UK COVID-19 Update: A&E Diverts, Tier Changes, 'Missing' Results

Tim Locke

December 17, 2020

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

A&E Diverts

NHS Providers said the latest NHS performance data for England showed "extremely challenging pressures".

Director of Policy and Strategy, Miriam Deakin, said: "We are deeply concerned that this week there were 44 A&E diverts, higher than anything we’ve seen across the last three winters and unusual so early in the season. These diverts are a result of localised pressures, indicating that some health and care systems are struggling with the number of patients who need their help.

"Despite best efforts by paramedics and hospital staff, this picture of growing pressure is also reflected in the worsening of ambulance handover times in the past week. Separate data shows that 21% more people were admitted to hospital for COVID-19 this week than the week before."

Tier Changes

More parts of England are moving into the highest Tier 3 on Saturday joining London, parts of Essex, and Hertfordshire announced earlier in the week. Areas include Reading, Portsmouth, and most of Surrey. Manchester stays in Tier 3 despite cases falling to below the national average.

Tier 3 will cover 68% of the population of England.

Bristol and North Somerset move from Tier 3 to Tier 2, and Herefordshire moves from Tier 2 to Tier 1.

The BMA praised Wales for tightening the law on Christmas household mixing yesterday and criticised Boris Johnson for not making a similar announcement for England. "Relaxing the rules will, without doubt, cost lives and the impact on the NHS in the New Year will be grave," Council Chair Dr Chaand Nagpaul said.

Doctors Association UK President, Dr Samantha Batt-Rawden, told LBC: "Our worry is that this has put the responsibility back onto the public instead of the Prime Minister making a brave decision to continue to protect the NHS."

'Missing' Test Results

Public Health Wales said system maintenance led to a delay in uploading 11,000 positive Lighthouse lab test results for 9-15 December.

That would make cases for that week nearly twice as high as previously reported.

The extra Welsh cases caused a jump in today's UK daily positive test figures to 35,383 from 25,161 yesterday. 

Incident Director Dr Robin Howe said: "It is important to note that this issue has not affected individuals receiving their results and the contact tracing process being commenced."

He also gave the latest data: "The number of Coronavirus cases continues to increase, with the 7-day rolling average passing 500 cases per 100,000 in Wales.

"Rates of infection have increased in 21 of the 22 local authorities over the last 7 days, with the 7-day rolling average now exceeding 1000 cases per 100,000 in one area."

Wales will go into a new national lockdown on 28 December.

Test and Trace

England's Test and Trace programme is now tracing 92.7% of contacts to tell them to self-isolate. That's up from 85.9% last week.

The Department for Health and Social Care said the better performance was due to changes that avoid multiple calls to the same household, and hiring more call handlers.

For in-person tests, 91.8% of results were received the day after testing.

Schools Infection Survey

The first results from a COVID-19 infection survey of schools in England found 1.24% of pupils and 1.29% of staff tested positive in November.

Infection rates were higher in secondary schools than in primary schools but the difference was not statistically significant.

The study involved Public Health England (PHE), the Office for National Statistics (ONS), and the London School of Hygiene & Tropical Medicine and tested nearly 10,000 students and staff across 63 secondary schools and 42 primary schools across 14 local authority areas.

The findings for schools match the separate infection survey in the general population that showed a 1.2% infection rate.

Chief Investigator, Dr Shamez Ladhani, PHE consultant, commented: "While there is still more research to be done, these results appear to show that the rate of infection among students and staff attending school closely mirrors what’s happening outside the school gates. That’s why we all need to take responsibility for driving infections down if we want to keep schools open and safe for our children."

Today secondary schools in England were told to stagger pupils' return in January. Testing is also on offer for staff and pupils.

Deaths

ONS data for November show COVID-19 was the leading cause of death in November 2020 for the first time since May in England (18.1% of all deaths), and Wales (21.6%).

For all deaths registered in January to November, COVID-19 was the second most common cause of death in England and Wales after dementia and Alzheimer’s disease.

Pregnancy & COVID Jabs

The Royal College of Obstetricians and Gynaecologists (RCOG) issued information to women about COVID-19 vaccination and pregnancy.

RCOG President Dr Edward Morris said in a statement: "As specific clinical trials of COVID-19 vaccines in pregnant women have not yet been carried out, there isn’t sufficient evidence to recommend the routine use of COVID-19 vaccines to pregnant or breastfeeding women.

"Women planning a pregnancy within 3 months of receiving the first dose are also being advised not to have the vaccine, but this is precautionary advice until we have information from research studies in pregnancy."

RCOG and the Royal College of Midwives are calling on the Government to fund research into suitability of approved COVID-19 vaccines in pregnancy and while breastfeeding.

President Macron

France's President Emmanuel Macron has become the latest world leader to test positive for coronavirus. Mr Macron had a test after showing symptoms but it isn't clear where he was infected. He's working from home during 7 days of isolation.

He met the Spanish Prime Minister Pedro Sanchez and Portuguese Prime Minister António Costa this week and both are now self-isolating.

Scans Backlog

BBC analysis of official figures suggests at least 4.4 million fewer diagnostic scans were performed in England between April and September this year compared to the same period last year.

Currently, 1 in 7 people are now waiting more than 3 months for a scan.

It quotes Jody Moffatt, head of early diagnosis for Cancer Research UK: "There is a cohort of patients out there that have not been diagnosed yet - and who knows what state they will be in when they are."

Vitamin D

New guidance from the National Institute for Health and Care Excellence (NICE) does not recommend vitamin D as a COVID-19 treatment.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: "As research continues on the impact of vitamin D on COVID-19, we are continuing to monitor evidence as it is published and will review and update the guidance if necessary."

Kids' Neurological Impact 

University of Manchester researchers have documented cases of 38 children from eight countries, including eight from the UK, who had brain and/or spinal cord abnormalities after COVID-19 infection.

  • Twenty six of the children recovered and six were on their way to recovery

  • Eight did not display the common respiratory symptoms associated with the virus

  • Four died from co-infections, including TB and MRSA

Joint senior author on the study published in The Lancet Child and Adolescent Health,  Professor Stavros Stivaros, said: "We hope our study will alert hospital doctors and A&E staff looking after children to the fact COVID-19 should be considered as one of the factors that can cause that brain and spinal cord dysfunction."

Fillings

Dentists should drill more slowly to help reduce possible aerosol spreading of COVID-19, according to Imperial College London and King’s College London researchers.

Dental drilling should also be avoided using a mixture of air and water as the abrasion coolants.

New parameters could produce 60 times fewer aerosol droplets, according to the research published in The Journal of Dental Research.

The research is being used to inform guidance changes.

Professor Owen Addison from King’s commented: "Because of the COVID-19 pandemic, dentistry has become a high-risk practice but the need for treatments hasn’t gone away. Our suggestions could help begin to open up dentistry to patients once again."

Well Informed?

With new information emerging daily about COVID-19, how well informed are people about the virus? UCL's continuing social study found 85% rate their COVID-19 knowledge as 'good' or 'very good'. That's up from 72% in March.

Five percent think they have 'poor' or 'very poor' knowledge, down from 10% in March.

Lead author, Dr Daisy Fancourt sounded a note of caution about the headline figures: "This is a complex virus and it is likely that people are overestimating their own knowledge of COVID-19 and this, coupled with the small but not insignificant proportion of the population who rate their knowledge poorly, means that public health messaging around the virus and its effects must be maintained.

"In particular this messaging needs to stress the importance of following the rules closely rather than bending rules or making modifications even if they might seem safe."

Relationships

Polling of 2000 adults for the relationships charity Relate found 39% will be spending Christmas without somebody they normally would because of COVID-19 restrictions.

However, 26% were relieved about not having to see certain family members this year.

Relate is expecting a busy start to 2021 with 13% of survey respondents planning to break up with their partner in the New Year.

Jab Recommendation

Sir Ian McKellan was among the latest over-80s to have his coronavirus jab.

"I would have no hesitation in recommending it to anyone," the actor said.

https://twitter.com/NHSEnglandLDN/status/1339314869598818311?s=20

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

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