UK worries about second COVID-19 wave in Europe, more quarantine steps possible

By Estelle Shirbon

LONDON (Reuters) – British authorities are worried about a second wave of coronavirus infections in Europe and will not hesitate to bring back more quarantine measures, possibly within the next few days, as they did with Spain.

Prime Minister Boris Johnson said COVID-19 was under some measure of control in Britain, but a resurgence in some European countries showed the pandemic was not over.

“It is absolutely vital as a country that we continue to keep our focus and our discipline, and that we don’t delude ourselves that somehow we are out of the woods or that that is all over, because it isn’t all over,” he said.

Last weekend Britain re-imposed a 14-day quarantine period on people arriving from Spain, a move that caused havoc with the reopening of the continent for tourism in the summer high season.

Health minister Matt Hancock stopped short of naming other European countries that might end up back on the quarantine list, but cited France as an example of one where infections have lately risen.

“I am worried about a second wave. I think you can see a second wave starting to roll across Europe, and we’ve got to do everything we can to prevent it from reaching these shores, and to tackle it,” Hancock said during an interview on Sky News.

When asked whether Britons should be prepared for more measures to be announced within the next few days, he said yes.

“The number of cases have gone up sharply in some countries in Europe … France now has more cases than we do, per day, and in Spain we saw the numbers shoot up which is why we had to take the rapid action that we did,” Hancock said on Talk Radio.

France reported almost 1,400 new cases on Wednesday, the highest daily increase in more than a month.

Britain reported 763 new confirmed cases on Wednesday.

Hancock said the authorities were working on possible ways to shorten the quarantine period for people coming from Spain, such as by testing them during the quarantine period.

“But we are not imminently making an announcement on it,” he said in a BBC television interview.

In Britain, the number of cases had stopped falling and was at best flat, which was a result of increased social contact as lockdown measures have gradually been eased, Hancock said. He urged people to keep following social distancing guidelines.

An analysis from Britain’s statistics office showed on Thursday that the United Kingdom has suffered the highest rate of excess deaths during the COVID-19 pandemic in a comparison of 21 European countries.

(Writing by Estelle Shirbon; Editing by Peter Graff and Frances Kerry)

Special Report: In shielding its hospitals from COVID-19, Britain left many of the weakest exposed

Special Report: In shielding its hospitals from COVID-19, Britain left many of the weakest exposed
By Stephen Grey and Andrew MacAskill

LONDON (Reuters) – On a doorstep in the suburbs of north London, three-year-old Ayse picked up a tissue to wipe away her grandmother’s tears – tears for one more victim of the virus.

The little girl was waiting for her mum, Sonya Kaygan. Her grandmother hadn’t broken the news that Kaygan, 26, who worked at a nearby care home, was dead, one of over 100 frontline health workers killed by the coronavirus in Great Britain.

The grandmother, also called Ayse, spoke through sobs. “Why? Why?” she repeated. Why couldn’t she visit the hospital to say her goodbyes? Why did so many die in her daughter’s workplace? At least 25 residents since the start of March, of whom at least 17 were linked to the coronavirus. It was one of the highest death tolls disclosed so far in a care home in England. And why did Kaygan and her colleagues resort to buying face masks on Amazon a month ago, protection that arrived only after she was in hospital?

A Reuters investigation into Kaygan’s case, the care home where she worked, and the wider community in which she lived provides an intimate view of the frontline of Britain’s war on the coronavirus. It exposes, too, a dangerous lag between promises made by Prime Minister Boris Johnson’s government and the reality on the ground.

Even as the government was promising to protect the elderly and vulnerable from the deadly virus, local councils say they didn’t have the tools to carry out the plan, and were often given just hours to implement new government instructions.

Policies designed to prevent hospitals from being overwhelmed pushed a greater burden onto care homes. With hospitals given priority by the government, care homes struggled to get access to tests and protective equipment. The elderly were also put at potentially greater risk by measures to admit only the sickest for hospital treatment and to clear out as many non-acute patients as possible from wards. These findings are based on documents from government agencies seen by Reuters, interviews with five leaders of local authorities and eight care home managers.

It is too early to reach final conclusions about the wisdom of these policies. Still, staff and managers of many care homes say they believe the British government made a crucial early mistake: It focused too much attention on protecting the country’s National Health Service at the expense of the most vulnerable in society, among them the estimated 400,000 mostly elderly or infirm people who live in care homes across Britain.

The government summed up that policy in the slogan “Protect the NHS.” The approach gave the country’s publicly-funded hospitals priority over its care homes. A UK government spokesman defended the strategy. “This is an unprecedented global pandemic and we have taken the right steps at the right time to combat it, guided by the best scientific advice.”

The effects of this approach have been felt desperately in Elizabeth Lodge, in Enfield, north London, where Kaygan worked.

The first coronavirus test of a resident of the Lodge only took place on April 29. That was 34 days after the first suspected case at the home, said Andrew Knight, chief executive of residential services at CareUK, a private company which operates the home. It was also 14 days after Matt Hancock, the UK health secretary, pledged tests would be available to “everyone who needs one” in a care home.

“The government’s response on testing has come way too late to have any meaningful effect on keeping the virus out of our homes,” said Knight, the CareUK executive, in a statement to Reuters.

So far, at least 32,300 people have died in Britain from the coronavirus, the highest toll in Europe, according to official UK data processed by 2 May. Out of those deaths, more than 5,890 were registered as occurring in care homes in England and Wales by April 24, the latest date available. These figures don’t include care home residents who were taken to hospital and died there.

Many care home providers believe the figures understate the number of deaths among care home residents because, in the absence of testing, not all are being captured. During the 10 weeks prior to the outbreak, including the height of the flu season, an average of 2,635 people died each week in care homes in England and Wales. By April 24, that weekly death toll had risen to 7,911. According to Reuters calculations, the pandemic has resulted in at least 12,700 excess deaths in care homes.

“I think the focus early on was very much on the acute sector,” or urgent hospital treatment, “and ensuring hospitals were able to respond in an effective way,” said Graeme Betts, acting chief executive of Birmingham City Council, which oversees the UK’s second-biggest city. “And I think early on care homes didn’t get the recognition that perhaps they should have.”

Helen Wildbore, director of the relatives and residents association, a national charity supporting families of people in residential care, said while it was right for the initial focus to be on protecting the NHS, “I think it has taken too long for the government to turn its attention” to vulnerable people outside hospital. “I think it’s fair to say that the sector has felt like an afterthought for quite a long time.”

Jeremy Hunt, a former Conservative Party health secretary and now chairman of the House of Commons health select committee, advocated banning visits to care homes by friends and family from early March, advice that wasn’t followed. Speaking to Reuters, he drew a parallel between the UK’s response to the coronavirus and the way it deals with peak winter demand for hospital services.

“What happens with any NHS winter crisis is the focus of attention immediately switches to the hospitals and dominates the system’s thinking,” he said. “Many people in the social care sector told me exactly the same thing happened with COVID-19.”

The government spokesman said protecting the elderly and most vulnerable members of society had always been a priority, “and we have been working day and night to battle coronavirus by delivering a strategy designed to protect our NHS and save lives.”

THE COCOON

Born in Northern Cyprus in 1993, Sonya Kaygan had come to the UK after studying English. She settled in Enfield, a north London borough of 334,000 people with a large community of Turkish origin, and one particularly hard-hit by the virus pandemic.

Kaygan lived with her mother and together they looked after her child. Both worked in different care homes: She worked night shifts and her mother worked the day shift. Kaygan’s monthly wages for three or four weekly 12-hour shifts added up to a take-home pay of about £1,500 – just short of the monthly rent of their home.

By the time a “lockdown” was imposed by the prime minister on March 23, the virus was spreading fast and Kaygan was beginning to feel sick. “She started feeling a bit uncomfortable,” her uncle Hasan Rusi said. “She had a temperature and was coughing. It might have been a cold, it might be a virus.”

Established plans drawn up by the government for dealing with a flu pandemic had always been clear that care homes could be a place for infection to spread. But on February 25, Public Health England, a government agency overseeing healthcare, stated it “remains very unlikely that people receiving care in a care home or the community will become infected.”

The guidance was widely reproduced on care home websites and stayed in force until March 13. It meant that few care homes restricted visits and few families withdrew their relatives from homes. No plan was put in place for testing staff. A government spokesman said that advice “accurately reflected the situation at the time when there was a limited risk of the infection getting into a care home.”

On March 12, the government shifted from what it termed a “contain” to a “delay” phase, after the World Health Organisation declared an international pandemic. The UK now focused efforts on mitigating the spread of virus through the general population, allowing “some kind of herd immunity” to develop, as the chief scientific adviser, Sir Patrick Vallance, explained on BBC radio on March 13. But, said Vallance, “we protect those who are most vulnerable to it.”

David Halpern, a psychologist who heads a behavioural science team – once nicknamed the “nudge unit” – advising the UK government, had expanded on the idea in a separate media interview on March 11. As the epidemic grew, he said, a point would come “where you’ll want to cocoon, you’ll want to protect those at-risk groups so that they basically don’t catch the disease.”

Nonetheless, Reuters interviews with five leaders of large local authorities and eight care home managers indicate that key resources for such a cocoon approach were not in place.

There weren’t adequate supplies of protective equipment, nor lists of vulnerable people, they said. National supply chains for food were not identified, nor was there a plan in place to supply medicines, organise volunteers, or replace care staff temporarily off sick. Above all, those interviewed said, there was no plan for widespread testing in vulnerable places like care homes or prisons, let alone an infrastructure to deliver it.

On March 23, Johnson announced another shift in strategy, replacing the mitigate-plus-cocoon approach with a broader lockdown. Schools, pubs and restaurants were shuttered, sport cancelled and everyone was told to stay at home.

For local leaders, caring for the most vulnerable became increasingly challenging. Typically, they said, new plans were announced in an afternoon national press conference by a government minister, with instructions to implement them, sometimes the next day, arriving by email to councils later that night. Ministerial promises, handed off to the councils, included drawing up a “shield list” of the most vulnerable, delivering food to them and organising and delivering prescription medicines. Even plans for using volunteers were announced nationally, without taking account of volunteer infrastructures that many councils had in place.

“From our vantage point, it sometimes looked like policy made up on the hoof,” said Jack Hopkins, leader of Lambeth Council in south London, an early hotspot for the virus outbreak. Local councils knew they had to act quickly, but there was no dialogue about how things should happen. “It felt very much like government by press release, with local government left to pick up the pieces,” Hopkins said.

It was the same experience in Birmingham, which was also hit hard by the virus. Betts, the council’s chief executive, wants to avoid dishing out criticism in a situation that is “new for everyone.” But, he said, “it did make it quite challenging from a local authority perspective, when, you know, the prime minister says at 5 pm or 6 pm that something’s going to happen. Eleven o’clock or midnight you get some guidance on it, and you’re meant to be off and running in the next day.”

The most acute problem identified locally early on was the shortage of adequate personal protective equipment (PPE) for NHS and care home staff. Yet Jenny Harries, England’s deputy chief medical officer, declared on March 20 that there was a “perfectly adequate supply of PPE” for care workers and the supply pressures have been “completely resolved.”

Five days later, Johnson told parliament every care home worker would receive the personal protective equipment they needed “by the end of the week.” This didn’t happen, and more than a month later, the government’s chief medical officer conceded publicly that shortages remained.

According to Nesil Caliskan, leader of Enfield Council, early statements that local shortages were caused by distribution difficulties proved to be a “downright lie.” The government simply didn’t have enough kit, she said.

The government didn’t respond directly to claims that it gave false assurances or insufficient time and support to councils to implement ministers’ instructions. A spokesman said an alliance of the NHS, industry and the armed forces had built a “giant PPE distribution network almost from scratch.” Councils had been supported with £3.2 billion in extra funding to support their pandemic response, he said, and 900,000 parcels of food have been delivered to vulnerable people.

DO YOU WORK FOR THE NHS?

Three days into the lockdown, on 26 March, the nation was urged to stand at their doorstep or window on a Thursday evening and applaud the NHS. Boris Johnson, by now already infected himself, led the cheering on the first occasion.

For some workers in Enfield, the chants left them uneasy. Working 12 hours shifts for barely £9 per hour, below the non-statutory London Living Wage of £10.75, they wondered if those cheers for caregivers were also meant for them.

“I’m one of them,” one care home employee, who asked not to be named, recalls telling her 12-year-old daughter as her neighbours clapped. The daughter teased her: “Oh, Mummy, they don’t talk about you. They talk about the NHS. Mum, do you work for the NHS?”

The caregiver replied: “No. But it’s the same. We care for people.”

The caregiver was one of three workers who recounted their experiences at an Enfield care home run by a firm called Achieve Together. Each described how, after a patient was sent to hospital on March 13 and confirmed to have the coronavirus, staff were issued with thin paper masks. After a fortnight, staff were told the masks should be saved for dealing with patients with symptoms, and they were taken away. And although several staff developed symptoms and had to isolate, no tests were available. A spokesperson for Achieve Together said staff had access to “more than sufficient supplies of PPE, including face masks and face shields, which are supplied and worn directly in line with Government advice.”

One night, caring for a resident with a lung infection who hadn’t been tested, she’d worn a thin blue surgical mask as she performed close-up procedures like feeding him and brushing his teeth.

The day she spoke to Reuters, April 24, health secretary Matt Hancock had reiterated to the BBC that tests were available for care workers. But for now, none was available for this care worker. Her only option was a drive-through centre, but she had no car.

“I want to be checked and really want to be checked as soon as possible,” she said. “If I had the choice.”

The spokesperson for Achieve Together described the health and wellbeing of residents and staff as “our absolute priority.” Staff and residents were tested “when the Government made testing available.” The company did not specify when those tests took place. It declined to comment on details of the home, citing a need to protect patient privacy.

AN INVISIBLE TRAIL

Kaygan’s workplace, the Elizabeth Lodge, in a leafy Enfield suburb, was built in the grounds of two former hospitals of infectious diseases. It is operated by CareUK, a large privately owned healthcare provider, and normally home to about 90 residents, looked after by 125 staff.

The borough has been hit hard by the coronavirus, with Enfield Council recording outbreaks in at least 42 out of 82 care homes, according to the council. The council and the Care Quality Commission, which regulates the sector, declined to disclose individual death tolls, citing privacy.

Elizabeth Lodge, according to several people with direct knowledge, was one of two Enfield homes most savagely stricken by the virus. The other, these people said, is Autumn Gardens. A senior manager at Autumn Gardens, which is privately owned, declined to comment.

Determining how Kaygan and so many residents at Elizabeth Lodge and other homes became infected will be hard. That is partly because, as Reuters has previously reported, as the outbreak began Britain had no plan for widespread testing for the virus once it started spreading in the community.

The Lodge’s management says it hasn’t identified the source of the outbreak there. The home began cutting down on visitors from the start of March, with almost all non-emergency visits barred from March 17.

“At this point anyone coming into the home, including team members and essential health care professionals, had their temperatures checked and went through a health screening questionnaire,” CareUK said in a statement to Reuters.

Kaygan’s last day of work was Friday, March 20th, and she called in sick the following week.

On Sunday, March 22, Mother’s Day in England, Kaygan popped round to drop off a bunch of flowers to two relatives, Kenan and his wife Ozlem, who helped bring her up as a child. They spoke on the doorstep. “She told us she had to go back to work. But I was adamant she should stay at home,” Kenan said. The day after, Johnson announced the nationwide lockdown.

According to the Lodge’s management, none of the residents displayed symptoms until March 26, in the home’s York wing. This was six days after Kaygan last worked, and 11 days after she had last worked in the York wing.

Across Enfield care homes, 48 cases of COVID-19 had been identified by March 27 and at least two people had died of the disease. By then all homes had essentially banned all visitors.

So how did infection take hold in care homes?

According to several care home managers, a key route for infection was opened up by an NHS decision taken in mid-March, as Britain geared up for the pandemic, to transfer 15,000 patients out of hospitals and back into the community, including an unspecified number of patients to care homes. These were not only patients from general wards. They included some who had tested positive for COVID-19, but were judged better cared for outside hospital.

In a plan issued by the NHS on March 17, care homes were exhorted to assist with national priorities. “Timely discharge is important for individuals so they can recuperate in a setting appropriate for rehabilitation and recovery – and the NHS also needs to discharge people in order to maintain capacity for acutely ill patients,” the plan said.

A Department of Health guidance note dated April 2 and published online further stated that “negative tests are not required prior to transfers / admissions into the care home.”

Jamie Wilson, a former NHS dementia specialist and founder of Hometouch, which provides care to people in their own homes, said that, based on his discussions with colleagues in the industry, he believes that care homes across the country had taken dozens of patients at risk of spreading the infection. While noting he wasn’t aware of specific cases, he described what he called an egregious and reckless policy “of sending COVID positive patients back into care homes and knowing that it’s so infectious a disease.”

The UK government didn’t respond directly to the question of whether discharges from hospitals had put the vulnerable at risk. But a spokesman said enhanced funding, testing and quarantine procedures should address those concerns.

One NHS infectious diseases consultant, who manages COVID-19 patients, said sending people sick with the coronavirus back to a care home could, in many cases, be the best thing for the patient, provided they could be cared for in the right way. Ideally, she said, all patients should be tested before transfer, and quarantined for up to a fortnight.

The problem was that most patients had not been tested for COVID-19, and care homes have few facilities to quarantine new arrivals.

In Birmingham, over 300 people were discharged into care homes from the start of March, “which is significantly higher than normal,” said council chief executive Betts. In Enfield, 30 patients were sent to care homes, about average, according to Enfield Council. One care manager in the borough, who manages several homes, said some of those transfers caused concern.

This manager recalled that, shortly after Johnson announced the lockdown, she had an argument with officials at a nearby hospital who wanted her to take back a resident who had been treated for sepsis. The hospital had coronavirus patients at the time. The manager would not name the hospital, to avoid identifying the patient. She said she agreed to the demand on one condition: that the resident, who was not displaying coronavirus symptoms, be tested. But the hospital refused, saying it did not have enough tests to assess asymptomatic patients.

Eventually, the manager backed down. A week or so later, several residents in the home began displaying symptoms consistent with COVID-19, she said. She didn’t give a precise figure. It is not known whether the transferred patient was the source of the outbreak.

“It was just so reckless,” she said. “They were not thinking at all about us. It was like they were saying, let’s abandon the old people.”

At the Elizabeth Lodge, between March 1 and March 19, four new residents arrived – two from hospitals and another two from other care homes. The Lodge’s management said, in a statement, there was no evidence these residents brought the virus into the home, “but we are continuing to review.”

Knight, the residential services chief executive at Lodge operator CareUK, said it was essential that hospital patients be tested before they were transferred. “We need to ensure not just that the test has been done, but that the results are available prior to making the decision about admission” to the home, he said in a statement to Reuters.

TEST, TEST, TEST

On March 12, Britain’s chief medical officer, Chris Whitty, announced the ending of most testing of the general population to focus on patients admitted to hospital. But Vallance, the chief scientific adviser, clarified to parliament a week later there would still be testing in isolated clusters of cases in the wider population.

By April 6, the Enfield council had recorded at least 26 deaths in care homes, and 126 suspected cases. Yet only 10 tests per day were being offered for the thousands of care staff across the whole of north London, said Enfield Council leader Caliskan.

Knight said that at Elizabeth Lodge, no tests were available for staff until after April 15, when Health Minister Hancock announced plans to test all residents and care home workers if they had symptoms. Even after Hancock’s pledge, only six tests were made available to Lodge staff and none to residents, Knight added.

Guidance from the Government, which has struggled to rapidly increase the overall availability of tests, remained that staff should simply stay at home and isolate if symptomatic. In his statement to Reuters, Knight said he and others in the industry had appealed to “senior members of the government to explain the challenges we were facing and how best they could support us.” He didn’t say who he spoke to.

Finally, on April 28, Hancock said all care home residents and staff could be tested even if they were not displaying symptoms. Again, the words didn’t match the experience on the ground.

Lisa Coombs, manager of the Minchenden Lodge in Enfield, home to up to 25 residents, said she had only secured a pack of 10 tests. Eight of these had returned a positive result. She’d been unable to secure tests for a further 10 residents even though some were displaying symptoms.

“What the government says is a load of rubbish,” she said. I “I am angry because we are not being supported.” She declined to discuss how many residents have died.

At Elizabeth Lodge, no residents were tested until April 29, said Knight. Even after that date the government’s Care Quality Commission, which has been supplying tests to homes, only provided enough for residents showing symptoms of coronavirus. Things improved “in a very limited way” in the last two weeks of April, said Knight, and now “appear to be gaining momentum.”

Getting access to testing on a meaningful scale now could reduce the impact of the virus in the coming months, he added.

A government spokesman said that a policy of testing everyone prior to admission into care homes was now being instituted, with a recommendation that hospital patients discharged into care homes are isolated for 14 days, even with negative test results.

MASKS

Sonya Kaygan, her mother Ayse recalled, never said much about her work or conditions at the Lodge. But one day, at the start of the outbreak, Sonya saw the long-sleeved gloves that her mother, a caregiver at another home, was using. “We don’t have those at our place,” Kaygan said. The Lodge told Reuters staff had all the equipment that was required.

Unbeknown to her family, Kaygan had ordered surgical facemasks on Amazon. They arrived in early April after she was hospitalized. Other carers at the Lodge ordered masks, too, said another staff member. And after Kaygan’s death, a different fellow employee posted on Twitter: “I work there and all of this has (been) very hard on us all and every one is right. We as carers don’t have enough PPE.”

Another employee at Elizabeth Lodge told Reuters that although staff raised concerns, many had to operate for weeks without face masks or visors. “I was petrified. Every time I went in there, I worried for myself, my family, the people living there, my colleagues,” she said.

She said at the start of March, she remembers two meetings where managers discussed with staff how they would respond if there was a coronavirus outbreak. She said employees questioned why they did not have more protective equipment. The management responded saying they were doing their best to bring more in.

Reuters could not independently verify this account. The Lodge’s management told Reuters that neither Kaygan nor any other employee raised concerns to managers about protective equipment.

It said in a statement that at the time Kaygan worked at the Lodge, face masks were not being used. That, according to the home, was because official guidance then recommended such masks were only necessary when working within a metre (three feet) of someone with COVID-19 symptoms. Public Health England said the home’s interpretation was in line with advice then in force that masks were only needed when in personal contact with someone, such as washing.

Across Enfield, supply of PPE was a major problem. According to council leader Caliskan, by the end of March, supplies in some homes were inadequate, and others were running out. The government repeatedly promised to send supplies, but when a much-anticipated delivery by the army arrived at the council depot on March 28, it took just 6 minutes to unload, she said. It contained only 2,000 aprons and 6,000 masks, which aren’t designed for repeated or prolonged use, for Enfield’s 5,500 care workers.

GETTING TO HOSPITAL

On March 31, just after 2 pm, Sonya Kaygan was picked up by an ambulance from the two-up, two-down home she shared with her mother and daughter. Kaygan was finding it increasingly difficult to breathe. As she walked to the ambulance, she turned to her mother and said: “If I never make it back, look after my baby.”

The ambulance crew said Kaygan would be taken to the nearby North Middlesex Hospital, but when the family called there later, there was no one of that name. Uncle Hasan tracked her down to Whipps Cross Hospital in Leytonstone, northeast London. Kaygan made video calls to her family, and asked Ayse to come and visit. But, as is the case in many countries, the hospital wouldn’t allow it.

In an email to Reuters, the NHS trust managing Whipps Cross said all visiting was “currently suspended other than in exceptional circumstances” to stop the spread of COVID-19.

Then news came that Kaygan would be intubated – sedated and put on a ventilator. Her last call was to a family member in Cyprus, about 6 am on April 2. “I’m going in now,” she said.

Kaygan’s hospital admission was swift. Many others have reported difficulties getting in.

Munuse Nabi, 90, lived in a care home in Ilford, East London. She was extremely fragile, with heart, lung and kidney problems. But she was also mentally strong with a pin-sharp memory, able to talk on the phone and flick through TV channels. “She was all perfect,” said son Erkan Nabi, a driving instructor.

In early April, Munuse developed a temperature and a dry and persistent cough, and lost her voice. As she got worse, a doctor examined Munuse by video link. When she began to struggle to breathe, Nabi urged the home to send her to hospital.

A nurse, he said, told him: “We’ve been told not to send people to hospital. Just leave them here. They’re comfortable.” He was upset. “They were trying to encourage me to leave her there basically to die.” He insisted they call an ambulance, and she was taken to hospital.

A spokesperson for the care home involved said staff were “doing everything we can to make sure our residents and colleagues stay safe and well throughout these challenging times.”

This approach to hospitalisation reflects what many homes took to be national guidance. An NHS England policy document issued on April 10 listed care home residents among those who “should not ordinarily be conveyed to hospital unless authorised by a senior colleague.”

The document was withdrawn within five days, after public criticism. The NHS did not respond to a request to discuss the document.

London’s ambulance service also issued new guidance.

Ambulance crews assess patients using a standard scoring system of vital signs. According to the Royal College of Physicians, a professional body for doctors, a patient who scores five or more on a 20-point scale should be provided with clinical care and monitored each hour. A patient scoring five would normally be taken to hospital.

But in early March, London’s ambulance service raised the bar for COVID-19 patients to seven.

“I have never seen a score of seven being used before,” said one NHS paramedic interviewed by Reuters. The medic spoke on condition of anonymity.

On April 10, the required score was lowered to five. In a statement, the London Ambulance Service told Reuters its previous guidance was one of several assessments used and clinical judgment was the deciding factor. Asked if the guidance reflected the national approach, the NHS did not respond.

Possible evidence of restrictions on admissions came in a study of 17,000 patients admitted for COVID-19 to 166 NHS hospitals between February 6 and April 1. The study showed that one-third of these patients died, a high fatality rate.

Calum Semple, the lead author and professor of outbreak medicine at Liverpool University, said, in an interview with Reuters, this indicated, among other things, that England set a “high bar” for hospital admission. “Essentially, only those who are pretty sick get in.” But, he said, there was no data yet on whether that high bar ultimately made people in Britain with COVID-19 worse off. The NHS didn’t comment.

FALSE VICTORY

On the hospital wards of London, by Easter Sunday, April 12, there was a sense of light at the end of the tunnel. Over the long holiday weekend, according to several doctors contacted by Reuters, some hospitals saw just a handful of new admissions.

But on the frontline of the efforts to protect the capital’s most vulnerable people, the worst was far from over. According to an official closely involved in London’s response to the coronavirus, the capital’s mayor, Sadiq Khan, was getting reports that food banks were close to running out. Crisis meetings were held all weekend to replenish stocks.

In Enfield, by Easter Sunday a total of 39 care home deaths linked to COVID-19 had been recorded, and 142 residents had suspected infections. By the end of last month, nearly 100 more residents of Enfield care homes would die. The total in the borough, as recorded by the council, would rise to 136 deaths linked to the virus in care homes by April 30, including care home residents who died in hospital.

On the national stage, the government projected a picture of success. Prime Minister Boris Johnson, at his first daily Downing Street briefing since recovering from coronavirus, said on April 30 that Britain was past the peak and had avoided overwhelming the health service.

“It is thanks to that massive collective effort to shield the NHS that we avoided an uncontrollable and catastrophic epidemic,” said Johnson.

Even so, deaths in care homes were surging.

On the third night of 90-year-old Munuse Nabi’s hospital stay, a doctor called her son Erkan to say her COVID-19 test had come back positive. As her condition was worsening and she was too fragile for invasive treatment, they would not be able to save her life.

Erkan, urged to visit, went to the hospital and was dressed up by staff in what he calls the “full battledress” protective gear, including visor and gown.

As doctors gave Munuse small doses of morphine to make her comfortable, Erkan stayed by her bedside all through April 19 and into the early hours of April 20, holding her hand as she slipped away.

It was in the early hours of April 17 that Kaygan’s family got the call they dreaded. She, too, had passed away.

Her mother posted a message on Facebook: “My soul, my angel, I lost the most beautiful angel in this world. We lost the most beautiful angel in this world.”

She still hasn’t worked up the strength to tell Kaygan’s daughter, three-year-old Ayse, that her mother is dead.

(reporting by Stephen Grey and Andrew MacAskill, additional reporting by Ryan McNeill, editing by Janet McBride and Peter Hirschberg)

UK researchers try to crack genetic riddle of COVID-19

By Guy Faulconbridge

LONDON (Reuters) – British researchers will study the genes of thousands of ill COVID-19 patients to try to crack one of the most puzzling riddles of the novel coronavirus: why does it kill some people but give others not even a mild headache?

Researchers from across the United Kingdom will sequence the genetic code of people who fell critically ill with COVID-19 and compare their genomes with those who were mildly ill or not ill at all.

The hunt for the specific genes that could cause a predisposition to getting ill with COVID-19 will involve up to 20,000 people currently or previously in hospital intensive care with COVID-19 and about 15,000 people with mild symptoms.

Scientists caution that their knowledge of the novel coronavirus, which emerged in China last year, is still modest though they say it is striking how it can be so deadly for some but so mild for others.

It is, as yet, unclear why.

“We think that there will be clues in the genome that will help us understand how the disease is killing people,” Kenneth Baillie, an intensive care doctor who is leading the study at the University of Edinburgh, told Reuters.

“I would bet my house on there being a very strong genetic component to individual risk,” Baillie said.

Health minister Matt Hancock called on people to sign up to the program. “If you’re asked to sign up to the genomics trial which is being run by Genomics England, then please do, because then we can understand the genetic links. It’s all part of building a scientific picture of this virus.”

The genome is an organism’s complete set of deoxyribonucleic acid or DNA, and in humans, it contains about 3 billion DNA base pairs.

But comparing them can be tough. There are 4 million to 5 million differences between any two people so scientists need a big sample, Baillie said.

“We don’t know at a mechanistic level, at the level of molecules and cells, what are the events that are actually causing people to get sick and die from this disease,” he said.

Baillie will work with the intensive care units across the United Kingdom, Genomics England and a global genetics research consortium known as the Genetics of Susceptibility and Mortality in Critical Care, or GenOMICC.

“By reading the whole genome we may able to identify variation that affects response to Covid-19 and discover new therapies that could reduce harm, save lives and even prevent future outbreaks,” said Mark Caulfield, chief scientist at Genomics England.

Some answers could come as soon as in a few weeks from a study of almost 2,000 people already underway, Baillie said, though it is likely that testing more people will ensure that the signals they detect are genuine.

The results will be shared globally.

“Your chance of dying from an infection is very strongly encoded in your genes – much more strongly than your chances of dying from heart disease or cancer,” Baillie said.

(Reporting by Guy Faulconbridge, Editing by Angus MacSwan and Andrew Heavens)

State-backed hackers targeting coronavirus responders, U.S. and UK warn

By Jack Stubbs and Christopher Bing

LONDON/WASHINGTON (Reuters) – Government-backed hackers are attacking healthcare and research institutions in an effort to steal valuable information about efforts to contain the new coronavirus outbreak, Britain and the United States said on Tuesday in a joint warning.

In a statement, Britain’s National Cyber Security Centre (NCSC) and the U.S. Cybersecurity and Infrastructure Security Agency (CISA) said the hackers had targeted pharmaceutical companies, research organisations and local governments.

The NCSC and CISA did not say which countries were responsible for the attacks. But one U.S. official and one UK official said the warning was in response to intrusion attempts by suspected Chinese and Iranian hackers, as well as some Russian-linked activity.

The two officials spoke on condition of anonymity to discuss non-public details of the alert. Tehran, Beijing and Moscow have all repeatedly denied conducting offensive cyber operations and say they are the victims of such attacks themselves.

State hacking groups “frequently target organisations in order to collect bulk personal information, intellectual property and intelligence that aligns with national priorities,” the NCSC and CISA said.

“For example, actors may seek to obtain intelligence on national and international healthcare policy or acquire sensitive data on COVID-19 related research.”

The warning follows efforts by a host of state-backed hackers to compromise governments, businesses and health agencies in search of information about the new disease and attempts to combat it.

Reuters has reported in recent weeks that Vietnam-linked hackers targeted the Chinese government over its handling of the coronavirus outbreak and that multiple groups, some with ties to Iran, tried to break into the World Health Organization.

The officials said the alert was not triggered by any specific incident or compromise, but rather intended as a warning – both to the attackers and the targeted organizations that need to better defend themselves.

“These are organizations that wouldn’t normally see themselves as nation-state targets, and they need to understand that now they are,” said one of the officials.

The agencies said hackers had been seen trying to identify and exploit security weaknesses caused by staff working from home as a result of the coronavirus outbreak.

In other incidents, the attackers repeatedly tried to compromise accounts with a series of common and frequently-used passwords – a technique known as “password spraying”.

“It’s no surprise that bad actors are doing bad things right now, in particular targeting organizations supporting COVID-19 response efforts,” a CISA spokesman said.

“We’re seeing them use a variety of tried and true techniques to gain access to accounts and compromise credentials.”

(Writing by Jack Stubbs; Editing by Peter Graff; Editing by Alex Richardson and Peter Graff)

UK says some children have died from syndrome linked to COVID-19

By Guy Faulconbridge and Kate Holton

LONDON (Reuters) – Some children in the United Kingdom with no underlying health conditions have died from a rare inflammatory syndrome which researchers believe to be linked to COVID-19, Health Secretary Matt Hancock said on Tuesday.

Italian and British medical experts are investigating a possible link between the coronavirus pandemic and clusters of severe inflammatory disease among infants who are arriving in hospital with high fevers and swollen arteries.

Doctors in northern Italy, one of the world’s hardest-hit areas during the pandemic, have reported extraordinarily large numbers of children under age 9 with severe cases of what appears to be Kawasaki disease, more common in parts of Asia.

“There are some children who have died who didn’t have underlying health conditions,” Hancock told LBC Radio.

“It’s a new disease that we think may be caused by coronavirus and the COVID-19 virus, we’re not 100% sure because some of the people who got it hadn’t tested positive, so we’re doing a lot of research now but it is something that we’re worried about.”

Children were until now thought to be much less susceptible than their parents or grandparents to the most deadly complications wrought by the novel coronavirus, though the mysterious inflammatory disease noticed in Britain, Spain and Italy may demand a reassessment.

“It is rare, although it is very significant for those children who do get it, the number of cases is small,” Hancock, one of the ministers leading Britain’s COVID-19 response, said.

He did not give an exact figure for the number of deaths.

Kawasaki disease, whose cause is unknown, is associated with fever, skin rashes, swelling of glands, and in severe cases, inflammation of arteries of the heart.

Britain’s National Health Service says the syndrome only affects about eight in every 100,000 children every year, with most aged under 5.

There is some evidence that individuals can inherit a predisposition to the disease, but the pattern is not clear.

Children either testing positive for COVID-19 or for its antibodies have presented gastrointestinal symptoms such as abdominal pain, vomiting and diarrhea in the last two weeks, the Spanish Pediatric Association said on Monday.

Though the children were otherwise in good health, their condition could evolve within hours into shock, featuring tachycardia and hypotension even without fever.

Most cases were detected in school-age or teenage minors, and sometimes overlapped with Kawasaki disease or toxic shock syndrome (TSS).

Parents should be vigilant, junior British interior minister Victoria Atkins said.

“It demonstrates just how fast moving this virus is and how unprecedented it is in its effect,” Atkins told Sky News.

Professor Anne Marie Rafferty, the president of the Royal College of Nursing, said she had heard reports about the similarity between cases in infants and Kawasaki syndrome.

“Actually there’s far too little known about it and the numbers actually at the moment are really too small,” told Sky News. “But it is an alert, and it’s something that’s actually being explored and examined by a number of different researchers.”

(Reporting by Guy Faulconbridge and Kate Holton in London and Clara-Læïla Laudette in Madrid; editing by Michael Holden and Angus MacSwan)

UK PM Johnson makes progress in COVID-19 fight, but still in intensive care

By Andy Bruce and Alistair Smout

LONDON (Reuters) – Prime Minister Boris Johnson continues to make progress, four days after being admitted to hospital with COVID-19, but he remains in intensive care as officials signalled there was no end in sight to an unprecedented national lockdown.

Johnson, 55, was admitted to St Thomas’ Hospital on Sunday evening with a persistent high temperature and cough, and was rushed to intensive care on Monday where he has since spent three nights receiving treatment.

Ministers have said he has been sitting up in bed and talking to medical staff.

“He’s still in intensive care but he continues to make positive steps forward and he’s in good spirits,” Foreign Secretary Dominic Raab said at a news conference in Downing Street.

Raab, who is deputising for Johnson during the most stringent shutdown in Britain’s peacetime history, said he had not spoken to the prime minister since he was admitted to intensive care.

“I think it’s important, particularly while he’s in intensive care, to let him focus on the recovery. We in the government have got this covered,” Raab told a news conference.

Earlier on Thursday, a Downing Street spokesman said Johnson had received oxygen support, but was not put on a ventilator.

The UK death toll in hospitals from coronavirus now stands at 7,978, a rise of 881 on the day but a smaller increase than the 938 seen in Wednesday’s data.

With Johnson absent and the death toll still mounting, the British government is wrestling with two major issues – how to finance a vast increase in state spending to support the shuttered economy, and when to start easing lockdown measures.

With the economy facing potentially the worst hit since World War Two, the government said it had expanded its overdraft facility with the Bank of England.

The central bank has agreed temporarily to finance government borrowing in response to COVID-19 if funds cannot immediately be raised from debt markets, reviving a measure last widely used during the 2008 financial crisis.

The BoE said it was a short-term measure and both it and government said any borrowing from the Ways and Means facility – effectively the government’s overdraft with the Bank – would be repaid by the end of the year.

The government has made pledges costing tens of billions of pounds to support businesses and workers hit by the virus. On Thursday, the government said an additional 1.2 million claims for welfare payments had been filed since March 16.

NO END TO LOCKDOWN

Raab said the peak of the virus outbreak had yet to be reached and that the government would not be able to say more about the duration of the lockdown until late next week, once experts have had chance to analyse data on how well it is working. It was introduced last month.

“The measures will have to stay in place until we’ve got the evidence that clearly shows we’ve moved beyond the peak,” he said.

While Johnson’s condition was said to be improving, it was unclear how long he might be incapacitated, with some political commentators saying there was a power vacuum in his absence.

Raab said on Thursday he had the power to make “necessary decisions” in the prime minister’s absence and that government will continue to follow the strategy set out by Johnson. He said cabinet could take decisions collectively.

The United Kingdom is entering what scientists say is the deadliest phase of the outbreak, with deaths expected to continue to rise over the Easter weekend.

But in a sign the shutdown measures were working, health officials have said the number of coronavirus infections and hospital admissions had begun to show signs of flattening.

“We’ve always been clear that it would take a period of time to see the impact of those measures in the statistics that we publish every day,” Johnson’s spokesman said.

“We’ve always said that if the scientific advice suggests further steps are needed we’d be prepared to take them, but for now our focus is on ensuring the steps we already have in place are properly enforced.”

Police said they would be taking tougher action to do just that before the four-day Easter holiday weekend because many people were continuing to ignore the ban on social gatherings.

(Additional reporting by Kate Holton; Writing by Michael Holden and Guy Faulconbridge; Editing by Angus MacSwan and Stephen Addison)

UK coronavirus deaths rise by 27% to 1,789

UK coronavirus deaths rise by 27% to 1,789
LONDON (Reuters) – The number of deaths from coronavirus in the United Kingdom rose by 27% in the space of a day to 1,789 as of Monday at 1600 GMT, the government said.

The number of confirmed cases rose by 14% to 25,150 as of Tuesday at 0800 GMT, the Department for Health and Social Care said.

(Reporting by Andy Bruce; editing by Stephen Addison)

UK coronavirus death toll rises to 1,408

LONDON (Reuters) – The number of people who have died after testing positive for coronavirus in the United Kingdom rose to 1,408, according to figures released on Monday, an increase of 180, a smaller rise than the previous set of numbers.

The figures are accurate up to 17:00 local time on March 29.

The previous increase saw the death toll rise by 209.

There are a total of 22,141 positive cases as of 0900 local time on March 30, the health ministry said.

(Reporting by Costas Pitas and Paul Sandle; editing by Stephen Addison)

Lockdown, what lockdown? UK begins tougher action against those ignoring shutdown

By Michael Holden

LONDON (Reuters) – Britain brought in tough measures on Thursday to curb the spread of coronavirus and ensure people obey the government’s virtual lockdown which many thousands are feared to have so far ignored.

The new powers allow police to issue instant fines those who leave their homes without good reason or gather in groups of more than two people.

In northern England, one police force has begun introducing random vehicle checkpoints to ensure the new rules are enforced while the head of the Church of England told Britons who were flouting the instructions to “get your act together”.

Last week, Prime Minister Boris Johnson ordered pubs, restaurants and nearly all shops to close, banned social gatherings and told people to stay at home unless they needed to buy food, go out to essential work or to exercise once a day.

While millions have respected the measures, roads and parks have remained busy, and the authorities across the country have repeatedly reported that people have not respected the 2 metre (6 foot) guidance on social distancing while others have continued to mingle.

On Thursday, a new regulations came into effect which give the authorities the power to impose a 30-pound fixed penalty on those who breach the rules. Repeat offenders could ultimately receive a fine of up to 960 pounds and might be arrested.

Those who did not pay up could be taken to court, where magistrates could impose unlimited fines, the government said.

“The prime minister has been clear on what we need to do: stay at home to protect our NHS and save lives,” said Home Secretary (interior minister) Priti Patel.

PARKS CLOSED

Some Britons have continued their daily routine and risked spreading the virus which the government fears could overwhelm the National Health Service if large numbers contract COVID-19.

In east London, police and the Tower Hamlets local authority said they had been forced to close Victoria Park, one of the largest and most popular open public spaces in the area, because people were failing to abide by the guidance.

The Royal Parks, a charity which looks after eight major parks across the capital, said it too was considering shutting its gates.

“It is up to all of us collectively to adhere to the latest guidance, otherwise we will have to consider closing the parks. We will keep the situation under constant review,” said Tom Jarvis, its Director of Parks.

Other cities have already closed some parks and facilities to meet the guidance on social distancing while Greater Manchester firefighters said they had received reports of lots of people having barbecues on moorlands.

Meanwhile police in Devon, southwest England, said when they has asked a young cyclist why he was four miles from his home and not following the rules, he had replied: “It only kills old people”.

The Archbishop of Canterbury Justin Welby, spiritual head of the Church of England, said people should not act selfishly.

“Get your act together,” he said to those who have been ignoring the strict government social distancing instructions.

“If you are not complying, you are risking other people’s lives, not just your own,” he told ITV News.

To ensure compliance, police in northern England said they would bring in vehicle checkpoints from Thursday, along with foot patrols to disperse any groups.

“We sincerely hope that we won’t have to resort to enforcement action, but if people do not comply, we will,” said Mike Walker, Assistant Chief Constable of North Yorkshire.

Meanwhile, Britain’s Director of Public Prosecutions Max Hill said anyone who claimed they had the virus and deliberately coughed at police or other emergency workers could be charged with common assault and face up to two years in jail.

“Let me be very clear: this is a crime and needs to stop.”

(Reporting by Michael Holden; editing by Guy Faulconbridge)

UK puts military on standby as coronavirus shuts down swathes of London

Reuters
By Guy Faulconbridge and Kylie MacLellan

LONDON (Reuters) – The United Kingdom put 20,000 military personnel on standby, closed dozens of underground train stations across London and Queen Elizabeth left the city for Windsor Castle as the coronavirus crisis shut down whole swathes of the economy.

As the coronavirus outbreak sweeps across the world, governments, companies and investors are grappling with the biggest public health crisis since the 1918 influenza pandemic, panicked populations and imploding financial markets.

Against a background of panic buying in supermarkets and the biggest fall in sterling for decades, the British government moved to quash rumors that travel in and out of London would be restricted.

“There is zero prospect of any restriction being placed on traveling in or out of London,” Prime Minister Boris Johnson’s spokesman told reporters.

He said police were responsible for maintaining law and order and there were no plans to use the military for this purpose, though the government put military reservists on formal notification.

But dozens of underground train stations across the capital were due to be closed and an industry source said supermarkets were expecting police support amid the fears that London was facing a virtual shutdown.

After ordering the closure of schools across a country that casts itself as a pillar of Western stability, Johnson on Wednesday said the government was ruling nothing out when asked whether he would bring in measures to lock down London.

Johnson has asked the government to come up with plans for a so-called lockdown which would see businesses closed, transport services reduced, gatherings limited and more stringent controls imposed on the city.

Queen Elizabeth on Thursday left the capital for her ancient castle at Windsor. The monarch has also agreed to postpone the planned state visit by Japanese Emperor Naruhito in June.

LONDON CLOSING?

London’s transport authority said it would close up to 40 underground train stations until further notice and reduce other services including buses and trains. The line between Waterloo station and the City of London financial district would be closed.

“People should not be traveling, by any means, unless they really, really have to,” London Mayor Sadiq Khan said.

Britain has so far reported 104 deaths from coronavirus and 2,626 confirmed cases, but UK scientific advisers say more than 50,000 people might have already been infected.

Britain faces a “massive shortage” of ventilators that will be needed to treat critically ill patients suffering from coronavirus, after it failed to invest enough in intensive care equipment, a leading ventilator manufacturer said.

With the world’s fifth largest economy coming to a standstill, the pound on Wednesday plunged to its lowest since March 1985, barring a freak “flash crash” in October 2016. On Thursday the pound was down 0.5% at $1.1570.

British shoppers were queuing around the block early on Thursday morning to buy basic supplies such as bottled water and tinned goods ahead of an expected toughening of measures to contain the coronavirus outbreak.

Supermarkets have been forced to limit purchases after frantic shoppers stripped shelves. Outside one Sainsbury’s supermarket in central London on Thursday, a huge queue had formed ahead of opening, with people standing calmly in the rain.

(Writing by Guy Faulconbridge; Additional reporting by Dylan Martinez, Kate Holton and Kylie MacLellan; Editing by Michael Holden and Giles Elgood)