UK COVID-19 Update: Delta Variant 'Doubles Hospitalisation', 4-Week Delay to England's Unlocking

Tim Locke

June 14, 2021

Editor's note, 14 June 2021: This article was updated with information from Public Health England, and a Downing Street briefing.

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

4-Week Delay to Easing England's Lockdown

Prime Minister Boris Johnson was due to confirm today the next stage of his roadmap for unlocking restrictions in England on 21 June. Instead he told a Downing Street briefing: "I think it is sensible to wait just a little longer."

The new date is 19 July to allow for more progress in the vaccination campaign  against the Delta variant: "And we will bring forward our target to give every adult in this country a first dose by 19 of July," Mr Johnson said. 

"I'm confident that we will not need more than 4 weeks," he said. 

The 30-person limit will still be lifted for weddings and wakes next week.

Chief Medical Adviser Professor Chris Whitty said: "The link between people getting an infection and being hospitalised has been substantially weakened, and a much smaller proportion of those infected are going into hospital, but it has not been completely stopped."

He added: "We all want to stress that at that stage [19 July]  rates will be higher than they are at the moment, but the next 4 weeks will reduce significantly the risk of a very high peak which could cause significant problems in terms of pressure on the NHS."

Mr Johnson did concede there are still unknowns: "I'm afraid, and we’ve got to be honest about this, the possibility that there is some new variant that is far more dangerous that kills people in the way that we currently cannot foresee or understand."

NHS Providers' Chief Executive, Chris Hopson, welcomed the delay, saying "a cautious approach is prudent".

"It will also mean less pressure on hospitals at a point when they are very busy recovering care backlogs and dealing with increased demand for emergency care with significantly reduced capacity, due to the need to prevent the spread of COVID-19 in hospitals."
 

This morning Health Minister Edward Argar said a one month delay could allow for another 10 million second vaccine doses to be administered. He told Sky News: "I think once we have got those second doses in people’s arms, once we have got that level of protection up to around that 81%, then I think people will be more comfortable with it."

The BMA said the fourth stage of the PM's roadmap "should not go ahead until there is a better understanding of the implications of the rapidly rising number of cases".

In an NHS Confederation member poll published at the weekend, 63% of 282 health leaders in England said 'no' to restrictions being lifted next week. Another 30% were in favour, and 6% didn't know.

Chief Executive, Matthew Taylor, said: "Cases of coronavirus are rising again and many of our members have said that it would be better for more adults to be vaccinated against the disease and for more to be understood about the Delta variant before we proceed any further with the final unlock. Any increase in COVID-19 cases will disrupt hospital services – but also create extra pressure for ambulance services, community care, primary care, and mental health care at a time when they are working so hard to restore services and meet high levels of non-COVID demand."

Commenting ahead of the announcement  via the Science Media Centre, Mark Woolhouse, professor of infectious disease epidemiology, University of Edinburgh, said: "The nature and timing of the transition from a major epidemic to living with COVID-19 was never likely to be straightforward. The delta variant has made the process considerably more difficult."

Delta Variant 'Doubles Hospitalisation' 

The University of Edinburgh’s ongoing EAVE II study using Scottish data from 5.4 million people has found the Delta variant is associated with approximately double the risk of hospitalisation compared with the Alpha variant.

The findings are published as a research letter in The Lancet.

In community cases at least 2 weeks after the second dose, the Pfizer/BioNTech vaccine provided 79% protection against infection from the Delta variant, compared with 92% against the Alpha variant. Meanwhile, the Oxford/AstraZeneca vaccine gave 60% protection against the Delta variant, and 73% against the Alpha variant.

Study lead, Professor Aziz Sheikh, said: "Over a matter of weeks the Delta variant has become the dominant strain of SARS-CoV-2 in Scotland. It is unfortunately associated with increased risk of hospitalisation from COVID-19. Whilst possibly not as effective as against other variants, two doses of the Pfizer/BioNTech and Oxford/AstraZeneca vaccines still offer substantial protection against the risk of infection and hospitalisation."

Commenting via the Science Media centre, Prof Rowland Kao, University of Edinburgh, said: "The fact that both of the two widely available vaccines appear to have some impact on both infection and hospitalisation (albeit reduced for the delta variant) is a reminder of the importance of continued vaccination as this will be one of the most important determinants in whether or not further easing in the future is likely to occur sooner rather than later.

"While hospitalisations are shown to be increased, the paper does not address the issue of demand on intensive care units, or deaths due to the delta variant, as there are as yet insufficient data on this.  These will be important determinants for any future decisions on further relaxation or, should they be merited, reintroduction of restrictions.  As infections are expected to continue to increase both due to the effects of existing levels of restriction (where R is clearly above 1) and the increased transmissibility of the delta variant, the data on deaths and ICU occupancy will continue to be monitored very closely."

Novavax issued a news release saying its COVID-19 vaccine demonstrated 90% overall efficacy in US Phase 3 trials involving 29,960 participants. It also gave 93% efficacy against predominantly circulating variants of concern and variants of interest, including the Alpha variant.

Public Health England (PHE) also released new data this evening on vaccine efficacy against the Delta variants.

  • The Pfizer/BioNTech vaccine is 96% effective against hospitalisation after two doses

  • The Oxford/AstraZeneca vaccine is 92% effective against hospitalisation after two doses

Dr Mary Ramsay, head of immunisation, said these were "hugely important findings".

PHE said further work is needed to establish the level of protection against mortality from the Delta variant.

All Welsh Adults Offered Jabs

The Welsh Government said all adults have now been offered COVID-19 vaccination, 6 weeks ahead of schedule.

"However, we are not being complacent," Health Minister Eluned Morgan said. "I want to encourage younger adults to take up this offer of the vaccine and we don’t want to see anyone left behind.

"We are keen to see 18 to 39-year-olds vaccinated and hope to reach our milestone of 75% take-up in this age group by the end of this month."

Vaccine Hesitancy Reducing

Fifty-two percent of people who said they'd definitely not have a COVID-19 jab last November/December have now been vaccinated, according to a survey of 1879 adults by King's College London and the University of Bristol.

Vaccine confidence doubled in ethnic minorities from 36% saying they were certain or very likely to be vaccinated in November/December to 72% now.

However, the researchers reported "a hardening of views at the other end of the spectrum, with 9% of the unvaccinated saying they definitely won’t get the vaccine, compared with 4% of the public overall who said the same in July 2020."

Bristol's Dr Siobhan McAndrew said: "There is an apparently large difference in intention to get vaccinated between religious groups, with Muslims in particular standing out – but when we control for characteristics associated with religion, such as ethnicity, immigration status, social class and age, these differences are much reduced, suggesting that it’s not religious belief in itself that’s the driver.

"Nevertheless, the connections that the religiously-active have with religious peers, faith community leaders, and with the NHS’s diverse workforce serve as a valuable communications resource. Tailored messaging via these channels will address specific community needs, reassure the cautious, and support vaccine confidence."

Rapid Tests Questioned

UK experts have been reacting to the US FDA's safety communication telling people to stop using the Innova SARS-CoV-2 Antigen Rapid Qualitative Test for diagnostic use. "The FDA has significant concerns that the performance of the test has not been adequately established, presenting a risk to health," it said.

Commenting via the Science Media Centre, Jon Deeks, professor of biostatistics,  University of Birmingham, said: "Given the issues raised, it is important that risk assessments are urgently undertaken in the UK by the manufacturer (which includes the Department of Health and Social Care for the repackaged NHS self-test) in consultation with the MHRA (the regulator) to assess whether similar risks occur with the supply and distribution of this test in the UK."

Prof Sheila Bird, formerly programme leader, MRC Biostatistics Unit, University of Cambridge, said the MHRA "needs urgently to clarify the extent of read-across from across the pond to the 7-kit lateral flow test-packs which DHSC has made available to UK citizens for twice-weekly asymptomatic screening and which currently feature in the randomised controlled trial of Daily Contact Tracing versus self-isolation that Michael Gove announced his participation in.

"The RSS [Royal Statistical Society] Working Group calls for stricter regulation of in vitro diagnostic tests and stronger heed to statistical science – notably study-design and statistical reporting standards – in their evaluation."

G7

The G7 summit in Cornwall ended with some pandemic commitments:

  • Leaders renewed calls for further investigations into the origin of SARS-CoV-2 in China, although Boris Johnson said, on current advice, it didn't look like it came from a lab.

  • There was a promise of a billion doses of COVID-19 vaccines over the next year, including 100 million from the UK.

  • There was the promise of a 100-day mission for a collaboration against future pandemics.

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

Graphics credit: PA Media

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