Covid-19 update: 17 July
by Steve Brown
17 July 2020
July and August must be a period of intense preparation for a ‘reasonable worst-case scenario’ for this winter which could see a second wave of Covid-19 infections and around 120,000 new coronavirus deaths.
This was the warning from the expert advisory group established by the Academy of Medical Sciences, which was tasked by the government with the job of developing an understanding of what a challenging winter might look like with a combination of Covid-19, bad seasonal flu and cold weather.
Its rapid review identified four challenges. First – that worst case scenario – if the virus’s reproductive rate rises to 1.7 from September, the country could be looking at a peak in hospital admissions and deaths in January/February next year. The modelling suggested this could mean nearly 120,000 deaths (with a range of 25,000 to 250,000) – over double the number in the first wave.
On top of this, the health service would face disruption of health and social care systems arising from Covid related reconfigurations. And it could face a backlog of non-Covid care, while also dealing with a possible influenza epidemic.
The report suggests a number of ways that the risks of this worst-case scenario can be mitigated. Maximising use of remote consultations, stratifying ‘entire healthcare settings into hot and cold areas’ and making use of Nightingale hospitals and private capacity will play a part – and the prime minister Boris Johnson responded to this at the end of the week with his announcement of a further £3bn for the NHS. But the report also calls for the capacity of the test trace and isolate programme to be ‘significantly expanded’.
At Prime Minister’s Questions this week, Labour leader Sir Keir Starmer called on Boris Johnson to confirm that the report’s recommendations would be implement in full and at speed. ‘The reality is this, Trace and Track is not working as promised as it stands today,’ he said. ‘The report makes clear it needs to be significantly expanded to cope with the risks of autumn and winter.’
Responding to a further question about whether the prime minister had read the report, Mr Johnson said he was ‘of course aware of the report’. The Test and Trace system was ’doing fantastic work’ and getting through to the vast majority of people who have the disease. ‘Our Test and Trace system is as good as or better than any other system in the world and will play a vital part in ensuring that we don’t have a second spike this winter,’ he said.
The latest report from the Department of Health and Social Care for its contact tracing service said 3,579 people had their cases transferred to the service between 2 and 8 July, the sixth week for the service that was launched in May. Just under 79% of these people were reached and asked to provide contacts and 78% of these provided details of one or more recent close contacts.
Of the 13,807 contacts identified, 9,811 (71%) were reached and asked to self-isolate. This means that to date 84% of 185,401 close contacts identified have been contacted and asked to self-isolate.
In this most recent week, half of the people tested in the community got their results within 24 hours and 85% within 48 hours. Home tests remain the bigger challenge in terms of turnaround times, with just 70% receiving results within 48 hours of taking a test.
Three quarters of positive tested people were contacted within 24 hours and four out of five of their non-complex contacts were asked to self-isolate within 24 hours of being identified. A separate report highlights that the average turnaround time in NHS pathology laboratories is 12 hours, with 95% being turned around in 24 hours.
NHS Confederation director, Layla McCay (pictured) said the slight improvement in numbers being reached was heartening. ‘But there is still more work to do as the scheme is still not reaching the 80% target for tracing close contacts recommended by SAGE (the Scientific Advisory Group for Emergencies). If more close contacts cannot be reached, it will be far more difficult to maintain safety and protect the NHS.’
She also highlighted continuing problems with test data being made available to local authorities. ‘If increasing the number of close contacts traced is a genuine goal, we would hope to see more transparency, making best use of the expertise of local directors of public health, to help trace and reduce outbreaks and ensure that planning for local lockdowns can be effective and, importantly, fast,’ she added.
Speaking at the end-of-week press briefing, at which Mr Johnson gave details of the £3bn NHS funding boost and set out a new timetable for easing restrictions, NHS Test and Trace chair Dido Harding said the service had come a long way and was getting better every week. ‘Over 30,000 people have given us their feedback and 87% were satisfied or very satisfied with the service,’ she said. ‘And when you get a test in person, you can be confident that you will get the test result the very next day.’
She underlined that coronavirus had not gone, but said it was now under control and the best way to keep it like that was to work locally together. A new ‘contain framework’ sets out how Test and Trace will work with local authorities and Public Health England and others to take action at a local level. Local authorities will be given new powers to close specific premises, cancel events or shut outdoor spaces and draft regulations will enable central government to intervene at a local level where necessary – for example to introduce stay-at-home orders or reduce the maximum size of gatherings.
Ms Harding said NHS Test and Trace would be ready for the winter with a new target to undertake 500,000 tests a day by the end of October, a contact tracing app and more people recruited to contact tracing teams.
Still with testing, health secretary Matt Hancock this week welcomed the initial findings of what has been billed as the country’s largest testing study. Undertaken by Imperial College London in conjunction with Ipsos Mori, the Real-time Assessment of Community Transmission (REACT-1) programme was commissioned by the Department and tested more than 120,000 volunteers in May to explore levels of infection in the general population in England. It found on average 13 positive cases for every 10,000 people, with an overall reproduction number of 0.57 – lower than previously reported. This suggests the virus was declining in May before lockdown measures were eased.
According to the findings, young adults, aged 18-24, were more likely to test positive than other age groups. People of Asian ethnicity were more likely to test positive than those of white ethnicity. And care home and health care staff were more likely to be infected during lockdown than the general population. The study has been upscaled and repeated for June, with a report expected within weeks and a second part of the programme (REACT-2) Is assessing different antibody tests, which can identify when someone has been infected in the past.
As part of the resumption of more normal services, NHS England and NHS Improvement wrote to GPs and commissioners at the end of last week to set out revisions to contracting and income protection arrangements. While remote triage and online consultations should continue, face-to-face care should also be delivered where clinically appropriate. ‘No practice should be communicating to patients that their premises are closed,’ the letter said. ‘Nor should they be redirecting patients to other parts of the system, except where clinically assessed as appropriate.’
Quality and outcomes framework (QOF) requirements for 2020/21 are being changed and practices will be asked to gear up for a major expansion of the winter flu programme and to focus on early cancer diagnosis and care of people with a learning disability. Practices will also be offered income protection on other indicators, subject to delivery of some simplified requirements in terms of care for those most at risk from coronavirus and those with long-term conditions.
‘By guaranteeing financial support and temporarily reducing the current QOF requirements, we are releasing capacity in general practice to focus on Covid recovery – and support those patients most in need of long-term condition management support,’ the letter said. A number of activities that practices had been given permission to deprioritise – including over-75 health checks – should now be resumed.
The HFMA recently highlighted the need to address underfunding in social care if real system working is to be achieved. And further calls were made this week to address local government budgets and recognise the interdependency of health and social care services. In a joint statement, NHS Providers and accountancy body CIPFA said that policy needed to be more joined-up and the whole health and social care system needed to be put on a sustainable footing.
‘Policy decisions about NHS funding must take into account the impact on social care, and vice versa,’ the statement said. ‘If local authorities do not receive adequate funding from government to balance their books, they may be forced to retender critical community and public health services at a time when frontline staff should not face uncertainty, and when those very services are critical for the population and a robust health and care response in the pandemic.’