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ObjectiveTo compare the effectiveness of the BNT162b2 mRNA (Pfizer-BioNTech) and the ChAdOx1 (Oxford-AstraZeneca) covid-19 vaccines against infection and covid-19 disease in health and social care workers.DesignCohort study, emulating a comparative effectiveness trial, on behalf of NHS England.SettingLinked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 Alpha variant was dominant.Participants317 341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a general practice using the TPP SystmOne clinical information system in England, and not clinically extremely vulnerable.InterventionsVaccination with either BNT162b2 or ChAdOx1 administered as part of the national covid-19 vaccine roll-out.Main outcome measuresRecorded SARS-CoV-2 positive test, or covid-19 related attendance at an accident and emergency (A&E) department or hospital admission occurring within 20 weeks of receipt of the first vaccine dose.ResultsOver the duration of 118 771 person-years of follow-up there were 6962 positive SARS-CoV-2 tests, 282 covid-19 related A&E attendances, and 166 covid-19 related hospital admissions. The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks after vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 20 weeks after first-dose vaccination with BNT162b2 was 21.7 per 1000 people (95% confidence interval 20.9 to 22.4) and with ChAdOx1 was 23.7 (21.8 to 25.6), representing a difference of 2.04 per 1000 people (0.04 to 4.04). The difference in the cumulative incidence per 1000 people of covid-19 related A&E attendance at 20 weeks was 0.06 per 1000 people (95% CI −0.31 to 0.43). For covid-19 related hospital admission, this difference was 0.11 per 1000 people (−0.22 to 0.44).ConclusionsIn this cohort of healthcare workers where we would not anticipate vaccine type to be related to health status, we found no substantial differences in the incidence of SARS-CoV-2 infection or covid-19 disease up to 20 weeks after vaccination. Incidence dropped sharply at 3-4 weeks after vaccination, and there were few covid-19 related hospital attendance and admission events after this period. This is in line with expected onset of vaccine induced immunity and suggests strong protection against Alpha variant covid-19 disease for both vaccines in this relatively young and healthy population of healthcare workers.

People with mild asthma will not be included in the UK’s sixth priority group for covid-19 vaccination, it has emerged. Those left out of early vaccination plans include people with well controlled asthma who take regular inhaled steroids, such as budesonide, and who would normally receive a request to come forward for flu vaccination each year. But others, including people who have been admitted to hospital as a result of their asthma symptoms, will be included. Asthma experts told The BMJ that there was no evidence to indicate that people with mild asthma were at a greatly increased risk of hospital admission or death because of covid-19. But the news has sparked confusion and anxiety among patients, given that NHS guidance has …

The UK government has proposed that, by increasing the gap between covid-19 vaccine doses, they will be able to vaccinate a larger number of people, resulting in greater public health benefit. From a lay perspective, this might seem to make sense. Experience from other vaccines shows that a longer gap can augment the immune response. But this approach belies …

This is a sebaceous cell carcinoma on the eyelid of a man in his 50s (fig 1). The patient had presented to his doctor a year earlier with a small nodule on the eyelid …

The UK’s approach of leaving an interval of three months between doses of the Oxford AstraZeneca covid-19 vaccine has been supported by new data, with the Oxford University researchers also saying the vaccine “may have a substantial impact on transmission.” The paper, a preprint currently under review at the Lancet , is an analysis of additional data from trials involving 17 177 participants in the UK, Brazil, and South Africa.1 It includes the results of a further month of data collection with 332 cases of symptomatic covid-19—an additional 201 cases than were previously reported.2 A single standard dose of vaccine provided 76% protection overall against symptomatic covid-19 in the first 90 days after vaccination with protection not falling in this time frame. It is not clear, however, how long protection might last with a single …

“Family doctor” might be an old fashioned way of describing a general practitioner, but it has some useful connotations. It indicates a relationship that stretches from postnatal checks and childhood illnesses, through pregnancies and long term conditions, to palliative and end-of-life care. I might consult with several members of the same family in the space of a week and sometimes have to listen carefully to multiple versions of the same events. A core skill of being a GP is remembering who told you what and being careful not to betray a confidence by responding: “Yes, …

Some people from minority ethnic groups appear to have much poorer health than white people—which can equate to being 20 years older than their actual age—a large observational study has suggested.1 A study published in Lancet Public Health on 28 January found evidence of stark health differences between various ethnicities in England. The findings prompted the authors to call for policy changes to improve ethnic parity for socioeconomic opportunity, service provision, and health outcomes. Lead study author Ruth Watkinson from the University of Manchester, said, “The disproportionate number of deaths from covid-19 in minority ethnic groups has highlighted inequalities in health among older adults in England. Our study adds detail to evidence of these inequities and their …

Concerns have been raised over how much protection a single dose of the Pfizer BioNTech covid-19 vaccine provides, following reports from Israel that it is much lower than expected. Israel, which, like the UK, is currently in its third national lockdown, has so far vaccinated more than 75% of its older people with at least one dose. Early reports from the vaccine rollout have suggested that the first dose led to a 33% reduction in cases of coronavirus1 compared with efficacy of at least 52% reported in clinical trials.2 A preliminary report from the Clalit Research Institute compared the infection data of 200 000 people aged 60 and over who were not vaccinated with the infection …

Photo credit: James O’Donoghue In 1992 Donal O’Donoghue, aged 36, was appointed consultant renal physician at the Hope Hospital (now Salford Royal Hospital) in Manchester, a post he held throughout his career. At the time, without national protocols, treatments were ad hoc. There was not enough access to haemodialysis, so 50% of dialysis patients were having peritoneal dialysis, although it is less suitable for elderly or frail patients. Keen to improve patient care, in 1993 O’Donoghue became director of the Greater Manchester Renal Network, England’s first managed clinical network. He reconfigured renal services with Salford Royal Hospital and the Manchester Royal Infirmary as the hubs, surrounded by satellite dialysis centres. O’Donoghue was concerned that kidney failure was associated with poor outcomes and very high costs and wanted to standardise treatment and move the focus upstream to improve rates of early diagnosis. While continuing to work at the Salford Royal, he took national appointments that put him at the centre of kidney medicine, where he could champion early intervention. In 2000 he became the inaugural president of …

People who have previously been infected with covid-19 are likely to be protected against reinfection for several months, but could still carry the virus in their nose and throat and transmit it to others, according to a study which regularly tested thousands of healthcare workers.1 The preprint reported interim results from Public Health England’s Siren study between 18 June and 24 November 2020. During that period, researchers detected 44 potential reinfections and 409 new infections. This equated to an 83% rate of protection from reinfection, which appeared to last for at least for five months from first becoming sick. The research team warned, however, …

Nearly half of intensive care unit (ICU) and anaesthetic staff surveyed for a study reported symptoms consistent with a probable diagnosis of post-traumatic stress disorder (PTSD), severe depression, anxiety, or problem drinking.1 The preprint, produced by researchers at King’s College London, aimed to get a picture of the rates of probable mental health disorders in ICU and anaesthetic staff in six English hospitals during June and July 2020. It found that while over half reported good wellbeing, many showed signs of mental health problems. The authors said that during the covid-19 pandemic, ICU staff have “faced a particularly challenging time” because of the high mortality among ICU patients with covid-19. “Difficulty in communication and providing adequate end-of-life support to patients and their next of kin, because of visiting restrictions, has been a …

The UK government has promised that every adult in the UK will be offered a covid-19 vaccination by the autumn as it set out plans to rapidly scale up its mass vaccination programme. The UK covid-19 vaccines delivery plan,1 published on Monday 11 January to coincide with the opening of seven new regional vaccination centres, said England will have capacity to vaccinate at least two million people per week by the end of January. This will be delivered across 206 hospital sites, 50 vaccination centres, and 1200 local vaccination sites run by primary and …

Two rheumatoid arthritis drugs will now be used to treat the patients with severe covid-19 in intensive care, after new findings have shown that they significantly improve survival and cut the time spent in hospital by a week to 10 days. Results from the REMAP-CAP trial showed that the interleukin 6 receptor antagonists tocilizumab and sarilumab reduced mortality from 35.8% to 27.3% compared with standard care—an absolute reduction of 8.5% and a relative reduction in mortality of 24%.1 The benefit was seen when the drugs were given within 24 hours of patients entering intensive care and were in addition to a corticosteroid, such as dexamethasone. Anthony Gordon, professor of anaesthesia and critical care at Imperial College London and chief investigator of the study, told a Science Media Centre briefing: “If we treat 12 patients it would save one life. This is a very big effect and really exciting.” The Department of Health and Social Care said that supplies of tocilizumab are already available in hospitals and that updated guidance would be issued to trusts across the UK encouraging …

Simply working harder cannot resolve the conflicts caused by responsibility without autonomy

The UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) has revised its guidance so that pregnant and breastfeeding women can receive the covid-19 vaccine. Writing in BMJ Opinion , Helen Hare, an acute medicine trainee, and Kate Womersley, an academic foundation trainee, said that the change had come after strong pressure from campaigners, clinicians, and some of the women affected.1 The MHRA had previously recommended that breastfeeding women should not be given the vaccine, which Hare and Womersley said had been interpreted by NHS trusts as a blanket ban. But on 30 December …

GPs should use their own discretion to decide whether to honour existing appointments to administer second doses of the Pfizer and BioNTech covid vaccine, the minister for covid vaccine deployment, Nadhim Zahawi, has said. Last week healthcare workers in England were told to reschedule appointments for the second dose of the vaccine after the government’s Joint Committee on Vaccination and Immunisation (JCVI) decided that vaccinating as many people as possible with a first dose should be the priority.1 The chief medical officers of all four UK nations subsequently wrote to doctors asking them to …

On 30 December the four UK chief medical officers announced that the second doses of the covid vaccines should be given towards the end of 12 weeks rather than in the previously recommended 3-4 weeks. Gareth Iacobucci and Elisabeth Mahase look at the questions this has raised

Healthcare workers are calling on the government to ensure that higher grade personal protective equipment (PPE) is mandatory for a range of procedures, such as fitting nasogastric tubes, because of the risk of aerosol transmission of SARS CoV-2. Current guidance from Public Health England is for hospital staff to wear surgical masks in most areas, with filtering face piece class 3 (FFP3) respirator masks required only in intensive care or when certain procedures are carried out that are known to generate aerosols. However, Public Health England’s current categorisation of some procedures as non-aerosol-generating is based on outdated evidence and leaves staff at increased risk of covid-19 infection, say campaigners. Fresh Air NHS, a group of frontline healthcare workers, has written an open letter to UK political leaders calling for the UK and devolved governments to recognise the importance of airborne transmission of SARS CoV-2 and ensure that measures are in place to protect staff and patients.1 The letter, signed by a thousand health professionals, calls for immediate access to FFP3 masks for all staff working with patients with …

A survey of over 7000 doctors conducted by the BMA in December found that, while many thought that their colleagues were coping with work during the covid-19 pandemic, most had concerns about the standard of patient care being delivered. Of 7067 doctors in England, Wales, and Northern Ireland who answered a question on their mental health,1 58% (4067) said that they had symptoms of depression, anxiety, stress, burnout, emotional distress, or another mental health condition related to or …

The BMJ columnist Partha Kar has been awarded an Order of the British Empire for services to people with diabetes. Kar was among over 30 doctors who received an award in the 2021 New Year honours list (see Related content).1 The consultant in diabetes and endocrinology at Portsmouth Hospitals NHS Trust said that the OBE was unexpected. “It’s a very pleasant surprise and an end of year present for what has been a very difficult year for everyone,” he said. “I genuinely believe there are many people in the …

Patients should receive the same type of covid-19 vaccine for their first and second doses, but they could be given different brands if the same vaccine is not available or if there is no record of which vaccine the person received first, Public Health England (PHE) has said. Mary Ramsay, head of immunisations at PHE, told The BMJ that “every effort should be made to give [patients] the same vaccine, but where this is not possible it is better to give a second dose of another …

The lack of planning for how to treat participants in covid-19 vaccine trials is a bad precedent, with the loss of potentially valuable safety and efficacy data, say research experts. Jeanne Lenzer reports

What you need to know A 24 year old woman from Nigeria presents to a male GP in the UK with vaginal discharge and inter-menstrual bleeding. She speaks limited English. Her notes show that she has received three diagnoses of sexually transmitted infections in the last year. She is accompanied by a man who looks older than she is, who offers to interpret for her. She responds without emotion to introductions and questions, and stares out of the window much of the time. An abusive or exploitative situation is suspected. The need for an intimate examination and further investigations is explained, and the accompanying man is politely asked to wait outside. The woman declines a chaperone. Further medical history is elicited through a telephone interpreter. The doctor asks gently whether she feels safe with the man and where she lives. The woman then becomes distressed and tearful and refuses to say anything further. Trafficked adults experience, or have experienced, complex physical and/or emotional trauma, and are usually considered to be adults at risk. The UK’s Care and Support Statutory Guidance, first published in 2014,1 cites modern slavery as one of the 10 …

Pulse oximetry devices used for warning of low blood oxygenation in covid-19 and other diseases may be missing three times as many cases of occult hypoxaemia in black patients as in white, says a study report published in the New England Journal of Medicine .1 Researchers looked at over 48 000 pulse oximetry readings in 8675 US white patients and 1326 US black patients, comparing them with more accurate arterial oxygen saturation measures taken almost contemporaneously. Among white patients whose pulse oximetry readings were 92-96%, the proportion who actually had arterial oxygen saturation below 88% was …

Doctors who see a patient with symptoms of “long covid” should consider the overall effects on the person’s life when deciding on referral, even if individual symptoms may not warrant it, says new guidance.1 Guidance on managing the long term effects of covid-19—from the National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN), and the Royal College of General Practitioners—covers the care of people who develop signs and symptoms during or after an infection consistent …

In the ancient Indian parable of the blind men and an elephant, the shape of the animal is appreciated differently by six blind men who conceptualise it only by touching part of its body.1 In a similar way, children may conceptualise severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in their own unique ways. Although SARS-CoV-2 infection is less severe in children2 (rare instances of multisystem inflammatory syndrome in children notwithstanding34), young people have nonetheless been at the forefront of policy makers’ concerns. This year …

ObjectiveTo provide global, regional, and national estimates of target population sizes for coronavirus disease 2019 (covid-19) vaccination to inform country specific immunisation strategies on a global scale.DesignDescriptive study.Setting194 member states of the World Health Organization.PopulationTarget populations for covid-19 vaccination based on country specific characteristics and vaccine objectives (maintaining essential core societal services; reducing severe covid-19; reducing symptomatic infections and stopping virus transmission).Main outcome measureSize of target populations for covid-19 vaccination. Estimates use country specific data on population sizes stratified by occupation, age, risk factors for covid-19 severity, vaccine acceptance, and global vaccine production. These data were derived from a multipronged search of official websites, media sources, and academic journal articles.ResultsTarget population sizes for covid-19 vaccination vary markedly by vaccination goal and geographical region. Differences in demographic structure, presence of underlying conditions, and number of essential workers lead to highly variable estimates of target populations at regional and country levels. In particular, Europe has the highest share of essential workers (63.0 million, 8.9%) and people with underlying conditions (265.9 million, 37.4%); these two categories are essential in maintaining societal functions and reducing severe covid-19, respectively. In contrast, South East Asia has the highest share of healthy adults (777.5 million, 58.9%), a key target for reducing community transmission. Vaccine hesitancy will probably impact future covid-19 vaccination programmes; based on a literature review, 68.4% (95% confidence interval 64.2% to 72.6%) of the global population is willing to receive covid-19 vaccination. Therefore, the adult population willing to be vaccinated is estimated at 3.7 billion (95% confidence interval 3.2 to 4.1 billion).ConclusionsThe distribution of target groups at country and regional levels highlights the importance of designing an equitable and efficient plan for vaccine prioritisation and allocation. Each country should evaluate different strategies and allocation schemes based on local epidemiology, underlying population health, projections of available vaccine doses, and preference for vaccination strategies that favour direct or indirect benefits.

Bavli and colleagues report that public health interventions against covid-19 are associated with increased rates of domestic violence.1 To tackle issues around the murder of women at the hands of men we need a wider change of narrative across society and the media. We need to change how women are portrayed when they are murdered by men. Headlines must stop trying to provide context (“he murdered her after she . . .”). This apportions blame to the …

Objective To comparatively examine differences in risk of clinical manifestations and death among people admitted to hospital with coronavirus disease 2019 (covid-19) and seasonal influenza. Design Cohort study. Setting US Department of Veterans Affairs. Participants Patients admitted to hospital with covid-19 between 1 February 2020 and 17 June 2020 (n=3641) and seasonal influenza between 2017 and 2019 (n=12 676). Main outcome measures Risks of clinical manifestations, healthcare resource use (including use of mechanical ventilation, admission to intensive care, and length of stay), and death, estimated using a doubly robust approach to build propensity scores that were then used along with covariates to adjust the outcome models. Results Compared with seasonal influenza, covid-19 was associated with higher risk of acute kidney injury (odds ratio 1.52, 95% confidence interval 1.37 to 1.69), incident renal replacement therapy (4.11, 3.13 to 5.40), incident insulin use (1.86, 1.62 to 2.14), severe septic shock (4.04, 3.38 to 4.83), vasopressor use (3.95, 3.46 to 4.51), pulmonary embolism (1.50, 1.18 to 1.90), deep venous thrombosis (1.50, 1.20 to 1.88), stroke (1.62, 1.17 to 2.24), acute myocarditis (7.82, 3.53 to 17.36), arrythmias and sudden cardiac death (1.76, 1.40 to 2.20), elevated troponin (1.75, 1.50 to 2.05), elevated aspartate aminotransferase (3.16, 2.91 to 3.43), elevated alanine aminotransferase (2.65, 2.43 to 2.88), and rhabdomyolysis (1.84, 1.54 to 2.18). Compared with seasonal influenza, covid-19 was also associated with higher risk of death, mechanical ventilator use, and admission to intensive care (hazard ratio 4.97, (95% confidence interval 4.42 to 5.58), 4.01 (3.53 to 4.54), and 2.41 (2.25 to 2.59), respectively) and 3.00 (2.20 to 3.80) additional days of hospital stay. Differences in rates of death per 100 patients between covid-19 and seasonal influenza were most pronounced in people over 75 years of age with chronic kidney disease or dementia and those with black …

The US Food and Drug Administration’s (FDA) independent panel of experts voted on 10 December in favour of emergency use authorisation for the Pfizer BioNTech covid-19 vaccine. The FDA is expected to approve the vaccine within days. Distribution to the states would then begin immediately. Full FDA approval will likely follow. The one day hearing of the Vaccines and Related Biological Products Advisory Committee was broadcast live on YouTube, Twitter, and Facebook. Questions were raised about the safety of the vaccine in people who have had severe allergic reactions and carry an epinephrine injection device, after two allergic reactions were reported in the UK following vaccination.1 Paul Offit, a vaccine expert at the Children’s Hospital of Philadelphia, said that “tens of millions of Americans” might …

The Oxford and AstraZeneca covid-19 vaccine prevented some asymptomatic covid-19 infections in phase III trials, but the effect was mainly seen in the group who received a half dose first, followed by a full dose, the peer reviewed efficacy results have shown.1 The study, published in the Lancet , found that vaccine efficacy against asymptomatic transmission was 59% in the group that received a half dose followed by a standard dose (seven cases among 1120 participants versus 17 cases among 1127 participants in the control group), but just 4% in the group that received two standard doses (22 among 2168 participants versus 23 among 2223 for the control). The researchers said, however, that as this was a secondary outcome, additional confirmation was still required. Analysis of the primary outcome—efficacy against symptomatic cases of covid-19—showed that the vaccine was 62.1% effective in participants who received two standard doses (n=4440) and 90% effective in …

Objective To characterise the symptoms of coronavirus disease 2019 (covid-19). Design Population based cohort study. Setting Iceland. Participants All individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) between 17 March and 30 April 2020. Cases were identified by three testing strategies: targeted testing guided by clinical suspicion, open invitation population screening based on self referral, and random population screening. All identified cases were enrolled in a telehealth monitoring service, and symptoms were systematically monitored from diagnosis to recovery. Main outcome measures Occurrence of one or more of 19 predefined symptoms during follow-up. Results Among 1564 people positive for SARS-CoV-2, the most common presenting symptoms were myalgia (55%), headache (51%), and non-productive cough (49%). At the time of diagnosis, 83 (5.3%) individuals reported no symptoms, of whom 49 (59%) remained asymptomatic during follow-up. At diagnosis, 216 (14%) and 349 (22%) people did not meet the case definition of the Centers for Disease Control and Prevention and the World Health Organization, respectively. Most (67%) of the SARS-CoV-2-positive patients had mild symptoms throughout the course of their disease. Conclusion In the setting of broad access to RT-PCR testing, most SARS-CoV-2-positive people were found to have mild symptoms. Fever and dyspnoea were less common than previously reported. A substantial proportion of SARS-CoV-2-positive people did not meet recommended case definitions at the time of diagnosis.

The UK’s independent Medicines and Healthcare Products Regulatory Agency (MHRA) has approved Pfizer and BioNTech’s covid-19 vaccine, with rollout now set to begin as early as next week, the government has announced. The mRNA vaccine, BNT162b2, was found to be up to 95% effective 28 days after the first dose in a phase III trial.1 The study evaluated 170 confirmed cases of covid-19, 162 of which were observed in the placebo group. There were 10 severe cases, nine of which were in the placebo group. The UK has secured a deal for 40 million doses of the vaccine (enough to vaccinate 20 million people), and delivery will be staggered throughout 2020 and 2021. Care home residents and workers will be prioritised to receive the vaccine first, followed by healthcare workers and people over 80. A spokesperson for the Department of Health and Social Care said, “The vaccine will be made available across the UK from next week. The NHS has decades of experience in delivering …

Half of those recently surveyed by the BMA (43%) said that they were currently experiencing work related depression, anxiety, stress, burnout, emotional distress, or other mental health condition and that it was worse than it had been before the pandemic.1 Indeed, the recent General Medical Council survey of doctors in …

Many children in wealthy countries face huge yet avoidable adversities, risk factors for toxic stress, and lifelong physical and mental health problems. Al Aynsley-Green notes how the pandemic has compounded this scandal, but presents a chance to reset the baseline

Patients’ socioeconomic circumstances should be routinely documented in their healthcare record, say Andrew Moscrop and colleagues

Pfizer and BioNTech have submitted their covid-19 vaccine candidate to the US Food and Drug Administration (FDA) for emergency use authorisation, after concluding a phase III trial. The mRNA vaccine candidate, BNT162b2, was found to be 95% effective 28 days after the first dose. The phase III trial evaluated 170 confirmed cases of covid-19, 162 of which were observed in the placebo group. There were 10 severe cases, nine of which were in the placebo group. In its announcement, Pfizer said the vaccine could be available to high risk populations in the US by the end of December 2020. Globally, it plans to produce 50m doses in 2020 and up to 1.3bn doses by the end of 2021. The companies have started submission processes in Europe, as well as Australia, Canada, and Japan. The phase III trial began …

Baily and Renwick discuss the management of Ludwig’s angina of dental origin.1 The immediate treatment will comprise airway management, fluid resuscitation, and antibiotic treatment. Sometimes, more often than not in our experience, surgical drainage of the swelling is needed. We …

Young, low risk patients with ongoing symptoms of covid-19 had signs of damage to multiple organs four months after initially being infected, a preprint study has suggested.1 Initial data from 201 patients suggest that almost 70% had impairments in one or more organs four months after their initial symptoms of SARS-CoV-2 infection. The results emerged as the NHS announced plans to establish a network of more than 40 long covid specialist clinics across England this month to help patients with long term symptoms of infection. The prospective Coverscan study examined the impact of long covid (persistent symptoms three months post infection) across multiple organs in low risk people who are relatively young and had no major underlying health …

The monoclonal antibody treatment bamlanivimab has been given emergency use authorisation by the US Food and Drug Administration for treating mild to moderate covid-19 in adults and children not admitted to hospital.1 The FDA says that bamlanivimab has been shown to reduce covid-19 related hospital admission or emergency room visits in patients at high risk for disease progression in the 28 days after treatment when compared with placebo. Bamlanivimab acts against the SARS-CoV-2 spike protein to stop the virus attaching to and entering human cells. The authorisation comes after Lilly, the company that makes bamlanivimab, announced last month that it would no longer test the drug on patients admitted to hospital with covid-19, as it was unlikely to help …

The head of the UK’s Recovery trial has urged NHS hospitals to recruit more patients to the study in order to speed up the development of treatments for covid-19. Recovery (randomised evaluation of covid-19 therapy) is the world’s largest randomised trial of covid-19 treatments, recruiting around 150 patients a day. Giving evidence to the Commons Science and Technology committee on 4 November, Peter Horby, the study’s chief investigator and professor of emerging infectious diseases and global health at the University of Oxford, told MPs that UK development of treatments for covid-19 has been “mostly a story of success.” Recovery was …

All care home residents in England should be allowed to receive visits from family and friends in a covid secure way despite new lockdown restrictions coming into force on 5 November, the Department of Health and Social Care will make clear in new guidance. The latest guidance, which has still to be published, marks a U turn from the department’s former policy during the lesser regional restrictions that preceded the new England-wide lockdown. The earlier guidance told thousands of care homes in England that visiting should be stopped in areas with tier 3 lockdown restrictions, apart from in exceptional circumstances such as visiting …

Caan makes an important assertion that adult suicide rates will only reduce when policy makers tackle health inequalities, with particular attention on adverse childhood experiences in the covid-19 pandemic.1 Currently, the UK Office for National …

Robust cellular immunity persists for at least for six months after even mild or asymptomatic SARS-CoV-2 infection, research has shown.1 The study of 100 people showed that all had a cellular immune response against SARS-CoV-2 six months after infection although the size of response was 50% higher in those who had experienced symptomatic disease. There has been concern that the cellular immune response following covid-19 infection may not be sustained. “This data is reassuring,” lead study author Paul Moss, from the University of Birmingham, told a Science Media Centre briefing on 2 November. “However, it does not mean that people cannot be re-infected. We need to have much larger population studies to …

The Nightingale hospital in Manchester is open and ready to admit patients from across the north west of England. But, in a surprising twist, it is only admitting patients who do not have covid-19. The facility, based at the Manchester Central Convention Complex (formerly known as G-MEX), is the first of the Nightingale hospitals to reopen to help take pressure off local hospitals. Sunderland and Harrogate are expected to be next, and all the others are on standby. A spokesperson for the NHS in the north west confirmed that the NHS Nightingale Hospital North West was open, expecting its first patients …

One small but significant impact of the covid pandemic has been its constraining effect on the academic output of women. The first signs of a sex imbalance were seen in the overwhelmingly male line-ups of experts speaking about covid-19 and the poor representation of women on government pandemic advisory panels.12 Meanwhile journals, including The BMJ and our specialty journals, have seen a worrying drop in the proportion of female first authors of research papers. It seems that, while lockdown may have provided men with time and space to boost their academic output, school closures …

As cases of covid-19 in the United States continue to surge, the scientific adviser to the president has suggested that the time may have come to mandate mask wearing. The White House chief of staff, Mark Meadows, admitted on 25 October that covid-19 infections were out of control in the US. “We’re not going to control the pandemic. We are going to control the fact that we get vaccines, therapeutics, and other mitigations, because it is a contagious virus, just like the flu,” he said in a CNN interview.1 Covid-19 cases have surged over the past few weeks, with about 75 000 new cases a day. The US, which currently has the world’s largest epidemic, has reported 8.7 million cases and 225 588 deaths as of 26 October.2 Anthony …