Covid-19 update: 5 June

by Steve Brown

05 June 2020

We are regularly and rightly reminded that the daily reports on hospitalisations, occupied ventilated beds and deaths are about much more than numbers – there are individuals and their families behind all the statistics. But statistical analysis is starting to tell us more about the Covid-19 virus and those most at risk.

Public Health England this week published Disparities in the risk and outcomes of Covid-19 confirming earlier reports and assessments about the virus’s differential impact on different parts of the population.HFMA Covid-19

The largest disparity found was by age. Among those already diagnosed with the virus, people who were 80 or older were 70 times more likely to die than those under 40. Working age men with a positive diagnosis were twice as likely to die as women and risks were also higher for those living in the more deprived areas and for black, Asian and minority ethnic (BAME) groups. (These analyses do no take comorbidities into account.)

The higher death rates among people of black and Asian ethnic groups is the opposite of what has been seen in previous years. And looking at confirmed Covid cases, people of Bangladeshi ethnicity had around twice the risk of death for people of white British ethnicity. Risk of death for people of Chinese, Indian, Pakistani, other Asian, Caribbean and other black ethnicity was between 10% and 50% higher than that for white British.

The analysis also underlines the concerns about deaths in care homes, with regular reports from the Office for National Statistics (ONS) providing a weekly reminder. By 8 May, care home deaths accounted for 27% of Covid deaths to date, Public Health England said.  And looking more broadly, the analysis shows that there have been 2.3 times the number of deaths in care homes than expected between 20 March and 7 May, when compared to previous years – equating to around 20,457 deaths.

Covid-19 deaths account for 46% of this excess, suggesting there are lots of excess deaths from other causes or there is under-reporting of the virus-related deaths.Saffron Cordery

NHS Providers deputy chief executive Saffron Cordery (pictured) welcomed the publication of the rapid review. ‘Trust leaders are concerned about increased risk to BAME staff, reflecting the wider inequalities long faced by BAME staff in the NHS workforce,’ she said. ‘This report will add to existing resources supporting a more informed response to this challenge.’

The ONS’ continued weekly publication this week highlighted that care home deaths have continued to grow as a proportion of all Covid deaths – up to 29% by 22 May. And looking at the most recent week (using deaths based on date of death registered up to 30 May, rather than date of registration), care home deaths accounted for nearly 40% of deaths in the week. This figure for the most recent week of data is above 50% in Scotland, where care home deaths related to Covid to date now just exceed those in hospital (both 46% of the total 3,911).

Concerns about NHS discharges into care homes to free up acute beds have continued to be raised. All patients being discharged to hospital now have to be tested first, but this policy was not in place at the outset of the pandemic.

NHS England and NHS Improvement published data showing a 56% drop in the number of NHS patients discharged into care homes between the end of January and 16 April. NHS Providers said this was further evidence to refute the suggestion that providers had systematically and knowingly transferred risk from the NHS into the care sector.

However other analysis suggested that the same data showed that, in the run up to the peak of infections, hospital discharge to care homes was higher than the previous year.

NHS Providers has already made its case in an earlier report, which insisted that trusts had consistently followed national guidelines. Some known or suspected Covid cases were discharged to care homes but this was always on the basis of local agreement. And there were only a couple of days where small numbers of asymptomatic patients may have been discharged into care homes and new arrangements were rapidly put in place.

Statistics were also to the fore around the government’s testing programme. There has been increasing concern and criticism of the government’s reporting of daily test numbers. These have centred on: the centre’s focus on capacity for tests, rather than actual tests delivered; the inclusion of posted tests, ignoring home tests that don’t get completed or that go astray; and the alarming difference between completed tests and number of people tested.

However, this week the criticism became a formal reprimand as the UK Statistics Authority waded into the argument. In a letter to health secretary Matt Hancock, the authority’s chair Sir David Norgrove said the figures were ‘still far from complete and comprehensible’. ‘The aim seems to be to show the largest possible number of tests, even at the expense of understanding,’ he said. ‘It is also hard to believe the statistics work to support the testing programme itself.

Test results should include key types of employment (such as medical or care staff), age, sex and location, Sir David said.

Testing is absolutely key to the success of the new Test and Trace system, but Labour leader Keir Starmer wanted to know why prime minister Boris Johnson was talking about a world beating test and trace service when it was weeks away from being fully operational.

NHS Providers was keen to recognise what had been achieved, but that this should not be oversold. ‘NHS Test and Trace can only at this point be described as a work in progress,’ said deputy chief executive Saffron Cordery. ‘Given how much depends on it, building public confidence in NHS Test and Trace is vital and ministers should stop describing it as world beating when it clearly currently isn’t.’

There have been reports suggesting that in the first week of the new service, only four in 10 Covid-positive patients were contacted and only around one third of the contacts they named. And a report in The Guardian newspaper claimed staff at the new service had been told the hope was for the programme to be operational at a world class level within three to four months.

At a Commons Health and Social Care Committee meeting, Dido Harding, executive chair of the NHS Test and Trace programme, was pushed hard on figures for contact tracing and test turnaround times.Jeremy Hunt

Committee chair Jeremy Hunt (pictured) asked her for the proportion of patients who had been contacted within 24 hours of testing positive; what proportion were willing to share their contacts’ details; the number of their contacts who had been approached within a further 24 hours; and the level of compliance with requests to isolate.

However, Baroness Harding said it was too early to give such figures. Referencing the earlier row over testing statistics and the intervention of the UK Statistics Authority, she said the figures must first be validated, though she hoped a weekly dashboard would be available before the end of next week.

Looking at broad averages, she said that more than 90% of results were being returned within 48 hours. However, Mr Hunt pointed out that SAGE believed contact must be made within 48 hours of a test taking place. This could not happen if it was taking 48 hours to receive results.

Baroness Harding acknowledged that speed was vital. ‘The speed of turnaround of testing is arguably at the moment much more important than increasing the capacity,’ she said. ‘And as we get ready for autumn/winter, we are going to need to expand capacity, speed up time and improve the reliability of testing.’

The prime minister later promised that all tests would be turned around within 24 hours by the end of June, although this commitment did not extend to ‘difficulties with postal tests or insuperable problems like that’.

Meanwhile the Test and Trace service continues to operate without the support of the contact tracing app, which was trialled recently on the Isle of Wight and was originally expected to be rolled out during May. Speaking on Thursday business minister Nadhim Zahawi said he could not give an exact date for the app roll-out. However, he said he ‘would like to think’ it would be in use by the end June.

The week, which saw further relaxation of lockdown measures and the introduction of a mandatory requirement to wear face masks on public transport (from 15 June), ended with a further statistical contribution. The ONS has continued to measure Covid-19 infections within the community, excluding hospitals and care homes. It’s latest estimates, based on its ongoing infection survey, suggest that an average of 53,000 people in England had the virus during the last two weeks of May. And it now puts the new infections per week at around 39,000. While the figures predate the latest lockdown easing, they do encouragingly represent reductions on earlier estimates.