UK COVID-19 Update: 'unprecedented pressure', staff jabs, photocall fail

  • Tim Locke, Medscape.com

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

'Unprecedented Pressure'

London's hospitals are on the verge of being overwhelmed by COVID patients even in a ‘best case' scenario, according to a leaked briefing document seen by the Health Service Journal.

England's Health Secretary said this morning: "We’re putting in the extra resources to make sure that the NHS gets the support it needs in the parts of the country where it’s under the most significant pressure."

This, he said, included putting London's Nightingale hospital on standby.

Commenting on the latest NHS England Urgent and Emergency Care Daily Situation Reports data, Siva Anandaciva, chief analyst, The King’s Fund, said: "The NHS is already under unprecedented pressure, but unfortunately the worst is yet to come. In some parts of the country – particularly London – hospitals are already operating at near full capacity even as the demand for care continues to mount. Social distancing measures on wards and the numbers of staff who are ill or self-isolating is making it harder than normal for the NHS to cope with high demand.

“Even before the pandemic, the NHS was in the midst of a staffing crisis and having to make do with poorly-maintained buildings. In the last financial year, the maintenance backlog rocketed by 40% to £9bn and the poor condition of buildings and equipment led to nearly 6000 cases where clinical services for patients were delayed or interfered with.

"This is a symptom of the wider under-investment in health over the past decade, which has seen the NHS going into the pandemic with 100,000 staff vacancies and deteriorating facilities and equipment."

NHS England Chief Executive Sir Simon Stevens told a Downing Street briefing: "We've got 50% more coronavirus in patients in our hospitals now than we had at the peak of the April first wave."

On Wednesday, the Commons voted to approve England's latest lockdown. The legislation allows restrictions to stay in place until the end of March if necessary.

Staff Jabs

NHS England responded to pressure from the BMA and other groups for an "immediate requirement" to vaccinate all frontline healthcare staff against COVID-19 in new operational guidance.

Before the announcement, BMA Chair of Council, Dr Chaand Nagpaul, said on Twitter: "46,378 hospital staff off sick with COVID, while NHS overwhelmed - patient care will continue to suffer unless frontline healthcare workers are urgently vaccinated which are leaving services brutally exposed. Giving all healthcare workers a COVID-19 vaccination could save their lives so they can help save yours."

Doctors' Association UK described the announcement as "brilliant news".

Hancock's Photocall Fail

GPs in England began the main rollout of the Oxford/AstraZeneca vaccine on Thursday with 180 GP-led services due to come online this week.

Matt Hancock arrived to mark this with a photocall at the Bloomsbury Surgery, Camden, North London, only to find the practice had not received its delivery.

GP Ammara Hughes told Sky News: "It's just more frustrating than a concern, because we've got the capacity to vaccinate and if we had a regular supply, we do have the capacity to vaccinate 3000-4000 patients a week."

Cross-party politicians in Birmingham wrote to Matt Hancock saying Pfizer jab supplies are running low and no Oxford jabs have yet been delivered.

Meanwhile, it’s been reported that some patients are expressing a preference for the Oxford vaccine.

Stockton-on-Tees GP Dr Paul Williams said on Twitter: "Some local patients have turned down an offer this weekend of getting a COVID vaccine when they found out it was the Pfizer one. 'I’ll wait for the English one'."

Local vaccination services are being issued with smaller packs of Pfizer/BioNTech jabs for use in care homes. GPs are getting an extra £10 for every care home resident vaccinated this month.

The MHRA issued advice saying that if there's enough of the Oxford vaccine left in a vial after use, an extra full dose can be used.

Prime Minister Boris Johnson said that nearly 1.5 million people across the UK have received their first dose of a coronavirus vaccine.

Pharmacies will also begin to offer the Oxford vaccine next week after some confusion over their role in England. "We are going to see pharmacies playing a really big role in vaccination," said Robbie Turner from the Royal Pharmaceutical Society.

Tocilizumab & Sarilumab 

The REMAP-CAP trial team issued new preprint data on the IL-6 receptor antagonists tocilizumab and sarilumab for hospitalised patients with moderate or severe COVID-19.

In November, the team reported how tocilizumab was likely to improve outcomes but the impact on patient survival and length of time on organ support in ICU was not clear.

The latest analysis shows that tocilizumab and sarilumab reduced mortality by 8.5%.

The drugs will be made available in the NHS with immediate effect.

Professor Anthony Gordon, chair in anaesthesia and critical care, Imperial College London, and ICU consultant, Imperial College Healthcare NHS Trust, said: "This is a significant finding which could have immediate implications for the sickest patients with COVID-19.

"We found that among critically ill adult patients – those receiving breathing support in intensive care – treatment with these drugs can improve their chances of survival and recovery.

"At a time when hospitalisations and deaths from COVID-19 are soaring in the UK, it’s crucial we continue to identify effective treatments which can help to turn the tide against this disease."

England's Deputy Chief Medical Officer Professor Jonathan Van-Tam commented: "This is a significant step forward for increasing survival of patients in intensive care with COVID-19. The data shows that tocilizumab, and likely sarilumab, speed up and improve the odds of recovery in intensive care, which is crucial for helping to relieve pressure on intensive care and hospitals and saving lives."

Martin Landray, professor of medicine and epidemiology, Nuffield Department of Population Health, University of Oxford, commented via the Science Media Centre: "Once again, we are seeing the incredible power of well-conducted randomised trials, delivered by frontline NHS staff at the bedside, to identify which of the many treatments we hope might work actually have real benefits for patients."

The study was posted on medRxiv after this article was published.

Test & Trace

Latest performance data for England's Test and Trace service for the last week of 2020 show a 24% rise in positive cases compared with the previous week.

Of those cases transferred to central contact tracing, 13.9% were not reached and 1.3% hadno communication details provided.

In Thursday's daily data another 52,618 UK positive tests were reported and 1162 deaths.

Another 3600 COVID-19 patients were admitted to hospital taking the total to 30,370, and 2821 ventilator beds are in use.

RCP Conference

The Royal College of Physicians (RCP) started its annual conference virtually on Thursday with a "double or quits" blueprint for expanding medical school places.

It also heard preliminary results from a large review of hospital care during the pandemic.

Around 97% of care for COVID-19 patients was acceptable, good, or excellent. However,   the pandemic appears to have exaggerated variability of care and advance care planning.

RCP Clinical Director for Quality Improvement and Patient Safety, Dr John Dean, said: "My colleagues in the NHS have been faced with unprecedented challenges during the pandemic but the RCP COVID-19 Study shows how almost all care provided has been of the right standard. We can, however, learn from excellent care, and variations in care,  just as we can learn from poor care."

Virus Variant

The World Health Organisation says the UK variant of SARS CoV-2 is likely to become the main type of the virus in circulation and has caused "an alarming situation".

Regional Director for Europe, Dr Hans Kluge, told a news briefing: "This variant is 'of concern' as it has increased transmissibility. So far, we understand there is no significant change to the disease this variant produces, meaning the COVID-19 is not more, nor less, severe. It spreads across all age groups, and children do not appear to be at higher risk. It is our assessment that this variant of concern may, over time, replace other circulating lineages as seen in the United Kingdom, and increasingly in Denmark."

Heart Failure

Heart failure patients should be prioritised for vaccination, according to North Bristol NHS Trust and Bristol Heart Institute researchers behind a study published in ESC Heart Failure.

A study of 283 patients found those with acute heart failure had a nearly double risk of death if they had COVID-19.

Study lead investigator Dr Amardeep Dastidar said in a news release: "Our results support prioritising heart failure patients for COVID-19 vaccination once it is available.

"In the meantime, heart failure patients of all ages should be considered a high-risk group and be advised to maintain social distance and wear a face mask to prevent infection."

Quitting Smoking

A new report from Action on Smoking and Health (ASH) and Cancer Research UK documents how local authority smoking cessation services in England adapted to remote working under lockdown.

As GP referrals fell, some teams got practices to send text messages or phone patients with a history of smoking.

The report concludes that the strengths shown under COVID-19 "must be recognised and valued in the new tobacco control plan for England, promised for July 2021, if the goal of a smokefree England in 2030 is to be achieved".

ASH Director of Policy, Hazel Cheeseman, commented: "During the toughest year for public health in our lifetime councils rose to the challenge, going above and beyond to provide vital support to those wanting to quit smoking. Councils deserve our praise, but they also deserve more funding for public health from Government after years of cuts.”

Eating & Drinking

The unhealthy effects of lockdown are uncovered in University of East Anglia research published in the British Journal of Health Psychology.

Online survey results of more than 1000 people shared in show young people, women and those who are overweight were more likely to adopt unhealthy behaviours. Some of those at greatest risk of COVID-19 had the most unhealthy behaviour changes.

UEA's Dr Felix Naughton said: "One of the most striking things we found was that people were eating around one portion less fruit and veg every day than they were before the pandemic.

"We had expected that people might have been eating more high-calorie sugary foods, but actually we didn’t see any change in the amount of high sugar foods people were eating."

There was a 20% reduction in exercise overall.

Dr Naughton added: "We found that being a key worker, older and male was associated with a greater number of drinks consumed on a typical day’s drinking, and consuming alcohol on a greater number of days was associated with being older and female."

MP's Thanks

Cardiff Labour MP Jo Stevens took to Twitter to thank the NHS staff who cared for her after she was admitted to hospital with COVID-19: "I cannot begin to describe my gratitude to the wonderful people who have cared for me in hospital. They are truly exceptional.

"I feel so fortunate to be back home knowing that for so many families, it has been a very different situation."

Adapted from Medscape UK.