UK COVID-19 Update: Scotland's 5 levels, lockdown confusion

  • Tim Locke, Medscape.com

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

Scotland's 5 Levels

Scotland has announced a new five level lockdown system from 2 November.

It starts at Level 0, which First Minister Nicola Sturgeon called "the closest to normality we can safely get to without more effective treatments for COVID or a vaccine against COVID".

Levels 1, 2 and 3 will be broadly equivalent to those in England.

Level 4 indicates the NHS is at risk of being overwhelmed.

Wales is beginning its 17-day national firebreak lockdown, and more areas of England start new tiers of restrictions this weekend. Warrington is to enter Tier 3.

Lockdown Confusion

UCL's continuing COVID-19 Social Study suggests that despite efforts to simplify measures, many people are still confused about the restrictions.

  • In England, 13% of people in England feel they ‘fully understand’ the current rules, while 51% understand ‘the majority’ of the rules

  • In Wales, 15% ‘fully understand’ and 62% understand ‘the majority’ of the rules

  • In Scotland, 15% ‘fully understand’ and 66% understand ‘the majority’ of the rules

Lead author, Dr Daisy Fancourt, commented: "Levels of understanding around what is and isn’t allowed under current lockdown restrictions have dropped markedly since nationwide ‘strict lockdown’ has ended. This issue may well also be exacerbated by the newly introduced system of tiers in England and the differing policies of the devolved nations.

"As well as this potentially leading to people breaking rules they don’t fully understand, confusing messages or unclear communication could result in people disengaging from trying to keep abreast of restrictions, which could well lead to lower compliance in the long-term."

Latest Office for National Statistics social impact data show 17% of those in a local lockdown area said they had not met up indoors with anyone, compared with 11% not under local lockdown.

Meanwhile, an Edinburgh University analysis of global data published in The Lancet Infectious Diseases found changes in lockdown measures took 1-3 weeks to affect R.

Professor Harish Nair from Edinburgh commented: "We found that combining different measures showed the greatest effect on reducing the transmission of COVID-19. As we experience a resurgence of the virus, policymakers will need to consider combinations of measures to reduce the R number. Our study can inform decisions on which measures to introduce or lift, and when to expect to see their effects, but this will also depend on the local context – the R number at any given time, the local healthcare capacity, and the social and economic impact of measures."

Latest Data

The UK's R number has gone down to 1.2-1.4 this week from 1.3-1.5 last week.

The growth rate is +3% to +6% per day.

Office for National Statistics (ONS) data show deaths in September were above the 5-year average, but COVID-19 did not appear in the top 10 causes of death in England or Wales.

Dementia was the leading cause of death. COVID-19 was in 19th place in England, and 24th place in Wales.

The weekly infection survey data show increasing infections.

An estimated 433,300 people in the community population in England had the coronavirus between 10 to 16 October, equating to around 1 in 130 people.

There were estimated to be 6.46 new COVID-19 infections per day for every 10,000 people in England, equating to around 35,200 new cases per day.

  • In Wales 16,700 people had COVID-19, equating to 1 in 180 people.

  • In Scotland 0.57% of people were estimated to have had COVID-19 which is about 1 in 180 people.

  • In Northern Ireland, 1.01% were estimated to have had COVID-19, which is around 1 in 100 people.

Heather Bovill from ONS commented: "The level of COVID-19 infections has increased in Wales and in all the regions within England apart from the South West. Within England, whilst young adults and older teenagers continue to have the highest levels of infections, there are increases in all age groups including the over 70s."

In Friday's daily data another 20,530 UK positive tests were reported and 224 deaths.

There are 7706 COVID-19 patients in hospital and 707 ventilator beds are in use.

Convalescent Plasma 

NHS Blood and Transplant is involved in one of the world's biggest COVID-19 convalescent plasma trials.

However, randomised research in India published in The BMJ found that after 28 days, 19% of participants in a plasma intervention group and 18% in the control group progressed to severe disease or died from any cause.

They concluded that "convalescent plasma showed limited effectiveness" for moderate COVID-19. They suggest that future research could explore using plasma with high levels of neutralising antibodies.

Prof Martin Landray, Professor of Medicine & Epidemiology, Nuffield Department of Population Health, University of Oxford and co-lead, RECOVERY trial, said the Indian trial was too small to give clear results, and: "Here in the UK, the RECOVERY trial is studying this important question at over 120 NHS hospitals across the country. The NHS Blood Transfusion Service is collecting convalescent plasma from people who have had coronavirus. The convalescent plasma is then tested and those units with the highest levels of antibodies are then used as part of the trial. Over 1900 patients have taken part in this particular part of the study so far and we continue to enrol patients in order to ensure that we get clear answers that will give doctors the information they need to treat future patients. We anticipate answers will become available within the next few months."

Elderly People's Cancer Symptoms

A survey for Cancer Research UK of 1000 GPs found 53% said fewer older adults are contacting them with possible cancer symptoms than before the pandemic.

Some improvements were seen with 62% seeing fewer older patients for cancer in June compared to 29% in September.

The charity's GP adviser, Dr Richard Roope, commented: "I’m really concerned that less of my older patients are contacting the surgery and it’s worrying that colleagues across the UK are reporting this too. GP surgeries and hospitals are changing the way they do things to help keep patients and staff safe and people should be reassured that it’s safe to visit them. The first contact is likely to be by phone, and where appropriate a face to face will follow."

Separately, the Patients Association called for continuing NHS care for all during the second wave.

Chief Executive Rachel Power said: "Patients have told us about the toll taken on them by not just COVID-19 itself, but also the emergency response earlier this year – both lockdown, and the drastic changes to NHS services. For many, it amounted to a rupture of their relationship with the NHS.

"As a nation, we can’t afford for this situation to get worse in the second wave."

Flu Jabs

Special authorisation has been given by the MHRA for the UK to buy stocks of the alternative Flublok flu vaccine from Sanofi to boost supplies.

"Flublok has been in regular use in the United States – and the evidence shows that it is an excellent product," England's Deputy Chief Medical Officer Jonathan Van Tam said.

"I want to reassure everyone that all vaccines have undergone robust clinical trials and rigorous checks by the regulator to ensure they are safe, effective and of a high quality."

Smoking Down, Alcohol Use Up

Lockdown saw trends in two unhealthy habits go in different directions, according to UCL research involving 1674 adults published in Addiction.

The percentage of people who reported stopping smoking more than doubled from 4.1% before lockdown to 8.8% in April.

However, high-risk drinking rose from 25.1% before lockdown to 38.3%.

Sewage Testing

Success has been reported in pilots of testing sewage water for traces of coronavirus to help detect local outbreaks.

In the South West of England, sewage sampling data showed a spike in coronavirus material despite relatively low numbers of people seeking tests.

Sewage testing has been expanded to more than 90 treatment sites with more to follow.

Dr Davey Jones, professor of soil & environmental science at Bangor University, said in a news release: "We showed that viral levels in wastewater mapped really well onto the success of lockdown measures in the first COVID-19 wave and to the emergence of the second wave."

Political Fallout

Will politicians be punished or rewarded for their response to COVID-19? Analysis of survey data from the UK, US, and India, published in the online journal BMJ Global Health , suggests neither.

The authors write that: "Politicians are unlikely to be punished or rewarded for their failures or successes in managing COVID‐19 in the next election."

They add: "It is not clear, for example, that the depression in life expectancies in the US, the continuing underperformance of the NHS in the UK, and the low‐level of public sector health expenditure in India has had much impact on elections in those countries."

However, the researchers acknowledge they recruited fewer people than they’d hoped in the UK, and that the surveys they undertook were carried out some time before elections were expected.

And Another Thing

The UK's bird flu alert level has been raised from low to medium after confirmed avian flu cases in swans in the Netherlands.

A statement from the UK’s four Chief Veterinary Officers said: "Following two confirmed cases of H5N8 avian influenza in the Netherlands we have raised the risk level for incursion to the UK from migratory birds to medium ahead of the winter migration season. The risk of the disease being introduced to poultry farms in the UK remains low."

Adapted from Medscape UK.