UK COVID-19 Update: Deaths pass 60,000, 'inappropriate' DNACPR decisions

  • Tim Locke, Medscape.com

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

Deaths Pass 60,000

UK deaths within 28 days of a positive COVID-19 test have passed the 60,000 milestone.

Thursday's figure of 414 took the total to 60,113. The figure for deaths where COVID-19 is mentioned on a death certificate is higher at 69,752.

The UK ranks fifth in the world for COVID-19 deaths behind the US, Brazil, India, and Mexico, according to Johns Hopkins University monitoring.

In Thursday's UK daily data, another 14,879 people have tested positive, 15,236 COVID-19 patients are in hospital, and 1315 ventilator beds are in use.

'Inappropriate' DNACPR decisions

Pandemic pressures were among reasons for DNACPR decisions being incorrectly "conflated" with other clinical assessments around critical care, the Care Quality Commission (CQC) found in an interim report.

The report said frailty was wrongly used as a sole basis for some clinical decisions early in the pandemic.

However, it said the misinterpretation was quickly acknowledged, and revised guidance was issued 5 days later.

CQC's Chief Inspector of Primary Medical Services and Integrated Care, Rosie Benneyworth, said in a statement: "It is unacceptable for clinical decisions – decisions which could dictate whether someone’s loved one gets the right care when they need it most – to be applied in a blanket approach to any group of people.

"Sadly, in the experiences that people have generously shared with us there is very real concern that decisions were made which not only overlooked the wishes of the people they affected, but may have been made without their knowledge or consent.”

She continued: "We have also highlighted the fact that it is possible in some cases that inappropriate DNACPRs remain in place – and made it clear that all care providers have a responsibility to assure themselves that any DNACPR decisions have been made appropriately, in discussion with the person and in line with legal requirements."

Parliamentary Report

The All-Party Parliamentary Group on Coronavirus has published a report into the Government's handling of the pandemic, making 71 key findings and 44 recommendations.

Findings include:

  • The UK Government’s centralised test and trace system is not working

  • Public messaging is unclear

  • Relaxing lockdown restrictions too early, without sufficient suppression, can cause more economic damage in the long term

  • Regular and accessible staff testing is critical to enable the NHS and social care sector to provide care

Commenting, Professor Andrew Goddard, president of the Royal College of Physicians said: "We’re pleased to see that the APPG on Coronavirus has recommended that testing should be available to frontline workers and their households as a priority, and that results should be accessible within 24 hours.

"Progress has been made, with asymptomatic testing now available to all staff in high-risk areas, but it is vital all doctors and their families have access to tests when they need them. As we stated in our evidence to the APPG, this is vital to prevent doctors needlessly self-isolating while they wait to see if a member of their household has COVID-19. Where tests are available, the delay in getting results causes big problems – it means clinicians have to cover each other and clinical activities risk being cancelled.

"Testing must remain a priority as staff begin to receive vaccines so we have the best chance of beginning to clear the non-COVID backlog of care. It’s important that we use the lessons learnt during the first stages of the pandemic to help us get things right in the months ahead."

Speed - a Brexit Bonus?

Unlike some of his ministers, Boris Johnson resisted an opportunity to describe the UK's Pfizer/BioNTech vaccine approval as being part of a 'Brexit bonus'.

England's Health Secretary Matt Hancock said in an interview: "It is absolutely clear that because we’ve left the EU I was able to change the law so that the UK alone could make this authorisation decision. So because we’ve left the EU, we’ve been able to move faster."

The UK is still under transitional arrangements with the EU until the end of the year, and normally vaccines must still be authorised by the European Medicines Agency (EMA).

However, a Government news release on 23 November made it clear that "if a suitable COVID-19 vaccine candidate, with strong supporting evidence of safety, quality and effectiveness from clinical trials becomes available before the end of the transition period, EU legislation which we have implemented via Regulation 174 of the Human Medicines Regulations allows the MHRA to temporarily authorise the supply of a medicine or vaccine, based on public health need."

The EMA is due to conclude its assessment during an extraordinary meeting on 29 December at the latest. A spokesperson for the EU said the EMA's procedure was "the most effective regulatory mechanism to grant all EU citizens access to a safe and effective vaccine".

There was criticism too from Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases: "We have the gold standard of a regulatory approach with the FDA," he told Fox News. "The UK did not do it as carefully and they got a couple of days ahead."

Commenting via the Science Media centre, Stephen Evans, professor of pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said: "I think it is possible that he has over-stated concerns about the UK assessment process for the Pfizer/BioNTech vaccine.

"The processes carried out by the FDA and the MHRA are basically very similar. The only major difference is that the FDA may reproduce all the tables submitted by a company by re-analysing the data. This has been a notable difference between the FDA and other regulatory authorities around the world. Virtually no other regulator will regularly reanalyse from raw data to verify the analysis carried out by a company. We do not know how often there are substantive differences between an FDA analysis and a company analysis. We may well see differences in interpretation of the data between a regulator and a company, but this type of difference is regularly seen by all regulators, whether they re-analyse the data or not."

MPS (Medical Protection Society) announced on Thursday that it will provide free medicolegal support to retired doctors who join the vaccination delivery programme.

Medical Protection Medical Director, Dr Rob Hendry, commented: "We want to ensure that previously retired members have one less thing to worry about should they assist with the NHS vaccination programme. We are here to provide advice and protection if it is needed."

Test and Trace

A change in procedures has led to an improvement in this week's Test and Trace performance figures in England.

Under-18s in a household are no longer contacted separately.

In the latest week, taking into account all contacts identified, 27.5% were not reached. The previous week 39.7% were not reached.

For in-person testing, 84.9% of results were received the next day.

Public Health England (PHE) surveillance data suggest COVID-19 activity at a national level has decreased between 23 and 29 November 2020. The hospital admission rate for COVID-19 was 14.01 per 100,000 in week 48 compared to 16.25 per 100,000 in the previous week.

Lateral Flow Tests

Lateral flow tests used for mass testing may miss half of cases, an official Department for Health and Social Care document shows.

'Community testing: a guide for local delivery' states: "The measured test sensitivity, in ideal hands, is 76.8%, meaning that just over 2 in 10 people who are infected will be given a false negative result, although sensitivity is likely to be lower under operational conditions.

"In the field evaluation in Liverpool, compared to PCR tests, these tests picked up 5 out of 10 of the cases PCR detected and more than 7 out of 10 cases with higher viral loads, who are likely to be the most infectious.

"These tests will not pick up everyone who has COVID-19. But no test is completely accurate and critically these tests pick up cases when they are at their most infectious."

Travel News

Travel between Wales and the whole of Northern Ireland along with areas of England and Scotland with the highest rates of coronavirus will not be allowed from 6 pm on Friday.

"Coronavirus doesn’t respect borders," First Minister Mark Drakeford said in a statement.

Radiotherapy Down

PHE data show the number of people with cancer having radiotherapy in England has dropped by 14% during the pandemic compared with the same time last year.

Sara Bainbridge from Macmillan Cancer Support commented: "This data supports what we have been sounding the alarm about for months – COVID-19 has caused significant disruption to cancer diagnoses and treatment. NHS professionals are doing an incredible job in the face of unbelievably challenging circumstances. Despite this, we know that tens of thousands of people are living with cancer which hasn’t yet been diagnosed and, as a result, they haven’t started treatment, while others have been forced to watch helplessly as their treatment is delayed or cancelled.

"It is critical cancer does not become the ‘Forgotten C’ in this pandemic. We must see Government action to ensure cancer services are protected through the winter and this second wave. By continuing to guarantee staff numbers, COVID-free spaces and the required testing, the public can be confident that NHS services are safe and open for business."

'COVID-19 Fear' & Diabetes

Diabetes UK is urging parents to seek help for type 1 diabetes symptoms in children after study results in BMJ Paediatrics Open suggested fear of COVID-19 was behind 40% of delayed diagnoses.

The data come from the UK Association of Children’s Diabetes Clinicians' survey in 88 diabetes units in England, Wales, and Northern Ireland between March and June.

Of all patients presenting as newly diagnosed T1D, 51% presented in diabetic ketoacidosis (DKA) and 54% presented with severe DKA.

Issues accessing GP services were cited in 22% of cases and 17% of cases involved "symptoms being misdiagnosed or not recognised as diabetes such as: symptoms mistaken for a respiratory illness during a GP video consultation, tiredness due to lack of routine and increased thirst attributed to a ‘heat wave’ by the family".

Diabetes UK Head of Care, Dan Howarth, commented: "It’s very concerning that many children and young people are not being diagnosed with type 1 diabetes until their symptoms become severe."

Medical Students

Medical students will be among the first to return to university 4-18 January next year. Most other courses will begin online before a phased return to campus from 25 January.

Thursday was the start of the travel window for students living away from home.

Arrangements are being made for universities in England to give students two rapid lateral flow tests, 3 days apart when they return after the Christmas break.

Parking Charges

UNISON says there's evidence some hospitals in England are starting to charge staff for parking again and is pressing for free parking to be reinstated.

Ministers say charges are a matter for individual trusts but free staff night shift parking remains a manifesto promise.

Adapted from Medscape UK.