• Patients in intensive care units across the UK are to receive potentially life-saving treatments for COVID-19
• Government ensures life-saving drugs will be available in NHS healthcare settings with immediate effect

Patients across the UK who are admitted to intensive care units due to COVID-19 are set to receive new life-saving treatments which can reduce the time spent in hospital by up to 10 days, the government has announced today (Thursday 7 January).

Results from the government-funded REMAP-CAP clinical trial published today showed tocilizumab and sarilumab reduced the relative risk of death by 24%, when administered to patients within 24 hours of entering intensive care.

Most of the data came from when the drugs were administered in addition to a corticosteroid, such as dexamethasone – also discovered through government-backed research through the RECOVERY clinical trial – which is already provided as standard of care to the NHS.

Patients receiving these drugs, typically used to treat rheumatoid arthritis, left intensive care between 7 to 10 days earlier on average. The rollout of these treatments could therefore contribute significantly towards reducing pressures on hospitals over the coming weeks and months.

Updated guidance will be issued tomorrow by the government and the NHS to trusts across the UK, encouraging them to use tocilizumab in their treatment of COVID-19 patients who are admitted to intensive care units, effective immediately.

Supplies of tocilizumab are already available in hospitals across the UK and clinicians will be able to treat all those admitted to intensive care units, potentially saving hundreds of lives. The department is working closely with Roche, who manufacture tocilizumab, to ensure treatments continue to be available to UK patients.

Health and Social Care Secretary Matt Hancock said:

The UK has proven time and time again it is at the very forefront of identifying and providing the most promising, innovative treatments for its patients.

Today’s results are yet another landmark development in finding a way out of this pandemic and, when added to the armoury of vaccines and treatments already being rolled out, will play a significant role in defeating this virus.

We have worked quickly to ensure this treatment is available to NHS patients without delay, meaning hundreds of lives will be saved.

I am hugely proud of the significant role our NHS and its patients have played in this international trial, and grateful to the outstanding scientists and clinicians behind REMAP-CAP who have brought this treatment to our patients.

Deputy Chief Medical Officer Professor Jonathan Van-Tam said:

This is a significant step forward for increasing survival of patients in intensive care with COVID-19. The data shows that tocilizumab, and likely sarilumab, speed up and improve the odds of recovery in intensive care, which is crucial for helping to relieve pressure on intensive care and hospitals and saving lives.

This is evidence of the UK’s excellent research infrastructure and life sciences industry advancing global understanding of this disease, which we have done both through our own programme of clinical research and through our ability to make very large contributions to international studies.

In June last year, the UK government approved dexamethasone as the world’s first treatment proven to reduce mortality for COVID-19. The REMAP-CAP trial found that the rate of death for those in intensive care units on corticosteroids, such as dexamethasone, and respiratory support alone was 35%, which was reduced to 28% when tocilizumab was also administered.

The government continues to work in partnership to ensure global equitable access to safe and effective treatments. Only multilateral collaboration can deliver at the speed and scale needed to end the global pandemic, and the government remains committed to participating in international trials such as this that seek to answer important questions about the virus.

The UK has played an integral role in these international efforts: three-quarters of patients enrolled globally have been NHS patients, in 142 hospitals across the UK – roughly half of the 289 total sites across the world. A quarter of all patients in intensive care with COVID-19 have enrolled and continue to volunteer to enrol in the REMAP-CAP trial – all of whom have made a vital contribution to the research needed to beat this disease.

Support also came from the UK’s National Institute for Health Research (NIHR), its well-established Clinical Research Network and the UK’s Chief Medical Officers. The UK government has, to date, provided £1.2 million to support the REMAP-CAP trial.

Professor Stephen Powis, NHS national medical director, said:

The fact there is now another drug that can help to reduce mortality for patients with COVID-19 is hugely welcome news and another positive development in the continued fight against the virus.

This signals how the NHS is working all the time to find new treatments and therapies, but the best advice for individuals is to remember the hands, face, space guidance.

The REMAP-CAP analysis has not yet been peer-reviewed.

Tocilizumab is administered intravenously in a one or two-dose regime. It has been demonstrated to be effective for patients requiring organ support when administered soon after admission to ICU.

Other trials such as the RECOVERY trial are assessing efficacy in wider patient groups outside of intensive care settings, but these are still ongoing. REMAP-CAP has not tested the effectiveness of tocilizumab in primary care settings.

Tocilizumab will be used to further reduce mortality from COVID-19 and in addition to dexamethasone, which is already standard of care for hospitalised patients receiving supplemental oxygen.

Tocilizumab and sarilumab have already been added to the government’s export restriction list, which bans companies from buying medicines meant for UK patients and selling them on for a higher price in another country. This will protect supply for UK patients by enforcing regulatory action on those who flout the restrictions.

The REMAP-CAP trial showed that mortality was 35.8% for patients receiving current standard of care alone, and that this was reduced to 27.3% using tocilizumab and sarilumab. This was a 24% relative reduction in risk of mortality for patients who entered intensive care.

In a statement, the commission outlined its concerns over contingency plans for pupils affected by the global COVID pandemic.

It said: ‘We, like teachers and parents across the country, share with the Education Secretary his concerns over young people missing out on education, and deeply regret that schools and colleges are now closed.

The loss of a normal exam season is also unfortunate.

‘But exams are only the test of knowledge – the bigger issue is the huge and growing learning loss during a year of massive disruption.

‘We need to think far more carefully, moving beyond sticking plaster solutions, and consider options such as allowing some children to retake a year, funded with extra resources.

‘The lesson of the pandemic has been that delay is costly. This is as true in education as it is in healthcare. The plans put forward in the statement yesterday are adequate – but they are late, and they are incomplete. In future, we would hope that government and the teaching profession can come together, with mutual trust, to plan effectively and holistically for all eventualities, so that plan A can switch to plan B with the minimum of fuss.

‘It is unfortunate that the Education Secretary has not chosen to share with schools the contingency plans he states he has already made so they could move seamlessly to delivering the necessary teaching, remote or otherwise.

Risk of losing motivation

‘And it is a significant problem that these plans are still not at a stage where teachers can get on with engaging year 11 and 13 students with a deliverable assessment process at the critical point when they are most at risk of losing all motivation.

‘All of this was foreseeable – in fact, we, like many others, called for a clear system of gathering centre assessed grades to be published at the beginning of the academic year- and it is not enough for the secretary of state to say the contingency plans are in operation when they so clearly are not ready yet.

‘When it comes to securing the futures of our most vulnerable children, we support the government’s efforts to ensure quality remote learning. But this needs to be backed up on the ground by speedy distribution of technical resources – both laptops and broadband access.

‘The initiative to make access to education sites free is welcome, as is the content being delivered by the BBC. The use of Ofsted to monitor remote learning, however, must be managed very carefully to avoid either the fact or the impression of being punitive – it has a role, but only to support and share best practices.

‘It is good that pupils without access to devices, functioning high speed broadband, or lack of learning space within the home are now considered vulnerable and are free to go back to school during lockdown. ‘Unfortunately, government has failed to communicate this effectively either to parents or schools and teachers. Efforts must be made quickly and loudly to rectify this.

Inequality gap widening by the day

‘The challenge now lies in two things – the speedy delivery of these promises, and the long-term support of the young people for whom this last year represents a catastrophic disruption in their lives. The inequalities in our schools are widening by the day – not just for those labelled as disadvantaged, but also for those who have huge struggles, both socially and economically, even if they don’t fall into limited and blunt categories like free school meals.

‘Vital steps must be taken now:

• The system for teacher assessment must be communicated to schools as a matter of absolute urgency. • Those whose learning loss is too significant to make up must be offered the possibility of resit years – and schools and colleges must be funded properly to provide this. • And Government must convene a new body to plan educational recovery and reassessment over the next five years.

‘We cannot look away from the disaster that will unfold if we yet again do not learn our lesson, and yet again fail to plan for the long term. ‘

Selling vintage and printed women’s fashion, Rustin and Mallory are an experienced exporter selling wholesale to customers in the USA, Europe and Australia as well as retail sales through their website.

Since the start of 2020, their exporting business has soared. 35% of their profits now come from overseas, up from 15% at the start of the year, enabling them to double their staff numbers at their warehouse in Bromsgrove, Worcestershire.

Their biggest overseas customer is Urban Outfitters, who have been clients for 15 years. However, financial uncertainty caused by the COVID-19 pandemic caused them to lose insurance cover, putting this longstanding relationship at risk.

Thankfully, their financial provider Bibby Financial Services put them in touch with UK Export Finance (UKEF), the UK’s export credit agency, who were able to quickly provide the required insurance to enable Rustin and Mallory to keep trading.

Harvey Morrison, Financial Controller at Rustin and Mallory, said:

Without UK Export Finance’s help we could have lost one of most important customers.

UKEF was extremely supportive and obtaining the insurance policy from them was quick and easy. Now we can keep selling to Urban Outfitters, supplying British fashion to the US market.

Phill Potter, Senior UKEF Export Finance Manager, added:

The COVID-19 pandemic has seen demand for our export insurance policy triple, as UK companies look to continue trading overseas. UKEF is here to support exporters like Rustin and Mallory to win overseas contracts, fulfil orders and get paid through these difficult times.

(Photo by Mike Mozart on Flickr. Used under Creative Commons).

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