Covid-19 update: 26 March

by Steve Brown

26 March 2021

Pressure continued this week on vaccine supplies as Europe looked to strengthen controls on Covid vaccine exports to help speed up its own vaccination programmes. Meanwhile, on the anniversary of the UK first going into lockdown, official statistics showed the human impact of the pandemic to date.

On Wednesday, the European Commission added the principles of reciprocity and proportionality as new criteria to be considered as part of its existing mechanism for authorising exports of Covid-19 vaccines.HFMA Covid-19

Unrest has been brewing for a while, with the European vaccination programme lagging well behind that in the UK. European Commission president Ursula von der Leyen has pointed to the European Union’s export of 77 million doses of vaccine to date – making it the biggest exporter of vaccines worldwide.

The changes mean that before authorising exports member states and the commission should consider whether the destination country restricts its own exports of vaccine or raw materials – the so-called ‘reciprocity’ criterion. It should also take into account whether the prevailing conditions in the destination country were better or worse than those in the EU – the ‘proportionality’ clause.

However the position was confused by a joint statement issued on Wednesday evening by the commission and the UK government, which suggested a reduction in hostilities. ‘We are all facing the same pandemic and the third wave makes co-operation between the EU and UK even more important,’ it said. ‘We have been discussing what more we can do to ensure a reciprocally beneficial relationship between the UK and EU on Covid-19. Given our interdependencies, we are working on specific steps we can take – in the short, medium and long term – to create a win-win situation and expand vaccine supply for all our citizens.’

On Thursday, the changes were presented to the European Council, made up of the European heads of state. Their statement following the council meeting read: ‘Accelerating the production, delivery and deployment of vaccines remains essential and urgent to overcome the crisis. Efforts to this end must be further intensified. We underline the importance of transparency as well as of the use of export authorisations. We recognise the importance of global value chains and reaffirm that companies must ensure predictability of their vaccine production and respect contractual delivery deadlines.’

This was widely seen as stopping short of banning vaccine exports and was described by BBC European editor Katya Adler as a ‘European fudge’. While the tougher restrictions were now available ‘in theory’, she argued, in practice leaders would rather not use them.

Europe’s focus of attention is clearly the Oxford/AstraZeneca vaccine in particular, claiming significant shortfalls in deliveries compared to contractual commitments. Prime minister Boris Johnson has insisted the UK has ‘not blocked the export of a single Covid-19 vaccine or vaccine components’.alok.sharma L

It is understood that the UK has a ‘UK first’ clause built into its contract for vaccines produced on home soil, in return for its early and significant investment in the vaccine’s development. Business secretary Alok Sharma (pictured) made it clear back in May last year that the government’s deal with AstraZeneca (before the vaccine had been proved to work) would mean ‘people in the UK will get the first access to it’.

And health secretary Matt Hancock this week told the Financial Times that the issue came down to contractual detail. ‘They have a “best efforts” contract and we have an exclusivity deal,’ he said. ‘Our contract trumps theirs. It’s called contract law – it’s very straightforward.’

Booster campaign

The vaccine programme continues to power ahead in the UK after two bumper days last Friday and Saturday saw more than 1.3 million receive their first dose, with numbers exceeding 300,000 in subsequent days. Across the UK, some 29 million people have now received a first dose, with a further 2.8 million also having their follow up jab.

First dose numbers are due to fall significantly in April, as supply issues mean the programme will be more focused on meeting second dose commitments. On Thursday an NHS England and NHS Improvement board meeting heard that there were plans to deliver some 2.5 million second doses every week in April.

A paper presented to the board also highlighted plans for a revaccination campaign in the autumn or winter, likely to be run in parallel with the seasonal flu vaccination campaign.

Tuesday marked a year on from the UK’s first national lockdown. Official figures showed that the death toll across the year was more than 126,000 using the definition of a death within 28 days of a positive test. This rises to more than 148,000 including all deaths where Covid-19 is mentioned on the death certificate. Looking at all deaths, the Office for National Statistics said that 10,987 people died in the week to 12 March in England and Wales. This was 4.4% below the five-year average – the first time that deaths have fallen below the five-year average since the beginning of September. Looking at the last 12 months, the number of excess deaths above the five-year average was nearly 121,000.

Speaking at the end of last week, Annie Campbell, from the ONS health analysis and life events team, said the UK no longer had one of the highest levels of cumulative excess mortality in Europe. ‘[But] it does persist to have some of the highest cumulative excess mortality rates for those aged under 65 years,’ she said. ‘Only Bulgaria had a higher cumulative excess mortality rate for this age group by the end of 2020, with the UK and its constituent countries having excess mortality levels well above most other European countries.’

The Health Foundation marked the lockdown anniversary with analysis showing that the more than 145,000 deaths due to Covid in the UK over the last year equates to up to 1.5 million potential years of life lost. Those who died lost up to 10 years of life on average. Three quarters of those who died were over aged over 75, with this group losing an average 6.5 years of life.

Legislative extension

England stands on the verge of a further easing of lockdown measures, with groups of six or two households able to meet outside from Monday according to the government’s timetable. And Wales has lifted travel restrictions within Wales from this weekend.

On Thursday MPs backed the extension of the Coronavirus Act 2020 for six months. This time-limited legislation enables the government to restrict public gatherings, close businesses and perform emergency registration of healthcare workers, among other things. Ahead of the vote, prime minister Boris Johnson highlighted that the end-of-lockdown timetable was separate to the continuing need for the legislation. Stressing his ‘data, not dates’ mantra, Mr Johnson underlined that the current timetable dates were ‘not before’ dates and no firmer than that.

NHS England reduced its emergency incident level from level 4 to level 3, reflecting reductions in the number of admissions and occupied beds related to Covid. This means the service will transition from a national command, control and co-ordination structure to a regional structure, but with national oversight.

Daily admissions across the UK are now at just over 350, according to latest figures – more than half the numbers being admitted each day at the start of the month. And the reducing pressure on hospitals can also be seen in the falling numbers of Covid patients still in hospital – now just over 5,100, again halving the numbers at the beginning of March.

However, NHS Providers chief executive Chris Hopson warned that the NHS ‘was not yet out of the woods’. ‘There are still over 4,500 new daily cases of Covid-19 and 650 patients in hospital requiring mechanical ventilation due to the virus,’ he said. And he highlighted the current third wave in Europe and concerns about new variants as reasons to proceed cautiously.layla.Mccay l

NHS Confederation director of policy Layla McCay (pictured) made a similar point. ‘The latest urgent and emergency care figures suggest the pressure on the NHS is easing a little, offering the much-needed beginnings of space for staff and service recovery as the health service looks beyond the pandemic,’ she said. ‘However, we must not pretend the crisis is over.’

A paper presented to Maidstone and Tunbridge Wells NHS Trust put this in stark terms. A ‘reasonably optimistic’ scenario would see Covid positive occupancy hitting between 50 and 100 over the summer, it said. At the higher end of this range, it would be on a par with the level experienced by the trust at the height of the first wave in April last year. With poorer adherence to social distancing the numbers would be even higher.

Jackie Daniel, chief executive of Newcastle upon Tyne Hospitals NHS Foundation Trust added her voice to the ‘no room for complacency’ argument, especially after experiencing such significant pressure in the second wave at the start of the year. The NHS also needs to focus on addressing the backlog in care that has built up during the pandemic, she said. ‘We haven’t seen numbers like this since 2008 and that will take a lot of effort from the same staff to deliver,’ she told BBC Radio 4’s Today programme.

Staff wellbeing

Dame Jackie’s point about the ‘same staff’ was picked up by confederation, which insisted nurses, doctors and other key workers needed to be given the time and space to recover from the pandemic. Failure to do so would risk the government’s target of recruiting an extra 50,000 nurses and would mean it would take even longer to address waiting times. Putting people first: supporting NHS staff in the aftermath of Covid-19  likened experience of health and care staff over the last year to ‘sprinting a marathon’ and calls for a ‘focus on all its people’ to be at the heart of recovery and reset planning.

NHS England and NHS Improvement picked up this point in its planning guidance for 2021/22, published on Thursday, setting staff wellbeing and action on recruitment and retention as one of six priorities. The guidance says trusts should encourage staff to make use of unused annual leave carried forward from 2020/21. Additional funds specifically to support catch-up will be triggered by systems achieving activity levels above set thresholds – see Finance regime unchanged for first six months.

The weekly report for NHS Test and Trace showed a continuing decrease in the number of people testing positive for coronavirus, despite an increase in testing. The 37,000 positive cases represented a 6% decrease on the previous week continuing a 10-week trend. Just over 33,000 cases were transferred to the contact tracing system. Nine out of 10 of these cases – nearly 30,000 – were reached and 25,000 of these (84%) collectively identified nearly 100,000 close contacts. Nine out of 10 of these contacts were reached.

Meanwhile it was announced that NHS Test and Trace will move to its new home from April as part of the new UK Health Security Agency. The agency – previously called the National Institute for Health Protection – will combine elements of Public Health England and the Joint Biosecurity Centre, as well as hosting the testing and tracing operation. Deputy chief medical officer Jenny Harries will be the new body’s chief executive, taking over from the current executive chair of NHS Test and Trace Dido Harding.