UK COVID-19 Update: ICU Admissions 'Heading The Wrong Way'

Tim Locke

September 30, 2020

Editor's note, 1 October 2020: This article was updated to correct daily case data.

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

ICU Admissions 'Heading the Wrong Way'

Last time there was a Downing Street COVID-19 news briefing the medical and science experts presented data without a minister present. Today they were joined by the PM.

"I wish I could tell you tonight that the impact of this package [of previously announced restrictions] has already begun to appear, but it will take time to feed through," Boris Johnson said, promising more regular news conferences "at this critical moment".

No new measures were announced today.

Chief Medical Adviser Professor Chris Whitty said rising cases aren't just due to extra testing. In some age groups test positivity was as high at 15% in parts of the country, he said.

The virus isn't just affecting younger age groups, he added: "Older people are getting this, and they are then having to go into hospital, and then transferring, some of them sadly, into intensive care."

ICU admissions, Prof Whitty said, are "definitely heading the wrong way".

Source: 10 Downing Street

He did, however, stress: "The NHS is absolutely open for business, and it is absolutely there, not just for emergencies, for cancer care, and for all other kinds of care."

Daily Data

Another 7108 UK COVID-19 cases were announced today and 71 deaths.

Chief Scientific Adviser Sir Patrick Vallance clarified daily case figures: "The number of cases that we're seeing now are picked up because there's much more testing. The number of cases that were reported in March were almost certainly a very big underestimate of the total. So it's much more likely that back in March and April, at the peak of this, we were seeing over 100,000 cases a day at certain times."

With cases rising, "We don't have this under control at the moment," he said.

There are now 2252 COVID-19 patients in hospital and 312 patients are using ventilator beds.

General Practice 'Needs Extra Support for Second Wave'

The BMA is warning that general practice needs urgent support, including resources, PPE, and a suspension of inspections, to cope with a second wave of COVID-19.

GP Committee England Chair, Dr Richard Vautrey, said: "With the UK recording a record number of daily COVID cases yesterday, GPs, like all doctors, are extremely concerned that without decisive action now services will be overwhelmed if we see another spike in the coming weeks and months.

"This means giving practices and the profession all they need – whether that’s an occupational health service similar to that already freely available to hospital workers so that staff get the vital risk assessments needed to protect them, or funding to extend surgery buildings to ensure social distancing and infection control measures are maintained, keeping patients and staff safe."

Hospital's Emergency Measures

The Royal Glamorgan Hospital has introduced temporary restrictions on services after a COVID-19 outbreak of 82 confirmed cases.

Planned surgery is suspended apart from a small number of cancer operations. Emergency admissions are being redirected to other hospitals but A&E remains open for walk-in cases.

Health board CEO Paul Mears said: "These decisions have not been taken lightly, and we understand that they will impact our patients, their families, our staff and partner organisations.  However, the safety of our patients and staff is of the utmost importance and we believe this is the right course of action, based on the professional advice given to us."

Latest Local Lockdowns

Denbighshire, Flintshire, Conwy, and Wrexham in North Wales are under new restrictions from this evening.

Wales' Health Minister, Vaughan Gething, said rising cases in these areas "are largely linked to people socialising indoors and are the pattern of transmission similar to what we have seen in South Wales".

The Speaker of the Commons Sir Lindsay Hoyle refused to allow rebel Conservative amendments to Government emergency power legislation. However, he said the Government pushing through new COVID-19 restrictions has been "totally unsatisfactory" and showed "a total disregard" for MPs.

Later Health Secretary Matt Hancock told the Commons: "I can confirm to the House that for significant national measures with effect in the whole of England, or UK-wide, we will consult parliament, wherever possible we will hold votes before such regulations come into force."

Nearly a Million Women Miss Breast Screening 

The charity Breast Cancer Now estimates that around 986,000 women have now missed mammogram appointments since screening programmes were paused in March.

It says the backlog is likely to include 8600 undetected cases.

Chief Executive Baroness Delyth Morgan commented: "We understand that the breast screening programme was paused out of necessity due to the global COVID-19 pandemic, but we must now press play to ensure that all women can access breast screening, and we cannot afford for the programme to be paused again."

A separate estimate from Cancer Research UK looking at cancer inequality predicts 20,000 cancer cases a year in poorer areas of the country.

Chief Executive Michelle Mitchell said in a news release: "The pandemic has exposed long-standing inequalities in healthcare across the UK. Government must pay close attention to the widening gap between richer and poorer areas, injecting much needed money into public health funding, including Stop Smoking Services, to help reduce this inequality." 

Millions Spent on Ventilators, Most Unused

A National Audit Office (NAO) report has found that £569 million was spent to buy ventilators early in the pandemic but most were not needed.

NAO described the urgent procurement process: "This urgency was reflected in their approach of: getting the programmes up and running very quickly; protecting their private-sector partners from financial risk; making early commitments to contracts; paying cash upfront for ventilators before they could be inspected; showing a willingness to accept that prices were higher than the normal market rate; deliberately supporting multiple ventilator challenge options; and drawing significantly on technical expertise and capacity from the private sector."

It said a stock of 30,000 ventilators is now available to the NHS. "Ultimately, the anticipated urgent demand for ventilators in mid-April did not materialise."

In a statement NAO head Gareth Davies said: "The Government acted quickly to secure the thousands of ventilators it thought it may need to safeguard public health. In the event far fewer ventilators were required than was anticipated during the first phase of the pandemic, resulting in a stockpile that may be needed for future peaks in clinical need.

"As with all aspects of its pandemic response, the Government should ensure that the learning from this experience is used to enhance its contingency planning for future public health emergencies."

Learning Lessons for Maternity Services

The Royal College of Obstetricians & Gynaecologists and the Royal College of Midwives say lessons from the first wave must be learned to avoid widespread staff deployment in future.

RCOG President Dr Edward Morris said: "We are acutely aware how difficult restrictions on birth partners attending maternity services have been for women and families throughout the pandemic. With increasing prevalence of the virus in many areas and a growing number of local lockdowns and restrictions, services are likely to reluctantly need to maintain some of these restrictions for some time to come. However, we know that all services are prioritising enabling birth partners to attend labour and birth, and as many key appointments, including scans, as possible.

"As we approach a potential second wave of the pandemic, we intend to support clinical leaders in maternity to continue to provide safe and personalised care to women and families, and to continue to plan service provision during these challenging times."

Healthcare Jobs

NHS England is reporting more people searching for healthcare jobs after watching TV documentaries like 'Ambulance'.

Google searches for ‘ambulance jobs’ rose by 70% it said.

National Medical Director Professor Stephen Powis said: "The 'Nightingale effect' of the public seeing on TV the relentless professionalism and compassion of NHS doctors, nurses, and paramedics during the first wave, has clearly made a difference."

Meanwhile nursing assistants are among the occupations that should be added to the UK's Shortage Occupation List to relieve pressure when freedom of movement ends after Brexit transitional arrangements at the end of this year.

The recommendations come in a report from the Commons Migration Advisory Committee.

RCN Chief Executive and General Secretary Dame Donna Kinnair commented: "We agree with the recommendation that nursing support workers and assistants across health and care be added to the shortage occupation list. But with tens of thousands of vacancies across the UK, these changes alone won’t end the workforce crisis which threatens the safe and effective care of patients.
 

“The Government must remove all arbitrary barriers that prevent talented and much needed health and care professionals working in the UK, including removal of the unfair tax for using the services they deliver. It must also progress a clear, well-funded plan to grow and develop our existing workforce and domestic routes into nursing."

Shielders' Mental Health

Depression and anxiety were twice as common among older people who were shielding under lockdown, according to the English Longitudinal Study of Ageing (ELSA) COVID-19 substudy.

Concerns focussed on getting food and essentials, sleep, and a lack of exercise rather than missed social contact.

Dr Paola Zaninotto from UCL commented: "As we approach the prospect of a further 6 months of COVID-19 restrictions, it is more important than ever that we ensure that people with multiple long-term health conditions are able to access the community health and social care services and support that they need."

The findings have not yet been peer reviewed.

Nurse Again Warns on Panic Buying

The nurse whose emotional appeal to shoppers to stop panic buying went viral earlier in March is renewing the message.

Some supermarkets have already begun restricting the number of essential items shoppers can buy as demand grows as cases rise.

York critical care nurse Dawn Bilbrough writes in the i: "Once again, as we face the second wave, there is no apparent problem with supply of goods to our supermarkets, so let’s not create a problem that doesn’t exist – please only take what you and your family need."

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

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