Covid-19 update: 12 March

Monday marked the first date in the government’s roadmap out of lockdown in England – with children returning to school. There are also encouraging signs both from the vaccination programme and in terms of falling infections and hospitalisations.

However, England’s chief medical officer Chris Whitty told the Commons Science and Technology Select Committee that modelling showed there would be another surge in the virus and that opening up too soon could lead to a more serious third wave.

‘What we are going to see, as things open up – what all the modelling suggests – is that at some point we will get a surge of the virus,’ he told the MPs. ‘And whether that happens, we hope it doesn't happen soon, it might for example happen later in the summer as we open up gradually or, if there is a seasonal effect, it might happen later in autumn or in the winter, there will be a further surge. And that will find the people who have either not been vaccinated or where the vaccine has not worked and some of them will end up in hospital and some of them will sadly go on to die. That is the reality of where we are.’

While some Conservative backbench MPs have been calling for the end to lockdown to be accelerated, Professor Whitty (pictured below) stressed that vaccines were not 100% effective. Vaccinations are rightly providing some protection to the elderly – those most at risk of severe illness and death. But younger people, who are at the end of the vaccination priority list, are the main drivers for transmission of the virus. Increased prevalence among this group would spread to the older population and could still produce significant deaths.

Minutes from a February meeting of the Scientific Advisory Group for Emergencies (Sage) underlined how even a successful vaccination programme would leave large sections of the population vulnerable.

‘A vaccine with efficacy of 85% against severe disease, with an uptake of 79%, would protect 67% of adults from severe disease,’ the group said, as an example. ‘Population level protection would be lower (adults make up 77% of the population), and protection against infection is likely to be lower than protection against disease.’

In Wales – where more than 1 million people or four in 10 adults have now received a first dose of vaccine – the government’s Technical Advisory Group has also highlighted the need to be cautious in loosening restrictions. ‘The modelling results suggest a third and fourth wave of the pandemic is likely if mixing increases,’ an update said.

The government’s Covid dashboard continues to show an improving position across the UK. A seven-day average of around 5,800 positive test results per day is back at the levels being reported in mid-September. Daily reported deaths are also continuing to fall. And there are increasing signs of reducing pressure on hospitals. Daily admissions as of last weekend stood at 532 – back at the levels seen in early October. And there are now fewer than 9,000 Covid patients in hospital. This level of inpatients was again last seen in October.

Vaccination progress

The bumper deliveries of vaccines promised by health secretary Matt Hancock for March have yet to materialise with daily first doses early in the week around the 200,000 mark (rising to 300,000 including second doses). This compares with some days in recent weeks when more than 500,000 doses have been delivered. However, those aged 56 and over in England were invited to book appointments this week and Mr Hancock said that two in every five adults in England had now received at least one vaccine.

The health secretary also accepted a recommendation from the Joint Committee on Vaccination and Immunisation to prioritise homeless people and rough sleepers for vaccination as part of the current first phase of the programme.

Speaking to a summit on global Covid-19 vaccine supply this week, Mr Hancock said he was proud of the decision the Oxford/AstraZeneca vaccine manufacturers to make the vaccine available at cost. ‘I encourage other manufacturers to follow suit,’ he said. ‘The Oxford/AstraZeneca vaccine is a gift to the world – and we want to see it used wherever it can save lives. We in the UK have licensed 100 million doses to protect our population, but billions of doses of the Oxford vaccine will be the mainstay of global access.’

However, a number of European countries this week suspended use of the Oxford/Astra Zeneca vaccine – or at least the use of one batch of the vaccine – after reports of blood clots forming in some people who had received the jab. The European Medicines Agency said there was currently no indication that vaccination had caused these conditions. Current information suggests that the number of thromboembolic events in vaccinated people is no higher than that seen in the general population, it said. And as of 9 March, 22 cases of thromboembolic events had been reported among the 3 million people receiving this vaccine in the European Economic Area.

Phil Bryan, vaccines safety lead at the Medicines and Healthcare Products Regulatory Agency, also underlined that the temporary suspensions of use of the vaccine by Danish, Norwegian and Icelandic authorities was a precaution while they investigate. ‘Blood clots can occur naturally and are not uncommon,’ he said. ‘More than 11 million doses of the Covid-19 AstraZeneca vaccine have now been administered across the UK.’ He also repeated the fact that the reports of blood clots were no greater than the number that would have occurred naturally in the vaccinated population.

Lateral thinking

There has been a renewed focus on the accuracy of lateral flow tests recently, particularly as they feature heavily in the reopening of schools. The Department of Health and Social Care this week highlighted new analysis of community testing data that showed the quick-result tests to have a specificity of at least 99.9%. ‘Real life scenarios suggest they are at least 99.9% specific, which means that the risk of false positives is extremely low – less than one in a thousand – which is a very good test,’ said Susan Hopkins Public Health England Covid-19 strategic response director.

In fact, the usual concern about lateral flow tests is false negatives – reassuring people that they are fine, when in fact they are infected. This is why the tests are often described as ‘red light’ tests rather than ‘green light’ – a positive result means you have the virus and should act accordingly; a negative result doesn’t necessarily mean you are virus-free. But the Royal Statistical Society has said that when infection prevalence is low, there is also a risk that the majority of positive tests could be false positives.

A statement from the society includes a clear explanation and diagram showing how the numbers work out. It suggests replacing one lateral test for a third of a school’s pupils in one week with a lab-processed polymerase chain reaction (PCR) test. This would help gather new intelligence on lateral flow versus PCR test performance for secondary school pupils without adding to pupils’ test burden, it said.

PAC report

In general though, it was a difficult week for NHS Test and Trace as the Commons Public Accounts Committee heaped criticism on the service, which is receiving funding of £37bn over two years. ‘Despite the unimaginable resources thrown at this project, Test and Trace cannot point to a measurable difference to the progress of the pandemic, and the promise on which this huge expense was justified – avoiding another lockdown – has been broken, twice,’ said committee chair Meg Hillier (pictured).

The committee called for the service to publish a ‘cough to contact’ metric as part of its weekly statistics. This would show how well the service measured up to the Sage calls for contacts to be reached within 48-72 hours of the original case developing symptoms. The MPs’ report also called for the service to reduce its dependence on expensive consultants (see MPs call for test and trace improvements).

The Independent Sage group of scientists, the unofficial advisory body, called for an urgent rethink to the test and trace system. ‘We know Covid-19 is not simply going to vanish and I’m afraid without a fully functioning system in place we will once again be forced into using the blunt instrument of lockdowns in the future,’ said Independent Sage chair David King. ’We can only hope this report acts as a wake-up call for the government and urge them to act now, put public health professionals in charge, and give us a fit for purpose system before it’s too late.’

However, there was some support for the much-criticised service. Former NHS trust chairman and well-known NHS commentator Roy Lilley argued that NHS Test and Trace was in fact a ‘massive management success’, which had started from scratch and inherited a ‘ropey’ set-up by the Department. What was actually needed was better communications from the government about how the system had stabilised and was running well, he said.

In the week to 3 March, NHS Test and Trace reported that 45,229 people tested positive for coronavirus – a 34% decrease on the previous week, despite an 11% increase in tests undertaken. Nearly 45,000 cases were transferred to the contact tracing system and just over 39,000 of these were reached (89%). Three quarters of these reached cases provided details of 99,000 close contacts and 91% of these contacts were reached by the service.

Results for nearly nine out of 10 in-person tests taken in the community were delivered within 24 hours. Results of nearly a third of tests from all routes were received within 24 hours.

Meanwhile in Wales, health minister Vaughan Gething (pictured) announced an extra £50m – on top of a previously announced £10m – to extend contact tracing over the summer. He also said that close contacts of positive-tested cases, who have been asked to isolate, would also now be offered a coronavirus test – at the start of their self-isolation period and again on day 8.

‘Although new case numbers have responded well to the current lockdown restrictions, there are significant uncertainties around the trajectory of the pandemic, which means it is highly likely we will need to maintain a substantial contact tracing operation for the foreseeable future,’ the minister said. ‘Even with the roll-out of the vaccination programme, testing and tracing will remain a vital part of our approach as lockdown restrictions ease and to tackle any new variants as people arrive from overseas.’

In England, performance statistics provided a stark view of the recovery challenge facing the NHS. At the end of January there were 4.6 million patients on the waiting list, with 304,000 of these having waited more than a year to start treatment. This compares with just 1,643 waiting more than a year in January 2020. There are also concerns about a hidden waiting list with referrals increasing as the service returns more to normal service delivery. Attendances at accident and emergency departments and admissions through A&E continue to lag behind the levels a year ago.

Saffron Cordery, deputy chief executive of NHS Providers, said the figures revealed ‘the incredibly steep mountain’ the NHS faced in clearing the backlog of care built up during the pandemic. ‘We know these pressures are reflected across both physical and mental health services, whether delivered within a hospital, in the community or in people’s own homes,’ she said.  ‘It is testament to the incredibly hard work of trusts and their dedicated staff that throughout January and February, they continued to carry out more consultations, operations, diagnostic tests, and cancer treatments than in the first wave, despite there being far more Covid-19 patients in hospitals across the country.’

She added that the lack of agreement on the NHS budget for next year was undermining trust leaders’ ability to plan frontline services, including addressing the care backlog.  

‘Talks between the Treasury and the NHS need to go up a gear and must be concluded this week,’ she said (see NHS has ‘expectation’ of increased Covid funds). ‘If they aren’t, there is a very real risk that trust leaders may have to start planning cuts of up to £7 billion - £8 billion from NHS services from 1 April for the first half of 2021/22.’