Editor's note, 25 November 2020: This article was updated to include additonal spending review comments.
These are the UK coronavirus stories you need to know about today.
NHS Pay Rise
Chancellor Rishi Sunak's spending review contained the promise of an NHS pay rise next year while other public sector workers face a pay freeze. "Taking account of the pay review bodies' advice, we will provide a pay rise to over a million nurses, doctors, and others working in the NHS." he told the Commons. The NHS Pay Review Body is due to make its recommendations in the first quarter of next year.
Dr Ellen Welch, spokesperson for the Doctors’ Association UK, said: "Spin from the Government today hailing a pay rise for doctors and nurses conveniently fails to mention the deep and lasting pay cuts of the previous decade. As we face the challenges of the second wave, doctors, nurses, and frontline healthcare workers have not been rewarded for their efforts or tremendous sacrifices during the pandemic."
Mr Sunak also announced in a press release: “Investment targeted at controlling and suppressing the virus - and saving lives, includes funding to enhance testing capacity, purchase vaccines, increase supply of key COVID-19 medicines, and purchase and distribute PPE."
There was also £3 billion "to support NHS recovery, allowing them to carry out up to a million checks, scans and operations".
Professor Andrew Goddard, president of the Royal College of Physicians, commented: "While this targeted funding will support clinicians to get by in the next 12 months, many of the pressures they face are caused by workforce shortages. There is no quick fix to this. It will require long-term funding commitments, including for a significant expansion of medical school places. The most effective way to reduce NHS backlogs and ease pressure is to increase the workforce that is available to treat patients."
Cancer Research UK Chief Executive, Michelle Mitchell, commented: "This spending review was a pivotal moment for the Government to back its ambitions to improve cancer survival, and today’s announcement is a step in the right direction. This investment will help to clear the backlog of millions of people waiting for cancer care and will begin to address major barriers to earlier diagnosis and treatment.
"Funding for some new diagnostic equipment is good news but much more will be needed. We’re particularly pleased that the Government has given the NHS additional money to train more staff which is desperately needed, but longer-term commitments to this will be vital."
Sally Warren, director of policy at The King’s Fund, commented: "The planned investment in health and social care is welcome given the wider financial situation. However, it is unlikely to be enough to address the pressures faced by services across the country, which are likely to require more emergency funding next year."
10 Day Notice for Vaccine Roll Out
GPs will get 10 days notice before a vaccine roll out in England and it won't be next week (starting 30 November).
A letter from Dr Nikki Kanani, NHS England’s medical director of primary care, and Ed Waller, director for primary care, says: "We will aim to give all sites at least 10 days notice of the first vaccines becoming available to ensure sites can be stood-up and clinics arranged.
“Vaccinations will not commence in PCN (primary care network) grouping sites during the week of 30/11."
Following on from the interim phase 3 results for the Oxford vaccine showing a half dose before a full dose was most effective, AstraZeneca will start discussions with the US Food and Drug Administration (FDA) to change its study design.
"In terms of how quickly, we will try and do that as quickly as possible," said Mene Pangalos, executive vice president of biopharmaceuticals research and development, adding it would be a "matter of weeks".
The head of the US Operation Warp Speed vaccine programme, Moncef Slaoui, told reporters the maximum age in Oxford's 90% effective half dose/full dose group was 55. Two full doses were 62% effective and this group included older volunteers, he said.
5 Days of Christmas
Experts have reacted to UK-wide plans to allow three households to mix for 5 days over Christmas.
SAGE scientist Prof Andrew Hayward, UCL, told the BBC the plan was like "throwing fuel on the COVID fire" and it would "definitely lead to increased transmission and likely lead to a third wave of infections with hospitals being overrun, and more unnecessary deaths."
Professor Paul Hunter, University of East Anglia, agreed via the Science Media Centre that: "Any relaxation of the restrictions over the Christmas period will almost inevitably lead to some increase in transmission and therefore, illness, hospitalisations, and sadly deaths."
However, he said: "The benefits on people’s mental health of being able to meet up with family over this time should not be underestimated.
"My personal view is that some relaxation of the rules in line with what is currently being reported will have sufficient benefits to justify the additional risks for the COVID epidemic. Providing that the new tier system is better managed than in October any increase in cases could be relatively short-lived."
Tiers System Assessed
Prof Hunter also published a preprint on England's tier system today. It found Tier 1 didn't work and re-allocation of areas to different tiers was too slow.
"We show quite clearly that Tier 1 restrictions were inadequate. They had little impact on transmission and allowed exponential growth in the large majority of authorities such as Kingston upon Hull, until it was moved into Tier 2, and Kings Lynn and West Norfolk," he said in a news release.
"We found that the impact in Tier 2 areas was mixed. Exponential growth was being seen in about half of authorities so the restrictions were not adequate in those areas. However, the infection rate declined in other areas so the restrictions seemed to be enough in some places.
"Tier 3, which barred all indoor household mixing in areas such as Rossendale and South Ribble authorities in Lancashire had the most impact and was effective in most of the authorities in that top tier.
"Based on this analysis, almost all of the regions in Tier 1 should have been in Tier 2. And about half of Tier 2 should have been in Tier 3."
PPE Report
The National Audit Office says England's PPE stockpiles were inadequate for a coronavirus pandemic and many frontline workers in health and adult social care reported not having access to the PPE they needed during the height of the shortages.
The stockpiles "provided an estimated 2 weeks’ worth, or less, of most types of PPE needed by the NHS and social care during the pandemic. Furthermore, the PIPP stockpile did not include gowns which were later needed during the pandemic," it said in a report.
The BMA says the UK then spent an extra £10 billion on PPE due to inflated prices.
BMA Deputy Chair of Council, Dr David Wrigley, commented: "At the onset of the COVID crisis, the BMA warned repeatedly that healthcare workers were being put at risk due to inadequate supplies of PPE. Time and time again, Ministers failed to take the action required to safeguard our most hard-pressed public servants and restore the confidence of the medical profession.
"Now we are in the midst of a second wave, it’s essential that the hard lessons of the first wave are learned and acted upon to ensure that everyone who needs it has guaranteed access to PPE that meets all safety as well as cultural requirements. More widely, it is time for a more accountable and transparent procurement policy that avoids the rip-offs of the past and prioritises quality and value for money over hastily-concocted deals with poorly-qualified suppliers."
Mutations
SARS-CoV-2 virus mutations seen so far do not appear to increase its transmissibility in people, according to a UCL-led study published in Nature Communications.
The findings come from an analysis of virus genomes from more than 46,000 people with COVID-19 from 99 countries.
First author Dr Lucy van Dorp said in a news release: "Fortunately, we found that none of these mutations are making COVID-19 spread more rapidly, but we need to remain vigilant and continue monitoring new mutations, particularly as vaccines get rolled out."
Anxiety
The number of young people with anxiety nearly doubled from 13% to 24% during the early stages of the pandemic and lockdown, according to University of Bristol research published in the British Journal of Psychiatry.
Co-lead researcher Dr Alex Kwong commented: "The highly detailed Children of the 90s questionnaire data reveals a worrying rise in young people’s anxiety – this looks like it is due to the pandemic itself and potentially the societal and economic fallout caused by the lockdown measures used to control the spread of the virus. Evidence suggests this is not going to be a short-term issue and that mental health support and interventions are urgently required to reduce some of the mental health inequalities that have emerged."
Dirty Money?
The Bank of England commissioned research on how much banknotes can spread coronavirus and it concludes the risk of infection appears to be low.
"Our study found that the level of virus found on a banknote remained stable for 1 hour after exposure. Over the next 5 hours, the amount of the virus present declined rapidly," it said.
"After 6 hours, virus droplets on banknotes had declined to 5% or less of their initial level on both paper and polymer notes."
Black Cab Ad Ban
A radio ad for London black cabs has been banned for exaggerating how much the vehicles could help reduce the spread of COVID.
"The permanent screen keeps me divided from the driver, it’s like being in my own bubble back here," the ad said.
However, the Advertising Standards Authority ruled: "Because on some back seats in London black cabs, passengers would not be 'over’ 2 metres from the driver or guaranteed to be completely separated from the driver, we therefore considered the ad exaggerated the extent to which features of a London black cab would reduce the spread of COVID-19 and was therefore misleading."
Sanitiser for Santa
Boris Johnson has responded to a child's concerns about whether Santa could spread COVID-19 by agreeing that leaving hand sanitiser by his cookies was "an excellent idea".
The PM told 8-year-old Monti the chief medical office had assured him there are no risks to health if Santa "behaves in his usual responsible way and works quickly and safely".
See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.
