UK COVID-19 Daily: 'normality by Xmas'?, PHE death data review

  • Tim Locke, Medscape.com

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

'Normality by Xmas'?

Boris Johnson announced a timetable for more loosening of England's lockdown measures at a Downing Street briefing this morning: "It is my strong and sincere hope that we will be able to review the outstanding restrictions and allow a more significant return to normality from November, at the earliest, possibly in time for Christmas."

But he did concede: "It's possible that the virus will be more virulent in the winter months."

As expected, the PM confirmed £3 billion of extra funding for the NHS in England "to get ready for winter", including keeping the Nightingale field hospitals open until March and using private hospital capacity

"We're making sure we're ready for winter and planning for the worst," he said.

However, the BMA said it was disappointed there was no mention of tackling the NHS non-COVID backlog.

Scotland, Wales, and Northern Ireland will also receive additional funds.

Testing capacity will be increased to at least half a million a day and there'll be "the biggest ever flu vaccination programme in the history of the UK".

From 18 July, local authorities in England get new powers to be able to close specific premises or outdoor spaces.

Next week he promised draft regulations for central government intervention in local areas.

"It has to be right that we take local action in response to local outbreaks," Mr Johnson said.

In announcing the removal of lockdown measures the PM said: "We will not proceed if doing so risks a second peak that would overwhelm the  NHS."

Measures included anyone being able to use public transport from 17 July.

From 1 Aug, "Instead of Government telling people to work from home, we're going to give employers more discretion and ask them to make decisions about how their staff can work safely."

Still Following the Science?

On Thursday, Chief Scientific Adviser Sir Patrick Vallance told MPs there was "absolutely no reason" for people to stop working from home.

Mr Johnson was asked if his top advisers weren't at the briefing because they disagreed with him.

"The Chief Scientific Adviser, the Chief Medical Officer, give us advice, which we of course take very, very seriously but in the end decisions are taken by the elected politicians. We have to weigh the advice that we get. And I don't think that our wonderful scientific and medical advisers would want to take those decisions for us," he said.

Also, from August, more leisure facilities can reopen but nightclubs and soft play areas remain closed. However, "We will restart indoor performances to a live audience, subject to the success of pilots."

And, "From October, we intend to bring back audiences in stadia, and to allow conferences and other business events to recommence."

For education: "In September, schools, nurseries and colleges will be open for all children and young people on a full-time basis as planned, and universities are also working to reopen as fully as possible."

There may be changes to 'bubble' arrangements. "Throughout this period we will look to allow more close contact between friends and family, where we can."

Mr Johnson admitted not everyone will agree with his decisions: "Some will say this plan is too optimistic, that the risks are too great." But he said if cases rise, "Let me reassure them, and reassure you, that we will not hesitate, at any stage, to put on the brakes."

'No-one Could Ever Recover From COVID-19 in England'

Oxford's Centre for Evidence-Based Medicine found a flaw in Public Health England's (PHE) coronavirus data methodology and has written about it in a blog post called: 'Why no-one can ever recover from COVID-19 in England – a statistical anomaly'.

Professors Yoon Loke and Carl Heneghan write: "PHE regularly looks for people on the NHS database who have ever tested positive, and simply checks to see if they are still alive or not. PHE does not appear to consider how long ago the COVID test result was, nor whether the person has been successfully treated in hospital and discharged to the community. Anyone who has tested COVID positive but subsequently died at a later date of any cause will be included on the PHE COVID death figures."

They conclude: "By this PHE definition, no one with COVID in England is allowed to ever recover from their illness. A patient who has tested positive, but successfully treated and discharged from hospital, will still be counted as a COVID death even if they had a heart attack or were run over by a bus 3 months later."

The rest of the UK nations only include deaths in their daily figures for deaths within 28 days of a positive test.

England's Health Secretary Matt Hancock has now called for an urgent review.

In a statement, Dr Susan Hopkins, Public Health England incident director, said: "Although it may seem straightforward, there is no WHO-agreed method of counting deaths from COVID-19. In England, we count all those that have died who had a positive COVID-19 test at any point, to ensure our data is as complete as possible. We must remember that this is a new and emerging infection and there is increasing evidence of long-term health problems for some of those affected.  Whilst this knowledge is growing, now is the right time to review how deaths are calculated."

PHE said that around 90% of deaths occurred within 28 days of a positive test, and if a 28-day rule was used there would have been 4149 deaths excluded from its published data.

Later, after Friday's daily death numbers had been released on the gov.uk dashboard, PHE announced it was suspending this publication. 

In a statement on the 'Coronavirus cases in the UK: daily updated statistics' page it said: "The Secretary of State has today, 17 July, asked PHE to urgently review their estimation of daily death statistics. Currently, the daily deaths measure counts all people who have tested positive for coronavirus and since died, with no cut-off between time of testing and date of death. There have been claims that the lack of cut-off may distort the current daily deaths number. We are therefore pausing the publication of the daily figure while this is resolved."

'Track' Coming Back to 'Test, Track, and Trace'?

At the Downing Street briefing Baroness Dido Harding, head of England's Test and Trace programme, confirmed there will be a contact tracing app after the NHSX one trialled on the Isle of Wight was scrapped: "There is lots more for NHS Test and Trace to do. We will keep growing so we can offer 500,000 tests a day by the end of October," she said.

"We will launch an app and backwards contact tracing to find the source of outbreaks. And we will recruit more people to work in local health protection teams."

She was also asked about progress on antibody testing, previously described by the PM as a "game changer".

She said there were no plans to extend this testing because of a lack of evidence on antibodies and immunity.

"At this stage it's too early to be able to say that it is or isn't a game changer. I think we all want it to be. Everyone wants to believe that we will find that sort of silver bullet in the science that means that we know that we're going to be safe, particularly for people who've suffered and been very ill. But at this stage we don't know that yet."

RCPCH: No Need for Children's 2 Week Pre-op Isolation

Pre-operative isolation for 2 weeks is no longer routinely recommended for children undergoing elective surgery in new recommendations from the Royal College of Paediatrics and Child Health (RCPCH).

It said: "PHE modelling data suggest that during periods of low community prevalence, isolation has very little impact on the risk of a child being infected at the time of admission to hospital."

Another of the recommendations out for consultation includes children being able to have treatment in either 'hot' or 'cold' COVID facilities.

Between March and May this year RCPCH said more than 50,000 children's operations were postponed.

Daily Deaths and Data

Another 114 UK COVID-19 deaths were announced on Friday before the publication of daily death estimates was 'paused', taking the total to 45,233.

Another 687 positive cases were reported on Friday taking the total UK confirmed cases to 293,239.

The R number for the UK remains at 0.7-0.9 and the growth rate is -5% to -1%.

The R rate range for English regions, apart from the North East and Yorkshire (0.7-0.9), is at 1 or above.

The growth rate range for London and the South West is up to +2 but notes with the data caution: "Low case numbers and/or a high degree of variability in transmission across the region means these estimates are insufficiently robust to inform policy decisions."

  • R in Scotland is 0.5-0.9

  • R in Wales is 'below 1'

  • R in Northern Ireland is R is 0.5-0.9

ONS Data

Office for National Statistics (ONS) data show the rate of deaths from all causes in June were "significantly lower than the 5-year average” in England and Wales.

The ONS Infection Survey Pilot estimated around 1 in 2300 people in the community in England had COVID-19 from 6 July to 12 July, equating to around 24,000 people.

In the same week, ONS estimates there were around two new COVID-19 infections for every 10,000 individuals in the community in England, or around 1700 new cases a day.

Separate ONS data show more people report wearing face coverings when they go out: 61% of adults in the past 7 days, compared with 52% the week before.

There were differences between the UK nations with 77% wearing face coverings when shopping in Scotland compared to 40% in England, and 30% in Wales.

Adapted from Medscape UK.