The video discusses the potential challenges faced by the UK's NHS during a winter influenced heavily by the ongoing Covid-19 pandemic. An official sensitive model prepared by Sage for the Cabinet Office outlines a reasonable worst-case scenario, suggesting significant excess deaths and a peak in demands for critical care facilities. The data highlight the need for NHS and local authorities to prepare while acknowledging the challenges posed by potential wide-ranging outcomes.

Experts, including Professor Helen Stokes Lampard and Greg Fell, weigh in on how effectively these projections, despite being seen as worst-case scenarios, serve as planning tools. They note the necessary collaborative effort between local health services and public adherence to preventive measures, emphasizing how some mitigation efforts have been effective thus far. Moreover, they identify a shift in Covid-19 epidemiology, with younger people contracting the illness, which could affect hospital admission rates.

Main takeaways from the video:

Please remember to turn on the CC button to view the subtitles.

Key Vocabularies and Common Phrases:

1. modelling [ˈmɒdəlɪŋ] - (n.) - The process of creating a representation of a complex situation in order to analyze and predict future outcomes. - Synonyms: (simulation, representation, prediction)

The government has been modelling just how bad things could get.

2. sobering [ˈsoʊbərɪŋ] - (adj.) - Having the effect of making someone more serious or thoughtful. - Synonyms: (serious, thought-provoking, chastening)

It's a sobering read, but it does state it's a reasonable worst case scenario.

3. mitigation [ˌmɪtɪˈɡeɪʃən] - (n.) - The action of reducing the severity, seriousness, or painfulness of something. - Synonyms: (alleviation, reduction, moderation)

People had died already in the first wave and improved mitigation

4. epidemiology [ˌɛpɪˌdiːmiˈɒlədʒi] - (n.) - The branch of medicine which deals with the incidence, distribution, and possible control of diseases. - Synonyms: (disease study, public health, medical science)

But what, what we've seen is a shift in the epidemiology

5. contingency [kənˈtɪndʒənsi] - (n.) - A future event or circumstance which is possible but cannot be predicted with certainty. - Synonyms: (possibility, likelihood, eventuality)

It is a worst case scenario and hopefully people will be planning, will need to plan for the most likely scenario and have a contingency for the worst, rather than use the worst case scenario as the basis for all of their plans

6. localize [ˈloʊkəˌlaɪz] - (v.) - To make something local in character or to restrict something to a particular place. - Synonyms: (concentrate, focus, confine)

In fact, what should be happening is the opposite. You're trying to get the public health doctors on the ground to develop the evidence and the data to localize the problems.

7. contextual [kənˈtɛkstʃuəl] - (adj.) - Related to or depending on the context of something; providing the surrounding information. - Synonyms: (circumstantial, surrounding, relevant)

And so these central positions should stop producing these very vague, implausible documents and repurpose their efforts to provide much better data for local planners, local public health doctors to work on the ground and make decisions on a contextual, local basis.

8. controversy [ˈkɒntrəˌvɜːrsi] - (n.) - Prolonged public disagreement or heated discussion. - Synonyms: (debate, disagreement, argument)

There's been a lot of controversy about some of this scientific modelling and predictions.

9. proactive [proʊˈæktɪv] - (adj.) - Creating or controlling a situation by causing something to happen rather than responding to it after it has happened. - Synonyms: (preemptive, anticipatory, preventive)

So those things are also really important to keep the number of cases as low as possible.

10. potency [ˈpoʊtənsi] - (n.) - The power or influence of something, especially in terms of its effectiveness or impact. - Synonyms: (strength, power, impact)

I mean, when you see this, this apparent difference between these big case numbers in France and Spain and here, does it give you any hope that the virus may be weakening in its potency or that treatment is improving?

Coronavirus - The 'reasonable worst case scenario' this winter - BBC Newsnight

Winter always a tough time for the NHS. But how much tougher will a winter in the shadow of Covid-19 be? The government has been modelling just how bad things could get. Newsnight has seen this official sensitive model, prepared by Sage for the Cabinet Office that sheds some light on the government's thinking. The report is to help the NHS and local authorities plan their services. So intensive care and mortuary space. It's a sobering read, but it does state it's a reasonable worst case scenario, so it's not a prediction and the numbers are subject to significant uncertainty. The model attempted to calculate excess deaths in England and Wales between July to March. The document said there would be a difficult autumn followed by a winter peak. It suggested there'd be 81,000 excess deaths directly attributed to Covid and there'd be 27,000 excess deaths not related to Covid.

In the first wave of COVID planning, how the NHS would cope was a crucial part of the response. Services were stopped to make way for people with COVID The experience of the period from March onwards is that very large spikes in demand probably require the NHS to cancel quite a lot of its planned work, particularly if there is an upswing in other emergency care because of winter conditions. A particular pinch point has been critical care intensive care units. We're very low on beds compared with our european neighbors. The report that you shared has very wide ranges of predictions, which probably makes it quite difficult for people to actually work out exactly what they should be doing. It is a worst case scenario and hopefully people will be planning, will need to plan for the most likely scenario and have a contingency for the worst, rather than use the worst case scenario as the basis for all of their plans.

The model makes various assumptions based on available data to work out how many people with COVID between November and March may need to be hospitalized or go to intensive care. The numbers in brackets reflect a very large range of possibilities. There's lots of uncertainty. Infected people hospitalised 2.4% hospitalised patients going to ICU, 20.5% all hospitalised patients dying 23.3% overall infection fatality ratio 0.7% but some are critical of the modelling and say some of it is already out of date. Newsnight has spoken to people in local authorities who say the wide range of possibilities in terms of hospitalizations and deaths make it hard to know if Covid will have little impact or if it will lead to catastrophic extra pressures.

It's unclear what to expect. I think this idea of taking a central command position and sending out this data in such a shoddy way is not helpful. In fact, what should be happening is the opposite. You're trying to get the public health doctors on the ground to develop the evidence and the data to localize the problems. Where is the issues happening? And so these central positions should stop producing these very vague, implausible documents and repurpose their efforts to provide much better data for local planners, local public health doctors to work on the ground and make decisions on a contextual, local basis.

At the end of July, England's chief medical officer, Professor Chris Whitty, said, these will be difficult trade offs, some of which will be decisions of government and some of which are for all of us as citizens, to do. It seems from the leaked document that restrictions may well be put in place between November and March. Schools will, however, remain open. Two week doubling times return throughout November. That is, incidents quadruples through November, after which policy measures are put in place to reduce non household contacts to half of their normal pre March 2020 lockdown levels. While all school contacts are assumed to be maintained, these measures are sustained until the end of March 2021.

The model suggests a fifth of deaths will occur in care homes lower than in the first wave. This, they say, is because of a smaller, susceptible population. People had died already in the first wave and improved mitigation. This document downplays the role of care homes going into this second wave, and seems to say all of the problems are going to be in hospitals, which has not been the case so far. And I think that's another area where this is just a mistake and an error.

Within the document, it's clear that the NHS and local authorities need to plan something they do year in, year out. But what is less clear is how much faith they can put in these assumptions. Well, in response to our report, a UK government spokesperson said, as a responsible government, we have been planning and to continue to prepare for a wide range of scenarios, including the reasonable worst case scenario. Our planning is not a forecast or prediction of what will happen. It reflects a responsible government ensuring that we are ready for all eventualities.

So is this government scenario going to help the health and care services prepare for what might lie ahead in the coming months? We're joined by Professor Helen Stokes Lampard, chair of the Royal Medical Colleges, and Greg Fell, director of public health for Sheffield. Welcome to you both. Professor Stokes Lampard, if I could start with you. You're obviously familiar with documents of these types, with all the caveats and the, and the statistical variability of them, but what do you make of that headline, 85,000 deaths figure across the UK. That's. That's a stark figure, isn't it? Yes, it's very stark. It's a very grave figure and it is a serious reminder to all of us that Covid isn't gone, Covid isn't faded away.

Covid is. Is very much with us and going to be very troublesome in the months ahead. However, we mustn't be too distracted by one headline figure when there is a huge amount of planning and preparation already underway and the population has learned so much about how to be better with respect to personal hygiene, protecting themselves and their loved ones. So all of us working together will be able to mitigate that. That is the reasonable worst case figure. We don't want to get to worst case figures. We absolutely all need to pull together right now to make sure that does not come to pass.

Now, when you hear experts like Carl Hennigan there in Deborah's peace asking questions about some of this, for example, the predicted doubling of infections or cases in August has not actually materialised. We know that since this document was drafted, it's less than that. Does that give hope that the mitigations that are in place, whether it's quarantine measures or local lockdowns, are effectively preventing this worst case from materializing? It gives us some hope and we have seen an upswing in the numbers. Unfortunately, we've seen a significant increase. Thank goodness. We have not seen an increase in deaths due to Covid. So we seem to be seeing an increase in younger, fitter people contracting the disease.

But that is because, by and large, people are still being responsible. People are now taking up the mantras to keep the vulnerable safe, to wear face masks and keep vigilant about personal hygiene and where local lockdowns have come in, whilst they haven't been popular, people have generally accepted them. And this is good citizenship. This is about us all doing our best for one another, not just ourselves, but our loved ones and our communities around us. And as we plan for the next stages, it's vital that this is a collaborative effort. This isn't just about the NHS working or about local government working or education. We are all in this together very actively.

Let's bring Greg fell in then, on that point, very much the granular picture in Sheffield. Do you feel prepared for what may lie ahead? We're as prepared as we can be. There's been a lot of learning from spring onward. Reflect on some of the very specific stuff from that learning. I think a lot of energy is put on the narrative of local that belies the work that me and my team and people like me are doing day in, day out, which isn't to do with local lockdowns, it is to do with very, very active surveillance, active encouragement to get testing and reinforcing the work that's been done by test and trace to make sure that's as effective as possible, that will avoid local lockdowns.

So those things are also really important to keep the number of cases as low as possible. We know cases will rise into the autumn of winter, there's no doubt about that. In that context of what you've just said about the effectiveness of local action, does that figure in the, the worst case scenario, that only 40% of cases will be stopped by these quarantines, isolation and other measures. Does that seem credible to you or is it too low, do you think? It strikes me as a bit low, to be honest. I've not seen the detail of the document. I've seen a high level output from it, but with none of the detailed assumptions that went into it. And I think professor got it just about right.

There's too much sub national variation to be able to do, to be able to make too many assumptions off from the basis of what we've seen to date. 40% effectiveness seems a bit low to me, but as none of us have really seen the detail, it's actually quite hard to comment on that one. But yeah, it does seem low. Ok, back to Professor Stokes Lampard. Look, I mean, on this journey that we've all been on, many people will have heard about the imperial model at an early stage, predicting hundreds of thousands of deaths. There's been a lot of controversy about some of this scientific modelling and predictions.

Do you think an exercise like this one still serves a purpose, notwithstanding those earlier controversies? Absolutely. It serves a purpose because we need something to plan around now. You know, we create worst case scenarios so that we can plan for them but avoid them. I mean, just in the same way we all take out insurance on our homes, hoping we'll never in our lifetimes need to claim on it. This is what this is all about, the nation to protect us for the future, which is the responsible and right thing to do. And if things work out better, well, that's marvelous.

And in terms of early predictions, the problem at the start of this is we had very little science to go on. The scientific data has been increasing all the time and exponentially. But the issues that Greg and Carl and others have raised is that with a disease of this nature with any pandemic, actually, you're going to have local outbreaks when you get past the first big peak. And it is the control of those outbreaks, it is the local public health teams, it is the local NHS, local citizens working together that will conquer it.

It isn't any one individual thing. And as we go into winter, I would really, really urge everybody to please keep trusting the messages that are coming out. It is in all our interests to get this right. I want to protect my loved ones. Thank you, Greg.

We've seen some really big case numbers in Spain and France, but hospital admissions and deaths not growing at the same speed. Does your experience in Sheffield tell you there's a difference between spikes in case numbers and hospital admissions and what you put it down to? We've seen just the same. So our case numbers in Sheffield are actually quite low at the moment. We expect they'll go up, as I've said. But what, what we've seen is a shift in the epidemiology. There's a definitive.

There's a definitive fall in the mean age of a case. Earlier on, in the peak of the pandemic, the mean age was in the sixties, probably mid to high sixties. Now it's in the mid thirties to the early forties. We know from the epidemiology that younger people, by and large, have a much milder illness and are much less likely to be hospitalized. Therefore, as we've seen, the cases fluctuate.

For us in Sheffield, our hospital activity and those that are poorly enough to get to intensive care is almost zero. It's a small handful of people a week, if that, to be honest. So whilst our cases will rise in the autumn, if they stay within the younger age population, that's far less worrisome. If they start to get back into the older population, then clearly we'll get into the. Into the space where there will be more hospital admissions.

So the onus is upon us to keep the number of cases as low as possible. Greg, thank you. Last word from Helen Stokes Lampard. I mean, when you see this, this apparent difference between these big case numbers in France and Spain and here, does it give you any hope that the virus may be weakening in its potency or that treatment is improving? Is there a sign for hope? There. There is a sign for hope in the sense that, as a nation, our citizens are being responsible and doing the right thing and listening to the advice and guidance, and that those who are most vulnerable are still being extremely careful.

That's what gives me hope. The virus, however, is not changing. And there's no sign that it is weakening. And I think we have to be very, very wary of it. Covid is going to be with us for a very long time.

There will nothing be post Covid. We'll have a post pandemic phase. But Covid is with us. And we need to learn to live with it, to tackle it. And to adapt our lives accordingly.

That isn't the most cheerful of message. But it's the responsible message. And as we go into winter, please, let's all be careful. Thank you. On that note of caution, I'm afraid we have to leave it.

Motivation, Leadership, Economics, Covid-19 Impact, Public Health Strategy, Nhs Preparedness, Bbc Newsnight