UK COVID-19 Update: 'Imperfect' Vaccines, Rule of Six 'Zero Impact'

Tim Locke

October 28, 2020

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

First Vaccines 'Imperfect'

The first generation of SARS-CoV-2 vaccines "is likely to be imperfect" and "might not work for everyone", according to Kate Bingham, chair of the UK Vaccine Taskforce, writing in The Lancet.

"We do not know that we will ever have a vaccine at all. It is important to guard against complacency and over-optimism. The first generation of vaccines is likely to be imperfect, and we should be prepared that they might not prevent infection but rather reduce symptoms, and, even then, might not work for everyone or for long," she wrote.

"Our strategy has been to build a diverse portfolio across different formats to give the UK the greatest chance of providing a safe and effective vaccine, recognising that many, and possibly all, of these vaccines could fail."

Other experts, also writing in The Lancet, have outlined the key challenges for assessing clinical efficacy of the current 44 vaccine candidates.

Lead author, Dr Susanne Hodgson, University of Oxford, said: "It is unlikely that we will see a single vaccine winner in the race against COVID-19. Different technologies will bring distinct advantages that are relevant in different situations, and additionally, there will probably be challenges with manufacturing and supplying a single vaccine at the scale required, at least initially. Taking a standardised approach to measuring the success of vaccines in clinical trials will be important for making meaningful comparisons, so that the most effective candidates can be taken forward for wider use."

Meanwhile, Moderna says UK regulators are to begin a rolling review of its vaccine: "This rolling review process allows the MHRA to begin its independent assessment using the information submitted by Moderna and accept new evidence as it becomes available until the application is deemed complete. This process can reduce time to authorisation while maintaining usual high standards of safety, efficacy, and quality," the company said in a statement.

More Non-essential Ops Cancelled

Leeds Teaching Hospitals NHS Trust is among the latest group to cancel many non-essential operations due to COVID-19 pressures.

As of yesterday it had 263 COVID-19 patients with 22 in ICUs."This means we have more COVID-19 patients in our hospitals now than at the peak of the pandemic in mid-April. Over the next 48 hours we expect the number of people in critical care to increase," it said in a statement.

"We are standing down some planned operations due to current pressures which means that some patients will have their treatment postponed; only essential operations are going ahead in most cases. We have stopped elective inpatient orthopaedics at Chapel Allerton completely and we have begun a rolling programme of theatre closures to increase critical care capacity.

"We expect this to continue throughout the week, which means some difficult decisions as we prioritise cases of higher urgency. We are prioritising urgent treatments, including cancer operations."

Daily Data

In today's daily data another 24,701 UK positive tests were reported and 310 deaths.

There are 9520 COVID-19 patients in hospital and 902 ventilator beds are in use.

Rule of Six 'Zero Impact'

London School of Hygiene and Tropical Medicine researchers say restrictions such as the rule of six and the 10pm pub closing are having a minimal impact on slowing the spread of COVID-19.

In a preprint study of 3222 people they write: "We determine that the rule of six and encouraging people to WFH [work from home], has seen the average person reduce contacts but these reductions are likely small. There was little suggestion that 10pm closure has affected the number of contacts that participants make outside home, work and school.

"In contrast to national restrictions, there was a strong suggestion that local restrictions reduced the number of contacts individuals make outside of work and school, though again, this effect was small in comparison to the national lockdown."

Stroke Risk

The Cambridge Stroke Research Group has found 1.4% of hospitalised COVID-19 patients experience a stroke, with a higher risk among older patients and those with pre-existing vascular conditions.

The findings come from an analysis of 61 studies involving more than 108,571 patients, and are published in the International Journal of Stroke.

But does COVID-19 increase stroke risk, or is the association due to widespread community COVID-19 infection? "The picture is complicated," said first author Dr Stefania Nannoni in a news release. "For example, a number COVID-19 patients are already likely to be at increased risk of stroke, and other factors, such as the mental stress of COVID-19, may contribute to stroke risk.

"On the other hand, we see evidence that COVID-19 may trigger – or at least be a risk factor for – stroke, in some cases. Firstly, SARS-CoV-2 more so than other coronaviruses – and significantly more so than seasonal flu – appears to be associated with stroke. Secondly, we see a particular pattern of stroke in individuals with COVID-19, which suggests a causal relationship in at least a proportion of patients."

Antiviral Trials

The antiviral drugs favipiravir and lopinavir/ritonavir, alone or in combination, are being tested to see if they stop early stages of COVID-19 under UCL's randomised FLARE trial.

Up to 240 adults aged 18 to 70 will be recruited in London hospitals.

Trial lead Dr David Lowe said in a news release: "To maximise the potential benefit, we are treating patients with very early onset infection and are looking for the additional or synergistic effects of adding a second drug [favipiravir or lopinavir/ritonavir].

"If we can find antivirals that decrease viral load early on, this might reduce the risk of transmission and later hospitalisation."

New Dashboard

The UCL-led interdisciplinary research collaboration i-sense has developed a new public health dashboard called COVID RED to help make sense of different public datasets. Co-developer Professor Christina Pagel said: "Increasing volumes of data are being shown in the media and in government press conferences as a basis for local tightening of restrictions. However, these data are often from disparate sources, and are not linked together to give a more complete picture of how we are doing.

"This was the motivation behind our dashboard development. We wish to contribute to the public understanding of COVID-19's spread, and support policymakers in identifying current areas of the Find, Test, Trace, Isolate and Support structure requiring strengthening."

Source:i-sense/UCL

Over 55s Most Critical of Pandemic Care

Over 55s are least likely to think care improved during the pandemic, the Care Quality Commission said.

It published results of a 'Because We All Care' campaign survey showing only 14% of over 55s said care improved during COVID-19 compared with 29% of under 55s.

Over 55s are also significantly less likely to think that it is acceptable for health and social care providers to offer a lower standard of care due to coronavirus.  
 

ESC Stays Online Only

European Society of Cardiology (ESC) President Professor Stephan Achenbach says all congresses, teaching courses, and exams, up to and including ESC 2021, will be delivered online.

"Until we can safely reinstate our in-person events, we believe these new initiatives will help fill the inevitable gaps," he said in an email to members. 
 

Stranger Danger

A survey from Public Health Wales suggests 76% of people believe they are more likely to catch coronavirus from strangers rather than their family or friends.

Professor Mark Bellis from PHW commented: "Although there is no specific data for Wales on which settings are most favourable for virus transmission, it increasingly appears that much, potentially most, transmission occurs through socialising and household interactions. That is why many restrictions are focused on reducing contact between households often in people’s homes and other enclosed spaces."

Other findings included:

  • 70% think we will still be having local lockdowns in 6 months' time

  • 32% think we will be in a national lockdown in 6 months' time

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

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