Sunday, 29 November 2020

To Save the NHS from collapse we have trashed our economy, Why?

So overwhelming has the covid 19 pandemic been that Health Services have not been able to cope. It is too late to wind back the clock. In a future pandemic hopefully the UK will close its borders more quickly, and not allow foreign holidays to re-infect the country. We also need to make investments to stop infectious diseases destrying our livelihoods. This is unlikely to be a "one time" crisis. Llanelli, my local town, has less footfall and more beggars, hard times for many. The banking district of Frankfurt is a long way from Llanelli but both face a real economic threat from this crisis, and even Frankfurt has beggars on the street. This crisis is definately worse in the UK because of mismanagement of our NHS. Staffed by heroes and led by the blind.
To "save the NHS" we are enduring lock downs and serious economic damage where we can least afford it. The income of the people must suffer, the economy must take a big hit or the NHS will be “overrun” by sick people infected by Covid 19, and none of us will get decent healthcare.Many of us are already not getting good healthcare, suffering on waiting lists, unable to see clinicians and having problems with access to prescriptions and other basic services. Why can’t the NHS cope?
The Truth is that the NHS is no longer a “health service” in the round, Constant cuts by governments, both red and blue in the last decades,“reorganisations “, supposedly to” increase efficiency “have stripped services. New management structures with the emphasis on economy and the removal of most doctors and nurses from representation on the executive boards has led to a service which far from promoting health throughout our communities, simply “deals” with the sick guided more by fiscal goals than the true welfare of the population. Much of the NHS estate has been sold off for development and there has been no real planning for massive health emergencies other than a possible influenza epidemic. Now, to disguise the fact that the hospitals and GP s can’t cope, we have to prevent community viral disease by personal isolation, social distancing and reducing human to human contact. A virus parasite needs a host to live in, multiply and ideally have a chance to release the new generation before the host’s immune system wipes them out. We are reduced to similar methods as those used to control the Black Death.
The economic consequences of lock down are grave, especially in areas of Wales where hospitality and tourism are big employers. Citizens unlucky enough to develop common serious diseases now, such as cancer and heart ailments may suffer delayed diagnosis and treatment, and add to the mortality and morbidity and distress , simply because the NHS cannot give them decent and timely treatment, as covid swamps all. After the first days of Covid 19, when huge efforts were made in Wales to construct field hospitals for which there did not seem to be either staff or patients, there is no clear health policy except “keep away from other humans” until the vaccines come. WE MUST CHANGE THE NHS SO THIS DOES NOT HAPPEN AGAIN Where are the plans to rebuild general capacity and infectious disease units within the NHS? This would help to stop new diseases spreading in the future, protect staff from infection, and allow control of future outbreaks without stopping treatment for all the other illnesses and injuries.Years of asset stripping have oriduced a system which cannot cope. A vaccine may help but it is not here yet. The virus may become endemic, may mutate and be a player in many winters to come. We cannot and must not repeat the “shut everything down” when any new infection arrives. Management discarded the old isolation hospitals, closed the convalescent wards and sold off everything else we could have used for extra capacity. We have no replacement state of the art infectious diseases units. Instead we have had multiple outbreaks of Covid 19 in our own hospitals, which were never built to prevent the spread of novel airborne infections like Covid. William Beverage and Aneirin Bevan planned and set up a welfare state in the 1940’s said to be available “From the Cradle to the Grave”. It has been recently been found seriously wanting. The grand ambitions have run aground not only because of a new virus, but also because the NHS has been failed both by our own Government in Wales and across the other UK nations. It has been whittled down to the cheapest options using the least inpatient treatment. Care in the community, works well for many chronic diseases. It certainly does not work for virulent infectious diseases, in fact it can spread them efficiently to the most vulnerable . The Welsh NHS has been emasculated, whittled to the bone, and was unprepared when a pandemic struck. If you keep cutting any service , the point comes when it can’t cope. Stressed, it is no longer fit for purpose. In fact some of the health management actions in this epidemic made things much worse, decimating care homes by sending them infected cases and even in hospitals professional staff were often infected by their own colleagues and their patients, in wards never designed to house serious infectious cases. The Welsh NHS needs a change of direction and cries out for leadership. (these are trainee doctors in Iceland where they do try to train enough doctors from their own country )
We are living in a nightmare caused by those who apparently had little interest in maintaining our NHS , our first line protection from disease and infection, paid for by our taxes. Where was the oversight, who was watching out for us? Can we even trust our Welsh Government to make good the mistakes and lack of resources that brought us here? The sticking plasters are being applied, but without major changes in the NHS, and planning properly for the future, we may repeat the nightmare all over again. Air travel will one day re-start, the economy will take the hit and recover, but the threat of another similar infection will still be there. We need to learn the lessons from this. Vaccines, drugs and the new treatment paths will probably help control Covid 19. But without an NHS infrastructure to isolate and treat new diseases, or resurgent old ones, we can easily find ourselves in the same nightmare by still running an NHS system with only “Just enough” to provide the minimum standard care, with no slack at all. We need a few empty emergency wards, some extra convalescent wards, all of which which could be used routinely for other uses but re-utilised quickly at short notice. How about a Welsh infectious disease centre with the proper staff compliment, and every hospital having some isolation cubicles where patients can safely be treated but disease cannot leak out to infect other patients and staff. When we don’t have an outbreak these specialist staff could tour the country,’giving lectures, training and checking readiness. This would probably cost less than the many field hospitals and emergency morgues built in haste and never used. Managers hate empty buildings and underutilized areas , but the nature of healthcare is that the needs are always changing, and disasters happen.. Keeping a few isolated empty wards, training a couple more infectious disease specialists won’t break the bank, but may save the economy in future. Many people have died with Covid. Many others have died or are expected to die because they could not access timely medical treatment for many other diseases such as cancer. Others have suffered severe mental stress and utter despair due to the social and economic wounds of the outbreak.
Could Wales cope in the future? The lack of NHS capacity and proper planning for pandemic emergencies has made a bad situation a lot worse . As a small country we could probably have done a lot better , and hopefully in the future we will. A manageable population of around 3 million and a country which can easily share knowledge and resources and in emergencies transport and share staff and kit around.Wales has decided not to train sufficient docotrs and nurses for reasons that are officially unknown.I suspect it simply is to save money- Why train our own doctors and nurses when we cam attract health workers from other counrtries by our high salaries?The UK has the best paid doctors outside of the USA. Why bother to trin our own when other countries do it for us? We have built a Welsh Health service with artificial boundaries and barriers to sharing and co-operation , unnecessary duplication of scarce resources in some cases ,We certainly have been selling off the family silver for a pittance in a vain attempt to balance the books of individual Health Boards with little consideration of the Health of the Nation as a whole. A vaccination program will be rolled out, the virus may well be checked and case numbers drop. Victory will be announced and the problem temporarily reduced, and even perhaps a new bank holiday to celebrate, "Covid day", But the NHS itself is sick in many ways and we need to mend it before then next new infectious disease arrives. But if the lack of capacity in the Welsh NHS itself is not addressed , if our scarce resources are not husbanded , and short term financial savings allowed to trump future quality improvements, the armistice will be only temporary. Another enemy may yet appear in similar guise and once more expose the poverty of our ambitions to keep our people safe for the long term.
Dr Sian Caiach

Sunday, 8 November 2020

The Wellness Project becomes the Breezy Village but new flood warnings may drown development

The Llanelli "Wellness Project" was a scheme to build housing for the elderly, a leisure centre, and a Health Sciences based business park.It was part of a well funded City Deal sponsored by UK Goverment and led by Carmarthenshire County Council and their Council's Chief Executive Mark James. There were said to be links with Swansea University, various drug companies, and a Kuwaiti Private Hospital and Medical School. The project needed £200 million pounds of private matched funding. Mysteriously the firm allegedly chosen to front up this money, Sterling Health, appeared to be a registered Company with no large assets and considerable debt. The planning application was delayed by NRW as the site of the development, a former dock area used as a refuse dump yeaars before, had not been properly asseessed and tested for contamination. The UK Goverment seems to have noticed the lack of the £200 milllion matched funding required for the grant aid to go ahead. The project was shelved. Image below is of the proposed "Wellness and Life Science Village" as it should have looked on completeion
Mr Mark James resigned after NRW delayed the development, in order for the County council to properly evaluate the site. Undeterred, the Council's Executive Board led by Plaid Cymru councillor, Emlyn Dole, rebranded the project as "Pentre Awel", Breezy Village, and clearly intended to build some residential units and other features on the site. The site area is adjacent to the shore of the Loughor estuary, the lake's lock gates have been neglected and left in an open position, allowing the waters to become tidal. Sea levels are rising and the flooding risks have increaased acording to NRW. Surely a safer site will now be found, as the original plan for housing was for the elderly? As you see in the photos below, the site is still undeveloped. There has been some fly tipping but it could be a beautiful site for leasure and wildlife if it was cleaned up and landscaped. Mr Mark James has remarked that the choice of site was due to the fact the 40 qcres of land was already owned by the council. Where else could he find land so cheap?
Wales' environmental organisation, Natural Resources Wales issues new guidance regularly on the likelihood of development site flooding and flood risks across the whole of Wales. This shows the large lake in the site as a likely flood risk and surely makes the development far less attractive to the housing and scientific buildings planned. The best use for the land, which may have been contaminated by the landfil process, is surely parkland and recreational activities. A great deal of money has likely been spent on the promotion of this site, which has failed to materialise due to lack of local funding, and probably an over ambitious plan to build a science park reliant on outside funding and foriegn private medical financial support which in the end did not materialise either from Kuwait or the Uk based Sterling Health. It turned out that the Kuwaiti firm had not yet built their private hospital and medical school and threatened to sue Swansea University, who had offered to host the Kuwaiti students in the UK, for damages, as their construction project in the Gulf was also stalled by the delay.
County and Borough Councils are often the recipients of grants for economic development and other projects, but this case shows that they can fail when the projects are not properly researched and "partners" are recommended who are unknown to the Councillors, and turn out to be unreliable. There was no detailed plan shown to councillors on the costs and opportunities. Why should Kuwaiti students come to Llanelli to study? Why did drug companies wish to hire the units the council would build? Why site a new leisure centre and retirment home for Llanelli so far out of town? This project has attracted the interest of Tarian, the welsh police fraud squad, who are investigating the County Council's involvement and Swansea University have taken disciplinary action against accademic staff involved. The process of police investigation of this strange project and its participants is not completed but hopefully there will be answers one day !

Tuesday, 20 October 2020

Covid 19 - why was the NHS so unready?

WHY WAS THE NHS SO POORLY PREPARED FOR COVID 19? Another lock down is about to start in Wales as many areas here display rising levels of Covid infection. Only Pembrokeshire and Ceredigion seen to have relatively low levels of new infections.
THE NHS WAS SET UP WHEN INFECTIOUS DISEASES WERE MAJOR KILLERS When Aneurin Bevan set up the NHS infectious diseases caused a great deal of death ans disability. Hospitals and sanatoriums were built to house and isolate the sick with infectious diseases. Tuberculosis, menigitis, septicaemia and polio were commonplace. Better living conditions, routine vaccinations and the development of antibiotics have led to a steep decline in infectious diseases but we know now, to our cost that we should have prepared better for the pandemic we have now. The risk has been ignored. When I was a medical sturdent there were still hospitals treating large numbers of patients in iron lung ventilators after polio had paralysed their breathing muscles. As a consultant I still saw a few patients cripled by polio as children. Nowadays polio is a rare infection and only a few dozen cases are repoted worldwide annually. some of the old diseases still occur, but a combination of healthier populations, vaccintions and prompt treatments and isolation have kept the numbers low in the West.
 Sars2/Covid 19 , is the virus that is causing so much trouble, Boris Johnson's "invisible mugger". A coronavirus originally from bats which was discovered in December 2019 in the customers of a wet market in Wuhan. Although some groups are more prone to serious complications and death, anyone can catch it. As plagues go, the death rate is modest – about 1% and falling as better treatments are found, but the groups most prone to serious complications and death , the elderly, obese, hypertensive, transplant recipients, cancer patients, etc can only avoid catching the disease by hiding from the invisible killer. As a large proportion of those infected by Covid 19 are asymptomatic, but infectious, some totally and others in the early days of the disease before they feel ill, every fellow human could be a possible source of the infection. You cannot tell who has it. Also. Test,track and isolate is much harder when many pass on the virus not even knowing they ever wwere infected.
HOW DO WE GET RID OF IT? In the absence of a "magic bullet treatment" at present we can only use the information we have about the virus to try to stop the tranmission. We know it is spread from person to person, mainly airborne, and so contact with others indoors, from outside our households is pretty dangerous. Social distancing and face coverings may well help but thre is no easy solution as yet. An effective vaccine would be great and as the doctors of the world learn more about the virus more drugs and therapies to save lives will emerge.
WHY WASN'T THE NHS READY FOR THIS? It was not ready for an entirely new, highly infectious virus despite the warnibg in 2002-3 of SARS 1, a very similar virus outbreak mainly in Asia and spread by air transport. THe UK only had 4 cases and no deaths. World wide it killed 700 people and had a 10% mortality.People were usually very ill with it, and it had a short interval between catching it and falling ill - 2 days rather than the 14 days or more of SARS.2. Test,track and trace worked well, and it was eradicated. It is now obvious that no governments or scientists yet have the instruments with which to permanently eradicate the SARS2-Covid19 virus. We are, for the time being, stuck with it, probably for at least a year or 2 and maybe longer. Lock downs, social distancing, masks, hand gel etc can slow it down, but that is all. New treatments and drugs are improving survival rates but not stopping all the deaths. Something like this has not been seen in recent times in the West and was something not expected by the NHS, . Pandemics are not unknown, far from it, but all of the UK have deliberately run down infectious disease services and isolation units, to save money, as governments of all colours have demanded NHS “efficiencies ” , otherwise known as cuts.
As these hospitals and units were closed, instead of being mothballed, they were generally sold off, often to developers, usually for building private housing to generate funds for whatever the NHS managers of the day desired. So both the extra space needed for isolation wards and the expertise in this new disease had to be built and learned fast by essentially unprepared health providers, whose previous policy was seemingly to ignore the threat .
Also, the growth of care homes and early discharge from hospital to other care in the community” has meant less medical supervision of the sick, This also allowed further asset stripping of the NHS, closing more geriatric wards and in general, reducing the choices for patients and increasing waiting lists for inpatient procedures. There was no slack in the system as any slack was pounced upon as an “efficiency saving” and eradicated. The effect of this general policy of the NHS has been, even pre-Covid, in many cases an increase the stress on the staff and a decease in the quality of care. Its a poor economy as leaving patients for long periods on waiting lists means that many deteriorate and need more treatment and some may even be told they are beyond cure. Only the private sector benefit from this, but unlike the USA, private medicine in the the UK rarely offers emergency treatments and has very little intensive care facility. Not much use in a pandemic.
LIONS LED BY LABRADOODLES [Labradoodles being dogs beloved by the wealthy middle classes and noted for enthusiastic devotion to their masters] After years of delivering healthcare on the cheap, but senior mangerial salaries keeping Aneurin Bevan spinning in his grave, the wake up call has come in the form of Covid. This virus does not fit with the plans of our healthcare managers. The NHS is unused to quck emergency responses to a real health crisis and here in Wales the response was building field hospitals which were mainly unused and so stayed empty. I supect general guidance was poor, and panic high, as local facilities were overwhelmed by severely ill patients with an unusual dispaly of symptoms and complications that no-one had been taught in medical school.
Our healthcare is managed overwhelmingly by a board of bureaucrats appointed by other bureaucrats who then appoint a token doctor and nurse to join them, with one or 2 trusted “members if the public” who are usually persons of note, and hardly representative of the public at large. Certainly no-one on a health board appears directly accountable to the public. Our front line staff are truly lions led by labradoodles, People who selflessly throw themselves into the battle against the virus are led by people selected for their talents of subservience to government and ability to look good while burying incompetence in platitudes and propaganda. We actually have had pandemic committees all over the UK, including Wales . They were planning for pandemic flu. When this virus is under control our planning for the next new infectious illness will hopefully be focussed more widely and our NHS more resilient. Its time for the NHS to become a more open and democratic system and accountable to those whose taxes pay for it IF OUR HEALTH BOARDS WERE ELECTED, NOT APPOINTED, WOULD THIS HAVE HAPPENED?
The answer is, that we would not have dodged the virus, but honesty about the clinical situation and wider and more open public discussion could have changed the atmosphere in which the public were asked to make the serious sacrifices necessary to stabilise the situation. Breaking bad news is never easy, but playing down a disaterous situation destroys trust. In our current position trust, and the confidence of the people, have to be won and kept.
If the Health Boards have a majority of elected members,{they may still need a senior doctor and nurse to consult) the board members will be people voted in whose conduct can be examined and judged.If they succeed they are rewarded, if they fail, they face replacement. In much of public service, deficiencies seem to be hidden rather than exposed and consequences for failure may be a quiet early retirement and a generous pension. A little more openness may actually inprove the relationship between the public and the public servants who we pay for. Without the trust and full cooperation of ordinary citizens everywhere, this crisis will last longer than it needs to, and none of us want that!
Dr. Siân Caiach Mob 07925 888053 Home 01554 785046 sian.caiach@gmail.com
Postscript : A reecent Guardian Article claims that Labradoodles are in fact, genetically mainly poodles, who could have guessed? https://www.theguardian.com/lifeandstyle/2020/sep/10/labradoodle-study-reveals-dogs-are-actually-mostly-poodle

Wednesday, 2 September 2020

The Big Stink

IN 2016, after 8 years of a legal action at the European Court, the UK Government was convicted of being in breach of the EU Urban Waste Water Directive in Llanelli,
a law which states that all urban sewage should be completely treated before discharge into any body of water. Not only was the local sewage treatment provider Welsh Water, spilling raw sewage into the Loughor Estuary/Burry Inlet but it was also aware that this site was supposedly a nature reserve and major Cockle fishery with E.U, Natura status. In Llanelli, an inadequate new sewage treatment plant had been in operation since 1997 , replacing many smaller ones and using UV light to kill the bugs. As the town grew with much new housing the sewage discharges increased. The rich cockle fishery was greatly diminished and in 2005 a mass cockle death event occurred known as the “big Stink” when millions of cockles rose to the surface of the Loughor estuary, died and rotted THe picture seems to show a shingle beach.It is the shells of millions of dead cockles in 2005. As this was Wales,huge efforts were made to hide the inadequacy of the local sewage system. Several reports suggested all sorts of reasons other than the sewage that could be killing the cockles and other wildlife. One of the worst deceptions was blaming, a “new” protozoal parasite Minchinia Mercinaria which was was said by a National Resources Wales officer to have caused havoc in the clam beds of Virginia. When I tracked down the scientific paper and its authors the organism had in fact not killed a single clam. The USA clam fishery is major business and “High Tech”. The “new” microscopic parasite was not a new organism to the world. It had been found in a routine sample of 180 juvenile hard clams. One of them had a small infection. Electron microscopy showed it had a new variant of a Minchinia parasite not yet described in the literature. The Virginia studies showed it to be harmless,,with 30% of other clams in the group showing antibodies to it having made a complete recovery. The only clams that died were those deliberately killed and dissected to find the parasites and antibodies The researchers realised that it was not a new organism as reports of it came in from all over the world when they published their techniques, and findings, including Llanelli. It could not have spread worldwide so quickly from Virginia but our local Cockle gatherers were blamed for bringing it in to the cockle beds on their boots. The fact that the Americans had shown it to be of no commercial significance, ie harmless to their fisheries, was kept from the public. Other theories included suicide by oversexed cockles, however the deaths were seasonal and similar to other sewage polluted waterways, where algal blooms reduce oxygen levels, suffocating shellfish.and other water dwellers.. The County Council Senior Officers must have been fully aware and kept on encouraging the Councillors to grant planning permission for more new houses, mainly for incomers , telling the county Councillors that more homes meant more council tax. A case was accepted by the European Court in 2008 in the name of Mr David Conrad Rees, Chair of the Sandy and Stradey Residents Committee, representing an area where sewage flooding was a serious problem.. He was joined by local cockle hand gatherers, many of whom had lost much their fishing grounds After 8 years of excuses and denials in Carmarthenshire,,the UK Government accepted guilt. Members of the public had to fight to prove the breach in EU rules. Welsh Water submitted a plan to provide more sewage treatment without the huge expense of building a new sewage treatment plant. It was called “Rainscape”. The idea was to remove surface water from the sewers by draining it away in a new pipe . The major element of Rainscape, the digging of a 1.5metre drainage tunnel to drain the groundwater from south Llanelli, has stalled and Rainscape has not yet been completed. The problem is that the drilling rig  appears to have hit one of the large aquifers which lie under the town and had somehow been missed  in the surveying of the tunnel route. This aquifer was uncharted and very large and extends under the train station and railway tracks. I have seen the Morgan Sindall report showing that there are difficulties in extracting this water and essentially nowhere to safely pump it to, at the time of writing the report, It also runs the danger of shifting the existing rail tracks if a void is formed beneath them. High groundwater levels are also a problem and could quickly refill the aquifer. There are ways of puttting a tunnel through an area like this but I am told these are civil engineering projects of high cost and some risk. Has Welsh Water got the funds to do this? This has meant that the last section of the Rainscape tunnel remains unfinished. As this is the scheme designed to produce the  improvement demanded by the European Court .There is no news. The Scheme cost over £90 million. . I’m concerned that raw sewage is still being discharged into the Burry Inlet and there is no sign of a plan B. Even more worrying is the County Council appears to have given planning permission for numerous buildings in the Llanelli catchment area over the past few years without checking that any improvement in sewage discharges had been achieved, surely adding  to the foul sewage loads into a Natura Wildlife site, and likely further deterioration of the very poorly "protected" habitats.  In Welsh tradition there have been few surveys of the wildlife or bacterial water quality studies – if you don’t look maybe no-one will notice! Llanelli Beach was last tested, I believe in 2009 , and the numbers of bacteria were so high the Council stopped testing. It is not a designated bathing beach and as it is owned by the council, who know it is probably still polluted, with never ne allowed to be. However, it is used for bathing and paddling by visitors. I have asked the County Council for the beach water to be tested many times. Unfortunately only "designated bathing beaches" are regulated and have regular testing, Llanelli Beach does not qualitf.
To me this looks like the Rainscape project has, at best , stalled and at worst, failed .I can see why it is difficult to dig the tunnel under the station but surely we should know the prognosis of the scheme? If it has failed or been seriously delayed it has significant planning implications and a new way must be found to clean up the estuary, instead of deliberately worsening of the pollution of our estuary. As the health of the Estuary is not regularly tested it could simply be declared “dead”, of no wildlife value and that I suspect , may be the goal, an argument o allow the pollution as much of the habitat has already been destroyed. It has been suggested to me that the project is on stop as Welsh Water hopes that leaving the EU will negate the findings against the UK in the European Court. Why do our elected Councillors allow the Burry Inlet to be an open sewer? I’d love to see it returned to a clean wildlife haven and prosperous fishery..The UK Government has accepted that there was a serious breach of the E.U. Urban Waste Water Directive in Llanelli , and expected Welsh Government,,through NRW as the regulating body and Welsh Water as the polluter, to remedy the situation long ago. Something has gone wrong and no-one is telling! It appears. very little has been done as requested by the European Court.. Welsh Water explain that without the frequent sewage spills into the estuary Llanelli would flood again with sewage and the pollution of the estuary and fishery is therefore necessary to preserve public health. What sort of 3rd world country do we live in?

Thursday, 4 June 2020

Hardship and Uncertainty - how long will we be living with the virus?

THE UNEXPECTED KILLER

Few people in the UK seriously envisaged a worldwide pandemic such as the one we have now. I recently spoke to a former member of the Wales Pandemic Committee who described the meetings as often more of "free lunch" than a serious attempt to work through the reality of various pandemic issues. Apart from setting aside stocks of masks and gloves, very little was done.

It's said that in the West we were expecting the next pandemic to be another strain of influenza. The plans were based on epidemic precautions to treat diseases like swine 'flu.


NHS " managed" first wave of SARS 2 ,but many patients still waiting for routine treatments


In 2009 -2010 a pandemic flu epidemic arose in Mexico and spread across the world. At least a quarter of a million people died, but because many European elderly people had some useful immunity to this type of 'flu, it did not have the devastating effect that was expected. Since then, flu vaccines have been used extensively in the West to shield the vulnerable from influenza outbreaks with general success.

In the Middle East and Far East,they had  experience with the new pandemic diseases SARS 1 and MERS, which  probably gave their countries, who had experienced nasty coronaviruses before, an advantage when Covid 19 emerged as it was similar to these previous diseases of which they had experience earlier in this century. They already had the expertise with deadly coronoviruses to use immediately. It is so close in nature to SARS that Covid 19  is officially now referred to as SARS - CoV2, - SARS2 for short

SARS 1 - Severe Acute Respiratory Syndrome was a very similar coronovirus, originating in bats and probably mutating after close exposure to other animals, which emerged in  China in 2002 and caused 8.000 cases over 26 counties with almost 800 deaths.. Like Covid 19 it is thought to have come from live food markets where animals are kept in close proximity to each other and in poor conditions. The symptoms were very similar except that diarrhoea as well as a high temperature and cough, was a common symptom. It was a severe illness and death rates were higher with around one in 3 cases needing hospital care and one in 10 people dying. This compares to a 1% death rate of SARS 2/ Covid 19 , the virus active here now.

Empty Streets across Europe - now lock downs being relaxed  
BORIS' INVISIBLE MUGGER

In the original SARS outbreak no drug cure was found and despite years of work, no vaccine  was ever produced. The disease was controlled and eventually eliminated by screening for high temperature, isolating those with symptoms and their contacts, and strict infection control in hospitals. As it was a more severe infection ,it was easier to track down carriers and follow up contacts.

 With SARS2 /Covid 19 many people have the virus and spread the virus with no symptoms themselves. A recent research report from China suggests that these carriers may feel well but still have the distinctive lung lesions of SARS "on CT scans, adopted by many Chinese hospitals for instant diagnosis, rather than a swab test with a wait for a result.
JAMA. 2020;323(14):1406-1407. doi:10.1001/jama.2020.2565

The Chinese have used lung CT lung scans for diagnosis and evaluation from early in their epidemic as they usually show the very distinctive Covid 19 lung lesions, even in those who feel well. In the UK we have struggled with testing for various reasons, and were not able to quickly isolate cases as the Chinese were, nor probably did we have their access to CT scanners.

We were in the UK  prepared for 'Flu, we had pandemic committees across the UK, officially "ready"  for a deadly flu epidemic but with no apparent expectation of a SARS type virus. Along with the large number of asymptomatic carriers, and the ease of spread,, the UK was unprepared for this new illness.

RESPONDING TO A NEW ILLNESS

The UK Government was reasonably quick to try to preserve the economy, setting up various schemes to lay off workers on 80% pay, a plethora of grants and financial assistance and a blatant  abandonment of most self employed people with modest incomes.

Here in Wales converting Rugby Stadiums and other buildings into hospitals that we eventually did not need, became a bit of an obsession .Now they are being reviewed. we will probably retain a few but the ones which were completely unused may well be "stood down". People who recover from ITU treatment do often need rehabilitation but it seems that the survivors were fewer than calculated and extremely keen to get out of hospital and have physiotherapy in the community.

Its difficult to assess whether or not we are  about to get a significantly bigger second wave , but in the absence of a vaccine or a preventative drug it would be logical to assume that we may well get a second wave and until we get on top of this virus, could easily have more waves later on.

SARS 1 was eliminated by 2004. It was starved of life by stopping people spreading it to others. Some of the survivors were monitored for antibodies long term, they all had plenty to start  with and the antibody counts fell off over 3 years or so, but not entirely, There were a big efforts to make a vaccine to SARS1 but none were successful, and as no new outbreaks happened the projects were abandoned.

WE NOW KNOW MORE, BUT IS IT ENOUGH?

SARS2 is a different animal in that a lot of victims do not show symptoms immediately, and some not at all. These cases are all infectious. Out doors is relatively safe because the virus appears mainly spread by coughs  and breathing, and outside the air dilutes it quicker. It takes a number of virus particles to start an infection and overwhelm our defences, so concentrating many people close together helps the virus spread easily,  hence social distancing .

 Indoors is more dangerous as the viruses can accumulate in the air and get breathed in more easily. Hygiene, hand-washing,social distancing and face coverings should help slow the spread, but relatively few of us have met this new virus before and so most of us probably have no immunity to it. We won't know until antibody tests are readily available to the public, how many of us have already had the illness.

 Research seems to be showing that the amount of virus carried by patients in their nose and throat is much the same in those who feel well throughout their infection compared to those who  are sick. So even if all of us who have symptoms isolate for 14 days , many people will still be distributing the virus into the air and on urfaces without even realising the danger they are to others. Some of these will eventually feel ill but many others may never know they have had it, without the further  tests not yet available to the public.Test , track and isolate is not as easy with this particular bug.

It seems easy - test everyone who feels ill with the right symptoms, if they are positive isolate them, find out who they have been in contact  with, and tell them to isolate too. If they get symptoms, they get a test as well and their contacts are traced if that test is positive. The idea  is to chase down every new infection and catch anybody likely to be a carrier before they have a chance to infect anyone else. In the end the virus is starved of victims and dies out.

There are a few things which could be problematic and make this difficult:

The accuracy of the testing.

No test is absolutely 100% effective. The original tests used in the UK had a significant false negative result, some because the virus was at too low a level early in the infection and others due to poor swabbing technique and problems with the test itself, but in combination some calculated that 10% or more positive cases may have wrongly been given negative results.
Presumably we have more accurate testing now, as if not, we will lose some cases which should  be isolated and have contacts traced. False negative tests could leave infectious cases in the community with false reassurance.

The number of cases infected who have symptoms.

There is now lots of evidence that this disease has a considerable number of asymptomatic carriers. These people feel fine and may never be aware that they are carriers. Some of these are the legendary "super spreaders" and these people unknowingly are dangerously infectious. Also, as the protocol is only  to test those with symptoms, these cases could be totally missed,

Co-operation of the public

There must be public trust for co-operation. People must understand why they must self isolate and at present  the plan is to ask everyone to self isolate after contact, even if you have had the virus before,

To self isolate for 14 days takes some commitment if you think you have already caught the virus, been isolated or even hospitalised, and got over it. I think these people will naturally feel most aggrieved , and should be offered an antibody test which  is evidence for having had the virus and recovered with some immunity

Although it is true that we do not know exactly how long the immunity lasts, it probably lasts at least a year and maybe longer if the SARS1 data is relevant. As we actually have do have antibody test kits to check the presence of antibodies, surely we could use them?

There have not been any proven cases of reinfection after recovery from the illness but there are cases of long lasting disease with complications where the virus was secreted for a long time before the patient was finally clear of the virus, This allowed them to test positive some weeks apart but was not thought to be a new infection, just a resurgence of the original one.

There is no scientific evidence I can find of any people definitely catching it twice. As there is no drug treatment for the disease, every survivor has had antibodies to the virus as it was the only way they could have recovered is through their own immune system finally killing the virus.

The Asymptomatic Carrier Problem

The test. track and isolate policy is planned to be used with symptomatic people. already sick with the virus. We know that many people just do not have symptoms, so may not be picked up.

 For instance an asymptomatic carrier may pass the virus to 2 people. He or she recovers without even knowing they were were ever infected. Of the 2 people infected by them,  one becomes sick, lets call them A, has a test and A's contacts are tracked and isolated and A isolates too.The original case may now be testing negative and may be asked to isolate,as a contact of A but its too late. Theyare  probably not infectious now. Even if they did test positive there is no way of knowing whether they were  infected by A, rather than the source of A's infection.

 The other has a mild or asymptomatic case, lets call them B and never gets tested and is unaware they are infectious,. A and B may not ever have met,  B may go on to infect other people. So this test ,track and isolate strategy in the presence of asymptomatic carriers may take a long time to totally eliminate the disease. It will "miss" some cases which are infectious but not exposed as such.

So  the hint of terror on the faces of our politicians and their medical and scientific advisers at their daily briefings is not just chronic stage fright, they are really worried..

We are dealing with a virus for which we  currently have no cure, and no prevention yet, other than stopping people getting close enough to each other to catch it or pass it on. Its not easy to spot who has it, hence the temperature checks at airports etc. Even these are not totally reliable.

 A study of 78 people who tested positive in Wuhan after visiting the wet market, where the original  outbreak occurred, 42% were asymptomatic. They were predominately female, and younger than the others in the group.

.Other studies suggest that asymptomatic carriers are present in between 25% to 50% of  all people actually infected. I doubt the scientists are confident of quickly containing the virus if up to half of all who get infected are not even aware of their condition. Add to this that around 40% of people  who will become ill  probably pass on the virus before actually becoming ill.  Eliminating the virus may not be easy. For the time being we are going to have to live with it, by hiding from it , while we cannot be exactly sure about who may actually have it.  Hence, avoiding everyone, as we cannot tell who is a carrier?

JAMA Netw Open. 2020;3(5):e2010182. doi:10.1001/jamanetworkopen.2020.10182

 Perfectly well looking people who don't realise they have the virus are as likely , or even more likely, to spread it as those who feel sick having similarly contracted the same virus. It is easy to catch from other people and Winter is coming, the time when we usually seek out warm and sheltered places in which to live, work and socialise.

The decisions of what to do are not easy. Since the first cases, we know more about the virus, but not enough to quickly eliminate it. Our doctors and medical staff are becoming more skilled at keeping severely ill people alive. Less people are dying  but too many are still  being killed by the virus.

For our leaders the difficulty is to balance the health issues with the massive hit to the economy we have taken. Enough people have already lost their jobs or had their businesses devastated.Tens of thousands of people have died in the UK and hundreds still die every week.

LIVES VERSUS LIVELIHOODS

 The more we restrict social contact the closer we get to eliminating the virus, and saving lives. Test, trace and isolate is not as straightforward as it looks in theory. Its going to take time and we probably will be fire fighting outbreaks until we get good immunity Either from a vaccine or from lots of us catching it, herd immunity will eventually reduce or stop the infection enough to return to "normal life", Neither path is likely to be quick or easy.

However, the more we restrict social contact the more we restrict important areas of the economy, the more jobs we lose, the more debt we incur. The poorer the Country gets.

Will the banks and big businesses dictate  policy yet again?  


How much weight and effort the Governments of Britain put into saving lives and saving the economy are largely political decisions; according to their powers ,ambitions and what they believe their populations will accept. However, the crisis itself  restricts their choices considerably, as so little is predictable, and much unknown. The available options are very limited and none of the strategies are without the danger of failure. It is not a simple choice between degrees of lock down and economic growth. The virus was completely novel and in many respects so is the strategy for manging the situation.

Who will decide the priorities? Probably not us!

 Siân Caiach 

Wednesday, 20 May 2020

A Draft from the Past - the Burn Family still trying to find out why they were victimised.

In my series of blogs on "The Councillors' lost daughter" I have described the torment suffered by the Burn family over ten years ago, Their daughter, Carina, has a rare genetic condition which means she cannot speak and has learning difficulties. She is able to communicate simply using a letter board, with her mother
.
 Carina was taken into care after allegations were made through her  2 occasional day carers that she was being sexually abused and involved, with her parents, in prostitution. Even though the carers had just been sacked by her mother, Julia, after Carina's spending money went missing without receipts, the story of abuse was naturally taken very seriously. The 2 carers "helped" Carina make detailed statements to the police implicating her parents.This disabled young woman who had always been assessed as having severe learning difficulties was even assessed by a Psychiatrist as a competent adult on the "evidence" of the 2 carers who assisted her in communicating  "like an adult", apparently tatally fooling the doctor! He was later criticised by the GMC.

The police found no evidence of abuse whatsoever, but social services were still suspicious of wrongdoing. Carina was put into residential care and not allowed to see her parents for almost 6 months.,

A scientific examination of Carina with her carers by a specialist communication expert eventually showed that neither woman could communicate with Carina at all .The Council delayed returning the girl to her parents, apparently desperate to find evidence to support their own actions, even inviting Professor Howlin to Carmarthen to explain how there was no evidence against her parents.

 The Professor had shown without doubt that the carers could not communicate with Carina at all, However, Carina could communicate with the professor and spelt out that she wanted to go home. She had the communication skills of a young child.

Even then Council officers appeared unconvinced and there was some evidence that they were  arranging to foster her out of County. The foster parents would have had no means of communicating with Carina and her parents could still have been prevented from contacting her.

  However, as the County Council insisted that Carina was a fully competent adult, her mother was able to invite her daughter to accompany her home at an access visit she was given with Carina.
Carina chose to go home with her mother.

Even though it had been proved that none of the Carers could communicate with Carina, a social worker claimed that Carina insisted she did not want to see her father. When she got home she was clearly delighted to see him.


Carina with her father, Robin Burn.

It is not unusual for public bodies to try to hide mistakes but Julia and Robin have been tortured for years as to why these awful accusations were made.Was it just a plan to get back at the parents for dismissing the carers that got out of hand or was there a deeper, more sinister reason?. Robin Burn was a local, outspoken, town councillor. He had moved from England to Carmarthenshire to give Carina the best quality of life possible and was active in the local community.

 He represented Plaid Cymru on Burry Port Town council but, as often happens, was no longer welcome in his political party after the "scandal" even though nothing was ever proved against him. Was this part of political campaign or a personal vendetta? Why did the 2 carers make such cruel allegations about Carina's loving parents. Did someone "put them up to it"

Julia, Carina;s mother, put up a change.org petition asking  for an  independent safeguarding investigation of the case. She is desperate to find out the truth about why all this happened. The employers of the 2 Carers, Perthyn, have asked Change.corg to take the petition down, Julia has asked Change.org to keep the petition active and it still is available.

 Perthyn were employed by Carmarthenshire County Council to provide the 2 carers. Julia and Robin are, as yet, no closer to finding out why their family suffered this awful experience. but are now aware that Perthyn do not wish their case  to be looked at again. Change .org are keeping the petition open on their site.


Change.org : Justice for Carina 

 Siân Caiach 

Friday, 6 March 2020

Too Big to Care - Taylor Wimpey asks for planning permission for a very dodgy wall,

We often hear the phrase "too big to fail", usually applied to banks and others whose financial organisations who get automatic bail outs from Central Governments.

But there are other huge companies who, sometimes like banks, may manage huge finances including large debts, who are also too big. They get automatic bailouts at a lower level of local and regional government, and their size and power allow them to brake rules and laws with impunity, and act totally selfishly.

Last month [21/02/2020] I called a community meeting in the Stradey and Sandy Area of my Council Ward. The main issue discussed was a local Housing Estate, recently completed, called  Parc Y Strade. As the name suggests, it was built on the site of the old Stradey Park Stadium in Llanelli. At the beginning of this century the rugby club was in major financial difficulties and had accumulated major debt. One of the club's directors had given it a multi million pound loan and he wanted his money back. Together with the Chief Executive of Carmarthenshire Council..Mark James. a plan was apparently hatched to build a new Stadium "out of Town" and sell the old site, practise pitches and adjacent plots of land suddenly acquired, perhaps by those "in the know," for development of a huge residential estate.355 homes have now been built there.

Parc Y  Strade  first phase Photo Sian Caiach


 The original land occupied by the Rugby Club, had been gifted to the People of Llanelli for recreational purposes by the Stradey Estate  The Scarlets plc went to court without informing the original donors, the Stradey Estate, and quite legally established ownership of the land through occupation. Of course this was simply in order to sell it on for profit very soon after.

Problem One was that the land was on an undefended C2 flood plain. According to the Assembly's official policy document, Planning Policy Wales, C2 land is too dangerous for building homes on. Only vital utilities, such as sewage pumping stations should be built on it.  On these grounds, the Assembly "called in" the planning permission and halted the process. Our Assembly Government has frequently been weak and this was no exception. Threatened by multi-million pound lawsuits from the developers Taylor Wimpey, Minster Jane Davidson threw in the towel with the support of local Assembly member Helen Mary Jones.

 Helen told a Llanelli Plaid Cymru meeting that the Assembly could be seriously financially damaged by the legal action and was more important to maintain the new devolved administration than a local issue. The reaction was a stunned silence, as I recall.

 It it did not bode well for "Planning Policy Wales" the book of instructions from the Assembly to Local Authorities, when a wealthy bully could dictate to the Assembly where they could build irrespective of community safety.


the southern boundary of Parc y Strade estate held up by a curtain pile wall - photo Sian Caiach  
To protect the new homes Taylor Wimpey was advised to raise the lowest areas of the site to 7 metres above sea level . This would raise the new homes out of the flood plain but also run the risk of flooding in the surrounding areas. The pile wall did not go well, the piles shattered the foul sewer main which ran in the lane below,

The wall was placed not on Taylor Wimpey's land but around 2 foot  over the boundary in Stradey Estate land, a lane through which the residents of  Sandy Road had legal access to their garages and back gardens. Narrowing the lane has caused access problems and in the retrospective planning permission now underway, Taylor Wimpey's agent  claims that the additional land was "acquired" from the Stradey Estate,There is no evidence that they have.

Patrick Mansel Lewis, the land owner, regards the placing of the wall on his land as theft, Taylor Wimpey declines to  answer his correspondence on the matter.

The pile wall already leaks and residents of the lane have impressive film on their phones showing water leaking through some of the piles' vertical joins as well as coming up underneath them, When Welsh Water dug up the lane to repair the sewer, 2 of the piles shifted and had to be re positioned to stand vertically after all the earth behind then had been removed. There appears to be no formal drainage behind the piles. Taylor Wimpey admits, in the planning documents, that they chose thin piles in order to maximise the land of surrounding their properties.

 By siting the piles on someone else's land Taylor Wimpey may have cleverly moved the piles and possibly liability of maintenance on to the owners of the appropriated/stolen land. I believe  the Stradey Estate has far less money than our National Assembly who capitulated to Taylor Wimpey's threats  before the estate was built. The local Planning Committee who now all know that the land is not Taylor Wimpey's are in a bind. 

The policy of the Council is to build as many homes as possible in Carmarthenshire to attract as many people as possible to move to the County and increase the council tax take.This has been supported by all major party groups including the current Plaid leadership. They normally bend over backwards to accommodate the big building companies. I hope for once, they will not allow this particular retrospective application. 

In the meantime the residents of Sandy Road have a rusting, leaking wall behind their homes which has already, during construction, left some of them without sewerage services for weeks. Some can no longer get their vehicles easily into their garages and parking spaces. The bin lorries now struggle to  reverse down the narrowed,long lane to pick up bin bags, and some are left  behind squashed. If the piles fail and collapse residents of the lane will lose access and amenity.

Although it is technically legal to ask for planning permission on land you do not own, I doubt it is actually legal to build on land you do not own with the objection of the real owner. Add the jeopardy of building a wall holding back tons of soil  and showing signs of leaking already. The residents are fearful of what may happen despite the claims of Taylor Wimpey that the wall will last 100 years.

 Siân Caiach

Update:
Having corresponded with Councillor Alun Lenny, Plaid Cymru, and Chair of the County Planning  Committee, he has asked me the following question:



Cllr. Alun Lenny

Sun, Mar 15, 9:33 PM (22 hours ago)
to me

Hello Sian
 .
As this is obviously an inquiry about a legal issue, would you be happy for me to forward your e-mail to the lawyer who usually advises the planning committee at the council’s legal department?

Best wishes,
Alun


I have replied that I am happy for him to take legal advice. I have asked for information as to the identity of the Lawyer concerned but have had no reply.

LATEST NEWS
An objection by the land owner Patrick Mansel Lewis, on whose land the pile wall was placed without permission, is available on line as a submission to the planning department among the papers for the retrospective planning permission. As well as the issues discussed above it is claimed that some of the pile sheets are no longer perfectly vertical. 
Mr Mansel Lewis asks for the planning permission to be rejected and the wall to be removed from his land by Taylor Wimpey.