Thank you for writing to me on the subject of the Parliamentary vote which ended the national lockdown while introducing a tiered system.
While I am fully aware of the concerns expressed and indeed the likely impact of ongoing restrictions on our daily lives and the impact on the economy I have absolutely no doubt that it is the right approach and a necessary course of action.
My decision was informed by the facts, by an examination of what other courses of action could be pursued and from my discussions with the local NHS.
As you will be aware locally we have been placed in Tier 2. I would have preferred the data to have led us to being Tier 1 but I understand why that decision was taken and, given the potential impact on public health, I support it.
I would rather we were through this dreadful period and had returned to normal. However Tier 2 is significantly better than lockdown and while Christmas will not be “normal” the regulations approved provide an opportunity for those who feel in a position to do so, to have a period of respite from many of the restrictions over the festive period.
No one wants us to have to maintain social distancing restrictions nor suffer the many adverse impacts they have on our personal lives, on the economy and on health.
However, although therapeutics have improved survivability and we know far more about this fatal illness now that we did in January, the reality is that there is no way yet available to suppress this virus once it is in the community other than maintaining social distance and identifying and preventing onward transmission from those infected.
The hope on the horizon are vaccines that, it looks extremely likely, will present a means to get on top of the virus and allow us to return to normal.
The UK has pre bought more vaccines than any other country per capita. I know from discussions at a local level how detailed is the preparation and planning to get these distributed. I am grateful to our local healthcare professionals, who have worked so hard during this truly awful time and have volunteered to work extra hours in the evenings and weekends to help deliver this huge vaccination programme.
It is tremendous news that the UK independent regulator has approved the first Covid vaccine for use. Hopefully others may follow.
The end is in sight but it will take months to complete a national immunisation programme and we still need to get there. There is a risk of incalculable damage being caused if we take the wrong step in the current period.
Peoples’ lives literally depend on the decisions taken now.
Some, I know, have questioned why the rest of society cannot “carry on as normal” when the majority of people who die from coronavirus are elderly and frail. I think the premise is wholly wrong for a series of reasons.
Age and underlying health conditions do play a role in making people more or less vulnerable to Coronavirus. Many, if not all of us, have older relatives, neighbours and friends and they are valued members of our communities. It is right that they are protected. A study carried out by academics at the University of Glasgow, suggested victims had over a decade to live, based on their age and prior conditions.
That is a decade which, for many, would mean being there for the marriage of children, the birth of grandchildren, for family, community and indeed business life. The benefits of saving lives flow not just to the potential victims but those around them.
Whilst many older people have died from this illness (though not exclusively older people) many more who catch Coronavirus are feeling lasting effects. A majority of the patients being referred for treatment for long Covid locally are of working age, a pattern I have no doubt will be reflected nationally. Symptoms can be debilitating and range from chronic fatigue, muscle pain, psychological issues as well as issues, such as difficulty breathing and heart problems, which require ongoing input from acute medical care providers. This is simply not an illness that only affects the frail and elderly, it’s impact is much wider.
Covid also risks having a huge impact on the ability of the NHS to meet other health needs as it did earlier this year. It is inevitable that a “once in a hundred years” public health emergency puts a significant strain on the health service.
In the first wave, five wards in East Surrey hospital had to be cleared of patients to provide emergency care for Covid patients. That is five wards and their medical staff who would ordinarily have been addressing vital healthcare needs.
Our very success in combatting the disease and reducing mortality means that patients on average are treated more successfully but for longer.
All of this makes it harder to conduct the vital normal services which the NHS provides – from scans, to cancer treatment, to elective surgery. Postponements from earlier in the year hang over our hospitals – we cannot allow our hospitals to face the same conditions as in the first wave, to do so would have hugely negative health consequences well beyond Covid.
Furthermore the first wave took place against a relatively benign backdrop. The flu season usually starts in January (the first week in January is often the busiest of the hospital year). We may be lucky: flu (given social distancing and the steps we are taking to suppress Covid) may be less prevalent this year than in “normal” times, we might have a mild winter. These are not however gambles anyone should take. The consequences of getting them wrong are too significant for too many people.
The data on positive cases, on hospital admissions and deaths from Covid are routinely and openly published on gov.uk. These are not speculative guesses but facts.
I have heard it suggested that “false positives” are causing the increased number of cases. The reality is that the number of false positives is, in statistical terms, tiny. As the Office for National Statistics (ONS) points out, for false positives to be the cause for the increased case numbers we would have seen an increase in the proportion testing positive claiming to have no symptoms. We haven’t, the proportion who are asymptomatic has remained stable.
We know what would happen if, at the end of this lockdown, we had not entered the tiered system.
We know because it has already happened.
Wales ended its “circuit breaker” lock-down three weeks ago. It loosened its restrictions. It has since experienced a huge spike in infections and is reintroducing stricter controls.
For those who oppose the tiered system it is worth considering what alternative approach is preferred?
As we know Sweden did embrace a different approach. It is (or at least was) held up as the route to achieve better health and economic outcomes.
It is too early to be clear on the factors which determine the differential impact of Covid 19 on different societies. However I suspect that future analysis may imply that Sweden has natural advantages compared to the UK. These include a much lower population density and the fact that more people live alone in Sweden than in any other country. If it is indeed proved that obesity (and related illnesses) has an impact on the severity with which Covid hits individual patients the 10 per cent obesity rate in Sweden (measured by BMI) is also nearly 2.5 times lower than the UK.
However even with these potential advantages their approach has, sadly, not succeeded. Sweden is enduring a deadly second wave and deep economic impact. It’s approach has accordingly shifted.
I appreciate some advocate seeking “herd immunity” and the theories proposed by “The Great Barrington Declaration”.
The WHO’s view is that exposing people to a potentially fatal illness in order to create population immunity is “scientifically problematic and unethical”.
There is also no evidence that it will work in practice.
Supporters of the “Great Barrington Declaration” believed as far back as May that the epidemic had “reached its peak” in the UK due to the establishment of herd immunity.
Alas as the increase in case numbers prior to the second lockdown show, the epidemic is still in our communities and left unchecked is capable of very significant, deadly, growth.
This is before one considers the risk of reinfection or the virus evolving
I am absolutely certain that given the current level of infection across the country, the current R rate and the upside risk to the R rate were controls to be lifted we could not “return to normal” at the end of lockdown. To do so would simply result in a further spike between now and Christmas and either a renewed lockdown, more severe than the tiers, or a worsening situation at the very moment of the year when the NHS is at its most stretched.
I have seen no alternative strategy presented which stands up to scrutiny.
Furthermore while the social, health and economic consequences of both lockdown and to a lesser extent the tiered system are very real I think any alternative which allowed the virus to let rip would produce a worse impact on all three factors.
I absolutely believe moving to a tiered system is necessary.
The tier system will see many improvements from “lockdown”: all shops can reopen as can many leisure venues, hairdressers, the list continues. Government is continuing to provide unprecedented support to the economy with furlough extended until March and specific support provided to specific sectors. I appreciate this comes at a huge cost but there are few circumstances in which it is more apparent that Government support is required.
By maintaining productive capacity through to what looks increasingly like a foreseeable end date we maximise our chances of rebounding from this economic downturn and recovering growth.
The idea that the economy would simply continue as normal had these restrictions not been put in place I do not believe is credible. The impact of disease, both direct and indirect and its debilitating effect of confidence, would have had hugely deep and damaging consequences - which may well prove more protracted.
The previous tiered system did have an impact on transmission, however analysis carried out by SAGE showed that stronger measures are necessary to prevent the epidemic from growing. In general, analysis showed that the former tier 1 measures were not able to stop the growth of the virus, tier 2 managed to slow but not reverse the pace of growth and tier 3 managed to get cases falling in most, but not all, areas.
The only question is in which Tier should our area fall.
In determining which tier regions should go into, five criteria have been considered:
· Case detection rates in all age groups
· Case detection rates in the over 60s
· The rate at which cases are rising or falling
· Positivity rate (the number of positive cases detected as a percentage of tests taken)
· Pressure on the NHS
In determining how to divide the country into regions, judgement calls have to be made around the connectivity of areas and the utilisation of NHS resources. Even within the Horsham constituency there have been at points significantly different data produced between its two Districts: Horsham and Mid Sussex.
It is possible that areas may be further defined as tiers are reviewed but initially a broader definition than a District has been used to ensure clarity and to represent a larger area in terms of community links and interaction.
On the week we entered lockdown, there were 87.6 cases per 100,000 in the Horsham District and 106.6 cases per 100,000 in the Mid Sussex District.
During the lockdown (but before the lockdown measures had had an effect) at its worst Horsham reached 122.4 cases per 100,000 and Mid Sussex reached 167.5 cases per 100,000. This trajectory, indicates I believe that had we not gone into lockdown these numbers would have continued (to) grow. As at the most recent data, there are now 70.2 cases per 100,000 in the Horsham District and 95.4 cases per 100,000 in Mid Sussex.
Sussex as a whole is at the lower end of infection rate per 100,000 population spectrum with only Cornwall and the Isle of Wight (both Tier 1) and Suffolk (Tier 2) below us.
Clearly the weekly data is constantly evolving (hence the tiers will be kept under review). However Sussex had experienced in the week to 19th November 2,047 confirmed cases with 25 outbreaks in the community recorded. Our case rate overall was down 4% on the previous week, although the case rate per 100,000 population for those aged 60 years and over had unfortunately increased to 86 per 100,000. The total percentage of individuals testing positive was 5%.
To put these into perspective, the Isle of Wight (which is in tier 1) had 100 cases over the same period, 3 community outbreaks, 71 cases per 100,000 (compared to 120 in Sussex), 44 per 100,000 for those aged 60 and above, a fall in case rates of 8% and a 3% positivity.
The reason why the two areas are being placed in different tiers is very apparent from the statistics. I know you will also appreciate the difference in connectivity between the Isle of Wight and our two Districts.
The worst possible scenario for us economically is a situation in which areas bounce in and out of lockdown as infection rates rise and fall. We all want to see a sustained fall in infection creating circumstances in which (as the vaccine programme progresses) we can see a trajectory to a sustained return to normality.
The tiers will be reviewed on the 16th December, as I have stated there are grounds for optimism that the positive trend in infection rates generated during the national lockdown may continue. However decisions to move areas down a tier, especially given the time of year in which this wave is being confronted, cannot be taken lightly.
I regret enormously that it is necessary but I am absolutely certain that the approach we are taking and for which I voted is the right approach. It will save lives and is likely to produce the least worse economic outcome in the hugely difficult circumstances we face.
We may have reached different conclusions but I can assure you I have thought deeply about the issues and voted for what I believe is indeed the right approach.
We can both, I hope, look forward to a far better 2021.