UK COVID-19 Update: Mix & Match Jabs Trial, Tributes to Lost Colleagues

Tim Locke

February 04, 2021

Editor's note, 4 February 2021: This article was updated to include today's daily data.

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

Mix & Match Jabs Trial

Recruitment has begun for 820 participants to take part in the COVID-19 Heterologous Prime Boost study (Com-Cov) trial on mixing and matching doses of two different vaccines.

Combinations of the Oxford/AstraZeneca and Pfizer/BioNTech jabs at different intervals are being studied. First results are expected in the summer.

Chief Investigator Matthew Snape, associate professor in paediatrics and vaccinology, said: "If we do show that these vaccines can be used interchangeably in the same schedule this will greatly increase the flexibility of vaccine delivery, and could provide clues as to how to increase the breadth of protection against new virus strains."

This morning, Vaccines Minister Nadhim Zahawi told Sky News there are currently around 4000 SARS-CoV-2 virus variants around the world: "All manufacturers, Pfizer/BioNTech, Moderna, Oxford/AstraZeneca and others are looking at how they can improve their vaccine to make sure that we are ready for any variant."

Commenting via the Science Media Centre, Ravi Gupta, professor of microbiology, University of Cambridge, said: "The vaccine minister is not referring to variants as we have come to know them, rather he is referring to individual mutations. The number of mutations has little actual relevance as many mutations emerge and disappear continuously.  Scientists are using 'variants' to describe viruses with mutations that are transmitting in the general population – there aren’t 4000 of those."

As of yesterday, 10.49m people have had a first dose of a COVID-19 vaccine, and 501,957 a second dose.

Analysis of Israel’s Data

There had been concerns in Israel that protection after a first Pfizer/BioNTech vaccine dose was as low as 33%. However, University of East Anglia preprint analysis of Israel's data show "vaccine effectiveness was pretty much 0 at day 14 but then rose to about 90% at day 21 before levelling off".

The authors conclude: "What our analysis shows is that a single dose of vaccine is highly protective, although it can take up to 21 days to achieve this. The early results coming from Israel support the UK policy of extending the gap between doses by showing that a single dose can give a high level of protection."

Vaccine Confidence

Global vaccine confidence is rising, according to Imperial College London/YouGov survey data from 13,500 people in the UK, Australia, Canada, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Singapore, South Korea, Spain, and Sweden.

In November, 41% would have a jab if offered. That's now risen to 54%.

People in the UK are most willing to be vaccinated (78%), and France the lowest (44%).

Dr David Nabarro from Imperial, and WHO Special Envoy on COVID-19, said: "It is very encouraging to see that as a number of safe and effective coronavirus vaccines are being rolled out across the world, there has been an apparent positive shift in people’s perceptions of these products."

Tributes to Lost Colleagues

Dr Gamal Osman/NBT

More COVID-19 healthcare deaths have been reported with praise for the "exceptional care" given by Consultant in Acute Medicine, Dr Gamal Osman, North Bristol NHS Trust, who died last week.

Chief Executive, Evelyn Barker, said: "The commitment Gamal showed to providing exceptional care to our patients, particularly over the last very challenging year is highly honourable. His courage in the face of the pandemic has saved lives, and he will always be remembered."

The team on the Acute Medical Unit said: "We are all aware that COVID poses a higher risk to BAME and older patients. In his early sixties, Gamal was well aware of this risk, particularly as he lost his brother to COVID in September 2020. Despite this tragedy, many conversations with friends, colleagues, and relatives trying to persuade him to minimise his risk and despite his awareness of the risk involved, he was committed to continuing to care for acutely unwell patients with COVID. Tragically he contracted COVID-19 3 weeks prior to the introduction of the COVID vaccine to frontline staff.  His passing is devastating to all of his colleagues."

Terry Boston-Marsh/EKHUFT

Tributes have also been paid to theatre nurse, Terry Boston-Marsh, 54, who died on Friday with COVID-19 at the Queen Elizabeth The Queen Mother Hospital, Margate. 

"Terry was, quite simply, one of the best. He was a hugely skilled member of the team who was highly respected by everyone he worked with," East Kent Hospitals Chief Executive Susan Acott said.

"He had been redeployed to the intensive care unit during the pandemic and quickly made his mark there thanks to his calm, kind nature and his support of staff, patients, and their families."

Karen Amber, principal operating department practitioner, added: "He had a wicked sense of humour, but never at anyone else’s expense, and he helped to keep spirits up even in the most stressful of situations.

"We will remember him as a truly kind, funny man with a heart of gold."

In Memoriam: Healthcare Workers Who Have Died of COVID-19

Test and Trace Positives

Latest figures from Test and Trace in England show 97.2% of in-person test results were returned the next day.

It also achieved the highest percentage of contacts reached so far (93.6%).

Public Health England (PHE) surveillance data show the hospital admission rate for COVID-19 was 25.26 per 100,000 between 25-31 January, compared to 33.66 per 100,000 in the previous week.

Case rates have decreased across all age groups. The highest rate is 358.6 per 100,000 population seen in those aged 30-39.

PHE Medical Director, Dr Yvonne Doyle, commented: "We may have passed the peak but must not become complacent."

Chief Executive of NHS Providers, Chris Hopson, said: "The latest COVID and winter figures show that while the NHS may have passed the peak of COVID-19 infections and hospital admissions, we are still in dangerous territory."

He added: "Although the number of patients in hospital with COVID-19 is falling from the peak last month, there are still 26,000 COVID positive inpatients, 40% higher than the peak of the first wave in April 2020.

"The NHS currently has nearly 70% more critical care beds than it did last winter, with some trusts still having to open more ICU beds last week to accommodate the sickest COVID-19 patients.

"These extraordinary pressures  will continue for a long time yet."

In today's daily data another 20,634 UK positive tests were reported and 915 deaths.

Another 2375 COVID-19 patients were admitted to hospital. The total is now 31,670, and 3625 ventilator beds are in use.

International Travel

A University of Aberdeen study published in BMJ Open found that international travel showed the biggest impact on increases in death rates on countries worst hit in the first wave of COVID-19.

First author, final year medical student Tiberiu Pana, said: "Our assessment of available data indicates that very early restrictions on international travel might have made a difference in the spread of pandemic in western Europe, including the UK."

Last week, the Government announced that UK nationals and residents returning from 'red list' countries will be placed in quarantine in hotel accommodation. However, the measures are not yet in place.

'Social murder’ 

The world's politicians must be held to account for their mishandling of the pandemic, argues BMJ Executive Editor, Dr Kamran Abbasi today.

A lack of political attention to the conditions in which people are born, grow, live, work, and age that exacerbate the pandemic could be classed as 'social murder', he writes.

"State failures that led us to two million deaths are 'actions' and 'inactions' that should shame us all," Dr Kamran Abbasi concludes.

Coughing Study

Preprint research from North Bristol NHS Trust and the University of Bristol suggests patients coughing "was associated with the highest aerosol emissions with a peak

concentration at least 10 times greater the mean concentration generated from speaking or breathing".

The study involved healthy volunteers and hospitalised COVID-19 patients breathing, speaking, and coughing while aerosol emission was measured.

The authors conclude: "Guidance on personal protective equipment policy should reflect these updated risks."

Vitamin D

Former Brexit Secretary David Davis used Prime Minister's Questions yesterday to ask Boris Johnson to look again at UK guidance on vitamin D as a COVID-19 treatment.

He cited data from Andalucía in Spain where the COVID-19 death rate "almost halved" after calcifediol was given to care home residents and some other patients.

National Institute for Health and Care Excellence (NICE) guidance in December found no evidence to support vitamin D as a COVID-19 treatment.

Mr Johnson said: "We will continue to monitor all the evidence about the efficacy of vitamin D and the treatment that he mentions."

The UK team behind an international survey into prescribing patterns for vitamin D for COVID-19 welcomed the intervention.

Professor Edward Jude said: "I hope the Prime Minister will urge NICE to look again closely at the evidence."

He hopes the data gathered will help inform the vitamin D debate: "We have had a fantastic response to our survey on vitamin D and COVID-19 so far. "We hope to close the survey in the next 2 days and would like to ask those who haven’t done the survey if they can please do so." There's a link to the survey here.

Home Worker Wellbeing

The shift to home working has been positive for health and wellbeing 45% of 678 people say  compared to 29% who say it is worse, according to polling for the Royal Society for Public Health (RSPH).

Polling took place last August and September and was supported by a bed company.

Negative impacts included:

  • Feeling less connected to colleagues (67%)

  • Taking less exercise (46%)

  • Developing musculoskeletal problems (39%)

  • Disturbed sleep (37%)

RSPH Chief Executive Christina Marriott said: "Our findings reveal that although working from home can be beneficial for people’s health and wellbeing, there are stark differences in how different groups have been affected. For people who have multiple housemates or are working from their bedroom or a sofa, the impact on their mental and physical health is extremely concerning and something we believe that employers need to address.

"The changes in the way that millions of people are working has the potential for employers to rethink how they are supporting their employee’s mental and physical health. Some form of home working is likely to continue for millions of people and we urge employers to take the necessary steps to ensure their staff can work from home as safely and healthily as possible."

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

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