UK COVID-19 Update: 52 Week Waits 'Worst Since 2008', Tocilizumab Benefits, Hunt's Regrets 

Tim Locke

February 11, 2021

Editor's note, 11 February 2021: This article was updated with today's daily data.

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

NHS Performance

Nearly a third of all patients who have needed hospital treatment for COVID-19 in England since the pandemic began were admitted last month, NHS figures show.

There were 242,307 COVID-19 hospital patients last year and 101,956 this January.

Fifty-two week waits were at the highest level since 2008. Health Foundation Senior Policy Fellow, Tim Gardner, said: "The 4.5 million people waiting for routine procedures like hip and knee operations at the end of December is the highest since records began, and includes nearly 225,000 people who have already waited over a year. These  patients – whether they are on waiting lists or not yet in the system – are likely to need treatment in the coming months and many could be sicker as a result of delays to their care."  

In emergency departments, January saw the highest ever number of 12 hour stays (3809), and the worst ever 4-hour performance at major emergency departments (70.1%).

Dr Katherine Henderson, president of the Royal College of Emergency Medicine, said: "The figures are terrible for patients and paint a picture of a truly battered and beleaguered health service. We were in an incredibly tough place going into the pandemic, but staff have worked magnificently throughout it."

Last year was the worst on record for cancer waiting times in England, data released today show. NHS England National Medical Director, Professor Stephen Powis, commented: "While the world’s attention has rightly been on COVID, NHS staff have worked extremely hard to provide essential services for those patients who need them, including 280,000 treatments for cancer patients along with millions of routine operations."

Data were also released on staff sickness. Chief Executive of NHS Providers, Chris Hopson, said: "The number of staff absences due to sickness or self-isolation remains deeply concerning.

"Across England, the latest data shows that nearly 92,000 NHS staff were absent from work with almost 45% linked to COVID-19 related sickness or self-isolation on 3 February. This means the number of COVID-19 related absences is nearly 7% higher than the previous month’s figure."

Learning lessons from the pandemic is one of the promises in the Government's white paper for changes to the NHS and social care in England published today.

Tocilizumab 

Oxford's RECOVERY trial has found tocilizumab reduces the risk of death in hospitalised patients with severe COVID-19, shortens the time until discharge, and reduces mechanical ventilation requirements. The findings were published in a preprint and the drug is being put straight into clincal use in the NHS.

A total of 2022 patients were randomly allocated to receive tocilizumab by intravenous infusion and were compared with 2094 patients randomly allocated to usual care alone.

Twenty-nine percent of patients in the tocilizumab group died within 28 days compared with 33% in the usual care group meaning one life would be saved for every 25 patients treated with the drug.

Joint Chief Investigator, Professor Peter Horby, said: "Previous trials of tocilizumab had shown mixed results, and it was unclear which patients might benefit from the treatment. We now know that the benefits of tocilizumab extend to all COVID patients with low oxygen levels and significant inflammation. The double impact of dexamethasone plus tocilizumab is impressive and very welcome."

Commenting via the Science Media Centre, Professor Stephen Evans, London School of Hygiene & Tropical Medicine, said: "The magnitude of benefit is not startling but is clinically important, with a reduction in deaths from 33% to 29%. The large size of the trial, and the careful way this trial has been conducted, lends confidence to this assertion of benefit in patients who are very ill."

England's Deputy Chief Medical Officer Professor Jonathan Van-Tam said: "The data published today mean many more patients in hospital with COVID-19 will have access to a proven treatment, speeding up their recovery and reducing the risk of mortality significantly."

Disability Risks

Latest Office for National Statistics (ONS) data show people with disabilities were up to 3.5 times more likely to die with COVID-19 than people without disabilities.

After adjusting for personal and household characteristics, and pre-existing health conditions, a smaller but statistically significantly increased risk of death remained unexplained for more-disabled and less-disabled women (1.4 and 1.2 times respectively) and more-disabled men (1.1 times) but not for less-disabled men.

For people with a medically diagnosed learning disability, the risk of death involving COVID-19 was 3.7 times greater compared to people without a learning disability.

The largest risk for people with learning disabilities was associated with living in a care home or other communal establishment.

Mehrunisha Suleman, senior research fellow at the Health Foundation, commented: "The high number of COVID-19 deaths among disabled people ultimately reflects wider failures in how the UK supports those who are vulnerable. Addressing this will require the Government to address the major and long-standing inequalities that the pandemic has highlighted."

UK Variant 'To Sweep the World'

The original UK 'Kent' virus variant is "going to sweep the world, in all probability," Director of the COVID-19 Genomics UK consortium, Sharon Peacock, told the BBC.

"Once we get on top of [the virus] or it mutates itself out of being virulent - causing disease - then we can stop worrying about it. But I think, looking in the future, we’re going to be doing this for years. We’re still going to be doing this 10 years down the line, in my view." she said.

Test and Trace in England recorded its highest number of people tested in a week, more than 3 million. More than a third of the population in England has now been tested since the service was launched.

Public Health England (PHE) surveillance data show COVID-19 activity decreased in the week to 7 February.

The hospital admission rate for COVID-19 was 18.99 per 100,000 compared to 25.58 per 100,000 the previous week. The highest hospital admission rates continued to be in over-85s.

PHE Medical Director, Dr Yvonne Doyle, said: "It is encouraging to see that the sacrifices we are all making are working, however we must continue with our efforts. The good direction could reverse quickly, and the rate of cases and hospitalisations remains worryingly high."

Sky News reported that the Government's online hotel quarantine booking website for international arrivals saw technical problems after going live earlier with some passengers seeing an 'undergoing maintenance' message.

Daily Data

In today's daily data another 13,494 UK positive tests were reported and 678 deaths.

As of yesterday, 13.5m people have had a first dose of a COVID-19 vaccine.

Anaesthetists' Mental Health

A Royal College of Anaesthetists member survey conducted 4-8 February with 477 responses found 34% reporting poor or very poor mental health caused by the pandemic, 18% are considering leaving medicine, and 39% plan to reduce their hours once normal services resume.

College President, Professor Ravi Mahajan, said: "Many of our members are being exposed to traumatic situations daily, they are mentally and physically exhausted...I have real concerns the healthcare service will not be able to function safely and effectively."

Hunt's Regrets

"We’ve really been on the back foot from the start on test and trace, and in some ways it dates back to the period when I was health secretary (2012 - 2018)," Jeremy Hunt admitted in an interview with The BMJ.

He conceded that the UK, along with other countries, planned for the wrong kind of pandemic: "We were sadly also part of a groupthink that said that the primary way that you respond to a pandemic is the flu pandemic playbook, rather than the methods that you would use for SARS and MERS."

He praised the vaccination programme as being "probably the most effective...anywhere in the world," but said: "The biggest mistakes in the social care sector were around the discharging of patients who were COVID-positive into care homes."

Mr Hunt says there should be a public inquiry into the UK’s handling of the pandemic once it is under control. "I don't think we would want to tie up Matt Hancock, Boris Johnson, or [vaccine deployment minister] Nadhim Zahawi in that kind of process at this stage."

Shielding Report

A National Audit Office report found the pandemic shielding programme "was a swift government-wide response to protect clinically extremely vulnerable people against COVID-19".

However, it found that at the start of the pandemic there was no way to quickly identify all those who needed to shield, with the full list of those eligible for support not stabilising until May.

Chief Executive of Asthma UK and the British Lung Foundation, Sarah Woolnough, commented: "Poor data on people with lung conditions has meant that some of the most vulnerable to COVID-19 have had to face agonising waits to find out whether they should shield or not, leaving them in distress and without vital support and supplies during the first national lockdown.

"We have heard from people who were sent a shielding letter in error, causing confusion and from others, who should have received a letter and were left unable to prove that they were clinically extremely vulnerable for weeks, forcing them to put their lives at risk and go into the workplace when they should have been at home.

"There’s an opportunity here to learn from mistakes and confused communication."

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

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