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New sickle cell treatment given to first patients in England

Sickle cell patients have begun receiving the first new treatment for the blood disorder in over 20 years.

The inherited condition can cause severe pain and organ failure, often requiring hospital admissions.

Crizanlizumab is given as a monthly infusion and is thought to cut visits to A&E by 40%. Loury Mooruth, 62, received the treatment at Birmingham City Hospital, having suffered repeated periods of intense pain for decades.

During a crisis, patients often need powerful opioid painkillers but Loury, like many others, has faced suspicion when at A&E.

"You know the protocol when you go in, which needles and so on. They think straight away you are a drug addict - they don't believe you," she says.

She has refused to go to hospital during a crisis for the past two years because of her negative experiences.

A report from MPs last year found "serious failings" in sickle cell care with some evidence of discrimination against patients.

Dr Shivan Pancham, a consultant haematologist at Birmingham City Hospital, told the BBC: "Our patients often find the experience in emergency departments challenging with a lack of understanding of the severity of pain.

"It is hoped with these new therapies if we reduce the likelihood of attending emergency departments, ultimately this will be much better for the patients."

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Source: BBC News, 24 February 2022

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NHS faces ticking ‘time bomb’ of 8m cancelled or delayed operations due to anaesthetist shortage

The NHS is facing a “time bomb” and will be forced to cancel or delay around 8 million operations each year by 2040, due to a lack of consultant anaesthetists across the services.

The Royal College of Anaesthetists (RCOA) said the current shortage of at least 1,400 staff across the UK means millions operations will not be able to take place.

The college has warned its speciality is facing a “perfect storm” of limited training places, poor retention and an ageing workforce with 39 per cent nearing retirement age.

The analysis found as demand for surgeries continue the need for anaesthetists is due to increase by 3.85 per year, meaning the NHS will need around 25,000 doctors in these posts by 2040.

Dr Fiona Donald, president of the RCOA said: “The NHS is facing an anaesthetic workforce time bomb. We already have profound workforce shortages that are preventing huge numbers of operations from taking place – and unless urgent action is taken, the problem is going to worsen.

“We would welcome government funding for additional anaesthetic training posts. One hundred additional posts per year would start to plug the gap and help get the UK back on a sound footing to be able to address the waiting list backlog. Without this investment, we foresee impacts to patient care and a further impact on the mental health of our current workforce – they need to be able to prioritise their own health and that of their families alongside the focus they already place on the health of patients and the public.”

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Source: The Independent, 22 February 2022

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Mothers who helped uncover the biggest NHS maternity scandal

Next month, a report will be published into one of the biggest scandals in the history of the NHS, the failures of maternity care at the Shrewsbury and Telford Hospital NHS Trust. The BBC's Michael Buchanan who helped uncover the problems examines why so many failures were allowed to happen for so long.

Kayleigh Griffiths' baby, Pippa, died at 31 hours old. The cause of death, the couple were later told, was an infection - Group B Strep. The Shrewsbury and Telford Hospital NHS Trust told the family they would carry out an investigation. But after several weeks of silence, Kayleigh contacted the trust to be told it was an internal investigation and the couple's input wouldn't be required. Kayleigh, an NHS auditor at a different trust, feared the truth was being hidden from her. That's when she decided to send the email to Rhiannon Davies, whose baby, Kate, also died at the Shrewsbury and Telford Hospital NHS Trust

As the bond between the mothers deepened, their conversations morphed into something else. Armed with little more than a gnawing suspicion, they started to scour the internet, coroner's records and death notices to see if any other families had received poor maternity care at the Shropshire trust.

They collated 23 cases dating back to 2000 - including stillbirths, neonatal deaths, maternal deaths and babies born with brain injuries. Appalled by what they had found, they wrote to the then health secretary Jeremy Hunt in December 2016, asking him to order an investigation. He agreed and in May 2017, senior midwife Donna Ockenden was appointed to lead the review.

One of the themes the inquiry has already noted, in an interim report published in December 2020, is that in many cases the trust failed to investigate after something went wrong, or simply carried out its own inquiry. Panorama has discovered the trust even developed its own investigation system, what they called a High Risk Case Review.

It was outside any national framework that has been used to help learn lessons from incidents and doesn't appear to be a system that's used in any other NHS organisation. Another consequence of the unorthodox system was that fewer incidents were reported to NHS regulators, limiting the opportunity to learn lessons.

One of the earliest cases on the original list of 23 compiled by the two couples was the death of Kathryn Leigh in 2000. Panorama has investigated the case and discovered that a theme identified almost two decades ago was to come up repeatedly in subsequent incidents.

The publication of the final report by Donna Ockenden next month will be a watershed moment in the history of the NHS - the revelation of multiple instances of maternity failures in a rural corner of England. Pippa Griffiths and Kate Stanton-Davies lived fewer than 40 hours between them, but their legacy, in terms of improved maternity care, could last decades.

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Source: BBC News, 23 February 2022

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Mysterious conditions are afflicting Americans after Covid. It could signal a looming cardiac crisis

Five months after being infected with the coronavirus, Nicole Murphy’s pulse rate is going berserk. Normally in the 70s, which is ideal, it has been jumping to 160, 170 and sometimes 210 beats per minute even when she is at rest — putting her at risk of a heart attack, heart failure or stroke.

No one seems to be able to pinpoint why. She’s only 44, never had heart issues, and when a cardiologist near her hometown of Wellsville, Ohio, USA, ran all of the standard tests, “he literally threw up his hands when he saw the results,” she recalled. Her blood pressure was perfect, there were no signs of clogged arteries, and her heart was expanding and contracting well.

Murphy’s boomeranging heart rate is one of a number of mysterious conditions afflicting Americans weeks or months after coronavirus infections that suggest the potential of a looming cardiac crisis.

A pivotal study that looked at health records of more than 153,000 U.S. veterans published this month in Nature Medicine found that their risk of cardiovascular disease of all types increased substantially in the year following infection, even when they had mild cases. The population studied was mostly White and male, but the patterns held even when the researchers analyzed women and people of color separately. When experts factor in the heart damage probably suffered by people who put off medical care, more sedentary lifestyles and eating changes, not to mention the stress of the pandemic, they estimate there may be millions of new onset cardiac cases related to the virus, plus a worsening of disease for many already affected.

“We are expecting a tidal wave of cardiovascular events in the coming years from direct and indirect causes of covid,” said Donald M. Lloyd-Jones, president of the American Heart Association.

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Source: Washington Post, 21 February 2022

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NHS not ‘human’ enough to get greater role in social care, says government review

The NHS should not be given greater control of social care because it is ‘hierarchical, centralised and not person-centred’, according to a government-commissioned review which is repeatedly scathing about the health service.

The review was ordered by then health and social care secretary Matt Hancock in June 2020. Cross-bench peer, writer and former Number 10 adviser Baroness Camilla Cavendish was asked “to make recommendations for social care reform and integration with health in the wake of the Covid-19 pandemic, which could fit alongside the funding reforms planned by the department in the context of the NHS long-term plan.”

In her final report, Baroness Cavendish wrote that “one answer” to the problems facing the sector “would be to let the NHS take over social care. On paper, this would join up the care continuum.”

However, she rejected the idea because of the NHS’ “hierarchical” and “centralised” nature. Baroness Cavendish also suggested the NHS’ role should be limited because it is “still struggling to join up primary and secondary care”.

In contrast to the NHS, she claimed: “Social care is more innovative, more responsive and human.”

She added: “The culture of the NHS is still largely one of ‘doing to’ patients, and the NHS has much to learn from social care about how to be responsive and human facing.”

Referencing “recent attempts to import the successful [Buurtzorg] model of self-managing teams into the NHS”, the cross-bench peer said these “have foundered, because the NHS culture cannot seem to cope with giving staff the autonomy required”.

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Source: HSJ, 23 February 2022

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Seven-week gap advised for elective surgery after Omicron

Despite a backlog of routine operations, NHS hospitals are being advised to delay elective surgical procedures by at least seven weeks if a patient has just had Omicron.

UK experts say it is a precaution since the first couple of months following infection is a riskier period, linked to poorer post-operative recovery.

In some circumstances the surgery may be urgent enough to go ahead, however. Patients should ideally have had all of their Covid vaccines too.

The advice has been issued by surgery and anaesthesia experts, including two Royal Colleges representing those professions.

The experts who drew up the recommendations say the desire to tackle waiting lists and backlogs must be balanced with delivering the safest care possible.

The latest expert guidance on routine operations recommends:

  • Elective surgery should not take place within 10 days of a confirmed Covid infection, mainly because the patient may be infectious which is a risk to staff and other patients.
  • Operations that happen in the six-week period after an infection - even an asymptomatic one - carry a higher risk of serious complications for the patient, experience suggests.

Dr Mike Nathanson, president of the Association of Anaesthetists, said: "The frustration felt by patients is immense and we - the healthcare professionals - want to do our jobs and provide these services when it is safe to do so and with the risks clear to all involved."

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Source: BBC News, 23 February 2022

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'Bullying, unsafe practices and dysfunctional culture': Consultant speaks out on Shropshire maternity scandal

A former consultant gynaecologist has told how he raised concerns over bullying, unsafe practices and a "dysfunctional culture" ahead of a report into a maternity scandal.

Bernie Bentick, who worked at Shrewsbury and Telford Hospitals Trust (Sath) for almost 30 years, has spoken publicly about maternity care at the trust for the first time.

Sath is at the centre of the largest inquiry in the history of the NHS into maternity care, which is expected to report next month. An official investigation is examining the care that 1,862 families received.

Mr Bentick says he told senior management several times about a deteriorating culture at Sath.

“I was increasingly concerned about the level of bullying, of dysfunctional culture, of the imposition of changes in clinical practice that many clinicians felt was unsafe," Mr Bentick told BBC's Panorama.

"If the resources had been made available to employ adequate numbers, to provide safe levels of care in accordance with national guidelines, then the situation may have been profoundly different.”

Mr Bentick went on to say that though some “cursory” investigations were launched into his complaints, he believed the trust responded in a way that tried to “preserve the reputation of the organisation.”

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Source: Shropshire Star, 23 February 2022

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CQC should not ‘sit in an ivory tower’ when rating ICSs, says preferred chair

The Care Quality Commission (CQC) should not ‘sit in an ivory tower and dream up what it thinks good looks like’ when it starts rating integrated care systems, the proposed new chair for the regulator has told MPs.

Ian Dilks, the government’s preferred candidate to become the CQC’s new chair, was questioned by the health and social care committee on Tuesday. During the session the committee chair’s Jeremy Hunt asked how Mr Dilks would make the rating of systems “a success”.

Mr Hunt said: “We became the first healthcare system in the world to ‘Ofsted rate’ our hospitals. Under your leadership, assuming you take up this role, we will become the first healthcare system in the world to do the same for entire geographical regions of health systems.”

Mr Dilks responded: “I don’t think it is up to the CQC to sit in an ivory tower and dream up what it thinks good looks like.”

“It will not be in anybody’s interest if the CQC comes up with a whole bunch of ratings and ICSs say, ‘well I don’t know how you got there’.” He added: “I think involving all parties in the development process so that what emerges has a high degree of acceptance.”

He was also asked at the session about what he had learnt about improving patient safety while working at NHS Resolution.

Mr Dilks said: “I do not think the system is good at learning… it needs some help and encouragement to firstly really understand what’s gone wrong when you have an outcome that isn’t the correct one, and secondly how do you encourage and support the system to do better the next time around.”

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Source: HSJ, 23 February 2022

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NHS to tackle 'unfair' maternity outcomes

A taskforce has been set up to tackle disparities in maternity care experienced by women belonging to ethnic minorities and those living in deprived areas.

Black women are 40% more likely to miscarry than white, studies suggest. Maternal death rates are also higher among black and Asian women.

Royal College of Obstetricians and Gynaecologists head Dr Edward Morris told BBC News implicit racial bias was affecting some women's care.

Patient Safety and Primary Care Minister Maria Caulfield said: "For too long disparities have persisted which mean women living in deprived areas or from ethnic minority backgrounds are less likely to get the care they need and, worse, lose their child.

"We must do better to understand and address the causes of this.

"The Maternity Disparities Taskforce will help level-up maternity care across the country, bringing together a wide range of experts to deliver real and ambitious change so we can improve care for all women - and I will be monitoring progress closely."

Chief midwifery officer Prof Jacqueline Dunkley-Bent, who will co-chair the taskforce, said: "The NHS's ambition is to be the safest place in the world to be pregnant, give birth and transition into parenthood - all women who use our maternity services should receive the best care possible."

The taskforce will meet every two months and focus on:

  • improving personalised care and support plans
  • addressing how wider societal issues affect maternal health
  • improving education and awareness of health when trying to conceive, such as taking supplements and maintaining a healthy weight
  • increasing access to maternity care for all women and developing targeted support for those from the most vulnerable groups
  • empowering women to make evidence-based decisions about their care.

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Source: BBC News, 23 February 2022

Source: BBC News, 

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NHS cuts to cover Covid costs may hit patient care, Labour warns

Patient care may suffer as a result of cuts to the NHS budget to fund the continuing costs of Covid, NHS leaders and Labour have said, after Sajid Javid refused to say where the axe would fall.

The Department of Health and Social Care (DHSC)  is trying to make savings from its budget to fund free lateral flow tests for elderly people, Covid surveillance studies and genomic sequencing, after the Treasury refused its request for £5bn in extra funding.

Although the government announced an end to most free mass testing and contract tracing on Monday, remaining Covid measures are expected to cost more than £1bn.

The Treasury and the DHSC refused to say exactly how much cash would be needed or which services would have to be cut back, prompting fears that the NHS could have to find savings at a time of a huge waiting list backlog.

It is understood that DHSC officials are working on identifying savings in the department’s £178.5bn budget for 2022-23, to fund the measures agreed on Monday, including maintaining a “baseline” testing capability that can be scaled up if necessary.

They have ruled out hitting Javid’s plan for tackling waiting lists, but a government source would not rule out any other areas being affected, saying a “significant amount of money” would have to be found by “reprioritising”.

Saffron Cordery, the deputy chief executive of NHS Providers, warned the government against abandoning its commitment to give the NHS “whatever it needs” to tackle Covid and called for transparency about “where the impact of these extra costs will fall”.

“Trust leaders are understandably anxious over reports that the ongoing and significant costs of living with Covid will be met by ‘reprioritising’ the NHS’s existing budget,” she said. “There is a very real risk of trade-offs affecting the quality of patient care – something no one wants to see.”

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Source: The Guardian, 23 February 2022

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Covid-19: Mexico City gave ivermectin kits to people with covid in “unethical” experiment

The government of Mexico City handed out nearly 200 000 “ivermectin based kits” last year to people who had tested positive for Covid-19, without telling them they were subjects in an experiment on the drug’s effectiveness.

The results of that experiment were then written up by public officials in an article placed on popular US preprint server SocArXiv. It became one of site’s most viewed articles, claiming that ivermectin had reduced hospital admissions by 52-76%.

But those officials have been under fire at home since SocArXiv withdrew the paper earlier this month, calling it “either very poor quality or else deliberately false and misleading.”

Opposition deputies in Mexico City’s Congress demanded hearings and said they would bring legal action against the paper’s lead author, José Merino, head of the city’s Digital Agency for Public Innovation.

Explaining the decision to withdraw the article—the first to be taken down by SocArXiv—the site’s steering committee wrote that it had responded “to a community groundswell beseeching us to act” in order “to prevent the paper from causing additional harm.”

The committee wrote, “The paper is spreading misinformation, promoting an unproved medical treatment in the midst of a global pandemic. The paper is part of, and justification for, a government programme that unethically dispenses (or did dispense) unproven medication apparently without proper consent or appropriate ethical protections.”

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Source: BMJ, 22 February 2022

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"'I feel less safe without Covid measures"

Medically vulnerable people say the decision to end Covid restrictions means their freedoms being eroded.

Prime Minister Boris Johnson announced that legal requirements, including the need to self-isolate if you test positive, will end on Thursday.

Two clinically vulnerable women in the West say not knowing who is infected means it is now more dangerous for them to leave their homes.

"It doesn't feel safe," said Chloe Ball-Hopkins, from Gloucestershire.

"My friends and family will continue to try and keep me safe, my partner will keep me safe, they'll continue to test before they meet me," said the 25-year-old from Wotton-under-Edge.

Miss Ball-Hopkins has already had her fourth vaccine dose as she is considered extremely clinically vulnerable.

She has a rare form of muscular dystrophy called nemaline myopathy which affects her respiratory system, and contracted sepsis in 2019 which undermined her immune system further.

Miss Ball-Hopkins said that while the easing of restrictions would feel like freedom to much of the population, it meant the opposite for her.

"I'm supposed to go out and live my life normally yet now I won't know if someone next to me in a supermarket is literally breathing Covid down on me, as I'm in a wheelchair.

"I was actually probably safer in January when everyone was wearing masks than I will be in a week's time. That makes no sense," she said.

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Source: BBC News, 22 February 2022

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Ovarian cancer symptoms are being ignored, UK charity warns

GPs and women are still ignoring key symptoms of ovarian cancer despite better awareness of the disease, a charity has warned, prompting fears that yet more patients will be diagnosed late and “die needlessly”.

Symptoms include frequently having a swollen tummy or feeling bloated; pain or tenderness in the tummy or the pelvis; having no appetite or feeling full quickly after eating, and an urgent need to pee or needing to pee more often, according to the NHS.

However, Target Ovarian Cancer is concerned that despite successful campaigns to boost awareness of the disease, many are still failing to act on the vital signs. “Key symptoms are being ignored – both by those experiencing them and their GPs,” a spokesperson said.

A poll of 1,000 women for the charity found 79% did not know that bloating was a symptom, while 68% were unaware abdominal pain was a sign, and 97% did not know feeling full was another. Most women (99%) did not know that needing to pee more urgently was also a sign, while evidence suggests women can often be told by their GP that their symptoms are more a symptom of irritable bowel syndrome (IBS), Target Ovarian Cancer said.

Ovarian cancer kills about a third of women with the disease in the first year after diagnosis, and is often diagnosed in the late stages. There are about 7,500 new ovarian cancer cases in the UK every year.

“These figures are incredibly disappointing,” said Annwen Jones, the chief executive of Target Ovarian Cancer. “We know we’ve shifted the dial in the past 10 years through the dedication of thousands of Target Ovarian Cancer’s campaigners, but it is not enough. Knowing the symptoms is crucial for everyone.

“We need to make sustained and large-scale government-backed symptoms campaigns a reality. Progress is possible. If we do this, fewer people will be diagnosed late, fewer will need invasive treatment, and, ultimately, fewer will die needlessly from ovarian cancer.”

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Source: The Guardian, 22 February 2022

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Every hospital trust in England limiting visitors despite move towards ‘living with Covid’

Patients face limits on visitors in every hospital trust in England, The Telegraph has revealed, with restrictions set to continue even once the country moves to "living with Covid".

It comes as Boris Johnson announces that all Covid regulations including self-isolation will be abolished at the end of February. 

The health service supports keeping some visiting restrictions in place while Covid remains in circulation among the general population, it is understood.

A spokesman said: "The NHS regularly reminds hospitals that visits for patients should continue to go ahead as much as possible and extra measures should already be in place so that this can be done safely."

NHS England encourages trusts to facilitate visits "wherever possible, and to do so in a risk-managed way", but it is up to individual trusts to set their own policies based on UK Health Security Agency guidelines.

Analysis by The Telegraph found that at least 34 hospital trusts across England still have routine visits suspended, with exceptions such as those for patients receiving end-of-life care and people with dementia. All 125 trusts have some form of visiting restriction in place. The most common policy is to have one named visitor per patient for the entirety of a patient's stay, who can only visit for one hour once a day.

Helen Wildbore, the director of the Relatives and Residents Association, said limiting patients to one nominated visitor put pressure on families, leaving the carer "exhausted".

She added: "If you’re going into hospital and you're not able to have your family with you, you're going to come out worse." In some cases, patients who needed hospital care had chosen not to go because they were worried about being isolated from family, she said.

Caroline Abrahams, the Charity Director at Age UK, said it was "imperative that hospitals open their doors to visitors again as wide as they possibly can" as the pandemic eases.

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Source: The Telegraph, 18 February 2022

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Visiting restrictions and the impact on patients and their families: a relative's perspective

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Diabetic patient found dead on hospital roof after medics ejected him while he was in shock

A diabetic pensioner died on the roof of a hospital after staff physically ejected him despite being in a “confused” state.

Stephen McManus, a long-term Type 1 diabetes patient, had earlier been rushed to Charing Cross Hospital in west London while suffering a hypoglycaemic episode.

Despite colleagues having expressed concerns about his slurred speech and erratic behaviour, a junior doctor decided the 60-year-old had the mental capacity to go home.

He was wheeled out of the building by security guards, despite having no phone, money and being in his slippers. His family had not been contacted to inform them he was being discharged.

Some time later Mr McManus re-entered the building and managed to gain access to a construction area, somehow finding his way onto the roof.

He was found dead the next morning following a police search after his family reported him missing.

An inquest has begun trying to establish why Stephen was allowed to leave the hospital in the first place and how he was able to access a potentially dangerous zone.

Mr McManus’s family say the case raises profound questions about the treatment of diabetic patients in the NHS.

“My father was an extremely vulnerable patient and the nature of his removal from the hospital is inexplicable, Jonathan McManus, his son, told The Telegraph.

“Had he been kept in hospital he would no doubt be alive today.”

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Source: Yahoo News, 19 February 2022

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USA: Covid infection increases risk of mental health disorders, study finds

Having Covid-19 puts people at a significantly increased chance of developing new mental health conditions, potentially adding to existing crises of suicide and overdoses, according to new research looking at millions of health records in the US over the course of a year.

The long-term effects of having Covid are still being discovered, and among them is an increased chance of being diagnosed with mental health disorders. They include depression, anxiety, stress and an increased risk of substance use disorders, cognitive decline, and sleep problems – a marked difference from others who also endured the stress of the pandemic but weren’t diagnosed with the virus.

“This is basically telling us that millions and millions of people in the US infected with Covid are developing mental health problems,” said Ziyad Al-Aly, chief of research and development at the VA St Louis Healthcare System and senior author of the paper. “That makes us a nation in distress.”

The higher risk of mental health disorders, including suicidal ideation and opioid use, is particularly concerning, he said.

“This is really almost a perfect storm that is brewing in front of our eyes – for another opioid epidemic two or three years down the road, for another suicide crisis two or three years down the road,” Al-Aly added.

These unfolding crises are “quite a big concern”, said James Jackson, director of behavioural health at Vanderbilt University’s ICU Recovery Center, who was not involved with this study. He is also seeing patients whose previous conditions, including anxiety, depression and opioid use disorder, worsened during the pandemic.

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Source: The Guardian, 18 February 2022

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Netherlands: First Long Covid legal cases involve healthcare staff

At least five people in the Netherlands who developed Long Covid through their jobs are planning to sue their employers for financial and emotional damage, according to RTL Nieuws. But lawyers, unions, company doctors and academics expect many more cases will arise and say they could take years to reach a conclusion, RTL said.

One case involves a residential care nurse who was told to take care of a patient without protective clothing. It later transpired that the unit manager knew the patient may have had coronavirus. The nurse has been at home for almost two years with Long Covid, and her salary has been reduced in line with sick pay regulations.

Ambulance worker Lenny Wagemans is also holding her former employer responsible for her illness. She picked up coronavirus in March 2020 after a patient coughed all over during a trip to hospital. She too did not have a face mask or other protection. 

Dealing with work related illnesses is often complex and with Covid it is difficult to establish exactly where an infection took place, said Utrecht University researcher Marlou Overheul. ‘You might have picked up coronavirus somewhere else and that can have an impact on a damages claim,’ she said.

The Federation of Dutch Trade Unions said last month over 500 healthcare workers face losing their jobs because they are suffering from Long Covid and have been on sick pay for the regulation two years.

MPs have voted in favour of a motion which calls on the government to formally recognise Long Covid as an illness and which will ensure all nursing staff are entitled to invalidity benefits. The government has asked the national health council to make recommendations about how to deal with Long Covid which will be published in the first quarter of this year.

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Source: Dutch News, 20 February 2022

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USA: Doctors are more likely to describe black patients as uncooperative, studies find

Medical records contain a plethora of information, from a patient’s diagnoses and treatments to marital status to drinking and exercise habits. They also note whether a patient has followed medical advice. A health provider may add a line stating that the patient is “noncompliant” or “non-adherent,” signalling that the patient has been uncooperative and may exhibit problematic behaviours.

Two large new studies in the US found that such terms, while not commonly used, are much more likely to appear in the medical records of Black patients than in those of other races.

The first study, published in Health Affairs, found that Black patients were two and a half times as likely as white patients to have at least one negative descriptive term used in their electronic health record. About 8% of all patients had one or more derogatory terms in their charts, the study found. The most common negative descriptive terms used in the records were “refused,” “not adherent,” “not compliant” and “agitated.”
 
The second study, published in JAMA Network Open, analysed the electronic health records of nearly 30,000 patients at a large urban academic medical centre between January and December 2018. The study looked for what researchers called “stigmatising language,” comparing the negative terms used to describe patients of different racial and ethnic backgrounds as well as those with three chronic diseases: diabetes, substance use disorders and chronic pain.
 
Overall, 2.5% of the notes contained terms like “nonadherence,” “noncompliance,” “failed” or “failure,” “refuses” or “refused,” and, on occasion, “combative” or “argumentative.” But while 2.6% of medical notes on white patients contained such terms, they were present in 3.15% of notes about Black patients.
 
Looking at some 8,700 notes about patients with diabetes, 6,100 notes about patients with substance use disorder and 5,100 notes about those with chronic pain, the researchers found that patients with diabetes — most of whom had type 2 diabetes, which is often associated with excess weight and called a “lifestyle” disease — were the most likely to be described in negative ways. Nearly 7% of patients with diabetes were said to be noncompliant with a treatment regimen, or to have “uncontrolled” disease, or to have “failed.”

The labels have consequences, warns Dr. Schillinger, who directs the Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. 

“Patients whose physicians tend to judge, blame or vilify them are much less likely to have trust in their doctors, and in the medical system overall,” Dr. Schillinger said. “Having health care providers who are trustworthy — who earn their patients’ trust by not judging them unfairly — is critical to ensuring optimal health and eliminating health disparities.”

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Source: The New York Times, 20 February 2022

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Early end to England’s isolation rules is a: "perilous and politicised pandemic response"

Today the Government is expected to announce the end to all Covid restrictions, including ending self-isolation and free testing in the country. However, in an open letter to the UK's Chief Medical Officer and Chief Scientific Officer, the UK science and medical communities say this is a "HUGE mistake".

The open letter expresses concern about the Government plans to end testing, surveillance surveys and legal isolation of Covid-19 cases and asks the Government to clarify the scientific advice underpinning these policy decisions as they do not believe there is a solid scientific basis for the policy.

"It is almost certain to increase the circulation of the virus and remove the visibility of emerging variants of concern." 

"The emergence of new variants and a resultant wave of infections can occur very quickly, potentially within just several weeks. The ability to rapidly detect and characterise new variants and to scale up necessary responses (such as TTI and vaccinations) quickly will be very important. Considerations for future response preparedness and surveillance infrastructure should take this into account." 

"We believe humanity is in a race against the virus."

The letter goes on to say that some form of surveillance must be continued to ensure the situation is well understood and new variants of concern identified. Lack of testing is not only detrimental to controlling the spread of SARSCoV2 and detecting new variants, it also puts people who develop Long Covid at a great disadvantage by not having a confirmation of their infection, which is integral to the diagnosis, support and care they need to receive. For the 1 in 4 people in the UK who are clinically vulnerable, the current approach appears a perilous and politicised pandemic response.

The authors of the letter are asking members of the UK science and medical communities to sign the open letter.

Read the letter in full and sign here

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Ministers warned getting rid of free Covid tests will lead to £500 ‘caring tax’

Abolishing free Covid tests for those who look after the vulnerable will amount to a “tax on caring” that would cost them more than £500 a year, ministers have been warned.

All remaining domestic Covid regulations that restrict public freedoms are ending, with Boris Johnson announing a move away from government intervention to “personal responsibility”. However, the scale of free testing to be retained is still being thrashed out within government.

Current data suggests that nearly 4 million people take regular Covid tests, including those who visit and help vulnerable relatives. That number also includes vulnerable people who work in settings that could put them at greater risk, where they have face-to-face contact with others.

Research based on the average cost of tests internationally, compiled by the Liberal Democrats, suggests that people who take two tests a week face an average bill of £534 a year. It comes after the government’s own scientific advisers have warned that removing free testing will “increase anxiety” and limit the “social participation outside the home” of those who are clinically vulnerable or who live with someone in that position.

“Charging people for the tests they need to safely see vulnerable loved ones is a tax on caring that risks leaving millions of people in lockdown by stealth,” said Ed Davey, the Lib Dem leader. “It means vulnerable people will see fewer loved ones and will be able to enjoy less of their lives. It is unfair and unjust. Ministers need to scrap these plans to stop a ‘cost of living with Covid’ crisis. Throughout the pandemic, people have been trying hard to do the right thing and keep others safe. The government should not be making that harder.”

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Source: The Guardian, 19 February 2022

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The millions of people stuck in pandemic limbo

When the coronavirus pandemic began, Emily Landon thought about her own risk only in rare quiet moments. An infectious-disease doctor at the University of Chicago Medicine, she was cramming months of work into days, preparing her institution for the virus’s arrival in the United States. But Landon had also recently developed rheumatoid arthritis—a disease in which a person’s immune system attacks their own joints—and was taking two drugs that, by suppressing said immune system, made her more vulnerable to pathogens.

Normally, she’d be confident about avoiding infections, even in a hospital setting. This felt different. “We didn’t have enough tests, it was probably around us everywhere, and I’m walking around every day with insufficient antibodies and hamstrung T-cells,” she said.

Two years later, Covid-19 is still all around us, everywhere, and millions of people like Landon are walking around with a compromised immune system. A significant proportion of them don’t respond to Covid vaccines, so despite being vaccinated, many are still unsure whether they’re actually protected—and some know that they aren’t. Much of the United States dropped COVID restrictions long ago; many more cities and states are now following. That means policies that protected Landon and other immunocompromised people, including mask mandates and vaccination requirements, are disappearing, while accommodations that benefited them, such as flexible working options, are being rolled back.

This isn’t a small group. Close to 3% of US adults take immunosuppressive drugs, either to treat cancers or autoimmune disorders or to stop their body from rejecting transplanted organs or stem cells. That makes at least 7 million immunocompromised people.

In the past, immunocompromised people lived with their higher risk of infection, but COVID represents a new threat that, for many, has further jeopardised their ability to be part of the world. From the very start of the pandemic, some commentators have floated the idea “that we can protect the vulnerable and everyone else can go on with their lives.” Seth Trueger, who is on immunosuppressants for an autoimmune complication of cancer, said. “How’s that supposed to work?”

He is an emergency doctor at Northwestern Medicine; he can neither work from home nor protect himself by avoiding public spaces. “How am I supposed to provide for my family or live my life if there’s a pandemic raging?” he said. 

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Source: The Atlantic, 16 February 2022

Further reading

Read further Covid-19 blogs and stories from staff on the frontline

 

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Millions in England face ‘second pandemic’ of mental health issues

Millions of patients in England face dangerously long waits for mental health care unless ministers urgently draw up a recovery plan to tackle a “second pandemic” of depression, anxiety, psychosis and eating disorders, NHS leaders and doctors have warned.

The Covid crisis has sparked a dramatic rise in the numbers of people experiencing mental health problems, with 1.6 million waiting for specialised treatment and another 8 million who cannot get on the waiting list but would benefit from support, the heads of the NHS Confederation and the Royal College of Psychiatrists have told the Guardian.

In some parts of the country, specialist mental health services are so overwhelmed they are “bouncing back” even the most serious cases of patients at risk of suicide, self-harm and starvation to the GPs that referred them, prompting warnings from doctors that some patients will likely die as a result.

“We are moving towards a new phase of needing to ‘live with’ coronavirus but for a worrying number of people, the virus is leaving a growing legacy of poor mental health that services are not equipped to deal with adequately at present,” said Matthew Taylor, the chief executive of the NHS Confederation, which represents the whole of the healthcare system in England.

“With projections showing that 10 million people in England, including 1.5 million children and teenagers, will need new or additional support for their mental health over the next three to five years it is no wonder that health leaders have dubbed this the second pandemic. A national crisis of this scale deserves targeted and sustained attention from the government in the same way we have seen with the elective care backlog.”

One family doctor in Hertfordshire, Dr David Turner, said he was so concerned about the situation that he had chosen to speak out publicly for the first time in his 25-year career. “I and many other GPs feel the issue has become critical and it is only a matter of time before a child dies,” he told the Guardian.

Turner said access to child and adolescent mental health services (CAMHS) was “never great pre-Covid” but was now “appalling”. The double whammy of a spike in demand and underinvestment in CAMHS was putting patients at risk, he added.

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Source: The Guardian, 21 February 2022

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Baby deaths force end to NHS targets for natural births

The NHS has abandoned targets that encouraged hospitals to pursue “normal births”, over fears for the safety of mothers and babies.

Maternity units were told in a letter to stop using caesarean section rates to assess their performance. It comes after repeated scandals in maternity units, blamed in part on a focus on pursuing natural births at the expense of safety.

The letter from Jacqueline Dunkley-Bent, NHS England’s chief midwife, and Dr Matthew Jolly, the national clinical director for maternity, instructed “all maternity services to stop using total caesarean section rates as a means of performance management”.

It added: “We are concerned by the potential for services to pursue targets that may be clinically inappropriate and unsafe in individual cases."

A final report into the deaths of dozens of babies at the Shrewsbury and Telford Hospital NHS Trust will be published next month. It is expected to be highly critical.

The midwife leading the inquiry, Donna Ockenden, has said women “felt pressured to have a normal birth” at the trust, adding: “There was a multi-professional, not midwife-led, focus on normal birth pretty much at any cost.”

Hayley Coates, 29, lost her son Kaylan after staff at Nottingham University Hospitals NHS Trust ignored her pleas for a caesarean section in March 2018. A coroner ruled that neglect contributed to Kaylan’s death. He suffered a fractured skull when he was delivered with forceps and was starved of oxygen.

Coates, a mother of three, said she welcomed the NHS England letter, adding: “I was just ignored when I asked multiple times for a caesarean section. I was told repeatedly: ‘You will have this baby naturally, you don’t want to go to theatre.’ If I had gone to theatre many hours before, my baby wouldn’t have died. They have a duty of care, and the mother’s wishes are supposed to be priority.”

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Source: The Times, 20 February 2022

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Government rejects calls to address nurse burnout and shortage

The government has rejected calls for an overhaul of NHS workforce planning amid concerns of staff shortages and a mounting backlog of patients.

It comes after a House of Commons health and social care committee report in 2021 found burnout among nurses and other healthcare professionals had reached an emergency point.

MPs had called for immediate action to support exhausted staff through a plan to cover staffing needs for the next two decades, led by Health Education England.

But in a government response to the report, the Department of Health and Social Care (DHSC) rejected calls for independent annual reports on workforce shortages and future staffing requirements.

Instead, a new duty in the recently introduced Health and Care Bill will require the health and social care secretary to publish reports on workforce planning in England every five years.

The duty is intended to compliment ‘investment on workforce planning and supply already underway’, the government’s response states.

But UNISON national nursing officer Stuart Tuckwood said a lack of an independent view on what is needed to support the NHS workforce risked the government focusing on cost ‘above all else’.

"The urgent focus for this year must be on preventing further gaps from appearing in the workforce, including nursing teams."

"The failure to grade staff properly for the jobs they do, ensure fair pay for additional hours and deliver flexible work patterns are all reasons cited by nurses, healthcare assistants and other staff for leaving."

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Source: Nursing Standard, 17 February 2022

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Doctor with Long Covid who suffered violent shakes and hallucinations attacks Boris Johnson's plan to 'live with virus'

A doctor who has suffered violent shakes and hallucinations during her ongoing 15-month battle with long COVID has criticised the government's plan to "live with the virus".

Dr Kelly Fearnley told Sky News she contemplated ending her own life due to the debilitating long-term effects of coronavirus, which she caught while working on a COVID ward in November 2020.

The 35-year-old from Leeds, who was previously fit and healthy, initially had flu-like symptoms before she suffered shortness of breath and painful rashes over her body, as well as swelling around her eye.

More than a year later, she is still unable to return to work due to the effects of long COVID, which have included violent shakes lasting up to 14 hours at a time, hallucinations, night terrors, severe pins and needles in her arms and legs, and a resting heart rate of 140 beats per minute.

With Prime Minister Boris Johnson set to unveil his "living with COVID" plan on Monday, Dr Fearnley branded it a "strategy of denial, driven by the need to cut costs" and she felt "angry and let down".

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Source: Sky News, 20 February 2022

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