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News

Seven days in medicine: 24 February to 2 March 2021

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n588 (Published 04 March 2021) Cite this as: BMJ 2021;372:n588

Covid-19

Health leader calls for review of England’s ICU bed capacity

Chris Hopson, chief executive of NHS Providers, which represents trust leaders, called for a review of critical care capacity in England, saying that it was “neither safe nor sensible to rely on NHS hospital trusts being able to double or triple their capacity at the drop of a hat as they’ve had to over the last two months.” The UK has 7.3 critical care beds per 100?000 people, whereas Germany has 33.8 and the US 34.3. The review must look at the distribution of beds, proximity to patients, and a need to concentrate expertise, Hopson said.

One in seven people in England have antibodies

Almost 14% of people in England had antibodies from either infection or vaccination against SARS-CoV-2 between 26 January and 8 February, up from 4.4% between 27 October and 10 November, showed data from the Real-time assessment of community transmission (React-2) study. The researchers also found that 91% of people who had received two doses of the Pfizer-BioNTech vaccine had antibodies, rising to 95.5% in people aged under 60. Among those who had a single dose of vaccine, antibodies were present in 95% of people under 30 but only 35% of those over 80. (Full story doi:10.1136/bmj.n561)

One dose of Pfizer vaccine cuts transmission by 75%

A 75% reduction in asymptomatic cases of covid-19 was seen in healthcare workers at Cambridge University Hospitals NHS Foundation Trust who received one dose of the Pfizer-BioNTech vaccine in the second half of January, an analysis published as a preprint has found, adding to the evidence that the vaccine reduces transmission. A Lancet study previously found that the Oxford-AstraZeneca vaccine was 59% effective against asymptomatic transmission in some recipients.1

WHO taskforce is set up to tackle oxygen shortages

A Covid-19 Oxygen Emergency Taskforce was launched by the World Health Organization’s partners, including Unitaid and Wellcome, to increase the supply of oxygen to low and middle income countries, where it is estimated that more than half a million people with covid-19 need 1.1 million cylinders of oxygen a day. Most of these countries are in Africa, where supply problems have been worsened by surges in covid-19 cases. The taskforce says $90m (£65m; €75m) is needed to tackle immediate problems in up to 20 countries, including Malawi, Nigeria, and Afghanistan.

Vaccination

Canada approves Oxford-AstraZeneca vaccine

The Oxford-AstraZeneca covid-19 vaccine was approved by Canada’s drug regulator for use in adults, including those aged over 65. The regulator said that the efficacy for use in over 65s was supported by factors outside clinical trials. This came after early evidence from Scotland showed that the vaccine reduced the risk of hospital admission by up to 94%, four weeks after the first dose, findings that may lead to changes in France, where the vaccine has so far been recommended only for adults under 65.

Phase 2 of UK vaccine rollout should follow age

The UK’s Joint Committee on Vaccination and Immunisation said that evidence indicated that an age based approach to vaccination remained the best way to reduce covid-19 deaths and hospital admission. After groups 1-9 have been vaccinated, people aged 40 to 49 are at the highest risk of hospital admission and should be prioritised for vaccination, followed by those aged 30 to 39, and then those aged 18 to 29. Mass vaccination targeting occupational groups would be more complex to deliver and may slow down the vaccine programme, leaving some more vulnerable people unvaccinated for longer, said the committee.

Charities join forces to boost vaccine uptake

Sixteen UK care charities, including the British Heart Foundation, Macmillan Cancer Support, and Mencap, formed a new partnership to encourage people with long term health conditions and their carers to get a covid-19 vaccine. They said they would use the combined strength of their networks to reassure people with long term health conditions about the safety and effectiveness of the vaccines.

PPE

Judge caps costs for court action

Mrs Justice O’Farrell agreed that campaigners taking the UK government to court over the award of huge contracts for personal protective equipment without advertisement or competition would have to pay no more than £250?000 if they lost their case. The charities the Good Law Project and EveryDoctor are challenging the award of contracts to Pestfix, a pest control company, Ayanda, a private fund, and Clandeboye, a confectionery wholesaler, in a case due to be heard in May. The government said its costs would probably reach £1m, which campaigners said would prevent them bringing a case, so they asked for costs to be capped. (Full story doi:10.1136/bmj.n566)

Workforce

NHS planning is a “joke,” says Hunt

The government’s decision not to publish precise figures on what workforce numbers are needed for the NHS and social care in the next 10, 15, or 20 years has made planning a “joke,” said England’s former health secretary, Jeremy Hunt, during a session for the health committee’s inquiry into workforce burnout and resilience. Care minister Helen Whately replied, “There is a huge amount of complexity, and workforce planning is not a simple thing to do. The other thing is the importance of joining up the plans for the workforce with service planning and also financial planning.” (Full story doi:10.1136/bmj.n564)

UK adopts WHO code for recruiting health staff

The UK updated its code of practice for the international recruitment of health and social care staff to align with the World Health Organization setting out how health and social care employers can recruit ethically from abroad. The code ensures that international recruits will be treated fairly and be provided with the appropriate support, provides safeguards against active recruitment from 47 countries on the WHO Health Workforce Support and Safeguards List, and sets out how the UK is supporting countries with the most pressing health and social care workforce challenges.

Wellbeing

NHS England expands mental health support with 40 hubs

NHS staff in England will be able to access evidence based mental health services from 40 hubs nationwide, NHS England said. Care will be provided free of charge, and the hubs will proactively contact those staff groups who are most at risk. The hubs have been modelled on the Greater Manchester Resilience Hub, which was set up to treat people affected by the Manchester terrorist attack in 2017, including NHS staff. Claire Murdoch, NHS England’s national mental health director, said that given the pressures of the pandemic it was vital that NHS staff were given extra support. (Full story doi:10.1136/bmj.n559)

Medical defence

England’s clinical negligence system needs urgent reform, say leaders

The Academy of Medical Royal Colleges, the Hospital Consultants and Specialists Association, and the Medical Defence Union wrote to the prime minister and the health and social care secretary for England, seeking urgent change to the clinical negligence system in England, which has seen the estimated bill for outstanding claims rise to an “unsustainable” £84bn. The letter calls for reform to aid the NHS’s recovery from the covid-19 pandemic. (Full story doi:10.1136/bmj.n551)

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