UK COVID-19 Daily: NHS Surcharge U-turn 

Tim Locke

May 21, 2020

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

NHS Surcharge U-turn

The Government has bowed to pressure from medical groups and unions to remove the health surcharge for overseas NHS and care workers.

Yesterday Boris Johnson told the Commons it was the "right way forward" to keep the levy. However, today he asked the Home Office and the Department for Health and Social Care to remove NHS and care workers from the NHS surcharge "as soon as possible".

England's Health Secretary Matt Hancock told the Downing Street briefing: "The purpose of the immigration health surcharge within the NHS is a fair one. And the purpose is to ensure that everybody contributes to the NHS. But also those who work within the NHS and within social care, are themselves making that contribution directly."

Labour's Sir Keir Starmer tweeted: "This is a victory for common decency and the right thing to do.

"We cannot clap our carers one day and then charge them to use our NHS the next."

Dr Samantha Batt-Rawden, president of the Doctors’ Association UK commented: "At a time when doctors and nurses from overseas are putting their lives on the line, exempting them from the surcharge is only right in recognition of their service to our country."

There's also been a development over indefinite leave to remain for the bereaved families of support staff.

Yesterday the Culture Secretary Oliver Dowden said he'd look into why the families of overseas carers, porters, and cleaners, who die with COVID-19 didn't have indefinite leave to remain in the UK, unlike doctors and nurses. Later the Home Office announced the rules had been changed and: "The offer of indefinite leave to remain will be effective immediately and retrospectively."

Testing Announcements

Health and care staff, patients, and care home residents, will be the first to receive NHS antibody tests to check they've had coronavirus.

Ten million tests have been ordered from two companies for all four UK nations, England's Matt Hancock announced.

"This is an important milestone, and it represents further progress in our national testing programme," he said.

Last week Public Health English approved the antibody tests from Roche and Abbot said to be up to 100% accurate and "game changers". Today the evaluations were published.

  • For the Roche test 93 convalescent samples were tested resulting in 78 positive results, 84% accuracy. All negative samples tested negative.

  • For the Abbott test 96 convalescent samples were tested resulting in 90 positive results, 94% accuracy. All negative samples tested negative.

Commenting via the Science Media Centre, Jon Deeks, professor of biostatistics and head of the Test Evaluation Research Group, University of Birmingham, said: "Whilst these error rates, particularly for Abbott, may still be low enough for these tests to have a useful role, they fall short of being game changers, and certainly cannot be described as 100% accurate."

Mr Hancock also said he was backing a new swab test from OptiGene that gives a result in 20 minutes without the need for samples to go to a laboratory.  "It is interesting to us because it is so fast,: he said. "You get the result on the spot."

Up to 4000 people of all ages and backgrounds will be tested in a trial that began today in Hampshire.

Overall, he said: "I'm prepared to back innovative developments even if they might never happen."

Scotland's Phased Plan to Ease Lockdown

Scotland will begin easing lockdown restrictions next week in a framework published today called: Scotland’s route map through and out of the crisis.

After the current lockdown there will be four phases. Phase 1 can begin with R under 1 for 2 weeks in Scotland.

Measures include allowing people from one household to meet another household outdoors, non-contact sport to resume, and social work services to restart.

Schools will open for 'blended' part-time classroom and online learning at the start of the autumn term on August 11th.

Scotland is trialling a test, trace, isolate, and support system called 'Test and Protect'.

First Minister Nicola Sturgeon told the Scottish Parliament: "We will conduct formal reviews, at least every 3 weeks to assess if and to what extent we can move from one phase to the next, but we will be constantly alive to when we can go faster, or indeed whether we have gone too far."

Anaesthetists' Concerns Over Restarting Services

A Royal College of Anaesthetists (RCOA) member poll has found 34% have low confidence in  their hospitals’ preparedness for  restarting non-COVID-19 NHS services.

Around 1500 responses were received to the online survey on the 13th and 14th May.

Other findings included:

  • Continuing concerns over access to testing for patients (17%), themselves (18%) and household members (31%)

  • 56% still have concerns over PPE supplies

  • 13% experienced delayed patient care due to a lack of PPE

  • 27% are concerned about anaesthetic drugs stocks over the coming month

  • 42% experienced mental distress

  • 12% feel at risk of burnout

  • 21% report low or very low team morale

RCOA President Professor Ravi Mahajan said in a statement: "While we fully agree that NHS services must resume, it is vitally important that we do this in a way that maintains staff and patient safety. We call for a greater investment in resources to facilitate this process and address staff wellbeing."

Daily Deaths and Data

Another 338 UK COVID-19 deaths were announced today taking the total to 36,042.

Of the 187 deaths in English hospitals, patients were aged between 14 and 98. Six aged between 46 and 94 had no known underlying health condition.  

There were 128,340 tests counted yesterday. This figure includes home tests that have been sent out but not yet processed. The current target is 200,000 tests a day by the end of the month. Yesterday 67,681 people were tested.

Another 2615 positive cases were reported today and 9543 people are currently in the hospital with coronavirus, down 14% from this time last week. 

There were 697 COVID-19 hospital admissions in England yesterday, and 13% of UK critical care beds are being used by COVID-19 patients.

England's Infection Rate

The Office for National Statistics (ONS) estimates that an average of 0.25% of the community population in England (137,000 people) had COVID-19 between 4th-17th May.

This was similar to its previous estimate, ONS said, indicating that the number of people with COVID-19 is "relatively stable". It estimated there were 61,000 new infections per week.

It found no differences in the proportions testing positive between men and women, different age groups, or health and social care workers compared with people not working in those jobs.

The estimates are based on tests on 14,599 people in 7054 households.

More News in Brief

  • There's been a lot of interest in vitamin D in reducing the severity of COVID-19 symptoms. However, an international consensus paper led by the University of Surrey warns against taking high doses of vitamin D supplements  (higher than 4000IU/d) as current research has so far found no benefit. Lead author of the paper published in BMJ Nutrition, Prevention, and Health, Professor Sue Lanham-New said in a news release that: "Too little can lead to rickets or the development of osteoporosis but too much can lead to an increase in calcium levels in the blood which could be particularly harmful."

  • Some NHS workers will be joining an international study to find out if chloroquine could help prevent COVID-19. The randomised CROWN CORONATION study is recruiting 30,000 healthcare staff around the world. UK lead investigator, Professor Laurence Lovat, UCL, said in a news release: "Our hypothesis is that chloroquine may decrease the COVID-19 burden by decreasing entry of the novel coronavirus into host cells and by inhibiting viral replication."

  • University of Edinburgh preprint research has confirmed wearing face coverings or masks can help reduce the distance covered by exhaled breath by up to 90%. Tests were done using a manikin connected to a coughing machine. Air can still escape if masks aren't well fitting, and air can be forced backwards in some cases. Researcher Dr Felicity Mehendale said in a news release: "It was reassuring to see the hand-made mask worked just as well as the surgical mask to stop the wearer’s breath flowing directly forwards. This suggests that some hand-made masks can help to prevent the wearer from infecting the public. But the strong backward jets mean you need to think twice before turning your head if you cough while wearing a mask; and be careful if you stand behind or beside someone wearing a mask."

  • Experts writing in the BMJ say the UK's recovery from COVID-19 must include tackling alcohol harms. Alcohol sales rose by 67% in the week to 21st March. Sir Ian Gilmore, chair of Alcohol Health Alliance UK, and Baroness Ilora Finlay, chair of the Commission on Alcohol Harms write: "As in so many aspects of the coronavirus epidemic, it will be only in hindsight that we will be able to measure the impact of social isolation, job losses, and financial meltdown on the alcohol balance sheet."

  • Lockdown guidelines are not being strictly adhered to by more than half of young adults, according to continuing UCL research. Lead author, Dr Daisy Fancourt, said in a news release: "Throughout lockdown, compliance with government advice has remained generally very high, but we have seen a decrease over the past 2 weeks. Confidence in government has fallen in England since the easing of lockdown was announced and is lowest in those under the age of 30."

  • Wales has increased the maximum fine for repeated breaches of lockdown rules from £120 to £1920. First Minister Mark Drakeford said in a statement: "These changes will send a strong signal to the small minority of people who are blatantly ignoring the rules and undermining the efforts of everybody else who are doing the right thing."

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

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