These are the UK coronavirus stories you need to know about today.
Three Tier Lockdown
As expected, England's local lockdowns are being put into three categories: medium, high, and very high alert levels. Currently, Boris Johnson told the Commons, there are "different sets of rules in different parts of the country that are now complex to understand, and to enforce". The new three-tier alert system is designed to simplify things.
'Medium' will cover most of the country with current national measures, including the rule of six, and the 10pm hospitality closing time.
'High' includes areas where local interventions have already been introduced with additional restrictions on household mixing.
'Very high' will apply "where transmission rates are rising most rapidly, and where the NHS could soon be under unbearable pressure".
Liverpool will move into 'very high' from Wednesday, with household mixing banned, and gyms, leisure centres, betting shops, adult gaming centres, and casinos closing.
The PM said he wasn't prepared to "let the virus rip" because "the bleak mathematics dictate that we would suffer not only an intolerable death toll from COVID, we will put such a huge strain on our NHS with an uncontrolled second spike that our doctors and nurses would be simply unable to devote themselves to other treatments for cancer, heart disease, and hundreds more that have already been delayed, and that would be delayed again with serious long-term damage to the health of the nation."
Mr Johnson promised a sunset clause on restrictions and a 4-week review.
Nightingales Mobilised
Three Nightingale hospitals in Manchester, Sunderland, and Harrogate are being prepared for large numbers of COVID-19 patients, Professor Stephen Powis, NHS England medical director, told a Downing Street briefing.
He also committed to regular testing for asymptomatic NHS staff in high-risk areas.
Professor Andrew Goddard, president of the Royal College of Physicians welcomed the testing announcement and said: "This is going to be a very hard winter, but doctors, nurses, and their colleagues stand ready to care for the nation. We all have a responsibility to protect them and the NHS so it can care for all patients, those with COVID-19 and those with other potentially life-threatening conditions."
Also presenting data at the briefing was Professor Jonathan Van-Tam, England's deputy chief medical officer who described a "marked pick-up" in cases, not just in younger age groups, and he warned that more deaths would follow rising cases.
At the weekend the BMA called for additional measures, including a tightening of the rule of six and mandatory face covering use in workplaces, and outdoors when physical distancing isn’t possible.
In Wales, Bangor became the latest place to come under local restrictions. There are 400 COVID-19 cases per 100,000 in the city.
Daily Data
In today's daily data another 13,972 UK positive tests were reported and 50 deaths.
There are 3837 COVID-19 patients in hospital and 442 ventilator beds are in use.
CQC Investigates Pandemic DNACPRs
The Department of Health and Social Care has asked the Care Quality Commission to review how Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were used during the first wave of the pandemic.
The scope is still being finalised but a report is expected early next year.
The CQC's Dr Rosie Benneyworth commented: "Along with partners we have been clear that it is unacceptable for advance care plans, with or without Do Not Attempt Resuscitation (DNAR) form completion, to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need. Through this review we will look to identify and share best practice in this complex area, as well as identifying where decisions may not have been patient-centred and ensuring mistakes are not repeated."
TB Jab
Could the BCG vaccine for TB offer coronavirus protection? University of Exeter Medical School is the UK lead for the international BRACE trial to help find out.
Professor John Campbell from Exeter commented: "BCG has been shown to boost immunity in a generalised way, which may offer some protection against COVID-19. We’re excited to be contributing to the large-scale, international BRACE study where we are seeking to establish whether the BCG vaccine could help protect people who are at risk of COVID-19. If it does, we could save lives by administering or topping up this readily available and cost-effective vaccination."
Kids Under Lockdown
The State of the Nation report into kids' wellbeing under lockdown found children and young people have been worried about friends or family catching coronavirus, catching it themselves, and missing school.
One in every 15 children has low happiness with their health, and there were indications that mental health difficulties have increased for some school-aged children during the pandemic, and there was an increase in psychological distress in older young people.
Private Boost
The Guardian reported private hospital groups have seen a big rise in patients opting to pay for procedures due to the NHS COVID-related backlog.
HCA Healthcare told the paper: "We have seen double the number of self-pay procedures in hip surgeries, ophthalmology (cataracts) and abdominal procedures on last year."
Spire Healthcare's COO John Forrest, said: "The biggest increase in inquiries has come from patients needing orthopaedic, obstetrics/gynaecology and ophthalmology care. These are people often suffering from debilitating conditions who might otherwise have to wait many months for treatment."
Maternity Restrictions
Research for the Association for Improvements in the Maternity Services found 43% of NHS trusts in England continued to impose some restrictions on partners' attendance.
The group's Vice-Chair, Nadia Higson, commented: "We have received many heart-rending calls from people affected by these restrictions, which reveal a lack of flexibility to respond to individual needs and a failure to consider the mental health impact of blanket restrictions. Yet we know some trusts have found ways to accommodate support for women, at least for mothers with specific needs such as severe anxiety, or if English isn’t their first language."
Flu Stocks
GPs have been given new guidance on ordering more flu vaccine doses amid increased demand.
More than 8 million additional doses have been procured which the Department for Health and Social Care said can be accessed once stocks run out.
COVID Honours
The Queen's Birthday Honours were delayed from June to allow for recognition of those at the forefront of the COVID-19 response.
Of the 1495 OBEs, MBEs, and other honours, 14% were from health and social care.
Among those honoured was Dean of The Faculty of Intensive Care Medicine, Dr Alison Pittard.
She coordinated critical care from home early in the pandemic due to a foot injury.
She commented: "I am thrilled to be awarded an OBE. It is such an unexpected honour and one that I will work to uphold the standards of by continuing to champion the fantastic work we do in Intensive Care Medicine in the UK. On a more personal note, a lovely reason to pop open some prosecco."
Bad Joke
The Mail reported on what it called a tasteless joke by England's Health Secretary Matt Hancock.
It claimed that in a Commons bar past the 10pm curfew he said: "The drinks are on me but Public Health England are in charge of payment methodology so I will not be paying anything."
Mr Hancock has denied the claims.
See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.
