UK COVID-19 Daily: dexamethasone 'breakthrough', BAME report part 2

  • Tim Locke, Medscape.com

  • UK Medical News
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These are the latest UK coronavirus stories you need to know.

Dexamethasone 'Major Breakthrough'

Dexamethasone reduces deaths by up to a third in hospitalised patients with severe respiratory complications of COVID-19, the University of Oxford's randomised RECOVERY Trial has found.

"It is a major breakthrough," Co-Chief Investigator, Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, told a news briefing. "The results are sufficiently clear, we can announce the results on Tuesday and people could be treated this evening or tomorrow."

The steroid that's been used for around 60 years costs £5 for a course of treatment in the NHS, and guidance has been issued to hospitals to use the treatment from on Tuesday.

A total of 2104 patients were randomised to receive dexamethasone 6mg once per day by mouth or by intravenous injection for 10 days and were compared with 4321 patients randomised to usual care alone.

Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021).

There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75; p=0.14).

Government Chief Medical Adviser Professor Chris Whitty called it "the most important trial result for COVID-19 so far".

Prime Minister Boris Johnson told the Downing Street briefing: "I'm absolutely delighted that the biggest breakthrough yet has been made by a fantastic team of scientists right here in the UK."

"This is the start of something important," Government Chief Scientific Adviser Sir Patrick Vallance said. "Other drugs might be added on top of it to make an even bigger effect in due course we hope."

The Department of Health and Social Care said extra stocks had been bought ahead of the positive trial result and there is already enough to treat more than 200,000 people.

In another development, the MHRA has told all UK clinical trials using hydroxychloroquine for COVID-19 to suspend recruitment of any more participants. The regulator said it followed emerging concerns about the use of the drug in COVID-19 and trial results showing no meaningful mortality benefit in hospitalised patients.

PHE BAME Report - Part 2

Public Health England has published the 'missing' second part of its report on the impact of COVID-19 on BAME communities.

The delayed report is called Beyond the data: Understanding the impact of COVID-19 on BAME groups, and makes seven recommendations:

  • Improved data collection about ethnicity and religion, including on death certificates

  • More research with participation of BAME communities on risks and mitigation

  • Improving BAME groups' access, experiences, outcomes with NHS and other services

  • Developing 'culturally competent' occupational risk assessment tools

  • Developing culturally sensitive education and prevention campaigns

  • Targeted culturally sensitive health campaigns and disease prevention programmes

  • Ensuring that COVID-19 recovery strategies actively reduce inequalities for long-term, sustainable change.

Professor Andrew Goddard, president of the Royal College of Physicians, commented: "Now that we have these recommendations, they must be placed at the core of both the NHS and the Government's plans to restart services, as well as plans for further COVID-19 outbreaks. There is no time for complacency and leaders at all levels should be made accountable for delivering these recommendations and regularly reporting on progress.

"We know that our members from BAME communities remain significantly more concerned about their health. Which is why we are disappointed at the slow progress in rolling out risk assessments to NHS staff. Only 24% of our members told us that they’d had a formal risk assessment two weeks ago, despite the NHS having known about the increased risk factors for weeks prior."

ONS Weekly Deaths Data

The Office for National Statistics (ONS) released its weekly data for deaths for England and Wales.

A total of 47,387 deaths involving COVID-19 were registered in England and Wales in the year to date up to 5th June 2020 (week 23). That's 15.4% of all deaths.

In week 23 there were 10,709 deaths registered in total, which the ONS said was higher than the previous week which had been affected by the late Spring bank holiday. Nick Stripe from ONS said on twitter this was 7% (732 excess deaths in week 23) above the 5-year weekly average.

Care home deaths were 335 higher than the 5-year average, while in hospitals the number of deaths was 538 fewer than the 5-year average. More than half of the COVID-19 deaths that occurred in week 23 happened in hospital (63.7%).

The ONS chart of fatalities on the actual date of death, not the date they were reported, shows a steadier decline than the daily reported numbers in the Downing Street briefing slides.

Daily Deaths and Data

Another 233 UK COVID-19 deaths were announced on Tuesday, taking the total to 41,969. 

There were 113,107 tests counted on Monday. This figure includes home tests that have been sent out but not yet processed. This takes the total tests to 6,981,493.

Figures for the number of people tested were last given on Friday 22nd May.

Another 1279 positive cases were reported on Tuesday taking the total UK confirmed cases to 298,136.    

There were 410 people admitted to hospital in the UK (excluding Scotland), and 385 mechanical ventilator beds are in use by coronavirus patients.

There are 5254 people in hospital with COVID-19, down from 6282 a week ago.

NHS Deaths

Among the recently announced NHS deaths was Rizal Manalo, known as Zaldy, 51, a nurse at Glan Clwyd Hospital in Denbighshire. He'd moved from the Philippines to work in the NHS.

His wife, Agnes, said he was "a hard working person who loved his job dearly".

Matron Karen Davies said: "Zaldy would always greet you with a smile in the morning and always had a story to tell. He was a caring and compassionate member of the team, a true gentleman."

Hospital Managing Director, Rab McEwan, also paid tribute: "It’s always hard when someone who serves the NHS dies before their time. We are desolate, and send our deepest sympathies to Zaldy’s family, colleagues and friends."

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

More News in Brief

  • Nearly 1in 5 people (22%) are estimated to have an underlying health condition that could increase the risk of severe COVID-19 if they become infected, according to modelling by the London School of Hygiene & Tropical Medicine published in The Lancet Global Health. "We hope our estimates will provide useful starting points for designing measures to protect those at increased risk of severe disease," commented author Associate Professor Andrew Clark.

  • A UK expert has poured cold water on a US modelling study on how COVID-19 might spread in droplets from flushing a toilet. "The viral load in faecal matter and the fraction of resulting aerosol containing the virus is unknown. Even if the virus were contained in the produced aerosols, it is unknown whether the virus would still be infectious; there is not yet clear evidence for faecal-oral transmission," commented Dr Bryan Bzdek, research fellow at Bristol Aerosol Research Centre, University of Bristol, via the Science Media Centre. However, he said closing the toilet lid before flushing is still a good idea. The research is published in the journal Physics of Fluids.

  • New Zealand has halted compassionate exemptions for travellers after two new COVID-19 cases were recorded in two women who'd arrived from the UK, TV New Zealand reported. The cases ended 24 days without any new cases. The women, one in her 30s, and the other in her 40s, were understood to have travelled to attend a funeral.

  • On Monday, we reported the Government had rejected footballer Marcus Rashford's appeal to continue free school meals over the summer holiday in England. However, a U-turn came just minutes after Scotland announced it would extend the scheme this year as part of the COVID-19 response. "Just look at what we can do when we come together," he tweeted. The PM said he only became aware of the campaign on Tuesday and has spoken to Marcus Rashford to congratulate him on his campaign.

  • Dr Emeka Okorocha, a 27-year-old A&E doctor from East London has attracted an online following after posting his contribution to the Black Lives Matter debate, a TikTok video asking people to treat him the same whether he’s in his scrubs or a hoodie.

Adapted from Medscape UK.