UK COVID-19 Daily: England's lockdown exit roadmap in 50 pages

  • Tim Locke, Medscape.com

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

England's Lockdown Exit Roadmap in 50 Pages 

What started out in last night's TV address by the Prime Minister as the "first sketch" of his roadmap for exiting lockdown in England grew on Monday to 50 pages.

The document, Our plan to rebuild: The UK Government's COVID-19 recovery strategy, confirmed a new emphasis on being alert to the dangers posed by the pandemic rather than a blanket call for people to remain at home.

New measures include more people going back to work, unlimited exercise, and an endorsement of the use of face coverings in some public settings. Guidance was also published on how to make a face covering from an old t-shirt.

There was also a commitment to boost the supply of PPE from overseas and domestic sources.

At the daily Downing Street briefing Government Chief Medical Adviser Professor Chris Whitty explained the thinking behind the limit on meeting one other person outdoors at a 2m distance: "The scientists on the SAGE group looked at this and are confident that the risks of transmission outdoors are much lower than the risks of transmission indoors, but they are not zero. So we therefore want to take these modest steps one stage at a time."

He and Government Chief Scientific Adviser Sir Patrick Vallance were asked if they approved the change from a 'stay at home' to the 'stay alert' message. "Yes," Sir Patrick said, "and science has had input to the whole plan."

Prof Whitty added: "Neither Sir Patrick or I would consider ourselves to be comms experts, so we're not going to get involved in actual details of actual comms strategies, but we are involved in the overall strategy … and we have been at every stage."

COVID-10 Deaths and Occupations

The Office for National Statistics (ONS) says doctors, nurses, and other healthcare workers were not found to have higher rates of death involving COVID-19 when compared with people of the same age and gender in the general population.

However, those working in social care had significantly raised rates of death involving COVID-19, with rates of 23.4 deaths per 100,000 males and 9.6 deaths per 100,000 females. 

The data for England and Wales covers deaths registered up to and including 20th April.

ONS said its analysis does not prove conclusively that death rates are caused by differences in occupational exposure. It did not adjust data for ethnicity, pre-existing conditions, or place of residence.

ONS said there is a clear correlation between exposure to disease and physical proximity to other people across all occupations. 

In a blog post, Ben Humberstone, ONS deputy director of health analysis and life events, said: "Despite being exposed to disease on a daily basis, and requiring close contact with others, health care workers, such as doctors and nurses, did not have higher rates of COVID-19 deaths compared with the rate among those of the same age and sex in the population as a whole.

"This could be because during the pandemic they are more likely to be using personal protective equipment (PPE), or have a greater knowledge of how diseases spread and are thus more likely to follow hygiene measures such as handwashing. Also, there may be deaths in some occupations which have not been registered yet because a coroner’s inquest is required."

Commenting via the Science Media Centre Professor Neil Pearce, professor of epidemiology and biostatistics, London School of Hygiene & Tropical Medicine, said: "This important report confirms that in the working-age population COVID-19 is largely an occupational disease. This is not just for health care and social care workers, but for many other occupations that involve contact with people. The highest COVID-19 death rates are for security guards, with high rates also for taxi drivers and chauffeurs, bus and coach drivers, chefs, sales and retail assistants, construction workers, and service occupations (including hospital porters, kitchen and catering assistants, and waiters)."

He added: "The findings are striking, and emphasise that we need to look beyond health and social care, and that there is a broad range of occupations which may be at risk from COVID-19. These are many of the same occupations that are now being urged to return to work, in some instances without proper safety measures and PPE being in place."

Daily Deaths and Data

Another 210 UK COVID-19 deaths were announced on Monday taking the total to 32,065. Weekend numbers tend to be lower.

Of the 209 deaths in English hospitals, patients were aged between 40 and 99. Of these, 12 aged between 55 and 97 had no known underlying health condition.  

Daily COVID-19 tests were back above the current daily target at 100,490.

Another 3877 positive cases were reported.

The head of the UK Statistics Authority has written to England's Health Secretary Matt Hancock asking for greater transparency on testing targets and reporting. Data includes home test kits that have been sent in the post but not analysed.

Sir David Norgrove wrote: "I know you are a strong supporter of the proper use of statistics and data and that you will understand that for the sake of clarity and confidence it is important that the target and its context should be set out."

He added: "We urge Government to update the COVID-19 national testing strategy to show more clearly how targets are being defined, measured and reported." 

There are now 11,401 people in hospital with coronavirus down from 11,768 the previous day. 

Sir Patrick Vallance told Monday's briefing the halving time in the number of those infected may be around 2 weeks currently. Also, serology evidence from "a couple of weeks ago" suggested around 10% of people in London were positive for antibodies and "somewhere around 4%" in rest of the UK.

NHS Deaths

Among the recently announced NHS deaths was Onyenachi Obasi, a health visitor and nurse from Barking and Dagenham in Essex.

Her niece Ijeoma Uzoukwu told the PA news agency: "She was a good example of unconditional love and just loved everyone."
  
In Memoriam: Healthcare Workers Who Have Died of COVID-19.

More News in Brief
  • The University of Oxford led UKOSS study of outcomes of 427 pregnant women and their babies in the UK during the pandemic was published on Monday as a preprint. It found 4.9 pregnant women per 1000 were admitted to hospital with COVID-19 and around 1 in 10 of these received intensive care. However, 55% of hospital admissions were women from BAME backgrounds. Five babies died. Three deaths were unrelated to COVID-19 but it was unclear whether it contributed to two stillbirths. Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists (RCOG), said in a statement: "We already know women from certain ethnic groups may be more likely to have pre-existing health conditions and complications, and socioeconomic inequalities impact on the accessibility of health services, and lead to poorer outcomes. We need to better understand these complex factors and how to make services fully accessible and inclusive so that no woman is left behind."

  • A European study, including the UK, has found that men’s blood has higher levels than women’s of angiotensin-converting enzyme 2 (ACE2) which COVID-19 uses to infect cells. The first author of the study published in the European Heart Journal, Dr Iziah Sama from UMC Groningen, said in a news release: "When we found that one of the strongest biomarkers, ACE2, was much higher in men than in women, I realised that this had the potential to explain why men were more likely to die from COVID-19 than women." However, commenting via the Science Media Centre, Professor Paolo Madeddu, professor of experimental cardiovascular medicine, University of Bristol, said: "This is an interesting article, but I do not agree with the authors’ conclusions and I don’t understand how they have made any conclusions about COVID-19 – this study did not look at COVID-19 patients."

  • The chair of NHS Improvement Baroness Dido Harding has been put in charge of England's test, track, and trace programme, including the NHSX app. She'd previously worked for Tesco's and Sainsbury's, and was CEO of TalkTalk when it suffered a cyber attack. In a statement, she said: "I welcome the opportunity to take on this role and help the brilliant efforts being made by the NHS and healthcare system to drive down infection rates and contain this virus. As we move to the next phase of the Government’s plan, I am confident that we can use the very best of our tech, research, and people power to help keep COVID-19 at bay."

  • Nurses working in London can apply for a £250 'thank you reward' from the Stelios Philanthropic Foundation through the RCN Foundation. The former easyJet boss Sir Stelios Haji-Ioannou said in a news release: "These awards are a demonstration of our heartfelt appreciation of and gratitude for the work of frontline nursing and midwifery staff in London during this pandemic. For many, it has meant long, stressful hours with little rest or relaxation and lengthy separation from friends, families and loved ones. I trust the money will be put to good use by way of reward when happier times return."

  • People who don't follow social distancing rules in a park in Singapore are being challenged by a robot dog, the BBC reported. The Boston Dynamics creation has a camera on board, and a loudspeaker to bark out social-distancing messages.

Adapted from Medscape UK.