UK COVID-19 Daily: R Variations, PPE Whistleblowers 

Tim Locke

May 15, 2020

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

R Variations

London's R number could be as low as 0.4, modelling from the University of Cambridge MRC Biostatistics Unit and Public Health England suggests.

The overall median value for England was 0.75 and for the regions:

  • North East and Yorkshire 0.8

  • South West 0.76

  • North West 0.73

  • East of England 0.71

  • South East 0.71

  • Midlands 0.68

  • London 0.4

The Government Office for Science also published the latest official R number range for the whole UK as being 0.7-1.0. That's risen since last week's estimate of 0.5 to 0.9.

It cautions that factors such as contacts, hospital admissions, ICU admissions, and deaths generally take 2-3 weeks for changes to be reflected in R.

PPE Whistleblowers

PPE whistleblowers in England should not be 'gagged', the Department for Health and Social Care has confirmed. 

Concerns were raised after the BBC's Newsnight programme heard from some doctors who'd been told by managers to stop speaking publicly about shortages of personal protective equipment. One was told to "stop causing a fuss".

Doctors' Association UK has also released results of its latest member survey which found:

  • 46.9% of respondents had been told not to raise concerns about COVID-19 or PPE via social media

  • 47.6% of respondents had been told not to speak to the press about COVID-19 or PPE

  • 15.2% of respondents who had offered opinions on social media had been challenged or disciplined

  • 32% of respondents had experienced bullying around the issues of raising concerns about PPE

Chief Executive of whistleblowing charity Protect, Liz Gardiner, said in a news release: "We have had many calls to Protect's advice line from NHS workers with concerns over PPE and some NHS staff have told us they do not feel safe speaking up, or are not aware of what support channels exist."

She added: "Trust leaders need to hear when things are going wrong and what their Freedom to Speak Up Guardians say about the importance of speaking up. Failing to listen up can undermine the whistleblowing culture of the trust and ultimately this may endanger the safety of staff and patients."

A Department of Health and Social Care spokesperson said: "Whistleblowers perform a vital and courageous service in ensuring safe care, and no one should ever be prevented from speaking up or discriminated against if they do."
 

Wales' Lockdown Traffic Lights System 

Wales has followed Northern Ireland in publishing a plan to exit lockdown with no timetable.

The plan is called 'Unlocking our society and economy: continuing the conversation', and uses a traffic light system:

The steps are:

  • Lockdown – Schools only open for vulnerable pupils and children of key workers, stay at home, essential travel only, work from home if possible

  • Red – Schools enabled for increased demand, local travel, click-and-collect retail, providing or receiving care and support to/from one family member or friend from outside the household allowed

  • Amber  –  Priority pupils to return to school in a phased approach; leisure travel, meeting small groups of family or friends for exercise, non-essential retail and services; more  travel to work

  • Green  –  Education open for all children and students, unrestricted travel subject to ongoing precautions, sport, leisure, cultural activities, socialising permitted, with physical distancing

First Minister of Wales, Mark Drakeford told a news briefing: "Our roadmap does not contain dates, because changes can only be made when the scientific and medical advice tells us it is safe to do so. But it does show how we are moving, carefully and cautiously, out of lockdown and into the red zone."

England's Roadmap to Restart Routine NHS Operations

NHS England's roadmap to restart routine operations and treatment includes patients self-isolating for 14 days and to be clear of symptoms before admission.

The plan also has a national framework:

  • Careful planning, scheduling and organisation of clinical activity

  • Scientifically-guided approach to testing staff and patients

  • Excellence in infection prevention and control

  • Rigorous monitoring and surveillance, and

  • Focus on continuous improvement

In a statement, England's NHS National Medical Director, Professor Stephen Powis, said: "Now that we are confident that we have passed the first peak of coronavirus, it is important that we bring back those services where we can, but only where that can be done safely – the virus is still circulating and we don’t want to put our patients, the public or our staff at greater risk."

Responding to the plans, BMA Consultants Committee Chair Dr Rob Harwood said that "hospitals must be allowed to recover before beginning the huge task of redesigning their services once more. NHS England have given no indication regarding timescales for change and the volume of non-COVID cases that are expected to be achieved."

He added: "As part of those provisions, the Government needs to demonstrate it is able to procure sufficient and appropriate PPE, not only for patients needing COVID care but also to protect all patients needing elective care and to protect the staff looking after them." 

Care Home Deaths Data

The latest Office for National Statistics (ONS) data for England and Wales showed that more than a quarter of care home residents' deaths were due to COVID-19.
From 2nd March to 1st May 45,899 deaths of care home residents were registered wherever they died. Of these:

  • 27.3% (12,526) involved COVID-19

  • 72.2% of care home residents' deaths occurred within a care home, 27.5% in hospital

  • 14.6% of hospital deaths were care home residents

  • COVID-19 was the leading cause of death in male care home residents, and the second leading cause of death in female care home residents, after dementia/Alzheimer's disease.

  • Dementia/Alzheimer's disease was the most common main pre-existing condition.

  • In the period between 10th April and 8th May care home deaths were 1990 deaths higher than the 3-year average.

Sarah Deeny, assistant director of data analytics at the Health Foundation, commented that the report "underlines the need for care home staff to be given adequate support to safely and effectively care for residents, particularly those at the end of their lives. Timely and accurate data from care homes is needed now more than ever, to better understand the underlying reasons behind the continued increase in deaths and help mobilise the resources the sector so desperately needs."

Health and Social Care Secretary for England, Matt Hancock told the daily Downing Street briefing about progress since measures started to be put in place to protect care home residents: "Two thirds of England's care homes have had no outbreak at all. The number of care homes reporting their first case each day has fallen from a peak of 219 to 59. I'm glad to report that since the peak, the number of COVID-19 deaths of people in care homes has halved, but whilst this is progress there is so much more to do.

"And this crisis has also demonstrated the imperative for reform. It's shown the importance of long-standing calls for closer working between health and social care."
 

BMA Supports Teaching Unions

Teachers have been meeting Government medical and science advisers to address safety concerns about partial reopening of schools in England in June. After the meeting the NASUWT said the meeting raised more questions than answers, and that no school should open unless it is safe to do so.

BMA Council Chair Dr Chaand Nagpaul has written to the National Education Union saying it has found the available evidence to support reopening of schools "thus far conflicting", and that "until we have got case numbers down much lower, we should not be considering reopening schools".

However, Matt Hancock said: "I wouldn't support a proposal to start to reopen schools unless it was safe to do so. And it is safe to do so."

Deaths and Data

Another 384 UK COVID-19 deaths were announced today taking the total to 33,998.

Of the 186 deaths in English hospitals, patients were aged between 15 and 99. Ten patients aged between 30 and 94 had no known underlying health condition.  

Daily COVID-19 tests rose to 133,784, moving towards the new target of 200,000 tests a day by the end of the month. Home tests that have been sent out but not processed are included. 

Another 3560 positive cases were reported.

There were 910 COVID-19 hospital admissions in England yesterday.

Currently 10,731 people are in UK hospitals with COVID-19 down from 12,298 this time last week, and 19% of UK critical care beds are being used by COVID-19 patients.

NHS Deaths

Among the recently announced NHS deaths was Dr Thaung Htaik, 65, a general medicine consultant at Great Western Hospitals NHS Trust in Swindon. 

Chief Executive Kevin McNamara paid tribute, saying Dr Htaik "was a universally well-liked member of the team, who was known for his unwavering dedication to his patients, positive attitude, and willingness to help". 

His family also issued a statement: "He always put others first and we know just how committed he was to looking after his patients both at this difficult time and throughout his career."

Also remembered were mental health nurse Lillian Mudzivare, and midwife Safaa Alam, both from Birmingham Women's and Children's NHS Trust.

Chief Executive Sarah-Jane Marsh paid tribute:

"Lillian was a much loved member of our Forward Thinking Birmingham team whose bubbly, vibrant and bright approach touched the lives of everyone who knew her.

"Her commitment to the mental health and well-being of young people always shone through and she was working hard towards becoming an advanced practitioner where she knew she would be able to make even more of a difference."

"Safaa was an amazing midwife whose skills and expertise helped to bring hundreds of new lives into the world, whilst supporting women on their journey to motherhood.

"We promise to continue to uphold Safaa’s values and commitment to safe maternity care, wrapped up in the kindness and compassion she exemplified."
  
In Memoriam: Healthcare Workers Who Have Died of COVID-19.

Convalescent Plasma: 'Limited Evidence'

A Cochrane review of convalescent plasma and hyperimmune immunoglobulin to treat COVID-19 patients has found limited evidence. "We are very uncertain whether plasma from people who have recovered from COVID‐19 is an effective treatment for people with COVID‐19. The completed studies we found were poor quality and their results could be related to the natural progression of the disease, other treatments that the participants received, or to convalescent plasma," the authors wrote. 

NHS Blood and Transplant’s Clinical Trials Unit is running a convalescent plasma trial in England. Head of the unit Dr Lise Estcourt said in a statement: "This Cochrane rapid review of the evidence shows there is currently only very limited evidence on the benefits and safety of convalescent plasma.

"This is why it is so important to perform large randomised controlled trials that are powered to detect a difference in outcomes that are important to patients such as decreasing mortality or the need for mechanical ventilation. In England we have opened a trial of convalescent plasma for adults admitted to intensive care (REMAP-CAP) and hope to open a trial in all hospitalised patients in collaboration with the RECOVERY trial for people of all ages."

'No Chaos' Over Pandemic PPE Stockpile

The latest rebuttal of critical media coverage comes from the Department of Health and Social Care over the Guardian and ITV News reporting on pandemic stockpile storage problems. In a blog post it tackled various claims:

There was 'chaos' in the storage company Movianto's warehouse delaying deliveries: "It is simply not true to suggest the stockpile has not always been readily deployable."

The army had to be 'scrambled' to Movianto’s warehouse to help organise and deploy the PPE: "The Armed Forces have been utilised in a wide-range of settings during the pandemic, such as in delivering testing." 

Emergency pandemic equipment was temporarily stored in a smoke-damaged warehouse that was found to contain asbestos: "It is entirely false to suggest the pandemic influenza stock has not been safely and securely stored at all times."

Photos and footage of inside the building showed pallets stored in aisles between racking, potentially slowing down access and delivery: "Only a small quantity of stock was stored in this way and that it was as part of the normal inventory checking process - some stock would be in the aisles as it is temporarily moved down from the racking to allow visual inspection."

The contract was awarded in 2018 despite the company facing financial difficulties: "The due diligence of the contract award, implementation and subsequent operations of the pandemic influenza preparedness plan (PIPP) contract have occurred in line with public procurement regulations and Logistics Industry normal operating practises."

More News in Brief

  • The National Institute for Health and Care Excellence (NICE) has produced two more COVID-19 rapid guidelines on chronic kidney disease (CKD) and interstitial lung disease. For CKD, medication should continue unless patients are advised to stop treatment by a healthcare professional, and they should be encouraged to self-monitor and self-manage the condition. The interstitial lung disease guidance gives clinicians advice on adjusting care to reduce patients’ exposure to COVID-19. and balancing the risks and benefits of drugs that affect the immune response.

  • Essex GPs won't be forced to verify deaths in person during the pandemic, the Echo reported. The BMA had threatened to take legal action against the Essex Coroner Service if it continued to enforce the demand. The newspaper quotes an Essex County Council spokesperson: "The guidance which the senior coroner issued on April 29th has been superseded by her letter dated May 7th which was sent out jointly with the East Anglian senior coroners. This latest letter has full regard for and accepts the Department of Health guidance published on May 5th."

  • The tough choices made by the NHS to respond to COVID-19 may have worsened health inequalities, according to public health doctors writing in the Journal of the Royal Society of Medicine.  They cite gynaecology, sexual health, paediatrics, and a drop in emergency department attendances. The authors wrote: "The NHS has taken swift action to expand capacity and reorganise services to help ensure that health services can help with an influx of seriously ill COVID-19 patients. Difficult choices have been made, and some unintended consequences are inevitable. Policymakers, managers and clinicians should take pause during this phase to protect the most vulnerable groups in our society from negative unintended consequences and avoid worsening health inequalities."

  • Only 1500 of the 18,000 contract tracers needed for England's track and trace plans have been recruited so far. Northern Ireland Secretary Brandon Lewis gave the figures to Sky News this morning. Overall he said there had been 15,000 applications.

  • The Crown Prosecution Service has found 44 charges brought under the emergency Coronavirus Act were incorrect because there was no evidence an infected person was involved. National Police Chiefs' Council Chair Martin Hewitt, commented: "These were unprecedented circumstances in which officers were presented with new powers within days of them being announced. This has all been done at pace and everyone in the Criminal Justice System has had to deal with a new body of legislation, which has undoubtedly led to some confusion."

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

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