UK COVID-19 Update: legal protection, pay campaign, vaccination ramps up

  • Tim Locke, Medscape.com

  • UK Medical News
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

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

Legal Protection

Health groups, including the BMA, are calling for new legal protection in case doctors and nurses are forced to choose between patients if the NHS becomes overwhelmed.

A letter to Matt Hancock, England's health secretary, and coordinated by the Medical Protection Society said: "The emergency legislation we propose should only apply to decisions made in good faith, in circumstances beyond their [healthcare professionals] control and in compliance with relevant guidance – it would not apply to wilful or intentional criminal harm, or reckless misconduct."

The Department of Health and Social Care said: "We have reassured NHS staff that existing indemnity arrangements will rightly continue to cover the vast majority of liabilities which may arise, and we have made specific arrangements so any member of staff not covered by existing indemnity schemes will be protected under the Coronavirus Act."

Matt Hancock, England's health secretary, told a Downing Street briefing: "The clear advice that I have is that it is not necessary at this point to change the law on this on this matter." 

Pandemic Pay Campaign

Health unions have written to the Prime Minister asking Boris Johnson to speed up the pay review process.

The campaign includes a poll of more than 2000 people by Savanta ComRes suggesting 86% of the public support some level of pay rise, and 40% support a significant increase.

The letter is signed by the heads of the Royal College of Nursing (RCN), UNISON, and the Royal College of Midwives. It says "hospitals are stretched to the limit" and that many staff are "demoralised and traumatised" and facing burnout.

RCN Chief Executive & General Secretary Dame Donna Kinnair said: "NHS staff are worse off now than 10 years ago. When tens of thousands of nursing jobs are vacant, the Government cannot afford to let more leave over low pay. A meaningful rise will bring in new nursing staff and keep experienced ones in post."

Public confidence in the NHS being able to cope with all those who are ill in the pandemic has fallen to its lowest level, according to new Ipsos Mori polling of 1065 adults.

Confidence is now at 60%, down from 72% in November, and 84% in May.

On Friday, Chief Medical Adviser, Professor Chris Whitty, said he believes the number of patients being admitted to hospital with COVID-19 will peak within the next 10 days but added: "The peak of deaths I fear is in the future."

In Monday's daily data, another 37,535 people tested positive and 599 deaths were reported. Another 3984 COVID-19 patients were admitted to hospital taking the total to 37,475, and 3789 ventilator beds are in use.

Vaccination Ramps Up

More people in the UK  have now been vaccinated (4m) than have ever tested positive (3.4m) for COVID-19.

The UK is delivering 140 jabs a minute, Vaccine Deployment Minister Nadhim Zahawi said Monday. Round the clock vaccination centres are to be piloted in London by the end of the month, he added.

Teachers, police, and other key workers could be prioritised after over-50s he said.

The Army is setting up 80 new NHS Scotland COVID-19 vaccination centres from Monday.

More large scale vaccination centres have opened in England, including at Taunton Racecourse, and Blackburn Cathedral.

While phase 1 priority over-80s are still being booked in, invitations are going out to over-70s, and clinically vulnerable groups.

As of Friday, the BMA said its vaccine tracker polling showed 23% of members have not yet had a first jab.

Doctors' Association UK raised concerns after the Foreign Secretary Dominic Raab wouldn't guarantee those who've had their first dose will get the second within 12 weeks. "What will happen in 12 weeks? Will the Government push another untried and untested schedule- mixing vaccines?" it tweeted.

Mixing vaccine brands is not recommended in the official guidance but not ruled out: "There is no evidence on the interchangeability of the COVID-19 vaccines although studies are underway. Therefore, every effort should be made to determine which vaccine the individual received and to complete with the same vaccine. For individuals who started the schedule and who attend for vaccination at a site where the same vaccine is not available, or if the first product received is unknown, it is reasonable to offer one dose of the locally available product to complete the schedule."

On Friday, Prof Chris Whitty responded to claims of unused vaccine doses being thrown away at the end of the day.

"Where there has been extra, people have been very sensible about it. And new things are coming in, for example, to try and increase by one dose, the number of doses you can get per vial, [and] other ways of trying to make sure we are as efficient as possible in ensuring that we get as minimum wastage as possible," he said.

Vaccine supply is the limiting factor, Prof Whitty said "not the capacity of the NHS to deliver".

Valneva hopes its COVID-19 vaccine can start to be used in the UK between July and September, according to the Mail on Sunday.  The UK has ordered 60 million doses and large scale manufacturing is starting soon.

Chief Executive Thomas Lingelbach said: "We cannot release it without regulatory approval so we’re in a little bit of a Catch-22 situation and there are certainly scenarios that we are currently discussing with the regulators."

Norway is taking a more cautious approach to vaccinating extremely frail elderly people after reports of 23 deaths among patients who'd been given the Pfizer/BioNTech jab.

The Norwegian Medicines Agency said that "common adverse reactions may have contributed to a severe course in elderly people who are frail".

Virus Variants

Thirty-five genomically confirmed and 12 genomically probable cases of the SARS-CoV-2 variant which originated in South Africa have been identified in the UK, Public Health England (PHE) announced on Friday evening.

Eight genomically confirmed cases of a Braziliant variant have also been identified in the UK but not the Manaus variant.

PHE's Dr Susan Hopkins said: "We are continuing efforts to understand the effect of the variants on transmissibility, severe disease, mortality, antibody response and vaccine efficacy."

On Friday, Government Chief Scientific Adviser Sir Patrick Vallance told a Downing Street briefing: "It’s possible that the variants will get round vaccines to some extent in the future."

He added: "But I think the vaccines themselves ... particularly the messenger RNA vaccines are really quite easy to adjust to changes in the virus."

Travel corridors to and from the UK have now ended and travellers to the UK need a negative test result before boarding transport, and have to self-isolate for 10 days on arrival.

The US Centers for Disease Control and Prevention (CDC) said the UK variant will be the predominant variant across the US by March.

Deaths

Global COVID-19 deaths passed the 2 million milestone on Friday, according to Johns Hopkins University in the US. The UK's mortality count ranks fifth behind the USA, Brazil, India, and Mexico.

Office for National Statistics data for December show there were 25.2% more deaths registered in England than the 5-year average.

In Wales, deaths were 37.5% higher than the 5year average.

COVID-19 was the leading cause of death in England (20.8%) and Wales (27.4%).

The age-standardised mortality rate of COVID-19 deaths was 233.6 deaths per 100,000 people in England and 374.4 deaths per 100,000 people in Wales.

Readmission

Preprint research from the Office for National Statistics, University College London, and the University of Leicester, found 29.4% of 47,780 hospitalised COVID-19 patients were readmitted after being discharged. Another 12.3% died.

Multi-organ dysfunction was common, and age, extrapulmonary pathophysiology, diabetes, and MACE were risk factors.

The authors conclude: "Urgent research is required to further understand the risk factors for PCS [post-COVID syndrome], so that treatment provision can be better targeted to demographically and clinically at-risk populations."

Convalescent Plasma

The RECOVERY trial has closed recruitment to its randomised convalescent plasma treatment for patients hospitalised with COVID-19.

The preliminary analysis on 1873 reported deaths among 10,406 randomised patients showed no significant difference in the primary endpoint of 28-day mortality (18% convalescent plasma vs. 18% usual care alone).

Follow-up is continuing before final results are published.

Joint Chief Investigator, Peter Horby, professor of emerging infectious diseases, Nuffield Department of Medicine, University of Oxford, said: "Whilst the overall result is negative, we need to await the full results before we can understand whether convalescent plasma has any role in particular patient subgroups."

Students

University students going home for Christmas may have caused 9400 COVID-19 infections, according to Cardiff University research published in the journal Health Systems.

Modelling was used suggesting each infected student returning home would produce an average of 0.94 secondary infections.

Professor Paul Harper from Cardiff said: "With the potential movement of over one million UK students for the Christmas vacation, even a modest 1% infection level (meaning 10 in 1000 students are infected, perhaps many of them without symptoms at the time of travel) would equate to 9400 new secondary household cases across the country."

AI

Artificial intelligence is being deployed in COVID-19 diagnostic imaging by NHS England.

The National COVID-19 Chest Imaging Database (NCCID) uses CT, MRI, and X-ray images to track patterns and markers of illness. It is available to hospitals and universities across the country.

Dominic Cushnan, NHSX, said: "We are applying the power of artificial intelligence to quickly detect disease patterns and develop new treatments for patients. There is huge potential for patient care, whether through quicker analysis of chest images or better identification of abnormalities.

"The industrial scale collaboration of the NHS, research and innovators on this project alone has demonstrated  the huge potential and benefits of technology in transforming care."

Blue Glasses

With more screen use under lockdown glasses designed to block blue light from electronic devices have become a talking point. The debate continues about whether they help protect eyesight.

The College of Optometrists says: "The best scientific evidence currently available does not support the use of blue-blocking spectacle lenses in the general population to improve visual performance, alleviate the symptoms of eye fatigue or visual discomfort, improve sleep quality or conserve macula health."

Adapted from Medscape UK.