Covid-19 update: 22 May

by Steve Brown

22 May 2020

The government continues to insist that the country is moving from alert level 4 to level 3 in its five point scale – albeit taking careful steps. The number of people in hospital fell below 10,000 for the first time since lockdown measures were imposed. The number of people on mechanical ventilators also continues to fall.

However, the NHS and care systems continue to face significant challenges. The NHS needs to meet the needs of Covid-positive patients, maintain capacity against further increases and a possible second peak, and steadily increase the amount of non-Covid activity it can undertake in parallel, while maintaining segregation and good infection control.HFMA Covid-19

But if the NHS is more in control of the virus, there also appear to be more people who think the time is right to start reviewing the national response to date.

With many opinions for and against the government performance, the National Audit Office will provide a factual basis for assessment. This week it began a programme of work to support Parliament’s scrutiny of the government response with the publication of an overview report.

This is a starter-for-ten of a report setting out simply the facts and figures of the response to date. The headlines of this response include £124bn of spending or commitments including £6.6bn for health and social care, £15.8bn for other public services, £19.5bn to support individuals and £82.2bn to support businesses. It does not assess the value for money or effectiveness of the various programmes.

Reports downstream will get into more of the detail. These are likely to cover: procurement and supply chains; fraud and error; capitalising on new ways of working; and maintaining focus on existing significant challenges.

Others have been quicker to move to judgement on performance. An article from public health professor Gabriel Scally in the BMJ described the public health response to Covid-19 as ‘too little, too late, too flawed’. The article made a number of recommendations. More public health experts should be recruited to the UK’s Scientific Advisory Group for Emergencies (SAGE) and plans for case finding, testing and community contact tracing should be ‘adequately resourced, decentralised and led by public health teams’, it said.

Health secretary Matt Hancock continued to promote the government’s plans to increase testing capacity to 200,000 test per day and to build an ‘army of contact tracers’ – 21,000 have been recruited to date – to manually trace the contacts of anyone who has had a positive test. This work will be supported by the NHS Covid-19 app, currently being trialled on the Isle of Wight, which will trace the contacts of those with symptoms of the virus, further helping to contain its spread.

Meanwhile the government also announced that health and care staff will be the first to receive antibody tests, after it agreed deals with Roche Diagnostics and Abbott Laboratories. The antibody blood tests check if a person has had coronavirus – as opposed to the swab tests that check for the current presence of the virus.

The NHS Confederation described the announcement as a ‘game changer’. Niall Dickson, the organisation’s chief executive, acknowledged that there were still unknowns. ‘We don’t yet know whether antibodies mean you are immune, and if so, for how long. We also need to know whether those with antibodies can still transmit the virus,’ he said. ‘But this will make a real difference, in understanding how and to whom the virus has spread and because it will help us to answer these pressing questions.’

Welcoming the decision to give health and care staff priority, he said a clear plan was needed for how the tests would be distributed.

NHS Providers was also in reflective mood. In particular, it was keen to rebut suggestions that the NHS had systematically discharged Covid-19 patients to care homes as part of a rapid discharge programme to free-up capacity in hospitals early on in the outbreak.

During the key period, the briefing – Spotlight on …recent NHS discharges into care homes – claimed that care homes were a minority destination. ‘Only 1 in 20 patients discharged from hospital went to a care home for the first time (the figure is 3 in 20 including patients who returned to care home settings),’ the report said.Saffron Cordery

NHS Providers acknowledged that the mortality rate in care homes during the virus outbreak should be subject to a public inquiry. ‘We can see that the failures of testing to date and the supply of personal protective equipment have hit the care sector particularly hard and remain problematic,’ said deputy chief executive Saffron Cordery pictured). ‘This is also indicative of the years of underinvestment, despite repeated government promises to resolve the crisis in social care.’

But the body was clear that the trust sector did not systematically or knowingly discharge Covid patients into care homes and followed national guidance throughout the pandemic. There had been cases of Covid-patients discharged into care homes, but these were on a planned and agreed basis. 

‘While there may have been a small number of asymptomatic patients discharged in the immediate period 17-19 March, this was quickly identified as an issue and appropriate arrangements were put in place,’ the report said.

In its latest update, the Office for National Statistics said that the number of Covid-related deaths in care homes increased as a proportion of all Covid deaths – up to just over 42% in the week to 8 May. Hospital deaths continued to account for more than half of all Covid-related deaths. For the year to date, care home deaths account for 27% of the total.