UK COVID-19 Update: NHS '2 Year' Backlog

Tim Locke

June 30, 2020

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

'2 Years' for NHS Backlog Recovery

NHS services could take as long as 2 years to recover from the effects of COVID-19, a Royal College of Physicians (RCP) member survey of specialists suggests.

Fewer procedures can be undertaken due to infection control measures affecting specialties in different ways, RCP found.

Respiratory and gastroenterology specialists expected it to take 2 years to recover from the COVID-10 backlog but cardiologists predicted 18–21 months.

RCP President Professor Andrew Goddard commented: "We cannot underestimate the extent of the work that still lies ahead for the NHS workforce, and the very real possibility of further COVID-19 outbreaks and additional waves, which would of course increase the challenge ahead."

A separate survey representing 158 NHS trust chairs and chief executives in England found that 54% were reporting increasing numbers of patients whose health conditions had become urgent by the time they sought help.

Chris Hopson, chief executive of NHS Providers, said in a statement: "Trust leaders are as frustrated as patients and service users that they can’t go faster. But it’s not just a case of flicking the light switch back on. COVID-19 brings a whole new set of demands and the overwhelming priority must be to provide safe care."

Sir Simon Stevens, chief executive of NHS England, told the Commons Health Select Committee today about the scale of the drop on non-COVID-19 treatment: "The number of elective admissions in March and April was around 725,000 lower than what we might have expected given pre-COVID levels of growth. The drop was greatest in April when we saw around 530,000 fewer elective episodes. That number has begun to recover quite significantly since then. As we speak, we think we’re now somewhere north of 55% of pre-COVID elective activity levels," he said.

New Laws for Leicester Lockdown

New legislation will be introduced to enforce a local lockdown in Leicester to tackle a spike in COVID-19 cases, the Government announced.

People in Leicester and some outlying areas will be asked to continue following stricter rules for at least another 2 weeks.

COVID-19 admissions to hospital in Leicester were between 6 and 10 per day rather than around 1 a day at other trusts according to the Health and Social Care Secretary for England, Matt Hancock.

Leicester City Council said it had had 3216 confirmed COVID-19 cases since the start of the epidemic. Of those, 944 cases were reported in the last 2 weeks, mainly in the east of the city.

'Whack-a-mole', Learning Lessons 

Prime Minister Boris Johnson thanked the people of Leicester for their "forbearance" in dealing with the new coronavirus restrictions and said that he'd continue to take "draconian steps if necessary to put on the brakes," to deal with future local outbreaks in a system he's described as "whack-a-mole". 

The PM was making a speech in Dudley in the West Midlands on future government building plans in England, including previously announced new hospitals.

He defended England's test and trace system: "We've got a testing capacity of 280,000 a day, and testing is a huge part of that whack-a-mole strategy." 

Mr Johnson also looked back on the Government's response to COVID-19: "I know that there are plenty of things that people will say we got wrong. And we owe that discussion, and that honesty, to the tens of thousands who have died before their time, to the families who have lost loved ones. And of course, there must be time to learn the lessons, and we will. 

"But I also know that some things went right, and emphatically right."

He cited the setting up of the NHS Nightingale hospitals, British companies responding to the ventilator challenge, and Oxford's dexamethasone research findings.

"We have the world's most brilliant medical minds, the world's best pharmaceutical companies, our doctors, our treatments, are the best in the world. And yet we have so many millions who have to wait for too long to see their GP, even before the new waiting lists, produced by the crisis," he said. 

We must use "this moment" to fix problems that were "most brutally illuminated in that COVID lightning flash". This includes social care, Mr Johnson said. 

He pointed to the sometimes "sluggish" response by some parts of Government: "Sometimes it seemed like that recurring bad dream when you're telling your feet to run and your feet won't move."

He promised further NHS funding, and, "We won't wait to fix the problems of social care that every government has flunked for the last 30 years. We will end the injustice that some people have to sell their homes to finance the cost of their care, while others don't."

He also announced a new science funding agency.

RECOVERY: Lopinavir-Ritonavir 'No Clinical Benefit' 

The latest findings from the University of Oxford's RECOVERY Trial of potential COVID-19 drugs show no clinical benefit in hospitalised patients treated with the HIV antiviral lopinavir-ritonavir.

In a news release the chief investigators said: "A total of 1596 patients were randomised to lopinavir-ritonavir and compared with 3376 patients randomised to usual care alone. Of these patients, 4% required invasive mechanical ventilation when they entered the trial, 70% required oxygen alone, and 26% did not require any respiratory intervention. There was no significant difference in the primary endpoint of 28-day mortality (22.1% lopinavir-ritonavir vs. 21.3% usual care; relative risk 1.04 [95% confidence interval 0.91-1.18]; p=0.58) and the results were consistent in different subgroups of patients. There was also no evidence of beneficial effects on the risk of progression to mechanical ventilation or length of hospital stay."

Deputy Chief Investigator Professor Martin Landray said: "These are clear results and once again emphasise the value of large randomised clinical trials in differentiating drugs we hope work from treatments we know do work. In many countries, current guidelines recommend lopinavir-ritonavir as a treatment for COVID-19. The results from this trial, together with those from other large randomised trials, should inform revisions to those guidelines and changes to the way individual patients are treated."

The Medical Research Council helped fund the trial. Its Executive Chair Professor Fiona Watt commented: "Whilst it is disappointing that lopinavir/ritonavir, like hydroxychloroquine, has been found to be ineffective, the earlier findings with dexamethasone were positive.  Researchers and health professionals are now focusing their efforts, and patient care, on other promising drugs."

COPCOV Hydroxychloroquine Trial Restarts

The University of Oxford is to restart its global COPCOV trial of hydroxychloroquine for the prevention of COVID-19 in healthcare workers after getting MHRA approval.

Recruitment of participants was suspended on 8th June after the MHRA told UK clinical trialists using hydroxychloroquine to treat or prevent COVID-19 to suspend recruitment of further participants.

However, on 17th June Oxford asked to restart recruitment. The evidence it gave was reviewed by the MHRA with advice obtained from the Commission on Human Medicines, and agreement has now been given.

Dr Siu Ping Lam, MHRA director of licensing, said in a statement: "We have reviewed the University of Oxford’s request to recommence recruitment for the COPCOV trial, investigating the use of hydroxychloroquine in the prevention of COVID-19. After analysing the additional risk mitigations and consulting the Commission on Human Medicines, we have given the clinical trial the green light to recruit more participants.

"Participant safety is our priority, so we will continue to monitor the trial to ensure ongoing appropriate measures are in place to maintain continued high levels of safety," he said.

Antibody Test Evidence Review

A Cochrane review of evidence found many studies assessing the accuracy of COVID-19 antibody tests had major shortcomings.

There were hopes that positive results could show some level of protection against re-infection.

Jon Deeks, professor of biostatistics at the University of Birmingham who leads Cochrane's test evaluation said: "A lot of people in the UK are very interested and keen to know, but there is no decision they should be making at the moment based on the results of that test."

Excess Deaths 'Back to Normal'

The latest Office for National Statistics (ONS) weekly data show the number of deaths registered in the UK in the week ending 19th June (week 25) was 10,681. That's eight deaths fewer than the 5-year average.

Overall, 49,371 COVID-19-related deaths were registered in England and Wales between 28th December and 19th June 2020.

Another 155 UK COVID-19 daily deaths were announced today, taking the total to 43,730.

There were 133,467 tests counted yesterday. This figure includes home tests that have been sent out but not yet processed. Figures for the number of people tested were last given on Friday 22nd May.

Another 689 positive cases were reported today taking the total UK confirmed cases to 312,654.

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

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