UK COVID-19 Update: CPAP Reduces Ventilator Need, Mandatory Staff Jabs Debate Continues

Tim Locke

August 05, 2021

These are the UK coronavirus stories you need to know about today.

CPAP Reduces Ventilator Need

CPAP reduced the need for invasive mechanical ventilation for coronavirus hospital patients with acute respiratory failure, according to preprint results from the Respiratory Strategies in COVID-19, CPAP, High-flow, and Standard Care study (Recovery-RS). 

Researchers also said use of high flow nasal oxygenation (HFNO) did not improve outcomes compared with conventional oxygen therapy and its use should be reconsidered.

Chief investigator Professor Gavin Perkins of Warwick Medical School said: "The RECOVERY-RS trial showed that CPAP was effective at reducing the need for invasive ventilation, thus reducing pressures on critical care beds.  The routine use of high flow nasal oxygenation, which can consume large amounts of oxygen, should be reconsidered as it did not improve outcomes. By giving patients the most effective treatment to begin with, we can help prevent resource shortages in our NHS and make sure the right type of ventilation is available to patients when it is required.

"This is the first large trial of different types of ventilation in COVID-19. While it is encouraging that these results can help reduce the number of people who require invasive ventilation, it is important to stress that, where it is needed, invasive ventilation can be lifesaving."

Long COVID

The Office for National Statistics (ONS) estimated 945,000 people in the UK,1.46% of the population, had long COVID as of 4 July. That's down slightly from the previous month.

The most common symptoms were fatigue, shortness of breath, muscle ache, and loss of sense of smell.

Prevalence was greatest in 35- to 69-year-olds, females, people living in the most deprived areas, health or social care workers, and those with another activity-limiting health condition or disability.

Latest Data

The NHS COVID-19 app in England and Wales sent 395,971 alerts in the week ending July 28. That's down 43% on the previous week.

Test and Trace in England said 189,232 people tested positive for COVID-19 that week, down 39% on the previous week. It is the first weekly fall since early May.

Of those transferred to NHS Test and Trace, 13.9% were not reached.

Young People

NHS England said 18-34-year-olds made up more than 20% of those admitted to hospital in July compared with 5.4% in January at the peak of the winter wave.

Northern Ireland is booking COVID-19 jabs for 16 and 17 year olds from tomorrow after yesterday's JCVI announcement.

Meanwhile, the World Health Organization called for a halt on COVID-19 booster jabs until at least the end of September.

"I understand the concern of all governments to protect their people from the Delta variant. But we cannot accept countries that have already used most of the global supply of vaccines using even more of it," said its head, Dr Tedros Adhanom Ghebreyesus.

Respiratory Protection Guidelines

International research headed by Imperial College London highlights how conflicting evidence on airborne transmission of SARS-CoV-2 early in the pandemic led to variations in guidelines that "may generate confusion, anxiety, and mistrust among health care professionals".

The UK recommended medical personnel wear face masks a week after the first World Health Organisation (WHO) guidance, the report noted.

The authors, writing in JAMA Network Open, concluded: "Inconsistencies in respiratory protection guidelines between neighboring countries created confusion over optimal measures. Strong collaborations between national and international organisations are critical in such circumstances."

Mandatory Staff Jabs Debate Continues

Mandatory vaccination of healthcare staff is "a blunt instrument to tackle a complex issue", according to Professor Helen Bedford, Great Ormond Street Institute of Child Health, London, and colleagues writing in The BMJ.

NHS staff vaccine uptake is already 90% in England, and making jabs mandatory "is not necessary, acceptable, or the most effective way to achieve high uptake, and it raises serious ethical issues about freedom of choice”, they write.

However, Professor Michael Parker, University of Oxford, said "there is a strong argument for considering the vast majority of health and social care staff to have a personal moral obligation to accept vaccination against infectious diseases that put their patients at significant risk of serious harm".

Heparin

Heparin may reduce the need for organ support in moderately ill hospitalised COVID-19 patients, according to a US study published in the New England Journal of Medicine.

However, similar results were not seen in critically ill intensive care patients.

Pandemic Cancer Care

A Cancer Research UK survey with results from 557 patients found 29% experienced delays, cancellations, or changes to their treatment from December 2020 to March 2021.

Pre-pandemic care was rated as 'very good' by 84% but 31% downgraded their rating during the pandemic.

The charity is calling for more investment in cancer survival and equipment. Chief Executive, Michelle Mitchell, said: "COVID-19 hit the health system hard and cancer services suffered as a result, but even before the pandemic struck cancer targets were not being met. And now, for the first time in decades, we’re faced with the fact that cancer survival could go backwards."

Isolation Payments

Wales is increasing self-isolation support payments from £500 to £750 to help remove financial barriers for people contacted by NHS Wales Test Trace Protect (TTP).

Health Minister Eluned Morgan said: "Our TTP service is extremely effective at supporting people and providing advice for those who have tested positive for the virus. It’s important we continue to invest to provide support to those who need it the most."

Travel News

France is off the 'amber plus' travel list and is now just amber. India is off the red list from Sunday, while Germany goes on the green list. Mexico is moving to red.

England's Health Secretary Sajid Javid said: "As well as moving more countries to the green list, today’s announcement also demonstrates the need for continued caution. Further countries have been added to the red list to help protect the success of our vaccine rollout from the threat of new variants."

NHS Ranking Drop

The UK has dropped from first place to fourth in a review of wealthy countries’ healthcare systems. The US was bottom.

The US Commonwealth Fund's Mirror Mirror report said: "The UK's drop in rank from #1 to #4 is associated with that country’s lower performance on several domains (such as access to care and equity) compared to 2017."

BMA Deputy Chair, Dr David Wrigley, commented: "The fact that the NHS has lost its place as the best health system in the world and is now in fourth place highlights the enormous impact that the pandemic has on the overall health service.

"This is absolutely no reflection on the tremendous efforts of all healthcare staff in the past year but rather a clear sign of the lack of investment by the Government and failure to adequately resource the NHS in its greatest hour of need.

"Rather than focusing on rushing through the reorganisation of our health service through the NHS bill – the wrong bill at the wrong time - the Government needs to redirect its attention to tackling the largest ever backlog of care and ensuring that patients are getting what they need. The Government must not allow this downward trajectory to continue."

Rashford's Food Plea

Marcus Rashford has written in The BMJ urging health professionals to help families apply for the Healthy Start scheme.

The footballer said 40% of eligible families are not registered for healthy food vouchers despite increasing food insecurity during the pandemic.

"We need you—every single one of you—to help us reach those most in need in our communities, especially given the planned digitisation of the scheme this autumn, which will disproportionately disadvantage those without easy access to the internet," he wrote.

BMA GP committee chair Dr Richard Vautrey commented: "All those in primary care can play a part in the collaborative effort that must be taken to promote this scheme and in doing so, contribute to the narrowing of the unacceptable health inequalities experienced by far too many."

Screentime

Adults spent an average of an extra 47 minutes a day watching TV and streaming during the pandemic last year than in 2019, according to media regulator Ofcom.

"TV and online video have proved an important antidote to lockdown life, with people spending a third of their waking hours last year glued to screens for news and entertainment," said Ofcom's Yih-Choung Teh.

See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.

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