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NHS treatment delays linked to more child deaths than coronavirus

More children died after failing to get timely medical treatment during lockdown than lost their lives because of coronavirus, new research by the Royal College of Paediatrics and Child Health (RCPCH) suggests.

Six children under the age of 16 have died from COVID-19 in Britain since the pandemic began, according to the Office for National Statistics (ONS). 

However, seeking medical help too late was a contributory factor in the deaths of nine children in paediatric care new analysis has found, with the figure likely to be higher.

A survey of 2,433 paediatricians, carried out by the RCPCH, found that one in three handling emergency admissions had dealt with children who turned up later than usual for diagnosis or treatment.

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Source: The Telegraph, 25 June 2020

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NHS test and trace unable to reach almost 30% of people with COVID-19

The government’s contact-tracing programme failed to reach almost 30% of people who tested positive for the coronavirus in England last week, the latest figures show.

Only 70% of the 6,923 people who tested positive for COVID-19 during the period were reached by NHS Test and Trace staff, according to the Department of Health and Social Care.

This means that 2,054 people with the virus – and potentially thousands of their close contacts – could not be traced by the new system.

The fact that one in four people with the virus had not been reached since the launch was “surprising and worrying”, said Keith Neal, emeritus professor of the epidemiology of infectious diseases at the University of Nottingham.

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Source: The Independent, 26 June 2020

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Coronavirus: UK must prepare for second virus wave says health leaders

Health leaders are calling for an urgent review to determine whether the UK is properly prepared for the "real risk" of a second wave of coronavirus.

In an open letter published in the BMJ, ministers were warned that urgent action would be needed to prevent further loss of life.  The presidents of the Royal Colleges of Surgeons, Nursing, Physicians, and GPs all signed the letter.

It comes after Boris Johnson announced sweeping changes to England's lockdown.

Following the prime minister's announcement, health leaders called for a "rapid and forward-looking assessment" of how prepared the UK would be for a new outbreak of the virus.

"While the future shape of the pandemic in the UK is hard to predict, the available evidence indicates that local flare-ups are increasingly likely and a second wave a real risk," they wrote in the letter.

"Many elements of the infrastructure needed to contain the virus are beginning to be put in place, but substantial challenges remain."

The authors of the letter, also signed by the chair of the British Medical Association, urged ministers to set up a cross-party group with a "constructive, non-partisan, four nations approach", tasked with developing practical recommendations.

"The review should not be about looking back or attributing blame," they said, and instead should focus on "areas of weakness where action is needed urgently to prevent further loss of life and restore the economy as fully and as quickly as possible".

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Source: BBC News, 24 June 2020

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People still avoiding hospital visits

Commenting on the newly-released Office for National Statistics (ONS) data on deaths registered weekly in England and Wales, the Health Foundation’s Chief Executive, Dr Jennifer Dixon, has expressed concerns that people are still avoiding visiting hospitals over fear of catching COVID-19.

Hospital admissions have plummeted in the wake of the coronavirus outbreak as people look to avoid exposure to the virus, but as we begin to emerge out of the other side of the pandemic and begin the restoration of services there has been a need to rebuild that faith in patients.

Dr Dixon said: “Today’s data show that deaths from COVID-19, and overall excess deaths, are decreasing. But while deaths in hospital are now below normal levels, deaths at home – just over 900 excess deaths in the week ending 12 June – remain higher than usual for this time of year.

“As COVID-19 now recedes from hospitals, a key question is whether enough has been done to reassure people of their safety when accessing care, balanced against the risks of not seeking care.”

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Source: National Health Executive, 24 June 2020

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NHS trust was negligent in failing to recognise child’s serious bacterial infection, says High Court

A High Court judge has ruled that an NHS trust was negligent in failing to consider early enough that a toddler with fever, lethargy, and vomiting might have had a serious bacterial infection and to give her intramuscular antibiotics.

Mr Justice Johnson said that doctors from University Hospital Southampton NHS Foundation Trust should have ordered a lumbar puncture on the 15 month old girl on the day she was first seen or the next day.

The girl, referred to in court as SC, was sent by her GP to the hospital by ambulance on 26 January 2006 with a note describing his findings on examination and ending “?meningitis.” The GP, Mark Dennison, had given her intramuscular penicillin.

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Source: BMJ, 22 June 2020

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CQC investigates its own response to concerns over troubled service

The Care Quality Commission (CQC) has launched a review into its own regulatory response to a troubled autism service.

The CQC has asked its head of inspection for child and justice services, Nigel Thompson, to examine its response to concerns that were raised about an autism service in south Staffordshire in 2019.

Concerns were reported directly to the CQC in early 2019, by parents of children under the services, while similar issues were highlighted in a report from the local Healthwatch branch last July.

In a statement, the CQC said: “Following concerns raised with us by families, in relation to The Hayes autism service run by Midlands Psychology, we are looking at the evidence we received about this service and how we assessed this to inform our regulatory response.

“We are looking into these concerns in accordance with our complaints process. As a learning organisation, we welcome all feedback and we have already met with some of the families, but some meetings have been delayed due to the covid-19 pandemic.”

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Source: HSJ, 25 June 2020

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The serious care failings the NHS tried to keep secret

The NHS has kept secret dozens of external reviews of failings in local services – covering possible premature deaths, unnecessary and harmful operations, and rows among doctors putting patients at risk – an HSJ investigation has found.

At least 70 external reviews by medical royal colleges were carried out from 2016 to 2019, across 47 trusts, according to information provided by NHS trusts, but more than 60 of these have never been published – contrary to national guidance – while several have not even been shared with the Care Quality Commission (CQC) and other regulators. These include reviews which uncovered serious failings.

Bill Kirkup’s review into the Morecambe Bay scandal in 2015 recommended trusts should “report openly” all external investigations into clinical services, governance or other aspects of their operations, including notifying the CQC. 

Since then the CQC has asked trusts for details of external reviews when it reviews evidence, and in July 2018 it began to ask for copies of their final reports, but HSJ’s research suggests this does not always happen.

James Titcombe, the patient safety campaigner whose son’s death led to the inquiry by Bill Kirkup into the Morecambe Bay maternity care scandal, said a review was now needed of whether its recommendations had been implemented.

“It is not acceptable that five years [on], there are still secretive royal college reports and patients are kept in the dark,” he said.

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Source: HSJ, 25 June 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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Cancer charities fear 18,000 extra deaths a year due to test delays

Almost half a million people are waiting at least six weeks for tests which could diagnose cancer – up from just 30,000 before lockdown, new analysis shows.

Ministers have been urged to urgently bring forward plans to tackle the backlog of patients waiting for care, with calls for weekly testing of staff to keep coronavirus infections off the wards.

Cancer charities fear there will be an extra 18,000 deaths a year because those with symptoms are not receiving prompt diagnosis and treatment.

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Source: The Telegraph, 23 June 2020

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Coronavirus: Warning thousands could be left with lung damage

Tens of thousands of people will need to be recalled to hospital after a serious OVID-19 infection to check if they have been left with permanent lung damage, doctors have told the BBC.

Experts are concerned a significant proportion could be left with lung scarring, known as pulmonary fibrosis. The condition is irreversible and symptoms can include severe shortness of breath, coughing and fatigue.

Research into the prevalence of lung damage caused by COVID-19 is still at a very early stage. It's thought those with a mild form of the disease are unlikely to suffer permanent damage. But those in hospital, and particularly those in intensive care or with a severe infection, are more vulnerable to complications.

In a study from China, published in March, 66 of 70 patients still had some level of lung damage after being discharged from hospital.

Radiologists in the UK say, based on the early results of follow-up scans, they are concerned about the long term-effects of a serious infection.

Prof Gisli Jenkins, of the National Institute for Health Research, is running assessment clinics for those discharged from hospital with COVID-19. He said: "My real concern is that never before in our lifetime have so many people been subject to the same lung injury at the same time."

NHS England has said it is planning to open a number of specialist COVID-19 rehabilitation centres to help patients recover from long-term effects, including possible lung damage.

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Source: BBC News, 24 June 2020

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Private provider’s contract suspended pending safety review

An independent provider’s NHS contract has been suspended, and a harm review is to be carried out on patients who have faced a long wait.

Kent and Medway Clinical Commissioning Group suspended DMC Healthcare’s contract to provide dermatology services in north Kent “to ensure patient safety” on Friday. It said it had showing some patients had been on waiting lists longer than they should have been.

It is unable to say how many patients are likely to be involved in the harm review, but it is expected to focus on those who have waited longer than they should or where harm is suspected.

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Source: HSJ, 24 June 2020

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PHSO to restart their work on NHS complaints

NHS England and Improvement have announced changes to the NHS’s complaints process during the coronavirus emergency.

Individual NHS organisations are being told to ensure complaints are still taken, and monitored for patient safety issues. However, NHS organisations have been given latitude over whether they launch full investigation processes in the short term, and being advised to ‘manage expectations’ about investigations being launched. Complaints that are logged will remain open until further notice.

The advice to NHS providers also says that where patients have been waiting over six months for a resolution to their complaint, consideration should be given now to making an effort to see if the complaint can be resolved.

NHS England and Improvement have announced that they will be advising NHS bodies to end their 'pause' in complaints handling from 1 July onwards. 

Similarly, the Parliamentary and Health Service Ombudsman (PHSO) reduced its complaints-handling activity during the emergency period. It is not accepting new complaints, and its helpline is temporarily closed. PHSO has announced that it will recommence work on existing complaints, and begin accepting new ones from 1 July.

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Source: The Patients Association, 15 June 2020 

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Governments and corporations need to guarantee safety of COVID-19 whistleblowers

Over 90 civil society groups and individual signatories are calling on all public authorities and private sector organisations to protect those who expose harms, abuses and serious wrongdoing during the COVID-19 crisis.

Since the beginning of the COVID-19 emergency, worrying reports concerning hospitals and public authorities retaliating against healthcare professionals for speaking out about the realities of COVID-19 have emerged worldwide, from China to the United States.

Transparency International urges decision-makers at the highest level to resist the temptation to control the flow of information and instead offer assurances to individuals who witness corruption and wrongdoing to blow the whistle.

Marie Terracol, Whistleblowing Programme Coordinator at Transparency International said: “The need for transparency and integrity, heightened in this time of crisis where abuses can cost lives, illustrates the essential role of those who speak up in the public interest."

“National governments, public institutions and companies should listen to workers and citizens who come forward and report abuses they witness and protect them from retaliation, including in countries which still do not offer robust legal whistleblower protection. If people feel they can safely make a difference by speaking up, more instances of abuses will be prevented and addressed, and lives might be saved.”

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Source: Transparency International. 22 April 2020

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New tool could be used to identify those most at risk from coronavirus

A new risk tool could be used to identify those most at threat from COVID-19, so GPs can give patients tailored advice, health officials have said. 

Scientists at Oxford University are working on a clinical risk prediction model, which aims to give individuals more precise information about the likely impact of the disease on them, instead of a blanket approach. 

Health officials said the plans aimed to allow “very individualised discussions” between patients and their doctors, in the event of future outbreaks, particularly as winter approaches. 

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Source: The Telegraph, 23 June 2020

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Health official defends discharging patients into English care homes

Discharging patients into care homes in England in early April, when the number of coronavirus cases was rapidly increasing, was neither reckless nor wrong, the Department of Health and Social Care’s (DHSC) most senior civil servant has claimed.

Faced with aggressive questioning from MPs on the powerful public accounts committee on Monday, Sir Chris Wormald, permanent secretary at the DHSC, said the guidance for discharge was correct based on the information available at the time.

Conservative MP Sir Geoffrey Clifton-Brown said to Wormald: “You were discharging them from hospital into care homes when care homes were already in dire trouble, some of the most vulnerable people in society, the testing wasn’t available, PPE [personal protective equipment] wasn’t available, the training wasn’t available. Wasn’t this a pretty reckless policy by the government?”

Wormald replied: “We don’t believe that. Now, as Prof [Stephen] Powis [national medical director of NHS England] described, at this point Covid was not considered to be widespread in the community.”

A clearly frustrated Clifton-Brown interrupted him saying there were already 1,000 care homes with coronavirus cases at the beginning of April. He also questioned why detailed advice in relation to coronavirus for the social care sector had not been issued until 15 April, almost a month after the equivalent information was provided to the NHS.

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Source: The Guardian, 23 June 2020

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Shielding to stop at end of July in England

The 2.2 million people who have been self-isolating in England during the pandemic will no longer need to shield from 1 August.

From 6 July, they will be able to meet up outdoors, in a group, with up to five others and form 'support bubbles' with other households.

The measures can be eased because infection rates are falling, the government says.

Among the list of people who should be shielding are solid organ transplant recipients, cancer patients undergoing chemotherapy, pregnant women with heart disease and people with severe respiratory conditions such as cystic fibrosis and severe asthma.

The government says it has worked with clinicians, GPs, charities, the voluntary sector and patient groups on the changes, but some charities are criticising the relaxing of the advice, saying many of the people they support do not feel it is safe to stop shielding.

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Source: BBC News, 23 June 2020

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Singapore to open-source national coronavirus encounter-tracing app and the Bluetooth research behind it

Singapore plans to open source a smartphone app its digital government team has developed to track citizens' encounters with coronavirus carriers.

The app, named TraceTogether, and its government is urging citizens to run so that if they encounter a Coronavirus carrier, it’s easier to trace who else may have been exposed to the virus. With that info in hand, health authorities are better-informed about who needs to go into quarantine and can focus their resources on those who most need assistance.

The app is opt-in and doesn’t track users through space, instead recording who you have encountered. To do so, it requires Bluetooth and location services to be turned on when another phone running the app comes into range exchanges four nuggets of information - a timestamp, Bluetooth signal strength, the phone’s model, and a temporary identifier or device nickname. While location services are required, the app doesn't track users, instead helping to calculate distances between them.

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Source: The Register, 26 March 2020

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Testing and contact tracing: a role for local leaders

Local authorities must be at the heart of contact tracing because COVID-19 is best understood as a pattern of local outbreaks rather than a national pandemic, says Sir Chris Ham and Robin Tuddenham in an HSJ article.

Community testing and contact tracing represent our greatest hope for managing the risks to health of COVID-19 until a vaccine and effective treatments become available. Experts in infectious disease base their understanding of this on previous pandemics, and the experience of countries like South Korea and Germany.

Work is underway at pace to resume contact tracking and tracing in England. It is understood that this programme will begin in earnest from 18 May following a pilot on the Isle of Wight. This work is a core part of Matt Hancock’s five-point plan for combating COVID-19, in support of some relaxation of lockdown anticipated soon.

Whilst the pace is understandable, the methods and approach taken are top down, lack an effective role for key regional co-ordination through the Integrated Care Systems/Sustainability and Transformation Partnerships and Local Resilience Forums, and risk marginalising the essential skills of local authorities, GPs and the voluntary and community sector in place, according to Ham amd Tuddenham.

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Source: HSJ, 5 May 2020

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NHS contact-tracing app originally set for May launch is now planned 'for winter'

The NHS contact-tracing app will not be ready before winter, a health minister has said, despite initially being promised in mid-May.

Lord Bethell said the Department of Health was "seeking to get something going for the winter". But, he told a committee of MPs, the app wasn't "the priority at the moment".

Lord Bethell confirmed the government still planned to introduce a contact-tracing app, describing it as "a really important option for the future".

The app has been the subject of a trial on the Isle of Wight, where the Department of Health says it has been downloaded by 54,000 people.

Lord Bethell said the trial had been a success, but admitted that one of its principal lessons had been that greater emphasis needed to be placed on manual contact tracing.

Asked why the app had taken so long to release, Lord Bethell told the Science and Technology Committee the Isle of Wight trial had shown that people "weren't frightened of it, as we were worried that they might be" - and had also provided "concrete examples" of successes in breaking transmission chains. But he admitted there had been "technical challenges", as well as an "ongoing battle" to persuade people the system was safe and privacy-protecting.

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Source: Sky News, 18 June 2020

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Contact tracing system rolled-out across Wales

A contact tracing system has this week been launched in Wales, initially a telephone based process, followed by an online system next week.

Anyone who has a positive coronavirus test result will be contacted by a team of contact tracers and asked for details of everyone they have had close contact with while they have had symptoms.

From Monday 8th June, a new online system will be used to support the process. People will have the option to use the system to provide details of their close contacts electronically.

The system has been trialled in four health board areas over the last two weeks and more than 600 contact tracers have so far been employed, with more to be employed.

Health Minister,  Vaughan Gething said “Today’s roll-out of the contact tracing element of our Test, Trace, Protect strategy is a significant step forward in the gradual move out of lockdown.”

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Source: HTN, 2 June 2020

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UK virus-tracing app switches to Apple-Google model

In a major U-turn, the UK is ditching the way its current coronavirus-tracing app works and shifting to a model based on technology provided by Apple and Google.

The Apple-Google design has been promoted as being more privacy-focused. However, it means epidemiologists will have access to less data.

The government now intends to launch an app in the autumn, but it says the product may not involve contact tracing at that point. Instead the software may be limited to enabling users to report their symptoms and order a test.

Baroness Dido Harding - who heads up the wider Test and Trace programme - will only give the green light to actually deploying the Apple-Google technology if she judges it to be fit for purpose, which she does not believe is the case at present. It is possible this may never happen.

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Source: BBC News, 18 June 2020

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NHSX is working on a contact tracking App

NHSX is working on a contact tracking app to trace the spread of coronavirus through the population.

Contact tracking is already in limited use for people who have tested positive and the discipline has a long history in tuberculosis outbreaks.

In a statement sent to HSJ, Matthew Gould, Chief Executive of NHSX, said : “NHSX are looking at whether app-based solutions might be helpful in tracking and managing coronavirus, and we have assembled expertise from inside and outside the organisation to do this as rapidly as possible.”

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Source: HSJ, 18 March 2020

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Coronavirus: Five things a COVID-19 symptom-tracking app tells us

The UK's scientists have been trying to trace COVID-19's path through the population ever since the coronavirus arrived on British shores.

In what is thought to be the largest study of its kind in the world, an app developed by King's College London (KCL) and technology company Zoe, which tracks symptoms of the disease, has been downloaded more than three million times in the UK.

Not to be confused with the government's contact-tracing app, the COVID-19 Symptom Study app allows users to report daily whether they feel healthy, and record any symptoms. The scientists have been using the data to estimate how the virus may have travelled through the population.

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Source: BBC News, 23 May 2020

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Coronavirus: Time running out on track and trace, NHS leaders warn

Time is running out to finalise a track and trace strategy that would avoid a potential second surge in coronavirus cases, NHS leaders have said.

The NHS Confederation warned of "severe" consequences to staff and patients if the right system was not established quickly and that lockdown measures should not be eased until a clear plan was in place.

Contact tracing identifies those who may have come into contact with an infected person, either through an app or by phone and email, so they can avoid potentially passing the disease on.

It follows the Prime Minister's pledge to introduce a "world-beating" contact tracing system in England from June.

Niall Dickson, chief executive of the confederation, which represents health and care leaders, welcomed Boris Johnson's pledge made at Prime Minister's Questions on Wednesday. But in a letter to Health Secretary Matt Hancock, Mr Dickson said without a clear strategy the UK was at greater risk of a second peak of the virus.

He said a strategy should have been in place sooner and if the right system was not instigated rapidly the ramifications for the NHS "could be severe".

Speaking on the Today programme, Mr Dickson said: "We are absolutely clear that contact tracing is the right thing to do, it is absolutely critical, it has got to be in place to prevent any notion of a second surge if the lockdown is being further released."

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Source: 21 May 2020

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Health experts criticise UK's failure to track recovered COVID-19 cases

The UK’s failure to report how many people have recovered from COVID-19 has been criticised by public health experts, who say a huge proportion of cases have remained “invisible” to the health service.

Britain is an outlier internationally in not reporting the number of people who have recovered from COVID-19 alongside statistics on deaths and numbers of identified cases. Chile is the only other nation not to share this information out of the 25 countries with the highest reported incidence.

A failure to monitor those who test positive for COVID-19 outside of hospital has left people feeling unsupported and alienated from the health system, the experts say. There is concern that because the majority of community cases have not been logged in patient records, it will be more challenging to research the long-term consequences of the disease.

Prof Devi Sridhar, the chair of global public health at the University of Edinburgh, said: “Not tracking people in the community, for me, [is] so astonishing. These people are completely invisible in the health system.”

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Source: The Guardian, 18 June 2020 

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