UK COVID-19 Update: 'Running on Empty', 'Inadequate' PPE Guidance 

Tim Locke

February 19, 2021

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

'Running on Empty'

A Royal College of Physicians (RCP) member survey with 1168 responses suggests 49% aren't getting enough sleep, 63% still felt tired or exhausted, and 27% felt demoralised.  

With many in need of time off, 63% said there had been no discussion in their organisation about timetabled time off to recuperate. 

"Doctors are running on empty," RCP President, Professor Andrew Goddard commented. "This has been the hardest year many of us have ever faced and, while physicians have shown incredible strength and resilience throughout the pandemic, they and their colleagues can’t keep working this way forever.

"Plans for tackling the backlog of non-COVID-19 care must recognise that recovery of NHS services includes the recovery of NHS staff. It’s important that healthcare workers take time off, so it is worrying to see so many physicians have not had this conversation at their place of work."

The poll, carried out last Friday, also found 24% hadn't had a formal or informal risk assessment, 18% didn't have the PPE they needed, and 18% still haven't been fit-tested for PPE.

Prof Goddard said: "It is reassuring that less than 1% of doctors told us they were off work due to COVID-19, down from 4% in January. While some of that will be down to the vaccine, previous infection and falling rates of infection in the community, it also suggests the risk of staff contracting COVID-19 is falling. Having said that, we must be prepared for a third wave and infection control remains as important as ever."
 

'Inadequate' PPE Guidance 

Current PPE guidance is "inadequate", according to a letter to the Prime Minister from a coalition of health groups, including the BMA and Royal College of Nursing (RCN).

There are fresh concerns about new evidence on airborne transmission. The letter says: "Measures to reduce airborne spread in high-risk health and care settings, which are mission-critical to the pandemic response, have thus far been inadequate. Current policies continue to emphasise the importance of fomite, droplet, and direct spread but do not properly address airborne transmission."

The RCN said more than 900 UK health and care workers have died with COVID-19 so far.

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

NHS 'House of Cards'

Wales is the latest nation to extend lockdown. Restrictions will stay in place for another 3 weeks but some younger children will begin returning to primary school next week. 

First Minister Mark Drakeford said: "We are seeing encouraging green shoots as we move into spring."

Prime Minister Boris Johnson is to make an announcement for England on Monday. The BMA says a 7-day case rate of 10 infections or fewer per 100,000 of population would allow for a safe and sustained return to a more normal social and economic life. That's around 1000 daily cases. Today there were more than 12,000 new cases reported.

Dr David Wrigley, BMA deputy chair of council, said: "It’s clear that there must be no arbitrary date set for lockdown easing, and that taking a cautious approach is the only way to save lives and stop the NHS from becoming overwhelmed to a point of no return. Ahead of Monday, we hope the Government remembers that our health service is currently akin to a house of cards – one wrong move by them, and it will surely collapse."
 

Infection Survey

The latest Office for National Statistics (ONS) infection survey data for the week ending 12 February continue to show COVID-19 prevalence:

  • In England, around 1 in 115 people had COVID-19, the previous week it was 1 in 80

  • In Scotland, around 1 in 180 people had COVID-19, the previous week it was 1 in 150

  • In Wales, around 1 in 125 people had COVID-19, the previous week it was 1 in 85

  • In Northern Ireland, around 1 in 105 people had COVID-19, the previous week it was 1 in 75

Sarah Crofts from ONS commented: "Whilst we are seeing a welcome further decrease in infection rates across the UK in the week ending 12 February, the numbers do still remain high and are similar to infection levels seen at the end of November across most of the UK.

"Additionally, while the new UK variant still accounts for the highest proportion of infections, the percentage of positive cases continues to decrease in all regions across England."

The UK's R number is now 0.6 to 0.9 down from 0.7 to 0.9 last week.

The growth rate is -6% to -3% per day.

Daily Data

In today's daily data another 12,027 UK positive tests were reported and 533 deaths.

Another 1490 COVID-19 patients were admitted to hospital. The total is now 19,392 and 2535 ventilator beds are in use.

As of yesterday, 16.9m people have had a first dose of a COVID-19 vaccine, and 589,591 a second dose.

UK Variant & Children

The UK virus variant does not cause more severe disease in children, according to a King's College Hospital study of 20 children in the first wave, and 60 in the second, published in The Lancet Child & Adolescent Health.

The authors wrote: "We have found no evidence of more severe disease having occurred in children and young people during the second wave, suggesting that infection with the B.1.1.7 variant does not result in an appreciably different clinical course to the original strain."

Oxford Jab Dose Gap

A 3-month gap between doses of the Oxford/AstraZeneca jab gives higher vaccine efficacy than a 6-week interval, according to a new exploratory analysis published in The Lancet.

The first dose offered 76% protection in the 3 months between doses.

Study author, Dr Merryn Voysey from Oxford said: "This latest analysis confirms our previous findings of the higher efficacy of a low- then standard-dose regimen. However, with additional data available, we have found that the enhanced efficacy and immunity may be partly driven by the longer interval between doses that was common in this trial group. This further supports the relationship we have found between vaccine interval and efficacy in those receiving two standard doses, which is the preferred regimen because there are more data to support its use, and because it is simpler to deliver a vaccine programme when the same vaccine is given for both doses."

Vaccine First Dose

A study of more than 7000 health workers in Israel, published in a letter in The Lancet , found the first dose of the Pfizer/BioNTech's vaccine is 85% effective after 15-28 days.

Commenting via the Science Media Centre, Professor Deborah Dunn-Walters, chair of the British Society for Immunology COVID-19 and Immunology Taskforce, said: "It should be noted that this study was carried out on people of working age, so it will be informative to see a similar study in older people after one dose. Although further research is needed, overall these new findings should provide reassurance around the UK’s decision to offer the two doses of the vaccine 12 weeks apart."

Boris Johnson, chairing the G7 leaders’ meeting, has promised the UK will send any future surplus COVID-19 vaccines to the COVAX scheme to help support developing countries.

He also wants to cut the time to develop new vaccines by two-thirds to just 100 days.

'We're Only Safe if We're All Safe': The Global COVID Vaccination Effort

Pregnancy

New guidance on COVID-19 and pregnancy stresses additional risks of severe illness are more likely in the later stages of pregnancy.

COVID-19 increases the risk of premature birth and can lead to worse maternal outcomes.

Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists (RCOG) said: "While we want to stress that the majority of pregnant women with COVID-19 experience only mild or moderate symptoms, this important update to our guidance confirms that pregnant women who are in their third trimester of pregnancy or have pre-existing medical problems are at a higher risk of developing severe illness. We encourage pregnant women to continue to pay particular attention to social distancing measures and good hygiene, and contact their maternity team if they have any concerns about their or their baby’s health."

Telemedicine Abortions

A study published in BJOG on telemedicine home abortions in England, Scotland, and Wales concluded: "A telemedicine‐hybrid model for medical abortion that includes no‐test telemedicine and treatment without an ultrasound is effective, safe, acceptable, and improves access to care."

Professor Dame Lesley Regan, chair of the RCOG abortion taskforce, said: "This study proves there is no medical reason not to make the current telemedicine service permanent."

Patricia Lohr, medical director, British Pregnancy Advisory Service (BPAS), commented:"Telemedical abortion care has protected women’s health and wellbeing during the pandemic, and women have told us how much they value the service and want it to continue so other women in the future can benefit."

Social Impacts

ONS social impact data for Great Britain show the proportion of adults reporting staying at home or only leaving for work, exercise, essential shopping, or medical needs in the past 7 days remained at 56%.

The proportion of adults who felt that it will take more than a year for life to return to normal increased to 29%, up from 27% last week.

Those offered a COVID-19 vaccine but who declined it remained at 1%.

ARIA

The Advanced Research & Invention Agency (ARIA) is being set up as an independent research body to fund "high-risk, high-reward" scientific research, the Department for Business announced.

Government Chief Scientific Adviser, Sir Patrick Vallance said it will "build on the UK’s world-class scientific research and innovation system. The importance of scientific innovation has never been clearer than over the last year and this new body provides an exciting new funding mechanism for pioneering R&D".

Professor Dame Ottoline Leyser, CEO, UK Research and Innovation said it "has tremendous potential to enhance the UK and global research and innovation system".

She added: "The agency will have the freedom to experiment with pioneering new funding models, extending the reach of the current system to support people and ideas in new and different ways."

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

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