UK COVID-19 Update: Booster Jabs, GPs' 'Breaking Point', 'Healthy' BMI Range Risks

Tim Locke

April 29, 2021

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

Booster Jabs Trial

Yesterday, an order for another 60 million more Pfizer/BioNTech vaccine doses for an autumn booster jab programme was announced.

England’s Deputy Chief Medical Officer, Professor Jonathan Van-Tam, told a Downing Street briefing a clinical trial starting this summer would be key to planning the booster programme:
"There's a study that will start in June called COVBOOST, and Professor Faust [University of Southampton] and Professor Snape [University of Oxford], are going to be running this, it will be available to many, many people across the UK because so many of us will have had a course of vaccines by then.

"People will be invited and randomised to different kinds of vaccines as the booster. 

"We'll get an idea then of which gives you the highest boost, which perhaps give you the broadest boost against a range of coronavirus variants, and indeed what the timings look like on that. 

"And that is another reason why the Vaccines Taskforce has invested in contracts with not just one or two manufacturers, but six or seven, so that we have that optionality, so we can always try and do the very best thing, scientifically, within the constraints of what we can realise in terms of supply at the time."
 

GPs 'Reaching Breaking Point'

Latest NHS GP data for England show 4.8 million more appointments delivered in March than February.

BMA GP Committee Chair Dr Richard Vautrey, commented: "So for GPs working 11 or 12-hour days, often leading heroic efforts to protect as many people as possible in their communities against a disease that has had such a devastating impact on all of us, it is heart-breaking and completely demoralising to hear accusations that general practice is not open and that patients are not being seen.

"This narrative, categorically proven wrong by today’s data, is extremely damaging at a time when morale is already reaching rock bottom and many GPs, practice managers and others in the practice workforce are reaching breaking point."

Professor Martin Marshall, chair of the Royal College of GPs, said: "We urgently need more GPs and other members of the practice team to manage increasing workload in general practice. Good progress has been made to encourage medical students to choose general practice, but we also need to see comprehensive plans to keep existing and experienced GPs in the workforce, protecting them from burning out by addressing ‘undoable’ workload, so that we can continue to deliver the high quality care that our patients rely on us for."

BMI Risks

A new UK study in The Lancet Diabetes & Endocrinology found COVID-19 risk increases with a BMI of 23kg/m2, which is considered to be in the healthy range.

Hospitalisation risk rose 5% for each one unit increase in BMI, and ICU admission risk was 10% higher for each unit increase. Worse outcomes were also seen in underweight people with a BMI less than 18.5.

Data were from more than 6.9 million people in England and more than 20,000 hospitalised COVID-19 patients.

Co-study lead, Professor Paul Aveyard, University of Oxford’s Nuffield Department of Primary Care Health Sciences, said: "We don’t yet know that weight loss specifically reduces the risk of severe COVID-19 outcomes, but it is highly plausible, and will certainly bring other health benefits."

In a linked comment article, Professor Krishnan Bhaskaran, London School of Hygiene & Tropical Medicine, said: "Key future research priorities will be to establish whether BMI affects vaccine efficacy, and to understand whether people outside the healthy BMI range (18·5–24·9 kg/m2) are at increased risk of post- COVID-19 sequalae. Further careful epidemiological study of these and other emerging questions will inform the ongoing public health response to this new disease that is likely here to stay."

Fully Vaccinated Freedoms

At last night's Downing Street briefing, Prof Van-Tam, was asked if the UK should follow the US in offering fewer restrictions to people who are fully vaccinated.

"If two people who both had two doses of vaccine and have both served at least 14 days after their second dose, then I would be highly confident scientifically that if they were reputable vaccines then indeed it would be incredibly safe for those two people to meet," he said.

He added: "But we just need to make sure we don’t have to go backwards again on any of this and just hold the line a teeny bit longer."

Prof Van-Tam also said data show "we are at or close to the bottom" of levels of UK COVID cases.

Test and Trace

Today's latest Test and Trace weekly data for England show a 9% decrease in positive cases to 21 April compared with the previous week.

Twenty percent fewer cases were referred for contact tracing.

There was a 16% increase in testing compared to the previous week, mainly due to school testing.

There were 4798 people quarantining in managed quarantine hotels.

Outdoor Masks?

Experts debated the merits of outdoor mask wearing in The BMJ today.

Babak Javid, University of California, San Francisco and colleagues, argue that "wearing masks outdoors, particularly at large outdoor gatherings such as sporting events or other settings where it will be difficult to maintain physical distance for prolonged periods, which may have a low but measurable risk of seeding a superspreading event - as well as normalising mask wearing behaviour in general - will bring benefits in reducing risks during the pandemic phase of COVID-19".

However, Dr Muge Cevik, University of St Andrews and colleagues, disagree, saying: "Less than 10% of reported COVID-19 cases involve outdoor transmission, and those are typically associated with prolonged close interactions or settings where people mix both indoors and outdoors. Moreover, no confirmed sizeable COVID-19 clusters or ‘superspreader’ events have been outdoors-only."

BMJ Patient Editor Amy Price’s husband died from COVID-19. In a commentary article she wrote: "When we run, talk, cough, or sneeze, respiratory droplets are released into the air.

"This is why I wear a mask even outside," she said.

"Regular mask wearing both inside and outside can help us protect each other by reducing spread at the source, even when we don’t know that we’re infected."

Mass Home Testing Questioned

Also in The BMJ, experts argue that mass home testing is "a misguided policy, unlikely to reduce transmission".

Public Health Consultants Angela Raffle and Mike Gill, wrote: "The temptation for people with symptoms to opt for unsupervised, rapid, and lower sensitivity self-testing may lead to false reassurance, as happens with other screening, leading to potential increases in transmission."

The comments follow JCVI Deputy Chair, Professor Anthony Harnden's comments to the  Science and Technology Committee yesterday: "I think everybody’s got to be cautious and just because you’ve been vaccinated, and just because you have a negative lateral flow test, [it] does not mean you’re invincible because these tests are not perfect."

Oxygen Factories for India

The UK's latest aid for India includes three oxygen generation units capable of producing 500 litres of oxygen a minute. The machines are the size of shipping containers.

India's health ministry reported 3645 deaths in the last 24-hour period.

111

The Guardian reported criticism of the Government's refusal to publish NHS 111 coronavirus response service (CRS) training material for England because it is "commercially sensitive".

A spokesperson for the bereaved families' group said the decision showed "a total disrespect to families and our loved ones".

NHS 'Privatisation' Briefing

The campaign group EveryDoctor briefed more than 100 MPs online today on the threat of NHS privatisation.

Consultant Anaesthetist Dr Megan Smith said: "I’ve seen NHS patients bumped from operations to make way for someone who is paying privately. I’ve seen the best equipment reserved for those private patients too. This is not what doctors want and it is not what the public wants. This cannot be allowed to continue."
 

Farewell, Sir Simon

NHS England Chief Executive Sir Simon Stevens is standing down this summer. He'll be made a life peer.

In a statement he said: "Joining the health service in my early twenties was one of the best decisions I’ve ever made, followed three decades later by the privilege of leading the NHS through some of the toughest challenges in its history. The people of this country have rightly recognised the extraordinary service of NHS staff during this terrible pandemic, as well as the success of our COVID vaccination deployment. As the pandemic recedes in this country, the NHS’s track record in advancing medical progress in a way that works for everyone rightly continues to inspire young people to join one of the greatest causes – health and high quality care for all, now and for future generations."

Hancock's Jab

Prof Vam-Tam gave England's 42-year-old Health Secretary Matt Hancock his first Oxford/AstraZeneca jab today at London's Science Museum.

Mr Hancock said on Twitter that it "didn’t hurt at all".

https://twitter.com/MattHancock/status/1387685802545647617

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

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