Risk of hospital admission for patients with SARS-CoV-2 variant B.1.1.7: cohort analysis #Covid19RftLks

BMJ | 2021| 373 |n1412 | Risk of hospital admission for patients with SARS-CoV-2 variant B.1.1.7: cohort analysis | doi: https://doi.org/10.1136/bmj.n1412

This nationwide cohort analysis set out to assess whether a causal relation exists between infection with the B.1.1.7 variant, compared with infection with wild-type SARS-CoV-2 variants, and the risk of hospital admission. A secondary aim was to re-estimate the mortality risk for patients with the B.1.1.7 variant compared with wild-type variants that has been reported in previous analyses of the study dataset.

The authors find that:

  • Patients with covid-19 who tested positive for the B.1.1.7 variant had a 1.52-fold hazard of hospital admission within 1-14 days of the first positive test compared with wild-type variants
  • The results likely reflect a more severe disease associated with the SARS-CoV-2 B.1.1.7 variant, particularly in patients aged 30 or older
Abstract

Objective To evaluate the relation between diagnosis of covid-19 with SARS-CoV-2 variant B.1.1.7 (also known as variant of concern 202012/01) and the risk of hospital admission compared with diagnosis with wild-type SARS-CoV-2 variants.

Design Retrospective cohort analysis.

Setting Community based SARS-CoV-2 testing in England, individually linked with hospital admission data.

Participants 839 278 patients with laboratory confirmed covid-19, of whom 36 233 had been admitted to hospital within 14 days, tested between 23 November 2020 and 31 January 2021 and analysed at a laboratory with an available TaqPath assay that enables assessment of S-gene target failure (SGTF), a proxy test for the B.1.1.7 variant. Patient data were stratified by age, sex, ethnicity, deprivation, region of residence, and date of positive test.

Main outcome measures Hospital admission between one and 14 days after the first positive SARS-CoV-2 test.

Results 27 710 (4.7 per cent) of 592 409 patients with SGTF variants and 8523 (3.5 per cent) of 246 869 patients without SGTF variants had been admitted to hospital within one to 14 days. The stratum adjusted hazard ratio of hospital admission was 1.52 (95 per cent confidence interval 1.47 to 1.57) for patients with covid-19 infected with SGTF variants, compared with those infected with non-SGTF variants. The effect was modified by age (P less than 0.001), with hazard ratios of 0.93-1.21 in patients younger than 20 years with versus without SGTF variants, 1.29 in those aged 20-29, and 1.45-1.65 in those aged more than or equal to 30 years. The adjusted absolute risk of hospital admission within 14 days was 4.7 per cent (95 per cent confidence interval 4.6 per cent to 4.7 per cent ) for patients with SGTF variants and 3.5% (3.4 per cent to 3.5 per cent ) for those with non-SGTF variants.

Conclusions The results suggest that the risk of hospital admission is higher for people infected with the B.1.1.7 variant compared with wild-type SARS-CoV-2, likely reflecting a more severe disease. The higher severity may be specific to adults older than 30 years.

[paper] Risk of hospital admission for patients with SARS-CoV-2 variant B.1.1.7: cohort analysis

REACT-1 study of coronavirus transmission: June 2021 final results #Covid19RftLks

Department of Health and Social Care | 17 June 2021 | REACT-1 study of coronavirus transmission: June 2021 final results

The Department of Health and Social Care have published the findings from Imperial College London and Ipsos MORI show, this independent report contains the final results of the REACT-1 study. The findings indicate that infections have increased by 50 per cent since the last REACT-1 study in May, with 1 in 670 people infected. In the period since nearly 109 000 volunteers were tested with PCR tests in England between 20 May and 7 June to examine the levels of COVID-19 in the general population. The latest data shows infections in England have increased by 50 per cent since the last REACT-1 report period, between 15 April and 3 May. Almost 109 000 volunteers tested in England between 20 May and 7 June 2021 as part of one of the most significant coronavirus (COVID-19) studies in the world.

Despite the success of the vaccination roll out, the report shows the prevalence of COVID-19 infections was rising rapidly during late May and early June, coinciding with Delta becoming the dominant variant

The main findings from the 12th round of the REACT study show:

  • between rounds 11 (15 April to 3 May) and 12 (20 May to 7 June), national prevalence has increased from 0.10 per cent to 0.15 per cent
  • exponential growth with a doubling time of 11 days and an R number of 1.44 in England during round 12
  • the highest prevalence was found in the North West at 0.26 per cent, up from 0.11 per cent in round 11; and lowest prevalence in round 12 was in the South West at 0.05 per cent
  • prevalence is highest in 5 to 12 and 18 to 24 year olds, rising from 0.16 per cent to 0.35 per cent and from 0.10% to 0.36 per cent respectively
  • prevalence in those aged 5 to 49 was 2.5 times higher at 0.20 per cent compared with those aged 50 and above at 0.08 per cent
  • at the beginning of February, the link between infection rates and deaths started to weaken. In late April, infection rates and hospital admissions started to reconverge, however, when split by age, the weakened link between infection rates and hospitalisations for ages 65 and over was maintained. The trends converge

REACT-1 study of coronavirus transmission: June 2021 final results

See also Findings from COVID-19 round 12 REACT-1 study published [press release]

More than one million jab appointments were booked since the NHS vaccination programme opened for every adult in England #Covid19RftLks

NHS England | June 2021 | More than one million jab appointments were booked since the NHS vaccination programme opened for every adult in England

People rushed to book 1 008 472 appointments in just two days – an average of more than 21 000 every hour, or six every second – on Friday and Saturday.

The figure does not include appointments made through local GP-led vaccination services or people getting jabbed at walk-in centres.

NHS bosses are urging people to book their appointment without delay as the health service enters the final push to protecting the country against the virus.

From walk in services at sports grounds, including Tottenham Hotspur Stadium and Stamford Bridge as well as Ashton Gate and St Helen’s Rugby Ground, to pop up clinics at universities such as in York and Canterbury, NHS staff are pulling out the stops to offer convenient jab appointments.

To date the NHS in England has delivered 62 million vaccinations in six months; fFour in five adults have now received their first dose of the jab, and with three in five already fully vaccinated after receiving two doses.The NHS is contacting people aged 40 and over to bring forward their second dose in line with updated JCVI advice with the NHS booking service now showing earlier time slots available for those who are eligible to rebook (Source: NHS England).

NHS England Over one million jabs booked as NHS vaccine programme opens to all adults

Covid-19: Prepare for a third wave, warns England’s chief medical officer #Covid19RftLks

NHS Confederation | June 2021 | Covid-19: Prepare for a third wave, warns England’s chief medical officer

Speaking at the NHS Confederation conference lats week Professor Chris Whitty, England’s chief medical officer, gave conference delegates his forward view on what the health service could expect from COVID-19 in the short, medium and long term. Prof Whitty confirmed that we are in the middle of a further surge, the height of which is currently uncertain. While the vaccination programme has been incredibly successful in reducing hospitalisations, deaths and transmission, the Delta variant is significantly more transmissible so infection rates will rise.

He anticipated a surge in the autumn and winter and warned that ‘Covid has not thrown its last surprise at us,’ as the emergence of any further variants is still unknown.

Five years from now, Prof Whitty expects we’ll have polyvalent vaccines that can respond to new variants, but until then the population will likely need several boosters each year to fight variants.

In combatting COVID-19, Prof Whitty highlighted the importance of looking at those hardest hit: people living in areas of deprivation and those living with co-morbidities. He called on the NHS to understand this and take action, while encouraging more generalists in nursing and medicine.

Finally, Prof Whitty praised the research carried out in the UK and the NHS to understand the virus and its impact. The volunteer spirit of UK citizens and NHS patients has meant UK research has led the science effort globally in identifying drugs and treatments, he said, and ‘this would not have been possible without the integrated nature of our care.’ (Source: NHS Confederation)

See also

The BMJ Covid-19: Prepare for a third wave, warns England’s chief medical officer

Third of suspected COVID-19 patients admitted to hospital had ‘do not resuscitate’ order in first wave #Covid19RftLks

NIHR | 17 June 2021 | Third of suspected COVID-19 patients admitted to hospital had ‘do not resuscitate’ order in first wave

Experts from the University of Sheffield’s School of Health and Related Research (SCHARR) present this post hoc secondary analysis of patients admitted with suspected COVID-19, the study aims to describe their characteristics and outcomes according to their DNACPR decision and identify factors associated with recording of a DNACPR decision.

The research team used data from 11 000 patients hospitalised with Covid-19 who are part of the PRIEST study (Pandemic Respiratory Infection Emergency System Triage) which aims to:

  • Optimise the triage of people using the emergency care system with suspected respiratory infections during a pandemic
  • Identify the most accurate triage method for predicting severe illness among patients attending the emergency department with suspected respiratory infection

The research project uses patient data from the early phases of a respiratory infection pandemic, such as for COVID-19, to test how well existing triage methods predict serious complications patients.

People with a DNACPR decision received some intensive treatments as frequently as those with no DNACPR decision, the researchers found. This provides reassurance that doctors were not denying patients with DNACPR decisions potentially life-saving treatment.

Nearly 1 in 3 (31 per cent) of patients admitted to hospital with suspected COVID-19 during the first wave had DNACPR decisions recorded. Of these, over half (59 per cent) survived their acute illness and 12 per cent received intensive treatment aimed at saving their life. From this the research team conclude that early DNACPR decisions were associated with recognised predictors of adverse outcome, and were inversely associated with Asian ethnicity. Most people with an early DNACPR decision survived to 30 days and many received potentially life-saving intervention

NIHR Third of suspected COVID-19 patients admitted to hospital had ‘do not resuscitate’ order in firs

Sutton, L., Goodacre, S., Thomas, B. & Connelly, S. | 2021| Do not attempt cardiopulmonary resuscitation (DNACPR) decisions in people admitted with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study | Resuscitation | https://doi.org/10.1016/j.resuscitation.2021.04.028

Abstract
Aims

We aimed to describe the characteristics and outcomes of adults admitted to hospital with suspected COVID-19 according to their DNACPR decisions, and identify factors associated with DNACPR decisions.

Methods

We undertook a secondary analysis of 13,977 adults admitted to hospital with suspected COVID-19 and included in the Pandemic Respiratory Infection Emergency System Triage (PRIEST) study. We recorded presenting characteristics and outcomes (death or organ support) up to 30 days. We categorised patients as early DNACPR (before or on the day of admission) or late/no DNACPR (no DNACPR or occurring after the day of admission). We undertook descriptive analysis comparing these groups and multivariable analysis to identify independent predictors of early DNACPR.

Results

We excluded 1249 with missing DNACPR data, and identified 3929/12748 (31%) with an early DNACPR decision. They had higher mortality (40.7 per cent v 13.1 per cent ) and lower use of any organ support (11.6 per cent v 15.7 per cent ), but received a range of organ support interventions, with some being used at rates comparable to those with late or no DNACPR (e.g. non-invasive ventilation 4.4 per cent v 3.5 per cent ). On multivariable analysis, older age (p less than 0.001), active malignancy (p less than 0.001), chronic lung disease (p less than 0.001), limited performance status (p less than 0.001), and abnormal physiological variables were associated with increased recording of early DNACPR. Asian ethnicity was associated with reduced recording of early DNACPR (p equal to 0.001).

Conclusions

Early DNACPR decisions were associated with recognised predictors of adverse outcome, and were inversely associated with Asian ethnicity. Most people with an early DNACPR decision survived to 30 days and many received potentially life-saving interventions.

t wave

Full paper available from Resuscitation

New data strategy launched to improve patient care and save lives

Department of Health and Social Care and The Rt Hon Matt Hancock MP | 20 June 2021 | New data strategy launched to improve patient care and save lives

The Department of Health and Social Care and The Rt Hon Matt Hancock have announced a new data strategy that will benefit patients, researchers and healthcare staff. The new strategy will be published next week for stakeholder and public consultation.

The announcement highlights how during the last 18 months, data has saved lives and helped ensure the NHS could provide better care to people suffering from COVID-19 and other health issues. This ensured doctors and nurses could deliver innovative support in the most effective and efficient way.By empowering frontline staff to share data for patient care in a secure way that preserves privacy, ground-breaking clinical trials were approved in record time. New services to care for people in their own homes were set up via remote digital monitoring, avoiding lengthy hospital stays.

This enabled rapid research into COVID-19 treatments such as dexamethasone, which has saved over a million lives across the world. By rapidly speeding up the process to grant approvals for trials to get underway – which previously would have taken around 100 days – and giving researchers access to data in a safe and secure way, this world-leading trial led to the discovery of the first proven treatment to reduce coronavirus mortality (Source: Department of Health and Social Care).

  • NHS patient data enabled world-first COVID-19 treatment saving one million lives
  • Draft strategy to set out new patient rights to access their health records

New data strategy launched to improve patient care and save lives

Women with poor mental health are less likely to attend breast cancer screening appointments

NIHR | 21 June 2021 |Breast cancer screening: women with poor mental health are less likely to attend appointments

This Alert from National Institute for Health Research (NIHR) highlights the findings of recent research that looked at resaons why women chose not to attend breast screening appointments. This research was conducted in Northern Ireland and included nearly 60 000 women between the ages of 50 and 70. They were all eligible for routine NHS screening for breast cancer. One in ten of the sample reported poor mental health. This group was almost a quarter (23 per cent) less likely to attend breast screening than women without mental health problems.

In the last decade evidence suggests that women who live in less affluent or urban areas, and those who are not married, are less likely to attend screening.

The researchers used data from the Northern Ireland Longitudinal Study includes data on one in four (28 per cent) of the Northern Ireland population. It includes women’s responses to questions on mental health in the 2011 Northern Ireland Census. The authors linked this information to women’s records on breast cancer screening. 

Their investigation into the factors that impacted on a woman’s likelihood not to attend a screening appointment were:

  • women with mental illness were less likely to attend screening than women who did not report mental health conditions
  • not being married or living in an urban area were each linked to a similar reduction (23 per cent less) in attendance
  • the effect of social deprivation was greater, and women in this group were 34 per cent less likely to attend breast screening
  • mental health had an impact across all groups of women, regardless of social deprivation, urban living or marital status.

The authors of the study call for health services to explore targeted interventions, such as more frequent appointment reminders. This could encourage women with mental illness to attend screening appointments. 

[Abstract] Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study.

If you’d like access to this paper, please request it from the Library

The impact of language on people living with long-term conditions: having the rug pulled out from underneath you

Evidently Cochrane | June 2021 | The impact of language on people living with long-term conditions: having the rug pulled out from underneath you

In this blog, two patients with lived experience of long-term conditions, explore the impact of language on people living with long-term conditions. The blog includes helpful tips for healthcare professionals for choosing helpful and appropriate language.

The blog also considers the evidence base on the importance of language. Recently a national group for diabetes published a document with NHS England, called ‘Language Matters’.  It has been copied in other languages and used as a model for other conditions like obesity, in the hope that the significance of language in care, in research, and perhaps even everyday life is given attention and that professionals reflect on their use of language.

The impact of language on people living with long-term conditions: having the rug pulled out from underneath you

Cochrane will also be holding a tweetchat on this topic this Wednesday ( 23 June 2021)

Join us for a tweetchat on Language Matters

Cochrane UK is hosting a conversation on Twitter on Wednesday 23rd June at 20.00 pm on the use and misuse of language when talking about long-term conditions. Everyone is welcome to join in, as we discuss these questions:

  1. What language used to talk about a long-term condition do you find problematic and why?
  2. What alternatives do you prefer and why?
  3. What impact does language used, positive or negative, have on you?
  4. What can we do, individually and collectively, to change problematic language?
  5. What advice and guidance is there to help health professionals around language use?

Join in using the hashtag #LanguageMatters and tag @CochraneUK. Cochrane Uk will also have a blog reflecting on the tweetchat.

Nuffield Trust: Tackling Covid-19: A case for better financial support to self-isolate #Covid19RftLks

Nuffield Trust | May 2021 | Tackling Covid-19: A case for better financial support to self-isolate

This briefing from the health think-tank the Nuffield Trust and the independent think- tank the Resolution Foundation argues that financial support through schemes similar to furlough should be expanded so that workers isolating can continue to receive their full wages.

Key points 
  • Evidence suggests that rates of compliance for self-isolating are worryingly low. A key factor driving low compliance is that many people face financial barriers and lose income for self-isolating.
  • Although the government has expanded financial and practical assistance to those isolating, the restrictive eligibility criteria, administrative complexity, and low levels of compensation involved in existing benefits mean that many people still lose earnings for staying home if sick with or exposed to the virus.
  • The £500 self-isolation support payments only cover about 1 in 8 workers, and statutory sick pay only covers a quarter of the average worker’s earnings – and misses out 2 million of the lowest paid workers altogether.
  • This paper sets out a costed proposal for removing these barriers and replacing incomes for those self-isolating. We propose using modified versions of the (Coronavirus) Job Retention Scheme and Self-Employment Income Support Scheme to compensate people who are self-isolating. The policy would allow self-isolating individuals – via their employer or through the Self-Employment Income Support Scheme – to apply for grants to fully cover the lost wages, up to a cap. This would expand support to anyone losing earnings as a result of self-isolation, and avoid people relying on discretionary packages that could be applied in variable ways.
  • If the numbers of people testing positive for Covid-19 and being transferred to NHS Test and Trace remained similar to those in early April 2021, our proposal is estimated to cost between £27 million and £39 million a month. This is equivalent to just 3% of the monthly budget (£1.25bn) allocated for NHS Test and Trace this year and may help ensure the value of that major investment.
  • There are barriers to self-isolation that go beyond lost earnings, which is why this policy must sit alongside ongoing funding for local councils to provide comprehensive self-isolation support packages. This includes practical help with housing and deliveries, as well as additional financial assistance for people with job insecurity, on low wages or not working.

The briefing is available in full from The Nuffield Trust

See also

Nuffield Trust Tackling Covid-19: A case for better financial support to self-isolate

Guidance issued after health checks at vaccination centres help to reduce stroke risk #Covid19RftLks

 Getting It Right First Time | June 2021 | Guidance issued after health checks at vaccination centres help to reduce stroke risk

This publication from GIRFT provides guidance for establishing a standard operating procedure (SOP) for health checks at vaccination centres to help reduce stroke risk

Initial pilot projects have demonstrated the benefit of giving people aged over 65 attending vaccination centres the option of an additional check to establish if they have atrial fibrillation (AF), an irregular heart rhythm that is a major cause of stroke.

Now the Oxford Academic Health Science Network (AHSN), in collaboration with the clinical leads for stroke at the Getting It Right First Time (GIRFT) programme, are sharing guidance on delivering checks in vaccination centres, to help systems that wish to follow suit.

The early focus of the mass vaccination campaign was on over-65s – the age group most at risk of stroke and other forms of cardiovascular disease. Offering targeted heart rhythm checks at vaccination centres has helped to reach some of these people.

Modelling suggests that 37 new cases of AF will be detected and one stroke prevented for every 5,000 people offered a heart rhythm check at a vaccination clinic each year. If everyone aged 65 and over was offered an annual rhythm check more than 1,000 strokes could be prevented in England every year.

This approach has now been rolled out across the wider Frimley Health and Care integrated care system, with people being offered additional tests as part of a full NHS health check. These include blood pressure and diabetes screening.

(Source: GIRFT)

Targeted AF detection in COVID-19 vaccination clinics