UK COVID-19 Update: Shielding Changes Made 'on Clinical Advice'

Tim Locke

June 01, 2020

Editor's note, 2nd June 2020: This article was updated to include a statistical update from the Department of Health and Social Care on the revised cumulative total for deaths.

Shielding Changes Made 'on Clinical Advice'

Several health charities expressed concern at the surprise weekend announcement of the ending of home shielding for many vulnerable groups in England and Wales from today.

Blood Cancer UK tweeted: "The way it has announced this on a Saturday night with no warning or consultation with charities and clinicians has created confusion. This adds to the impression already created that the shielding group isn’t high enough on its list of priorities."

The Royal College of GPs (RCGP) said it would "advise extreme caution" over the change to lockdown advice.

RCGP Chair Professor Martin Marshall said in a statement: "The latest Government advice is just that - it is not a 'green light' allowing us to return to our previous way of life and there is a very real risk that all the good work we have achieved so far in the battle against COVID-19 could be very swiftly undone, with very serious consequences."

Some scientific advisers to the Government have also warned of the dangers of easing lockdown restrictions too far and too fast if the public is to be protected from a second wave of the COVID-19 pandemic.

Health and Social Care Secretary for England, Matt Hancock, told today's Downing Street briefing: "When the clinical advice said that it was safe to be able to advise those who are shielded to be able to go outside, so long as they stay 2 metres away from others, then I think it's a small step, it's a very positive step for those who have been shielding, and I know that it's been very well received by those who are shielding."

Mr Hancock denied the changes were "rushed through" despite being told many GPs reported being inundated with questions from anxious shielded patients.

Prof John Newton, director of health improvement, Public Health England, heading the testing programme in England, said: "The main consideration is the rate of infection in the community...all the indications are that that is decreasing, albeit slowly."

The BMA has also warned this is not the time to be complacent about easing lockdown measures. Its latest member poll found just under 48% of 7268 respondents were not confident about their ability to manage patient demand if there is a second peak of COVID-19.

Council Chair Dr Chaand Nagpaul said in a statement: "Of course, as doctors we understand the impact that lockdown has had on people’s health and wellbeing and how eager people are to return to some semblance of normal life. But this must be done gradually and sensibly, and the Government must also take every measure possible to support the public and employers in stopping the spread of the virus, whether that’s in outdoor places, reuniting with friends and loved ones, or returning to work."

The Latest on England's Test and Trace Programme

Prof Newton was asked about reported problems with the tracing programme: "The Test and Trace programme is working well. The data are flowing from the testing portal into the contact tracing software... all have been built relatively new, so we're very pleased to see that all working well and the contacts are being identified."

Prof Newton conceded tracers were not yet working flat out: "Many of them are not fully occupied but we wait and see. One of the challenges of course, of this, is to build a system that can respond to whatever comes in the future. And that is a little difficult to predict.

"We think there will be flare-ups in different parts of the country, we'll need to be able to divert resources as required."

Prof Newton and Mr Hancock were asked how many of the around 9000 positive cases reported since the programme started have been contacted. "The vast majority," was Mr Hancock's reply.

Prof Newton said: "The system is working well. We will be publishing some figures soon." 

He added: "If you could bear with us we are still making sure that we get the reliable data. What we don't want to do is to produce some data then have to go back and correct it."

Matt Hancock was asked if lockdown measures would really be brought back if R goes over 1.0: "We've always said that we're prepared to reintroduce measures, whether that's nationally or in response to a localised outbreak, if that is necessary."
 

Contact Tracing Begins in Wales

Wales began its Test, Trace, Protect programme today, catching up with the rest of the UK. Anyone testing positive for COVID-19 will be asked for details of close contacts.

These are people they've been within 1m of and had a face-to-face-conversation, had skin-to-skin contact with, or have coughed on, or been in other forms of contact with for a minute or longer; they have been within 2m of for more than 15 minutes, they have travelled in a vehicle with or sat near on public transport.

Close contacts will be asked to self-isolate for 14 days.

An online contact reporting system is due to be in place from next Monday.
 

'Hero' Doctors 'Not Superhuman'

The BMA's latest member polling found 41% of 7821 doctors were experiencing depression, anxiety, stress, burnout, emotional distress or another mental health condition relating to or made worse by their work, with 29% saying this had become worse during the pandemic.

There's been a 40% increase in use of the BMA’s wellbeing support services.

"This week has seen a sea-change with doctors coming forward in an outpouring of heart-breaking accounts that lay bare the heavy toll that COVID-19 has had on our mental health and wellbeing," Dr David Wrigley, BMA council deputy chair and wellbeing lead, said in a statement.

"From working longer hours in often unfamiliar settings and under increased pressure, to having to see a large number of patients dying day after day and attempting to console their relatives, the emotional strain doctors have been placed under is huge," he said.

"Throughout this pandemic doctors and healthcare workers have been painted as heroes – and the efforts that they have gone to in caring for their patients is certainly heroic. But they are not superhuman. They need to feel able to seek help and that help must be readily available."

Daily Deaths and Data

In a change to the Downing Street briefing format from today, the Government minister now presents the daily data slides, not a doctor or scientist.
 
Another 111 UK COVID-19 deaths were announced today, the lowest since the lockdown began in March, taking the total to 39,045.

At the weekend 113 deaths were announced on Sunday and 215 on Saturday.

After the briefing, the Department of Health and Social Care issued an update clarifying that the cumulative totals for deaths have been revised to include an additional 445 deaths from the period 26th April to 31st May. 

At the weekend the UK's testing capacity reached the Government's 200,000 daily target. This includes 40,000 antibody tests a day. However, overall daily tests carried out remain far lower than the available capacity. Figures for the number of people tested were last given on Friday 22nd May.

There were 128,437 tests counted yesterday. This figure includes home tests that have been sent out but not yet processed. 

Another 1570 positive cases were reported today, the lowest since 25th March, and 7541 people are currently in hospital with coronavirus down from 8830 this time last week.

Another 479 people were admitted to hospital in England with COVID-19 and 9% of critical care beds are in use by coronavirus patients.
 

NHS Deaths

Among the recently announced NHS deaths was Dr Abdy Sedghi, a GP based at Lister Hospital in Stevenage.

Chief Executive of East and North Hertfordshire NHS Trust, Nick Carver, paid tribute: "Abdy made a big impact with his charisma and personality. He was devoted to his patients, taking time to understand their problems and worries."

In Memoriam: Healthcare Workers Who Have Died of COVID-19.

More News in Brief

  • Labour MP Rosie Duffield apologised and resigned from her frontbench role after admitting breaching lockdown rules to meet a married man she didn't live with, the Mail on Sunday reported. At the weekend Downing Street briefings Dominic Cummings-related questions continued for England’s deputy CMOs. Professor Jonathan Van-Tam said: "In my opinion the rules are clear and they have always been clear. In my opinion they are for the benefit of all. In my opinion they apply to all." Dr Jenny Harries said that "as a matter of sort of personal and professional integrity, I will always try and follow the rules." 

  • The SAGE expert advisory group has published more documents but not any from the most recent meetings. These are said to "still contain sensitive information, with policy advice still under live consideration". Government Chief Scientific Adviser Patrick Vallance said: "Openness and transparency around this disease is a social imperative, which is why it's important we don't wait to publish minutes and evidence."

  • The MHRA has asked providers of laboratory-based COVID-19 antibody home fingerprick test kits to temporarily stop providing the services until they have been properly assessed and validated. Graeme Tunbridge, MHRA interim director of devices, said in a statement: "Use of unvalidated sample types may lead to unreliable results and as such we are working closely with the service providers, laboratories, and test manufacturers to resolve the regulatory and patient safety issues. People who have purchased one of these sampling kits, and received an antibody test result, should not consider the result to be reliable and should not take any action based on it."

  • A Sunday Telegraph article is the latest to receive an official rebuttal. The paper claimed the UK abandoned testing in March because the system 'could only cope with five coronavirus cases a week'. Public Health England Chief Executive Duncan Selbie said the claim was "wholly inaccurate". The statement continued: "Once there was clear evidence of widespread, sustained community transmission and the Prime Minister announced the move to delay phase, contact tracing was unlikely to control the outbreak alone. At this point contact tracing was targeted where it could be most effective during this phase – focusing on the most vulnerable, for instance, carrying out contact tracing in care homes, hospitals and institutional environments."

  • Employers could face legal action over COVID-19 exposure, a University of Stirling expert has warned in the journal New Solutions . Professor Andrew Watterson said in a news release: "Employers have a duty to report occupational diseases. However, COVID-19 is not yet classified as an occupational disease under the Prescribed Industrial Diseases scheme, which would generate workers’ compensation. Under current legislation, incidents where a worker is exposed, or possibly exposed, to COVID-19 is reported to the Health and Safety Executive under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013. There are concerns that occupational COVID-19 cases will not be reported, and those that are may not be fully investigated, recognised or compensated for."

  • A national memorial to honour NHS and emergency workers who died during the pandemic is being planned by the charity National Emergency Services Memorial and is being designed by sculptor Philip Jackson. The BMA tweeted that it is "a sobering reminder of the bravery of health and social care workers, risking their own and their families lives for the good of their patients".

https://twitter.com/SkyNews/status/1266561033386315779

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

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