Covid-19 update: 28 May

Speaking to a joint session of the Health and Science and Technology committees, the former adviser said that ministers, officials and advisers had fallen ‘disastrously short of the standards that the public has a right to expect’.

But his most explosive allegations related to the prime minister Boris Johnson, who he said was not fit to get the country through the pandemic, and health secretary Matt Hancock, who he said should have been sacked for lying on multiple occasions.

There were clearly scores being settled by Mr Cummings, who left Downing Street following a backroom power struggle at the end of last year. And many would argue that the former adviser is an unreliable witness after his implausible eyesight-testing drive explanation for breaching lockdown rules last year. But his insider’s account of the government’s response to the pandemic undoubtedly made for compelling viewing.

He said that Mr Johnson had initially dismissed Covid as a scare story and that the UK had been too slow to lock down and close borders.  He also claimed that Mr Hancock had assured him and the prime minister early in the pandemic that hospital patients would be tested before they went back to care homes, before subsequently finding out that this was not the case.

In a statement in the Commons, Mr Hancock insisted ‘these unsubstantiated allegations around honesty are not true’ and that he had been ‘straight with people in public and private throughout’. Mr Johnson said that ‘some of the commentary I’ve heard doesn’t bear any relation to reality’. ‘We followed to the best we could the data and the guidance we had,’ he said.

Away from the bitter slanging match about who said and did what, there are signs that the number of cases of people with coronavirus are rising.  The latest daily figure of 3,542 (Thursday), reported on the government Covid-19 dashboard, is the highest for some six weeks. And Public Health England’s weekly surveillance report confirmed that overall case rates increased slightly in the latest week up to 23 May. This slight increase was seen in most regions and in all age groups and ethnic groups.

Within this overall picture, there are particular concerns about rising numbers of the B.1.617.2 variant of the virus across the UK. Latest figures show a further 3,535 cases were discovered in the last week, bringing the total detected cases to nearly 7,000. The most affected areas continue to be Bolton, Bedford and Blackburn with Darwen, although there are small numbers of cases in most parts of the country.

At a government briefing on Thursday, Mr Hancock said that more than half and potentially as much as three-quarters of all new cases are now of this variant. Rising cases are a concern, but the real aim is to use vaccination to break the link between cases and hospitalisations. While there is typically a lag of around two weeks between increases in positive cases and hospitalisations, Public Health England said that hospitalisations were rising in some affected areas. However, hospital attendances and admissions are predominantly in unvaccinated individuals.

Nationwide, up to 25 May, 201 people confirmed as having the Indian variant attended accident and emergency, resulting in 43 admissions. However, it is at this point hard to see this increase in the national figures, which still show a reducing trend line for daily admissions up to the 23 May and patients in hospital beds hovering around 900.

Responding to the latest figures on the Indian variant, NHS Confederation chief executive Danny Mortimer (pictured) urged the government to think carefully about its next steps. ‘While health leaders understand why the government is eager to end restrictions and restart normal life, they also know why this must be done with the utmost caution,’ he said. Although the vaccination programme had been a ‘huge success’, the fact that the majority of those now in hospital had either not been vaccinated, or had received only one dose, was an indication that there is still a long way to go.

He called on the government to make good on commitments to overcome barriers to self-isolation and support people financially where needed. The government did in fact this week unveil new self-isolation support pilots in nine areas across England. Run in partnership with local authorities and backed with £12m of government funding, the pilots will test a range of initiatives including providing alternative accommodation for people in overcrowded households and increasing social care support for vulnerable adults.

Vaccine impact

The vaccine programme continues to make good progress. Nearly 39 million people have now received a first dose of vaccine and 24 million have received a second dose. Public Health England now estimates that  the vaccines have prevented 13,200 deaths in people aged 60 years or older in England (up to 13 May) and nearly 40,000 hospitalisations in those aged 65 and over. These figures do not allow for the impact of vaccination on transmission and so the full effect is likely to be even greater.

There are also some encouraging signs about vaccine effectiveness against the B.1.617.2  variant of the virus. A Public Health England study has shown that the currently used vaccines, after two doses, were just as effective against the so-called Indian variant as they were against the Kent variant (B.1.1.7).

The Pfizer-BioNTech vaccine was 88% effective against symptomatic disease from the B.1.617.2 variant two weeks after the second dose, compared to 93% effectiveness against the B.1.1.7 variant. Two doses of the AstraZeneca vaccine were 60% effective against symptomatic disease from the B.1.617.2 variant compared to 66% effectiveness against the B.1.1.7 variant. And both vaccines were 33% effective against symptomatic disease from B.1.617.2, three weeks after the first dose compared to around 50% effectiveness against the B.1.1.7 variant.

And in further vaccine news, the single-dose Janssen Covid jab has been added to the list of usable vaccines in the UK, and will now be available later this year, after it was approved by the Medicines and Healthcare Products Regulatory Agency. It joins the Pfizer/BioNTech, Oxford/AstraZeneca and Moderna vaccines that are already approved for use.

New guidance from the Getting It Right First Time programme and the Oxford Academic Health Science Network also points to a way of getting even greater value out of the vaccine programme. Pilot projects have demonstrated the benefit of giving people aged over 65 attending vaccination centres the option of an additional check for atrial fibrillation (AF) – a major cause of stroke.

While risk factors for stroke are usually picked up at routine GP appointments, the pandemic has reduced face-to-face consultations. Offering heart rhythm checks at vaccination centres is seen as a way of reaching some of these people and modelling suggests 37 new cases of AF will be detected and one stroke prevented for every 5,000 people offered a heart rhythm check. If everyone aged 65 and over was offered an annual rhythm check, more than 1,000 strokes could be prevented in England every year.

App surge

Interest in being able to demonstrate vaccine status has also driven a major increase in the number of people registering to use the NHS App. Covid-19 vaccine status was added to the app in early May and 1.3 million people have subsequently downloaded and registered, bringing the total number of registered users to 4.8 million. The boost in downloads has side benefits, with more than 11,000 people registering their preference for organ donation in just four days.

According to the latest report from NHS Test and Trace in England, nearly 11,000 cases were transferred to the contact tracing system in the week to 19 May. Tracers were unable to reach more than 800 of these (8%). And nearly 1,500 of those that were reached either had no recent contacts or could not provide details of close contacts. However, the 8,422 that did provide contact details collectively identified 40,000 close contacts and 86% of these were reached and asked to self-isolate.

The English tracing service has been under less scrutiny in recent weeks as virus levels have fallen, reducing the number of cases transferred to the service for tracing. But with cases now rising, the service’s role will be increasingly important and it is likely to face renewed scrutiny.

‘We are at a crucial point in the pandemic with new variants leading to a spike in cases after weeks of falling infection rates,’ said NHS Providers deputy chief executive Saffron Cordery (pictured). ‘As the final stage of lockdown easing approaches, it is absolutely critical that we have a test and trace system that is robust enough to combat the spread of new Covid-19 variants.’

She said it was encouraging that, of those picked up by NHS Test and Trace, fewer people were testing positive compared with the previous week. And test turnaround times had also improved. ‘But this risks being offset by figures showing fewer people overall are being tracked by the system,’ she said. ‘Test and Trace must improve if we are to contain and eliminate the threat of current and new potential Covid-19 strains.’

Meanwhile the Royal College of Surgeons of England has called for the government to commit an additional £1bn for surgery every year for the next five years and to create surgical hubs across the country to help tackle the elective surgery backlog created by the pandemic.

The college’s report – A new deal for surgery – in total makes 12 recommendations. These include bringing hospital bed numbers in line with the OECD average over time and building NHS capacity to reduce reliance on the independent sector in future pandemics or crises. It welcomed the extra £1bn for the current year as part of the Elective Recovery Fund, but said this could not be a one-year commitment only. ‘To make a lasting impact on the elective backlog’ this needed to be made recurrent for at least a further five years. And the forthcoming health and care bill should be amended to require the government to report annually on progress addressing the backlog.

The hubs approach builds on models that were set up in some areas during the pandemic, identifying some hospitals as Covid-light surgery centres. The college wants this extended with at least one hospital acting as a Covid-light site in each integrated care system – and more than one site in larger systems.

Surgery must be available on the NHS all year-round, not stop and start,’ said Neil Mortensen, the royal college’s president. ‘If a dangerous new variant of Covid-19 takes hold, or another bad flu arrives in the autumn, we cannot allow surgery to grind to a halt again or waiting lists will become insurmountable.’