UK COVID-19 Update: ICU PTSD, 24/7 jabs, PPE concerns

  • Tim Locke, Medscape.com

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

ICU PTSD

Nearly half of staff working in England's ICUs reported severe anxiety, depression or post-traumatic stress disorder, according to King’s College London research published in the journal Occupational Health.

The study included 709 staff in nine ICUs last June and July.

Of these, 41% were doctors, 49% nurses, and 10% other healthcare staff.

Although 59% reported good wellbeing, 45% met the threshold for probable clinical significance for at least one of:

  • Severe depression (6%)

  • PTSD (40%)

  • Severe anxiety (11%)

  • Problem drinking (7%)

  • Frequent thoughts of being better off dead, or of hurting themselves in the past 2 weeks (13%)

Lead author, Professor Neil Greenberg, commented: "Evidence-based mechanisms should be in place so all healthcare workers, including ICU staff, can promptly access treatment for mental health issues. If we protect the mental health of healthcare workers during the COVID-19 pandemic, staff will be better able to sustainably deliver high-quality care to the large numbers of patients seriously unwell with COVID-19."

Dr Pallavi Bradshaw from the Medical Protection Society said the results "make for difficult reading” and: "For most healthcare workers COVID-19 will be the biggest health crisis in their careers, with countless patients and colleagues lost. Without support to deal with a range of mental wellbeing issues, many are at risk of becoming burnt out and disillusioned or suffering in silence with chronic psychological injuries - both of which put the safety of themselves and their patients at risk. Many others may sadly choose to leave the profession."

Daily Data

In Wednesday's daily data another 47,525 UK positive tests were reported and 1564 deaths, the highest so far.

Another 4253 COVID-19 patients were admitted to hospital taking the total to 36,489, and 3496 ventilator beds are in use.

24/7 Jabs

Ministers had previously said there was no "clamour" for extending vaccination hours but Prime Minister Boris Johnson told the Commons: "We'll be going to 24/7 as soon as we can."  No further details were given.

Despite recent prioritisation of doctors and frontline staff for vaccination, an ongoing BMA member survey of more than 10,000 doctors finds 32% still haven't had a first jab.

Across the UK, as of Tuesday, 2,431,648 people have had their first dose and 412,167 had a second dose.

England's Health Secretary Matt Hancock told Sky News this morning that the UK's vaccination plan is "on track". He clarified the target as everyone in the four top groups being "offered a slot" by 15 February.

AstraZeneca UK President Tom Keith-Roach told the Commons Science Committee: "We’ve released just over 1.1 million doses, to date, and we are scaling up as we’ve said very rapidly. And this will happen imminently, to releasing two million doses a week, we’re absolutely on track to do that.

He added: "We’re scaling up to two million a week imminently, and certainly we hope to be there on or before the middle of February."

Earlier the vaccines minister Nadhim Zahawi declined to give extra information about the roll out programme and deliveries. He cited not wanting the UK to appear to "show off" and "national security".

Public Health England’s Head of Immunisation, Mary Ramsay, told the MPs second doses could be delayed further: "Like we changed the schedule very quickly before Christmas, this is a very fast moving field, and if more data emerges it may well be that the balance of those first doses, getting more first doses to people is a priority."

She added: "If we’re seeing very high levels of protection, for example in the vulnerable groups, it may be more important to get more younger people vaccinated."

Journalist and Labour peer Joan Bakewell is threatening to take Mr Hancock and the Government to court over delaying second jabs, saying the move was unlawful and unsafe.

Baroness Bakewell had her first dose of the Pfizer/BioNTech jab last month

"Older people are in limbo: they need to know whether delaying the Pfizer vaccine is both safe and legal. I am bringing this case because I believe the Government needs to make this clear," she told The Guardian.

Meanwhile, China’s Sinovac vaccine showed "general efficacy" of 50.38% in latest trial results from Brazil.

Lawrence Young, virologist and professor of molecular oncology, University of Warwick, commented via the Science Media Centre: "The reporting of the Sinovac trial of Coronavac (an inactivated whole virus vaccine) is very confusing.

“The revised 50.4% efficacy rate from the Brazilian clinical trial includes those who had ‘very mild’ cases of COVID-19 whereas original reports indicated an overall efficacy of 78% for mild to severe cases. The same vaccine has been trialled in Turkey (reported efficacy 91.25%) and Indonesia (reported efficacy 65.3%). The data from China only report a 94.9% seroconversion rate in a Phase I/II clinical trial with no report on efficacy.

"It is difficult to interpret all this information without seeing the full datasets."

PPE Concerns

The BMA says PPE provision remains inadequate, putting staff at risk.

It has written to Public Health England asking for an urgent review of guidance.

In the letter, BMA Council Chair, Dr Chaand Nagpaul, says: "If healthcare workers fall ill from being infected and are unable to work, it will be devastating for the health service at this time of critical pressures, and it will compound the pressures besieging hospitals and GP practices."

He also said PPE fit remains a problem: "Female doctors are still struggling to find masks that fit, often failing the ‘fit test’ or being left with sores and ulcers after long shifts when wearing masks that did not fit. We have raised concerns in the past that PPE is designed to fit men, not women - despite the fact that 75% of the NHS workforce are women."

Medical Students

Doctors' Association UK said it has "heard some incredibly worrying things from medical students across the country about safety and education during placement."

It has written to the Medical Schools Council to raise concerns, including:

  • Student and patient safety, including lack of access to testing and appropriate PPE

  • Lack of flexibility for those at increased risk from COVID

  • Confusion about the role of medical students

Hotel Plans

London's Nightingale field hospital has begun admitting non-COVID patients as plans emerged to use hotels for some NHS patients. The ExCeL centre is also one of England's mass vaccination centres.

NHS England's London Regional Medical Director, Dr Vin Diwakar, told a Downing Street briefing: "This means that hospitals have more beds to care for COVID-19 patients themselves, and for our very sickest patients. But we cannot do this indefinitely.

"There comes a point where if the infection gets further out of control, more and more patients from London will need to be transferred elsewhere."

The hotel plan isn't yet a "concrete proposal" Matt Hancock told Sky News. "There are huge pressures on the NHS and we are looking to all different ways that we can relieve those pressures.

"We would only ever do that if it was clinically the right thing for somebody. In some cases, people need sit-down care, they don't actually need to be in a hospital bed."

Lockdown Compliance

Ongoing research from UCL finds 'majority compliance' with the lockdown rules has risen to 96%.

However, only 43% of people who developed COVID-19 symptoms requested a test.

Of those who had symptoms, 38% did not isolate for the recommended 10 days or more, and 13% did not isolate at all.

Lead author, Dr Daisy Fancourt, said: "The high number of people not requesting a COVID test when they have symptoms is worrying."

Problems getting tests, distance to test centres, or not knowing how to request them were often cited.

"The number of respondents who say they are not isolating for the recommended number of days is also deeply concerning," Dr Fancourt said.

"The increased adherence to self-isolation rules among those with a higher household income suggests that many of those not isolating are breaking guidelines due to financial concerns, and more support needs to be put in place to allow people to self-isolate without fear of losing out financially."

Scotland is tightening lockdown measures from Saturday. These include restricting click and collect to essential items, takeaways only serving through hatches, and a ban on drinking alcohol outdoors.

Inhaled Interferon Beta 

A Phase 3 trial of inhaled interferon beta to help prevent COVID-19 becoming more serious began on Wednesday Royal Infirmary.

Consultant Respiratory Physician Dr Michael Crooks, principal investigator for the trial in Hull, said: "We are hopeful this trial will confirm the effectiveness of inhaled Interferon Beta in helping people recover from the virus and preventing them developing severe disease.

"Any treatment we can provide to help patients recover faster has massive benefits for them and our hospitals."

Southampton University Hospital developed the treatment approach with the biotech company Synairgen.

Previous research released in July suggested patients receiving the drug had a 79% lower risk of developing severe disease compared to placebo.

There were concerns over the drug increasing ACE2 protein levels.

However, Southampton's Professor Jane Lucas said in a news release on Tuesday: "We were excited to discover a new form of ACE2, and became even more interested when we realised that may be protective against SARS-CoV-2 in the airways rather than an entry site for infection. We believe this may have important implications for managing COVID-19 infection and we are starting further studies to investigate this further."

The latest findings were reported in Nature Genetics.

School Testing

There's more criticism of lateral flow tests in The BMJ , experts warning about using the tests for school testing.

"There is a real risk that the serial-testing strategy of contacts may increase rather than decrease COVID cases in schools," Professor Jon Deeks and Royal Statistical Society experts warn.

On Tuesday, Prof Deeks raised concerns about the widespread use of lateral flow tests when they have been shown to miss 60% of asymptomatic cases.

Lockdown Brains

A survey of more than 2000 adults for Alzheimer’s Research UK by Yonder found 14% of respondents think their brain health has declined since the start of the pandemic.

The poll is being used by the charity to support its new Think Brain Health awareness campaign.

Chief Executive Hilary Evans said: "There is a clear appetite among the public to improve their health and looking after the brain must become a core part of our approach to good overall health."

Lockdown Drinking

Some people are drinking more under lockdown, a survey for UCL shows.

Among drinkers:

  • 26.2% drank more

  • 25.7% drank less than usual

  • 48.1% drank about the same

Alcohol use increased among younger people, females, and those with anxiety.

The survey was carried out 21 March to 4 April 2020.

Co-author, Dr Melissa Oldham, said that "targeted approaches to provide support for certain groups who are more likely to drink more is needed, particularly with the start of this third lockdown".

The DOI for the study will be 10.1016/j.drugalcdep.2020.108461.

Online Abuse

Doctors' Association UK President and intensive care registrar, Dr Samantha Batt-Rawden, has told the BBC how she receives 20-30 abusive messages a day.

She blames COVID sceptics and anti-lockdown activists.

She's responded with a campaign to post blue hearts on social media to back NHS workers.

Adapted from Medscape UK.