UK COVID-19 Update: Infections 'Halving Every 2 Weeks', Long COVID 'An Occupational Disease'

Tim Locke

February 18, 2021

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

Infections 'Halving Every 2 Weeks'

The latest data from the Imperial/Ipsos MORI REACT-1 study show national prevalence of COVID-19 in England fell to 51 per 10,000 4-13 February from 157 per 10,000 between 6-22 January.

Prevalence is now similar to last September's figures. The highest current weighted prevalence is among 18-24-year olds and primary school children.

There was a halving time of 15 days and an R number of 0.72, based on testing of 85,400 volunteers.

Risk factors highlighted for infection included living in large households, being in deprived neighbourhoods, and areas with higher numbers of people with Asian ethnicity.

Imperial's Professor Paul Elliott said: "These encouraging results show that lockdown measures are effectively bringing infections down. It’s reassuring that the reduction in numbers of infections occurred in all ages and in most regions across the country.

"While the trends we’ve observed are good news, we need to all work to keep infections down by sticking to the measures which are designed to protect us and our health system."

Commenting via the Science Media Centre, Kevin McConway, emeritus professor of applied statistics, The Open University, said it appears to be too soon for the vaccination programme to be having an effect: "If vaccination were making the difference, you’d have expected the 65+ group to have shown much the biggest improvement, and that hasn’t happened. 

"The REACT-1 team believe that instead the observed falls are most likely due to reduced social interaction during lockdown, because that affects all ages. I very much agree with that.  I’d hope that there might be some effect of vaccines in later REACT-1 rounds, and maybe even in the rest of the current round – but that’s not certain. 

"We know from the vaccine trials and from early data from Israel that vaccination should have a big effect on serious COVID-19 illness and death, but the evidence that vaccines reduce infectivity isn’t so strong yet."

The Guardian reported on a leaked classified Joint Biosecurity Centre report finding people in poorer areas were less likely to self-isolate because they couldn't afford to do so. It also mentioned a "perfect storm" of low wages, cramped housing, and test and trace failures leading to "stubbornly high" infection rates in deprived parts of England.

England's Test and Trace service reported a 29% decrease in positive cases 4-10 February compared to the previous week.

Leeds is the latest area targeted for surge testing to try to prevent the spread of the South African virus variant.

Public Health England's surveillance data show the hospital admission rate for COVID-19 has fallen to 14.64 per 100,000 in the latest week to 19.40 per 100,000 the previous week.

Winter Pressure

NHS Providers has responded to the latest weekly winter performance data for the NHS in England.

Deputy Chief Executive, Saffron Cordery, said: "The number of patients with COVID-19 in hospital has dropped to 16,458, which is less than half the level of January’s peak. While it is positive news that the number of COVID-19 patients requiring ventilation is decreasing nationally, today’s data also highlights that in some trusts critical care units are still operating at double the capacity of last year, particularly in London and the South East.

"Meanwhile, the number of patients arriving at hospital by ambulance has reduced to the lowest level seen across the last four winters, and delays in handing patients over to hospitals have continued to improve."

Northern Ireland is extending its lockdown to 1 April. However, some children will go back to school during March.

Daily Data

In today's daily data another 12,057 UK positive tests were reported and 454 deaths.

Another 1531 COVID-19 patients were admitted to hospital. The total is now 20,156 and 2614 ventilator beds are in use.

As of yesterday, 16.4m people have had a first dose of a COVID-19 vaccine, and 573,724 a second dose.

COVID-19 and Heart Damage

An MRI study published in the European Heart Journal found that 54% of 148 patients hospitalised in London with COVID-19, who had raised troponin levels, had some myocardial injury.

Lead researcher, Marianna Fontana, professor of cardiology, UCL, said: "Raised troponin levels are associated with worse outcomes in COVID-19 patients. Patients with severe COVID-19 disease often have pre-existing heart-related health problems including diabetes, raised blood pressure and obesity.

"During severe COVID-19 infection, however, the heart may also be directly affected. Unpicking how the heart can become damaged is difficult, but MRI scans of the heart can identify different patterns of injury, which may enable us to make more accurate diagnoses and to target treatments more effectively."

Long COVID 'An Occupational Disease'

Long COVID should be registered as an occupational disease for frontline staff, a group of 65 MPs and peers are telling the Prime Minister in a letter. The campaign is backed by the BMA.

The group March for Change has also launched a petition.

The group's Dr Mike Galsworthy tweeted: "We’re demanding that NHS staff who contract #LongCovid and can’t work get fully compensated."

The BBC quoted a Department of Health and Social Care spokesperson saying employers should "make full use" of existing support for staff.

Around 1 in 10 people who have COVID-19 develop long COVID and four studies into the condition have been given £18.5m funding, it was announced today.

Vaccine Passports

Experts from the Ada Lovelace research Institute have entered the debate about vaccine passports.

They conclude: "The expert group came to the view that, at present, vaccination status does not offer clear or conclusive evidence about any individual’s risk to others via transmission.

Without that, it cannot be a robust basis for risk-based decision making, and therefore any roll out of a digital passport is not currently justified.

"However, given that evidence on transmission will emerge, and other countries and companies are developing such systems, the UK Government must act urgently to address the public policy issues that arise, and create clear and specific guidelines and law around any appropriate uses, mechanisms for enforcement, and methods of legal redress."

Criminalising Vaccine Misinformation

Experts have been debating in The BMJ whether people who spread vaccine misinformation should be criminalised.

Professor Melinda Mills, University of Oxford, wrote: "The freedom to debate, and allow the public to raise legitimate vaccine concerns to fill the knowledge void, should not extend to causing malicious harm."

However, Jonas Sivelä, Finnish Institute for Health and Welfare, said "criminalising anti-vaccine misinformation could make it grow even stronger".

He concludes that "trust in authorities, governments, and the healthcare system is key when it comes to ensuring high vaccine acceptance. The only way to sustainably reduce misinformation about vaccination—and to strengthen vaccine confidence and acceptance in the long run—is to increase trust in these institutions and authorities in different countries."

Remote Prescribing Guidance

The GMC has issued updated guidance on remote prescribing that comes into effect from 5 April.

'Good practice in prescribing and managing medicines and devices' covers good practice for remote and in-person consultations when prescribing unlicensed medicines, and for when patient care is shared with another doctor.

It says controlled drugs should not be prescribed unless doctors have access to patient records, except in emergencies.

There's stronger advice on information sharing, saying it may be unsafe to prescribe if a patient refuses consent to share information with other relevant health professionals.

GMC Medical Director and Director of Education and Standards, Professor Colin Melville, said: "We understand the enormous pressures the profession is under as the pandemic continues and the vaccination programme is rolled out across the UK.

"Our updated guidance supports doctors who are navigating what for many has become a new reality of remote medicine, helping them to maintain good patient care in these incredibly challenging circumstances. It’s vital that the principles of good practice apply, whether a consultation is face-to-face or remote."

Oxford Jabs 'Remaining on Shelves' in Germany

The German news site FOCUS reported on "increasing reports of dwindling acceptance" of the Oxford/AstraZeneca vaccine.

Der Spiegel quoted the Ministry of Health in North Rhine-Westphalia saying that "the willingness to vaccinate with regard to AstraZeneca has so far tended to be restrained".

Westfälische Nachrichten reported that in Münster, about 30% of ambulance workers and outpatient nurses didn't attend their vaccination appointments last week.

However, Federal Health Minister Jens Spahn told RTL TV he would be vaccinated "expressly" with the AstraZeneca jab, adding: "This is a safe and effective vaccine."

Medical associations and organisations also issued a statement saying approved vaccines work effectively and should all be used.

BAME Vaccine Uptake

Prince Charles told the British Asian Trust he was "saddened" over "variable uptake" of jabs among Black and Asian communities.

Only 55% of Black people in England aged 70-79 and 73% of people from South Asian backgrounds have been vaccinated, compared to 86% of White people in the same age group, according to OpenSAFELY data.

Many commercial TV channels are showing a special independently produced video tonight to encourage uptake. It stars Sanjeev Bhaskar, Meera Syal, Romesh Ranganathan, Beverley Knight, Denise Lewis, David Olusoga, and Hugh Quarshie.

https://twitter.com/TVSanjeev/status/1362354504360988672?s=20

 

Yellow Cards

In the week to 7 February, the MHRA said it had received 3882 Yellow Cards for the Pfizer/BioNTech vaccine, 8680 for the Oxford/AstraZeneca jab, and 41 with no brand specified. That's around three to four Yellow Cards per 1000 doses.

Injection site reactions were the most common side effects, along with 'flu-like' illness, headache, chills, fatigue, nausea, fever, dizziness, weakness, aching muscles, and rapid heartbeat.

Severe allergic reactions to the Pfizer/BioNTech vaccine had a reporting rate of 1-2 cases per 100,000 doses.

The regulator said it continues to review reported cases of Bell’s Palsy but the number of reports so far is similar to the expected natural rate.

It concludes: "The overall safety experience with both vaccines is so far as expected from the clinical trials. The expected benefits of the vaccines in preventing COVID-19 and serious complications associated with COVID-19 far outweigh any currently known side effects."

Nursing Students

There's been a 34% rise in applications for nursing courses with 48,830 in England this year compared with 35,960 at the same time last year.

UCAS Chief Executive, Clare Marchant, said: "Overall, applications are buoyant as students plan their futures for life after lockdown. We expect offer rates to remain at the high levels of recent years as universities and colleges have several months to plan and be flexible to accommodate the increase in applicants."

England's Chief Nursing Officer, Ruth May, said: "During COVID-19, the level of interest in working for the NHS has trumped lots of other careers options, and that speaks volumes about how people recognise our profession, particularly following our most challenging year."

Case Study: Micro Patient With Huge BMI

Somehow an NHS computer system allowed a patient's height to be recorded as 6.2cm instead of 6 foot 2 when he registered with a GP a year ago.

That gave 32-year old Liverpool Echo political editor Liam Thorp a BMI of 28,000. He only found out when he was invited for a COVID-19 jab despite having no underlying health conditions.

He asked what had happened and told the paper: "A nervous sounding chap on the line began quietly explaining to me that there had been a mix-up in offering me a vaccine at this stage."

He got in touch with the Liverpool Clinical Commissioning Group, "like the diligent, tiny, morbidly obese journalist that I am".

Its Chair, Dr Fiona Lemmens, told him: “I can see the funny side of this story but also recognise there is an important issue for us to address."

She added: "We would encourage anyone who has received a text invitation that they think they are not eligible for at this stage, to contact their GP practice to clarify. This will help ensure that more vulnerable people get vaccinated first."

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

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