UK COVID-19 Daily: A&E Record Low, Antibody Test, Diabetes Risk

Tim Locke

May 14, 2020

These are the UK coronavirus stories you need to know about today.

'Seismic' Impact on Non-COVID NHS Use

NHS England's latest monthly performance figures show a big drop in non-coronavrius use, which one commentator has called 'seismic'.

There was a 56.6% reduction in the number of people visiting A&E departments - a record low.

"Today's figures show coronavirus is having a seismic impact on how people are using the NHS," Tim Gardner, senior fellow at the Health Foundation, said in a statement. 

"This unprecedented shift in the way people are using health services – while it does ease the immediate pressures on the NHS - is a major concern and could mean that potentially urgent health problems are going undiagnosed or chronic problems are getting worse."

Dr Simon Walsh BMA emergency medicine lead and consultants committee deputy chair commented: "In a recent BMA survey, 4 in 10 doctors said the long-term impact on patient clinical demand was their greatest worry. Today’s figures illustrate those fears all too well, with longer waits for patients being referred by consultants for elective care."

He added: "GPs and hospitals must be given the resources they need to cope with what will undoubtedly be a surge in demand for routine care in the weeks and months ahead."  

Professor Stephen Powis, NHS England medical director said in a statement: "A&E attendances were sharply down, but the majority of these reductions were for lower risk conditions. 

"Urgent cancer referrals are now picking back up – having doubled over the past 3 weeks – and the NHS has launched a public information campaign reminding the people of the importance of seeking care for urgent and emergency conditions."

Professor Jonathan Van-Tam, England's deputy CMO told the daily Downing Street briefing: "We absolutely understand that the National Health Service is not a COVID treatment service. It has had to focus on that in the last few months, but everybody in health is conscious of the fact that as soon as is physically and humanly possible, services must be restored to normal. But that takes time and it has to be done at a paced, measured, safe way."

Data on cancelled elective procedures is not currently being collected and published.

Diabetes Tops Mortality Risk List

Another 428 UK COVID-19 deaths were announced today taking the total to 33,614. 

Of the 207 deaths in English hospitals, patients were aged between 33 and 100. Six of the patients aged between 35 and 95 had no known underlying health condition. 
 
Data were also published of English hospital deaths to date by known pre-existing health conditions:

  • Diabetes 26%

  • Dementia 18%

  • Chronic Pulmonary Disease 15%

  • Chronic Kidney Disease 14%

  • Ischaemic Heart Disease 10%

  • Asthma 7%

  • Received treatment for a Mental Health condition 5%

  • Chronic Neurological Disorder 3%

  • Rheumatological Disorder 3%

  • Learning Disability and or Autism 2%

Daily COVID-19 tests rose to 126,064 the highest since the 100,000 daily target was introduced. Home tests that have been sent out but not processed are included. 

Another 3446 positive cases were reported. 

There were 902 COVID-19 hospital admissions in England yesterday.

Currently 11,041 people are in UK hospitals with COVID-19 and 20% of UK critical care beds are being used by COVID-19 patients.

Professor Van-Tam said: "There's been a 14% drop in the total number of people in hospital since last week, and again this is moving in the right direction." 

Restarting Health and Care Services 

Health groups have warned restarting health and care services paused for the COVID-19 response will take many months. 

The Health Foundation, The King’s Fund, and Nuffield Trust, have been giving evidence to the Commons Health and Social Care Select Committee.

In statements ahead of the hearing, Jennifer Dixon, chief executive of the Health Foundation, said: "Responding to the virus has exposed strengths and weaknesses in our health and social care system. Getting services back up and running, taking account of likely future pressures from COVID-19, winter, and the backlog of ill health from delayed care will be a steep climb."
 
Richard Murray, chief executive of The King’s Fund, said: "The health and care system is a complex web of inter-related services: when one part fails, patients and service users can easily fall between the gaps. All aspects of the health and care system will need to be back up and running if services are to return to any semblance of normality."
 
Nigel Edwards, chief executive of Nuffield Trust, said: "Hospitals and a whole range of services provided in the community will have to be remodelled to control infection and keep people safe, by separating out coronavirus patients and testing constantly and quickly at every level. We must be honest that this will slow things down."

NHS Providers also published a report today called Towards a new normal: Balancing COVID-19 and other healthcare needs.

It says restarting services is a priority, and brings new challenges:

  • Backlogs, including elective surgery

  • Significant new demand for COVID-19-related mental health services 

  • Complex needs of 2m new shielded patients 

  • Patients with more complex needs because they didn't seek care earlier

  • NHS support for the social care system "in full crisis"

Chief Executive Chris Hopson was also appearing before the Commons committee. "Trusts will do all they can to restart services as quickly as possible. They’ll seek to solve every problem they encounter as they've consistently done so far," he said before the hearing.
 

Infections

The Office for National Statistics (ONS) estimated that at any given time between 27th April and 10th May an average of 0.27% of the community population in England (148,000 people) had COVID-19 based on its weekly swab test survey of 10,705 people in 5276 households.

Of those working in patient-facing healthcare or resident-facing social care roles, ONS said 1.33% tested positive.

The survey also found no evidence of differences in the proportions of positive tests between the age categories 2-19, 20-49, 50-69, and 70 and over.

Meanwhile, more than 25% of the UK population is likely to have already been infected with COVID-19, according to a study by the University of Manchester, Salford Royal and Res Consortium.

Published local authority data was used for the modelling that's published in the International Journal of Clinical Practice.

University of Manchester researcher Dr Adrian Heald said in a news release: "COVID-19 is a highly infectious condition and very dangerous for a small group of people. However a much larger group seem to have low or no symptoms and have been unreported.

"This study tries to provide an estimate of the number of historic infections – and gives us all a glimmer of hope that there may be light at the end of the tunnel."

Antibody Test '100% Accurate'

Public Health England has approved an antibody test from Roche said to be 100% accurate.

Prof John Newton, national coordinator of the UK Coronavirus Testing Programme, said: "We were confident that good quality antibody tests would become available when they were needed.

"Last week, scientific experts at PHE Porton Down carried out an independent evaluation of the new Roche SARS-CoV-2 serology assay in record time, concluding that it is a highly specific assay with specificity of 100%.

"This is a very positive development because such a highly specific antibody test is a very reliable marker of past infection. This in turn may indicate some immunity to future infection although the extent to which the presence of antibodies indicates immunity remains unclear."

Prof Van Tam said: "I anticipate that it will be rapidly rolled out in the days and weeks to come as soon as it is practical to do so. I also anticipate that the focus will be on the National Health Service and on carers in the first instance."

He added: "This is a good test that will stand us in good stead moving forwards, and I think it will be incredibly important as the days, weeks, and months go by."

Prof Van Tam continued: "It's going to take us time to understand whether the antibodies, in all cases, protect against infection," adding: "The final science question is how long into the future do the antibodies last for? It is not automatic by any means that these are going to be lifelong." 

NHS Deaths

An editorial in the British Journal of General Practice questions the government’s campaign to encourage retired doctors to return to clinical practice, Univadis from Medscape reported.

A significant proportion of doctors who have died so far from COVID-19 have been over 60 years of age. "This raises questions about the government’s campaign to encourage retired doctors to return to NHS roles. The high proportion of deaths that have occurred in doctors aged >60 suggests that the NHS should be very cautious about placing these doctors in frontline clinical roles where they may be at risk of contracting COVID-19 infection," the authors wrote.

Among the recently announced NHS deaths was Dr Karamat Mirza, still working at 84 as a GP at the Old Road Medical Practice in Clacton, Essex.

Local CCG Chief Executive Dr Ed Garratt paid tribute: "We are deeply saddened to learn of the death of Dr Mirza, a respected and much-loved GP who had served the patients in his local community for more than 4 decades." 
  
In Memoriam: Healthcare Workers Who Have Died of COVID-19.

Kawasaki-like Condition in Children

Italian doctors writing in the Lancet found a 30-fold increased incidence of Kawasaki-like disease in children. They wrote: "Children diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response to the virus, were older, had a higher rate of cardiac involvement, and features of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe form of Kawasaki disease."

There have also been UK cases and Dr Julia Kenny, consultant in paediatric infectious diseases & immunology at Evelina London Children’s Hospital, responded to the study in a statement: "Evelina London Children’s Hospital has more than 50 children with a similar syndrome and whilst very few tested positive for the virus on swabs the majority of the children tested positive for COVID-19 antibodies when subsequently tested, suggesting their disease is associated with exposure to the virus.

"These children have also shown significant cardiac symptoms and have proved difficult to evaluate clinically, often appearing less unwell than their very abnormal blood tests and cardiac investigations would suggest."

Writing in a linked comment in the Lancet, Professor Russell Viner, president of the Royal College of Paediatrics and Child Health and professor of adolescent health, UCL Great Ormond Street Institute of Child Health, who was not involved in the study, said: "Understanding this inflammatory phenomenon in children might provide vital information about immune responses to SARS-CoV-2 and possible correlates of immune protection that might have relevance both for adults and children. In particular, if this is an antibody-mediated phenomenon, there might be implications for vaccine studies, and might also explain why some children become very ill with COVID-19, while the majority are unaffected or asymptomatic."
 

More News in Brief

  • ITV News' poll of 2000 black, Asian and minority ethnic (BAME) doctors and healthcare workers found concerns about "systemic discrimination" on the front line of COVID-19 care. Among the results: 50% felt discriminatory behaviour has played a role in the high death toll and 1 in 5 said they had personal experience of this; 53% did not feel comfortable raising concerns about deployment; 60% said a lack of PPE was a factor in the disproportionate death toll; 85% were more scared as a result of disproportionate deaths of BAME medics.

  • Scotland has followed England in announcing a death in service benefits scheme for families of all frontline NHS staff. BMA Scotland Chair Lewis Morrison said in a statement: "Perhaps most importantly today’s scheme covers those who have had to leave the pension scheme. It means families won’t simply get a one-off payment, but the lifetime benefits that are a key advantage of the NHS pensions scheme. That will include some of those at the lower end of the pay scale who may not be protected due to being unable to afford scheme membership, the new volunteers who are putting themselves forward onto the front line and those members of existing workforce who due to a range of issues are less well assured."

  • The Royal College of Nursing (RCN) wants more accurate data collected on health and care staff who test positive for COVID-19, including ethnicity and underlying health conditions. Chief Executive Dame Donna Kinnair said in a news release: "We must have better record-keeping of the number of health and care staff who have died and consistency between the four nations if we are to have the robust data analysis needed for more effective policies and implementation."

  • Northern Ireland has moved its COVID-19 escalation level for critical care to 'low surge'.  Belfast City Hospital's Tower Block was designated as a Nightingale Hospital but the full capacity wasn't needed and it is being stood down.

  • Health groups, including the British Lung Foundation (BLF), have warned the lockdown could lead to more children being exposed to secondhand smoke. A YouGov panel of 4007 respondents found 12% of smokers who live with children say they are smoking indoors more than they did before the lockdown. Medical Director Dr Nick Hopkinson said in a statement: "Exposure to secondhand smoke is one of the leading causes of poor respiratory health in children. Smokers need to take their smoke outside but should try to quit if they can."

  • Wales' lockdown rule change to allow picnics wasn't because of a newspaper story about its health minister eating chips outdoors, the BBC reported. Vaughan Gething told the Welsh Parliament he'd been walking with his wife and young son, who "was hungry and we bought some chips - all within the rules".

  • A University of Hertfordshire professor has teamed up with video game developer Martin Jacob to create an online game to teach social distancing to children. In 'Can You Save The World?' players have to walk down a busy street keeping a safe distance from pedestrians, cyclists, and people sneezing. Richard Wiseman, professor of the public understanding of psychology, said in a news release: "Social distancing is a vital part of stopping the spread of COVID-19 and by creating this game we hope to affect real-life behaviour."

https://twitter.com/jartin_macob/status/1258472485504385026

See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.

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