Medical Centre

The news today that the MHRA has approved the AstraZeneca adenoviral ChAdOx1 nCoV-190 vaccine for use in the UK is excellent news for the Covid-19 vaccination programme. The results of the vaccine trial published in the Lancet earlier in December were encouraging, even if the overall efficacy of 70% was lower than the 90-95% being reported for mRNA vaccines from Pfizer-BioNTech and Moderna. The vaccine still prevented serious cases of illness amongst the recipients. The AstraZeneca vaccine is cheaper than the mRNA vaccines and can be stored in a conventional vaccine fridge. Hence, it is an easier vaccine to use in primary care and community settings, including in low and middle income countries. The most commonly reported adverse reactions from the vaccine were fatigue, headache, feverishness, and myalgia. More serious adverse events were rare and not believed to be directly related to the vaccine. One caveat for all the Covid-19 vaccines is that we don’t yet know how long the immunity...

During the Covid-19 pandemic, various treatments and management strategies are being examined to see if they can either help prevent Covid-19 or improve outcomes once people are infected. There are suggestions from some studies that Vitamin D could improve outcomes in people with Covid-19. The National Institute for Health and Care Excellence (NICE) recently assessed assess the role of Vitamin D in Covid-19. In its evidence review, NICE concluded that there was currently insufficient evidence to recommend Vitamin D for the prevention and treatment of Covid-19. NICE did recommend, however, that people in the UK should follow government guidance on taking Vitamin D supplements; particularly people from groups at higher risk of Vitamin D deficiency. The panel also conclude that there was a need for further research on Vitamin D supplementation for preventing and treating Covid-19. Larger prospective studies with sufficient power to look at key outcomes, and also to examine outcomes in su...

  In a Daily Mirror article published on Christmas Eve, Matt Roper and I discuss ways to stay safe this Christmas when the UK is in the midst of a pandemic, with Covid-19 cases rising across the country. The key action is to minimise mixing indoors with people from other households. Think carefully before you socialise, particularly if this will be with people at higher risk of death and complications from Covid-19, such as the elderly and those with long term health problems. How often should we wash or sanitise our hands? You should aim to get into a routine for handwashing. I would recommend handwashing around every two hours during the daytime. You should also wash your hands before and after any activity that might increase the risk of infection, such as handling food or when you have been in contact with other people. Using soap and water is fine, and there is no need to use expensive hand sanitiser unless soap and water are not readily available. Should we keep the wi...

The Covid-19 situation in London is now very serious, with the number of Covid-19 cases doubling in the past to week to around 50,000. Infection rates are highest in the North-East of London, with increases seen all across the city.  The number of hospital patients with Covid-19 has increased to around 3,000 compared with around 1,600 one month ago. The number of patients requiring ventilators has increased by 100 over the last week to around 360. There are also pressures on other parts of the NHS, such as GP, mental health, and community services. The new strain of SARS-CoV-2 is now becoming the most commonly identified strain in London and the South-East of England. It appears to be more infectious than other strains, and this will drive up the number of cases, people requiring hospital treatment and deaths. The latest statistics show how rapidly the situation can change. From a period around one month ago, when case numbers were falling and NHS pressures were sustainable, we are...

People in many areas of the United Kingdom will be living under tight Covid-19 restrictions for the next few months. In London and the South-East of England, for example, this means being placed under Tier 4 restrictions.  For the NHS, there will be two main priorities during this period. The first will be to rapidly implement the Covid-19 vaccination programme. This is our best hope of bringing the pandemic under control and allowing life to start to return to normal. But success requires working on a speed and scale not seen before for any public health programme in the United Kingdom. Adequate supplies of vaccine must be secured and the infrastructure put in place to administer vaccines rapidly to tens of millions of people.  The second priority will be to ensure that people with non-Covid illnesses receive the care they need. This will be very challenging in the middle of a pandemic. We have already seen a large backlog of NHS work build up in 2020. The NHS must ensure tha...

 After a period from mid to late November in which the number of people with a positive Covid-19 test in the UK declined, in recent weeks we have unfortunately seen a rise in Covid-19 cases, with over 28,000 cases reported in the UK on 18 December. This rise in case numbers has been particularly high in parts of London and South-East England, leading today to these areas being placed into a new Tier 4 Level. Infection rates are also increasing in other parts of the UK, such as Wales. Despite the enthusiasm and optimism generated by the Covid-19 vaccination programme, the number of people being vaccinated is well-below the level needed to start to reduce infection rates in the community. Without a very rapid escalation in the Covid-19 vaccination programme, which in turn depends on further vaccines being licensed for use in the UK and very quickly obtaining a much large supply of vaccines than we have available now, it will be sometime (perhaps several months, depending on vaccine a...

After a period from Mid-November onwards in which the number of people with a positive Covid-19 test in the UK declined, in recent days we have unfortunately seen a rise in Covid-19 cases, with over 25,000 cases reported in the UK on 16 December. This rise in case numbers has been particularly high in parts of London and South-East England, leading to more areas of England being placed in Tier 3.  Despite the enthusiasm and optimism generated by the Covid-19 vaccination programme , the number of people being vaccinated is well-below the level needed to start to reduce infection rates in the community. Without a very rapid escalation in the Covid-19 vaccination programme, which in turn depends on very quickly obtaining a much large supply of vaccines than we have available now, it will be sometime (perhaps several months, depending on vaccine availability) before enough people in England and elsewhere in the UK are vaccinated to have an impact on Covid-19 infection rates.  For ...

The news that two UK recipients of the Covid-19 Pfizer-BioNTech mRNA vaccine suffered allergic reactions illustrates the need for accurate recording of any adverse events following administration of Covid-19 vaccines. As these vaccines are new, we don’t yet have long-term data on their safety and efficacy. This data is essential to help build public confidence in these vaccines and ensure take-up of the vaccines is high; not just in the UK but globally as well. The data will also help identify how frequently vaccination is needed to ensure vaccine recipients retain their immunity to Covid-19.  The UK is well-placed to collect this data. We have a National Health Service that has developed computerised medical records for use in general practices on a population of around 67 million people. These electronic medical records provide longitudinal data on people’s health and medical experiences. They can now also be linked to other data; such as hospital admissions records and mortali...

Globalisation impacts the epidemiology of communicable diseases, threatening human health and survival globally. The ability of coronaviruses to spread, quickly and quietly, was exhibited with Severe Acute Respiratory Syndrome in 2002–2003 and, more recently, with COVID-19. Not sparing any continent, the World Health Organization declared a COVID-19 pandemic on 11 March 2020. In an article published in the Journal of Royal Society of Medicine , we discussed how higher income countries can support the response to Covid-19 in low income countries. Despite high-income countries being inordinately impacted, due to the increasing number of COVID-19 cases, SARS-CoV-2 continues to represent a looming threat to the Global South, leading the World Health Organization to previously state that ‘Our biggest concern continues to be the potential for COVID-19 to spread in countries with weaker health systems’ and that Africa could become the next epicentre.  However, while academics, public heal...

Mental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. In a paper published in the journal BMJ Open , we reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices. Fifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. The interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care. We concluded that while there ...

The results of the AstraZeneca adenoviral ChAdOx1 nCoV-190 vaccine trial published in the Lancet today are encouraging, even if the overall efficacy of 70% is lower than the 90-95% being reported for mRNA vaccines from Pfizer-BioNTech and Moderna; and from the Russian Sputnik adenoviral vector vaccine.  The AstraZeneca vaccine is cheaper than the mRNA vaccines and can be stored in a conventional vaccine fridge. Hence, it is an easier vaccine to use in primary care and community settings, including in low and middle income countries. The most commonly reported adverse reactions were fatigue, headache, feverishness, and myalgia. More serious adverse events were rare; none of which were thought to be due to either of the vaccines used in the study.  Based on these results, once the vaccine is approved by the MHRA, I would like to see it rapidly adopted by the NHS. The vaccine is highly suited for use in UK primary care as it can be stored in general practices and given to patient...

Covid-19 vaccinations will kick off within days but it seems some people need a sharp dose of facts first. In an article published in the Daily Mirror , Matt Roper and I debunk some of the common myths and misconceptions about vaccines. Scepticism about vaccines has been growing throughout the pandemic and a recent survey found that one in five British adults may refuse to take a coronavirus jab – even though it is probably our only hope of a return to normality.   1. MYTH: A vaccine produced so quickly can’t be safe Most vaccines take years to develop, test and approve for public use but, says Dr Majeed, a global effort has meant scientists have been able to work at record speed. He says: “Covid-19 vaccines have to go through the same process of approval as other vaccines. Funding was made available immediately and studies set up rapidly. "There have been a lot of technological developments that allow vaccines to be developed much more quickly.”   2....