UK COVID-19 Update: Farewell PHE, Hello NIHP

Tim Locke

August 18, 2020

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

PHE's Replacement Confirmed

"The National Institute for Health Protection (NIHP) will have a single and relentless mission: protecting people from external threats to this country's health. External threats like biological weapons, pandemics, and of course, infectious diseases of all kinds." Those were the words of England's Health Secretary Matt Hancock announcing a widely previewed replacement for Public Health England.

"It is conceived amid crisis but it will help maintain vigilance for years to come," he said in a speech at the Policy Exchange.

The new body brings together, under a single leadership team, Public Health England, NHS Test and Trace, and the Joint Biosecurity Centre. It will continue to work with the CMOs of Scotland, Wales, and Northern Ireland.

Earlier Matt Hancock praised PHE staff: "Our nation's public health experts have delivered incredible work during this pandemic." However, it had come under fire for overstating England's daily death figures.

NIHP will be led by the head of Test and Trace Baroness Dido Harding while there's a "global search" for future leadership.

For non-external health threats like obesity Mr Hancock said he'll consult on embedding health improvement "right across the board".

NIHP Reaction

Yesterday, Chief Executive of PHE, Duncan Selbie, said he was "sorry beyond words" the news of the body being scrapped was leaked before staff were told.

The Royal Society for Public Health said in a statement: "With a huge strain already placed upon the public health system by COVID-19, this decision, and the nature of its announcement will cause further stress and uncertainty to the public health workforce in England and across the UK."

Reacting to the announcement, Nigel Edwards, chief executive of the Nuffield Trust said: "The Government risks making a major misstep by dismantling its own public health agency at such a crucial time."

Richard Murray, chief executive of The King’s Fund, said: "PHE appears to have been found guilty without a trial. It is unclear what problem government are hoping to solve by carving up PHE and redistributing its responsibilities. Undoubtedly, there are questions to be answered about England’s handling of the COVID-19 crisis, but the middle of a pandemic is not the time to dismantle England’s public health agency."

Mr Hancock did say it is he who is accountable to Parliament.
 

COVID-19 Link to Type 1 Diabetes in Children

COVID-19 may be linked to an onset of type 1 diabetes in children, an Imperial College London study published in Diabetes Care suggests.

At the peak of the pandemic North West London hospitals saw 30 cases of children presenting with new type 1 diabetes symptoms, around twice as many cases as normal.

Not all children were tested for COVID-19 but five had evidence of past or current coronavirus infection.

Commenting via the Science Media Centre, Prof Deborah Dunn-Walters, chair of the British Society for Immunology taskforce on COVID-19 and Immunology, and professor of immunology at the University of Surrey, said: "As not all children in the study were tested for COVID-19, the findings do not show that this increase was linked to the COVID-19 pandemic, in fact, it is currently unclear what was behind this rise in cases.

"COVID-19 is caused by the virus, SARS-CoV-2, and we know that other viral diseases can act as a trigger for some autoimmune diseases, such as Guillain-Barre syndrome. As SARS-CoV-2 is such a new virus, there is still much we need to learn about how it interacts with our immune systems and the long-term effects that it might have on us."

COVID-19 & Depression

The number of adults with some symptoms of depression in Great Britain nearly doubled during the pandemic, Office for National Statistics data show.

The survey of 3500 found depression rates at 9.7% in July 2019 to March 2020 and 19.2% in June 2020.

Tim Vizard from ONS commented: "Nearly 1 in 5 adults were experiencing some form of depression during the pandemic, almost doubling from around 1 in 10 before. Adults who are young, female, unable to afford an unexpected expense or disabled were the most likely to experience some form of depression during the pandemic."

COVID-19 Case Characteristics

ONS also produced new data on case characteristics from its Infection Survey. Over the last 8 weeks it found:

  • Of those testing positive on nose and throat swabs over the study period only 28% reported symptoms around the time of the test

  • Asian or Asian British people were more likely to test positive that White people and a higher percentage of individuals from ethnic minorities may have had COVID-19 in the past.

  • People living alone were more likely to test positive than those in two-person households but there was no evidence of differences for larger households

  • It wasn't possible for ONS to say whether those working in patient-facing healthcare roles were more likely to test positive than others but a higher percentage of those in patient-facing healthcare roles or resident-facing social care roles tested positive for antibodies

ONS Weekly Deaths

ONS also reported registered deaths in England and Wales in week 32 (to 7 August) were below the 5-year average for the 8th week in a row. UK deaths were also below the 5-year average.

It found 152 English and Welsh deaths mentioning COVID-19 on death certificates, the lowest in the last 20 weeks.

For places of COVID-19 death, 63.4% were in hospital, 29.6% in care homes, 4.7% in private homes, and 1.4% in hospices.

Nurses 'Stopped From Handling COVID-19 Triage Calls'

The Independent reports that nurses and non-medical staff have been removed from work taking calls from patients to the NHS England COVID-19 Clinical Assessment Service, part of 111,  over safety concerns.

It said a leaked email revealed an audit found more than half of callers received potentially unsafe advice and one person may have come to harm due to assessment handling.

It quotes an email to staff from Clinical Assurance Director Enid Povey: "Unfortunately, these call audits resulted in a number of clinical incidents having to be raised. These incidents are currently being investigated, with one escalated as a serious untoward incident with potential harm to the patient."

Doctors' 'Extreme Concern' Over Former Shielders

A group of medical organisations has issued a joint statement expressing "extreme concern" over clinically extremely vulnerable people losing income protection if they are unable to work from home.

Shielding arrangements ended earlier this month. The signatories include the Royal College of Physicians (RCP), the Royal College of Emergency Medicine, Royal College of GPs, and the Royal College of Paediatrics and Child Health.

They point out the difficulties for clinicians in assessing individual risk factors. Among the recommendations is putting arrangements in place so that people at very high risk do not have to return to work if they cannot work from home.

RCP Registrar Professor Donal O’Donoghue commented: "Official shielding advice may have ended, but we cannot assume that patients who were previously shielding now no longer need protection from COVID-19.

"It is incredibly important that clinically vulnerable people continue to receive appropriate advice and care for the underlying conditions that have rendered them vulnerable in the first place, including having access to the flu vaccination."
 

‘A’ Level Concerns for Future Doctors

The BMA has added its voice to concerns for A level students wanting to study medicine after the grading fiasco and teacher assessment U-turn.

Medical Students Committee co-chairs Gurdas Singh and Chris Smith said: "...on the basis of being allocated poorer grades than expected, many will have missed out on a place at any of their chosen schools, taking instead a non-medical course. For others, this could mean having to take a gap year, which could present a whole new set of issues for disadvantaged students.

"All of these scenarios could mean an end to many students’ desires to have a career in medicine, and so the BMA is calling on medical schools to review the applications of those who were not awarded a place in light of this...announcement. Equally, students who have successfully secured a place at medical school shouldn't have this revoked, and any subsequent increase in places must be matched by funding and resources throughout medical school, followed by additional jobs in the foundation programme when appropriate."

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

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