UK COVID-19 Daily: lockdown 'making a difference'

  • Tim Locke, Medscape.com

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

PPE

Yesterday, Communities Secretary Robert Jenrick told the Downing Street briefing about the millions of PPE deliveries being made in England.

Today, Doctors Association UK (DAUK) said: "Although we have been given assurances that NHS supply chains have been overhauled and that the armed forces have been delivering more PPE, this is still not reaching the front lines. In some places this has already run out."

DAUK President Dr Samantha Batt-Rawden, said: "Despite assurances on PPE from the Government, doctors on the front line are telling us everyday that the problem is far from fixed. At a time when the country is relying on frontline NHS staff this is unforgivable. With the tragic loss of another NHS doctor and colleague it is now more important than ever that we protect the front line."

Prof Yvonne Doyle, Public Health England (PHE) medical director told the Downing Street briefing today: "Getting supplies to the front line is absolutely critical to ensure that people feel safe. It comes alongside a refresh of the guidance to ensure the people are clear what equipment should be used in both circumstances and that is very active at the moment." 

PHE told Medscape UK the PPE guidance is currently under review and will be published "early this week".

Testing

Around 25% of doctors are off work, sick or in self-isolation,  Prof Andrew Goddard of the Royal College of Physicians said earlier.

Promises of the scale of testing, of staff and patients, against what's being delivered had been questioned during the day.

Prof Doyle said: "There are a number of strands, and we've heard one mentioned already here which is the 25,000 tests per day that Public Health England and the NHS are well on the way to meeting by mid to late April. 

"Now there are a number of others,” she said, including antibody testing. "This, at the moment, is under investigation. It is a test that is novel, it would be a point-of-care testing. So it would be done, for instance, in the home, and it could be done at scale."

However, she said: "This testing needs to be evaluated to make sure it's valid."

Deaths

Government Chief Scientific Adviser, Sir Patrick Vallance, told the briefing there were signs the lockdown was starting to have an effect. "The measures are in place, they are making a difference. They are decreasing the contact, which is so important to spread the disease. And we're doing a good job at cutting that down."

Today hospital deaths of COVID-19 patients rose by 180 to 1408. Future statistics will also include out-of-hospital deaths.

Overall, Sir Patrick said: "We expect this to get worse over the next couple of weeks, because there's a lag phase between getting the disease and people turning up in hospitals. So you would expect to see a continuation of this at least over 2 or 3 weeks, then a stabilisation, and a gradual decrease thereafter. 

Earlier, NHS England Chief Executive, Sir Simon Stevens, said 9000 COVID-19 patients are currently being treated in hospitals in England, up from 6000 on Friday.

Sir Patrick commented: "That's not an acceleration. It's quite important, and it tells you that actually this is a bit more stable than it has been."

He added: "The number of hospital admissions,” he said, "has gone up roughly the same amount each day, suggesting that we're not on a fast acceleration at the moment." 

Sir Patrick was the latest official to be asked how long measures might last: "Once we know that we've got this curve below the ICU capacity and stable, then of course, it's time to start asking the question which is being asked across the world at the moment: 'How do we release those measures and manage this going forward?' So I think it's premature to put a time, an absolute time, on how long this goes on for. We need to do phase 1 and then we need to think about how we release these in the right way, and the right approach in order to be able to allow the curve to stay below the ICU capacity."

However, he said that doesn’t mean capacity won't be breached: "You can't promise, and I certainly wouldn't promise that every single ICU is never going to breach its number because that happens every winter. But, the aim is to try and keep that below, across the country, and that's what we're shooting for." 

NICE Updates Rapid Critical Care Guidance

The National Institute for Health and Care Excellence (NICE) has updated its rapid guidance on COVID-19 critical care clarifying the universal use of Clinical Frailty Scale (CFS).

NICE has acted on concerns raised by patient groups over people with learning disabilities, autism, and other stable long-term disabilities, that CFS use would put them at a disadvantage when admission decisions were under pressure.

NICE guideline [NG159] now says additional patient factors need to be considered when interpreting CFS scores. Critical care clinicians should also be aware of the limitations of using the CFS tool as the sole assessment of frailty. 

CFS scores should not be used in younger people, those with stable long-term disabilities, learning disabilities, autism, or cerebral palsy. 

NICE said individualised assessments are recommended where CFS is not appropriate.
 
Abortion 

The Government's U-turn on emergency abortion measures has changed again.

Home abortion pills will be available via telemedicine. Previously the measure was announced and then retracted. The official announcement is back on the Department of Health website.

Ann Furedi, CEO of the health charity BPAS, said: "We welcome the confirmation we have received today that the government will re-instate telemedicine for Early Medical Abortion in England. This will prevent tens of thousands of women from having to travel needlessly to clinics and will also enable many of our healthcare professionals to provide teleconsultations and prescriptions from the safety of their own homes." 
 
Loss of Taste and Smell

Sir Patrick was asked if reports of loss of taste and smell being associated with COVID-19 would be added to official symptom guidance: "Loss of taste and smell is something that can happen with other respiratory viruses as well. It does seem to be a feature of this from what people are reporting, and it is something that obviously people should take into account as they think about their symptoms. 

"I think it's really for the chief medical officer to decide at what point, if any, the diagnostic change takes place in terms of self-isolation. Those symptoms that we're learning about for this disease are the ones that you know, we're going to get more information over time, but new persistent cough, or fever, captures the vast majority of people with this illness." 

More News in Brief

  • The NHS is asking grounded cabin crew with first aid training to help staff the new NHS Nightingale field hospitals. They'd carry out support roles, such as changing beds, and other non-clinical tasks, under the supervision of nurses and senior clinicians on the wards. Chief Nursing Officer for England, Ruth May, said in a statement: "The NHS is mobilising like never before, but the scale of this challenge has not been seen in peacetime so we need all the support we can get."

  • The Prime Minister's chief adviser Dominic Cummings is self-isolating with coronavirus symptoms after his boss tested positive last week.

  • Prince Charles ended his 7-day self-isolation having previously tested positive for COVID-19.

  • The Formula 1 firm Mercedes-AMG High Performance Powertrains has worked with University College London (UCL), and University College London Hospitals NHS Foundation Trust (UCLH), to make a CPAP device for COVID-19 patients. The device already has MHRA accelerated approval.

  • Scottish First Minister Nicola Sturgeon said the decision had been taken to start work on turning the Scottish Exhibition Centre in Glasgow into a temporary NHS hospital. It could be ready in 2 weeks, initially with 300 beds, which could be expanded to provide capacity for more than 1000 patients. 

  • Some population-level screening programmes in Scotland have been temporarily suspended to free-up staff. Wales had already made a similar announcement. Dr Sharon Hillier, director of Screening Division, Public Health Wales said: "We are in unprecedented times and this has been a difficult recommendation for us to make. However, pausing some of the screening programmes in Wales will avoid the need for participants to come into contact with others at our screening venues and we recognise that we invite some participants who are in the identified vulnerable groups." 

  • Firefighters are taking on additional tasks, including collecting bodies, driving ambulances, and delivering food and medicines. Fire Brigades Union General Secretary, Matt Wrack, said in a statement: "We face a public health crisis unparalleled in our lifetimes. The coronavirus outbreak is now a humanitarian emergency and firefighters rightly want to help their communities."

  • Last week dentists were told to stop all routine treatment. Today the regulator CQC said there'd been reports of some ignoring this, and issued a warning: "If these reports are accurate, then dental staff and the public may be exposed to unnecessary risk of virus transmission. Where CQC are informed of such cases we will consider action using our regulatory powers."

  • The return to the NHS by thousands of doctors and nurses was highlighted today by the World Health Organisation (WHO)."We're pleased by the 20,000 health workers in the UK who have offered to return to work," Tedros Adhanom Ghebreyesus, WHO director-general, said in his daily news briefing. 

Adapted from Medscape UK.