandemic such that a bunch of inadequacies were not properly tested by the arrival of that virus.

I've tended to mention that report in the past when I have been taking the piss out of what we call 'the containment phase' in our traditional pandemic plans. Again that particular report doesnt really explore the issues and implications properly because of the nature of that pandemic. But it still had criticism for the containment phase, but it went for a 'it confuses the public' angle rather than exploring how deadly that approach could be:

Although communications materials were in general good, certain terms used during the pandemic were unclear and caused confusion. Given the critical importance of the public clearly understanding the advice being given by government, some of the terminology should be revisited. In particular, ‘containment’ was used to describe a strategy which was not intended to contain the disease but to slow the spread.

There were certainly numerous occasions during the current pandemic where I had to point out to people that we werent sincerely trying to contain the virus or the latest variant of it. And my recognition of that was certainly based on the 2009 approach.

I should say that I nearly choked when I read how the current committee report chose to briefly characterise that swine flu review:

20. Following the Swine flu outbreak of 2009, the then Government set up an independent review of the UK’s response to the 2009 influenza pandemic, which reported in July 2010. The review, led by Dame Deirdre Hine, found that pandemic preparedness was, generally, “impressive”.

It was only possible to judge the response as impressive because the virus didnt test various limitations,. Even so it gave a glimpse of some of the bullshit and British exceptionalism that would continue to infect our experts thinking on pandemic matters. For example the 2009 UK approach caused some head scratching around the globe when we decided to throw huge amounts of Tamiflu around in an attempt to use it as a prophylactic. And the abandoning of testing once we'd gone past the misnamed 'containment' phase offered strong clues about the failures to bother with testing at a crucial stage of the current pandemic:

The move away from containment had a significant effect on the surveillance mechanisms employed to monitor H1N1 activity. Laboratory confirmation of all cases was discontinued in favour of clinical diagnosis, which meant that surveillance information would focus primarily on the geographical spread, trend, intensity and impact of the virus. The discontinuation of routine laboratory testing also meant that, rather than providing an absolute number of confirmed cases, estimated ranges of cases were produced by the Health Protection Agency based on available surveillance information.

 

[elbows]

Plenty of responses to the report on the BBC live updates page today.

https://www.bbc.co.uk/news/live/uk-58880971

I think I'll just quote this one and leave it at that.

As the government's pandemic response comes under renewed scrutiny, A&E nurse Mark Boothroyd recalls the anxiety he and colleagues felt as the number of UK cases began to grow.

“We were wondering when they were going to lock down, we were wondering what other countries were doing and we were wondering why they weren’t copying them," says Boothroyd, who works at St Thomas' Hospital in London.

"They must have thought we were invincible."

He tells the BBC it was "infuriating" when Prime Minister Boris Johnson said on TV on 3 March last year that he shook hands with people he met on a hospital visit, including Covid patients.

"It was completely against all the guidance that was out at the time. It was almost making a joke out of it. That was entirely the wrong message to the public and showed he wasn’t taking the thing seriously,” says Boothroyd.

Along with the discussions about herd immunity, he says it reflected a belief that the country could just "ride it out" like the flu, and misunderstood how bad Covid-19 could be.

Even the Lib Dems couldnt fail to notice some of the areas that the report didnt really touch on.

Layla Moran, the Liberal Democrat MP who chairs the All-Party Parliamentary Group on coronavirus, says the report is "notable by its silence on a number of key areas".

She highlights the "catastrophic mismanagement of schools", the continued under-delivery on donations of vaccines to poorer countries and "no mention of long Covid in 151 pages".