UK COVID-19 Update: Second Wave 'Critical Stage', Hospital Transmission Report

Tim Locke

October 29, 2020

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

Second Wave 'Critical Stage'

Imperial's REACT continuing community COVID-19 swab testing study estimates 96,000 people a day in England are becoming infected. The latest swabs were collected on Sunday and the data are published in a preprint.

  • Infections are doubling every 9 days with infections increasing across all age groups and areas of the country.

  • An estimated 128 people per 10,000 now has the virus compared to 60 in 10,000 as of 5 October.

  • R is estimated to have risen to 1.6.

The authors conclude: "The co-occurrence of high prevalence and rapid growth means that the second wave of the epidemic in England has now reached a critical stage. Whether via regional or national measures, it is now time-critical to control the virus and turn R below 1 if further hospital admissions and deaths from COVID-19 are to be avoided."

Experts have commented via the Science Media Centre.

Professor Igor Rudan, joint director of the Centre for Global Health and WHO Collaborating Centre, University of Edinburgh, said: "This study should be considered very accurate and reliable scientific evidence that shows that a very large second wave of COVID-19 pandemic is underway.  It will inevitably lead to a very large number of infections, severe episodes and deaths in the coming weeks and months.  Efforts will be required to reduce the national reproduction number below 1.0 again.  The measures that were in place over the past 2 months across most of Europe were clearly insufficient to prevent the new large growth of infected cases and fast spread of the virus." 

Paul Hunter, professor in medicine, UEA, said: "Although we do not know for certain what the prevalence of infection was at the April peak, it is likely that infection rates now are very similar to and maybe even higher than at the peak in April."

Dr Simon Clarke, associate professor of cellular microbiology at the University of Reading, said: "We can expect this situation to continue to deteriorate if authorities remain slow to react."

Nowcast and Forecast

Also published today is the Cambridge MRC Biostatistics Unit's weekly Nowcast and Forecast.

It estimates:

  • 55,600 daily infections in England with cases "particularly high" in the North West, and the North East and Yorkshire

  • The number of daily deaths is likely to be between 237 and 422 by 5 November

  • London, followed by the North West, continues to have the highest attack rate

Lead researcher, Professor Daniela De Angelis, commented: "The estimated trends in R values and growth rates show signs that the epidemic is growing at a slower pace in most regions. However, the rising number of infections and the R values remaining above 1 clearly indicate continued transmission, leading to the prediction of a steep rise in the number of COVID-19 deaths.

"Curtailing this transmission will require sustained social distancing interventions."

PHE Data

Meanwhile Public Health England's weekly national flu and COVID-19 surveillance reports showed case rates increased in every age group except for those aged 10-19, which saw a small decrease.

Case rates per 100,000 were highest in the North East, North West, and Yorkshire & Humber.

The COVID-19 hospitalisation rate was 10.01 per 100,000 compared to 7.74 per 100,000 in the previous week.

Flu activity remains low, including GP consultations and hospital admissions.

In the weekly test and trace performance data for England, 80.5% of those transferred to the contact tracing system were reached and asked to provide information about their contacts.

Taking into account all contacts identified, 60.3% were reached.

Reasonable Worst-case Planning Scenario

The Spectator published a leak of SAGE's 'Reasonable Worst-case Planning Scenario' warning of 85,000 direct COVID-19 deaths from the beginning of July this year to the end of March next year.

The document says: "It should be noted that this is a scenario, not a prediction. The nature and precise timings of any peaks in infection and, in particular, demand on healthcare are subject to significant uncertainty. The scenarios are sensitive to initial conditions and any increase in the starting estimates of numbers of infections, hospitalisations, or deaths could lead to a larger peak."

Daily Data

In today's daily data another 23,065 UK positive tests were reported and 280 deaths.

There are 10,308 COVID-19 patients in hospital and 957 ventilator beds are in use.

In England, parts of the Midlands, Yorkshire as well as Luton and Oxford city will move into Tier 2 restrictions on Saturday.

Scotland has announced new restrictions from Monday:

  • Dundee, Inverclyde, and Ayrshire go into Level 3

  • Aberdeenshire, Fife, the Borders, Dumfries and Galloway go into Level 2

  • The Highlands and most of the Islands go into Level 1

HSIB Hospital Transmission Report

The Healthcare Safety Investigation Branch (HSIB) has issued recommendations on reducing hospital transmission of coronavirus in England following SAGE evidence in May that around 20% of patients were reporting symptoms 7 days after admission.

"Our report sets out 39 key findings that cover everything from hospital design and guidance to PPE and testing capacity," said Principal Investigator Kathryn Whitehill in a statement.

"This detailed insight enabled us to develop safety recommendations that would aid short and long term planning and ensure that NHS trusts had measures they could implement immediately."

Among the recommendations are the need for clear national safety guidelines, regular staff testing, and helping with staff "fatigue and emotional distress".

Commenting, Miriam Deakin from NHS Providers, said: "The report also rightly highlights the potential consequences of staff fatigue and emotional distress. In our recent survey of trust leaders 99% said they were concerned about current levels of burnout across the workforce."

Health Workers and Families Account for 1 in 6 COVID-19 Hospital Cases

University of Glasgow and Public Health Scotland research published in The BMJ finds healthcare workers and their families account for 17% of COVID-19 hospital admissions in the working age population.

'Front door' roles, such as paramedics and A&E teams had the highest risk, though overall hospital admission rates were low.

The observational findings come from Scottish workforce data for 158,445 healthcare workers and 229,905 household members, from 1 March to 6 June 2020.

"These findings should inform decisions about the organisation of health services, the use of personal protective equipment, and redeployment," the authors conclude.

Emergency Consultant's Warning

Emergency department consultant Dr John Maxwell has told reporters Northern Ireland has reached 103% occupancy and "I can’t remember when it was as tough as this before," the Belfast Telegraph reported.

"All the staff are working at their absolute max and unquestionably they are tirelessly trying to deliver the best care they possibly can in what are really challenging and difficult circumstances at the minute in the middle of this second surge of the pandemic.

"We are very concerned that this could be one of the worst winters that the NHS in Northern Ireland is going to experience unless we act to change and to do something different to get control of the situation."

Praise for GPs

England's general practice appointment data for September show:

  • A 20% increase in appointments compared to August

  • 56.6% of appointments were face-to-face

Dr Nikki Kanani, NHS England's medical director of primary care took to twitter to praise GPs: "These figures show what many of us have known intimately throughout the pandemic - that our general practice teams, because it has been a team wide effort, have been working incredibly hard to rapidly adapt how we offer care to make sure that we keep our patients, and our staff safe while maintaining services."

Scotland's Care Home Discharge Report

After the publication of a critical report, Scotland's First Minister Nicola Sturgeon has again said she's "deeply sorry" over 78 SARS-CoV-2 positive patients being discharged from hospital into care homes.

She said the Public Health Scotland document contained "hard messages" and that she was "determined" to "continue to learn and apply lessons". 

More Self-isolate App Alerts 

England and Wales' contact tracing app is to issue more alerts to tell people to self-isolate after an update.

"The update to the risk threshold is expected to increase the number of people asked to self-isolate by the app, having been in close contact with someone who tested positive," head of the app Gaby Appleton said in a blog post.

"Compared to when we first launched the pilot of the app in August, this update reduces the chance of telling you to isolate when you're at low risk, without reducing the number of people at high risk who are notified to self-isolate," she said.

"Another benefit of upgrading the app and employing new technology is we can also stop the 'possible exposure' or 'near miss' notifications which many users have received in recent weeks."

She said the app has now been downloaded by more than 19 million people, around 40% of eligible adults.

'Forgotten C'

A new report from Macmillan Cancer Support, called 'The Forgotten C? The impact of COVID-19 on cancer care', estimates that as many as 50,000 people in the UK have cancer which has not yet been diagnosed because of pandemic disruption.

The charity warns undiagnosed cancer cases could double by this time next year if referrals and screening don't catch up.

Macmillan released images of nearly 100 pairs of 6m long footsteps on a beach near Scarborough before they were washed away by the tide.

Chief Executive Lynda Thomas said in a statement: "These footprints represent the tens of thousands of people who are yet to hear the life-changing news that they have cancer, and those who are having their appointments disrupted once again. It is simply unacceptable if these people face unbearable and unprecedented delays which could see their hopes for the future washed away."

Source: Macmillan Cancer Support

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

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