UK COVID-19 Daily: self-isolation period extended from 7 to 10 days

  • Peter Russell, Medscape.com

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

Changes to Self-isolation

The self-isolation period for people who test positive for COVID-19, or show symptoms, has been extended from 7 to 10 days across the UK.

The change was announced by the chief medical officers (CMOs) of all four nations as concerns grow about a possible 'second wave' of the coronavirus.

The joint statement said that there was growing evidence that "people with COVID-19 who are mildly ill and are recovering have a low but real possibility of infectiousness between 7 and 9 days after illness onset".

After considering the evidence, the CMOs said that "at this point in the epidemic, with widespread and rapid testing available and considering the relaxation of other measures, it is now the correct balance of risk to extend the self-isolation period".

The move came after Thursday's nowcast and forecast from the Cambridge MRC Biostatistics Unit which estimated that the R infection rate was close to 1 in most areas of England.

It said the R number could be as high as 1.38 in South West England with a median of 1.04, with the South East second highest at an upper range of 1.25 and median of 1.02.

The Unit estimated the number of infections each day in England at 3000 (95% confidence level 1600–5520).

It also predicted that the number of deaths each day was likely to be between 43 and 84 by mid-August.

Matt Hancock, the Secretary of State for Health and Social Care, told BBC Radio's Today programme that the Government was "absolutely determined to do everything we can to protect this country from a second wave. We can see a second wave rolling across Europe, we can see it in the figures in Spain, and some other countries, and we'll take the action that we that we need to take."

Mr Hancock confirmed that ministers were considering whether to revise the current 14 day self-isolate rule for travellers returning from Spain.

The change to strike Spain off the air corridor exemption list was taken last weekend following a spike in cases on the Spanish mainland.

Mr Hancock said the Government would not hesitate to impose further restrictions for returning travellers if the situation justified it. "In the middle of a global pandemic we just have to be realistic about the fact that these things change, because the pandemic changes in other countries," he said.

Commenting on Thursday's announcement, Prof Peter Openshaw, spokesperson for the British Society for Immunology, said: "With a sustained decline in total infection rates, keeping the coronavirus infection rate low is now a top priority. 

"Given some hints of resurgence, today's news that the period of isolation following symptom onset is to increase from 7 to 10 days is to be welcomed. 

Our knowledge of SARS-CoV-2 infection is increasing all the time. We now know that people with COVID-19 seem to be most infectious (i.e. most likely to spread the disease to other people) at about the time of symptom onset. However, recent studies have found that there are cases where infectious virus can still be recovered from respiratory secretions up to 9 days after symptom onset. This, in theory, means that such people may be capable of transmitting the virus."

England Recorded Highest Excess Mortality Rate in Europe

England saw the highest overall relative excess mortality in Europe, official figures showed.

The Office for National Statistics (ONS) said that after Spain, England experienced the highest peak rates of death between the end of February and the middle of June.

While England did not have the highest peak mortality, it did have the longest continuous period of excess mortality out of 21 European countries, resulting in England having the highest levels of excess mortality in Europe for the period as a whole.

Scotland had the second highest peak out of the four UK nations, the figures showed.

In the UK, Birmingham saw the highest peak excess mortality of any major British city at 249.7% in the week ending 17 April.

Edward Morgan, an analyst at ONS said: "While none of the four UK nations had a peak mortality level as high as Spain or the worst-hit local areas of Spain and Italy, excess mortality was geographically widespread throughout the UK during the pandemic, whereas it was more geographically localised in most of Western Europe.

"Combined with the relatively slow downward 'tail' of the pandemic in the UK, this meant that by the end of May, England had seen the highest overall relative excess mortality out of all the European countries compared."

Dr Veena Raleigh, senior fellow at The King's Fund, said: "Over the past decade, life expectancy improvements in the UK have lagged behind our European peers.

"With the worst coronavirus death toll in Europe, there is a very real risk that the UK will slide even further down the life expectancy league tables.

"The priority for the UK is to control the pandemic and learn lessons ahead of a potential second wave, but it is also essential to tackle the underlying reasons for stalling life expectancy in recent years – many of which contribute to poor COVID-19 outcomes."

NHS 'People Plan' Published

NHS England launched a 'People Plan' aimed at putting the wellbeing of health service staff at the centre of NHS recovery.

It includes proposals for a new recruitment, retention, and support package.

Among the plans are:

  • Making all roles across NHS England and NHS Improvement available for flexible working patterns from January 2021

  • Risk assessments for vulnerable staff, including black and ethnic minority colleagues

  • Encouraging former staff to return to practice as part of a recruitment drive during 2020 to 2021

  • Boosting the mental health and cancer workforce

  • Working with universities to increase over 5000 undergraduate places from September 2020 in nursing, midwifery, allied health professions, and dental therapy and hygienist courses

  • A new £10 million fund for clinical placements for nurses, midwives, and allied health professionals to support employers in educating and training the next generation of health professionals

Matt Hancock said this morning that he also wanted to "bottle the things in the NHS that went well" during the current pandemic, and "empower people to do more with less bureaucracy and rules, and more supporting their professional judgement".

Mr Hancock later expanded on his vision during a speech on Thursday at the London headquarters of the Royal College of Physicians (RCP).

Prof Andrew Goddard, RCP president, commented later: "He's right that it shouldn't take a pandemic to highlight the importance of things like decent rest facilities and food for staff but if his words are followed by action then this will, of course, be very welcome.

"The RCP has been at the forefront of arguing for using technology to transform the way in which services are provided, for the benefit of patients and the environment, but the government and the NHS must make sure that they bring everyone with them on this journey.

"In a recent survey, 50% of our members told us that they didn't have access to a webcam."

Suzie Bailey, director of leadership and organisational development at The King's Fund said a year after the plan was due, Thursday's announcement was "another interim stop-gap and falls a long way short of the workforce strategy the NHS so desperately needs".

She continued: "Even before the pandemic, the UK health and care workforce was in a state of crisis, with high levels of work-related stress, reports of overworked staff looking to leave their jobs, and a shortage of around 40,000 nurses.

"Although today's plan includes some welcome measures to support the health and wellbeing of staff and tackle discrimination, warm words will be worth little without a credible implementation plan."

Hugh Alderwick, assistant director of policy at the Health Foundation, said: "The NHS went into the pandemic with a workforce gap of around 100,000 staff, yet the plan does not say how this will be addressed in the medium term."

GPs Embrace Remote Consultations

The extent to which primary care in the UK had responded to remote consultations was revealed in a survey by the Royal College of GPs (RCGP).

Its survey of 829 GPs found that between 9 and 22 July on average:

  • 61% of GP appointments were conducted by telephone

  • A further 16% were spent on telephone triage

  • 11% were conducted face to face

  • 6% were conducted by SMS or email

  • 4% were online or via video

  • 3% were home and care home visits

Prof Martin Marshall, chair of the RCGP, said: "The increase in telephone triage and consultations we have seen during the COVID-19 pandemic has been out of necessity – and in line with official guidelines. That isn’t to say there aren't lessons to be learnt from the new ways we have been working in general practice. The pandemic has shown care can be delivered effectively and safely remotely, where appropriate.

"Telephone consultations are, of course, not new, but before the pandemic they accounted for around a quarter of consultations – during the pandemic, it’s been more like 70%, with face to face appointments reserved for those patients who really needed them."

Social Care Response 'Too Slow'

The Government acted too slowly and did not do enough to support social care users and staff during the COVID-19 pandemic, a report said.

Two briefing papers by the Health Foundation said that social care has been given far lower priority than the NHS.

The findings echo a report on Wednesday by the Public Accounts Committee which said that the Government's approach to social care during the pandemic had been "slow, inconsistent and, at times, negligent".

The Health Foundation found that policy action on social care had focused primarily on care homes to the detriment of other vulnerable groups of users and services, including those receiving domiciliary care.

Since March there had been more than 30,500 excess deaths among care home residents in England, and 4500 excess deaths among people receiving domiciliary care, the report noted.

Dr Jennifer Dixon, the Foundation's chief executive, called for "long-overdue reform which should include action to improve pay and conditions for staff, stabilise the care provider market, increase access to publicly funded services, and provide greater protection for people against social care costs".

Dementia Symptoms 'Worsened' After Lockdown

The COVID-19 lockdown has led to a "shocking" deterioration in symptoms for people with dementia, an investigation by the Alzheimer's Society found.

Isolation had led to 82% of people with dementia, or their carers, reporting a deterioration in symptoms.

The report was based on a survey of 1831 people carried out in June.

It found that, of those who noticed a deterioration:

  • 50.4% ticked 'memory loss'

  • 47.5% ticked 'difficulty concentrating'

  • 47.1% ticked 'agitation or restlessness'

  • 32.7% ticked 'struggling with speaking or understanding speech'

  • 27.6% ticked 'loss of daily skills'

  • 26.8% ticked 'difficulty reading or writing'

Social activity was key to helping slow the progression of symptoms of dementia, the Alzheimer's Society said.

Chief executive Kate Lee warned that "people with dementia are at huge risk from a second wave if we don't take urgent steps to protect them".

Daily Deaths and Data

Public Health England (PHE) is pausing publication of daily death data after England's Health Secretary Matt Hancock ordered an investigation into its methodology.

However, data are still published on another gov.uk page with 38 UK COVID-19 deaths announced on Thursday, taking the total to 45,999.

Another 846 positive cases were reported on Thursday taking the total UK confirmed cases to 302,301.

Adapted from Medscape UK.