Covid-19 update: 18 June

The onward march of the Delta variant, particularly among younger people, was a reminder that the country remains vulnerable despite the success of the vaccination programme. But there was some positive news, with the emergence of a new treatment and research confirming the effectiveness of vaccines against the Delta variant.

Boris Johnson’s widely expected announcement delaying the final stage in the relaxation of restrictions in England until 19 July included details of how the NHS will respond to the Delta variant. According to Public Health England (PHE), new Covid cases are overwhelmingly of the Delta variant – making up 99% of sequenced and genotyped cases across the country.

The prime minister said the vaccination programme would be accelerated, with the second vaccine dose brought forward from 12 to eight weeks after the first to ensure full protection is gained sooner. Those who received a first dose by mid-May will be offered a second by 19 July. All adults in England will be offered a first vaccine by 19 July, affording them some level of protection in the weeks following their jab.

No restrictions from earlier stages of the government plan will be reimposed, but weddings and funerals will no longer be limited to 30 people from 21 June.

Scottish first minister Nicola Sturgeon (pictured) announced a three-week delay to allow more people to be vaccinated. Over-40s are being encouraged to book an earlier appointment for their second dose, if this is currently scheduled more than eight weeks after their first. All areas of Scotland had been due to move to level 0, the lowest level of the country’s five-tier system, from 28 June, but the first minister said reported daily cases were running around 1,000. At the time of the announcement (15 June), there were 137 people in hospital, with 17 in intensive care and two deaths recorded.

A review, to take place next week, will consider if any changes are possible from 28 June. But she downplayed the possibility of this happening. ‘Given the current situation – and the need to get more people fully vaccinated before we ease up further – it is reasonable I think to indicate now that it is unlikely that any part of the country will move down a level from 28 June.

‘Instead, it is more likely that we will opt to maintain restrictions for a further three weeks from 28 June and use that time to vaccinate – with both doses – as many more people as possible.’

The administrations in Northern Ireland and Wales also announced delays. In the former, a number of measures, including increasing the number of people who can gather in homes and outdoors, will now be pushed back to 5 July at the earliest, with a review on 1 July.

Wales first minister Mark Drakeford announced a four-week pause to combat the growth of the Delta variant. Regulations will be reviewed on 15 July, though small changes – including a measure that could increase attendances at wedding and civil partnership receptions, and wakes – have been made.

In England, Mr Johnson said restrictions could be lifted by 5 July if the data shows rapid improvement, but the figures are currently going the wrong way. Across the UK, case numbers have been on the rise in recent weeks, though nowhere near the levels seen during previous waves. There were a little over 11,000 cases on 17 June – on 17 May there were 1,979. On 17June, there were 9,371 cases in England – 2,935 (46%) more than a week ago. The other UK nations have also seen cases rise. Hospital admissions also increased, with more than 1,300 patients admitted in the last week across the UK.

PHE said 806 people were hospitalised with the Delta variant, an increase of 423 since last week, and of the total 527 were unvaccinated and 84 had received both doses.

Though rising, daily deaths remain at a relatively low level, due to the success of therapeutics, the vaccination programme and perhaps the younger profile of the patients contracting the virus – Covid generally appears not to be as severe in younger people.

The Department of Health and Social Care figures on growing case numbers were backed up by findings from the Imperial College London and Ipsos Mori React-1 study. This showed infections have increased 50% since their last report in May. The study, carried out between 20 May and 7 June, covered more than 100,000 people in England, and found rapid increases in infections, which coincided with Delta becoming the dominant variant.

During the study period, there was exponential growth in infections, with a doubling time of 11 days. Prevalence was highest in five to 12, and 18 to 24-year-olds, highlighting the importance of vaccinating young adults to stop the spread.

Decision context

Health and social care secretary Matt Hancock said the report set the context for the decision to delay the further lifting of restrictions.

‘Cases are now rising, but thanks to our incredible vaccination programme and enhanced response package including surge testing, we have the tools to curb the spread of this virus. We all must hold our nerve that little bit longer as our vaccine rollout continues,’ he added.

Mr Hancock confirmed during a speech to the NHS Confederation virtual annual conference on 17 June that all over-18s in England are now able to book their first doses. Confederation policy director Layla McCay (pictured) said that with warnings over a potential winter surge of coronavirus it was essential people book their vaccinations as soon as possible.

‘Vaccines are cutting hospitalisations, deaths and transmission rates from coronavirus, so it is good news that all adults will now be able to book in their first doses, particularly because our members are telling us the people in hospital with Covid-19 now tend to be younger than those in previous waves.’

Later, the Department announced that four in five adults in the UK had received a first dose, with 58% having both.

Vaccines buy time, allowing health services to bear down on the spread of the virus – hence the faith politicians have put in the vaccination programme. New evidence published this week by Public Health England shows that, after two doses, the AstraZeneca vaccine is 92% effective against hospitalisation from the Delta variant, and the Pfizer vaccine 96%.

The Department also continued its policy of targeting areas where cases of the Delta variant are beginning to cause concern. Following additional help for parts of the North West of England last week, this week it announced additional support for Birmingham, Blackpool, much of Cheshire, Liverpool City Region and Warrington, as well as Reigate and Banstead in Surrey.

Measures include surge testing, tracing, isolation support, and maximising vaccine uptake to suppress the variant and break chains of transmission.

On a positive note, a study reported this week that two monoclonal antibodies – antibodies created in a lab – reduced the risk of death in patients with severe Covid and who have not mounted a natural antibody response.

Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, University of Oxford, was joint chief investigator for the trial exploring the use of casirivimab and imdevimab. He said: ‘These results are very exciting. The hope was that by giving a combination of antibodies targeting the SARS-CoV-2 virus we would be able to reduce the worst manifestations of Covid-19.

'There was, however, great uncertainty about the value of antiviral therapies in late-stage Covid-19 disease. It is wonderful to learn that even in advanced Covid-19 disease, targeting the virus can reduce mortality in patients who have failed to mount an antibody response of their own.’

Reinfection risk

We learnt more about the Delta variant, with Public Health England saying there was a low risk of reinfections – its study found there were almost 16,000 possible reinfections in the period from June 2020 to 30 May 2021 out of nearly four million confirmed first infections. There were fewer than 500 probable reinfections, and 53 confirmed reinfections.

PHE’s Covid-19 strategic director Susan Hopkins said it was understandable that people were concerned about whether reinfection was possible. ‘While we know that people can catch viruses more than once, this data currently suggests that the rate of Covid-19 reinfection is low. However, it is important that we do not become complacent about this – it is vital to have both doses of the vaccine and to follow the guidance at all times to reduce your chance of any infection,’ Dr Hopkins added.

Finally, the government courted controversy by deciding that all care home workers in England should be double vaccinated to protect residents. If passed by Parliament, a new law will mean that from October, and a subsequent 16-week grace period, anyone working in a care home registered with the Care Quality Commission must have both doses of a vaccine unless they are medically exempt. The law will cover all staff, including agency workers and volunteers, as well as contractors, hairdressers and beauticians who come into homes.

A further public consultation will be launched in due course on whether to make Covid-19 and flu vaccination a condition of working in health and care settings.

Unite assistant general secretary Gail Cartmail said: ‘Unite strongly opposes forcing any health and social care workers to have a vaccine or risk sacrificing their job. Encouragement, not compulsion is the advice of the World Health Organization for the very good reason that such an approach is shown to work.’

David Fothergill, chair of the Local Government Association community wellbeing board, said it was a complex and sensitive issue, and voluntary uptake of the vaccine should continue to be encouraged. ‘Care providers will find this new requirement challenging,’ he added. ‘The care workforce should also be supported through other measures, such as through increased pay or improved terms and conditions, which could form part of a long-term, sustainable solution for adult social care.’