Covid-19 update: 21 May

by Steve Brown

21 May 2021

As lockdown restrictions were eased across England, Wales and Scotland this week – and with changes due in Northern Ireland on Monday – all eyes were on the rising numbers of the B.1.617.2 variant of the Covid-19 virus. Further opening up of society is likely to be dependent on how easily the virus transmits and whether existing vaccines protect against infections and severe illness.

More than 3,400 cases of the variant – the most concerning of three variants first discovered in India – have now been detected across the UK, according to the latest update from Public Health England. There are so far no firm figures for how transmissible it is relative to the current dominant strain in the UK – B.1.1.7, the ‘Kent’ variant. However the government’s Scientific Advisory Group for Emergencies (Sage) said last week that there was a ‘realistic possibility that it is as much as 50% more transmissible’. If this was the case, modelling suggests there could be a resurgence of hospitalisations ‘similar to, or larger than, previous peaks’.HFMA Covid-19

Health secretary Matt Hancock told a Wednesday briefing that there was ‘increasing confidence’ that the vaccines were effective against the variant. And this was reaffirmed on Thursday by World Health Organization regional director for Europe Hans Kluge, who said that ‘all Covid-19 virus variants that have emerged so far do respond to the available approved vaccines’.

In the UK, vaccination and surge testing are the main responses to outbreaks of the so-called ‘Indian’ variant in hotspots around the country. More than 14,000 vaccines were administered in Blackburn and Bolton between Friday and Wednesday alongside 75,000 extra tests.

The health secretary added that the government was now using two further tools to help identify outbreaks early. These include travel patterns, helping to decide where the virus is at risk of spreading, and wastewater analysis, which is now undertaken across 70% of the country.

As a result, six other areas were now being targeted with surge testing and increased vaccinations, including: Bedford, Burnley, Leicester, Kirklees, North Tyneside and Hounslow. The Scottish government is taking similar action in Glasgow and Moray.

However, while the government talked up the UK’s ‘sensitive biosecurity surveillance system’, the BBC said it had seen a report claiming failures in England’s Test and Trace system were partly responsible for the surge in the Indian variant in Blackburn with Darwen. The council was one of eight local authorities provided with details of a limited number of positive cases over a three-week period in April and May, meaning contacts were not traced.

According to the BBC, the report said the spread of the variant may be ‘partially or largely attributable to risks in the international travel control system’ and this was ‘exacerbated by the sporadic failure of the national Test and Trace system’.

Second dose acceleration

The health secretary got poetic as he referred to replacing the ‘shield of restrictions with the sword of our vaccination programme’. Some 70% of the adult population in the UK has now had their first dose of vaccine, with 40% having received both doses, and the government is now looking to get more people fully protected.

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To mitigate the impact of the B.1.617.2 variant, the Joint Committee on Vaccination and Immunisation (JCVI) has advised that the gap between doses for those over 50 should he shortened from 12 to eight weeks. NHS medical director for primary care Nikki Kanani (pictured) wrote to NHS leaders at the weekend setting out the actions now required by this change to the programme.  A frequently asked questions document on the second dose programmed has also been updated, clarifying that the recommended dosage interval is now eight to nine weeks (56-63 days) for people in priority cohorts 1-9 and 11-12 weeks (77-84 days) for people in cohorts 10 onwards.

Mr Hancock also praised Oxford University and AstraZeneca for the ‘gift to the world’ of their vaccine. The decision to deliver this vaccine ‘at cost’ meant that the UK had ‘probably done more than any other nation to help vaccinate the world’s poorest’. More than 400 million of the 1.5 billion vaccines delivered across the world have been Oxford/AstraZeneca and it had been used in 160 countries – with 170 million doses being used in India alone. And of the 67 million doses delivered through the international Covax programme, 65 million have been Oxford/AstraZeneca.

Public Health England also highlighted new analysis that for the first time estimates that two doses of the Oxford/AstraZeneca vaccine provide around 85% to 90% protection against symptomatic disease. It also estimated that some 13,000 deaths had been averted by the overall vaccine programme in people aged 60 or over in England and this was likely to be an underestimate as it only took into account the direct effects of vaccination.

On a global level, World Health Organization director general Tedros Ghebreyesus again highlighted the disparity in access to vaccines. The fact is that high income countries account for 15% of the world’s population, but have 45% of the world’s vaccines. And this represented a form of ‘vaccine apartheid’. In a speech to Commonwealth health ministers, he said the Covax programme had helped, but the more than 6o million doses shipped to 124 countries covered just 0.5% of the combined population of those countries. ‘The problem is not getting vaccines out of Covax,’ he said. ‘The problem is getting them in.’

In further vaccine news, details were unveiled this week of the world’s first Covid-19 vaccine booster study in the UK. The Cov-Boost clinical trial will see thousands of volunteers receiving booster jabs. It will look at seven different vaccines as potential boosters, given at least 10 -12 weeks after a second dose. Initial results are expected in September and will inform plans for a booster programme.

Although there are concerns about the B.1.617.2 variant, in general the government’s Covid-19 dashboard shows the virus remains at a relatively low level – with a seven-day average of around 2,300 positive cases per day. However there have been increases in recent days, although it is too early yet to see the impact of this week’s easing of restrictions.

Latest figures for daily hospitalisations, which lag trends in positive cases by up to two weeks anyway, are comfortably below 100 and there are fewer than 900 Covid patients in hospital beds.

The latest report from NHS Test and Trace in fact shows a 5% increase in the number of people testing positive in the week to 12 May from a very slightly reduced number of tests. Some 11,000 cases were transferred to the contact tracing system and this led to the identification of 41,000 close contacts. And between eight and nine out of 10 of these were reached by contact tracers and asked to self-isolate.

Travel concerns

There has been an increased focus on the government’s border control after Monday’s rule changes ended the ‘stay in the UK’ regulation. The controls require people entering the UK from amber listed countries to quarantine at home, while anyone who has recently been in a red listed country must isolate in a managed hotel. In the week to 12 May – so before the travel restrictions were eased – 10,882 people started quarantining at home and 7,104 in a managed quarantine hotel – meaning more than half a million people have now been through a formal quarantine process since the managed quarantine service began in February.

Concerns were this week raised about this traffic light system, with confusion over what was allowed. While Monday was seen as enabling foreign holidays to start up, there are only 15 green listed countries and territories including Portugal, Iceland, Israel, Australia, New Zealand and the Faroe Islands. And of these only Portugal and Iceland are currently accepting UK tourists.

Most popular holiday destinations, including Spain, France, Greece, Italy, Canada and the US, are on the amber list, and are still off-limits for travel. However, there were conflicting messages given through the week about circumstances where travel to an amber list country might be permitted. Prime minister Boris Johnson said this should be limited to ‘extreme circumstances, such as the serious illness of a family member’.keir starmer p

Labour leader Keir Starmer (pictured) said the consequences of the government’s loosened travel restrictions were that ‘150 flights a day are going to amber list countries and travel agents are reporting surges in holiday bookings to those countries’. He called for the prime minister to ‘drop this hopeless system, get control of our borders and introduce a proper system that can protect against the threat of future variants of the virus’.

The government last week signalled its intent to hold a public inquiry next spring into its handling of Covid-19. However the National Audit Office got the ball rolling this week with a report looking at what lessons can be already be drawn. Pulling together learning from 17 previously published reports on Covid-19, the audit body said the UK was not as prepared for the pandemic as it could have been, with the government lacking detailed contingency plans to manage the unfolding situation. The virus has also ‘laid bare existing fault lines within society’ and exacerbated inequalities. Long-term solutions are needed for an unreformed adult social care system, workforce shortages, issues caused by legacy IT systems and the financial pressure felt by central and local government, it said.

The financial watchdog called on the government to consider which Covid-19 related spending commitments are likely to be retained for the long-term and what these additional spending commitments mean for long-term financial sustainability. (See Pandemic preparation requires action on finance and staffing).

Backlog challenge

The immediate challenge facing the NHS is how it addresses the backlog of care that has built up during the pandemic, with a concern that referrals and waiting lists will swell further as the public starts to feel more comfortable with taking problems to GPs. NHS Providers chief executive Chris Hopson this week said that while public focus was on elective surgery and cancer care in hospitals, there are also serious backlogs in mental health and community services.

‘There are early indications that on current trajectories, it could take the trusts with the biggest backlogs between three to five years to get back to where they should be,’ he said. The NHS needed to transform care and the government should provide extra funding to enable that transformation.

‘A key part of the solution to tackling waiting lists in the early 2000s was five successive years of 7% plus real terms increase in annual NHS funding. This is more than double current plans. And there was a laser like focus on reducing elective waiting lists.’

While the current context was very different, the NHS could only do what it needs to do with the right investment – and the £1.5bn this year to tackle elective waiting lists and increase mental health capacity ‘can only be a first instalment’, he added.