Covid-19 reader: 10 September

by Steve Brown

10 September 2021

Vaccination has weakened the link between infection and hospitalisation, but a careful eye is being kept on the numbers. Meanwhile should all health and care staff be required to be vaccinated? And evidence is published of the pandemic’s unequal regional impact. All in this week’s suggested reading.

Reading the numbers

Government/Office for National Statistics, coronavirus dashboard/report

COVID-19 landscape web banner_293x178For many people life has returned to something approaching normal. Social lives have restarted. Football grounds are full. And for many people furlough has come to an end and there has even been a return to workplace working. But the coronavirus is still here and cases are rising. The latest seven-day average shows that nearly 39,000 cases are being reported each day – that is a 15% increase in a week.

However, positive cases are part of ‘living with the virus’. The key indicator to watch is how cases are translating into hospitalisations. Here the latest seven-day average is 964 admissions per day, which represents just a 2.9% increase over the week. So, there is an increase, but nowhere near the same magnitude.

However, deaths within 28 days of a positive test have jumped more significantly over the course of seven days. The 921 deaths reported in the latest week represent an increase of nearly 19%. However, the size of this increase may well still reflect delayed reporting of deaths over the bank holiday period.

The Office for National Statistics this week reported that the 11,666 deaths from all causes across the UK in the week to 27 August (before the bank holiday) were 1,251 more than the five-year average. Of these, 769 involved Covid-19, which was a nearly 18% increase on the previous week. With schools returning and the distorting effect of bank holiday reporting receding, all eyes will be on the key statistics of hospitalisation and deaths over coming weeks.


Should compulsory vaccination be introduced for all health and care staff?

Department of Health and Social Care, consultation

The government this week opened a consultation on whether to make it compulsory for NHS and care workers to have both Covid-19 and flu jabs. It has already brought in regulations that, from 11 November, will require all those aged 18 or over working or volunteering in a care home to prove they have been vaccinated or to demonstrate they are exempt. The new proposals would harmonise arrangements for all health and care staff and extend the ‘condition of deployment’ approach to health and care staff in other settings.DoB_shutterstock_Covidvacc_landscape

The arguments for the mandatory approach centre on providing protection for staff and patients/residents and having a consistent approach across the different sectors. There is good evidence that the vaccines provide protection against infection – and uninfected individuals cannot transmit the virus. Vaccines may also help to reduce transmission because even when people get infected, they may be ill for less time or have a reduced level of viral shedding.

Flu vaccination has been recommended for decades. And while flu is itself dangerous for those in clinical risk groups, there is particular concern right now. People infected with both flu and Covid-19 are more than twice as likely to die as someone with Covid alone.

Some may be surprised by the potential compulsory approach given Covid-19 vaccination uptake is already good across the sectors. In the NHS, 92% of NHS trust staff have received one dose, with all regions above 90% apart from London at 86%. Overall, 88% of staff have had both doses. At the organisational level, uptake of a first dose ranges from 83% to 97%, but is above 90% for more than three-quarters of trusts. The range for both doses is from 78% to 94%.

Vaccination uptake among primary care workers stands at 87% for a first dose, with a greater level of regional disparity.

For care workers, 91% of carers in homes for older adults have taken up the vaccination, falling to 87% in younger adult care homes, 81% for domiciliary care staff and 75% in other settings.

Vaccination of healthcare staff against flu has increased significantly in the last 20 years – reaching nearly 77% last year. However, uptake ranges from 53% to 100% at the trust level. And in GP practices and independent healthcare providers, uptake stretches from 61% to 93%. In social care, latest figures show just 33% of staff are confirmed as immunised – although the immunisation status is not known for a third of staff.

Saffron Cordery, deputy chief executive of NHS Providers, said the mandatory vaccination of staff raised complex employment, legal, ethical and practical questions. She pointed out that uptake among healthcare staff was higher than in the general population – a position trusts had worked hard to achieve by supporting staff who were hesitant about having the vaccine.

While there were wide ranging views on taking a mandatory approach, she said there were alternatives including making vaccination a condition of employment for new entrants rather than retrospectively imposing it for all existing employees. ‘Should the government choose to proceed, it will need to fully consider the consequences of mandatory vaccinations, including the potential impact on trusts for suspending and dismissing staff who refuse to be vaccinated, redeploying them away from the frontline, at a time when the NHS already has significant staff shortages,’ she said.  

And Matthew Taylor, NHS Confederation chief executive, said the detail of the proposals needed to be understood. ‘But the focus must remain on increasing vaccine confidence and the approach taken to date to encourage uptake through informed consent remains the preferred option.’


Evidence of an unequal pandemic

Northern Health Science Alliance, report

People living in the north of England were more likely to die from Covid-19, spent nearly a month-and-a-half more in lockdowns, suffered worse mental health and were made poorer than the rest of England during the first year of the pandemic, a new report has claimed.

A year of Covid-19 in the North: regional health inequalities in health and economic outcomes – published by the Northern Health Science Alliance, Policy@Manchester and the northern National Institute for Health Research – said that the mortality rate due to Covid was 17% higher in the North than the rest of England, while the mortality rate due to all causes was 14% higher.

About half of the increased Covid-19 mortality in the north and two-thirds of the increased all-cause mortality were linked by the researchers to potentially preventable higher deprivation and worse pre-pandemic health. The North’s care home Covid mortality was 26% higher than the rest of England and 10% more hospital beds were occupied by Covid patients.

The report also highlighted larger reductions in elective activity in the region as a result of Covid than across the rest of the country.

On average people in the North had 41 more days of the harshest restrictions than people across the rest of England. And the region also saw a bigger increase in minor psychiatric disorders such as anxiety and depression. Wages were already lower than in the wider country before the pandemic, but these fell further during Covid, while wages actually increased elsewhere. And the unemployment rate in the North was 19% higher than the rest of England.

Clare Bambra, a professor at Newcastle University, said the report showed that regional health inequalities had resulted in an unequal pandemic. ‘The government’s levelling up agenda needs to seriously address health inequalities in the North – for all generations,’ she said.