UK COVID-19 Daily: test, track, and trace

  • Tim Locke, Medscape.com

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

Test, Track, and Trace

"Test, track, and trace" was Thursday's key message from the Downing Street briefing.

There were 23,560 COVID-19 tests in the UK in the last 24 hour reporting period. Of those, 2985 were key workers and their households, with 752 testing positive.

Health and Social Care Secretary for England, Matt Hancock, told the Downing Street briefing capacity was now at 51,000 tests a day. The target is to carry out 100,000 tests a day by the end of the month.

Mr Hancock said: "From today, employers of essential workers will be able to go on gov.uk to get a test for any of their staff who need a test, and from tomorrow, any essential workers who need a test will be able to book an appointment on gov.uk themselves directly.

"This all applies for people in essential workers' households too who need a test. It's all part of getting Britain back on her feet."

He said: "We're preparing for this now by hiring an initial 18,000 people, including over 3000 clinicians, including public health specialists. We'll be training up the massed ranks of our contact tracers over the coming weeks, and roll out the service. 

"This test, track, and trace will be vital to stop a second peak of the virus."

Prof John Newton, director of health improvement, Public Health England, who is in charge of testing, said: "We are currently on track to reach 100,000 tests per day as planned. In fact, we're somewhat ahead of where we thought we'd be at the stage." 

Earlier, the BMA called for testing sites to be set up in all major towns to help get healthcare staff back to work.

While mobile testing and home kits are in their early stages regional test sites are the main focus for staff testing.

Professor Dame Parveen Kumar, the BMA board of science chair said in a statement: "When a healthcare worker feels unwell or is having to self-isolate because they’re living with others who are sick or have symptoms, expecting them to make a long, round trip to get tested is a very big ask. They may not even have a car but if they do, leaving behind unwell family members for several hours to get a test, is stressful. The Government says there has been a lack of demand for staff testing, but this is completely opposite to what doctors across the country are telling us on a daily basis."
Population Testing

Twenty thousand English households are being recruited into the first part of general population COVID-19 tracking. The project involves the Department for Health and Social Care, Office for National Statistics, University of Oxford, human data science company IQVIA, and the National Biosample Centre.

Professor Sarah Walker of University of Oxford Nuffield Department of Medicine said in a statement: "This is one of the largest and most important studies underway into the COVID-19 virus and will transform our understanding of the infection."
Commenting via the Science Media Centre Professor Gary McLean, professor in molecular immunology, London Metropolitan University, said: "This study will assess 'have you got it' by measuring levels of virus by PCR test, and 'have you had it' by antibody levels – we do not know if this will detect current infection with IgM levels, past infection with IgG levels or both."

Lockdown for Rest of Year, Maybe Beyond

Scotland's First Minister Nicola Sturgeon issued the "first cut" of the country's roadmap out of lockdown "to start a grown-up conversation" about the issues. That's a different approach to the Westminster Government which has set out tests that need to be met but not a draft plan.

However, Ms Sturgeon said the lockdown wouldn't be fully lifted "possibly for the rest of this year, and maybe even beyond". The document is called 'COVID-19: A Framework for Decision-Making'.

On Wednesday, UK Government Chief Medical Adviser Prof Chris Whitty said COVID-19 vaccines and drugs would need to be in place before measures could be lifted "and the probability of having those anytime in the next calendar year are incredibly small".    

Nicola Sturgeon said: "We will use public health interventions and technology to the maximum possible to help us control this virus. In the next phase extensive testing, tracing of the contacts of those who test positive, and isolation of symptomatic people to break the chain of transmission, will be a central part of the approach that we take, and the preparations to make that possible are already underway."

The document talks about some businesses being able to open earlier, and changes that may be needed in schools: "Classrooms may have to be redesigned to allow social distancing so maybe not all children can go back to or be at school at the same time," Ms Sturgeon said.

"There is no fast track to the new normal," Dr Hans Kluge, World Health Organisation regional director for Europe warned on Thursday. His message to governments considering loosening lockdown measures was: "Complacency could be our worst enemy at this time. We cannot permit ourselves to believe we are secure and safe. Any steps to ease social and physical distancing measures must be carefully considered and gradually undertaken." 

Anaesthetists' PPE Concerns

The Royal College of Anaesthetists is the latest group to highlight members' PPE concerns. Results from 2174 member responses to a 24 hour online survey starting 15th April found:

  • 73% were concerned for their health over a lack of adequate PPE

  • Over a quarter felt pressured to some degree to treat COVID-19 patients without adequate protection

  • 38% were unable to access COVID-19 testing for themselves

  • 43.9% have experienced mental distress over the past month

Its President Professor Ravi Mahajan said in a statement: "These survey findings make for concerning reading. They highlight the immense pressures our members are dealing with as they continue to provide outstanding care to the many seriously unwell COVID-19 patients." 

Data and Deaths

Another 616 UK hospital COVID-19 deaths were reported on Thursday bringing the total to 18,738.

Of the 514 deaths reported in English hospitals, patients were aged between 31 and 100. Of these, 16 aged between 37 and 92 had no known underlying health condition.  

Government Chief Scientific Adviser Sir Patrick Vallance said: "Deaths remain at a plateau, coming down slightly, not coming down fast. I would expect that to continue for another couple of weeks, and we will then see a faster decline thereafter." 

On the number of people in hospital with COVID-19, he said: "You can see a very clear decline in London. You can see that in other areas there are declines such as in the Midlands, and you can see nearly all areas, this is flat, or on the way down."

He added: "We're still at that period coming through the peak, but you can see it's headed very much in the right direction."
 
ICU occupancy, he said, "reached a plateau and is gradually decreasing".

NHS Staff Deaths

All deaths of health and social care workers during the COVID-19 pandemic should be referred to the coroner for independent review, according to BMJ Editor-in-Chief Dr Fiona Godlee. She writes in the journal that the UK government response to this crisis "has been characterised from the beginning by complacency, arrogance and delay, worsened in subsequent weeks by broken promises about the supply of PPE, apparent ignorance of the situation on the front line, and poorly explained and shifting guidance.

"So that we can learn for the future, honour the sacrifice, and seek compensation for families, all deaths of health and social care workers should be referred to the coroner for independent review."

Matt Hancock was asked if there'd be support for the families of NHS workers who've died similar to that given for members of the armed forces. "Of course this is something that I'm looking into, and I hope to be able to say something more about it very soon." 

Among recently reported NHS worker deaths were:

Julie Penfold, 53, died of COVID-19 at the hospital she worked at, Arrowe Park, on the Wirral. She’d been on a career break due to health reasons. Her husband Nick was quoted saying: "She loved her job. When she was at school, all she ever talked about was being a nurse."

Grant Maganga, 56, was a mental health nurse at Hurst Place in Ashton-under-Lyne, Manchester. Trust Director Clare Parker said: "Grant was an exceptional nurse who cared deeply for his patients and lit up the room with his infectious smile and positive personality."

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

More NICE Rapid Guidance

The National Institute for Health and Care Excellence (NICE) has issued two more rapid COVID-19 guidelines. 

  • Gastrointestinal and liver conditions [NG172]: Gives clinicians advice on adjusting care to reduce patients' exposure to COVID-19 and risks and benefits of immune response drugs.

  • Acute myocardial injury [NG171]: This guidance takes account of acute myocardial injury being seen in 9.5% of all hospitalised patient deaths in Italy and gives advice to non-cardiologists on recognising undiagnosed heart conditions.

PM's Nurses Give First Interviews

The two nurses praised by Prime Minister Boris Johnson for his care in ICU at London's St Thomas' Hospital have given their first interviews. 

Luis Pitarma from Portugal said: "The responsibility I was going to hold in my hands was quite overwhelming.

"I didn't really know how to address him - should I call him Boris, Mr Johnson, or Prime Minister? My matron reassured me and said to be myself like I am with any other patient."

The PM told him to call him Boris.

Jenny McGee told TV New Zealand the PM didn't get special treatment: "Absolutely not. We take it very seriously who comes into intensive care, these patients who come into us, it’s a very scary thing for them so we don’t take it lightly and he absolutely needed to be there." 
More News in Brief
  • The European Medicines Agency (EMA) issued a reminder about the risk of serious side effects of chloroquine and hydroxychloroquine. The drugs are being used in clinical trials as potential COVID-19 treatments. The EMA said: "Recent studies have reported serious, in some cases fatal, heart rhythm problems with chloroquine or hydroxychloroquine, particularly when taken at high doses or in combination with the antibiotic azithromycin."

  • CR Clarke & Co has received MHRA approval for it’s Rapidly Manufactured CPAP unit and will be working with partners to produce 80 devices for further testing. Welsh Economy Minister Ken Skates said the company "worked quickly and brilliantly to devise a product which could potentially save thousands of lives as we face the challenge of coronavirus". 

  • University Hospital Southampton has become the first in the country to widely introduce newly designed PeRSo respirator hoods. They were designed and built in partnership with the University of Southampton and engineering companies. A fabric hood goes over the head with a HEPA air filter, and a plastic visor covers the face. Hospital CMO Dr Derek Sandeman said: "While the currently-available standard PPE equipment provides high levels of protection for all staff when used appropriately and in line with infection control guidance, any development which could improve that protection is very welcome."

Adapted from Medscape UK.