UK COVID-19 Update: 12 Hour Waits, Lateral Flow Tests Questioned

Tim Locke

January 12, 2021

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

12 Hour Waits

The Royal College of Emergency Medicine (RCEM) Winter Flow Data show nearly 1 in 20 patients across the UK is waiting 12 hours or more to be admitted to hospital.

Between 28 December to 3rd January:

  • 4-hour standard performance dropped to 71.87%, the worst performance for this project

  • Capacity increased by 1.08% (254 beds) on the previous week

  • Attendances increased by 4.42% (2320 patients) on the previous week

RCEM believes NHS England is under-reporting 12 hour waits.

RCEM President Dr Katherine Henderson commented: "It is a dire situation to be in. Our departments are crowded, with many places having no choice but to administer care in corridors – as shown by the number of patients waiting 12 hours or longer. Not only is this dangerous in and of itself but it increases the risk of nosocomial infection which we cannot allow in the middle of a pandemic. It also makes it more difficult to get patients offloaded from ambulances and our great paramedic crews back out to help the next person who needs them.

"In the short term we must do all we can to maintain flow through our hospitals, while we deal with the third wave. But in order to eliminate the long-term problem of 12 hours waits, we must first measure them properly. NHS England have announced the consultation on the Clinical Review of Standards, and we want to see the new measures implemented as soon as possible.

"New metrics will help us better understand the problems EDs face and enable us to take better preventative action to stop dangerous crowding and corridor care."

Yesterday's daily data show another 4193 COVID-19 hospital admissions taking the total to 32,294. There are 3098 ventilator beds in use.

The head of NHS England, Sir Simon Stevens, told a committee of MPs yesterday: "It's worth remembering that this affects all ages. A quarter of the COVID admissions to hospital right now are for people aged under 55."

Lateral Flow Tests Questioned

Experts writing in The BMJ are calling for a Government rethink on widening use of Innova lateral flow tests.

Professor Jon Deeks, Institute of Applied Health Research, University of Birmingham, and colleagues say people are being misled about their accuracy, risks, and false negatives.

They cite a pilot study in Liverpool in which 60% of infected symptomless people went undetected. However, the Government uses a 77% detection rate figure.

"The UK Government is widening the roll out of the Innova lateral flow test without supporting evidence, and we understand that this may soon extend to further home use. This may cause serious harm. We call on the Government urgently to change course," they write.

More than £1 billion has been spent on the tests.

The experts ask why they are still being used: "It seems at least plausible that this is because hundreds of millions of Innova testing kits were purchased before it was known how they would perform in people without symptoms and when administered by less than expert hands. These tests are now sitting in warehouses around the country. The message has gone out that 'they have to be used', or 'as long as testing detects otherwise unknown cases, the whole exercise will be worthwhile'," they write.

Deaths 'Highest Since Spanish Flu'

Latest Office for National Statistics (ONS) data for the week 28 December to 1 January show the number of deaths registered in England and Wales was 26.6% above the 5-year average. However, ONS said the increase should be treated with caution.

COVID-19 accounted for 31.2% of all deaths.

Deaths involving COVID-19 as a proportion of all deaths in hospitals increased to 47.7% from 40.2% the previous week.

Places of COVID-19 deaths were:

  • Hospital 55,372 (67.8%)

  • Care homes 20,661

  • Private homes 3942 deaths

  • Hospices 1100

  • Other communal establishments 315

  • Elsewhere 279

In a blog post, Sarah Caul from ONS reported that the overall number of deaths registered in 2020 was 75,925 higher than we would have been expected when looking at the 5-year average between 2015 and 2019.

The provisional age-standardised mortality rate in 2020 was 1043.5 deaths per 100,000 population, around 8% higher than the 5-year average. "This is the highest it has been in more than a decade (since 2008)," she said.

Last year saw the second highest number of non-war-related deaths since the Spanish flu in 1918, although ONS points out the population has risen a lot since then.

There have been 81,653 deaths registered that mentioned COVID-19 on the death certificate.

King’s Fund Chief Executive, Richard Murray, commented: "‘It will take a public inquiry to determine exactly what went wrong, but mistakes have been made. In a pandemic, mistakes cost lives. Decisions to enter lockdown have consistently come late, with the Government failing to learn from past mistakes or the experiences of other countries. The promised “protective ring” around social care in the first wave was slow to materialise and often inadequate, a contributing factor to the 26,200 excess deaths among care home residents last year.

"Like many countries, the UK was poorly prepared for this type of pandemic. However, the NHS was already overstretched when it began, with over 100,000 vacancies and high levels of staff stress and burnout, while social care was at breaking point following a decade of neglect from successive governments. The exhausted staff who have supported, treated, and saved so many lives, often at the expense of their own wellbeing, will need time to recover."

Enforcing Lockdown

Yesterday ministers were stressing the importance of staying local in England for permitted outdoor exercise. Then the Evening Standard reported how Prime Minister Boris Johnson travelled 7 miles to the Olympic Park for a bike ride.

England's Health Secretary Matt Hancock told a Downing Street briefing: "If you went for a long walk and ended up 7 miles away from home that is OK, but you should stay local."

Downing Street said no rules had been broken by the PM but Labour's Andy Slaughter said: "Once again it is do as I say, not as I do."

Metropolitan Police Commissioner Dame Cressida Dick told the BBC the PM's bike ride was "not against the law". However, she said England's rules on staying local could be clearer.

Police forces report issuing more fines for lockdown breaches and Commissioner Dick wrote in The Times that it is "preposterous that anyone could be unaware of our duty to do all we can to stop the spread of the virus".

Morrisons and Sainsburys were the first supermarkets to announce they would be enforcing face covering rules in their stores. Mr Hancock commented: "I applaud the action Morrisons has taken today[11/1]...they have said that they will not let people in without a mask unless they clearly have a medical reason."

Mr Hancock promised support bubbles would not be stopped in any review of restrictions: "I can rule out removing the bubbles that we have in place, the childcare bubbles, the support bubbles are very important and we're going to keep them," he said.

EMA

The European Medicines Agency has received an application to approve the Oxford/AstraZeneca vaccine.

Under an "accelerated timeline" approval could be given after a meeting on 29 January.

The agency had already received clinical trial data from the UK, Brazil, and South Africa.
 

Gut Bacteria

UK experts have responded to observational Hong Kong research published in The BMJ suggesting gut bacteria has a role in the severity of COVID-19 and immune response.

Microbiome imbalances could also play a role in long COVID, the authors suggest.

Daniel Davis, professor of immunology, University of Manchester, told the Science Media Centre: "At the moment this idea is still speculative but it demands further investigation, especially given the huge importance of understanding ‘long COVID'. Overall, this new research doesn’t yet lead to a clear public health message in terms of treatments or therapies, but does set the scene for a hugely important realm of new science."

Lockdown Eyesight 

A YouGov survey of 2000 people for the charity Fight for Sight suggests eyesight has worsened under lockdown for 38% of respondents.

Charity Chief Executive Sherine Krause said: "With the COVID-19 pandemic having forced so many of us to move to digital working, online learning and even virtual socialising, it is not surprising that our screen time has soared this year. However, it’s vital that the benefits of increased digital access and use during lockdown do not come at the detriment of our eye health."

The charity stressed most high street opticians remain open if people have concerns and recommended people take screen breaks to avoid eye strain.

Free School Meals

The Department for Education is investigating after nutritionally poor quality free school meal parcels were delivered to some families in England.

"We are looking into this," the Department said. "We have clear guidelines and standards for food parcels, which we expect to be followed. Parcels should be nutritious and contain a varied range of food."

One of the suppliers, Chartwells, said it was investigating and: "This does not reflect the specification of one of our hampers."

England footballer and children's food campaigner Marcus Rashford tweeted earlier that "children deserve better than this".

https://twitter.com/MarcusRashford/status/1348736192729251854?s=20

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

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....