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Coronavirus: Disabled and vulnerable patients must be involved in treatment decisions including resuscitation, says NHS England

NHS England has said disabled and vulnerable patients must not be denied personalised care during the coronavirus pandemic and repeated its warning that blanket do not resuscitate orders should not be happening.

In a joint statement with disabled rights campaigner and member of the House of Lords, Baroness Jane Campbell, NHS England said the COVID-19 virus and its impact on the NHS did not change the position for vulnerable patients that decisions must be made on an individualised basis.

It said: “This means people making active and informed judgements about their own care and treatment, at all stages of their life, and recognises people’s autonomy, as well as their preferences, aspirations, needs and abilities. This also means ensuring reasonable adjustments are supported where necessary and reinforces that the blanket application of do not attempt resuscitation orders is totally unacceptable and must not happen.”

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Source: The Independent, 26 May 2020

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Coronavirus: Dementia patients 'deteriorating' without family visits

Relatives of care home residents with dementia should be treated as key workers, leading charities say.

In a letter to the health secretary, they write that the care given by family members is "essential" to residents' mental and physical health.

They argue the current limits on visitors have had "damaging consequences" and they want visits to resume safely, with relatives given the same access to care homes and coronavirus testing as staff.

Signed by the bosses of leading charities including Dementia UK and the Alzheimer's Society, the letter calls on the government to "urgently" address what it calls the "hidden catastrophe" happening in care homes.

The charities say that this "enforced separation" has caused a "deterioration" in residents' mental and physical health, particularly for those living with dementia - who make up more than 70% of the population of care homes.

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Source: BBC News, 9 July 2020

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Coronavirus: Delirium 'may be common' in Covid seriously ill

Delirium and confusion may be common among some seriously-ill hospital patients with COVID-19, a study in The Lancet suggests.

Long stays in intensive care and being ventilated are thought to increase the risk, the researchers say. 

Doctors should look out for depression, anxiety and post-traumatic stress disorder (PTSD) after recovery, although most patients, particularly those with mild symptoms, will not be affected by mental health problems.

The evidence is based on studies of patients with severe acute respiratory syndrome (Sars) and Middle-East respiratory syndrome (Mers), as well early data on COVID-19 patients.

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Source: BBC News, 19 May 2020

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Coronavirus: Delirium 'key symptom' in frail older people

Doctors and carers should look out for signs of confusion or strange behaviour in frail older people because it could be an early warning sign of COVID-19, research suggests.

Even if they have no cough or fever, delirium is more common in vulnerable over-65s than other, fitter people of the same age. But it's not yet clear why this extreme confusion or delirium happens.

In this King's College London study, data from more than 800 people over the age of 65 was analysed. They included 322 patients in hospital with COVID-19, and 535 people using the Covid Symptom Study app to record their symptoms or log health reports on behalf of friends and family. All had received a positive test result.

The researchers found that older adults admitted to hospital who were classified as frail were more likely to have had delirium as one of their symptoms, compared with people of the same age who weren't frail.

For one in five patients in hospital with Covid, delirium was their only symptom.

The study calls for more awareness of it in hospitals and care homes.

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Source: BBC News, 30 September 2020

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Coronavirus: Deaths of hundreds of frontline NHS and care workers to be investigated

The deaths of hundreds of NHS and social care workers infected with coronavirus are under investigation by medical examiners, The Independent has learnt.

Ministers have asked medical examiners in England and Wales to review all deaths of frontline health and social care staff infected with the virus to determine whether the infection was caught as a result of their work.

The review, which started last month, is likely to cover more than 620 deaths including nurses, doctors and care home staff across England and Wales, since the beginning of March.

It could trigger a number of investigations by hospitals, the Health and Safety Executive, and coroners into the protection, or lack of, for staff during the pandemic when many hospitals ran out of protective masks and clothing for staff.

Hospitals have already been ordered to risk assess workers who may be more susceptible to the virus, such as those from a black and minority ethnic backgrounds or those with existing health conditions.

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Source: The Independent, 12 August 2020

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Coronavirus: Cover-up fears as reviews of COVID-19 deaths among NHS staff to be kept secret

Ministers have been accused of trying to cover up the findings from investigations into hundreds of health and social care worker deaths linked to coronavirus after it emerged the results will not be made public.

The Independent revealed on Tuesday that medical examiners across England and Wales have been asked by ministers to investigate more than 620 deaths of frontline staff that occurred during the pandemic.

The senior doctors will review the circumstances and medical cause of death in each case and attempt to determine whether the worker may have caught the virus during the course of their duties.

But now the Department of Health and Social Care (DHSC) said the results will be kept secret with the aim of helping local hospitals to learn and improve protection for staff.

Separately, trade unions and NHS Providers, which represents hospital trusts, have urged the government to ensure full investigations into every death and to be transparent about findings to reassure health and social care staff ahead of any second wave.

Sir Ed Davey, acting leader of the Liberal Democrats, said: “We currently have one of the highest number of deaths of health and care workers in Europe. The government has utterly failed to protect staff in both hospitals and care homes. The fact that now they are trying to cover up how and why each tragic death occurs is a disgrace."

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Source: The Independent, 15 August 2020

 

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Coronavirus: Concern over protective kit guidance change

Concerns have been raised that updated government guidance on personal protective equipment (PPE) could put hospital staff and patients at risk.

Healthcare workers have been advised to reuse gowns or wear different kit if stocks in England run low.

Unions representing doctors and nurses have expressed concerns about the updated Public Health England guidance.

Healthcare staff treating patients with Covid-19 have previously been advised to wear long-sleeved disposable fluid-repellent gowns.

But Public Health England changed its guidance on Friday, outlining three options if the gowns are not available as "some compromise is needed to optimise the supply of PPE in times of extreme shortages".

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Source: BBC News, 18 April 2020

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Coronavirus: Close family to be allowed to say goodbye to the dying

Close family members will be able to see dying relatives to say goodbye under new coronavirus guidelines, Health Secretary Matt Hancock has said.

He said the UK would introduce new steps to "limit the risk of infection" and allow goodbyes "wherever possible".

Many loved ones have been unable to say goodbye to family and friends since stringent restrictions were introduced on life in the UK on 23 March.

Mr Hancock highlighted the death of Ismail Mohamed Abdulwahab, 13, from Brixton, south London. Ismail died alone in hospital last month and his close family were then unable to attend his funeral because they were self-isolating.

Speaking at Wednesday's briefing, Mr Hancock said the reports made him "weep". "Wanting to be with someone at the end of their life is one of the deepest human instincts," he said.

New government guidelines for social care providers, published shortly after the briefing, say that care homes should still "limit unnecessary visits" but advises that "visits at the end of life... should continue"

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Source: BBC News, 16 April 2020

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Coronavirus: Charity seeks judicial review on care home visit guidance

A dementia charity is seeking a judicial review of the government guidance on care home visits.

John's Campaign says many care homes in England are still refusing regular face-to-face visits, often essential for people with severe dementia. Dr Angela McIntyre, a retired doctor backing the campaign, has not seen her 92-year-old mother since March.

A Department of Health spokesman said: "We know limiting visits in care homes has been difficult for many families."

He added: "Our first priority is to prevent infections in care homes, and this means that visiting policy should still be restricted with alternatives sought wherever possible.

"Visiting policies should be tailored by the individual care home and take into account local risks in their area."

But John's Campaign believes the guidance does not take into account how important visits from family members are for dementia patients and believes it could be in breach of the law.

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Source: BBC Health, 3 September 2020

 

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Coronavirus: Care watchdog urged to re-start routine inspections of care homes and mental health units

A dozen charities and voluntary organisations have now called on the Care Quality Commission (CQC) to re-start routine inspections of care homes and mental health units amid concerns about care of patients during the coronavirus pandemic.

The watchdog suspended its routine inspections of care providers on 16 March, but said it would inspect providers in “a very small number of cases” where it had concerns for patients such as allegations of abuse.

The CQC’s chief executive said the watchdog’s decision was designed in part to limit the spread of the disease but he added that since inspections were curtailed inspectors had maintained contact with providers and helped to source protective equipment for staff.

The Relatives and Residents Association, a national charity for older people in care and their relatives, has written to the CQC’s chief executive Ian Trenholm asking him to “urgently reconsider” the decision to stop inspections.

Edel Harris, chief executive of Mencap has also highlighted concerns for hundreds of children with learning disabilities who she said were detained in “modern-day asylums” adding: “Some families are rightly terrified about what might be happening to their loved ones behind closed doors. With family contact cut and CQC inspections reduced during lockdown, there is huge concern about who is making sure that some of the most vulnerable people in society are being kept safe and well during this national crisis.”

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Source: The Independent, 26 May 2020

 

 

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Coronavirus: Care regulator warns hospitals and nursing homes over infection risk as it urges the public to give more feedback

Watchdog chief says increasing patient feedback will be the fuel to drive improvements in patient safety

Some hospitals and care homes are failing to take action to protect patients from coronavirus as cases rise across the country, the head of the care watchdog has warned.

In an interview with The Independent, Ian Trenholm, the chief executive of the Care Quality Commission (CQC), said a series of inspections had revealed a minority of homes and hospitals were not doing enough to prevent infection. 

He said in one case a care home appeared to have made a “conscious decision” not to follow the rules on wearing masks and gloves and was now in the process of being closed down by the watchdog due to safety fears.

Mr Trenholm also revealed the CQC would be looking closely at patients struggling to access services because of the impact of COVID-19 and he warned it would act if some groups were disproportionately affected.

The CQC is being forced to move away from its regular inspections of hospitals, care homes and GPs due to the pandemic but Mr Trenholm said it would be redoubling efforts to encourage patients to give feedback on the care they received, adding the watchdog would be more explicit in future about the action it takes.

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Source: The Independent, 21 September 2020

 

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Coronavirus: Care homes still expected to take COVID-19 hospital patients as deaths mount

Hospitals are continuing to discharge patients infected with Covid-19 into Britain’s struggling care homes, despite new figures showing deaths in the care sector still rising while those in hospitals are falling.

Deputy chief scientific adviser Dame Angela McLean revealed the government was now seriously concerned about the scale of the outbreak in care homes.

She said the number of deaths was now almost half of those in hospitals adding: “There is a real issue that we need to get to grips with.”

In March care homes were told they had to accept thousands of patients discharged from hospitals to help hospitals free up 33,000 beds ahead of the coronavirus surge. But due to a lack of community testing it was not possible to test all patients, meaning the virus may have been able to spread without detection.

Public Health England data last week showed the virus has now established itself in more than 4,500 care homes across the country.

Sarah Scobie from the Nuffield Trust health think tank said: “The vulnerable social care sector is now becoming the epicentre of the COVID-19 pandemic in this country. Despite a very small decrease in overall deaths from the previous week, the numbers in care homes are still growing."

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Source: The Independent, 6 May 2020

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Coronavirus: Care homes mentioned only twice in five months of Sage minutes

The government’s top scientific advisers discussed care homes only twice between January and May, according to newly published minutes.

Records for meetings of the Scientific Advisory Group for Emergencies, or Sage, which is the key group of experts advising ministers on how to react to the COCID-19 outbreak, reveal a lack of discussion about the risks facing care homes.

Between January and May, Sage minutes mention care homes only twice, before the start of lockdown in the UK and weeks before the numbers of deaths made headlines across the country.

Shadow care minister Liz Kendall said she was concerned not enough action had been taken and added: “It is clear that social care and the NHS were not treated equally, nor as two sides of the same coin.”

James Bullion, president of the Association of Directors of Social Services said the publication of the minutes "appears to reinforce the impression that social care has been an afterthought – a secondary consideration after the NHS. This cannot continue."

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Source: The Independent, 1 June 2020

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Coronavirus: Care homes in England warned of rise in infections

The government has written to care home providers in England to warn them of a rise in new coronavirus infections within the sector.

A letter from the Department of Health urged care bosses to take "necessary action to prevent and limit outbreaks". Cases were mainly among staff but risked spreading to residents, it said.

It comes as a further 3,330 positive cases were recorded in the UK - the third consecutive day in which cases have been over 3,000. It brings the total number of confirmed cases to 368,504.

Friday's letter from the Department of Health and Social Care said testing data had revealed an increase in the number of positive results in care homes and called on the care sector to work with the government.

"You will know already that we are experiencing a rise in confirmed Covid-19 cases across the UK population," wrote Stuart Miller, director of adult social care delivery.

"I need to alert you to the first signs this rise is being reflected in care homes too."

"I am writing at the earliest opportunity, so we can work in partnership to prevent further spread of the disease. The rapid flow of data and information, to and from care providers, is vital to this effort."

Mr Miller said the infections had been detected chiefly among staff but had been transmitted to residents in some cases. He went on to stress "the importance of regular testing and consistent use of PPE".

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Source: BBC News, 14 September 2020

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Coronavirus: Care home staff struggling to get tests

Care homes looking after thousands of vulnerable residents have said none of their staff has been tested for coronavirus. Out of 210 care providers spoken to by the BBC, 159 said none of their workers had had a test.

BBC England spoke to care homes and companies across the country, who between them employ nearly 18,000 staff and have almost 13,000 residents. Many said they had seen no testing at all, while others have spoken of struggles to access official test centres after reporting online that they have symptoms. Some have told how staff face long journeys to test centres, with one reporting a three-hour round trip.

On Sunday it was announced that the military will begin testing essential workers in mobile units operating at sites in "hard to reach" areas, including care homes.

Anna Knight runs Harbour House Care Home on the Dorset coast and said getting enough personal protective equipment (PPE) and testing for coronavirus were her biggest challenges.

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Source: BBC News, 26 April 2020

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Coronavirus: Care home deaths 'starting to decline'

The number of deaths linked to coronavirus in care homes in England and Wales has fallen, figures show.

The Office for National Statistics analysis showed there were 2,423 fatalities where the virus was mentioned on the death certificate in the week ending 1 May. That is down from nearly 2,800 the week before.

More than 8,300 deaths in care homes have been linked to virus since the epidemic started. The number of hospital deaths have been falling since early April but the government and care sector had been struggling to contain outbreaks in care homes.

Despite the drop, the virus is still have a major impact on the overall number of deaths in care homes. The total number seen in the week to 1 May is still nearly three times higher than you would normally expect.

That means there a large number of deaths happening where the cause is unclear.

One suggestion has been that the lack of testing in care homes has meant coronavirus has not always been listed on death certificates when it should.

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Source: BBC News, 12 May 2020

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Coronavirus: Cancer surgery delays risk 'thousands' of deaths

The NHS must ensure cancer-surgery delays do not cost more lives than the number of COVID-19 patients saved, the Institute of Cancer Research says.

In some cancers, a three-month delay could make the difference between a tumour being curable or not, Prof Clare Turnbull said.

And her modelling suggested delaying surgery risked thousands of additional deaths.

NHS England is already urging people to seek help for worrying symptoms, but by the end of April, cancer referrals had dropped by an estimated 70%.

Cancer doctors have told BBC News of having to make difficult decisions to postpone some patients' care during the coronavirus crisis.

As normal service resumed, the NHS should prioritise "certain cancer types in particular", Prof Turnbull said.

Lung and colorectal cancers, for example, were particularly fast moving. But for others, such as prostate and certain breast cancers, treatment could more safely be delayed.

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Source: BBC News, 20 May 2020

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Coronavirus: Cancer patient's chemotherapy put on hold

A woman with brain cancer has been told her chemotherapy has stopped because of the coronavirus outbreak.

Nancy Carter-Bradley, 44, from Hampshire, said the health secretary should ring-fence cancer treatment.

She said her treatment at a London hospital had paused as it was at full capacity and oncologists were helping with the response to coronavirus. Imperial College Healthcare NHS Trust said it was "exploring use of private healthcare facilities".

Mrs Carter-Bradley, from Penwood, said she had been dealing with "unbelievable stress" since she was informed her chemotherapy at Charing Cross Hospital for stage three brain cancer would be paused.

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Source: BBC News, 26 March 2020

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Coronavirus: Calls for government to plan public inquiry

The government must set out plans for an inquiry into its handling of the coronavirus pandemic, the health service ombudsman has said. This was not about blaming staff but about "learning lessons", he said.

Ombudsman Rob Behrens said patients were reporting concerns about cancelled cancer treatment and incorrect COVID-19 test results.

Ministers have not committed to holding an inquiry, but have accepted there are lessons to be learned.

The Parliamentary and Health Service Ombudsman (PHSO) stopped investigating complaints against the NHS on 26 March, to allow it to focus on tackling the COVID-19 outbreak.

But people had continued to phone in with these concerns, Mr Behrens said.

"Complaining when something has gone wrong should not be about criticising doctors, nurses or other front-line public servants, who have often been under extraordinary pressure dealing with the Covid-19 crisis," he said.

"It is about identifying where things have gone wrong systematically and making sure lessons are learned so mistakes are not repeated."

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Source: BBC News, 1 July 2020

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Coronavirus: Australian scientists map how immune system fights virus

Scientists in Australia say they have identified how the body's immune system fights the Covid-19 virus.

Their research, published in Nature Medicine journal on Tuesday, shows people are recovering from the new virus like they would from the flu.

Determining which immune cells are appearing should also help with vaccine development, experts say.

"This [discovery] is important because it is the first time where we are really understanding how our immune system fights novel coronavirus," said study co-author Prof Katherine Kedzierska.

The research by Melbourne's Peter Doherty Institute for Infection and Immunity has been praised by other experts, with one calling it "a breakthrough".

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Source: BBC News, 17 March 2020

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Coronavirus: Antibody test lacks 'proper assessment'

COVID-19 antibody tests for NHS and care staff are being rolled out without "adequate assessment", experts warn.

The tests could place an unnecessary burden on the NHS, the 14 senior academics say in a letter in the BMJ,

Last month, the government said it had bought 10 million antibody tests and asked NHS trusts and care homes to make them available to staff in England. Officials say the blood tests - to see if someone has had the virus - will play an "increasingly important role".

The group of scientists say as a positive result is unable to prove immunity, the tests offer "no benefit" to hospitals and care staff. The results do not change what personal protective equipment staff must wear, for example.

The academics also suggest there is little data on how well the test works for people at highest risk - including people belonging to some ethnic minorities and older patients. Instead, they call for other carefully designed strategies to help monitor the spread of the virus.

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Source: BBC News, 25 June 2020

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Coronavirus: Ambulance staff 'feeling unprotected'

Ambulance staff are being put at risk by a lack of protective equipment to guard them against coronavirus, according to a trade union.

GMB says its members are "scared" about their own safety and their families. The union claims one in five ambulance staff in London are off sick with coronavirus-related sickness.

The government says hundreds of millions of protective items have been delivered to NHS staff around the country.

According to the GMB Union, 679 frontline ambulance crew in the London Ambulance Service are off sick due to Covid-19-related sickness.

Among those at work, some say they feel unprotected either because of a lack of or inadequate personal protective equipment (PPE).

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Source: BBC News, 8 April 2020

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Coronavirus: 9 in 10 dying have existing illness

More than 9 in 10 people dying with coronavirus have an underlying health condition, figures from the Office for National Statistics (ONS) show.

The ONS looked at nearly 4,000 deaths during March in England and Wales where coronavirus was mentioned on the death certificate. In 91% of cases the individuals had other health problems.

The most common was heart disease, followed by dementia and respiratory illness. On average, people dying also had roughly three other health conditions.

The ONS has also looked at the differences in death rates by age and sex, with men twice as likely to die with coronavirus. Unsurprisingly, the risk of dying increases with age, rising sharply from age 60 years onwards.

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Source: BBC News, 17 April 2020

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Coronavirus: 86% of doctors in England expect second wave within six months

Almost 86% of doctors in England say they expect a second peak of coronavirus in the next six months, according to a new survey, as concern continues to grow over a recent rise in cases.

On Friday, new results from a population-based study suggested the R number for England is now at 1.7, with infections doubling every 7.7 days. While the prevalence of the disease remains lower than it was in the spring, an R value above 1 means cases could grow exponentially.

Sunday marked the third day in a row that new coronaviruses cases reported for the UK topped 3,000 – the highest figures since May – with 2,837 new cases reported in England alone. While testing has increased over the past months, experts have said this does not fully explain the recent surge.

In a poll, the British Medical Association (BMA) asked more than 8,000 doctors and medical students in England what their top concerns were out of five possibilities, from a second peak of coronavirus to sickness and burnout among staff and winter pressures, including a possible flu outbreak. Almost 30% of respondents selected a second peak as their number-one worry.

Overall, 86% of respondents said they believed a second peak of coronavirus during the next six months is either “quite likely” or “very likely”.

When asked which of a range of factors might risk causing a second peak, almost 90% of respondents agreed or strongly agreed that failures of the test-and-trace system posed a risk, while a similar proportion cited a lack of infection-control measures in places like bars and restaurants, and 86% agreed or strongly agreed confusing messaging on public health measures was a risk.

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Source: The Guardian, 14 September 2020

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Coronavirus: 70% of BAME pharmacists have had no risk assessment

More than two-thirds of black, Asian and minority ethnic pharmacists have not had workplace risk assessments for coronavirus, a survey suggests.

Of the 380 hospital and community-based pharmacists surveyed by the Royal Pharmaceutical Society and the UK Black Pharmacists Association, 236 were from a BAME background.

Of those, 166 (70%) said they had not been approached by their employer to have a risk assessment.

The RPS called the results "shocking". It has called on employers to take urgent action to ensure ethnic minority pharmacists are risk assessed.

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Source: BBC News, 26 June 2020

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