We all agree that lockdown should only be eased once we have passed the peak.  But what peak? There are three possible: infections, hospital admissions and deaths. The numbers in hospital or in intensive care will also peak, or have done so, but, if they are collected at all, they are not reported. The original strategy, and it was right, was to spread the emergency so that the NHS could handle it. Those who are infected but stay at home are little, if any, burden on the NHS.  In any case the Department of Health and Social Care (DHSC) do not have the slightest idea how many non-hospitalised cases there are in the community. They are not tested (unlike Germany) and not sampled. 

So far as deaths are concerned, the DHSC only tracks English deaths in hospitals.  For the saddest of reasons, deaths actually reduce the load on the NHS. The DHSC has very little idea of how many Covid-19 deaths occur in care homes or domestically.  The number of deaths is compiled from certificates completed by GPs visiting, online or in person, corpses who tend to be unresponsive as to their symptoms. The GP has to guess or take the opinion of the unqualified carer or leave it to a coroner weeks later. The weekly estimates by the National Statistics Office are not reconciled with the daily estimates by Public Health England (PHE).

In short, the only peak that matters, for lockdown exit purposes, is that for hospitalisations.

So how does that analysis compare with the “five conditions” announced for starting exit yesterday: “They are: ensuring that the NHS can cope across Britain; a sustained and consistent fall in the daily death rate; evidence that the rate of infection is decreasing to “manageable levels”; enough testing and protective equipment to meet demand; and no risk of a second peak large enough to overwhelm the NHS”?

Firstly, Downing Street has no mandate on health matters for Britain, only for England.  Secondly the DHSC has no reliable figures for deaths and hospitalisations is a better measure for NHS coping.  Thirdly, the DHSC has no measures of infections. Fourthly the government claims we already have enough protective equipment even if the front line does not agree.  Once hospitalisations are falling and now that local suppliers are filling the gaps, we can begin. 

He is, however, right that caution should be exercised. Returning too quickly to normal too soon might precipitate a major second wave of hospitalisations. But that is a matter of how the exit proceeds, not when. Whether it is at the end of April or June, the second wave problem remains the same.  And we certainly cannot wait for the entire population being vaccinated in two years’ time. For a discussion of the urgency of leaving lockdown see yesterday’s paper “Reopening Britain” by Eamonn Butler and Matthew Lesh. Being later in the pandemic experience than our largest European comparators, notably Italy, Germany, France and Spain, allows the UK some evidence of other lockdown exit experiences.

PHE reports Covid-19 tests, both positive and negative, and deaths, daily and cumulatively.  No comparative data or trends are shown and there is some misreporting as past data are amended, making the figures exceedingly difficult to track.  Frankly, the data for the latest day should be disregarded. The figures for positive Covid-19 tests are reported now as “cases” but the cumulative discrepancy for the UK (between the total and four nations’ figures) was 7,151 (7%) on 15th April which may be explained by Pillar 2 swab testing for key workers and their households. PHE’s elucidation “cases in people who have not been tested are not included in the confirmed case counts” is textbook Zen Buddhism.  We have to take these “cases” as proxies for Covid-19 hospitalisations.  Obviously, there are quite a few patients thought to have Covid-19 who turn out not to have, quite a few who test positive but wrongly and some who test positively but do not need hospitalisation.  As the trend lines compare like with like, such problems probably do not matter.

The trend on hospitalisations looks like this:

It would appear from the above graph that hospitalisations have peaked but even if not, a cautious and gradual relaxation of lockdown should now be put in hand.  It can always be frozen or reversed if cases turn upward again. The more serious matter is that no lockdown exit strategy has yet been announced. Perhaps the DHSC and Public Health England have yet to give that matter any thought.  As discussed in an earlier blog, it would not be surprising if that were the case.  We need urgently to know what it is, to shine sunlight upon it, to debate it and, hopefully, for us all to support and implement it.