Pyser Testing

Hospitals

NHS Told to Differentiate Between Patients in Hospital “For Covid” and Those in Hospital “With Covid” – and Not Before Time

After almost 15 months of various forms of lockdown, hospitals have finally been told to change the way they collect data on patients who test positive for Covid. They have been instructed to differentiate between those who are actually sick with Covid symptoms and those who test positive but are actually ill with something else. The Independent has the story.

NHS England has instructed hospitals to make the change to the daily flow of data sent by NHS trusts and told the Independent that the move was being done to help analyse the effect of the vaccine programme and whether it was successfully reducing Covid sickness…

One NHS source said the new data would be “more realistic” as not all patients were sick with the virus, adding: “But it will make figures look better as there have always been some, for example stroke [patients], who also had Covid as an incidental finding.”

In a letter to hospital bosses on June 7th, shared with the Independent, NHS England’s Covid Incident Director, Professor Keith Willett, said that from now on NHS England wanted “a breakdown of the current stock of Covid patients into those who are in hospital with acute Covid symptoms (and for whom Covid is the primary reason for being in hospital); and those who are primarily in hospital for a reason other than Covid (but for whom the hospital is having to manage and treat the Covid symptoms alongside their primary condition)”.

He added: “In lay terms, this could be considered as a binary split between those in hospital ‘for Covid’ and those in hospital ‘with Covid’. We are asking for this binary split for those patients newly admitted to hospital and those newly diagnosed with Covid while in hospital.”…

NHS England data on hospital admissions is published daily at a regional level and several days later on the Government’s dashboard. An internal daily dashboard of Covid data tracks infections across hospitals but is not made public.

Professor Ian Douglas from the London School of Hygiene and Tropical Medicine said: “I think there are good arguments for presenting these data separately – people in hospital ‘with’ vs ‘for’ Covid, as it does partly address the burden to health services due to the virus. Not completely though, because people in hospital with Covid will presumably also need to be treated differently to avoid further spread, which places some extra burden on the hospitals.

“I’ve got no idea what the split is like at the moment, and importantly we won’t know retrospectively what the trend is. Following on from that, there are only a few days before any announcement about June 21st, which may not give us long enough to be sure about what direction the ‘for Covid’ numbers are going.”

This change resembles the recent shift in the definition of a “case” by the CDC in America, where an infection in a vaccinated person is now only a “case” when the person is hospitalised or dies, whereas with the unvaccinated any positive PCR test still counts as a “case”, no matter how mild or asymptomatic.

Now, I’m all in favour of a more restrictive and conventional definition of case that gives a more realistic picture of the impact of the disease. But one can’t help suspect it’s more about politics than science when the kind of change many of us have been calling for since the start only comes once it helps to create the impression that the vaccines are working.

The Independent report is worth reading in full.

England’s NHS Waiting List Hits Five Million for the First Time

In striving to “protect the NHS”, we have instead placed it under record levels of pressure. The number of people waiting to start hospital treatment in England alone continues to rise and has passed five million for the first time. The number waiting for more than a year remains significantly higher than before Covid – and lockdowns – began. The number of people who actually require treatment will be higher still since many are expected to be living with undiagnosed diseases, such as breast cancer, having been reluctant to burden the health service with check-ups during the pandemic. The Guardian has more.

NHS England’s latest set of monthly performance figures, published on Thursday, show that the waiting list stood at 5,122,017 in April – up 171,720 in a month.

The total has risen from the 4.95 million who were on it in March, which was itself almost 252,000 up on the 4.698 million recorded in February – a month-on-month rise of 5.4%.

The number of people being forced to wait at least a year for treatment in hospital, especially surgery, has fallen for the first time in over a year but remains a serious problem. Thursday’s figures also show that 385,490 people have now been waiting more than 52 weeks, 50,637 down on the 436,127 who were in that position last month.

Such long waits are a new phenomenon. In contrast, in March last year – before Covid triggered a suspension of much NHS care – just 3,097 patients had faced such an unusually long delay.

Ministers, NHS chiefs, medical groups and health charities are worried that growing numbers of patients are facing lengthening waits for vital care including cancer treatment, a hip or knee replacement, heart operations and surgery to remove cataracts to improve eyesight.

Worth reading in full.

Stop Press: Professor Karol Sikora, on Lucy Johnston’s “Sketch notes on a pandemic” podcast, says: “I’ve been working in oncology for nearly 50 years and I’ve never seen a crisis like this before.”

Hospital Admissions For Covid Continue to Fall in Scariant “Hotspot” Bolton

The number of people being admitted to hospital to be treated for Covid continues to fall in the former Indian Delta variant “hotspot” Bolton. The MailOnline has the story.

[The] latest NHS figures show there were 42 people in hospital in the Royal Bolton Hospital with the virus on June 1st, last Tuesday, down from 49 at the peak of the new variant scare a week earlier.

The number of people being admitted to hospital each day has tumbled, too, to just three on May 30 compared to 14 five days before. The numbers are trailing a decline in cases which appears to show a spike in new variant cases has come under control.

The same pattern is hopefully beginning to unfold in neighbouring Blackburn, the U.K.’s current hotspot which has also been hit by the Indian “Delta” strain, where infection numbers among over-60s have started to fall following a rise.

Although the borough’s infection rate was still rising at the end of May, a decline in infections among older people should help officials to keep hospital admissions and deaths under control.

More than 12,000 cases of the B.1.617.2 variant have been spotted so far in the U.K. and Public Health England last week admitted for the first time that it has become the most common variant in Britain. Almost one in five officially recorded cases – 2,149 – have been in Bolton, with another 724 in Blackburn with Darwen.

But the fact that Bolton has turned the tide of the super-infectious strain suggests it can be successfully controlled without lockdowns, instead using testing, contact tracing and vaccinations.

Covid hospital admissions started rising in Bolton in the first week of May around 10 days after cases began to rise – it can take several weeks for infected patients to become ill enough to need medical care…

Its coronavirus infection rate spiked 10-fold from just 44 cases per 100,000 people in the week ending April 22nd to a peak of 453 per 100,000 a month later on May 21st.

Cases have been most common in under-55s, who are least likely to have had two doses of a vaccine, but hospital admissions rose in the wake of the rocketing cases. Only a small fraction of patients had been fully vaccinated.

Health Secretary Matt Hancock last week admitted the link between infections and hospital admissions, which vaccines should separate, has so far been “broken but not completely severed”.

Worth reading in full.

Stop Press: According to the Prime Minister’s spokesman, quoted in the Guardian, “[it] still remains that there is nothing in the data currently to suggest step four [of the lockdown roadmap] can’t go ahead at the earliest date”.

But we do need to look very closely at the data over this coming week, which will be crucial to decide and really to get a sense of the data, particularly on hospitalisations and whether or not the excellent vaccine rollout programme has sufficiently severed that link between the increase in cases, which we always expected to happen, particularly after step three, and that subsequently leading to hospitalisations and deaths.

Worth reading in full.

Almost 9,000 Patients Died Within 28 Days after Catching Covid in English Hospitals

Up to 8,700 patients died within 28 days after catching Covid while in hospital for another medical problem, according to NHS data provided by the hospitals themselves. University Hospitals Birmingham is the trust which has recorded the highest number of hospital-acquired Covid infections, as well as the highest number of deaths from Covid caught in hospital. The Guardian has the story.

NHS leaders and senior doctors have long claimed hospitals have struggled to stop Covid spreading because of shortages of single rooms, a lack of personal protective equipment and an inability to test staff and patients early in the pandemic.

Now, official figures supplied by NHS trusts in England show that 32,307 people have probably or definitely contracted the disease while in hospital since March 2020 – and 8,747 of them died.

That means that almost three in 10 (27.1%) of those infected that way lost their lives within 28 days.

Guardian graphic based off figures from freedom of information requests.

The Guardian obtained the data under freedom of information laws from 81 of England’s 126 acute hospital trusts.

The responses show that every trust had to grapple with what doctors call nosocomial or hospital-acquired infection. Many hospitals were unable to keep Covid-positive patients separate from those without the disease, which led to its lethal transmission.

According to the FoI responses, University Hospitals Birmingham trust had the highest number of deaths (408), followed by Nottingham University Hospitals (279) and Frimley Health (259). Nine trusts had 200 or more deaths.

However, the numbers of deaths are influenced by factors such as a hospital’s size, number of single rooms and capacity of its intensive care unit, and the makeup of its local population and level of infection among them, as well as weaknesses in infection control procedures.

At a handful of trusts, about a third of all people who died after catching Covid had become infected in hospital. They include Royal Cornwall hospitals (36%), Salisbury (35.2%) and Kettering general hospital (31.2%).

The answers provided to the Guardian reveal that the 8,747 who died were all in hospital for another reason, such as treatment for a fall, flare-up of a serious illness, or to have an operation.

The figures include people who died in hospital and after discharge. They do not distinguish between those who died of Covid, with Covid or of another condition potentially exacerbated by the virus, such as a heart attack.

Worth reading in full.

Hospitals Are Overcounting Children Admitted for Covid

Almost half of the children in hospital recorded as having needed inpatient treatment for Covid may have actually needed treatment for something else and happened to test positive, a new U.S. study suggests. The MailOnline has the story.

Out of 117 children who tested positive were treated as inpatients in Stanford University’s Lucile Packard Children’s Hospital, 53 were likely not sick enough from the virus itself to need inpatient treatment. 

Children younger than 18 make up only 12.4% of U.S. Covid cases, and less than a fraction of a per cent of the total number of deaths from the virus, Centers for Disease Control and Prevention data show. 

An estimated one to three per cent of Covid hospitalisations for Covid are among children – but the new Stanford study suggests the real figure may be even lower…

The new study, published Wednesday in the journal Hospital Pediatrics, took a closer look at data on 117 children who were either hospitalized for a Covid-linked syndrome – MIS-C, which occurs after kids are infected with coronavirus – or who tested positive after arriving at the hospital. 

The children were hospitalized between May 10th, 2020 and February 10th, 2021. 

About 40% of those children were completely asymptomatic for Covid. 

Another 28% displayed only symptoms of mild-to-moderate coronavirus infections. 

Nine kids became severely ill from Covid, including three who probably were not hospitalized because of the infection, but became seriously sick with Covid during their stay, their medical charts suggest. 

Only 15 out of the 117 children were determined to be critically ill (about 13%). Fourteen of them were likely brought to hospitals specifically because of their Covid symptoms. 

One child was admitted to the hospital to undergo surgery for a congenital heart problem. They had no symptoms when they arrived at the hospital, but later tested positive and fell critically ill, likely due to the combination of Covid and their heart condition. 

Fourteen children were diagnosed with MIS-C – multi-system inflammatory syndrome in children – which has been linked to Covid. These children may not have gotten severely ill during the acute phase of infection with coronavirus, but it set off a chain of immune responses that brought on the potentially life-threatening inflammation. 

All-in-all, only a little over half of the kids who were logged as hospitalised for Covid were actually sick enough from the virus itself to need inpatient treatment for it. 

The other 45% were likely hospitalised for something else and just happened to test positive for Covid. 

Worth reading in full.

Almost Five Million People Waiting to Start NHS Hospital Treatment in England Alone

The number of people waiting to start hospital treatment has risen to 4.95 million in England alone, according to the latest NHS figures. “It’s the highest number since records began back in August 2007,” Sky News reports.

The Express and Star has more.

Data from NHS England also showed that the number of people having to wait more than a year to start hospital treatment stood at 436,127 in March.

This is the highest number for any calendar month since August 2007, when the figure was 578,682.

In March 2020, the number having to wait more than a year to start treatment was significantly lower at 3,097.

This record again highlights the disruption caused to the nation’s health by a year of lockdowns and the NHS’s focus on Covid. The number of people admitted for routine treatment in hospitals in England was up 6% in March 2021 compared with a year earlier – but for many, lockdown has already taken its toll.

The Express and Star report is worth reading in full.

Stop Press: The NHS is to receive £160 million to help tackle this backlog. The Guardian has the story.

Hospitals will use the money to buy mobile CT and MRI scanning trucks, put on extra surgery in evenings and at weekends, and look after patients at home in “virtual wards”…

NHS England has designated groups of NHS trusts working together in 12 parts of the country as “elective accelerators”. They will be given up to £20 million each if they manage to carry out 20% more planned activity – diagnostic tests, operations and outpatient appointments – by July than they did at the same point in 2019-2020, before the pandemic struck.

Worth reading in full.

Stop Press 2: NHS consultants are asking for a “minimum 5% pay rise” and have produced a glossy brochure setting out their case. “After a year in which the NHS has experienced its greatest crisis, and in which consultants have been leading on the frontline since day one in the fight against COVID-19, it is time that consultants were rewarded fairly for the vital clinical leadership they bring to the NHS,” it says. No mention of the ~20% of all people hospitalised with Covid having caught the disease in hospital.

Major Study Finds “Abundance of Patients Admitted to Hospital With Covid Within Seven Days of Vaccination”

A new study of Covid hospital patients has found once again a spike in infections post-vaccination – what the authors call “an abundance of patients admitted to hospital within seven days of vaccination”.

The ISARIC4C consortium’s COVID-19 Clinical Information Network (CO-CIN) enrolled 52,280 Covid patients who were admitted to hospital between December 8th and April 10th. Of these, 3,842 had received at least their first vaccine dose, which is 7.3% or one in 14.

The researchers found that the median time between receiving a first jab and the onset of Covid symptoms was nine days. Since the median time from infection to symptom onset is five days, this suggests the majority contracted the disease in the days after vaccination.

The graph above shows how many of the vaccinated Covid patients experienced symptom onset on each day since vaccination. Note the massive spike on the day of vaccination and the three days afterwards. Although the authors do not say it in so many words, clearly the vaccines here are bringing on the symptoms. Why else would the frequency of symptom onset increase by 400% from the day before vaccination to the day of vaccination and in the following days?

The authors offer a few potential explanations. They suggest elderly and vulnerable people who had been shielding may have become infected through the exposure involved in the vaccination programme. Or perhaps they stopped shielding or being careful as soon as they got vaccinated, wrongly assuming they were immune.

The authors also raise the possibility that recent asymptomatic or mild COVID-19 could be triggered by vaccination into “symptoms likened to COVID-19 symptoms including fever”.

The study’s co-lead Dr Calum Semple, Professor in Child Health and Outbreak Medicine at the University of Liverpool, was clear where he stood on this, saying that the spike indicated “people are letting their guard down because they’ve been vaccinated. There is evidence here that people are unfortunately assuming that they’re protected very quickly after vaccination and that’s not the case.”

Such behavioural change was likewise blamed by Michael Day writing in the BMJ in March. Dr Clare Craig wrote a thorough riposte in the same journal, pointing to ONS data showing that the vaccinated did not increase their social contact and asking how it would explain similar spikes in care homes. She suggested other explanations were more likely, such as a drop in white blood cells in the days after vaccination as observed in the Pfizer trial, which may temporarily suppress immunity.

The spike in symptomatic Covid from day zero plainly cannot be explained by behaviour change, and as the authors suggest looks very much like the vaccine somehow re-triggering an old or existing Covid infection.

The good news from the study is that the vaccinated did not make up a large proportion of those hospitalised with Covid during December and January, though by late February and March (when all the over-65s were vaccinated) they made up a sizeable chunk of a much reduced total.

The authors note that the first dose of the vaccine doesn’t appear to reduce death among the high-risk hospitalised, saying “mortality appears to remain high for people in high-risk vaccination tiers who are admitted to hospital with symptomatic SARS-CoV-2 infection (COVID-19) despite vaccination 21 days or more previously”. It is not clear if this is a temporary effect owing to adverse effects of the vaccine or a permanent gap in the protection it offers.

How much longer can governments and scientists ignore the evidence of the post-vaccine spike in infections, found in study after study? When will they stop lazily blaming people for getting themselves infected and commit to investigate it properly?

Small Proportion of Vaccinated People Have Died Of Covid – and Most Caught the Virus before the Vaccine Could Have Taken Effect

NHS data shows that only a very small proportion of people who have received a Covid vaccine have been admitted to hospital with the virus and died. Around 70% of these people caught Covid before the vaccine would be expected to work, according to a new study, and many were also elderly and frail. The Guardian has the story.

A small number of people vaccinated against Covid have been admitted to hospital with the disease and died, researchers have found, but most were frail and elderly and caught the virus before the jab could have taken effect.

Scientists say their findings are reassuring. They bear out the conclusions of trials of the vaccines in use in the U.K., which show the jabs are highly effective but do not protect everyone.

The ISARIC/Co-CIN study was designed to give the Government’s scientific advisory body, SAGE, an early signal of whether or not the vaccines were working. 

“We’re saying that the vaccine does work. In fact, this is good real-world evidence of it working, but there are some few failures. And when these failures do occur, sadly, people die, but that’s because they’re elderly and frail,” said Professor Calum Semple, a Co-Lead of ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium).

More than 52,000 people were admitted to hospital with Covid in England, Scotland and Wales between December 8th and March 10th. Of those, 3,842 had been vaccinated. The researchers had information on the date of the first dose of vaccine for 3,598 of them and information on the date of a second dose for 140.

The vaccines would not be expected to work fully until three weeks after they were given, said Dr Annemarie Docherty, an Honorary Consultant in Critical Care at the University of Edinburgh. Most of those admitted post-vaccination were infected just before or in the couple of weeks after receiving their jab. The median time from vaccination to symptoms in the study was 15 days.

“Around 71% of the vaccinated patients that we have in hospital in Isaric developed their symptoms before the vaccine would be expected to work,” she said. “So we’re really only talking about 29% of these patients where we would have hoped the vaccine to prevent hospital admission.”

A total of 526 patients out of 52,000 (1%) had been vaccinated more than three weeks before they developed Covid symptoms and were hospitalised. Of those, 113 died. Most of them (97) were in the two highest risk categories, so frail, elderly or otherwise highly vulnerable.

Worth reading in full.

Number of Covid Hospital Patients in England Falls to Seven-Month Low

The number of people in English hospitals with Covid has fallen to the lowest level since last September, according to the latest NHS figures. The total is down by 96% from the peak in January. The Evening Standard has the story.

The number of patients in hospital in England with Covid has dropped to its lowest level for seven months, figures show.

A total of 1,310 patients were in hospital at 8am on April 27th, according to figures from NHS England.

This is the lowest since 1,299 on September 21st, and is down 96% from a record 34,336 on January 18th.

During the first wave of the virus, patient numbers peaked at 18,974 on April 12th 2020.

Both south-east and south-west England are reporting numbers down 98% on their second-wave peak, while eastern England has seen its number drop by 97%.

Patient numbers in the Midlands have fallen 96%, with London north-west England and the combined region of north-east England and Yorkshire all seeing drops of 95%.

The number of hospital admissions of patients with Covid has also dropped significantly since January.

Yet more good news, but will the Government – transfixed by the threat of Covid variants – take any notice?

Worth reading in full.

People in England Waiting to Start Hospital Treatment Hits Record High

The number of people waiting to receive hospital treatment continues to rise, with 4.7 million people stuck on a waiting list by the end of February in England. This is the highest number since 2007, highlighting the impact of a year in which the NHS focused on Covid patients at the expense of many others. BBC News has the story.

Around 4.7 million people were waiting for routine operations and procedures in England in February – the most since 2007, NHS England figures show.

Nearly 388,000 people were waiting more than a year for non-urgent surgery compared with just 1,600 before the pandemic began.

During January and February, the pressure on hospitals caused by Covid was particularly acute.

NHS England said two million operations took place despite the winter peak.

However surgeons said hospitals were still under huge pressure due to the second wave of Covid, which had led to “a year of uncertainty, pain and isolation” for patients waiting for planned treatment.

Tim Mitchell, Vice-President of the Royal College of Surgeons of England, has asked how much longer those whose treatments have been delayed can be expected to wait.

Although the most urgent operations for cancer and life-threatening conditions went ahead, hundreds of thousands of patients waiting for routine surgery such as hip and knee operations, cochlear implants and vascular operations had their treatment cancelled or postponed.

People have been patient as they’ve seen the battering the pandemic has given the NHS, but how much longer can they be expected to wait?

This news again highlights the importance of Professor Karol Sikora’s oft-repeated, yet consistently ignored proposal for a Government press conference to be held which is entirely dedicated to non-Covid related illnesses.

Worth reading in full.