UK COVID-19 Update: PPE calls rejected, vitamin D survey

  • Tim Locke, Medscape.com

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

Higher Level PPE Calls Rejected

Public Health England (PHE) and the Department of Health and Social Care (DHSC) said there were no plans to change PPE guidance after the BMA and other health unions and groups raised concerns over new virus variants.

PHE Medical Director, Dr Yvonne Doyle, said: “NHS staff are under immense pressures and their safety has always been our highest priority.

"The NHS Infection Prevention Control group has reviewed the latest evidence and has advised that PPE should continue to be worn as laid out in the current IPC guidance, with FFP3 masks required for staff undertaking clinical aerosol-generating procedures. This is supported by WHO.

"Emerging evidence and data on variant strains and transmission will be continually monitored and reviewed."

A Department of Health and Social Care spokesperson said: "The safety of NHS and social care staff has always been our top priority and we continue to work round the clock to deliver PPE that helps protect those on the front line.

"Guidance on the safest levels and standards of PPE is written by experts and agreed by all four UK Chief Medical Officers.

"Our guidance is kept under constant review based on the latest evidence."

Oxygen

The Care Quality Commission is "closely monitoring" oxygen rationing at Southend Hospital in Essex.

Deputy Chief Inspector of Hospitals, Heidi Smoult, said in an emailed statement: "We have followed up directly with the trust regarding their oxygen supply systems to fully understand the issue, and the actions being taken to keep patients safe and ensure any temporary deviation from NICE guidelines is thoroughly risk assessed. The trust is being supported by NHS England and Improvement and we are closely monitoring the situation."

Meanwhile, some patients have been transferred from London hospitals to Newcastle due to capacity pressure.

The BBC quoted North of England Critical Care Network Director Lelsey Durham: "Whilst not ideal, it is correct to ensure that every person, regardless of location, has access to a critical care bed if they require one."

Brazilian Variant

One of two types of variants of the SARS-CoV-2 virus believed to have originated in Brazil has already been detected in the UK, according to Professor Wendy Barclay, Imperial College London.

However, she said it is not the "one of concern". Prof Barclay is a member of the new G2P-UK consortium of scientists studying emerging variants.

A travel ban from South America and Portugal came into force this morning.

This evening, Prime Minister Boris Johnson announced international travel corridors will end from Monday alongside the start of mandatory pre-travel negative test results.

Later, Public Health England said 35 genomically confirmed and 12 genomically probable cases of the SARS-CoV-2 variant which originated in South Africa have been identified in the UK.

Latest Data

The UK's R number is now 1.2-1.3. Last week it was 1.0-1.4.

The growth number is +2% to +5%.

The MRC Biostatistics Unit's 'nowcast and forecast' was published on January 14 suggesting there are currently 60,200 daily new infections in England.

It also predicts the number of daily deaths is likely to be between 518 and 860 on 28 January.

Professor Sheila Bird, formerly from MRC, commented via the Science Media Centre: "It is possible, although we’ll need to see data for a few more weeks to confirm, that COVID-deaths may have peaked this week. Unfortunately, the second wave has been broader and is likely to cost more lives than the first."

In Friday's daily data another 55,761 UK positive tests were reported and 1280 deaths.

Another 4262 COVID-19 patients were admitted to hospital taking the total to 37,282, and 3672 ventilator beds are in use.

Jabs

ONS data show 86% of adults are likely or highly likely to have a vaccine if offered, compared with 78% in mid-December.

As of January 14, 3.2 million people have had first jabs.

So far 34.6% of over-80s in England have had at least one dose of the COVID-19 vaccine as of 10 January, PHE said.

Dr Mary Ramsay, head of immunisation at PHE, said: "To have vaccinated over a third of all over-80s by this point in the programme is a great achievement and I want to pay tribute to all those across the health system who have made this happen."

She added: “These data will help us to evaluate the protection from the vaccine and to effectively target the roll out of the programme to help control the virus and save lives."

School Testing

The Guardian reported that the MHRA has not approved lateral flow rapid testing for daily mass use in England's schools.

The paper said there were concerns over false reassurance from negative tests.

Biostatistician Professor Jon Deeks, University of Birmingham, has been critical of the accuracy of the tests and told the Guardian: "This clarification of the unsuitability of lateral flow tests for saying people are not infected with SARS-CoV-2 from the MHRA demonstrates that they are taking their responsibility seriously to ensure that tests are used in a safe way."

Vitamin D Survey

A consultant diabetologist and endocrinologist has launched a global survey into prescribing patterns for vitamin D for COVID-19.

Recent research published in BMJ Open found vitamin D deficiency was more common in Asian (53.7%) and Black (34.9%) people than in White people (12%). Scotland had the highest prevalence of vitamin D deficiency (23.5%).

National Institute for Health and Care Excellence (NICE) guidance in December found no evidence to support vitamin D as a COVID-19 treatment.

However, Professor Edward Jude, Tameside Hospital NHS Foundation Trust,  says: "The COVID-19 pandemic has caused devastation across the globe and the virus seems to be spreading unabated. It has been demonstrated that countries that are most affected are the ones that are in colder climates mainly and it is thought that the population of these countries who are vitamin D deficient may be one of the reasons why the virus is spreading so rampantly."

He says the anonymous survey is designed to understand prescribing patterns but also doctors' personal use of vitamin D. There's a link to the survey here.

Lockdown

Businesses in Wales will have to carry out a specific COVID-19 risk assessment under new legislation. Issues to be considered include adequate ventilation, hygiene, enforcing physical distancing, and use of PPE and face coverings.

ONS social impacts data for Great Britain show 88% of adults support current lockdown measures, up from 78% over Christmas.

People were more likely to stay home, with 90% leaving home for any reason; down from 93% over Christmas.

Fewer people are meeting family or friends in a public place, at 7% compared with 17% over Christmas.

Junior Doctor Rotation

Pausing the junior doctor rotation in London because of COVID-19 pressure is "understandable", BMA junior doctors committee chair Dr Sarah Hallett said on Friday.

"The situation in London is dire and clinical pressures are high. With a large number of juniors ready to rotate we understand the need to act to protect patient safety and the wellbeing of junior doctors," Dr Hallett commented.

There are exemptions for doctors who want to continue with rotation.

COVID Racism

'Structural racism' is playing a role in worse COVID-19 outcomes for ethnic minorities, according to an analysis published in The BMJ.

First author, Dr Mohammad Razai, St George’s, University of London, said: "The impacts of racism and discrimination on health are well established and measures must be taken to address the root causes of these disparities. At the same time, we need to urgently protect ethnic groups most at risk of adverse outcomes from COVID-19.

"Our paper shows the weight of evidence and historical trends demonstrating poorer outcomes for ethnic minority patients. The effects of racism, in particular systemic racism, are still not widely recognised and must be acknowledged by both healthcare professionals and policymakers so that more can be done to redress the balance and reduce these inequalities."

Pneumonia DNA Test

Cambridge researchers have developed a DNA test to quickly identify secondary infections in high pneumonia risk COVID-19 patients.

"Early on in the pandemic we noticed that COVID-19 patients appeared to be particularly at risk of developing secondary pneumonia, and started using a rapid diagnostic test that we had developed for just such a situation," said co-author Dr Andrew Conway Morris from Cambridge’s Department of Medicine and an intensive care consultant.

"Using this test, we found that patients with COVID-19 were twice as likely to develop secondary pneumonia as other patients in the same intensive care unit."

The PCR test detects the DNA of the bacteria in around 4 hours. The research results are given in the journal Critical Care.

Old Age

The pandemic has highlighted health inequalities in old age and urgent action is needed to address this, according to a report from the House of Lords Science and Technology Committee.

Committee Chair, Lord Patel, said: "The Committee found that the Government needs to urgently address the key issues of reducing health inequalities, implementing health system reforms and promoting lifestyle changes."

The International Longevity Centre gave evidence to the committee. Its Director, David Sinclair, commented: "COVID-19 has highlighted the inequalities in ageing. Too many of us are ageing badly.

"The Government’s aim to deliver 5 extra healthy years of life by 2035 is laudable and exciting but completely unachievable without major policy change. We need a major focus on preventative health, not just nice policy words."

Science Scepticism

Former director of public health Professor John Ashton says scientific scepticism may be reinforced by the UK’s rush to be first to approve COVID vaccines.

Writing in the Journal of the Royal Society of Medicine,  Prof Ashton says: "To risk the trust of the public for the sake of a couple of weeks’ propaganda advantage could prove to be unforgivable should vaccine uptake fall below that required for the ubiquitous 'herd immunity' as a result of giving oxygen to the sceptics."

He cautions: "The voices of the anti-vaxxers have found new breath, fuelled by the breakdown of trust between governors and governed, the rise of ‘fake news’ and the amplifying impact of social media."

Meanwhile, the NHS is tackling fake news it says is causing people from ethnic minorities to avoid COVID-19 vaccination.

NHS England anti-disinformation campaigner, Dr Harpreet Sood, told the BBC: "We need to be clear and make people realise there is no meat in the vaccine, there is no pork in the vaccine, it has been accepted and endorsed by all the religious leaders and councils and faith communities."

E-rostering

Digital shift scheduling is coming to 38 NHS trusts in England and it could save you at least 34 minutes a week, DHSC said.

Digital staff passports are also being trialled with training records available on smartphones to help rapid redeployment, such as for the COVID-19 response.

Care Minister Helen Whately said: "E-rostering is a crucial tool to make the most of our dedicated healthcare professionals’ time for looking after patients – something which is needed more than ever during this pandemic.

"Managing shifts more effectively also makes it easier to work flexibly, giving our hardworking clinicians a better work/life balance."

Adapted from Medscape UK.