UK COVID-19 Update: Concerns Over Treatment Backlog, EU Worries Widen on Oxford Vaccine Batch

Peter Russell

March 11, 2021

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

Hospital Backlog Shows the 'Steep Mountain the NHS Must Climb'

The increase in the number of COVID-19 cases during winter severely affected hospital services, including cancer and routine surgery, latest NHS England figures showed.

The number of patients waiting to begin treatment reached 4.6 million in January.

More than 300,000 NHS patients have been waiting for more than a year for planned care.

January saw an 11% drop in the number of people in England being seen by a specialist for suspected cancer following an urgent referral by their GP, compared with the same time last year.

Sara Bainbridge, head of policy at Macmillan Cancer Support, said: "Today’s results show that COVID-19 continues to cast a long shadow over people living with cancer."

Waiting lists have grown since early 2020 when all non-urgent operations were postponed ahead of the first wave of the pandemic.

Prof Stephen Powis, NHS England's medical director, said that the surge in hospital admissions in January had contributed to pressure on hospitals. "Admitting more than 100,000 COVID patients to hospital in a single month inevitably had a knock-on effect on some non-urgent care," he said.

"However, thanks to the hard work of NHS staff and the innovations in treatment and care developed over the course of the pandemic, hospitals treated more than one million people with other conditions in January, at the peak of the winter wave, nearly twice as many as they did last April.

"That is a testament to the skill, dedication, and commitment nurses, doctors, therapists, and countless other staff showed in the most challenging period in NHS history."

NHS Providers described the latest figures as "stark".

"Today’s data reveals the incredibly steep mountain the NHS must climb as it seeks to clear the substantial backlog of care that has built up during the pandemic," commented Saffron Cordery, the organisation's deputy chief executive.

She said that with less than a month to go before the end of the financial year, trust leaders had yet to hear details of next year's NHS budget that could allow them to plan frontline services and address the treatment backlog.

Dr Jennifer Dixon, chief executive of the Health Foundation, said: "The government and NHS leaders will now need to be clear with the public about how they intend to deal with the backlog of unmet need, as well as achieve the ambitions to modernise care set out in the NHS long term plan. 

"This will need significant investment at the next Spending Review, in particular if we are to see improvement on waiting lists and plugging staff shortages, which are holding back progress."

NHS Staff 'Under Intense Pressure'

The British Medical Association (BMA) said the latest NHS Staff Survey demonstrated the intense pressure that health workers have been under during the pandemic, and the severe impact it has had on their health and wellbeing.

It found that 44% of staff reported feeling unwell as a result of work related stress in the last 12 months, up from 40.3% in 2019.

The BMA said it echoed its own February survey which suggested that half of respondents reported work-related mental conditions, while almost 60% said exhaustion and fatigue were higher than normal.

Dr Rob Harwood, BMA consultants committee chair, said: "Given this backdrop, and with more than half of staff telling today's survey that they're working extra hours unpaid on a weekly basis, it's no surprise that one in five respondents say they are planning on leaving the NHS entirely."

Meanwhile, a mental health disorder was experienced by almost 58% of frontline health and social care workers in the UK during the first COVID-19 lockdown, a study suggested.

Researchers from University College London (UCL) and the University of Haifa, Israel, found that:

Significantly, the study found that it was not just doctors and nurses who were experiencing clinically significant distress, but all staff from across the health and social care sectors, including ambulance workers, hospital porters, and pharmacists.

The study, published in the European Journal of Psychotraumatology,  involved 1194 participants who completed an online survey between May 27 and July 23 2020.

The research identified that worries about infecting others with SARS-CoV-2, concerns about access to personal protective equipment, and being unable to talk to managers about how they were coping, were specific factors affecting their mental health.

Dr Jo Billings, who co-authored the report, said the findings "also highlight that staff redeployed into new frontline roles are at particular risk of being traumatised and are likely to require additional support during redeployment".

The research was conducted by the COVID Trauma Response Working Group, formed by UCL psychiatrists and psychologists, who called for immediate additional mental health support for health and social care workers.

Lead author, Dr Talya Greene (UCL Psychiatry and University of Haifa) said: "Let’s be clear: we may be on the verge of a mental health crisis across the health and social care sector. So, we need to make sure that specialist help is offered and accessible across all the different roles and settings."

Call for Review of Pfizer Dosing Interval for Cancer Patients

Delaying a second dose of the Pfizer/BioNTech vaccine could leave more than half of cancer patients with little protection against SARS-CoV-2, a preprint study suggested.

Researchers from King's College London (KCL) and the Francis Crick Institute found that antibody responses three weeks after the first dose was given were only 39% in solid cancers and just 13% in haematological cancers, compared to 97% in patients who did not have cancer.

The study, expected to be released on pre-print server medRxiv shortly, involved 151 cancer patients and 54 healthy controls. Of these, 47 received two 30-μg doses of the BNT162b2 vaccine, administered intramuscularly 21 days apart. However, following a change in guidelines, participants who had not received their second shot by December 29 received only one dose within the study period with a planned follow up booster 12 weeks later.

Co-authors Dr Sheeba Irshad and Prof Adrian Hayday called for the Joint Committee on Vaccination and Immunisation to urgently review UK policy for the Pfizer/BioNTech dosing interval for cancer and other immuno-suppressed patients.

"We show that following first dose, most solid and haematological cancer patients remained immunologically unprotected up until at least five weeks following primary injection; but this poor one dose efficacy can be rescued with an early booster at day 21," said Dr Irshad.

Lawrence Young, professor of molecular oncology at Warwick Medical School, told the Science Media Centre that "this study does raise the issue of whether patients with cancer, other diseases, or those undergoing therapies that affect the body's immune response (e.g. transplant recipients, rheumatoid arthritis) should be fast-tracked for their second vaccine dose."

'No Indication' Oxford Vaccine Causes Blood Clots: EMA

The European Medicines Agency (EMA) said a preliminary inquiry found no evidence linking the AstraZeneca/Oxford COVID-19 vaccine to illness in two people who received it in Austria, one of whom subsequently died.

Austrian authorities suspended the use of batch number ABV5300 of the vaccine as a precautionary measure after a patient was diagnosed with multiple thrombosis and died 10 days after vaccination. Another individual was hospitalised with pulmonary embolism after receiving the vaccine and is now recovering.

The EMA said this batch had been delivered to 17 EU countries and comprised one million vaccine doses.

It said that although an investigation was continuing, there was "currently no indication that vaccination has caused these conditions, which are not listed as side effects with this vaccine".

It said that information available so far indicated that the number of thromboembolic events in vaccinated people was no higher than that seen in the general population.

Today, Denmark said it was also suspending the use of vaccines from the batch.

The Medicines and Healthcare products Regulatory Agency (MHRA) said it had "not been confirmed that the report of a blood clot was caused by the AstraZeneca COVID-19 vaccine".

Dr Phil Bryan, MHRA vaccines safety lead said they were "keeping this issue under close review", but that "people should still go and get their COVID-19 vaccine when asked to do so".

Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, described the Danish move as "a super-cautious approach based on some isolated reports in Europe".

Daily Data

In today's daily data another 6753 UK positive tests were reported and 181 deaths. Total deaths within 28 days of a positive test now stand at 125,168. There have been 143,259 deaths with COVID-19 on the death certificate. 

Another 532 COVID-19 patients were admitted to hospital. The total is now 8977, and 1237 ventilator beds are in use.

As of yesterday, 23,053,716 people have had a first dose of a COVID-19 vaccine, and 1,351,515 a second dose.

European Approval for Jansen Vaccine

The EMA has granted a conditional marketing authorisation for Janssen's COVID-19 vaccine in people aged 18 and over.

It is the fourth vaccine COVID vaccine to be approved in the EU.

The decision followed trial results showing that the one-shot vaccine reduced symptomatic COVID-19 cases by 67% after 2 weeks compared to those who received a placebo.

The UK has secured 30 million doses with deliveries expected later this year, subject to regulatory approval.

More Cases of P.1 Variant of Concern

Four more cases of the SARS-CoV-2 'variant of concern', P.1, or VOC-202101/02, have been identified in England.

Three of the cases were in South Gloucestershire and one in Bradford, West Yorkshire, Public Health England said.

The cases in South Gloucestershire were all close or household contacts of two existing P.1 cases in the area.

The individual in Bradford tested positive for COVID-19 in late February after travelling back from Brazil via Paris on February 14.

The latest cases bring the total number of P.1 variant cases in the UK to 10, of which seven were in England and three in Scotland.

Wales to Fund Strategy for Obesity and Diabetes

The Welsh Government promised to invest £65 million to combat obesity and diabetes which it said would help support adults and children in Wales likely to be severely affected by the pandemic.

The money, outlined in the Welsh Government Budget, was announced ahead of the publication next week of the '2021-22 Healthy Weight: Healthy Wales' strategy, which has been updated to reflect the impact of COVID-19.

Eluned Morgan, Minister for Mental Health and Wellbeing, said: "We have seen the coronavirus doesn't discriminate who it targets, but those who are in poor health are much more likely to be severely affected by this awful virus."

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

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