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How can we measure the true scale of UK Covid hospital admissions? | Coronavirus



The number of patients in hospital with Covid is rising, but not all are admitted because of Covid.

Chris Hopson, chief executive of NHS Providers, which represents hospitals in England, has cautioned against overinterpreting hospital admissions data. “What our guys are saying is that incidental cases are about 25% to 30% of cases arriving … They are seeing an increase in the number of hospital admissions, but it’s not going up in an exponential way,” he said.

But just how many people are actually being hospitalised because of Covid, and how should the numbers be counted?

What are the current figures for hospital admissions?

The daily reported figure for Covid hospital admissions covers the total reported admissions to hospital and diagnoses while in hospital.

According to data from NHS England, the figure is rising, at 1,374 on 26 December compared with 926 on 19 December – a 48% increase over seven days.

Some reports suggest the majority of new hospital Covid patients are not “true cases”. Is that right?

What is clear is that while numbers are increasing, admissions are not rising as fast as cases, even taking into account the time lags between infection and becoming severely ill.

However hospital admissions data is not separated into those admitted with Covid or because of it.

This means that getting a true handle on the proportion of hospital admissions because of Covid is tricky, but is it possible to gain some insights from the figures already available.

The most recent available NHS England data reveals that on 26 December there were 1,338 new hospital cases. Of these 1,082 were either admitted in the previous 24 hours for the first time with Covid or were diagnosed in hospital in the previous 24 hours where the test was within seven days of admission.

In other words, 256 of the reported Covid hospital admissions – about 20% – were actually due to hospital-acquired infections, meaning the patients were originally admitted for different reasons.

This approach does not take into account those already infected with Covid but admitted for other reasons.

Dr David Strain, senior clinical lecturer at the University of Exeter medical school, said in his experience the vast majority of Covid patients are admitted because of Covid rather than the infection being an incidental finding.

And Hopson also suggested hospital bosses were reporting a figure of between 25 and 30%, so not the majority.

Should we be reassured that so many people are being admitted with Covid, rather than because of it?

Not really. Even those patients admitted ‘with’ rather than ‘because of’ Covid may only have required hospital care because of the disease itself.

“We [have] seen many other people who have been otherwise stable [with] chronic diseases such as heart failure, ulcerative colitis etc that caught Covid and had a rapid deterioration. Although they are regarded as “incidental Covid”, this sudden deterioration in otherwise stable disease can be attributed to the virus,” said Strain, adding people who have Covid also have poorer outcomes after surgery.

An alternative is to look at the total number of patients admitted, not just those with Covid, with Hopson noting some trusts have not seen an overall rise in admissions. However Strain said his experience is that overall unplanned admissions have risen. What’s more, he said, the approach has drawbacks. “The problem with looking at all admissions is, if the hospital is full, we don’t admit the surgical patients or people who we should be bringing in for elective procedures,” he said.

Is there another way to look at the situation?

As Hopson has noted, it is better to use numbers of Covid patients in hospital rather than new Covid admissions, as the data is more up to date. It also gives a more accurate picture of the pressures on the health service.

NHS England publishes a breakdown every week of the total number of Covid patients in hospital, together with the number who are being treated primarily for Covid.

The latest data gives figures up to 21 December – new figures are expected in the coming days. The data shows that of the 6,245 Covid patients in acute trusts in England on 21 December, 4,432 – or over 70% – were being treated primarily for Covid.

The remaining 30% of Covid patients in hospital were primarily being treated for another issue; however that does not necessarily mean they were not receiving some care for Covid as well.

Incidental Covid patients

Dr Julian Tang, a professor of respiratory sciences at the University of Leicester, said that the proportion of people in hospital with Covid, rather than because of it, will vary a lot between different hospitals depending on factors including the local incidence of Covid.

NHS data reveals the situation varies by region, with about 22% of Covid patients in hospital on 21 December primarily being treated for another issue in the south-west, compared with 39% in the Midlands.

Should patients in hospital or admitted with Covid, not because of it, be discounted from the Covid data?

Some have suggested including figures for patients with Covid is misleading as they may, for example, simply be receiving treatment for a broken leg.

But Covid can lead to more disease in those admitted for another reason, longer hospital stays, more frequent readmissions or outpatient visits and even – in some cases – death. Patients with Covid also need to stay in Covid wards, putting pressure on bed numbers, and meaning elective surgery is postponed or cancelled.

Covid patients also pose a risk of passing the infection to others, including other patients and staff. At present the NHS is hard hit by staff sickness and isolation due to Covid.

“When it comes to burden on the healthcare system, we should absolutely not discount them,” said Strain.

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Solar storms may cause up to 5500 heart-related deaths in a given year



In an approximate 11-year cycle, the sun blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field, which may disrupt our body clock and ultimately affect our heart


17 June 2022

A solar storm

Jurik Peter/Shutterstock

Solar storms that disrupt Earth’s magnetic field may cause up to 5500 heart-related deaths in the US in a given year.

The sun goes through cycles of high and low activity that repeat approximately every 11 years. During periods of high activity, it blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field.

These so-called solar storms can cause glitches in our power grids and bring down Earth-orbiting satellites. A handful of studies have also hinted that they increase the risk of …

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UK Covid infection rate rising, with more than a million cases in England | Coronavirus



Coronavirus infections are rising in the UK, figures have revealed, with experts noting the increase is probably down to the more transmissible BA.4 and BA.5 Omicron variants.

The figures from the Office for National Statistics (ONS), based on swabs collected from randomly selected households, reveal that in the week ending 11 June an estimated one in 50 people in the community in England are thought to have had Covid – around 1.13 million people.

The figure is even higher, at one in 45, in both Wales and Northern Ireland, while it was highest in Scotland where, in the week ending 10 June, one in 30 people are thought to have been infected.

While the figures remain below the peak levels of infection seen earlier this year, when around one in 13 people in England had Covid, the findings are a rise on the previous week where one in 70 people in England were thought to be infected. Furthermore, the data reveals increases in all regions of England, except the north-east, and across all age groups.

Experts say that a key factor in the increase is probably the rise of the Covid variants of concern BA.4 and BA.5.

“Infections have increased across all four UK nations, driven by rising numbers of people infected with the BA.4 and BA.5 Omicron variants,” said Kara Steel, senior statistician for the Covid-19 Infection Survey.

While Steel said it remained too early to say if this was the start of another wave, others have warned it may already have begun, with increased mixing and travelling among other factors fuelling a rise in cases.

Among concerns scientists have raised are that BA.4, BA.5 and another variant on the rise, BA.2.12.1, replicate more efficiently in human lung cells than BA.2.

Prof Azra Ghani, an epidemiologist at Imperial College London, said the latest figures were not surprising, and might rise further.

“This increase in infection prevalence is likely due to the growth of the BA.4 and BA.5 Omicron subvariants, which as we have seen elsewhere in Europe, appear to be able to escape immunity generated from previous Omicron subvariants,” she said.

“It is therefore possible that we will continue to see some growth in infection prevalence in the coming weeks and consequently an increase in hospitalisations, although these subvariants do not currently appear to result in any significantly changed severity profile. This does however serve as a reminder that the Covid-19 pandemic is not over.”

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NHS to offer women in England drug that cuts recurrence of breast cancer | Breast cancer



Thousands of women in England with breast cancer are to benefit from a new pill on the NHS which reduces the risk of the disease coming back.

The National Institute for Health and Care Excellence (Nice) has given the green light to abemaciclib, which cuts the chance of breast cancer returning after a patient has had surgery to remove a tumour.

Trials showed that patients who had the drug with hormone therapy had a more than 30% improved chance of their cancer not coming back after surgery, compared with hormone therapy alone.

“It’s fantastic thousands of women with this type of primary breast cancer will now have an additional treatment option available on the NHS to help further reduce the risk of the disease coming back,” said Delyth Morgan, the chief executive of charity Breast Cancer Now.

“The fear of breast cancer returning or spreading to other parts of their body and becoming incurable can cause considerable anxiety for so many women and their loved ones.

“New effective treatments such as abemaciclib, which can offer more women the chance to further reduce the risk of the disease recurring, are therefore extremely welcome and this is an important step change in the drug options available for this group of patients.”

The twice-a-day pill is suitable for women with hormone receptor-positive, HER2-negative, node-positive early breast cancer at high risk of recurrence who have had surgery. About 4,000 women will benefit initially, Nice said.

Helen Knight, the interim director of medicines evaluation at Nice, said the draft recommendation came less than a month after abemaciclib received its licence.

“The fact that we have been able to produce draft recommendations so quickly is testament to the success of our ambition to support patient access to clinically and cost effective treatments as early as possible,” said Knight. “Until now there have been no targeted treatments for people with this type of breast cancer.

“Abemaciclib with hormone therapy represents a significant improvement in how it is treated because being able to have a targeted treatment earlier after surgery will increase the chance of curing the disease and reduce the likelihood of developing incurable advanced disease.”

Abemaciclib works by targeting and inhibiting proteins in cancer cells which allow the cancer to divide and grow. It normally costs £2,950 for a packet of 56 150mg-tablets, but the manufacturer, Eli Lilly, has agreed an undisclosed discounted price for NHS England.

“Thanks in part to this latest deal struck by NHS England, NHS patients will be able to access another new targeted drug for a common and aggressive form of breast cancer,” said Prof Peter Johnson, the cancer director of NHS England.

“Abemaciclib, when used alongside a hormone therapy, offers a new, doubly targeted, treatment option, helping to increase the chances of beating the cancer for good, as well as meeting the NHS’s commitment to delivering improved cancer care under our long-term plan.”

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