Vinay Prasad

Hi, Duncan.

Yes, what we've seen is hospital deaths trending down, but actually in the home and in the care home setting, there are actually more deaths now than there are in hospitals.

And importantly, in the home setting, 90% of the deaths were non-COVID.

And this was pretty similar in care homes, a bit less, but about 70% of the excess deaths potentially in care homes were actually not COVID.

So there are two reasons this could occur.

One is it's a reporting issue.

We just people are dying.

They weren't seen and they died very suddenly and they didn't put Covid.

Or second is actually there's something else going on.

There's an issue about people are not seeking care or actually other conditions are increasing and increasing dramatically.

I think it's a little bit of both.

Well, first off is to say that list sort of fits with we did a systematic overview looking at treatment where there's evidence to show they actually reduce hospital admissions.

And so we looked at all the systematic reviews and it's really important and it's interesting.

There are lots of treatments that reduce surrogate measures.

But actually hard endpoints, there are actually less treatments.

And the conditions we found them in were heart failure, coronary disease, asthma, COPD and actually schizophrenia, mental health conditions.

So that fits with that common list, if you like.

And then a list of treatments that have actually been shown to reduce admission is far less than you consider.

So there's that list.

The second issue is I think we need to then go back to NICE now and start stripping out of the NICE guidelines, which actually activities have been shown to actually facilitate reductions in admission and hard endpoints.