UK COVID-19 Update: 'COVID loves a crowd', GPs rebooking second jabs

  • Tim Locke, Medscape.com

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

'COVID Loves a Crowd'

"COVID loves a crowd, so please leave the parties for later in the year," NHS England's  National Medical Director Professor Stephen Powis said at last night's Downing Street briefing.

And while another 50,023 new cases were reported on Wednesday, England's Deputy CMO Professor Jonathan Van-Tam cautioned: "It is almost certainly true that the NHS has not yet seen the impact of the infections that will have occurred during mixing on Christmas Day. And that, unfortunately, is also rather sobering."

He added his note of caution about New Year's Eve celebrations: "You have just got to play your part now in bringing us back from this very dangerous situation that we find ourselves in."

Prof Van Tam displayed a slide showing how the new variant is causing a rise in cases while other variant cases are falling: "And that obviously is of enormous concern that the new variant with its increased transmissibility, is beginning to spread to other areas of the UK."

Buckinghamshire's Major Incident

Buckinghamshire followed Essex in declaring a major incident due to concerns that a rapid rise in COVID-19 cases could overwhelm the county's health and social care services.

Neil Macdonald, chief executive officer, Buckinghamshire Healthcare NHS Trust, said in a statement: "Due to a rise in the number of people being admitted to hospital with COVID-19, along with the need to maintain services across the Trust, some temporary changes have been made to ensure safe and appropriate staffing levels at all times and to ensure that we have enough beds to meet current and anticipated demand. This includes postponing or delaying some non-urgent operations and outpatient appointments but urgent operations, including cancer, will continue as planned."

The Independent reported how several patients from across Kent have been taken to Plymouth, Southampton, Bristol, and Leeds as hospitals ran out of beds.

Prof Powis said England's Nightingale hospitals were asked a few weeks ago to be ready to take patients if required. "Some of them are already doing that in Manchester, taking step down patients, in Exeter managing COVID patients, and in other places, managing diagnostic services."

He added: "What we've learned over the year is that we can use the Nightingales for a variety of purposes...so we will be keeping those purposes under review.

"Our first steps though in managing the extra demands on the NHS are to expand capacity within existing hospitals. That's the best way to use our staff. If needed, we can also put in place mutual aid between hospitals and healthcare organisations. That's exactly what's happening in London, the South East, and East of England."

BMA Council Chair Dr Chaand Nagpaul said: "As we hear more reports of hospitals declaring major incidents, ICU beds reaching 100% capacity in parts of the country, and patients having to be transferred to other hospitals for care, it is vital that everything possible is done to bring down the spread of the virus."

Meanwhile, there are many social media posts from doctors highlighting how hospitals are being affected.

Latest Data

NHS England performance data show the number of hospitalised COVID-19 patients rose by more than 27% in 7 days, and COVID-19 critical care bed use rose by 35%.

NHS Providers' Deputy Chief Executive, Saffron Cordery, said: "We know COVID-19 cases are rising sharply, with the new variant making a big impact, so more demand for treatment is 'baked in'. We are in for a very difficult new year."

England's Test and Trace service reported a 33% rise in positive tests 17-23 December.

Of cases transferred for central contact tracing, 7.4% were not reached.

There were another 55,892 positive cases reported on Thursday, the highest ever daily total.

UK deaths within 28 days of a positive test now stand at 73,512, with another 964 reported on Thursday.

GPs Rebooking Second Jabs

The BMA has criticised the decision to make GPs rebook second Pfizer jabs for thousands of patients after a change in JCVI advice on Wednesday.

Instead of 3 weeks, second jabs are being done at 12 weeks to allow wider first dose vaccine coverage.

On Thursday, Pfizer maintained that the vaccine is designed to be given 21 days apart. "The safety and efficacy of the vaccine has not been evaluated on different dosing schedules as the majority of trial participants received the second dose within the window specified in the study design," the company said in a statement. 

Chair of the GP Committee, Dr Richard Vautrey said: "This group of very elderly patients is at the highest risk of death if they contract COVID-19, which is why GPs are so concerned for them.

"It is grossly and patently unfair to tens of thousands of our most at-risk patients to now try to reschedule their appointments. Local leaders are telling us that it’s unprofessional and impractical to amend the appointments for thousands of frail elderly patients, particularly those booked and who have already made arrangements to have their second vaccination in the next 2 weeks."

Doctors Association UK (DAUK) GP Committee spokesperson, Dr Vinesh Patel, said: "A patient can’t consent for a treatment then have the treatment changed without their permission, especially when the evidence for change is lacking. Most of these patients are over the age of 80, have already arranged transport and so cancelling their second vaccine at such short notice will cause untold levels of anxiety."

The BMA said the existing commitment for second jabs should be respected and if GPs honour the appointments, it will support them.

Meanwhile, GPs in England will get an extra £10 for every care home resident they vaccinate against COVID-19 by the end of January.

NHS organisations have also been asked to start vaccinating nurses, doctors, and other staff immediately, as additional supplies become available. Previously only unused doses were being used.

Dr Nikki Kanani, GP and NHS medical director for primary care, NHS England, said: "As we head into the New Year with a second vaccine that is also more versatile we will be able to expand the programme and ensure that the majority of care home residents are protected within the next 4 weeks or so.

"It is also great news that we will be able to begin vaccinating NHS staff serving on the front line to protect them against coronavirus."

Defence Secretary Ben Wallace told Times Radio he had plans "for up to 250 teams of [military] mobile medically-trained personnel who could go out and administer the vaccine around the country - that would be over 100,000 a day they could potentially deliver if that is requested by the NHS."

No Quick EU Approval for Oxford Vaccine

Despite the MHRA's approval of the Oxford/AstraZeneca vaccine a quick EU approval is not expected.

"They have not even filed an application with us yet", European Medicines Agency (EMA) Deputy Executive Director Noel Wathion told the Belgian newspaper Het Nieuwsblad on Tuesday.

However, a rolling review of data has been taking place with the last data received on 21 December.

In a statement the agency said: "EMA is aware that the UK MHRA has granted a temporary authorisation of supply of the vaccine in the emergency use setting, which is distinct from a marketing authorisation.

"EMA, its European experts and the European Commission are working towards conditional marketing authorisation of COVID-19 vaccines, with all the safeguards, controls and obligations that this imposes. It guarantees that the vaccine meets rigorous EU standards for safety, efficacy and quality."

Meanwhile, US Operation Warp Speed vaccination programme Chief Adviser Dr Moncef Slaoui said recruitment for a late stage clinical trial of the jab involving 29,000 people is almost complete.

"We project, if everything goes well with readout an emergency use authorisation may be granted somewhere in April," he said.

Pregnancy & COVID Jabs

The Royal College of Obstetricians and Gynaecologists has welcomed the latest JCVI guidance on a risk-based approach to COVID-19 jabs during pregnancy.

RCOG President, Dr Edward Morris, said: "This updated advice from the JCVI means that vaccination in pregnancy should be considered in women who are frontline health or social care workers or have underlying conditions that put them at very high risk of being infected with, transmitting or experiencing serious complications of COVID-19.

"We support this risk based approach until data exist to support routine vaccination in pregnant women. We also welcome the advice that breastfeeding women may be offered vaccination and that those who are trying to become pregnant do not need to avoid pregnancy after vaccination.

"For frontline health and social care workers, and other priority groups, informed decision-making should be facilitated. It is important that women continue to be offered occupational protection during pregnancy, regardless of their vaccination choice."

RCOG and the Royal College of Midwives are calling for research studies to be funded to establish the suitability of any approved COVID-19 vaccines in pregnant and breastfeeding women.

New Variant

The new variant of the virus causing rising cases around the UK does not appear to cause more severe illness than other variants, according to a Public Health England technical briefing.

In a study, 1769 people infected with the new variant were compared with 1769 who had what was called the 'wild-type' virus. The two groups were matched for age, sex, and location.

Forty-two people were admitted to hospital, 16 with the new variant and 26 cases with the wild type. There were 12 deaths in variant cases compared to 10 deaths in the wild-type group.

The authors wrote: "Preliminary results from the cohort study found no statistically significant difference in hospitalisation and 28-day case fatality between cases with the variant and wild-type comparator cases."

However the 'secondary attack rate' was higher with the new variant.

Lost Colleagues

"Today we remember those doctors who have sadly died of COVID-19 in the UK this year," The BMJ tweeted on Thursday.

At least 204 frontline health and care workers have died during the pandemic, according to the PA News Agency.

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

Farewell EHIC, Hello GHIC

The end of the Brexit transitional arrangements at 11 pm tonight also signals the end of the European Health Insurance Card (EHIC) giving free or discounted healthcare when travelling to the EU.

Cards are still valid until they expire and a replacement scheme is being set up called a UK Global Health Insurance Card (GHIC).

However, GHICs and most UK EHICs, will not cover travel to Norway, Iceland, Liechtenstein, or Switzerland.

Adapted from Medscape UK.