Jumat, 17 April 2020

Coronavirus: Medics to be asked to reuse gowns amid shortage fears - BBC News

Doctors and nurses in England are to be asked to treat coronavirus patients without fully protective gowns and to reuse equipment due to shortage fears.

The decision came in a reversal of guidance to hospitals from Public Health England on Friday.

Earlier this week, the BBC reported the plan was being considered as a "last resort".

It comes as NHS Providers warned some hospitals' supplies could run out in 24 hours.

Chris Hopson, head of the association, which represents healthcare trusts across England, said in a tweet: "We have now reached the point where the national stock of fully fluid repellent gowns and long-sleeved laboratory coats will be exhausted in the next twenty-four to forty-eight hours."

He said that national leaders have left "no stone unturned" - but gowns that were ordered weeks ago are currently only arriving in "fits and starts".

Public Health England changed its guidance, which until now required long-sleeved, disposable, fluid-repellent gowns for people treating Covid-19 patients.

Now it says if these gowns are not available, staff can wear washable medical gowns or non-fluid-repellent equipment.

Documents seen by the BBC said the measures were considered earlier this week to cope with "acute supply shortages"

It comes as the UK recorded 847 new coronavirus-related deaths in hospitals on Thursday, taking the total to 14,576.

A Department of Health spokesman said: "New clinical advice has been issued today to make sure that if there are shortages in one area, frontline staff know what PPE to wear instead to minimise risk."

And Health Secretary Matt Hancock said he "would love to be able to wave a magic wand" to increase supply of personal protective equipment (PPE).

"But given that we have a global situation in which there is less PPE in the world than the world needs, obviously it's going to be a huge pressure point," he told a virtual committee of MPs.

Mr Hancock admitted the supply of gowns was "tight" but said he was aiming to get enough gowns to staff this weekend.

He added that the government was doing everything it could "to get that PPE to the front line".

Dr Rob Harwood, consultants committee chairman at the British Medical Association, said: "If it's being proposed that staff reuse equipment, this must be demonstrably driven by science and the best evidence - rather than availability - and it absolutely cannot compromise the protection of healthcare workers.

"Too many healthcare workers have already died. More doctors and their colleagues cannot be expected to put their own lives on the line in a bid to save others, and this new advice means they could be doing just that. It's not a decision they should have to make."

At least 50 NHS workers have now died after contracting coronavirus.

Shadow health secretary Jonathan Ashworth said: "Week after week, we hear of problems in PPE getting to the front line despite what ministers tell us at Downing Street press conferences.

"This ongoing failure needs fixing and ministers must explain how they will fix it urgently."

In other developments:

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2020-04-17 21:00:00Z
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Amazon's investment in virus-hit Deliveroo provisionally cleared by UK antitrust watchdog - CNBC

A food delivery cycle courier waits for orders from Deliveroo, operated by Roofoods, in London, U.K., on Dec. 22, 2016.

Simon Dawson | Bloomberg | Getty Images

Britain's competition watchdog has provisionally cleared Amazon's investment in food delivery start-up Deliveroo.

The Competition and Markets Authority said Friday that it had taken the decision due to a "deterioration" in Deliveroo's financial position caused by the coronavirus outbreak.

"Without additional investment, which we currently think is only realistically available from Amazon, it's clear that Deliveroo would not be able to meet its financial commitments and would have to exit the market," Stuart McIntosh, chair of the CMA's independent inquiry group, said in a statement.

"This could mean that some customers are cut off from online food delivery altogether, with others facing higher prices or a reduction in service quality. Faced with that stark outcome, we feel the best course of action is to provisionally clear Amazon's investment in Deliveroo."

Amazon was the lead investor in Deliveroo's $575 million funding round announced back in May last year. But antitrust regulators froze the e-commerce giant's minority stake, citing competition concerns raised by the deal.

Amazon has in the past operated an online takeout business, called Amazon Restaurants, but it shuttered U.K. operations in 2018 and closed down completely the following year. The CMA previously argued that Deliveroo's cash injection from Amazon could reduce competition by removing the possibility of the e-commerce giant re-entering the market.

Both companies disputed the suggestion that Amazon would be hesitant to re-enter the U.K. market alone as a result of the deal. They also pointed out the possibility for other players like U.S. firm DoorDash and Spanish start-up Glovo to enter the British food delivery space.

UK lockdown hits food delivery

Many restaurants in the U.K. have been forced to close as a result of the Covid-19 lockdown measures, prompting Britons to turn to food delivery services such as Deliveroo and Uber Eats.

The CMA said that while Deliveroo had witnessed a recent boost to grocery sales, these were "limited" and failed to make up for losses in its restaurant business.

Deliveroo had recently informed the regulator that the impact of the coronavirus epidemic meant it would "fail financially and exit the market without the Amazon investment."

It comes shortly after Britain's government announced a three-week extension to the country's lockdown restrictions.

The CMA said it was now asking for feedback on its provisional finding by May 11 and that the deadline for its final decision was June 11.

Deliveroo said on Friday that it was "delighted" with the CMA's decision, adding it would "be a boost to the U.K. economy."

"The unprecedented health crisis we all face has disrupted businesses across the country," the company said in a statement. "This investment will help us to overcome immediate and long-term challenges, allow us to continue to improve our service for customers, enable us to develop new innovations and offer people even greater choice."

An Amazon spokesperson said in a statement that its investment in Deliveroo "will benefit both consumers of Deliveroo's service and its small business restaurant partners."

The Amazon-Deliveroo deal isn't the only transaction the CMA has been investigating. It launched a probe into Dutch firm Takeaway.com's £6.2 billion ($7.7 billion) takeover of British rival Just Eat at the start of the year, but recently lifted restrictions preventing the two companies from integrating. The watchdog said its investigation remains ongoing.

Online food delivery has seen intensifying competition with a variety of players operating in the space, from GrubHub to Uber Eats. The market last year saw increased signs of consolidation, in the form of Takeaway.com's Just Eat deal and the sale of Uber's Eats business in India to local operator Zomato.

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2020-04-17 18:11:27Z
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Amazon's investment in virus-hit Deliveroo provisionally cleared by UK antitrust watchdog - CNBC

A food delivery cycle courier waits for orders from Deliveroo, operated by Roofoods, in London, U.K., on Dec. 22, 2016.

Simon Dawson | Bloomberg | Getty Images

Britain's competition watchdog has provisionally cleared Amazon's investment in food delivery start-up Deliveroo.

The Competition and Markets Authority said Friday that it had taken the decision due to a "deterioration" in Deliveroo's financial position caused by the coronavirus outbreak.

UK lockdown hits food delivery

Many restaurants in the U.K. have been forced to close as a result of the Covid-19 lockdown measures, prompting Britons to turn to food delivery services such as Deliveroo and Uber Eats.

The CMA said that while Deliveroo had witnessed a recent boost to grocery sales, these were "limited" and failed to make up for losses in its restaurant business.

Deliveroo had recently informed the regulator that the impact of the coronavirus epidemic meant it would "fail financially and exit the market without the Amazon investment."

It comes shortly after Britain's government announced a three-week extension to the country's lockdown restrictions.

The CMA said it was now asking for feedback on its provisional finding by May 11 and that the deadline for its final decision was June 11.

Deliveroo said on Friday that it was "delighted" with the CMA's decision, adding it would "be a boost to the U.K. economy."

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Amazon's investment in virus-hit Deliveroo provisionally cleared by UK antitrust watchdog - CNBC

A food delivery cycle courier waits for orders from Deliveroo, operated by Roofoods, in London, U.K., on Dec. 22, 2016.

Simon Dawson | Bloomberg | Getty Images

Britain's competition watchdog has provisionally cleared Amazon's investment in food delivery start-up Deliveroo.

The Competition and Markets Authority said Friday that it had taken the decision due to a "deterioration" in Deliveroo's financial position caused by the coronavirus outbreak.

Amazon was the lead investor in Deliveroo's $575 million funding round, announced back in May last year. But antitrust regulators froze the e-commerce giant's stake, citing competition concerns raised by the deal.

Amazon has operated an online takeout business in the past, called Amazon Restaurants, but it shuttered U.K. operations in 2018 and closed down completely the following year. The CMA has argued that Deliveroo's cash injection from Amazon could reduce competition by removing the possibility of the e-commerce giant re-entering the market.

Online food delivery has seen intensifying competition with a variety of players operating in the space, from GrubHub to Uber Eats. It's also an industry providing critical services for many people now stuck at home due to the coronavirus pandemic.

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U.K. Paid $20 Million for New Coronavirus Tests. They Didn’t Work. - The New York Times

LONDON — The two Chinese companies were offering a risky proposition: two million home test kits said to detect antibodies for the coronavirus for at least $20 million, take it or leave it.

The asking price was high, the technology was unproven and the money had to be paid upfront. And the buyer would be required to pick up the crate loads of test kits from a facility in China.

Yet British officials took the deal, according to a senior civil servant involved, then confidently promised tests would be available at pharmacies in as little as two weeks. “As simple as a pregnancy test,” gushed Prime Minister Boris Johnson. “It has the potential to be a total game changer.”

There was one problem, however. The tests did not work.

Found to be insufficiently accurate by a laboratory at Oxford University, half a million of the tests are now gathering dust in storage. Another 1.5 million bought at a similar price from other sources have also gone unused. The fiasco has left embarrassed British officials scrambling to get back at least some of the money.

“They might perhaps have slightly jumped the gun,” said Prof. Peter Openshaw of Imperial College London, a member of the government’s New and Emerging Respiratory Virus Threats Advisory Group. “There is a huge pressure on politicians to come out and say things that are positive.”

A spokesperson from the Department of Health and Social Care said that the government had ordered the smallest number of tests allowed by the sellers and that it would try to recover the money, without specifying how.

The ill-starred purchases are in some ways a parable of the risks in the escalating scrum among competing governments racing for an edge in the fight against the pandemic.

The still-emerging tests for antibodies formed in response to the virus are the next stage in the battle. By enabling public health officials to assess where the disease has spread and who might have some immunity, widespread use of the tests is seen as a critical step in determining how and when to lift the lockdowns currently paralyzing societies and economies in much of the world.

“You can’t lift the lockdown as long as you are not testing massively,” said Nicolas Locker, a professor of virology at the University of Surrey. “As long as the government is not testing in the community, we are going to be on lockdown.”

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The gamble on the Chinese antibody tests, though, is also a barometer of the desperation British officials felt as public pressure has mounted over their slow response to the virus. One prominent expert, Jeremy Farrar, the head of the Wellcome Trust, a British nonprofit that is a major funder of medical research, recently warned that “the U.K. is likely to be certainly one of the worst, if not the worst affected, country in Europe.”

Long before the development of an antibody test, Germany, for example, the continent’s leader in containing the virus, began conducting as many as 50,000 diagnostic tests a day to help trace and isolate cases. That rate is now nearly 120,000 a day.

As of Wednesday, Britain was still conducting less than 20,000 diagnostic tests a day. Having missed a previous target of 25,000 diagnostic tests a day by the middle of April, officials are now promising to reach 100,000 a day by the end of the month and as many as 250,000 a day soon after that.

British officials have said that they started out behind because they lack major private testing companies of the sort found in Germany and the United States, which are capable of manufacturing and performing tens of thousands of diagnostic tests.

But by the time Britain began pushing in earnest to expand its capacity, it was also trailing behind most of Europe in the competition to buy up the limited supply of compounds, tubes and even swabs needed for diagnostic tests to determine a current infection with the virus.

So when the Chinese offers of antibody tests arrived, the officials knew that almost every government in the world was hunting for them, too. Nationalists like President Trump were pressuring domestic suppliers not to sell outside their borders. Oil-rich Persian Gulf princes were bidding up prices.

Medical companies in China, where the virus first emerged, seemed to hold all the cards, typically demanding yes-or-no decisions from buyers with full payment upfront in as little as 24 hours.

The two Chinese companies offering the antibody tests, AllTest Biotech and Wondfo Biotech, both said their products met the health, safety and environmental standards set by the European Union. Public health officials reviewed the specifications on paper while the British Foreign Ministry hurriedly dispatched diplomats in China to ensure the companies existed and to examine their products.

Representatives of both AllTest and Wondfo declined to discuss prices.

Within days of the deal, enthusiastic health officials back in London were promising that the new tests would vault Britain into the vanguard of international efforts to combat the virus.

Appearing on March 25 before a parliamentary committee, Sharon Peacock, a professor of public health and microbiology at Cambridge University who is the senior public health official overseeing infectious diseases, testified that the tests would require only a pin prick in the privacy of one’s home and would soon be available at minimal cost from either local pharmacies or Amazon.

“Testing the test is a small matter,” Prof. Peacock assured lawmakers. “I anticipate that it would be done by the end of this week.”

After quietly admitting last week that the testing had in fact proven unsuccessful, health officials are now defending the purchase as prudent planning and valuable experience.

It was to be expected, Prof. Chris Whitty, Britain’s chief medical officer, said in a news conference. “It would be very surprising if first out of the gate we got to the best outcome that we could for this kind of test,” he said. “It made a lot of sense to get started early.”

But Greg Clark, the chairman of a parliamentary committee examining the coronavirus response, said the government’s promises appeared unrealistic.

“There is no country in the world that is able to operate in massive scale antibody tests yet,” he said in an interview.

“I think it’s now clear,” he added, “that we should have moved earlier and more expansively to make use of all of the testing facilities that we could have.”

After British complaints about the test kits surfaced, both Chinese companies blamed British officials and politicians for misunderstanding or exaggerating the utility of the tests. Wondfo told Global Times, a Chinese newspaper, that its product was intended only as a supplement for patients who had already tested positive for the virus.

AllTest said in a statement on its website that the tests were “only used by professionals,” not by patients at home.

Doctors say the government’s descriptions of the antibody tests could also be misleading.

By comparing the antibody tests to pregnancy tests, officials seemed to be suggesting the antibody tests would determine whether a patient was currently infected. But a discernible level of antibodies may not appear in the blood until as long as 20 days after infection — meaning a person with the virus would test negative until then.

The British military laboratory at Porton Down is also working on an antibody test, but primarily to help public health officials assess the course of the pandemic by surveying samples of the population, not to inform individual patients. The government is hoping to repurpose some of the stored Chinese-made kits for this sort of population-level testing.

Do-it-yourself pinprick tests like the ones the British government ordered from China are far more complicated and much further off than such laboratory tests, researchers say. It is not yet certain what degree of immunity recovery from a past infection may confer, either.

Rapid antibody tests “have limited utility” for patients, the World Health Organization warned in an April 8 statement, telling doctors that such tests remained unfit for clinical purposes until they were proved to be accurate and effective.

British officials, though, were eager for a breakthrough.

Even in late March, as the pandemic overwhelmed hospitals in Italy and Iran, British officials brushed off the advice of the World Health Organization to expand diagnostic testing as quickly as possible.

By the time Britain began pushing in earnest to expand its testing, every country in the world was competing for the same materials.

To make up the shortfall, academic research laboratories have sought to convert themselves into small-scale clinical testing facilities, typically focusing on the needs of local hospitals.

“If it comes around from the government, all well and good,” said Ravindra Gupta, professor of clinical microbiology at Cambridge University’s Department of Medicine, “but we have to prepare for nothing to come. It would be crazy to wait.”

Cancer Research UK, a nonprofit organization, is converting its research laboratories to conduct as many as 2,000 tests a day. But its capacity has been limited to a few hundred because of difficulty and delays in obtaining scarce materials, said Prof. Charles Swanton, its chief clinical officer.

Even the swabs used to obtain samples had turned out to be scarce, he said, and his laboratory ultimately agreed to pay a Chinese supplier as much as $6 a swab — about 100 times the typical cost. “It took about 10 days to get them,” Professor Swanton added.

The British division of the drug giant AstraZeneca began setting up a testing facility last month for its own essential workers, said Mene Pangalos, the executive overseeing the effort. But at the request of the British government, AstraZeneca and its rival drug company GlaxoSmithKline have teamed up to repurpose a laboratory at Cambridge University to carry out as many as 30,000 diagnostic tests a day by the beginning of May.

AstraZeneca hopes to develop a laboratory test for antibodies, too, Mr. Pangalos said. But that will take until at least the middle of next month, and a home-based test, such as the British government tried to order, would take much longer, he added.

“Everyone is overpromising at the moment,” he said. “I don’t want to overpromise.”

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2020-04-17 10:33:04Z
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U.K. Paid $20 Million for New Coronavirus Tests. They Didn’t Work. - The New York Times

LONDON — The two Chinese companies were offering a risky proposition: two million home test kits said to detect antibodies for the coronavirus for at least $20 million, take it or leave it.

The asking price was high, the technology was unproven and the money had to be paid upfront. And the buyer would be required to pick up the crate loads of test kits from a facility in China.

There was one problem, however. The tests did not work.

The ill-starred purchases are in some ways a parable of the risks in the escalating scrum among competing governments racing for an edge in the fight against the pandemic.

Latest Updates: Global Coronavirus Outbreak

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Updated 12m ago