Letter BMJ Mil Health: first published as 10.1136/bmjmilitary-2021-001812 on 4 March 2021. Downloaded from

108 million cases have been recorded COVID-19 resources through Friends of since the first death on 11 January 2020 (‘WHO’)). The USA has sustained over Millbank website 480 000 deaths and 27 million cases, far higher than anywhere else (‘Johns Hopkins David Vassallo ‍ ‍ University Dashboard’). Catastrophe threatens low-income­ and war-torn­ coun- tries (‘COVID-19 Resource Centre – The I would like to update you on the ongoing for the NHS’ and ‘Coronavirus: What the Lancet’), but also those with divergent work of the Friends of Millbank further to Military’s doing to fight COVID-19’. government policy responses: Brazil has our last letter published in BMJ Military ‘Coronavirus timeline up to lockdown’ suffered over 237 000 deaths, second only Health.1 Friends of Millbank is a society provides salutary reminders of the rapidity to the USA (‘Johns Hopkins University that celebrates the heritage, achievements with which a virulent new pathogen can Dashboard’). and ongoing relevance of military medi- threaten society. ‘IHME COVID-19 Resurgent malaria, measles and other cine, normally holding talks at the former Projections: the next few months’ shows illnesses, due to disrupted prevention Royal Army Medical College (now how national responses may affect this campaigns or healthcare systems, are Chelsea College of Arts) in Millbank, pandemic’s course. seriously compounding the global effect, London. The Royal Army Medical College Daily COVID-19 deaths in UK hospi- best shown through excess mortality rates was the British Army’s centre of excel- tals peaked at 866 in the first wave, on (‘Office for National Statistics’, ‘Our lence for postgraduate military medicine 10 April 2020.3 This single day’s toll was World in Data’). and tropical health, and the home of the more than twice that of British personnel The economic effects on society are Journal of the RAMC (now BMJ Military killed by hostile action (405) in Afghani- huge (‘IMF – National Policy Responses Health), between 1907 and 1999. stan over 14 years. The UK’s official toll to COVID-19’), hence the drive to ease Our meetings ceased when the UK surpassed 40 000 on 5 June, less than lockdowns, see ‘COVID-19 Policy Tracker instituted a national lockdown in March 3 months after the first death on 8 March. – The Health Foundation’ for England, 2020 due to the coronavirus pandemic. In the USA, where the first death was on and ‘Lockdowns around the world’. Easing We now hold monthly online talks, open 6 February, fatalities surpassed 100 000 lockdown prematurely risks further waves. to all, advertised through our website. As on 28 May—more than the total from the New outbreaks can escalate exponentially our contribution to tackling the pandemic Korean, Vietnam and Iraq wars combined. if unchecked, especially if new variants and misinformation on the subject, The pandemic’s first wave soon passed of the virus prove to be more infective or copyright. we continue to collate the best official due to national responses. However, resistant to vaccines. The guiding princi- online resources into a regularly updated premature easing of restrictions led to a ples are Test, Trace and Isolate (‘WHO’). COVID-19 portal on our website which much worse second wave commencing The most effective prevention measures we recommend to your readers.2 In this late 2020 (‘WHO – COVID-19 weekly are ‘Hands, Face, Space and Air’: hand description, names in italics refer to links, situation reports’ and ‘European Centre for hygiene, masks, physical distancing and prime examples being ‘World Health Disease Prevention and Control’). In the fresh air ventilation, with personal protec- Organisation’ [WHO], ‘GOV-­UK’ and UK, the number of people testing newly tive equipment in healthcare settings http://militaryhealth.bmj.com/ ‘NHS – Latest advice’. positive with COVID-19 escalated to (‘WHO’, ‘CDC’). See also ‘A history of Once online, start with the thought-­ over 60 000 daily shortly after Christmas the medical mask’ and ‘CDC – Cloth face provoking personal perspective ‘LSHTM (‘GOV.UK – The COVID-19 dashboard coverings – DIY guide’. Other control Viral Podcast – Peter Piot’s battle with (UK only)’). Inevitably, the UK’s death rate measures are quarantine (of asymptom- COVID-19’. Piot is director of the London then surged to well over 1000 cases daily, atic travellers) and isolation (of symp- School of Hygiene and Tropical Medicine remaining so into February, and peaking tomatic persons and their contacts), see (see ‘LSHTM – COVID-19 Resources’)— at 1820 deaths on 20 January 2021 (more ‘NHS COVID-19 App’ and ‘NHS – Latest and he fell seriously ill with COVID-19 in than twice as high as in the first wave).4 advice’. Mental health can be adversely March 2020. The ‘RSM Live – COVID-19 The cumulative UK death toll reached affected by quarantine, be kind to yourself Series webinars’ are excellent value. Front- 100 000 on 26 January and will exceed and others. line health professionals will benefit from 120 000 by Easter. Hospitals came under Fortunately, effective vaccines are on September 29, 2021 by guest. Protected ‘Coronavirus – e-­Learning for Healthcare extreme and sustained pressure before becoming available (‘COVID-19 Vaccine (e-­LfH)’ and ‘St George’s online course’. this wave began receding due to another tracker’), although the logistical chal- There are excellent international courses: national lockdown and vaccine rollout. lenges are immense. The UK vaccinated ‘WHO – Online courses for COVID-19, The rate of decrease was agonisingly slow 14 million people in just 2 months, but Ebola, Cholera, Polio’. Keep abreast of due to the appearance of a new and more many countries lag far behind. There is latest clinical information (including on infectious UK variant of the virus. See no specific treatment yet though clinical virus variants, vaccine effectiveness and ‘GOV-­UK Science – Latest R number’ for outcomes have improved. Herd immu- long-­COVID) with ‘COVID Reference the virus’s reproduction number (R) in nity remains elusive (the ‘Serotracker - The COVID Textbook (current online UK: 0.7–0.9 on 12 February 2021, after a Dashboard’ shows seroprevalence rates). edition)'. Continue to be inspired by peak of 1.6 in October, and the first time This highlights the importance of collab- ‘Captain Tom Moore’s 100th Birthday walk R dropped below 1.0 since July; ‘COVID orative research, exemplified by power- Messenger’ shows the situation around houses that shape government strategy: Retired, Friends of Millbank, UK England. ‘Imperial College’, ‘Johns Hopkins Univer- COVID-19 deaths continue rising sity’, ‘Oxford University’ and the ‘Royal Correspondence to Mr David Vassallo, Chairman, sharply worldwide (as of 12 February Society’. Do use the ‘COVID-19 Symptom Friends of Millbank, Fareham PO13 9NJ, UK; ​ DJVassallo@aol.​ ​com 2021, over 2.3 million deaths and Study app’. 292 Vassallo D. BMJ Mil Health August 2021 Vol 167 No 4 Letter BMJ Mil Health: first published as 10.1136/bmjmilitary-2021-001812 on 4 March 2021. Downloaded from

This is not a time for complacency, or for the duration of the covid-19 pandemic or until ORCID iD to let down our guard (Stay Alert!). Lives otherwise determined by BMJ. You may use, download David Vassallo http://orcid.​ ​org/0000-​ ​0003-2182-​ ​647X may be lost by undue haste. Stay informed, and print the article for any lawful, non-­commercial purpose (including text and data mining) provided stay safe, stay well. that all copyright notices and trade marks are REFERENCES retained. 1 Vassallo D. COVID-19 resources through Friends of Millbank website. BMJ Mil Health 2020;166:440. Collaborators not applicable. © Author(s) (or their employer(s)) 2021. No commercial 2 Friends of Millbank and COVID-19 portal. Available: Contributors I am the sole contributor to this letter. re-­use. See rights and permissions. Published by BMJ. www.friendsofmillbank.​ ​org/covid-​ ​19 Funding The authors have not declared a specific 3 London School of Hygiene & Tropical Medicine. Peak grant for this research from any funding agency in the in COVID-19 deaths occurring in English hospitals public, commercial or not-­for-­profit sectors. passed on 8 April. Available: https://www.lshtm.​ ac.​ ​ To cite Vassallo D. BMJ Mil Health uk/newsevents/​ ​news/2020/​ ​peak-covid-​ ​19-deaths-​ ​ Competing interests None declared. 2021;167:292–293. occurring-english-​ ​hospitals-passed-​ ​8-april​ [Accessed 12 Patient consent for publication Not required. Received 13 February 2021 Feb 2021]. Provenance and peer review Not commissioned; Accepted 16 February 2021 4 Cumulative number of coronavirus (COVID-19) deaths internally peer reviewed. Published Online First 4 March 2021 in the United Kingdom (UK). Available: https://www.​ This article is made freely available for use in BMJ Mil Health 2021;167:292–293. statista.com/​ ​statistics/1109595/​ ​coronavirus-mortality-​ ​ accordance with BMJ’s website terms and conditions doi:10.1136/bmjmilitary-2021-001812 in-the-​ uk/​ [Accessed 12 Feb 2021]. copyright. http://militaryhealth.bmj.com/ on September 29, 2021 by guest. Protected

Vassallo D. BMJ Mil Health August 2021 Vol 167 No 4 293