UK COVID-19 Daily: 'we are past the peak'

  • Tim Locke, Medscape.com

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

'We Are Past the Peak' 

Prime Minister Boris Johnson was back heading the Downing Street briefing for the first time in weeks. During his absence from Number 10, he’d been in ICU with COVID-19, and after recovering at Chequers, he and his partner had a baby.

On 22nd April England's Health Secretary Matt Hancock said: "We are at the peak."  

On Thursday, the PM said: "I can confirm today that for the first time we are past the peak of this disease. We're past the peak and we are on the downward slope, and we have so many reasons to be hopeful for the long-term."

However, he said: "I'm not going to minimise the logistical problems we have faced in getting the right protective gear to the right people at the right time, both in the NHS, and in care homes, or the frustrations that we've experienced in expanding the numbers of tests. 

"But what I can tell you is that everyone responsible for tackling these problems, whether in government, or the NHS, or Public Health England, local authorities, we are throwing everything at it, heart and soul, night and day, to get it right. And we will get it right."

He pointed to the UK "leading international efforts" to find a vaccine. "Today, Oxford University has announced a partnership with AstraZeneca to develop what they believe could soon be a means of inoculating ourselves against this disease. 

"But until this day comes," he said, "we're going to have to beat this disease by our growing resolve and ingenuity." 

He promised to set out a comprehensive plan next week "to get our economy moving" and children back to school.

Earlier this week Scotland advised public wearing of face coverings, which Matt Hancock dismissed as being based on "weak science".

On Thursday, Boris Johnson said: "I do think that face coverings will be useful, both for epidemiological reasons, but also for giving people confidence that they can go back to work."
 
On Wednesday, on the basis of as yet unpublished data, remdesivir "will be the standard of care" for patients with COVID-19, said Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, during a news conference at the White House.

On Thursday, Government Chief Scientific Adviser Sir Patrick Vallance was asked if he agreed with that positive assessment: "This is a really promising first step," he said.

"It's definitely not a magic bullet to cure this, but it does show that drugs are going to be possible to have an effect on this virus."

Testing Target Day

Thursday marked the end of the month and the date by which England's Health Secretary Matt Hancock set a target to achieve 100,000 COVID-19 tests a day. 

Thursday's data will be reported on Friday. There were 81,611 tests carried out yesterday. 

A report published on Thursday by NHS Providers said the testing target was a "red herring". Chief Executive Chris Hopson said in a news release: "Setting a target for a number of tests for 30th April may have had a galvanising effect. But what matters most is an updated strategy to take us through the exit from lockdown."

UK National Testing Strategy Coordinator Professor John Newton wrote a blog post about meeting what some people said was an impossible goal. He wrote: "The 100,000 a day target was set for two purposes.  It was intended to motivate the programme and set the scale of our ambition. It has certainly done that.  More importantly, we knew from our calculations that we would need something like this level of testing to be ready for the next phase."

A new home testing project was announced on Thursday. The REal-time Assessment of Community Transmission (REACT-1) programme will see 100,000 randomly selected people in England being invited to provide nose and throat swabs for antigens testing.

In a news release, Professor Paul Elliott from Imperial College Healthcare NHS Trust said: "Community testing is a vital next step in ongoing efforts to mitigate the pandemic, but to be successful this must be based on robust scientific evidence. Through this important programme, we will gather the critical knowledge base necessary to underpin community testing programmes and facilitate a greater understanding of the prevalence of COVID-19 in the UK."

Deaths and Case Data

Wednesday's deaths total saw a big jump with the addition of care home and community deaths to the hospital data. On Thursday, the combined hospital, care home, and community total rose by 674 to 26,771.

Of the 391 deaths in England, patients were aged between 15 and 101. Of these, 15 aged between 49 and 97 had no known underlying health condition.

Prof Carl Heneghan and Dr Jason Oke, Centre for Evidence-Based Medicine and Nuffield Department of Primary Care Health Sciences, University of Oxford, commented on the English data: "These deaths are distributed back to the 12th of March. This data continues to trend down and consistent with previous analyses, the peak day of deaths was the 8th of April."

Sir Patrick Vallance gave an update on the latest data.

"R is below 1, we think it's between 0.6 and 0.9 across the nation," he said.

On new cases: "We know that the total number of cases is on its way down."

On hospital bed occupancy: "You can see very clearly the decrease in the number of people in hospital in London, you can see a slightly flatter situation in some other places." 

On critical care bed use: "The number of patients in critical care and those on ventilators is coming down right the way across. It's coming down slowly as you would expect, but it's on its way down." 

NHS Deaths

Among recently announced NHS workers deaths were:

Mohan Adiseshiah, 78, former head of the department of vascular surgery at University College London Hospital.

Vice-president of the Vascular Society Michael Jenkins described Mr Adiseshiah as a ground-breaking doctor and a "lovely, humble man," The Standard reported.

He continued: "I worked with Mo as a trainee at the Middlesex Hospital in the 90s and he really was a pioneer in endovascular surgery at a time when only a handful of people were doing it in the UK."

Ken Lambatan was a cardiac research nurse from St George’s Hospital, London and the Clinical Research Facility.

In a statement,  St George’s Chief Executive Jacqueline Totterdelll and Professor Jenny Higham, principal, St George’s, University of London, said everyone was "deeply saddened" by his death. "Ken was very popular with staff, and described as a ‘true gem’ by those that knew him well. He was dedicated to his role as a research nurse here at St George’s, and was as popular with his patients as he was with colleagues."

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

BAME Risk Assessments

Precautionary COVID-19 risk assessments are to be carried out for black, Asian and other minority ethnic background (BAME) doctors. Data suggest BAME groups are worse affected by the virus than other ethnicities. 

A letter from NHS England said: "On a precautionary basis, we recommend employers should risk-assess staff at potentially greater risk and make appropriate arrangements accordingly." 

Somerset NHS Foundation Trust has also written to BAME staff saying: "We have updated our risk assessment which supports managers with these conversations to ensure they understand the concerns and needs of our BAME colleagues and their families." It continues: "While we don’t yet have any conclusive research or national guidance, we feel that this is the right approach to take. We also hope that you feel comfortable sharing any concerns you have about any underlying conditions so that these can be taken into consideration when planning your work."

The BMA said there's an urgent need for a comprehensive risk profiling tool to be consistently used across the NHS.

Professor Tim Cook, honorary professor in anaesthesia, University of Bristol, commented via the Science Media Centre: "The disproportionately high number of BAME health and social care workers dying from COVID-19 is striking, so I welcome news that NHS England has recommended these individuals to be identified as potentially at greater risk.  Our analysis showed 63% of healthcare workers who have died from coronavirus were BAME individuals. More than half of those individuals were not born in the UK and more than four-fifths were staff employed by the NHS."
 
More News in Brief
  • The Guardian reported that coroners have been told not to investigate systemic PPE provision failures when reporting on the causes of NHS worker deaths. It quotes Chief Coroner for England and Wales Mark Lucraft QC's guidance that "an inquest would not be a satisfactory means of deciding whether adequate general policies and arrangements were in place for provision of PPE to healthcare workers". Doctors' Association UK has written to the Chief Coroner asking for guidance to be reviewed. Chair Dr Rinesh Parmar said in a statement: "It is wholly unacceptable that the families of those who have laid down their lives for the good of our country should be left with no formal investigation into their deaths and the potential failings that led to those deaths."

  • Calling NHS frontline staff  'heroes' and 'angels' could cause problems, one researcher suggests. Dr Esther Murray, senior lecturer in health psychology at the Queen Mary University of London, said: "The hero and angel tropes which we see bandied about are also highly problematic because they make it look as if people signed up to die, like a hero does, but they didn’t. It also makes it harder for NHS staff to talk about how they really feel because opinions get polarised - are you a hero or a coward? A lot of staff feel like cowards but they are not at all, they’re just quite justifiably frightened and angry." She was speaking on the publication of a review paper on the psychological wellbeing of medical staff in the European Heart Journal. 

  • NHS charity fundraiser Captain Tom Moore - now honorary Colonel Tom turned 100 on Thursday. He was treated to a Spitfire flypast, a letter from the Queen, and 125,000 birthday cards. His sponsored garden walk has now raised more than £30m.

Adapted from Medscape UK.