Last updated: 17.00, 8 April 2020

The current COVID-19 global pandemic is constantly evolving. The Center for Systems Science and Engineering (CSSE) at John Hopkins University data dashboard indicates that there are now more than 1.43 million reported cases globally, with the number of mortalities at 82,000 and with 301,000 people recovered from the virus. There is currently no vaccine available for COVID-19. 

In the UK, on 23 March, the Prime Minister announced new measures to tackle the spread of COVID 19, effective immediately. The public have been told they must stay at home, apart from essential travel. The UK Government has issued full guidance on staying at home and away from others. Full UK Government resources are available here.

On 12 March, the UK Government announced that the 'delay' phase of the COVID-19 action plan had commenced. On 16 March, UK Prime Minister, Boris Johnson announced that people or those living with people with a persistent cough or fever must self-isolate for 14 days. 

The number of cases in the UK continues to rise and UK nationals have been advised against all non-essential travel overseas. Schools across the UK were closed on 20 March until further notice. Bars, restaurants, leisure centres, cafes and gyms were closed on 21 March, followed by non essential shops on 23 March. 

During this COVID-19 pandemic it is vitally important that patients and the public recognise that they must continue to seek medical assistance if they have symptoms which cause concern, or they already are being treated for a serious health condition. The risk of developing other serious or life-threatening conditions remains unchanged and people must be fully confident that they can and should, seek medical assistance if they are worried about themselves or a relative.

The NHS not only remains open to see people with urgent and serious problems, it is actively asking that such people seek help. Urgent and acute illnesses or conditions will continue to be treated and the public must not hold back from seeking NHS help regarding serious illness in themselves or their family. This applies to new symptoms or recurrences of existing conditions.

Coronavirus Act 2020

On 17 March it was announced that new laws would be introduced in the UK through the Coronavirus Bill to protect public health, increase NHS capacity, strengthen social care and support the public. The Coronavirus Bill is now an Act of Parliament (law).

The Act sets out a wide variety of measures including some relating to NHS staff and healthcare regulation:

"The (Act) will allow recently retired NHS staff and social workers to return to work without any negative repercussions to their pensions..... It will enable regulators to emergency register suitable people as regulated healthcare professionals, such as nurses, midwives or paramedics. This might include (but will not be limited to) recently retired professionals and students who are near the end of their training. Registered staff can then be used appropriately, with decisions made on a local basis, to increase the available health and social care workforce and enable essential health and care services to function during the height of the epidemic”

UK four nation responses to COVID – 19

Scotland

The Scottish Government has an online hub for the latest news and guidance. On 17 March, the First Minister and Jeane Freeman, Cabinet Secretary for Health advised the Scottish Parliament that the NHS in Scotland has been placed on an emergency footing for at least the next three months.

The Scottish Government announced on 30 March that it will temporarily pause a number of screening programmes (Breast Screening (mammograms); Cervical Screening (smear tests); Bowel Screening (home test kits); Abdominal Aortic Aneurysm (AAA) Screening (ultrasound of abdomen) and Diabetic Retinopathy (Eye) Screening (images taken of the eye)) to enable healthcare staff to be re-allocated to support other essential services, including COVID-19 laboratory testing and covering for colleagues who are unwell or self-isolating.

On 1 April, Cabinet Secretary for Health, Jeane Freeman wrote to the Health and Sport Committee about COVID-19. The letter details further information regarding ICU capacity and ventilators, community care, care homes, and care at home, PPE distribution, testing for key workers, NHS staffing, guidance for shielded groups and mental health.

England

All the guidance and information on the UK Government online hub is applicable in England unless otherwise stated. 

Wales

Welsh Government guidance on COVID-19 has been published and annoucements are regularly updated. All non-essential hospital procedures have been cancelled and Mark Drakeford AM, First Minister made a statement on further measures being taken on 17 March.

Northern Ireland

Guidance from the Northern Ireland Executive is available. Health Minister Robin Swann previously outlined actions that will be taken in Northern Ireland.

Action Plans to tackle COVID -19 in the UK

The UK Government has published an action plan, and the Scottish Government has published its response to date. The 4 phases of the UK's approach are:

  • Containment - caring for any infected people and identifying their close contacts
  • Delay - deciding what actions to take to slow down the spread
  • Mitigate - damage limitation if the virus spreads widely
  • Research - constant and ongoing work to inform the three other phases

Discussions with CMOs

Over recent weeks, the College has participated in teleconferences with the Chief Medical Officers (CMO) for England and Scotland regarding coronavirus. Through this process, the College has been advised that Public Health England (PHE) have published a flow chart for management of a suspected case of COVID-19 acute respiratory disease. The UK CMOs have co-signed a letter in support of UK doctors.  The GMC has published information for healthcare professionals.

The CMOs for England and Scotland (Professor Chris Whitty and Dr Catherine Calderwood), have regularly updated representatives from the Royal Colleges, including the Royal College of Physicians of Edinburgh. Below are the main highlights from their most recent updates:

  • It is positive news is that most of public are adhering very well to the restrictions in the UK and modellers think this will assist in taking the pressure off the NHS in due course
  • Incubation period is up to 14 days and illness appears to last longer than seasonal flu. 
  • COVID-19 appears to result in peak virus shedding after symptoms begin, and then decreases at approximately 10-11 days.
  • Coronavirus differs from SARS in that SARS viraemia was mainly deep in the lung tissue, where Coronovirus is mainly upper airways.
  • The virus remains on hard surfaces for up to 72hrs – and, for practical reasons, the virus will be gone by then. The virus fades faster on soft furnishings or clothes. 
  • The CMO in Scotland has been advised that the R0 (the number of cases one case generates on average over the course of its infectious period) is 2-3, meaning that one person with coronavirus could infect another two or three people on average.  
  • There are a number of vaccine trials around the world beginning/about to begin. The CMOs in England and Scotland don't think that a mass vaccine will be available within the year. Vaccine trials running on the premise that “this might work".
  • The mortality rate for coronavirus is estimated at 2-3% versus the Chinese Sars outbreak in 2002, which was 10%.

Discrimination

The College has noted reports in the UK, and around the world, of people being discriminated against and targeted with abuse because of their ethnicity. In that regard, it is vital that all health professionals, including physicians, are able to play their part in minimising the spread of false information about coronavirus. People from China, or any other “at risk” country, must have their nationality respected and be protected from harm. The College would encourage all clinicians to lead by example by communicating accurate, up to date information, and following official guidance and evidence-based advice issued by public health authorities (see below). 

International update: WHO

The WHO has published online a range of public health advice and information on COVID-19, including situation reports, technical guidance, travel advice, and advice for the public about how to protect themselves.

Guidance and information for UK medical professionals

NICE have now issued rapid guidelines and evidence reviews on COVID - 19.

Updated figures for cases and mortalities in the UK can be found each day, from 2pm, on the UK Government website. A range of other information can be found on the UK Government website including advice for clinicians. A helpful patient flow chart is available along with a letter on COVID-19 NHS preparedness and response. 

The GMC  has now published information about coronavirus on their website for healthcare professionals. They announced on 19 March that for doctors due to revalidate before the end of September 2020, this will be deferred by one year. They have also published a supportive statement intended to reassure doctors that during these unprecedented times, the GMC recognises the level of burden and change imposed on the profession. 

The GMC is also contacting doctors who may be granted temporary registration to help deal with the coronavirus (COVID-19) pandemic, outlining the process they would need to follow and informing them of what they should do if they want to opt out. Once the Secretary of State requests the GMC to grant temporary registration to this group, contact details for doctors granted that status would be shared with the health services in the UK nation matching their address. Those bodies would then contact these doctors to discuss if, how, where and when they might be asked to work. The Scottish Government and NHS England have published guidance on returning to registered professional practice to help with patient care. 

The GMC have published a statement setting out the UK wide approach agreed to facilitate the early provisional registration as doctors of suitable final year medical students once they have graduated, and the early full registration of suitable Foundation Year 1 doctors.

Public Health England (PHE) and Health Protection Scotland (HPS) have each produced clinical guidance for initial management of coronavirus. The PHE guidance for clinicians is publicly available on their website, including for primary care and secondary care. The HPS guidance for primary care and secondary care is also online. A range of other information and guidance can be found on the HPS website. Information Governance Advice is also available from the Scottish Government.

In Scotland, NHS Boards must ensure that all front line healthcare professionals have access to HPS guidance and have a clear understanding of the management and investigation procedures for suspected cases. NHS Boards should also cascade the information to any non-NHS clinicians working in private healthcare settings if such establishments are located in their area. Information and updates from the Department of Health in Northern Ireland are also available.

Guidance on childcare provision for key workers has been published by the UK Government and Scottish Government

On 31 March, the UK Government confirmed that around 2,800 migrant doctors, nurses and paramedics, employed by the NHS whose visa is due to expire before 1 October will automatically have their visas extended, free of charge, for one year.

What next?

The College continues to receive regular updates from relevant public health bodies and departments, including the CMOs for England and Scotland. At this stage, it is important that public health and health protection departments continue to keep the public and clinicians updated as much as possible during what is a fast-moving situation. 

I hope that you have found this update helpful. We will continue to monitor coronavirus closely, and if you have any enquiries, please do get in touch.

Dr Conor Maguire, International Vice President