UK COVID-19 Update: mass vaccination sites, jab bureaucracy busting

  • Tim Locke, Medscape.com

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

Lockdown Law

England's third national lockdown restrictions became law on Wednesday ahead of being debated in Parliament.

England's Health Secretary Matt Hancock told the Commons: "We know that while the winter weeks will be difficult, we now know what the way out looks like, and accelerating the deployment of COVID vaccines, making the most vulnerable groups safe, and everyone playing their part ...That is the route out of this pandemic."

Mass Vaccination Sites

Seven mass vaccination sites are being set up in London, Newcastle, Manchester, Birmingham, Bristol, Surrey, and Stevenage.

Downing Street said the centres would be run by NHS staff and volunteers.

Sky News reported that nearly 3.5 million doses of the Oxford/AstraZeneca vaccine are awaiting MHRA approval.

Each batch has to undergo independent safety testing that can take up to 3 weeks.

The regulator told the broadcaster it was working in parallel with AstraZeneca's batch testing process to help speed up delivery.

Vaccines Minister Nadhim Zahawi told Sky News the "Herculean effort" to vaccinate all top four priority groups, around 14 million people, by mid-February is achievable.

"It is a stretching target no doubt, but I'm confident that with this plan that the NHS have put together that we will deliver this."

After criticism by the Royal College of GPs of the bureaucracy surrounding retired GP volunteers returning to help with vaccinations,  Matt Hancock told the Commons: "We have removed a series of the unnecessary training modules that have been put in place, including fire safety, terrorism, and others."

Mr Hancock added: "I'm a fan of busting bureaucracy," and "It is not necessary to undertake anti-terrorism training in order to inject vaccines."

Excess Deaths

Office for National Statistics data for the last week of 2020 showed registered deaths in England and Wales were 44.8% above the 5-year average, and were the highest so far in the second wave.

However, this week contained fewer bank holidays than previous years and revisions are likely due to delayed reporting.

COVID-19 was mentioned in 25.3% of all deaths.

Commenting, Veena Raleigh, senior fellow at The King’s Fund said: "There is no doubt that 2020 was a terrible year, with almost 78,000 more deaths in England and Wales since the start of the pandemic in March compared with the preceding 5-year average. The UK has already experienced amongst the highest excess mortality rates among European countries, and deaths are unfortunately continuing to rise inexorably this month.

"With the new coronavirus variant driving rapidly rising infection rates throughout December, and the impact of the relaxation of rules over Christmas still to be added to these figures, we will sadly continue to see the deadly consequences of the rapid spread of the virus over the coming weeks.

"It is impossible to quantify the impacts of individual factors on the spread of the virus, but the failure to respond more quickly, even if it meant making unwelcome decisions, has undoubtedly been a contributor. The roll out of vaccinations will help in reducing the death toll but the virus will remain a deadly threat for months to come. The pandemic is far from over, and the Government needs to learn urgently from the consequences of its previous responses to the crisis, and from other countries that have seen significantly lower death tolls."

In Wednesday's daily data another 62,322 UK positive tests were reported, and 1041 deaths, the highest since April.

Another 3179 COVID-19 patients were admitted to hospital taking the total to 30,451, and 2645 ventilator beds are in use.

'Surge in Cases' After Lockdown Leak 

A preprint observational study from the University of East Anglia found "a clear surge in infections" after media leaks in the week before November's national lockdown in England.

Data were analysed from 315 local authorities and "this surge was almost exclusively associated with Tier 1 and Tier 2 authorities. In Tier 3 authorities where hospitality venues were only allowed to operate as restaurants there was no such surge."

The study also found "the spike was most obvious in the 20 to 24 and 25 to 29 age groups".

It concludes that the beneficial effects of the national lockdown in Tiers 1 and 2 "were probably undermined because of increased socialising in the days before implementation".

Second Dose Delay Debate

The debate over delaying second doses of COVID-19 vaccines to help expand coverage continues.

The decision to delay second jabs is allowing first dose coverage to be doubled, according to Chief Medical Adviser Professor Chris Whitty.

However, an opinion article in The BMJ from five scientists said: "The JCVI advice and the CMO’s decision to delay the second dose to between 4-12 weeks is not based on data from the [Pfizer/BioNTech] trial, but on an assumption of what would have happened if the second dose hadn’t been given at 21 days. While assumptions can be useful for generating a hypothesis, alone they are not a sufficient reason to alter a known effective dosing regimen."

The experts from Nottingham, Manchester, and De Montfort Universities say: "The second dose should continue to be provided at 21 days until the MHRA and/or JCVI make the data on which the JCVI recommendation is based publically available for independent scientific review."

The World Health Organisation also issued guidance. "We deliberated and came out with the following recommendation: two doses of this (Pfizer/BioNTech) vaccine within 21-28 days," Alejandro Cravioto, chair of WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE), told a news briefing.

"[WHO] SAGE made a provision for countries in exceptional circumstances of (Pfizer) vaccine supply constraints to delay the administration of the second dose for a few weeks in order to maximise the number of individuals benefiting from a first dose."

He added: "I think we have to be a bit open to these types of decisions which countries have to make according to their own epidemiological situations."

Denmark approved a delay of up to 6 weeks between the first and second doses of the Pfizer/BioNTech vaccine.

"If you go longer than 6 weeks, we cannot see the scientific evidence that you are protected with certainty. Therefore we cannot recommend that." Head of the Danish Health Authority, Soren Brostrom, said.

Moderna Vaccine

The European Medicines Agency (EMA) has approved Moderna's COVID-19 vaccine.

"This vaccine provides us with another tool to overcome the current emergency,” said Emer Cooke, EMA executive director.

The jab is still being assessed by the UK's MHRA.

The EMA said the vaccine demonstrated a 94.1% efficacy in a clinical trial.

It is the second coronavirus vaccine approved by EMA after the Pfizer/BioNTech jab.

Cancer Ops Cancelled 

Some cancer operations are being cancelled in parts of London due to COVID-19 capacity problems.

A spokesperson for King’s College Hospital NHS Foundation Trust said in an emailed statement: "Due to the large increase in patients being admitted with COVID-19, including those requiring intensive care, we have taken the difficult decision to postpone all elective procedures, with the exception of cases where a delay would cause immediate harm. A small number of cancer patients due to be operated on this week have had their surgery postponed, with patients being kept under close review by senior doctors."

Smoking

Smokers have a 29% increased risk of COVID-19 symptoms, and, if they test positive, are twice as likely to have to go to hospital than non-smokers, according to King's College London research published in Thorax.

Data was analysed from the ZOE COVID Symptom Study App

Lead researcher Dr Mario Falchi commented: "Some reports have suggested a protective effect of smoking on COVID-19 risk. However, studies in this area can easily be affected by biases in sampling, participation, and response. Our results clearly show that smokers are at increased risk of suffering from a wider range of COVID-19 symptoms than non-smokers."

Nursing Temporary Register

The Royal College of Nursing (RCN) has welcomed an expansion of the COVID-19 temporary register by the Nursing and Midwifery Council (NMC).

NMC Chief Executive and Registrar, Andrea Sutcliffe, said in a statement: "In response to the increasing pressures, we are announcing...the further expansion of the temporary register so that as many overseas-trained nurses as possible can opt in to help if they wish to.

"In agreement with the Department of Health and Social Care and the four UK Chief Nursing Officers, we are initially inviting just over 2000 nurses who have trained overseas and are ready to take the final stage of their permanent registration application process, to join the temporary register."

RCN Chief Executive and General Secretary, Dame Donna Kinnair, commented: "These measures are vital to expand the nursing workforce temporarily and help services in providing the highest level of care to patients.

"The level of vacant nurse jobs in England was high before the pandemic and nursing staff have been stretched even further in the last 10 months."

WHO Wuhan Investigators

A WHO team of 10 experts planning to investigate the origins of COVID-19 in Wuhan has been denied entry to China.

Director-General Tedros Adhanom Ghebreyesus said he was "very disappointed".

WHO emergencies chief, Mike Ryan said: "We trust and hope that is just a logistic and bureaucratic issue that can be resolved very quickly."

Clapping Returns

Clap for Carers is back on Thursday at 8 pm but the weekly event will now be known as Clap for Heroes.

The campaign's website says: "Clap For Heroes will not only celebrate our NHS, care workers and key workers – from delivery drivers to postal workers, emergency services to teachers – but will also acknowledge every hero who has played their part through the pandemic, including but not limited to: home-schoolers, neighbours, scientists, volunteers, all those who wear masks when out, those who have stayed at home and socially distanced, shop workers, those in the arts and hospitality sectors, everyone who has battled or is still battling COVID-19 (or caring for a loved one who is unwell), and also those sorely missed loved ones and friends who have been tragically lost to the virus."

Adapted from Medscape UK.