Health & Wellbeing

Mental health support, jobs and training among key recovery priorities for West Midlands Citizens’ Panel

Residents from across the West Midlands have put forward their priorities and principles to rebuild the region following the coronavirus pandemic.

The priorities were proposed by a Citizens Panel convened by the West Midlands Recovery Coordination Group (RCG) to understand the residents’ views in prioritising our recovery.

The panel, consisting of 36 locals from across the region and a range of backgrounds, met throughout the summer to learn about the issues facing the region and share experiences of how the pandemic has affected them and their families.  

As a result, they agreed six priorities they think should be addressed to help the region recover:

Getting back to normal, safely - ensuring people can live safely and there is clear guidance as we move out of lockdown and to avoid a second peak.
Healthcare - making sure that patients can be treated, avoiding risk of Covid-19, and the healthcare system gets back on track to diagnose and treat people when they need it. It also means promoting healthy living to reduce demand for the NHS in the long-term.
Mental Health – specific emphasis on making sure that anyone who needs mental health support knows where to find it and is guided to access support.
Education - preparing children to go back to an adapted school environment, ensuring their safety and wellbeing. Making sure that every child is supported to make up for lost time so children from all backgrounds are equally able to achieve their goals.
Employment - creating new jobs, with an emphasis on apprenticeships and entry-level jobs. Making sure that additional training is provided to give people the right skillsets to enter the workforce and getting people who have lost their jobs for Covid-related reasons back into work.
Promoting and supporting business - especially smaller and/or local businesses and the self-employed for example by encouraging people to buy local. Providing financial and business support to help them get back on their feet and protect jobs.

The RCG is now coordinating work with partners across the region to shape plans to deliver in each of these areas.

Deborah Cadman chair of the RGC said: “Before the pandemic, the West Midlands was one of the best regions to live, work and play. While we have been badly hit by the pandemic, I know that the region can reset and rebuild stronger than ever.

“Every person that lives in the West Midlands has played a part in its success and it’s important that they can now also play a part in its recovery. That’s why we established this panel, to ensure the views of the people we serve are shaping the region’s recovery. The RCG has listened to what our residents think should be our priorities and will now set out plans to deliver them.”

As well as the six priorities the Citizens Panel put forward four principles to guide community recovery. The full set of recommended priorities and principles from the Citizens Panel can be found in the final report issued by BritainThinks who delivered the programme. Insights from the Citizens’ Panel also formed the basis of a survey of 500 members of the public in the West Midlands, also conducted by BritainThinks
 
Councillor Brigid Jones, the chair of the Citizens’ Panel steering group and WMCA portfolio holder for inclusive communities, said: “The Panel is made up of a cross section of the West Midlands and we have asked them for their considered views on what recovery should look like.

“They have taken time to listen to others and learn how decisions are made by the region’s leaders. Now they have given us their responses we will be using them to help guide our recovery.”

Now that summer has begun in earnest, research reveals why ditching your PJ’s before bed could be more beneficial than you think.
 
In the summer months, the average household temperature in the UK rises to 20 degrees[1]. With this in mind, online furniture retailer, Furniture Choice, polled the British public to find out how this could affect their sleeping habits, revealing that one in four (23%) Brits already choose to sleep in the nude, which doctors claim can result in significant health benefits. 
The study also found that 40% of Brits don’t generally have a good night’s sleep, with nearly a quarter (24%) stating they only get six hours of sleep a night - despite the recommended 7-9 hours [2].
 
But the sleep issues don’t stop there as over a third (36%) reported waking up in the morning feeling tired, with a sore back (32%) and a sore neck (27%).
 
Dr Sarah Brewer, a general practitioner, explains that sleeping in the nude may not cure those aches and pains, but it does have other significant health benefits to consider, especially during the summer months: “Sleeping naked means that your body remains cooler during the night, which is important as overheating is a common cause of disturbed sleep.
 
“Being over-hot in bed by even 3-4 degrees changes brain-wave patterns, reduces the amount of time you spend in REM sleep, increases the chances of waking up and reduces deep sleep.”  
 
Dr Brewer states there are five key benefits of sleeping naked:

1. Aids weight loss If sleep is disrupted from being too warm, your body produces more cortisol than usual, leading to an increased appetite.
2. Improves skin problems Overheating at night can worsen many skin conditions, such as eczema, so sleeping naked can help prevent this.
3. Reduces risk of fungal skin infections Candida yeast cells change from the superficial ‘harmless’ cell form, to invading threat form, when conditions are warm and moist. Sleeping naked and airing areas susceptible to thrush can lead to fewer recurrent Candida infections. 
4. Improves relationships with significant other Sleeping naked gives a sense of freedom and may help couples feel more loving. Humans are highly-tuned to the sight of bare skin, which acts as a signal for sexual arousal.
5. Improves male fertility Testosterone hormone is secreted at night and rises in certain stages of sleep. If a man feels too hot and his sleep is disturbed as a result, his testosterone production may be reduced. Sleeping naked helps to promote a healthier sleep pattern, so normal testosterone production occurs.

With this in mind, experts at Furniture Choice developed a comprehensive guide to help people get the best night’s sleep possible. To find out more, visit: https://www.furniturechoice.co.uk/advice-and-inspiration/how-to-get-a-good-nights-sleep_a068

Rebecca Snowden, Interior Style Advisor at Furniture Choice, said: “It’s shocking to see how many Brits aren’t currently getting a good sleep every night. Our bodies repair themselves during sleep so a good night’s rest is crucial to a happy and healthy life. If thinking more about your bedroom attire, or lack thereof, is one way of fixing your sleeping pattern this summer, we think it’s definitely worth trying for those struggling to get some shut-eye.

“Staying away from blue-screen lights a couple of hours before bed, and taking a bath, are also great ways to prepare our bodies for going to sleep. It’s also important to have a mattress and pillows that are designed to your requirements, ensuring you have a comfortable night’s sleep.

“Take a look at our sleep guide to get the most out of bedtime.”

UK Prime Minister Boris Johnson has warned there are signs of a "second wave" of coronavirus in Europe, as he defended a 14-day quarantine on travellers from Spain.

He said the government had to be "swift" - and hinted at further action against other countries if necessary.

But airline Jet2 said information from the government was "contradictory and often comes with little or no notice". It comes after the Spanish prime minister called the UK's decision to change the rules for Spain "unjust". Pedro Sánchez said tourists in most regions in Spain would be safer from coronavirus than in the UK.

The UK is advising against all non-essential travel to Spain, including the Balearic and Canary Islands. It also removed Spain and its islands from the list of countries that are exempt from the 14-day quarantine rule.

The PM said it was up to individuals to decide whether they wanted to take the risk of travelling during the pandemic. "These are decisions for families, for individuals, about where they want to go," he said. Meanwhile, Germany has advised against travel to three areas of Spain.

Speaking during a visit to Nottinghamshire, Johnson said: "What we have to do is take swift and decisive action where we think that the risks are starting to bubble up again. "Let's be absolutely clear about what's happening in Europe, amongst some of our European friends, I'm afraid you are starting to see in some places the signs of a second wave of the pandemic."

It came as the UK reported a further 119 coronavirus deaths - taking the official number of fatalities so far to 45,878 - but the daily figure is typically higher due to delays in reporting deaths at the weekend. An additional 581 positive cases have also been reported across the UK, a small dip on recent days.

Asked about reports that the 14-day period could be reduced, Mr Johnson said: "We are always looking at ways in which we can mitigate the impact of the quarantine. "At the moment you have got to stick with the guidance that we are giving, we have given the guidance now about Spain and about some other places around the world."

On whether the 14-day quarantine period could be cut, transport minister Baroness Vere said the government was "looking at a range of options" including "testing people on certain days" after they arrive.

Ministers are also "certainly looking" at the idea of restrictions on travel to regions rather than whole countries, she said during an urgent question in the House of Lords.

People in Wolverhampton who have been shielding during the coronavirus pandemic will shortly receive a ‘care pack’ which includes a reusable face covering and advice on how to adapt when the period of shielding is paused on 1 August.

The packs will be sent to nearly 6,000 clinically extremely vulnerable people over the coming days thanks to a collaboration between the City of Wolverhampton Council, the Royal Wolverhampton NHS Trust and Wolverhampton Wanderers Football Club.

The washable and reusable face covering features the words ‘Project Relight’, an acknowledgment of the city’s campaign to recognise how the people of Wolverhampton have played their part in the fight against coronavirus.

Also included in the pack is information on preventing the spread of Covid-19 and how to stay safe when out and about, useful advice that will assist those shielding to regain some normality to their lives over the coming months.

There is also a treat for football fans, with a special message from Wolves manager Nuno Esprinto Santo offering words of hope and encouragement.

From Saturday 1 August, Government guidance is being relaxed with clinically extremely vulnerable people no longer advised to shield, but support will remain available to them from the City of Wolverhampton Council and local NHS volunteers.

People who have been shielding will retain priority for supermarket delivery slots and will still be able to access help with shopping, medication, phone calls and transport to medical appointments.

Leader of the Council, Councillor Ian Brookfield, said: “We’ve said from the very start of this pandemic that we would do everything in our powers to support the people of Wolverhampton throughout this national emergency.

“The past few months have been extremely challenging for us all, but particularly so for our most vulnerable residents.

“We know the end of shielding will be a really daunting time for many and we want to let them know that we will continue to be there for them and that they can still call us when they need assistance.

“As part of this continuing support, we’re really pleased to have worked with the Royal Wolverhampton NHS Trust and Wolves to develop special care packs which will be sent out to 6,000 of our most vulnerable residents in the coming days. We hope they will prove really useful and help us all overcome the challenges ahead together.”

Wolves captain Conor Coady said: “The last few months have been an incredibly difficult time for everyone, especially for the clinically vulnerable who have been shielding safely in their homes.

“Getting used to our new way of life can be an anxious time, and we hope the care package will help with that process for some of the city’s most vulnerable residents.

“As a squad, we are just happy to be able to offer our support to those people that have given us their support and backing over the years. Together, we are stronger, and we will get through this.”

David Loughton CBE, Chief Executive of The Royal Wolverhampton NHS Trust, said: “I want to say a huge thank you to everyone involved in protecting and supporting individuals who may be at highest risk during this pandemic.

“Working in partnership with the City of Wolverhampton Council and Wolves we are happy to support the special care packs that are being distributed to our most vulnerable residents and hope it will help them with the upcoming changes.”

While clinically extremely vulnerable people should continue to follow strict social distancing measures and continue to remain home as much as possible, from 1 August they will be able to take part in more everyday activities like shopping and visiting places of worship.

And from 1 August, shielders who need to work and cannot do so from home will be able to return to work as long as their workplace is Covid-secure, adhering to the latest guidance available. Shielders should speak to their employer in the first instance.

Project Relight launched in June with the release of a short film centring around the city motto ‘Out of Darkness Cometh Light’, reflecting on recent challenging times and also looking ahead to brighter days. It can be seen at https://www.14dd5266c70789bdc806364df4586335-gdprlock/watch?v=PtGJZJFJtTU.

Project Relight has also seen the unveiling of a new mural for the city by Wolverhampton artist Steve ‘Graffoflarge’ Edwards. The mural in Old Hall Street on the site of the City Learning Quarter, proudly boasts the ‘Out of Darkness Cometh Light’ motto.

Everyone is reminded they should book a test if they show symptoms of Covid-19, such as a high temperature, a new, continuous cough or a loss or change to your sense of smell or taste. For more information, and to apply for a test, please go to www.gov.uk/coronavirus or call 119. All appointments must be booked in advance.

People can also use the Royal Wolverhampton NHS Trust's Ask A&E tool at http://rwt.nhs.uk/askaande/ to input and monitor their symptoms and speak to a healthcare professional via video chat if required.

Anyone in Wolverhampton who tests positive for Covid-19 will be contacted by NHS Test and Trace and will need to isolate and share information about people that have been close contacts recently.

The latest information and guidance around coronavirus is available at www.gov.uk/coronavirus and on the council’s own coronavirus pages at www.wolverhampton.gov.uk/coronavirus. There’s lots of advice on how people can protect themselves and their families from coronavirus from the NHS at www.nhs.uk/coronavirus.

The council’s Stay Safe, Be Kind campaign offers clear and simple advice about how people can help themselves, and how they can support others who may be particularly vulnerable at this time.

A unique type of blood testing equipment manufactured by a small company in West Wales is emerging as an important tool for understanding how Covid-19 affects the body and for choosing the best treatments for patients.

Benson Viscometers designs and manufactures blood viscometers which, put simply, measure the thickness of blood. In June, doctors at Emory University in the USA, hit on the idea that blood thickness (or viscosity) might be an important pointer for deciding how to treat Covid-19 patients. They had noticed that many Covid-19 patients had unusual blood clotting that did not respond to the usual anti-clotting medication.

“We were unsettled by the fact that some patients with severe Covid-19 had atypical blood clots, even when therapeutically anticoagulated,” says Cheryl Maier, Assistant Professor of Coagulation and Transfusion Medicine, Department of Pathology and Laboratory Medicine, Emory University School of Medicine and medical director of Emory’s Special Coagulation Laboratory. 

“This prompted us to consider other causes of clot formation, like hyperviscosity, which can be detected by plasma viscosity testing. We found that the sickest patients with Covid-19 had the highest plasma viscosity levels, more than twice normal levels. We also found that patients with the highest viscosity levels were more likely to have a blood clot. We think that the inflammation caused by SARS-CoV-2 infection causes the hyperviscosity, which may contribute to blood clots in some patients.”

She adds that the viscosity levels in the sickest Covid-19 patients were similar to those seen in a type of blood disorder called hyperviscosity syndrome, where the high viscosity leads to dangerous sludging of the blood in the brain and other organs.

“We need larger studies to understand whether hyperviscosity is simply a marker of severe Covid-19 or actually contributing to blood clots in these patients,” she says. “Nevertheless, we’re trying to determine any beneficial role of lowering the viscosity in these patients through a treatment called plasma exchange.”

In the UK, Addenbrookes Hospital is using Benson Viscometers’ equipment to explore how best to understand and treat Covid-19. They have been carrying out the test on all suspected Covid-19 patients to establish a link between PV (plasma viscosity) and Covid-19 and to explore how plasma viscosity relates to the severity of and/or recovery from the disease.

“The tentative results so far, prior to sufficient statistical analysis, clearly show that there is an increase in the PV level associated with a positive Covid result. This is in line with what we would expect,” says Daniel Gleghorn, Senior Biomedical Scientist - Automation Lead, Clinical Haematology, Cambridge University Hospitals NHS Foundation Trust.

“I believe the PV test has potential as a useful marker in the diagnostic assessment of patients with suspected Covid-19 and for monitoring disease progression.”

He adds that the PV test has some important advantages over other tests that are used to detect inflammation, including cost and availability.

“From a laboratory management perspective, it is well documented that the PV test provides a more useful indicator of infection, inflammation and malignancy than the traditional ESR,” he says. “It is also a cost-effective test compared with other expensive biochemical methods, can be performed on the same EDTA tube used for a full blood count and is quick and easy to perform.

“There is also the benefit of a less complicated and reliant supply chain for consumables and reagents. This has been significantly affected for other tests (CRP, procalcitonin and Interleukin-6) where this is not the case due to a worldwide increase in demand and the effects of lockdowns on distribution networks.”

Meanwhile, Health Services Laboratories in London is also on the case. HSL is a partnership between the Australian company TDL (The Doctors Laboratory), UCLH (University College London Hospitals NHS Foundation Trust), The Royal Free London NHS Foundation Trust and North Middlesex University Hospital.

HSL’s flagship laboratory, 'The Halo' in London (one of the largest pathology laboratories in Europe) is using the plasma viscosity test to monitor inflammatory status in certain groups of Covid-19 patients, and is exploring the possibility that high inflammatory markers might indicate the need for alternative strategies for stroke prevention in these patients.

“The aim is to get an overall insight on the reoccurrence of strokes despite patients being on antiplatelet medication and to identify the battery of tests available that can help in these cases,” says Deepak Singh, Head of Department, Haematosis, at Health Service Laboratories.

For Benson Viscometers, these developments have led to heightened interest in the clinical analysers the company has been making for over 20 years. Demand for viscosity testing has now risen so much in the light of Covid-19 that the company is about to take on an additional development premises in Haverfordwest.

Bernie Benson, who created Benson Viscometers, is pleased to see his equipment helping to shape the understanding of Covid-19 and the development of effective treatments.

"It is encouraging to see the growing intensity and vigour of interest in blood and blood plasma viscosity which has been generated by the demand for answers on how to combat the coronavirus," he says. " We are able to apply our ingenuity and ability to adapt and respond to the rapidly changing demands and needs generated as a result of this global pandemic.

“The plasma and serum viscosity test is highly valued and routinely used by many eminent UK hospitals for a range of conditions, and it is exciting to see how blood viscosity tests are now being utilised in the USA."

Looking to the future, there is clear potential that the wider use of these blood tests will lead to a significant improvement in the outcome for critically ill patients and that the high value of this approach will be recognised.

“Covid-19 is not going away, well at least not for the next few years,” says Daniel. “There is however, a need for a diagnostic and prognostic testing strategy not just for the short term, but for many years ahead. If it can be proven that a PV test can be used as part of a diagnostic algorithm, possibly as a positive predictive indicator for Covid-19 it may then form part of a recognised battery of tests for this purpose.

“In addition, determining the prognostic value of PV will hopefully provide an aid to clinicians showing a potential improvement or deterioration in the patient’s condition. The clinicians can then act appropriately in a timely manner. Plasma viscosity at point of care for these patients may also be a possibility.”

A network of coronavirus-testing walk-in centres is to be set up across England in an attempt to persuade more people to come forward for testing.

Several hundred walk-in units will be up and running by the end of October, in time for winter, when there is concern cases could start to rise. They will complement the existing drive-through centres, mobile testing units and home-ordering service.

It comes amid concern people are still not coming forward for testing. The government's weekly random test of 30,000 people, run by the Office for National Statistics, suggests there are about 1,700 new infections a day. But the testing service is picking up only about a third of those.

Some of that will be because people are not showing symptoms when they are infected, but bosses at the NHS Test and Trace service said they wanted to see more people come forward for testing. Meanwhile, Public Health England has released its weekly report into local infection rates.

It shows Blackburn has had the most positive cases per 100,000 people over the past week at nearly 80.

Leicester, which was placed into local lockdown earlier in the month, has seen cases fall.
Extra measures have been introduced in Blackburn, including tougher guidance on household mixing. But a full local lockdown is not on the cards yet.

Luton has also been designated an area for intervention alongside Leicester and Blackburn.
It means some of the restrictions being eased nationally from this weekend, including the re-opening of gyms, will not now happen there. Other areas among the top 10 are Kirklees, Sandwell, Rotherham and Bradford.

These are all being closely watched, with local public health teams encouraging those who have been in close contact with confirmed cases to self-isolate. Overall, there are signs the contact tracing service - NHS Test and Trace - is beginning to improve on some measures.

Some 80% of people who tested positive over the past week provided details of close contact. Of those close contacts provided 78% were reached and asked to isolate, up from 72% last week.

NHS Test and Trace head Baroness Harding said she was pleased with the performance. But she said the "most important lever" in keeping the virus at bay was to get more people to come forward for testing, which was why a network of walk-in centres was being created.

"NHS Test and Trace relies on everyone playing their part," she said. "We all need to get a test if we have symptoms, share details of our contacts if we test positive and self-isolate when asked to do so."

The UK will be living with coronavirus for many years to come and even a vaccine is unlikely to eliminate it for good, experts are warning.

Wellcome Trust director Prof Sir Jeremy Farrar told the House of Commons' Health Committee "things will not be done by Christmas". He went on to say humanity would be living with the virus for "decades". It comes after the prime minister said last week he hoped for a return to normality by Christmas.

Prime Minister Boris Johnson made the comments as he set out plans to further ease restrictions, including the opening of leisure centres and indoor swimming pools later this month and the prospect of mass gatherings being allowed from the autumn. But experts giving evidence to the cross-party group of MPs said it was important to be realistic that the virus would still be here.

Sir Jeremy, a member of Sage, the government advisory body, said the world would be living with Covid-19 for "very many, many years to come. Things will not be done by Christmas. This infection is not going away, it's now a human endemic infection.

"Even, actually, if we have a vaccine or very good treatments, humanity will still be living with this virus for very many, many years.... decades to come." He urged against complacency during the summer, saying the period was a "crucial phase" to prevent a second wave.

"If we have any sense of complacency of 'this is behind us', then we will undoubtedly have a second wave, and we could easily be in the same situation again." He said it was important to further build up testing capacity as well as investing in treatments and vaccines.

Prof Sir John Bell, of the University of Oxford, said he thought it was unlikely that Covid-19 would ever be eliminated despite the positive news announced on Monday that trials by his university had triggered an immune response - an important step in developing a vaccine.

"The reality is that this pathogen is here forever, it isn't going anywhere," he told MPs. Look at how much trouble they've had in eliminating, for example, polio, that eradication programme has been going on for 15 years and they're still not there. So this is going to come and go, and we're going to get winters where we get a lot of this virus back in action.

The vaccine is unlikely to have a durable effect that'll last for a very long time, so we're going to have to have a continual cycle of vaccinations, and then more disease, and more vaccinations and more disease.

"So I think the idea that we're going to eliminate it across the population, that's just not realistic."

The government's chief medical adviser was also quizzed by MPs.

Prof Chris Whitty was asked at length about the UK's record so far in tackling coronavirus.
He defended moves to end attempts at trying to contain the virus in March, while defending the actions of ministers accused of announcing lockdown too late.

Crucial evidence about the scale of the outbreak and modelling about how quickly it could spread was presented to ministers on 16 March. But it was a full week later that a total lockdown was announced.

Prof Whitty said it was not a "huge delay" given the "enormity" of the decision. He also pointed out that others steps were taken in the meantime, including the closing of schools.

Meanwhile, Health Secretary Matt Hancock has defended the government's record on testing - and his decision to set the target of providing 100,000 tests a day by the end of April. The move has been criticised with some describing it as arbitrary. But Mr Hancock told the Science and Technology Committee, which was sitting after the Health Committee, that it was important because of the need to "scale up" at an unprecedented speed.

"The point of the big, hairy, audacious goal is to say to the whole system, 'this is where we're going, you do your bit, let's get there'."

UK coronavirus statistics:

45,422 people had died in hospitals, care homes and the wider community after testing positive for coronavirus in the UK as of 5pm on Monday, up by 110 from the day before
Separate figures published by the UK's statistics agencies show there have now been 56,100 deaths registered in the UK where Covid-19 was mentioned on the death certificate
In the 24-hour period up to 9am on Tuesday, there had been a further 445 lab-confirmed cases. Overall, a total of 295,817 cases have been confirmed since the outbreak began

Around 15,955 fewer vital heart ultrasounds in the West Midlands during lockdown

According to the British Heart Foundation around 15,955 fewer heart ultrasound tests were carried out in the West Midlands after lockdown began. 

Latest NHS England data (1) shows the number of completed echocardiograms fell by nearly two-thirds (65 per cent) across April and May compared to February this year. 

Echocardiograms, also known as echo tests, are ultrasound scans that enable doctors to diagnose, give a prognosis, and determine follow-up treatment for a range of heart conditions, such as heart valve disease, and heart failure.  

The figures show the considerable impact the pandemic has had on patient treatment and care. Only 8,889 echo tests were carried out in April and May this year, compared to 24,844 completed in the same months last year. 

The BHF says heart patients have been hit doubly hard by the Covid-19 pandemic. Long waits for tests like echocardiograms could lead to more deaths from undiagnosed heart conditions. At the same time, people living with heart and circulatory disease are more likely to develop complications from Covid-19. 
 

As the number of completed echo tests has fallen, patients have been waiting longer for these tests due to a fall in GP referrals and the temporary pausing of cardiology services for all but the most urgent cases. By the end of May this year, around 65 per cent of people referred for an echo had been on the waiting list for six or more weeks, compared to just 1 per cent at the end of February. 

Long-term delays to this kind of treatment and care could lead to a devastating domino effect which results in greater pressure on hospitals and worsening health for patients, according to the BHF. The leading charity is calling for heart services to be reinstated quickly and safely as a priority. 
 
Dr Sonya Babu-Narayan, Associate Medical Director at the BHF and Consultant Cardiologist, said: “Heart patients have been hit doubly hard by the coronavirus pandemic. Not only are they at greater risk of complications from Covid-19, but they have also faced delays to vital treatment and care. 
 
“Echocardiograms and other tests are used to diagnose and monitor a range of heart and circulatory conditions and are often among the first steps in someone’s treatment journey. Delaying them could have a devastating knock-on effect on the rest of their care, preventing them from accessing the specialist treatments they may desperately need in time. Ultimately, this could lead to patients becoming sicker as they await care and, ultimately, more deaths. 

“The NHS is now facing a cliff edge as it contends with resuming services and tackling a significant and growing backlog of treatment, all while continuing to fight Covid-19.  These challenges are great, but they are not insurmountable. Restoring and maintaining care for patients living with long-term conditions, such as heart and circulatory diseases, must now become a priority.” 
 
The latest figures come as BHF funded research published this week also showed how important echo imaging can be for patients with coronavirus in hospital. The paper, published in European Heart Journal - Cardiovascular Imaging, revealed that one in three patients hospitalised with Covid-19 who received an echocardiography scan had their treatment changed as a result. 

 
The BHF is now calling for the full breadth of heart services to be restored step by step as the NHS begins to look beyond just providing emergency care. 
 
Echo tests must be carried out in a safe environment and wherever possible, heart investigations need to be co-ordinated to limit the number of times a patient has to visit hospital. 
 
People with stable heart conditions who may have become unstable during lockdown must be followed up urgently. In addition, services that help patients stay out of hospital must be reinstated to reduce pressure on the NHS in the long term. 

 
Diagnosing and treating risk factors for heart and circulatory diseases also remains crucial to prevent additional cases far into the future. 

During the pandemic, the BHF is doing all it can to offer information and support to people living with heart and circulatory diseases throughout the current crisis, and beyond, through its website and Heart Helpline. 

 
In addition, BHF funded researchers across the UK are already carrying out studies that could rapidly lead to increased understanding and improved care for people with heart and circulatory diseases affected by Covid-19. This includes work to better understand why Covid-19 illness can lead to heart complications, as well as studies looking at the indirect impact of the pandemic on patients with heart and circulatory diseases. 

Housework in India usually involves a lot of heavy lifting. Unlike in the West, few Indian homes are equipped with dishwashers, vacuum cleaners or washing machines.

So, dishes have to be individually cleaned, clothes have to be washed in buckets and hung out to dry, and homes have to be swept with brooms and mopped with rags. Then there are children to be looked after and the elderly and infirm to be cared for.

But what happens when the help can't come to work because there is a nationwide lockdown?

In one unique case a petition urging Prime Minister Narendra Modi to intervene.

"Does the handle of a jhadu (broom) come printed with the words: 'to be operated by women only'?" asks the petition, published on change.org.

"What about the manual of the washing machine or gas stove? Then why is it that most men are not doing their share of housework!"

The petition's author, Subarna Ghosh, who was fed up of cooking and cleaning and doing laundry while trying to work from home, wants the prime minister "to address the issue in his next speech" and to "encourage all Indian men to do an equal share of housework. It's a fundamental question, why don't more people talk about it?" she wrote.

Ms Ghosh's petition has gathered nearly 70,000 signatures - a reflection of the scale of gender inequality in homes across India. According to an International Labour Organization report, in 2018 women in urban India spent 312 minutes a day on unpaid care work. Men did 29 minutes. In villages, it was 291 minutes for women as against 32 minutes for men.

In Ms Ghosh's Mumbai home it was no different. The petition came out of "life experiences of my own, and also of lots of women around me". The burden of housework had always been hers, she said. "I do cooking, cleaning, making beds, laundry, folding clothes and everything else."

Her husband, a banker, was "not the type to help with housework", she said. Her teenage son and daughter sometimes chip in.

Ms Ghosh, who runs a charity which works on reproductive justice, said the expectation that she would be the one to compromise on work was much higher during the lockdown.

"My work suffered, at least in April, the first month of the lockdown. I was exhausted all the time, I was tired every day. Our family dynamics changed. I definitely complained a lot. And when I complained people said, 'Then don't do it'."

Ms Ghosh took their advice - for three days in early May, she didn't do any dishes or fold any clothes.

"The sink was overflowing with unwashed dishes and the pile of laundry grew bigger and bigger," she said. Her husband and children realised how upset she was and they cleaned up the mess. "My husband has started helping me with chores.

He understood I was very affected by it, that it was bothering me a lot," she said. "But our men are also victims of this culture and society. They have not been trained to do housework. They require a little bit of hand-holding."

That's because in India, as in many other patriarchal societies, girls are groomed from a young age to be perfect homemakers. It is taken for granted that the housework is their responsibility and if they went out and got themselves a job, they would just have to do "double duty" - manage both home and work.

She said: "As a child, it was always me who had to do house chores, work in the kitchen and help out my mom," wrote one woman, Pallavi Sareen, when I asked friends and colleagues on Facebook for their stories about division of labour. "My brother wouldn't even serve himself lunch."

Most who replied saying their homes were gender neutral had either lived abroad or married men who had spent time in the West. The stories closer to home were different.

"Housework is still considered a woman's job," wrote Upasana Bhat. "Even if men offer to help, how many will do so if the couple live with the in-laws? That would be a truly progressive day. I know of women whose husbands help out, but can't lift a finger in the kitchen when his parents visit."

According to an Oxfam report, Indian women and girls put in more than three billion hours of unpaid care work daily. If it were assigned a monetary value it would add trillions of rupees to India's gross domestic product. But in reality, the cost of housework is rarely calculated. It is seen as something a woman does out of love.

Growing up, Ms Ghosh thought differently. She saw her mother and aunts do all the housework and thought, "No way I'm going to be like that".

When she married, the fault lines over housework were partly hidden because of the presence of domestic help, leading to a false sense of equality at home. "Domestic help also helps maintain peace in our homes," she said. "The chores are taken care of and it seems all is well."

But the lockdown brought the family face-to-face with the daily drudgery of housework and with the inequality that had been "shoved under the carpet".

"The lockdown made these chasms more glaring," Ms Ghosh said. "It also gave me an opportunity to look it in the eye and lay it bare." So she set about petitioning the prime minister.

The women she spoke to in her neighbourhood said they were equally frustrated with housework, but most found the idea that their husbands help around the house ludicrous.
"Many asked me, 'How can he cook or clean?' Many, in fact, praised their husbands for being easy-going. They'd say, 'He's very nice, whatever I cook he eats without complaining'."

The issue was so close to home that it was difficult to confront, Ms Ghosh said. "When it's your own father, brother or husband, how do you question them? But the personal is political too - so I need to talk about it, but I also have to play the good wife."

When Ms Ghosh told her husband that she was starting a petition he was "very supportive", she said.

"His friends made fun of him. They asked him, 'Why didn't you just do some housework? Look, now your wife has gone and petitioned Modi. He took it on the chin," she said, laughing. "He told them, 'Because more men listen to Mr Modi than their own wives'."

Ms Ghosh's petition was also criticised by a lot of people on social media. Many chided her for bothering the prime minister with "a frivolous matter. Some people wrote to me saying Indian women need to do their housework. Yes we do, but where are the men?"

Asked about whether she thought Mr Modi would talk about housework she said: "I'm hopeful.

“Mr Modi has a huge support base among women, so he should talk about an issue that's important to women. When the rainy season started, he talked about cough and cold, so why can't he talk about gender equality?"

NHS staff use free shuttle bus 10,000 times to get to work during Covid outbreak

The free shuttle bus service set up to ferry NHS staff in the West Midlands to hospital during the coronavirus lockdown has been used more than 10,000 times.

The West Midlands ring and ride minibuses were redeployed at the start of April and targeted at hospitals and care facilities where regular bus and rail services had been reduced. Shuttle buses have been running from park and ride sites at Metro stops and railway station car parks to hospitals. The service has proved particularly popular with staff working at Good Hope Hospital in Sutton Coldfield, Wolverhampton’s New Cross Hospital and Walsall’s Manor Hospital.

Paul Jennings, NHS Birmingham and Solihull Sustainability and Transformation Partnership leader, said: “We are absolutely delighted that so many local NHS and care staff have been able to get to work during COVID-19, thanks to the shuttle bus service.
 
“This service was established to support our amazing staff to be able to get to work in a safe, efficient and convenient way, at a time when they are going above and beyond to help provide the best possible care for local people. We would also like to thank the bus drivers who have brought a smile to colleagues’ faces on their journeys and looked after our teams so well.”
 
Mayor of the West Midlands Andy Street said: “I am delighted that we have been able to help so many of our frontline NHS staff get to work during lockdown, especially at a time when regular public transport services were reduced. It meant that some hospital staff, who were busy dealing with the pandemic, did not have to worry about how they were getting to work every day. They’ve made a heroic effort during this crisis and this was one way we were able to offer practical help.”

TfWM is part of the West Midlands Combined Authority (WMCA) and Councillor Ian Ward, WMCA portfolio holder for transport and leader of Birmingham City Council, said: “TfWM has worked with transport operators to keep the network running throughout the outbreak to support our key workers and help those with no private transport to get their essential supplies.

“However, where there were gaps due to reductions in service, we have made good use of the ring and ride fleet to provide extra support and make journeys to work easier for NHS staff.”

The ring and ride minibus fleet, operated by National Express Accessible Transport (NEAT) under contract from Transport for West Midlands (TfWM) was able to be redeployed because the vast majority of its regular users did not need transport during lockdown.

The shuttle buses were targeted at locations as a supplement to regular public transport services or to make up the final part of a journey such as between Sutton Coldfield railway station and Good Hope Hospital. In some cases the minibuses needed to be pre-booked by staff. Each minibus carries a maximum of two passengers to ensure social distancing is maintained.  The shuttle buses will run until further notice.

Millions of people around the world could be exposed to dangerous levels of heat stress - a dangerous condition which can cause organs to shut down. Many live in developing countries, and do jobs that expose them to potentially life threatening conditions. These include being out in the open on farms and building sites or indoors in factories and hospitals.

Global warming will increase the chances of summer conditions that may be "too hot for humans" to work in.

An emergency medic, Dr Jimmy Lee's labouring in the stifling heat of tropical Singapore to care for patients with Covid-19. There's no air conditioning - a deliberate choice, to prevent the virus being blown around - and he notices that he and his colleagues become "more irritable, more short with each other"
.
And his personal protective equipment, essential for avoiding infection, makes things worse by creating a sweltering 'micro-climate' under the multiple layers of plastic.
"It really hits you when you first go in there," Dr Lee says, "and it's really uncomfortable over a whole shift of eight hours - it affects morale."

One danger, he realises, is that overheating can slow down their ability to do something that's vital for medical staff - make quick decisions. Another is that they may ignore the warning signs of what's called heat stress - such as faintness and nausea - and keep on working till they collapse.

It's when the body is unable to cool down properly so its core temperature keeps rising to dangerous levels and key organs can shut down. It happens when the main technique for getting rid of excess heat - the evaporation of sweat on the skin - can't take place because the air is too humid.

And as Dr Lee and other medics have found, the impermeable layers of personal protection equipment (PPE) - designed to keep the virus out - have the effect of preventing the sweat from evaporating.

According to Dr Rebecca Lucas, who researches physiology at the University of Birmingham, the symptoms can escalate from fainting and disorientation to cramps and failure of the guts and kidneys.

"It can become very serious as you overheat, and in all areas of the body."

A system known as the Wet Bulb Globe Temperature (WBGT) measures not only heat but also humidity and other factors to give a more realistic description of the conditions.

Back in the 1950s, the US military used it to work out guidelines for keeping soldiers safe. When the WBGT reaches 29C, for example, the recommendation is to suspend exercise for anyone not acclimatised. Yet that's the level Dr Lee and his colleagues are regularly experiencing at Singapore's Ng Teng Fong General Hospital.

And at the top of the scale - when the WBGT registers 32C - the US says strenuous training should stop because the risk becomes "extreme". But levels that high have recently been recorded inside hospitals in Chennai in India by Prof Vidhya Venugopal of the Sri Ramachandra University.

She's also found workers in a salt pan enduring a WBGT that climbs during the day to 33C - at which point they have to seek shelter. And in a steel plant, a ferocious level of 41.7C was recorded, the workers being among the most vulnerable to what she calls "the huge heat".

"If this happens day-in, day-out, people become dehydrated, there are cardiovascular issues, kidney stones, heat exhaustion," Prof Venugopal says. As global temperatures rise, more intense humidity is likely as well which means more people will be exposed to more days with that hazardous combination of heat and moisture.

Prof Richard Betts of the UK Met Office has run computer models which suggest that the number of days with a WBGT above 32C are set to increase, depending on whether greenhouse gas emissions are cut. And he spells out the risks for millions of people already having to work in the challenging combination of extreme heat and high humidity.

"We humans evolved to live in a particular range of temperatures, so it's clear that if we continue to cause temperatures to rise worldwide, sooner or later the hottest parts of the world could start to see conditions that are simply too hot for us."

Another study, published earlier this year, warned that heat stress could affect as many as 1.2bn people around the world by 2100, four times more than now. According to Dr Lee, "it's not rocket science".

People need to drink plenty of fluid before they start work, take regular breaks and then drink again when they rest. His hospital has started laying on "slushie" semi-frozen drinks to help the staff cool down. But he admits that avoiding heat stress is easier said than done. For him and his colleagues, going for rests involves the laborious process of changing out of PPE and then back into a new set of equipment.

There's a practical problem as well - "some people do not want to drink so they can avoid having to go to the toilet," he says. And there's a professional desire to keep working whatever the difficulties so as not to let colleagues and patients down at a time of crisis.

People who are highly motivated can actually be at the greatest risk of heat injury, says Dr Jason Lee, an associate professor in physiology at the National University of Singapore.

He's a leading member of a group specialising in the dangers of excessive heat, the Global Heat Health Information Network, which has drawn up guidelines to help medics cope with Covid-19. It's spearheaded by the World Health Organization (WHO), the World Meteorological Organization (WMO) and the US weather and climate agency Noaa.

Dr Lee says that as well as measures like rest and fluids - and shade for outdoor workers - a key strategy for resisting heat stress is to be fit.

"By keeping yourself aerobically fit, you're also increasing your heat tolerance, and there are so many other benefits too."

And he sees the challenge for medics, sweating inside their PPE as they deal with Covid-19, as "almost like a full dress rehearsal" for future rises in temperature.

"This climate change will be a bigger monster and we really need a coordinated effort across nations to prepare for what is to come. If not," he says, "there'll be a price to be paid."

The pandemic has led to a sharp fall in the number of children around the world being vaccinated, the UN says.

The decline in immunisation against diphtheria, tetanus and whooping cough over the first four months of the year is the first in nearly three decades.

World Health Organization head Dr Tedros Ghebreyesus said vaccines were a hugely powerful public health tool.

He said the suffering and death caused by children missing out on vaccines could dwarf that caused by the virus.

Immunisation programmes in three-quarters of the more than 80 countries that responded to a UN survey have been disrupted, Unicef and the WHO said.

They said the disruptions were linked to a lack of personal protective equipment for health workers, travel restrictions, low health worker staffing levels and a reluctance to leave home, all of which saw programmes curbed or shut down.

By May this year at least 30 measles vaccinations campaigns had been cancelled or were at risk.

Measles outbreaks were already rising before the pandemic struck, with 10 million people infected in 2018 and 140,000 deaths, most of whom were children, according to UN data.

Unicef head Henriette Fore said the coronavirus had made routine vaccinations a "daunting challenge".

"We must prevent a further deterioration in vaccine coverage... before children's lives are threatened by other diseases, she said, adding: "We cannot trade one health crisis for another."

Disruption to the global immunisation programme is extremely bad news, particularly for the world's poorest countries. It is estimated that immunisations save up to 3m lives a year by protecting children against serious diseases.

The Unicef programme is specifically targeted at children who would otherwise struggle to receive good quality health care, but although vaccines now protect more children than ever before, millions of children still go without protection, and it is estimated that more than 1.5m people die each year from diseases that vaccines could prevent.

Experts believe that low immunisation rates among poor and marginalised children seriously compromise all the gains made in other areas of maternal and child health, so major disruption on the scale outlined in this new report will inevitably cost a lot of lives.

Coronavirus has consumed huge amounts of healthcare resources worldwide as the international community has focused on efforts to combat the deadly impact of the virus.

It has also made delivery of healthcare difficult, particularly in poorer countries where supply chains have been disrupted, facilities and protective equipment can be basic, and fear of being infected has put people off attending clinics. But diseases such as measles, diphtheria, and cholera are already on the rise, underlining the urgency of finding ways to tackle this problem.

Progress on immunisation had already been stalling before the pandemic, the UN agencies said.

In 2019 nearly 14m children - more than half of them in Africa - did not get life-saving vaccines against diseases such as measles and diphtheria. Two-thirds of them were in 10 countries: Angola, Brazil, DR Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan, and The Philippines.

Meanwhile, historically high rates of immunisation had fallen in Latin America and the Caribbean, the UN said, with immunisation coverage falling by at least 14 percentage points in Brazil, Bolivia, Haiti and Venezuela over the past decade.

"The likelihood that a child born today will be fully vaccinated with all the globally recommended vaccines by the time she reaches the age of five is less than 20 percent," Unicef and the WHO said.

New Covid-19 measures brought in to
Blackburn with Darwen

New measures to curb the spread of Covid-19 in Blackburn with Darwen have been introduced after a spike in cases.

For the next month, people living within the Lancashire authority must observe the rules in a bid to avoid a Leicester-style local lockdown. The new measures include tighter limits on visitors from another household, and officials have called on people to bump elbows in place of handshakes and hugs.

Mass testing began at the weekend after 61 new cases sprang up within a week.
Residents are being told to wear cloth face coverings in all enclosed public spaces, including workplaces, libraries, museums, health centres and hair and beauty salons.

Blackburn with Darwen's public health director, Prof Dominic Harrison, also called for people only to bump elbows with anyone outside their immediate family.
He said public protection advice for small shops was being stepped up to ensure social distancing was being observed. Targeted testing is taking place in the borough, and residents have been told they do not need to have symptoms to be tested.

Prof Harrison said: "These steps will help and we are appealing to everyone in Blackburn with Darwen to follow them to protect themselves and their loved ones. If we don't, a local lockdown, like in Leicester, becomes a very real possibility."

He said increased testing would mean a "rise in the number of cases" in the next seven to 10 days. If rates were continuing to rise after two weeks, he said, the authority would "have to consider reversing some of the national lockdown lifting measures locally.

“This would be done one by one until we see a reversal in the current rising trend," he said.
"It's up to everyone to make sure we don't have to do that."

He said there would also be "targeted work" after a rise in infections within the South Asian community - in particular "cluster infections" among families living in small terraced houses.

When "one person gets infected in a multi-generational household, all the household members are getting infected", Prof Harrison said.

Figures show Blackburn with Darwen recorded 47 new cases per 100,000 in the week ending Saturday, up from 31.6 the previous week. In Leicester, where a local lockdown has been imposed, the rate has risen from 115 per 100,000 to 118 over the same period.
But this is still down from 152.2 in the seven days to June 27.

Based on figures released on Tuesday, Pendle in Lancashire currently has England's second-highest rate of new cases for the week, rising from 14.2 per 100,000 to 76.6 in the week to 11 July.

Information videos are being produced in English, Urdu and Gujurati to spread the message in the former mill town. Council leader Mohammed Khan said the authority was working to spread the message that "life cannot go back to normal just yet, and we must all make sacrifices to avoid a local lockdown".

He said: "We are doing everything we can to get a grip on the virus, and we need everyone in Blackburn with Darwen to pull together to help us.

"Please continue to do your bit to stick to the rules to protect yourself and your family."

On the 8^th July, Tropical Sun welcomed Angel Foundation UK JA to its London headquarters to celebrate the very real contribution that the foundation has been making towards the Healthcare and Ministry of Education in Jamaica.

Angelia Christian, Founder of Angel Foundation UK JA, along with its Treasurer, Martin Daay, and Secretary Sandra Delapenha, former Mayor of Havering Cllr Michael Deon Burton and DJ Dr Love joined by MD Sanjay Wadhwani, Commercial Director George Phillips, FD Adam Reader, and Community Brand Ambassador Paul Harrison to officially hand over second batch of computers and monitors to the foundation for its Portland Mount Pleasant Primary School IT Suite appeal.

“It was a joy to see some of the computers which we had donated last year on the Angel Foundation website,” began Paul Harrison, “and of course, to have received our Certificate of thanks, from Stoney Hill Technical High School.”

As well as pursuing their passion of bringing the flavours of the world to dinner tables across the nation, Tropical Sun prides themselves on their work with local and international communities.

Previously they have kept their community and charity work fairly low-key, but in response to inquiries from customers and partners, Tropical Sun have shared some of the work they are doing.

“Our history of commitment to a number of Schools in Jamaica is ongoing, including Jose Marti Technical High School & White Marl Primary School both of whom we have supported, and is further enhancing the learning opportunities and improving the computer literacy of the next generation of children.” Harrison continued.

Angel Foundation UK JA is dedicated to supporting education and health in Jamaica. Founded in 2011 by the inspirational Angelia Christian, the organisation has raised crucial funding and equipment for numerous schools, hospitals and more, touching the lives of many thousands of people.

You too can get involved by visiting their website at https://angelfoundationja.com/.

For more information about Tropical Sun and their products, check out the video below on their Ackee Production Process!

A fast-track health and care visa has been unveiled as part of the UK's plans for a points-based immigration system when freedom of movement with the EU ends in January.

Home Secretary Priti Patel said employers would be encouraged to invest in workers from within the UK. But the new system, she added, would also allow them to "attract the best and brightest from around the world".

Unions have expressed concerns that the visa will exclude social care workers. The health and care visa will be open to workers who have a confirmed job offer in one of a series of "skilled" roles within the NHS or care sector - or for NHS service providers, such as doctors, nurses, radiographers, social workers and paramedics.

However, the GMB union, representing NHS staff, described the new rules as an "embarrassing shambles", criticising the exclusion of frontline care home workers and contractors, and pointing out that a minimum salary threshold meant many cleaners, porters and support staff would also not qualify.

The new visa system is set to come into force on New Year's Day, immediately ending freedom of movement with the EU. Under the government's plans when the Brexit transition period ends, those wishing to live and work in the UK must gain 70 points.

There is a mandatory requirement for visa applicants to have an offer of a job on a list of eligible occupations and speak English - earning them 50 points.
There is a minimum salary requirement of £20,480.

Further Points would be awarded for meeting criteria such as holding a PhD relevant to the job, or earning more than a "general salary threshold" of £25,600. Those with job offers in "shortage occupations" such as nursing and civil engineering would also be able to earn extra points.

In a written ministerial statement to the House of Commons, Ms Patel said: "At a time where an increased number of people across the UK are looking for work, the new points-based system will encourage employers to invest in the domestic UK workforce, rather than simply relying on labour from abroad.

"But we are also making necessary changes, so it is simpler for employers to attract the best and brightest from around the world to come to the UK to complement the skills we already have."

Labour said it would scrutinise the proposals "very carefully", saying the government had "rushed through immigration legislation with very little detail in the middle of a global pandemic".

One of the biggest arguments for leaving the EU is that it would allow the UK to sets its own immigration policy.

The government's aim is a system that provides flexibility for employers - so the minimum salary threshold starts at just over £20,000 and there's no need to prove that a job couldn't have been offered to someone already living in the country.

But there are restrictions too: the vast majority of vacant positions in the social care sector will not be filled from immigration as these workers are not classed as skilled - and they're not eligible for the rebranded NHS and care workers fast track visa.

In short, care workers won't be able to apply for a visa dedicated to care. Ministers say immigration can't solve the care sector's problems which, they argue, are down to poor pay and career prospects - making the job unattractive to British workers who could be capable of filling the roles.

The new health and care visa will have a reduced fee. Those applying for it should expect a reply within three weeks, the government said.

Caroline Abrahams at charity Age UK said it was a "care visa in name only. Care will scarcely benefit at all since the vast majority of care workforce roles are ineligible".

The union Unison said the work of the social care sector was in crisis long before the coronavirus pandemic and failing to include care workers was a "disastrous mistake that will make existing problems spiral".

Shadow home secretary Nick Thomas-Symonds said: "To exclude care workers from the health visa is a clear signal that this government does not appreciate the skill and dedication these roles involve... it is yet another insult from this Tory party to those who have been at the frontline of this crisis."

However, the prime minister's official spokesman said the government wanted employers in the sector to invest more in training and development for people already in the UK - including EU citizens - to become care workers, and it had provided additional funding to support it. "Our independent migration advisers have said that immigration is not the sole answer here," he added.

The home secretary said frontline health workers would not have to pay the Immigration Health Surcharge - the fee of up to £400 a year that most migrants who have not been granted permanent residency in the UK need to pay to receive NHS care.

Ms Patel also said the visa process for students was being refined, with a new graduate route being launched next summer to "help retain the brightest and the best students to contribute to the UK post-study". International students would be able to stay for a minimum of two years after finishing their studies, she said.

The paper also confirms that foreign criminals who have been jailed for more than a year could be banned from coming to the UK and foreign nationals already in the UK who have been sentenced to a year or more in prison "must be considered for deportation".

After weeks of discussion about the relative benefits of face covering when out and about, ministers have confirmed that it will be mandatory to cover faces in shops in
England and like in Scotland, with those failing to comply facing a fine of up to £100 from the 24th July.

It is quite the shift. At the start of the crisis, the government's scientists suggested that masks could do more harm than good. There were nerves too about creating sudden demand from the public to get hold of medical grade coverings when there was a worldwide spike in demand as the pandemic took hold. But more evidence has emerged about how coronavirus can be transmitted through the air.

Politicians are also keen to find ways to make consumers feel more comfortable going back out into the world, as the economy struggles to come alive again. But things have changed a lot since the start of the lockdown when the government's 'stay at home' message was heard loud and clear.

The vast majority of the public stuck to the instruction carefully. Millions tuned into the daily press briefings for the latest information, wanting answers, but wanting guidance too. The expected decision to go ahead on face coverings comes after a scrappy few days when ministers have given different impressions in different interviews.

Chancellor Rishi Sunak appeared without a mask for the cameras serving food. Eyebrows were raised when he was chatting to customers over their vegan katsu without covering his face. The Culture Secretary, Oliver Dowden, did mask up when observing Picassos in the Royal Academy the next day. Then the Prime Minister donned his two quid mask in a recent photo-call.

But Michael Gove made that call for "common sense", and even this morning, the Justice Secretary, Robert Buckland, was saying coverings should be "mandatory perhaps" - a contradiction if ever there were. Clarity, for shops in England at least, should come but you wouldn't be blamed for wondering quite what you are meant to do.

For the government's critics it's another example of ministers playing catch up after allowing confusion to spread. During the early stages of the Covid crisis the public surprised politicians by being very willing to listen and follow the rules.

In this more complicated phase, any hint of a messy message could make them less likely to comply.