The ninth survey of RCP fellows and members during the COVID-19 pandemic shows that while morale appears to have slightly improved, physicians who have worked tirelessly throughout the pandemic are now in urgent need of rest and recuperation.
Headlines
- The vaccine rollout and reducing COVID-19 admissions appears to have had a positive impact on morale, with those reporting feelings of worry falling from 48% to 28%. But only half reported getting the sleep they needed all or most of the time. 88% said there had either been no discussion about time off to recuperate in their organisation, or didn’t know if there had been.
- 97% of respondents had had the first dose of a vaccine. 95% of them had received the Pfizer-BioNTech vaccine. As the second dose must be of the same type as the first, this is important information for those managing the supply.
- Just under 3% of respondents had been present when someone was denied a vaccine because they did not have identification, proof of address or an NHS number, or because of their immigration status, which goes against NHS England advice.
- 60% of respondents said they were fairly or completely confident that their organisation’s IPC measures were effective. 18% felt they did not have the PPE they needed for managing COVID-19 patients, down from 21% in January.
- Only 9% of respondents were taking time off, and 58% of those were taking annual leave. Nobody reported that they were self-isolating. Less than 1% were off with acute COVID-19 and slightly more were off with long COVID, the first time long COVID has caused more sickness that the acute illness.
- For those who had a positive PCR test result, 30% had had a lateral flow test in the previous two days. Of these flow tests, only two thirds (67%) were positive, reinforcing that a negative lateral flow test has limitations.
- Half of respondents (51%) were taking a vitamin D supplement, and 58% of those were already taking it before the pandemic. There was no evidence from this survey that vitamin D use either before or during the pandemic was associated with a reduced rate of infection based on PCR testing or antibody status.
The tail end of the second wave
Over three quarters (76%) of respondents reported falling COVID-19 admissions, rising to 81% in London. Concerns still remain about the impact of COVID-19 admissions on their organisation’s capacity to deliver safe and effective care, but they are waning. Over a quarter (26%) were very concerned compared to 56% in January, but 58% were somewhat concerned (41% in January). As with January’s findings, the majority were more concerned for their non-COVID patients, but that rose from 52% to 62%.
18% of clinicians reported working in a different area to usual, down from 20% last month and 29% in the first wave in April 2020. Almost half (49%) of clinicians redeployed were working in a COVID-19 ward, similar to January (45%).
The emotional and physical toll of working for almost a year to tackle COVID-19 continues to be evident, although the vaccine rollout and reducing COVID-19 admissions appears to have had a positive impact. A large proportion (63%) still felt tired or exhausted, 28% worried and 27% demoralised, but 48% were worried last month. 27% reported feelings of determination, down from 37% in January, although 18% did feel optimistic – a small increase from January. As in January, around a third (32%) felt supported.
Highlighting the knock-on impact of working in these difficult conditions, only 51% reported getting the amount of sleep they needed all or most of the time in the previous four weeks. Respondents in London were the worst affected – only 42% got the amount of sleep they needed all or most of the time, and 11% said they never got the amount of sleep they needed, compared to 8% for all respondents.
Given this, it is concerning that 63% said there had been no discussion in their organisation about timetabled time off to recuperate, and a further 25% just didn’t know. 12% said they hadn’t arranged to have any time off and didn’t feel they needed it, but almost a quarter (24%) simply said they hadn’t arranged it.
Growing delays for diagnostic testing
Delays to diagnostic testing for both inpatient and outpatient services are becoming worse, with endoscopy and clinical physiology services still the most severely affected. 90% reported delays in both for outpatients, up from 82% for endoscopy and 83% for clinical physiology in November 2020. Nuclear medicine services are also experiencing serious delays, with 74% citing delays for outpatients and 64% for inpatients.
Vaccine
97% of respondents had received the first dose of a vaccine, and 18% of those had received the second dose. Two thirds were having the second dose within 12 weeks, but 15% said they didn’t know when they would receive it.
95% had received the Pfizer-BioNTech vaccine. As the second dose must be of the same type as the first, this is important information for those managing the supply.
There have been concerns about people being denied a vaccine because they did not have identification, proof of address or an NHS number, or because of their immigration status. Just under 3% (29 respondents) had been present when this happened, which goes against NHS England advice.
Infection prevention and control
60% of respondents said they were fairly or completely confident that their organisation’s IPC measures were effective. 16% were not at all confident.
In terms of personal risk, as in previous surveys around a quarter (24%) reported having neither a formal nor informal assessment. 18% felt they did not have the PPE they needed for managing COVID-19 patients, down from 21% in January. 4% said they hadn’t been able to access the PPE that PHE advise in the past two weeks, which while low is still a concern.
As in January, the majority (82%) had been or were able to be fit tested for the PPE they were currently using. That leaves almost a fifth still saying ‘no’, and 21% said they weren’t confident fit checking their PPE before entering patient facing areas.
Testing and time off
Only 9% of respondents were taking time off, and 58% of those were taking annual leave. Only 7% of those taking time off had confirmed COVID-19 (fewer than 1% of total respondents), down from 24% in January. Nobody reported that they were self-isolating.
Over two thirds (67%) had had a PCR test at any point, and 27% in the previous two weeks. Of that 27%, the majority (88%) were able to access the test in the first 24 hours. 40% received the results within 24 hours, and 90% within three days. Over a quarter (27%) tested positive and 7% of them were admitted to hospital.
78% reported being provided with lateral flow tests to do each week. For those who had a positive PCR test result, 30% had had a lateral flow test in the previous two days. Of these, two thirds (67%) had received a positive result.
Respondents had generally (88%) been able to access an antibody test if they needed one. 27% reported a positive result, compared to 22% in November 2020 and the highest since June 2020 (31%). The highest number of positives were reported among geriatricians (17%) and respiratory physicians (13%).
Long COVID
There was a small increase in the proportion of respondents citing long COVID as the reason for taking time off work, up from 7% of those taking time off in January to 10%.
Among those who had a positive PCR test result, symptoms persisted for a week or less for 30%. For 18% they persisted for two weeks, for 25% up to six weeks, and between 6 weeks and 6 months for 12%.
The most common symptom was fatigue, reported by 85%. That was followed by pain (32%) and breathlessness (29%). 18% reported cognition problems and 9% limb weakness. 56% reported other symptoms, including persistent anosmia, headache, dizziness, myalgia and a cough.
Vitamin D
For the first time, we asked respondents whether they were regularly taking a vitamin D supplement. Half (51%) were, and 58% of those were already taking it before the pandemic. Respondents under the age of 30 were less likely to be taking one, but rates were similar across all other age groups.
Two fifths (41%) were taking 800-1000IU/day, 29% 400IU/day and 17% 1000-4000 IU/day. The majority (64%) were taking it for general or immune health and 31% in the expectation that it might reduce the risk or severity of COVID-19.
A quarter (26%) of respondents who had received a positive PCR test result for COVID-19 were already taking a supplement before the pandemic. The proportion was the same for those who had received a positive antibody test result. There was no significant difference compared to those not taking supplements.