Covid-19 update: 29 May

by Steve Brown

29 May 2020

The week was dominated by one event – the revelation that the prime minister’s chief aide Dominic Cummings made a 260-mile trip to County Durham, despite lockdown restrictions and his wife being ill with from coronavirus symptoms.

Having developed symptoms himself and recovered – and made a 60-mile round trip to Barnard Castle to test his eyesight – Mr Cummings returned to London. He claimed that he behaved reasonably and legally and his actions, which he said were to give him and his wife access to childcare if it was needed, were covered by exceptional circumstances allowed for by lockdown rules.HFMA Covid-19

While the prime minister and cabinet ministers rallied around Mr Cummings, there was less support across the media. In the NHS, the real concern was over the potential damage to the government’s public health messaging.

NHS chief executive Niall Dickson said the organisation would not comment on the merit of individual cases or on the actions of any member of the prime minister’s team. ‘However, whether or not any criticism is justified, we and our members are concerned at the damage that may be done to public and NHS staff confidence in government guidance because of the way this story has unfolded,’ he said.

‘We cannot stress too much that the guidance has saved tens of thousands of lives and that following the guidance in the weeks ahead is going to be as vital as ever, when discretion will inevitably be greater as the lockdown eases.’

The importance of messaging and the public’s adherence to lockdown measures was underlined later in the week when the government launched its test and trace service. (Scotland and Wales launched their own programmes under slightly different names. Contact tracing is already underway in Northern Ireland.)

Under the new contact tracing service, anyone testing positive for Covid-19 will be contacted by NHS Test and Trace and asked to share information about recent interactions. Anyone who has been in close contact with that person will then be asked to stay at home for 14 days, even if they do not have symptoms.

The whole system will depend on people complying with this instruction – performing what health secretary Matt Hancock described as their ‘civic duty’. Contacts identified in this way and asked to self-isolate will not be tested unless they develop symptoms themselves. Wider testing would put severe pressure on current capacity.Vaughan Gething

In launching the Welsh Test, Trace, Protect strategy, health minister Vaughan Gething (pictured) said the scale of testing capacity needed in Wales and across the UK was unprecedented. And he explained why a positive test result rather than virus symptoms would be the trigger for identifying contacts. At present on average only 12% of tests are returning a positive result,’ he said. ‘Consequently, contact tracing initiated by contact with a symptomatic individual (ie someone who has sought a test) could result in many people being asked to isolate when there is no positive case.’

NHS Providers' deputy chief executive Saffron Cordery said that test and trace was welcome but warned there was a lot of catching up to do. ‘Testing in many places is still too slow,’ she said ‘For many health and care providers the turnaround time is three to seven days. Trusts won’t be able to restart normal services like routine surgery until that’s been sorted out, with rapid and reliable access to testing for all patients and staff. We don’t see the plans in place to do that.’

She added that local plans to deal with Covid hotspots would take weeks to complete. ‘Rather than pretending we are about to see a world class test and trace service, the government should acknowledge that this will take time. It should not repeat the mistake of overpromising and under-delivering.’

The government earlier this month set a new target to provide 200,000 tests per day by the end of May. However there has been concern about the methods being used to measure performance against this target. These have reportedly included double counting of saliva and nasal samples from the same patient and the inclusion of posted testing kits in the number of daily tests undertaken.

BBC Radio 4’s More or less statistics programme (also available as a podcast) has also highlighted the inclusion of tests for research purposes in daily counts. For example, the government reported 136,486 tests were delivered on 15 May – surpassing its earlier 100,000 target. But the programme said that if you strip out posted kits and tests done solely for research purposes, then just 69,900 were actually carried out for diagnostic purposes.

There has also been increasing scrutiny of the significant difference between tests undertaken and people tested. On the same day – 15 May – More or less pointed out that the 69,900 tests were done on 43,298 people. Clinical reasons given for this gap include testing different samples from the same patient, repeating tests because of inconclusive results and double checking a negative result from someone who had previously tested positive. However the difference in the two numbers is startling. 

Systems have also this week been asked to start rolling out antibody testing for NHS staff and patients as soon as laboratory capacity permits. This ''have you had it' test will provide information on the prevalence of Covid-19 in different regions of the country. 

The Office for National Statistics gave its weekly update on registered deaths including those related to Covid-19. For the year to date, 65% of deaths involving the coronavirus have occurred in hospital (26,817 deaths), with the 11,650 deaths in care homes accounting for a further 28%.

The Health Foundation continues to be concerned about the huge loss of life in care homes. ‘While the number of weekly deaths in care homes appears to be falling, excess deaths are still significantly above the five-year average – and national figures mask differences in deaths between regions and population groups,’ said the thinktank’s chief executive Jennifer Dixon (pictured).Jennifer.Dixon l

The organisation’s own analysis shows that care homes in London and the North have been worse hit by Covid-19 than other regions in England. And social care staff – mostly women – are around twice as likely to die from COVID-19 as other adults.

'Government action on social care during the pandemic so far has been slow – the 'action plan' for social care was published nearly a month after the lockdown was introduced,’ said Dr Dixon. ‘Protecting vulnerable people needing social care should be given more obvious priority. Targeted action to tackle local outbreaks in care homes must include effective testing and tracing and ensuring consistent supplies of personal protective equipment to prevent a further spike in avoidable deaths.'

The week ended with a major government announcement on further relaxations to lockdown measures. Prime minister Boris Johnson said that the five tests that needed to be achieved before adjusting lockdown measures had now been met. There were 475 hospital admissions on 26 May, down from 3,121 on 2 April. Coronavirus patients were now occupying just 11% of ventilator beds, compared to 41% in April.  The seven-day rolling average death rate now stood at 256, down from a peak of 943 in April.

The rate of infection is also down. Over the last seven days an average of 2,312 new case were confirmed each day, down from a peak of 5,066 in the first week of May (even though there has been increased testing).

And while he acknowledged ‘the difficulties on testing and personal protective equipment that the country has faced since the start of the outbreak’ he pointed to significantly increased testing capacity and 100 new PPE deals with suppliers around the world enabling the country to rebuild stocks.

Finally, he said there was confidence that ‘limited and cautious’ adjustments to the lockdown would not risk a second peak that overwhelms the NHS.

Measures in England include partially reopening schools, phasing in the introduction of retail outlets and allowing people to meet up in groups of six, while still observing social distancing rules.

However there remain concerns about the timing of the changes and Dominic Cummings’ lockdown odyssey continues to cast its shadow.

Writing on twitter, NHS Providers chief executive Chris Hopson said exiting lockdown safely required continued adherence to social distancing guidelines. ‘But lots of anecdotal evidence suggests that the events of the last week have decreased public trust and confidence in the guidelines and therefore the likelihood of observance,’ he said.

He acknowledged good economic and social reasons to end lock down as soon as possible, but said there was a need for greater discussion. ‘Shouldn’t we be having a better and deeper debate on what the risks here are and whether it is right to be easing lockdown in the way proposed…rather than just breathing a huge sigh of relief? And shouldn’t our politicians and media be leading this debate more effectively?’