Covid-19 reader: 30 July

Will the third wave overwhelm the NHS?

Nuffield Trust deputy director of research Sarah Scobie blog

Recent data on Covid-19 positive cases, from the government’s Covid-19 dashboard, are hard to interpret. Rapid rises in the first half of July saw daily cases effectively double to nearly 55,000. In contrast, the end of July saw a full week of falling numbers before numbers rose again. However, at over 25,000 cases a day, the figures still look very high compared with those at the beginning of June, which were in the 3,000 to 4,000 range.

Despite a complex picture on case numbers, hospital admissions and even Covid deaths are increasing. In a blog this week, Nuffield Trust deputy director of research Sarah Scobie, asks what this might mean for the NHS, considering both the direct and indirect effects of the virus.

First, she tackles those rising admissions. Covid patients spend a median of seven days in hospital, although this may reduce in this wave as the patient ages reduce. Even so, she says that 38% more beds were occupied by Covid patients on 18 July compared with the previous week. Surveillance data from GP practices, 111 services and A&E all show increasing demand and Covid-related staff absences doubled during June, making service delivery even harder.

In addition to the direct pressures, Ms Scobie (pictured) also looks at knock-on impacts. The waiting list is already at a record high and will be difficult to address while Covid cases remain high. Patients awaiting complex surgery that may need intensive care could be particularly impacted. And with Covid patients typically requiring longer stays in intensive care than surgical patients, each Covid admission could result in several postponed operations.

Primary care is also feeling the heat, as it looks to support those waiting longer for hospital treatment, while also continuing to support the vaccination programme.

Ms Scobie points out that Covid wards are already being reopened and planned operations cancelled and this will become more widespread if hospital cases continue to rise. And for this wave, there will be no lockdowns to help control Covid or other demand pressures. ‘While the NHS will prioritise the most urgent treatment to cope with demand during this Covid wave, this will be at a cost in terms of postponed care and poorer outcomes for many,’ she concludes.

The case for waiving intellectual property on vaccines

World Health Organization director general Tedros Ghebreyesus, July speech

Over 3.5 billion vaccines have been distributed globally, but more than 75% of these have gone to just 10 countries. This startling fact – underlined by WHO director general Tedros Ghebreyesus (pictured) in a speech last week as part of discussions with the World Trade Organization around promoting equitable access to Covid-19 vaccines – has led to a situation where ‘the haves are opening up, while the have-nots are locking down’, he said.

Dr Tedros described vaccine inequity as a moral failure, but said it was also epidemiologically and economically self-defeating. The WHO wants 10% of the population of every country to be vaccinated by September, at least 40% by the end of the year and 70% by the middle of next year. Meeting these milestones is the way to end the pandemic.

However, this will require 11 billion doses of vaccine. And while dose sharing is vital – with the UK starting its own contribution this week – it is only a short-term solution. ‘We need to dramatically scale up the number of vaccines being produced,’ he said. ‘This can be done by removing the barriers to scaling up manufacturing, including through technology transfer, freeing up supply chains, and intellectual property (IP) waivers.’

He acknowledged that the IP system played a vital role in fostering innovation in pharmaceutical companies. ‘But this pandemic is an unprecedented crisis that demands unprecedented action,’ he said. ‘With so many lives on the line, profits and patents must come second.’ He added that this was not an argument to ‘snatch property’. Instead, high income countries should provide incentives to the private sector so they can avoid financial problems because of IP waiver.

This week the UK government began the delivery of nine million Covid-19 vaccines around the world – the first instalment in its promised 100 million vaccines to be donated by June 2022. Four fifths of the 100 million doses will be delivered via the global Covax initiative. Five million of this first instalment will be channelled through Covax, with the remainder shared bilaterally with countries in need.

The donation of vaccines is on the back of £548m of UK funding for Covax since it was set up, although it is vaccine doses that the initiative needs urgently now. The UK was also a major funder of the Oxford/AstraZeneca vaccine, which is being produced on a non-profit basis. More than half a billion doses of the Oxford/AstraZeneca vaccine have been delivered globally, with two-thirds going to lower- and middle-income countries.

Estimating the impact of vaccines

Public Health England, Covid-19 vaccine surveillance report

It is now estimated that Covid-19 vaccines have prevented 22 million infections and 60,000 deaths. The figures for the period up to 23 July are included in the latest Covid-19 vaccine surveillance report from Public Health England and compare with previous estimates up to 9 July of around 37,000 deaths and 11 million infections. Jamie Lopez Barnal, consultant epidemiologist at PHE said the figures showed the vaccine programme was having a ‘remarkable impact’. ‘As cases have increased, the true scale of protection from the vaccine programme has become clear,’ he said. The report also estimates that upto 11 July, based on the direct effect of vaccination and vaccine coverage rates, that around 52,600 hospitalisations have been prevented in those aged 65 and over in England. And with increasing evidence that vaccines prevent infection and transmission, this figure is likely to be an underestimate.