Covid-19 update: 1 April

Prime minister Boris Johnson heralded Monday as a ‘big day for many of us’ as the easing of restrictions in England meant that outdoor gatherings of either six people or two households are now allowed in England. Rules are different across the UK. In Scotland four people from a maximum of two households can meet socially outdoors. In Wales, rules allow six people from two households to meet outdoors, including in gardens. In Northern Ireland, households can’t currently mix in private gardens, but 10 people from two households can meet in public parks and spaces.

However, Mr Johnson said the country ‘must proceed with caution’. ‘It is great to see that yesterday we recorded the lowest number of new infections for six months, deaths and hospital admissions across the UK are continuing to fall,’ he said on Monday. ‘But that wave is still rising across the channel, and it is inevitable as we advance on this roadmap there will be more infections, and unavoidably more hospitalisations and sadly more deaths.’

While the Sunday figure he pointed to will have been low in line with weekend trends, the seven-day average figures make the same point. Infections are now back at the level they were at in mid-September, when the virus was starting to rise after low levels during the summer. Daily hospital admissions – below 300 across the UK in the latest figures – also reflect mid-September pre-second-wave levels. And there are now just over 4,000 Covid-19 patients in hospital beds, according to the government’s Covid 19 dashboard.

The Office for National Statistics’ also reported a second consecutive week where the number of registered deaths in England and Wales was below the five-year average. Again, it was back in September last year when this was last the case.

However, NHS Providers were also championing a steady-as-she-goes approach to the further easing of restrictions, claiming the country remained in ‘uncharted territory’ with the pandemic. ‘We must not let our guard down, despite the easing of restrictions,’ said its deputy chief executive Saffron Cordery (pictured). ‘Covid-19 cases have not gone away, there are still 532 patients [in England] in hospital requiring mechanical ventilation due to the virus and people are still losing their lives to this disease. We must remain vigilant against new variants of the virus.’

There was further reassuring news about vaccines. The programme in the UK continues to steam ahead. Across the UK, more than 30 million people have now received a first dose of vaccine – representing around 57% of all UK adults. In addition, some 4 million people have had their second doses – around 7% of all adults. Supply issues mean the programme will focus much more on second doses during April.

Vaccine research updates

There are continuing reports about vaccine effectiveness too. Research by University College London found that a single dose of either the Oxford/AstraZeneca or Pfizer vaccines stopped 62% of infections in care homes. The Vivaldi study looked at data from more than 10,000 care home residents in England with an average age of 86. It compared the number of infections in vaccinated and unvaccinated groups. The results showed a single dose was effective at preventing 56% of infections after four weeks, rising to 62% of infections after five weeks. The timing and size of protection was similar for both vaccines.

‘Our findings show that a single dose has a protective effect that persists from four weeks to at least seven weeks after vaccination,’ said UCL Institute of Health Informatics associate professor Laura Shallcross. ‘Vaccination reduces the total number of people who get infected, and analysis of lab samples suggests that care home residents who are infected after having the vaccine may also be less likely to transmit the virus.

‘We can also infer that the vaccines protect against the highly transmissible UK variant, as this was prevalent during the study period,’ she added.

The BBC has also highlighted a growing body of evidence to suggest that the vaccine is having an impact on transmission as well as preventing serious illness. For example, a study of 40,000 health workers in England suggested one dose of the Pfizer/BioNTech vaccine demonstrated effectiveness of 72%, rising to 86% for two doses. The conclusion was that the vaccine effectively prevented both symptomatic and asymptomatic infection in working age adults.

And another study of hospital workers in Cambridge found a 75% decrease in asymptomatic infections after vaccination (12 days or more after vaccination).

The recent concerns about the possible links between the Oxford/AstraZeneca vaccine and reports of a small number of rare blood clots across Europe seemed to have been put to bed by statements from UK and European regulators a fortnight ago. The European Medicines Agency concluded at the time: the benefits of the vaccine outweighed the risk of side effects; the vaccine was not associated with an increase in the overall risk of blood clots; but it may be associated with very rare cases of blood clots to do with thrombocytopenia.

Research was recently undertaken to understand if the small number of rare blood clotting disorders, reported in Norway and Germany, had also been observed in vaccinated individuals in Wales. Results reported this week found no reported cases in the vaccinated population (compared with 19 cases in the 25 months to the end of January this year. The study looked at 440,000 people vaccinated up to the end of January using both of the vaccines currently being administered.

However concerns were reignited when Germany this week suspended routine use of the AstraZeneca vaccine for people aged below 60 after its medical regulator – the Paul Ehrlich Institute – reported that it had now counted 31 cases of sinus vein thrombosis among the 2.7 million people so far vaccinated with this product. The decision was taken by the German vaccine committee – known as Stiko – with further recommendations expected by the end of April about the approach to administering second doses in younger people who have already received a first dose.

The European Medicines Agency is continuing to review these very rare cases and this week repeated its message. ‘A causal link with the vaccine is not proven, but is possible and further analysis is continuing,’ it said. ‘The EMA is of the view that the benefits of the AstraZeneca vaccine in preventing Covid-19, with its associated risk of hospitalisation and death, outweigh the risks of side effects.’

The statement is clear, but could leave as-yet-unvaccinated people convinced of the benefits of vaccination, but with a preference for a different vaccine. And it leaves Europe in the awkward position of criticising AstraZeneca for shortfalls in deliveries, while several constituent countries are restricting its use. The continuing undermining of confidence in the vaccine, despite multiple regulators backing its use, has significant implications. The vaccine is being produced at cost with no profit for AstraZeneca. Its affordability means it is seen as fundamental to the global vaccination programme.

World roll-out

World Trade Organization director-general Ngozi Okonjo-Iweala (pictured) said this week that vaccines had given the world a chance of stopping Covid-19 in its tracks and jump starting the world economy. ‘But this opportunity could be squandered if large numbers of countries and people do not have equal access to vaccines,’ she said.

In an interview with the BBC, the former finance minister for Nigeria and former chair of the global vaccine alliance, Gavi, highlighted AstraZeneca’s deal to transfer its know-how to a mass vaccine manufacturer in India. ‘There is some capacity in developing countries unused now,’ she is reported saying. ‘Let's have the same kind of arrangement that AstraZeneca has with the Serum Institute of India.’ She suggested other vaccine manufacturers should follow this lead.

Meanwhile back in the UK, further concerns were being raised about the impact of the NHS Test and Trace system. The service – which is costing £37bn over two years – was described as having ‘limited’ effectiveness in research published in the British Medical Journal. It found that just one in five people request a Covid test if they have symptoms, only half of those surveyed identified the main symptoms of the virus, and, across all waves of the pandemic, just 43% of people adhered to rules around self-isolation.

A recent report from the Commons Public Accounts Committee acknowledged the service had been set-up and staffed at incredible speed. But it concluded there was ‘still no clear evidence to judge [its] overall effectiveness’. ‘It is unclear whether its specific contribution to reducing infection levels, as opposed to the other measures introduced to tackle the pandemic, has justified its costs,’ it said.

Fewer people continue to test positive for coronavirus, according to the weekly report from NHS Test and Trace. The nearly 37,000 positive tests in the week to 24 March – a 2% reduction on the previous week – means that positive tests have been reducing for 11 weeks now. This is despite major increases in testing in recent weeks due to the return of secondary school students and the use of lateral flow tests.  

(The government also reintroduced confirmatory polymerase chain reaction (PCR) for supervised testing using positive lateral flow test results this week. The Royal Statistical Society recently raised concerns about problems with false positives when the infection prevalence is low. While addressing this issue, the confirmatory testing will also support new genotype assay testing, which will help reduce the time taken to identify virus variants of concern.)

Nearly 31,000 cases were transferred to the contact tracing system in the latest week and 28,000 (91%) were reached. Some 24,000 (86%) of these reached cases identified 95,000 close contacts and 90% of these contacts were reached and asked to self-isolate.

The government will be monitoring the impact of this week’s relaxations on social distancing rules, with further changes scheduled for 12 April. Wales also this week set out next steps in returning the country more to normal. The deadline for the full return of children and students in Wales to face-to-face education has been set for 12 April, when all remaining non-essential retail and close contact services will also be allowed to reopen. Outdoor hospitality could then reopen at the end of the month, with further restrictions lifted in May.

These are all dependent on the public health situation and how the virus develops and spreads over the coming weeks. The NHS Test and Trace service – and the separate services in the other UK nations – will have a major role to play in identifying outbreaks and helping to keep the virus at bay.