UK COVID-19 Update: circuit break', 'highly accurate' rapid test

  • Tim Locke, Medscape.com

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

'Circuit Break'

Reports of Government plans for new England-wide lockdown measures described them as a 'circuit break' lasting a few weeks to 'short-circuit' rising COVID-19 cases.

Schools and businesses would stay open but measures could include restrictions on social gatherings, pubs, and restaurants.

Experts have been commenting via the Science Media Centre.

Mark Woolhouse, professor of infectious disease epidemiology, University of Edinburgh, said: "The idea of a 'circuit breaker' is very simple. The aim is to use additional social distancing measures to reduce the R number well below 1 for a short period; 2 weeks has been suggested. That would drive down the incidence of new infections, perhaps by as much as half if R fell to a similar value as during lockdown, though that may be optimistic. Lower incidence means a lower risk of infection and, for the minority most vulnerable to COVID-19, lower risk of severe illness, although the latter benefit might not be seen until after the circuit breaker was over."

Jonathan Ball, professor of molecular virology, University of Nottingham, said: "It does seem ironic that after encouraging mass attendance at pubs, cafes, and restaurants through ‘eat out to help out’ that we are now contemplating restricting or closing those activities down."

Health Secretary Matt Hancock told Sky News: "The last line of defence is full national action and I don't want to see that but we will do whatever is necessary to keep people safe in a very difficult pandemic."

Another 4322 UK positive cases were reported on Friday. There are 1020 COVID-19 patients in hospital and 127 ventilator beds in use. Twenty-seven deaths were also reported.

New Restrictions

The latest local lockdown restrictions in England will affect parts of the North West, the Midlands, and West Yorkshire.

London's New Year's Eve fireworks display has been cancelled due to COVID-19, Mayor  Sadiq Khan told LBC Radio.

Testing and Vaccination

On Thursday, Baroness Dido Harding, head of England's Test and Trace service told MPs on the Science and Technology Committee: "I don't think anybody was expecting to see the really sizable increase in demand that has happened over the last few weeks."

She confirmed demand for tests is "significantly outstripping the capacity".

Concern over a lack of tests, however, was dismissed as "carping" by Leader of the Commons Jacob Rees-Mogg.

The i reported that emergency powers are planned to allow use of COVID-19 vaccines before the end of the Brexit transition period this year even if they haven't been approved by the European Medicines Agency (EMA).

A public consultation on the proposal says: " ‘Unlicensed’ does not mean ‘untested’: this temporary authorisation process exists to address the possibility that, in certain situations of public health need, the licensing authority may consider that the balance of risk and benefit to patients justifies the temporary supply of the relevant vaccine pending the issue of a product licence."

On Friday, the EMA endorsed the use of dexamethasone for COVID-19 patients on oxygen or mechanical ventilation following the positive results in Oxford's RECOVERY trial.

ONS Data

The latest Office for National Statistics (ONS) Infection Survey data show "a marked increase" in infections.

An estimated 59,800 people in England had COVID-19 during the most recent week, or 1 in 900 people.

There were estimated to be 1.10 new infections for every 10,000 people, equating to around 6000 new cases per day.

Katherine Kent from ONS commented: "Our evidence shows that there was another marked increase in the number of COVID-19 infections in England last week with increases in most regions but particularly in London and the North West.  These infections seem to be mostly focused in younger people who have seen the largest rise in infections."

Separate ONS data show that people with disabilities and health problems accounted for 59.5% of all COVID-19 deaths in England and Wales between March and July.

Disabled people accounted for 16% of the 2011 census population.

Public Health England Surveillance

Public Health England's latest surveillance data show in week 37 the hospitalisation rate was at 1.42 per 100,000 compared to 0.77 per 100,000 in the previous week.

The ICU/HDU rate was at 0.14 per 100,000 in week 37 compared to 0.07 per 100,000 in the previous week.

PHE Medical Director Yvonne Doyle said in a statement: "We’re seeing clear signs this virus is now spreading widely across all age groups and I am particularly worried by the increase in rates of admission to hospital and intensive care among older people. This could be a warning of far worse things to come."

R Number

The UK's R number is now 1.1-1.4 up from 1.0-1.2 last week.

The growth rate is +2% to +7% per day.

R for England is 1.2-1.4 and the growth rate is +3 to +7.

R in Scotland is 1.1-1.4. The growth rate for Scotland is estimated as being between +1% and +8%.

R in Northern Ireland is around 1.2.

R in Wales is 0.7-1.0.

90 Minute Test 'Highly Accurate'

A 90-minute COVID-19 test has over 94% sensitivity, and 100% specificity, according to research by Imperial College London in The Lancet Microbe.

A paediatric-sized nose swab is inserted into the DnaNudge Lab-in-Cartridge device. It is already in use at eight London hospitals, and the Government has ordered 5.8 million kits for UK-wide use.

Lead author Professor Graham Cooke said in a news release: "These results suggest the test, which can be performed at a patient’s bedside without the need to handle any sample material, has comparable accuracy to standard laboratory testing. Many tests involve a trade-off between speed and accuracy, but this test manages to achieve both. Developing an effective bedside test in under 3 months has been an incredible collaboration between teams of engineers, clinicians and virologists."

Professor Paul Hunter, UEA, commented via the Science Media Centre that "there are a few issues that need to be considered before the tests could be rolled out for near patient testing. It is not entirely clear who processed the CovidNudge tests that were undertaken and what training they received.  Also, there is the need for a testing machine but it is not clear how many tests could be processed at any one time.  If as it appears on the image only a single specimen could be analysed as a single time then multiple units may need to be purchased for any busy clinic."

Care Homes

ITV News reported on a leaked email from Middlesbrough Council to care homes asking if they'd be prepared to accept COVID-positive patients when they are discharged from hospital.

That news broke before new Government plans were announced to help care homes in England over the winter, including the provision of free PPE.

All but essential movement of staff between care homes would be stopped to help spreading infection.

A new role of Chief Nurse for Adult Social Care is being created.

BMA Council Chair Dr Chaand Nagpaul commented: "We have seen first-hand the devastation of the pandemic on our care homes as the shameful neglect and under-resourcing of adult social care was laid bare.

"It is absolutely right that the Government increases funding to protect the older, more vulnerable population who will undoubtedly be worried about their future and their health this winter. Now, more than ever, we need to see clarity over the Government’s long-term ambitions for funding social care."

Breast Reconstruction Delays

The latest example of the pandemic affecting cancer care is more than 1500 breast cancer patients waiting "many months, possibly years" for breast reconstruction after services were suspended in March, according to Breast Cancer Now.

Chief Executive Baroness Delyth Morgan commented: "Reconstructive surgery is an essential part of recovery after breast cancer for those who choose it. Women with breast cancer have told us these delays are causing them huge anxiety, low self-esteem and damaged body confidence, and all at a time when the COVID-19 pandemic has denied them access to face-to-face support from healthcare professionals and charities."

Adapted from Medscape UK.