One in five NHS cancer staff had Covid-19 in the first wave

One in five NHS cancer staff had Covid-19 in the first wave

October 30, 2020

One in five cancer doctors and nurses in UK hospitals ‘were infected with Covid-19 during the first wave of the pandemic’

  • The majority of staff with antibodies did not recall symptoms of the coronavirus
  • And a substantial proportion had lost their antibodies within four weeks 
  • The study of 400 oncology NHS staff suggests more mass testing is needed

One in five cancer doctors and nurses in UK hospitals were infected with Covid-19 during the first wave of the pandemic, a study suggests.  

The majority of those who had antibodies in their blood – a sign of previous infection – did not recall symptoms of the coronavirus, suggesting their were ‘silent carriers’. 

And a substantial proportion — roughly a third — had lost their antibodies within four weeks, which may indicate they at risk of catching the infection again. 

The study of 400 oncology staff within the NHS suggests there is a need for more extensive testing of the workforce. Without it, experts said doctors, nurses and radiographers within cancer care, their families and their patients continue to be at great risk of Covid-19.

It comes amid concerns about the provision of treatment for cancer patients during the coronavirus crisis. Up to 50,000 cancer cases have gone undiagnosed over the pandemic, a leading charity warned today.

Millions more have faced delays in crucial treatment because during lockdown the health service focused on Covid-19 patients, while other services, such as cancer care, were scaled back.

Some 33,000 of cancer patients are still waiting now, but with the UK facing a ‘second wave’ of Covid-19, some hospitals have already started restricting services. 

One in five cancer doctors and nurses in UK hospitals were infected with Covid-19 during the first wave of the pandemic, a study suggests. The highest proportion was in nurses

The study included nurses, doctors, radiographers and admin staff in patient-facing roles working at oncology departments at three large East of England NHS Trusts.

These were Cambridge University Hospitals NHS Foundation Trust, North West Anglia NHS Foundation Trust and Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust. 

At the start of June, staff were given an antigen test, which tells if you are currently infected with the coronavirus.

At the same time they were also given two different antibody tests, which reveal if you have previously had the infection. 

No-one tested positive for antigens, meaning they were most likely not infected at the time they were swabbed for the virus.

But 18.4 per cent tested positive for antibodies specific to the SARS-CoV-2 virus, suggesting they had previously been infected.

The highest rates were among oncology nurses (21.3 per cent), followed by doctors (17.4 per cent), administrators (13.6 per cent) and radiographers (8.9 per cent).

Just 38 per cent those who tested positive for the antibodies reported previous symptoms suggestive of Covid-19, suggesting the rest were ‘asymptomatic’ – meaning they did not show symptoms.

UP TO 50,000 CANCER CASES HAVE GONE UNDIAGNOSED  

Up to 50,000 cancer cases have gone undiagnosed during the pandemic, a leading charity warned yesterday.

It said NHS services could take almost two years to recover.

Macmillan Cancer Support added that the country was ‘at a crossroads’ and said shutting down cancer care this winter could cost thousands of lives.

Experts predict the number of patients with undiagnosed cases of the disease could double by this time next year – unless cancer services are protected.

They estimate it will take the NHS at least 20 months to tackle the backlog caused by coronavirus so far.

A further 33,000 cancer sufferers are facing delays in starting treatment because of the pandemic, the report said.

NHS England said the grim forecast does not factor in the work of health staff in recent weeks to bring ‘cancer treatments back to pre-pandemic levels’.

The new report – The Forgotten C? The Impact of Covid-19 on Cancer Care – details the devastating impact of the backlog on diagnosis and treatment.

It said lockdown led to a drastic fall in referrals as thousands avoided going to their GP with possible cancer symptoms.

Disruption to vital appointments, operations and treatments all contributed to the ‘worrying’ backlog.

Macmillan Cancer Support has called for Health Secretary Matt Hancock to ensure vital cancer services will not be downgraded because of winter pressures and amid rising virus cases.

Lynda Thomas, chief executive at the charity, said: ‘Cancer care is at a crossroads and services cannot be shut down this winter.

‘Because of the pandemic, we estimate that an additional 50,000 people are missing a cancer diagnosis and others are having their appointments disrupted once again.

‘It is simply unacceptable if they face unbearable and unprecedented delays which could affect their chances of survival.’

She added: ‘Cancer doesn’t stop for Covid-19 and neither can our health services.’

There are fears it is only a matter of time before stretched hospitals start to buckle under the rising demand from Covid patients in the ‘second wave’.

Nottingham University Hospitals trust yesterday admitted some cancer operations had been cancelled this week. 

Meanwhile the opening of a flagship cancer unit at University College London Hospitals Trust has been delayed until next summer ‘due to the complexity of the project and the impact of the pandemic’.

However, they may have shown signs of Covid-19 – like a headache or fatigue – but brushed them off as something else.

All staff were retested four weeks later in July to see how their immunity had held up.

Antibodies are parts of the ‘adaptive’ immune system, the part that learns to recognise pathogens so that the next time they enter the body, they can start fighting it off straight away.

Only 13.3 per cent of the staff tested positive for antibodies in July. Of these, 92.5 per cent were previously positive and 7.5 per cent were newly positive.

Of those who tested positive for antibodies in June, 32.5 per cent had become lost their antibodies when retested four weeks later.

The findings indicate that the antibodies waned over time, which means a number of things.

Firstly, it could show that the 18 per cent figure in June was an underestimation of how many staff had actually caught the virus, if those who had it in March of April no longer had antibodies.

And it may mean staff who have had the virus are vulnerable to a second reinfection.

However, even if a test can’t find antibodies circulating in the blood, the body could still rapidly produce them in the future.

It doesn’t necessarily mean the body has forgotten how to fight Covid-19, and a person may have only a milder bout of disease the second time round.

And antibodies are just one of several key components involved in immunity. T cells, types of white blood cells, also play a role in preventing reinfection but can’t be tested for easily. 

The truth on immunity is still murky. But the study adds to research this week from Imperial College London that showed 26 per cent fewer Britons have coronavirus antibodies now than at the peak of the first wave.

Imperial College London scientists, who led the research, said they suspect natural protection against Covid-19 lasts between six to 12 months. 

Dr David Favara, from Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge, led the Covid-19 Serology in Oncology Staff (CSOS) Study.

He said: ‘We began work on this research in April 2020, when the UK was still under Covid-19 lockdown.

‘At that time there was no widely available formal testing programme for NHS staff, symptomatic or asymptomatic, and I was concerned about the impact of transmission of the virus to our oncology patients.’

He said he believes this was the first study to specifically investigate exposure to the virus in patient-facing oncology staff who were at work during the peak of the pandemic in the UK between March and June.

‘The UK has guidance from the UK Royal College of Radiologists on testing patients for the virus antigen prior to their radiotherapy treatments, and broad advice for testing staff,’ Dr Favara said.

‘Considering our findings, we propose that there should be a focus on routinely testing oncology nursing staff for both the virus antigen and antibodies until an effective vaccine becomes available.’

A number of top experts have called for regular testing of healthcare workers, whether they have symptoms of not, including Professor Charles Swanton, who works at the Francis Crick Institute and Cancer Research UK’s chief clinician. 

The study will be presented next week at the National Cancer Research Institute Virtual Showcase, put on by the UK-based National Cancer Research Institute (NCRI).

At the same briefing, a survey will be presented which suggests 69 per cent of oncology staff believe patients’ access to ‘standard of care treatment’ – meaning the standard NHS treatment available – has been compromised as a result of the pandemic.

Almost 2.5million people missed out on cancer screening, referrals or treatment in the UK at the height of lockdown, according to Cancer Research UK, even though the NHS was never ovewhelmed as feared would happen. 

The study also found 66 per cent felt able to do their job without compromising their personal safety.

But 42 per cent of staff felt they were likely to be at risk of poor wellbeing and 34 per cent indicated signs of burnout.

However, the majority said they felt able to work well during this time and an average score of around seven out of 10 was reported, where 10 indicates being able to work to their best.

The survey was of 1,038 doctors, nurses, pharmacists, administrators and allied health professionals working in oncology. 

HOW CANCER PATIENTS ARE BEING DELAYED 

NHS data published in this month was another reminder of the sheer impact Covid-19 has had on treatment for other diseases.

Macmillan Cancer Charity pointed out the NHS England data, which reflected care in August, revealed:

  • LOWER GP REFERRALS: The number of people in England being seen by a specialist for suspected cancer following an urgent referral by their GP was 169,660 in August 2020. This is around 30,700 lower than it was the same time last year, a drop of 15 per cent.  
  • FEWER SUSPECTED CANCER PATIENTS SEEN IN TWO WEEKS: 87.8 per cent of those who saw a specialist did so within two weeks of their initial urgent referral – this is the worst result on record in England for this cancer waiting times target.  
  • 22% FEWER PATIENTS STARTING TREATMENT: 20,177 patients started treatment for cancer in August 2020. Under normal circumstances, this figure would be expected to be around 25,800 – a reduction of 22 per cent and 5,600 people. 
  • 9% FEWER PATIENTS HAVING SURGERY: The number of people having surgery as a subsequent treatment for cancer was around 4,000 in August 2020. This is lower than last month’s figures and a nine per cent drop than what would be expected compared to previous years.
  • 18% FEWER PATIENTS STARTED TREATMENT AFTER REFERRAL: Under normal circumstances, around 13,700 people in England start treatment for cancer following urgent GP referral for suspected cancer specifically every month (i.e. excluding those diagnosed through other routes, e.g. cancer screening). In August 2020, this figure was 11,197, which means the number of people starting treatment following an urgent GP referral for suspected cancer is around 2,500 lower, a drop of 18 per cent.
  • 82% FEWER PEOPLE TREATED LOWER CANCER SCREENINGS: 82 per cent fewer people in England started treatment for cancer following a cancer screening appointment in August 2020 compared to August 2019. Just over half of these people (56 per cent) started treatment within 62 days of their screening appointment, against a target of 90 per cent. 

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