Covid-19 update: 15 January

The government’s UK Covid-19 vaccines delivery plan, published on Monday, confirmed the target of vaccinating the main priority groups as identified by the Joint Committee on Vaccination and Immunisation. These four groups include care home residents and their carers, health and social care workers, those who are clinically extremely vulnerable and everyone 70 or over.

The further target is then to vaccinate the further five priority groups – everyone 50 or over and anyone over 16 with an underlying health condition – by a more vague ‘spring’ deadline.

On Monday, just over 145,000 people received their first dose of vaccine, with a further nearly 21,000 getting dose two. In total 2.4 million people had received a first dose of vaccine. Subsequent days have seen big increases in the number of vaccinations administered – figures reported on Thursday showed that nearly 280,000 people in in the UK received a first dose on Wednesday.

However, with 12 million people in England in the first four priority groups (15 million across the UK), the programme will need to increase the rate of delivery. To hit its February target, the programme needs to be vaccinating 350,000 people a day, seven days a week. Every shortfall from the required daily average means even higher rates will be needed in the coming weeks.

There has been increasing pressure on the government to step up the pace of the programme, with questions about why the programme was not operating around the clock. In Prime Minister’s Questions this week, prime minister Boris Johnson said 24/7 vaccination centres would be opening ‘as soon as we can’ – following a pilot involving healthcare staff. ‘At the moment the limit is on supply,’ he said. ‘We have a huge network and they are going exceptionally fast. It is thanks to the work of the NHS and to the vaccine taskforce that we have secured more doses per capita than virtually any other country in the world – certainly more than any other country in Europe.’

The Department of Health and Social Care’s plan said that in England, by the end of January, at least 2 million people per week will be vaccinated from 206 active hospital hub sites, 1,200 local vaccination sites, including GP-led centres and community pharmacies, and 50 mass vaccination centres. It said that already 96% of the population is within 10 miles of a vaccine service and by the end of January everyone would be. However there have been reports of some centres being difficult to access for the elderly, with volunteers needed to drive people for their jabs.

Care home push

This week has also seen a push to get care home residents vaccinated using the easier-to-handle Oxford/AstraZeneca vaccine. A letter from NHS England and NHS Improvement primary care medical director Nikita Kanani (pictured) to vaccination sites and clinical commissioning groups highlights that for every 20 vaccinations in care homes, one death is potentially preventable.

It calls on primary care network vaccination services to administer the first dose to care home residents and staff in their older adult car homes by the end of this week wherever possible and by 24 January at the latest. The letter also increases the additional payment paid to vaccination services for care home vaccinations from the previously agreed £10 to £30 for first doses delivered by 17 January and £20 for doses delivered next week. Doses delivered after 24 January and all second doses will attract the £10 fee.

Meanwhile a Public Health England study has found that people infected with Covid-19 in the past are likely to have immunity from the virus for a period. It said that this naturally acquired immunity would provide 83% protection against reinfection compared to people who have not had the disease before and this appeared to last at least five months. However, these people may still be able to transmit the virus to others. The study will continue to assess whether protection may last for longer and will consider the immune response from vaccines later in the year.

Daily reported cases remain extremely high across the UK. Even so Thursday’s 48,682 cases – following several days in the high 40,000s – marks a reduction on last week when there was a daily high of 68,053 reported cases.

The high level of positive cases puts increasing pressure on contact tracing services – identifying those who have been in contact with people who have tested positive and asking them to self-isolate is the main tool outside of the vaccine in stopping transmission. Miriam Deakin, director of policy and strategy at NHS Providers, this week highlighted that while more close contacts had been identified in the most recent week by NHS Test and Trace in England, the number of contacts per case remained low.

Some 388,000 cases were transferred to the English contact tracing system in the week to 6 January, according to its latest report, representing a 44% increase on the previous week. Nearly 87% of these were reached and 78% of these (some 262,000 people) provided details of close contacts. In total they gave details of 737,000 close contacts – fewer than three contacts per person. Just under 93% of these contacts were reached. This percentage remains much higher than earlier in the pandemic thanks to changes in contact procedures. Since November, the person testing positive is asked to inform household members to self-isolate and these are all counted as ‘contacted’ without requiring a separate call from NHS Test and Trace.

For tests in the community, results of just 18% were reported back within 24 hours, which Ms Deakin said still left ‘room for much improvement’.

Self-isolation support

The Department of Health and Social Care heralded the fact that, counting those who tested positive and their close contacts, the service reached a record 1 million people during the week. However, there is continued concern about the level of compliance with requests to self-isolate, with many people facing significant financial hardship if they can’t leave the house and work. The government has set up a support scheme which provides £500 payments to those on low income who are asked to self-isolate and can’t work from home – and this week it extended the scheme until the end of March.

However, there are concerns about difficulties in accessing these payments. The BBC’s Newsnight programme highlighted figures showing that 49% of applicants in Leeds had been turned down. This rose to 70% in Dudley and 77% in Liverpool. It is not clear why cases are failing, but reasons offered included the lack of a valid NHS Test and Trace number. In some areas – Barnsley for example – the council is supplementing government money.

‘The big challenge for many of our families is there are people on low incomes who aren’t on benefits, who still find it a struggle to self-isolate,’ said Barnsley Council leader Stephen Houghton. The government said it had made £50m available, with an additional £20m to come, to ensure local authorities can make payment to people on low incomes who need to self-isolate and was working with local government to understand how the scheme was progressing.

The Department also published an interim evaluation report on the Liverpool Covid-19 community testing pilot this week. The city introduced testing for asymptomatic residents in November and encouraged people to be tested regularly. Between 6 November and 9 December, a quarter of the 500,000 population took up the offer of a lateral flow test, with this rising to 36% adding in those taking a polymerase chain reaction (PCR) test. Nearly 900 individuals were identified as positive using the lateral flow tests and 2,902 via PCR.

Uptake of testing in the most deprived areas was half that in the least deprived areas and yet the highest positivity rates were in the most deprived areas.

Hospital pressures

Pressure on the NHS remains the over-riding concern. NHS Providers chief executive Chris Hopson pointed at the numbers of Covid-19 patients in beds as a good proxy of overall acute hospital pressure. Across England, this rose by 18% over the last week with 32,689 Covid patients in hospital on Wednesday. But he said that the South West was a particular worry, with a 37% increase over the week and a 6% increase over the previous day.

He said it was ‘good news’ that elsewhere daily increases were now at 1% to 2%, compared to the 5%-8% and a few double digit rises being seen last week. And there appeared to be clear signs that the rate of increase in London and the South East was slowing.

But he underlined that these were still ‘eye-watering increases’. ‘We've seen 5,000 new Covid-19 patients in English hospital beds in just a week,’ he said. ‘That's equivalent to 10 hospitals full of new Covid patients in just seven days.’ And since Christmas, Covid patients had effectively doubled in East of England, the South West, London and the South East. ‘Across England as a whole we now have 15,000 more Covid patients in hospitals compared to Christmas day, equivalent to 30 hospitals full of new Covid patients.’

Figures released by NHS England and NHS Improvement showed that staff absence was a particular problem. They revealed that across England, almost 100,000 staff were absent from work with almost 50% linked to Covid-19 related sickness or self-isolation on 6 January.

This will have an inevitable consequence for the ability to meet Covid demand and to continue non-Covid activity. The latest official waiting time statistics, released this week, show that even at the end of November there were 4.46 million patients waiting to start treatment with more than 192,000 waiting more than 52 weeks. And weekly sitrep reports show that many intensive care units are continuing to operate at or close to capacity. Recent pressures will only have worsened this position.

Sarah Scobie, Nuffield Trust deputy director of research, said the NHS was working in a time ‘unlike anything in its history’. ‘The reports from intensive care units and hospitals are sobering with staff under intolerable strain from this deadly wave of the pandemic,’ she said.

She pointed to a clear bottleneck in patients coming into hospitals through ambulance services with thousands of patients forced to wait 12 hours before a bed could be made available. ‘We know there is yet worse to come,’ she said. ‘Hospitals have substantially more Covid-19 patients in hospital than the first wave's peak (almost 50% more), with even urgent cancer operations postponed in the hardest-hit areas. If we do not begin to see case numbers tumble, there is a risk our health service could become a national Covid service for weeks to come.’

There have been reports of cancer operations being postponed in the North West because of a shortage of critical care beds. And University Hospitals Birmingham NHS Foundation Trust’s renal transplantation team announced that it was temporarily suspending its waiting list patients for 14 days and pausing kidney transplantation due to the critical situation with Covid-19 in the area.

The consistent message across the four nations is that, while the vaccination programme offers a way out of the pandemic, right now the country needs to stay focused on observing social restrictions and minimising contacts.

The English government has warned that restrictions will be more tightly policed going forward, although there has been a backlash over the vagueness of some rules – whether people are allowed to travel short distances to take their daily exercise, for example. It has so far resisted any further tightening of restrictions.

However Scotland did tighten rules this week. Weekly cases per 100,000 people have trebled since early December and, although there are some signs that lockdown was starting to have an effect, first minister Nicola Sturgeon said there was no room for complacency.

New measures include stopping click and collect services, takeaways and drinking alcohol in public. ‘Case numbers in Scotland, while we see early signs of optimism that they might be beginning to stabilise are nonetheless far too high,’ she said. ‘The new variant is highly infectious and all of us need to do everything we can to reduce transmission while the vaccination programme picks up pace and does its work.’