Casebook July 2022

Casebook July 2022

Posted: July 18th 2022


In this edition, the persistence of covid, a scary heatwave, Kate Bingham Speaks, the power of TikTok, Social Care Challenges and “Steady as She Goes” in terms of progress around key activities at the National Centre for Rural Health and Care.

‘The way it’s playing out is unexpected’: UK faces up to changing waves of Covid

Very interesting article on the changing face of Covid….

“We’d expected strong seasonal wintertime patterns where you don’t see a lot outside those winter months,” said Kissler (Harvard Epidemiologist). This was because, with limited information to go on at the time, respiratory viruses have a natural advantage in the winter when people are cooped up indoors and when our immune systems are potentially less effective. And for many viruses, once a winter wave has passed, people remain immune for long enough to suppress infection until the following year.

Two years on, Kissler’s view has changed. “We’re in a different landscape now,” he said. “The fact we’re having such a rapid succession of variants – we seem to be racking them up at alarming speed – is the most surprising thing and that’s changed the way the waves look.”

“I would’ve thought it would have reached a steady state by now,” he said. “It seems the opposite is the case.”

Others have also been taken by surprise by this pattern. “It does look as if the successive waves are getting closer together,” Prof Peter Openshaw, an immunologist at Imperial College London, said. “They are actually becoming more frequent, with one piling in on top of the other.”

The change, Openshaw said, is that in the first year of the pandemic, new waves were driven by the emergence of more transmissible variants, such as Alpha and Delta, which spread infection more easily. Now, successive variants, including the latest BA.2.75 variant, nicknamed Centaurus, are being driven primarily by “immune escape” – the ability to infect people who have been vaccinated and infected, even fairly recently.

UK heatwave: people urged not to use trains from Monday

The heatwave we are experiencing on an unprecedented basis is part of a new normal with significant health implications according to this story, which tells us:

But the chief executive of the College of Paramedics, Tracy Nicholls, warned that the heatwave posed real danger, particularly to the vulnerable such as elderly people.

“This isn’t like a lovely hot day where we can put a bit of sunscreen on and go out and enjoy a swim or a meal outside,” she said. “This is serious heat that could actually ultimately end in people’s deaths because it is so ferocious and we’re just not set up for that sort of heat in this country.”

Meteorologists have given an 80% chance of the mercury topping the UK’s record temperature of 38.7C, set in Cambridge in 2019, with temperatures in London expected to hit 40C on Tuesday.

Scientists said the link between climate change extreme heatwaves was now clear. “This shows the UK is already on a warming trend when it comes to heat extremes,” said Dr Mark McCarthy from the Met Office. “Human-caused climate change has set us on a course to see temperature extremes in the UK that would be highly unlikely under a ‘natural’ climate.”

The new health secretary, Steve Barclay, said extra measures were being put in place for ambulance services, including the provision of more call handlers and extra working hours.

Nicholls said the announcement was welcome, but added: “I don’t know how that money will translate into hours, because it’s quite late in the day, quite honestly.”

Victor Adebowale, the NHS Confederation chair and crossbench peer, said that many hospital buildings in the UK were not equipped for extreme heat.

UK has missed chances to prepare for future pandemics, says ex-vaccines tsar

The marvellous Kate Bingham has some interesting home truths to share! Speaking of the pandemic, she said there had since been missed opportunities – including failing to bring scientific and commercial expertise into the government, and not pursuing the creation of bulk antibody-manufacturing capabilities in the UK.

Antibodies are proteins that are produced in the body to fight off an infection. While their production can be triggered through vaccination, this is not always the case for people who are immunosuppressed. As a result, one way to protect those with weak immune systems is to give them laboratory-made antibodies.

Among therapies that rely on such manufacturing is Evusheld, AstraZeneca’s combination of two long-acting antibodies that helps to prevent Covid infections in immunocompromised people who cannot be vaccinated. While approved for use by the Medicines and Healthcare products Regulatory Agency, the UK, which has about 500,000 immunocompromised people, has yet to place an order for the therapy.

The vaccine taskforce’s 2020 Achievements and Future Strategy report cited the ability to make antibodies in bulk as critical for future pandemic preparedness.

Bingham said in order to have bulk-scale manufacturing of antibodies it was necessary to have bio-processors with capacity of up to 20,000 litres, noting that such processors could also be used for other biological products, including vaccines, and would allow the UK to export.

“We’re way off that [capacity]. So all our biological therapeutics are all imported,” she said, adding the reason for the situation is simple. “Just lack of government appetite,” she said.

Bingham also suggested lessons had not been learned about the need for scientific and commercial expertise in government, noting that a recent advertisement for the new director of the Covid-19 vaccine unit within the UK Health Security Agency failed to mention industry experience, a science background or experience in drug discovery, development, manufacture or regulation.

“It just talks about sort of ability to manage. So I think that tells me that the civil service is going back to plan A, which is they control everything again,” said Bingham.

“[That is] why the vaccine taskforce was created in the first place, because they didn’t have those skills.”

Bingham added she would not return to her former role, if asked, should there be another pandemic.

“The answer is no, because they should have recruited somebody in-house to deal with it,” she said. “They shouldn’t be scrambling for people on the outside to come in and help.”

Perhaps best known for her role in securing a panoply of Covid vaccines for the UK, Bingham said it was a surprise that so many turned out to be effective.

Herefordshire dad loses 10 stone dancing on TikTok

The very useful coming together of social media and public health make this article a great read! It tells us;

A dad who topped the scales at 30 stone (191kg) said dancing on TikTok helped him shed a third of his weight.

Adrian Scarlett, 52, said he always struggled with his weight but his young children gave him a "wake-up call".

The father-of-three has dropped more than 10 stone (64kg) through diet, determination and dancing on the platform under the name Bye Bye Fatman.

Mr Scarlett's videos have had millions of views and now he wants to help others lose weight too.

"I've had a binge-eating disorder throughout my adult life," he said.

"Any time I have been under stress, food has been the comfort."

Now weighing 18 stone, he is continuing his journey through diet and dancing

He said he "changed his mindset" after getting married and raising his children aged six, three and 20 months.

Mr Scarlett, a teacher at a school in Hereford, said meal replacement shakes helped him to shift the first few stones, which he continued with healthy eating and exercise.

"My children were my wake-up call," Mr Scarlett said.

He documented his journey through a number of dance videos to trending songs on TikTok using his @Bye_Bye_Fatman profile.

It has attracted about 52,000 followers and more than 3.1m likes.

"As the audiences increase, I am now held accountable by more and more people and it is impossible to fail because I have people watching me," he said.

Social care: 'The worst it's been in my 36 years in care'

The challenges facing social care providers are at their worst in rural settings. This article tells us:

Home care providers say care workers are leaving their jobs because of the rising costs of fuel and reluctance to work long hours after the pandemic.

At the same time the demand for social care is rising and hospitals are facing backlogs as they say they have patients they cannot discharge without care in place.

How are care providers coping and what can be done to solve the issues?

Prema Fairbourn, is chair of the Suffolk association of independent care providers and runs Primary Homecare, which provides carers to go into people's homes.

"All care agencies are having that same problem that they do not have enough staff," she says.

"At one point I had about 80 members of staff but that has dropped now to about 47, that's a big drop.

"I think staff have had a big rethink since the pandemic and their work/life balance is more important to them.

"So they are look at the unsocial hours they have to do in the care sector and they don't want to do it."

Fuel costs are also an issue she says. "Whatever we pay them a lot of it is swallowed up."

While there are fewer carers in the industry, Ms Fairbourn says: "The demand is great and the backlog in the hospital lists is huge and I don't know how they are going to service all those [care] packages."

Other Stuff

Here is a brief update on key NCRHC activities.

Parliamentary Inquiry

It is now approaching six months since the publication and launch event for the report.  It was well attended and hosted virtually by the office of Anne Marie Morris MP. The key note speaker was Sir Chris Whitty. Approaching 100 individuals attended the event and the report and the presentations setting out the learning from it were outlined effectively and well-received. A number of follow up actions are planned post report and feedback on progress to date along with a plan for a second push to generate further interest was considered by the Board at its June meeting.

Health Education England Legacy Funding

Planning for the implementation of the following programme of activities continues:

1) Piloting of the National Centre for Rural Health and Care Toolkit (PI recommendation 4)  – We have 4 early adoption areas on standby to implement the rural health and care toolkit, develop with Rural England. They are: Devon, Lincolnshire, Suffolk and Shropshire. Output 4 detailed case studies and the directly positive health outcomes arising in these settings. 

2) Develop a curated network for innovative primary care centres which are community focused (PI recommendation 12) – identifying and sharing best practice about multi-agency working, self-care and increased health literacy in relation to rural health inequalities. We intend to have an initial focus on coastal settlements associated with the key health workforce challenges identified in the PMOs 2021 report. Output a gazeteer of best practice and a fully functioning and self supporting ongoing network. 

3) Create a knowledge exchange of good practice and problem solving focused on the rural challenges associated with the interface between health and care (PI recommendation 10 and 11) – we will undertake detailed research across England and follow the international good practice leads arising from the Parliamentary Inquiry to look at writing up and sharing examples of where dislocation at the interface of health and social care, in the context of local delivery blight desired outcomes. This will focus on more effective resourcing of early discharge from acute settings, the most effective examples of staffing of domiciliary care and the effective use of technology to support innovation. We will not only create a repository of good practice but we will create a self supporting network of rural ICS interested in this theme, beginning with our own membership, but open to all.  Outputs detailed report covering best practice and a dedicated ongoing community of practice.

4. Create a rural mental health network (PI cross cutting) – there is significant recognition of the need for a good practice and network facility to address the particular nature of rural mental health. The Scottish national rural mental health strategy has delivered a real impetus in terms of the recognition of this issue and has driven preventive improvements and a recognition of the importance of this issue from a workforce perspective, both in terms of the skills needed to address mental health challenges in rural settings and the mental health challenges facing rural health practitioners. Output, Rural Mental Health Strategy and good practice dissemination materials and plan. 

Northern Ireland Rural Proofing Toolkit

Our work with all the Health Trusts in Northern Ireland has borne good fruit. We now have a fully fledged Northern Ireland version of the rural proofing for health toolkit. We anticipate launching it in October, potentially at Stormont. In the meantime our partners in Northern Ireland who have been involved in the development of the new version will present it as an example of good practice at an OECD international symposium on rural policy in the Republic of Ireland in September.