UK COVID-19 Update: 'Higher Mortality' With New Variant, R Down, No 'Cash for Compliance'

Tim Locke

January 22, 2021

Editor's note, 22 January 2021: This article was updated with the latest data, new information from a Downing Street briefing, and additional comment.

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

'Higher Mortality' With New Variant 

The UK SARS-CoV-2 virus variant is linked to higher mortality as well as spreading more easily, today's Downing Street briefing was told.

With the new variant, 13-14 out of 1000 60-year old men infected might be expected to die, an increase from 10 out of 1000 for the old virus.

Chief Scientific Adviser Sir Patrick Vallance said: "When we look at data from...patients who are in hospital with the virus, the outcomes for those with the original virus or the new variant look the same." 

However, he said: "When data are looked at in terms of those who've been tested positive...there is evidence that there's an increased [mortality] risk for those who have the new variant compared to the old virus.

"Now that evidence is not yet strong, it's a series of different bits of information that come together to support that."

However, he said there's good clinical data to suggest that vaccines should be as effective against the new virus as against the old one.

The South African and Brazilian variants may be less susceptible to vaccines, he said.

Experts have been commenting via the Science Media Centre.

Ian Jones, professor of virology, University of Reading, said: "The NERVTAG [New and Emerging Respiratory Virus Threats Advisory Group] report supporting the enhanced death rate attributed to variant B1.1.7 is at pains to stress that the data is limited and the conclusions preliminary. However, an increased case fatality rate is certainly possible with a virus that has upped its game in transmission. But grim as it sounds, whether the fatality rate is 1% or 1.3% doesn’t really change the fact that for a minority of people this is a very dangerous virus that is best avoided."

Paul Hunter, professor of medicine, University of East Anglia, said: "This is a really disappointing finding and will certainly have implications for how we manage the epidemic over coming months."  

'Mixed Picture' on New UK Cases 

Latest Office for National Statistics (ONS) infection survey data for the week ending 16 January show a "mixed picture" for new UK infections. There's a slight decrease in England, a levelling off in Scotland and Wales, but an increase in Northern Ireland.

The percentage of people in England likely to have had the new variant decreased in London, the South East, and the East of England, and has levelled off in other regions.

  • In England - 1,023,700 people had COVID-19 equating to around 1 in 55. In London it was 1 in 35.

  • In Scotland - 55,700 people had COVID-19, equating to around 1 in 100 people.

  • In Wales - 44,000 people had COVID-19, equating to around 1 in 70 people.

  • In Northern Ireland - 29,400 people had COVID-19, equating to around 1 in 60 people.

The UK's R number has dropped to 0.8 to 1.0 this week. Last week it was 1.2-1.3 for the UK as a whole.

The growth rate is -4% to -1% per day.

In today's daily data another 40,261 UK positive tests were reported and 1401 deaths.

Another 4034 COVID-19 patients were admitted to hospital. The total is now 38,562, and 3960 ventilator beds are in use.

As of yesterday, 5.38m people have had a first dose of a COVID-19 vaccine, and 466,796 a second dose.

No 'Cash for Compliance'

Despite widespread media coverage of a leaked document, Downing Street denied there are plans to pay £500 to anyone testing positive for COVID-19 to encourage more testing and compliance with self-isolation.

Government polling suggested that only 17% of people with symptoms were coming forward for testing, 25% comply with 10-day self-isolation after a positive test, 15% went to work as normal.

BAME Mortality Risks

Patients from Asian and Black backgrounds suffered disproportionate rates of premature death from COVID-19, according to a study of 1737 patients by Queen Mary University of London and Barts Health NHS Trust published in BMJ Open.

  • Asian patients were 1.54 times more likely, and Black patients 1.8 times more likely, to be admitted to ICU and to receive invasive ventilation, compared to White patients.

  • After adjustment for age and sex, patients from Asian backgrounds were 1.49 times more likely to die compared to those from White backgrounds, and patients from Black backgrounds were 1.30 times more likely to die.

  • Asian and Black patients experienced a 50–80% increased risk of receiving mechanical ventilation in ICU compared with White patients of a similar age.

Lead author Dr Vanessa Apea commented: "Authentic community based participatory research to understand the drivers of these differences, and co-creation of solutions are key to achieving health equity in these communities."

BAME ED Doctors' Risks

A December survey from the Royal College of Emergency Medicine (RCEM) with 780 respondents found nearly 1 in 5 BAME staff had not yet had a COVID-19 risk assessment. That compared with nearly 3 in 10 of all respondents.

BAME respondents were also more likely not to have received any PPE training.

Almost half of BAME respondents failed PPE fit testing 'very often', 'often', or 'sometimes’, compared to just over a third of White respondents.

RCEM's Dr David Chung commented: "A person's race or ethnicity should not increase their occupational risk, but this is still sadly the reality, and this must change. We must look at forward planning, starting with the vaccine roll out; we cannot allow the same disparities to occur."

ONS Vaccine Data

The latest ONS social impact data for adults in Great Britain show:

  • 7% had already received at least one dose of a COVID-19 jab

  • 5% had been offered the vaccine and were awaiting it

  • 1% were offered a jab but declined it

  • 87% had not yet been offered the vaccine

Of those who were unlikely to have the vaccine or had decided not to have it, the most common reasons were:

  • Worries about long-term effects on health (43%)

  • Side effects (42%)

  • How well the vaccine works (40%)

Care Home Deaths

The BBC reported Scotland's Crown Office is investigating COVID-19 deaths at 474 care homes. The investigation is called Operation Koper.

The independent care sector group Scottish Care commented in a statement: "We believe these investigations are wholly disproportionate and are causing irreparable damage to the professional integrity of nurses and carers who are exhausted beyond measure in fighting the virus."

Kids & PPE

Concerns that children admitted to hospital would be afraid of staff wearing PPE have been allayed in a small study.

A team from Liverpool's Alder Hey hospital looked at 63 children with a median age of 9 years, 60% boys and 40% girls.

They found 49% scored zero for anxiety indicating perfect induction of anaesthesia. There was no significant difference in anxiety when a sedative pre-medication was given. The data were presented to the virtual Winter Scientific Meeting of the Association of Anaesthetists.

The authors conclude: "This study suggests that PPE does not contribute to anxiety in children and young people who need anaesthesia and surgery. Most patients experienced extremely low levels of anxiety at induction. PPE provided reassurance and increased a child's confidence in anaesthesia. Two thirds of children reported staff PPE made them feel safe and happy, and none reported being scared by PPE."

A second study presented to the meeting looked at how PPE affected 106 staff in a survey.

Ninety-two percent felt wearing enhanced PPE affected team performance and 65% strongly agreed that PPE has an effect on the performance of the team.

The authors from University Hospitals Dorset NHS Foundation Trust conclude: "Our survey shows that PPE has a negative impact on staff wellbeing and team performance. We are now looking at the introduction of personal respirators and new communication resources, such as whiteboards and walkie-talkies. The authors feel floating staff members are vital to facilitate adequate breaks. The survey is currently being repeated to review staff's wellbeing in PPE with our changing pathways."

GMC Priorities

The General Medical Council (GMC) has set out its latest priorities under the pandemic.

Already opened ‘fitness to practise investigations’ will still progress "where possible", a flexible approach is being taken to revalidation, and ID checks will be suspended again.

In a recent letter to doctors, GMC Chair Dame Clare Marx, said: "I know how anxious some doctors are about the way in which actions and decisions taken in this environment may be reviewed. I want to reassure them that, should any concern be raised, the context in which a doctor is working will be fully taken into account."

Lockdown Loneliness

University of Exeter and King’s College London research published in International Psychogeriatrics found loneliness in over-50s during lockdown was linked to worsening depressive and other mental health symptoms.

The research was based on data from 3000 participants and the continuing PROTECT online study.

Professor Clive Ballard, University of Exeter Medical School, said: "We are only just beginning to learn the impact that COVID-19 is having on the health and wellbeing of older people. For example, the effect of any economic impact may not yet have emerged. Our large scale study will span a number of years, and will help us understand some of the longer-term effects of COVID-19 on mental health and wellbeing, and ultimately, on whether this has any knock-on effect on aspects of ageing, such as brain function and memory."

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


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