UK COVID-19 Update: Infections Levelling Off, Oxford Jab Restrictions Fallout, Herd Immunity Tomorrow?

Tim Locke

April 08, 2021

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

Infections Levelling Off

The rate of new COVID-19 infections has levelled off in England with an estimated 1 in 500 people currently infected, according to the ongoing Imperial/Ipsos MORI REACT study. That's down approximately 60% on February's data when 1 in 204 were infected.

The data are from 140,844 home swab tests carried out 11-30 March.

Vaccination is likely to be responsible for over-65s having the lowest levels of infection, and schools opening behind 5-12 year olds having the highest number of infections.

REACT Programme Director, Professor Paul Elliott, said: "We have seen a gratifying fall in infections since our last survey in February, with infections dropping by around 60% overall. This is hugely encouraging and shows we’re headed in the right direction.

"However, in our most recent data there has been a flattening off in the infection rate with an R number now around one. This shows that we need to continue to approach the situation with caution and keep sticking to the rules."

Deaths and Other Data

Office for National Statistics (ONS) data show the number of deaths registered in England and Wales in the week ending 26 March was 5% below the 5-year average, the third consecutive week that deaths have been below the 5-year average.

COVID-19 accounted for 7.2% of all deaths compared with 9.3% the previous week.

Separate ONS data looked at symptoms in those who test positive.

Sarah Crofts from ONS said: "The classic symptoms of fatigue, headache and cough are still the most commonly reported by those infected with the virus, while only around 1 in 5 experience loss of taste or smell only.

"Around half of those we tested did not report any symptoms even whilst having high levels of the virus present in their body. This underlines that people in the community may unknowingly have the virus and potentially transmit it to others."

The least commonly reported symptoms were abdominal pain, diarrhoea, and nausea or vomiting.

The latest Test and Trace data for England show a 21% drop in positive tests (29,293 people) in the week ending 31 March.

Herd Immunity

UCL dynamic causal modelling suggests a herd immunity threshold of 73.4% will be reached by tomorrow.

The researchers concede: "Much like long-term weather forecasts, the ensuing predictions should not be taken too seriously because there is an inherent (although quantified) uncertainty about underlying epidemiological and socio-behavioural variables."

Commenting, Dr Adam Kucharski, associate professor in infectious disease epidemiology, London School of Hygiene & Tropical Medicine, said: "Unfortunately, the modelling approach used to produce this analysis has a history of making over-confident and over-optimistic predictions."

Fallout From Oxford Jab Restrictions

There's been more reaction to the MHRA Oxford/AstraZeneca blood clotting safety review decision to offer alternative vaccines to under-30s. "This is a vanishingly rare but sadly very serious adverse event," Jonathan Van-Tam, England's deputy chief medical officer, told a news briefing.

Andrew Pollard, professor of paediatric infection and immunity, University of Oxford, said: "We are reassured to see that safety monitoring continues under the close scrutiny of regulators and public health authorities as the vaccine is rolled out around the world.

"The identification of rare cases of blood clots, which might be associated with the vaccine, shows that the safety system works, and has also allowed MHRA and EMA to conclude that the benefits of vaccination continue to outweigh the risks, while putting in measures to help mitigate any possible risk."

BMA Chair of Council, Dr Chaand Nagpaul, commented on the possible need for some patients under-30 to travel further for alternative jabs, or wait longer: "It’s important that NHS England does everything it can to make this process as easy as possible so that patients will get their first and second doses so that the public can continue to have confidence in the programme."

Professor Martin Marshall, chair of the Royal College of GPs, said: "We now need assurance that there will be enough supply of other vaccines to be able to vaccinate patients aged 18-29, if they choose not to have the AZ vaccine."

Other experts have commented via the Science Media Centre. Dr Simon Clarke, associate professor in cellular microbiology, University of Reading, said: "This whole process has shown how important it is for the Government to be open and transparent about safety monitoring and not to gloss over or downplay any potential concerns there may be in the emerging data."

Prof Kevin McConway, emeritus professor of applied statistics, The Open University, agreed with the decision but said: "I just want to warn against anyone thinking this can be the last word on the matter. There’s still so much that we don’t know, and can’t know yet. Evidence, understanding, and policies will change as we learn more."

England's Health Secretary Matt Hancock told Sky News the UK has "more than enough" doses of Pfizer/BioNTech and Moderna jabs for under-30s.

Meanwhile, pharmacist Alison Astles, whose brother Neil died on Sunday after developing a post-vaccination blood clot, told the BBC: "Despite what has happened to Neil and the impact on our family, I still strongly believe that people should go ahead and have the vaccine."

She said the risk of clots is "very, very small and my brother was extraordinarily unlucky".

Australia is now recommending the Pfizer/BioNTech vaccine for under-50s in preference to the AstraZeneca jab. The AstraZeneca vaccine will only be given to under-50s when the benefits clearly outweigh the risks.

Moderna Jab Antibodies

The Moderna vaccine, which started to be administered in Wales and Scotland yesterday, gives antibody protection for at least 6 months after the second dose, according to a Phase 1 study of 33 healthy individuals published in the NEJM.

The US authors wrote: "Ongoing studies are monitoring immune responses beyond 6 months as well as determining the effect of a booster dose to extend the duration and breadth of activity against emerging viral variants. Our data show antibody persistence and thus support the use of this vaccine in addressing the COVID-19 pandemic."

End of Life Care

A report has found palliative and end of life care wasn't seen as a frontline service during the pandemic.

The document, Better End of Life, comes from Marie Curie, King’s College London, Hull York Medical School, University of Hull, and the University of Cambridge.

Lead researcher, Professor Katherine Sleeman, King’s College London, said: "The COVID-19 pandemic accelerated the need for palliative and end of life care in the UK. However, the experiences of those affected by dying, death, and bereavement – whether as a result of COVID-19 or other conditions - have had little scrutiny to date. It is essential that we learn from the achievements and weaknesses in care that the pandemic has exposed, to improve future provision of palliative, end of life, and bereavement care."

Pancreatic Cancer Surgery

Only 32% of hospitals are carrying out the same number of pancreatic cancer operations as before the pandemic, the Evening Standard reported.

The data are from specialist groups, including the Pancreatic Society Of Great Britain and Ireland. During the second wave early this year, 40% fewer surgeries were carried out compared to before COVID-19.

Favipiravir 

The antiviral drug Favipiravir is to be investigated as a possible at-home COVID-19 recovery treatment in the Oxford-led PRINCIPLE trial.

Co-lead Investigator, Professor Chris Butler, said that "favipiravir blocks the complicated molecular dance that happens between a virus and our own cells when the virus is replicating.

"Until now, we have been testing medicines that have not typically been used to treat viral infections. This is the first drug we will be testing that was designed specifically to target viruses."

Infliximab 

Patients being treated with infliximab had weakened immune responses to the first dose of the Oxford/AstraZeneca and Pfizer/BioNTech vaccines, compared with patients on vedolizumab (Entyvio), although a very significant number of patients from both groups seroconverted after their second dose, according to a University of Exeter preprint study of patients with inflammatory bowel disease.

"Antibody testing and adapted vaccine schedules should be considered to protect these at-risk patients," said one of the authors, Dr Nicholas Kennedy.

Pandemic Challenges One Year On

NHS Providers is warning that NHS workforce challenges may be worse than at the start of the pandemic.

Commenting in a podcast, Richard Mitchell, chief executive at Sherwood Forest Hospitals NHS Foundation Trust, said: "The challenge we’re facing now is probably greater than the challenge we faced 12 months ago."

Meanwhile, NHS England said the pandemic caused a 'Nightingale effect' in recruitment. In the first 3 months of the year 10,000 healthcare support workers were taken on.

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

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