Good afternoon and welcome to my regular patient safety update which is unsurprisingly a bit of an omnibumper edition this week as we all come to terms with the latest scary numbers.

A MILLION A DAY? The Health Secretary told the House of Commons that there are currently around 200,000 daily infections of this variant in the UK. Reports this morning suggest we may see a further 300-400,000 infections today and given the doubling time we could be up to a million a day within a week. To put that in perspective, the highest recorded daily infections previously recorded was ’just’ 81,475 – around a quarter of today’s number. So even if Omicron is much milder (more on that later) the NHS could still be overwhelmed by hospitalisations. Parts of the system are already cancelling elective procedures.

EARLY SIGNS from South Africa appear to show you are 29% less likely to get hospitalized from Omicron as from other variants, suggesting it is perhaps milder. But this is being openly questioned by others - including Chris Whitty - on the basis of data reliability and a younger population. This warning from the Chief Medical Officer of Moderna to the Science and Technology Select Committee yesterday was particularly sobering. He even talked about the possibility of Delta and Omicron co existing in the same person potentially leading to even more dangerous variants. More positively, although the protection from transmission drops to 30% after two Pfizer doses  protection against hospitalization remains pretty high at 70%. This, coupled with the fact that the UKHSA thinks a third dose increases protection against symptomatic infection back to 70% makes it a very different picture to last Christmas: whilst most of us will be personally safer, the risks to the NHS will be much higher. Shame, frankly, on the nearly five million adults who could have, but have not had a first dose.

FROM FASTEST TO SLOWEST In that context I do find it hard to understand why we have allowed ourselves to become so slow in approving new vaccines having been a world-beater just a year ago. As I said in the House of Commons on Monday we have been slower to approve boosters than Israel, slower to approve teenage vaccination than France, and slower on the over 5s than the US. There were three whole months between the booster programme starting in September and the JCVI deciding all adults should get a third dose. I put this to Professor Wei Shen Lim, Chair of the COVID-19 panel at the JCVI at the Scient and Technology Committee yesterday. His argument seemed to essentially be that boosting people too soon would mean people’s protection would wear off - but surely with the risk of variants that has turned out to be the wrong judgement.

CAN BOOSTERS SAVE US? The booster programme has now been accelerated to offer all adults a jab by the end of the month which seems to have had the desired effect judging by the queues. It is definitely our best hope but may not be enough according to this depressing but convincing read. Last night the House of Commons agreed to the introduction of COVID passes, an extension of where face coverings are mandatory, and the removal of the requirement for contacts of Omicron cases to self-isolate. Political coverage this morning has focused on the damage to the Prime Minister’s authority from having 100 Conservative rebels, but what strikes me most is how distorted the libertarian argument against covid passes has become. This excellent piece by William Hague in yesterday’s Times explains why libertarians should support covid passes. His central point is that freedom comes with responsibilities as well as rights, including taking reasonable measures to help keep others safe from infection in a pandemic. But given how fast Omicron is spreading the vote actually felt like it was fighting yesterday’s war - the issue now is not whether we have covid passes but whether nightclubs are able to open at all.

CQC SUSPENDS INSPECTIONS Given the pressures on NHS staff caused by Omicron and the acceleration of the booster programme the CQC has sensibly announced they are postponing on-sight inspection activity with immediate effect. As a big fan of CQC inspections I write this with a heavy heart even though it is clearly the right thing to do.

HSIB NATIONAL INVESTIGATION Their latest report into delays in recognising acutely unwell infants was released at the end of last week. It particularly highlighted how difficult it is for NHS staff to differentiate between fevers caused by mild viruses and those by deadly bacterial infections. It recommended five safety improvements to help with this largely based on better communication and training.

COVID LATEST STATS These don’t include the full Omni-picture which is why I have left them to the end. The ONS suggested that around 900,000 people in England had the virus in the week ending 1st December, roughly the same as the week before and equivalent to 1 in 60 of the population. There are 7,672 covid patients in hospital and this is the key number to keep an eye on to gauge the full extent of Omicron’s impact. But nearly 6,000 were admitted in the last 7 days, a 10% increase. 

THE BORING BIT As ever you can sign up to receive this update via our website here and please tell any friends you think might enjoy it.

THE BETTER BIT (WE HOPE) Have a wonderful Christmas all - stay safe, healthy and happy - and see you in the New Year.

Jeremy Hunt