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Coronavirus: More tests promised for care homes

All care home residents and staff with COVID-19 symptoms will be tested for coronavirus as laboratory capacity increases, the government has promised.

Health Secretary Matt Hancock said he was "determined" to ensure everyone who needed a test had access to one. 

Care providers have been calling for more testing for weeks, with charities saying the virus is "running wild" amid outbreaks at more than 2,000 homes. At the moment only the first five residents who show symptoms in a care home are tested, to determine whether there is an outbreak of the virus.

Providers have also complained that deaths among residents were being "airbrushed" out of official figures and demanded greater support for the industry.

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Source: BBC News, 15 April 2020

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GPs tell patients to buy their own oxygen as NHS supplies run low

GPs are advising patients with respiratory diseases to buy oxygen privately amid shortages of the gas across the NHS.

Last week hospitals were warned to urgently consider limiting how many patients were given oxygen simultaneously.

Hospitals usually have a pipeline to pump liquid oxygen from a central store to the wards, but most do not have the capacity to meet the demand from the number of patients they are treating with COVID-19.

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Source: The Times, 12 April 2020

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One in 10 hospital nurses absent due to coronavirus

One in 10 nurses working in acute hospitals are off work due to coronavirus, according to internal NHS figures seen by HSJ.

Internal NHS figures from the COVID-19 national operational dashboard state that, on Saturday, English acute trusts reported that 41,038 nurses and midwives were absent . 28,063 (68%) were COVID-19 related. The total nursing and midwifery headcount in acute trusts is about 280,000 — meaning roughly 10% are off on covid-related absence.

There are ongoing complaints from staff about their access to COVID-19 tests — which, it is hoped, will hope reduce the absence rates from suspected cases — while national officials say these are now being made available.

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Source: HSJ, 14 April 2020

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Coronavirus: 'Difficult' cancer care decisions taken

Cancer doctors say difficult decisions are having to be made to postpone some patients' care during the coronavirus crisis.

Some treatments such as chemotherapy can weaken the immune system, and potentially put patients at greater risk from COVID-19. Some of those affected have been expressing concern.

Roisin Pelan is 38 and lives in Lancashire. She has incurable breast cancer and had been taking chemotherapy tablets every day. Every three months she also visits the hospital to receive the drug intravenously. Last month she was told her chemotherapy treatment would be stopped for 12 weeks.

"It's terrifying they've stopped treatment that I know is keeping me alive," she says.

"To have that taken away is just unbearable. How do we know it's only going to be 12 weeks? This pandemic could go on a lot longer."

NHS England has told trusts that all essential and urgent cancer treatments must continue but specialists should discuss with patients whether it is riskier for them to undergo it or delay.

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Source: BBC News, 13 April 2020

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Coronavirus: What's happening in UK care homes right now is a scandal our grandchildren will ask about

Once COVID-19 seeps into care homes, it is a monumentally difficult job to protect the residents, writes Sky's Alex Crawford.

We will look back at this appalling, tragic episode in our global history, and our children and grandchildren will ask us: "Did that really happen? Did you really leave the most vulnerable of our society - the elderly, the infirm, the defenceless, the muddled, sick and weak - in care homes, shut away from their closest relatives? Did you leave them to be ravaged by a deadly virus, and do very little to help them?"

Because that is what's happening right now. There are elderly people - many with Alzheimer's, many with dementia, many frail - in thousands of residential homes up and down Britain, and they are very much at risk.

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Source: Sky News, 11 Aril 2020

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80% of coronavirus patients on ventilators in New York die

Eight in ten coronavirus patients placed on ventilators in New York City have died, according to officials.

New York state has recorded more cases than any country other than America itself. The tally rose by 10,000 in 24 hours to 159,937, ahead of Spain and Italy, which at different times have reported the most infections in the world. The US, which now holds the position, had 463,433 confirmed cases yesterday and the national death toll was 16,504.

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Source: The Times. 10 April 2020

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For survivors of severe COVID-19, beating the virus is just the beginning

The next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalised with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives.

Many will likely deal with lingering effects of the virus — and of the emergency treatments that allowed them to survive it.

“The issue we’re all going to be faced with the most in the coming months is how we’re going to help these people recover,” says Lauren Ferrante, a pulmonary and critical care physician at the Yale School of Medicine.

Hospital practices that keep patients as lucid and mobile as possible, even in the throes of their illness, could improve their long-term odds. But many intensive care unit doctors say the pandemic’s strain on hospitals and the infectious nature of the virus are making it hard to stick to some of those practices.

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Source: Science, 8 April 2020

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Coronavirus: NHS workers' lives at risk over PPE shortages, says BMA

NHS staff still do not have the protective equipment they need to treat coronavirus patients, medics have said.

The British Medical Association (BMA) said doctors were putting their lives at risk by working without adequate protection.

It comes as the health secretary said 19 NHS workers had died with coronavirus since the outbreak began.

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Source: BBC News, 11 April 2020

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Intensive care doctors question 'overly aggressive' use of ventilators in coronavirus crisis

Doctors seeing patients with blood oxygen levels so low they are surprised they are conscious – yet they are sitting up and talking.

British and American intensive care doctors at the front line of the coronavirus crisis are starting to question the aggressive use of ventilators for the treatment of patients. 

In many cases, they say the machines – which are highly invasive and require the patient to be rendered unconscious – are being used too early and may cause more harm than good. Instead they are finding that less invasive forms of oxygen treatment through face masks or nasal cannulas work better for patients, even those with very low blood oxygen readings.

Dr Ron Daniels, a consultant in critical care at University Hospitals Birmingham NHS Foundation Trust, on Thursday confirmed reports from US medics that he and other NHS doctors were revising their view of when ventilators should be used. 

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Source: The Telegraph, 9 April 2020

 

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'Our hospitals weren't made to use this much oxygen'

Shortages are dogging the fight against the coronavirus. At Bradford Royal Infirmary (BRI) it's still only possible to test six staff for the virus per day, consultants have been making their own personal protective equipment, and there's an urgent need to save oxygen.

Searching for ways round the problem, Dr Tom has been working with Leeds University on a 3D-printed valve that could be attached to the hospital's ventilators to reduce the amount of oxygen they use.

But he also began looking at CPAP machines used to treat sleep apnoea at home. These maintain air at a continuous pressure, inside a mask, to keep the user's airways open - they have to be repurposed to provide oxygen for use in the hospital, but they use much less of it than standard hospital ventilators.

They said, 'Yes we've got 2,000, how many do you want?''' he says. "And so our plan is to start with 100 and to see whether, if we use these early enough during a patient's stay, we can prevent people deteriorating and needing to go on to the more complex ventilators, and needing to come to the intensive care unit."

We've been testing them over the weekend, and there's evidence from China and from the US that they seem effective. They just help inflate your lungs and that seems to be beneficial.

They are also very simple, which means that there's no need for a huge amount of training.

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Source: BBC News, 7 April 2020

 

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Hundreds of UK care home deaths not added to official coronavirus toll

Hundreds of people are dying in care homes from confirmed or suspected coronavirus without yet being officially counted, the Guardian has learned.

More than 120 residents of the UK’s largest charitable provider of care homes are thought to have died from the virus in the last three weeks, while another network of care homes is reported to have recorded 88 deaths.

Care England, the industry body, estimated that the death toll is likely to be close to 1,000, despite the only available official figure for care home fatalities being dramatically lower.

The gulf in the figures has prompted warnings that ministers are underestimating the impact of Covid-19 on society’s most frail, and are failing to sufficiently help besieged care homes and workers.

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Source: The Guardian, 7 April 2020

 

 

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Trusts to ‘run out of gowns this weekend’

London trusts have been warned not to expect deliveries of gowns from the national supply chain for at least the next few days, HSJ understands.

Without central deliveries, providers risk running out of gowns ahead of the Easter weekend. Trusts will have to rely on existing supplies and any new stock they procure independently. 

Staff performing or assisting aerosol-generating procedures on confirmed or suspected covid-19 patients should wear gowns, according to the latest guidance from Public Health England.

But supplies have been an issue for weeks, with trust procurement leads raising concerns about dwindling gown stocks last month. It recently emerged that gowns were not included in national pandemic stockpiles, unlike other forms of personal protective equipment like masks and gloves.

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Source: HSJ, 9 April 2020

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Record fall in A&E attendances sparks fear sick people could be avoiding hospitals

Medical leaders have warned sick patients not to avoid getting help from the NHS after a huge drop in the numbers of people attending A&E departments sparked fears some could die without care.

In March, the number of people going to their local emergency department fell by 600,000, or 29 per cent, compared to same month last year, the lowest number of attendances since 2010.

While the NHS has battled for years to reduce the number of people going to A&E for unnecessary reasons, the sudden fall during the coronavirus epidemic has worried officials that the pandemic could be deterring people who have genuine need and who could become sicker or even die as a result of staying away.

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Source: HSJ, 9 April 2020

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Hospitals recruit vets to staff COVID-19 wards

Hospitals are turning to the veterinary workforce to fill staffing gaps on intensive care wards ahead of an expected peak of COVID-19 patients, HSJ can reveal.

Torbay and South Devon Foundation Trust has recruited 150 vets to enrol as “respiratory assistants”, amid preparations for a 10-fold increase of intensive care patients.

Another trust, Hampshire Hospitals FT, has asked vets and dentists to become “bedside support workers” as part of its response to COVID-19 pressures.

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Source: HSJ, 9 March 2020

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We need a Nightingale model for rehab after COVID-19

A major new model of post-acute care is needed for the discharge and rehabilitation of patients following COVID-19 infection, say Alice Murray, Clare Gerada, and Jackie Morris.

A comprehensive plan must be made for the 50% of COVID-19 patients who will require some form of ongoing care following admission to intensive care, with the goal of improving their long-term outcomes and freeing-up much-needed acute hospital capacity.

While the current focus is quite rightly on emergent cases, planning should be set in place to create post-acute care resources and facilities for the surge in numbers of people with the physical, psychological and functional consequences of prolonged ITU stays and or hospital admission following COVID-19 infection.

One potential solution is to provide mass facilities, on a scale to match the Nightingale Hospitals in so-called “Centres of Excellence”, requisitioned for those who survive but need care and cannot return to their own homes, with both residential and day care units available.

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Source: HSJ, 9 April 2020

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Coronavirus pressures 'put organ transplants at risk'

The UK's organ transplant network could be forced to shut down as a result of the coronavirus outbreak, the body that runs the scheme is warning.

One factor is the pressure on intensive care beds, according to NHS Blood and Transplant (NHSBT). But there is also the risk to transplant patients, who have their immune systems suppressed so their bodies don't reject new organs.

This is a dilemma for those like Ana-Rose Thorpe, from Manchester, who is waiting for a liver transplant.

Now aged 29, Ana-Rose has lived with hepatitis almost her entire life after contracting it as a baby. The disease has taken its toll and now her liver is failing and she is in desperate need of a transplant.

"Having to go into hospital while there are coronavirus patients there is very worrying," she says.

"Whilst my body could withstand the transplant, the longer I'm not being monitored, not being seen as often as I was, the longer I leave it, I could just get sicker and sicker.

"I feel like it's patients that are already on the transplant list, patients waiting for other operations, we have just been swept aside."

"It's my life - it is a matter of life and death," Ana-Rose says.

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Source: BBC News, 9 April 2020

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Could this be the start of wholesale change in how the NHS and social care operate?

The health service has been promised “whatever it needs” to deal with the coronavirus pandemic, but government spending choices reveal possible long-term changes to funding and policy. 

Having initially promised the health service “whatever it needs, whatever it costs” on 11th March, the government made this official when Matt Hancock issued a ministerial direction allowing the Department of Health to “spend in excess of formal Departmental Expenditure Limits”—effectively providing a blank cheque.

But while the government’s actions are designed for the immediate crisis, they may be difficult to reverse once the peak of coronavirus has passed. Indeed, they could yet change how the health service operates on a permanent basis.

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Source: Prospect, 7 April 2020

 

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Coronavirus: NHS staff with Covid-19 given wrong test results

Some Welsh NHS staff with Covid-19 have been given wrong test results and were told they did not have coronavirus, BBC Wales has learned.

They are among a group of ten who have been given incorrect results - including eight from Aneurin Bevan Health Board and two from elsewhere.

It is not clear how many of the ten had Covid-19 and were told they did not, or vice versa.

The Gwent-based heath board said the staff were contacted "immediately".

It happened when a small number of test samples from a batch of 96 were attributed to the wrong patients.

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Source: BBC Wales, 7 April 2020

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Design of new breathing aid developed by Mercedes to be made freely available

The designs of a new breathing aid developed by engineers at the Mercedes F1 team, University College London (UCL), and clinicians at UCL Hospital have been made freely available to support the global response to COVID-19. It's the latest development in Formula 1’s Project Pitlane effort to help fight coronavirus.

The Continuous Positive Airway Pressure (CPAP) devices, which help coronavirus patients with lung infections to breathe more easily, were developed by engineers at the Mercedes team and University College London (UCL), and clinicians at UCL Hospital after a round-the-clock effort to reverse engineer a device that could be manufactured rapidly by the thousands.

After patient evaluations at UCLH and across sister hospitals in the London area, the device received regulatory approval last week. An order for up to 10,000 has now been placed by the British National Health Service, and the Mercedes AMG High Performance Powertrains technology centre in Brixworth – the facility where the F1 team’s highly successful power units are developed and built – is now building 1,000 devices per day.

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Source: F1, 7 April 2020

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Report finds 'recurrent safety risks' in East Kent NHS maternity care

“Recurrent safety risks” around clinical care at an embattled NHS trust’s maternity service have been identified in a report published on Tuesday.

The Healthcare Safety Investigation Branch (HSIB) has been investigating East Kent hospitals university NHS foundation trust since July 2018 after a series of baby deaths.

Among those treated at the trust was Harry Richford, whose death was “wholly avoidable”, seven days after his emergency delivery in November 2017, an inquest found.

Speaking on Tuesday, Harry’s grandfather Derek Richford said it is clear that sufficient lessons were not learned from his death.

The independent report, published on Tuesday by the Department of Health and Social Care, discusses 24 maternity investigations undertaken since July 2018, including the deaths of three babies and two mothers.

It said: “These investigations have enabled HSIB to identify recurrent safety risks around several key themes of clinical care in the trust’s maternity services.”

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Source: The Guardian, 8 April 2020

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Hospitalising coronavirus patients can cause more deaths, data from Italy suggests

Sending coronavirus patients to hospital can dramatically increase death rates, the experience of two hard-hit Italian regions suggests.

Veneto and Lombardy are neighbouring regions but have seen sharply differing fatality rates since the contagion broke out in northern Italy in late February. Despite having equally well-equipped hospitals and similar levels of wealth, Lombardy’s death rate is around 17% while that of Veneto is around 5%.

One reason for the disparity is that Veneto has tested many more people – the more tests that are carried out, the more positive cases are found, and that brings down the overall death rate among those infected.

But another key factor, experts believe, is that Lombardy admitted more patients to hospital, whereas Veneto urged them to stay at home or treated them in local health clinics.

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Source: The Telegraph, 6 April 2020

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Coronavirus concerns delay treatment for cancer patient

Nick has terminal bowel cancer. He’s been told he won't receive chemotherapy for three months because it would put him more at risk of the coronavirus.

He fears having the treatment taken away would shorten his life.

Current NHS guidelines say cancer specialists should discuss with their patients whether it is riskier for them to undergo or to delay treatment at this time.

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Source: BBC News, 6 April 2020

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ORCHA launches COVID-19 Health App Formulary

Health apps have grown enormously in popularity, even more so during the COVID-19 Pandemic. Since early March, more than 500 health apps contain coronavirus-related keywords in their description.

People are taking advice from these apps, often using them to share sensitive information. Yet, in a time of fake reviews, scams and personal data breaches, not all health apps can be trusted. 

The Organisation for the Review of Care and Health Apps (ORCHA) has launched a health app formulary to help healthcare professionals and consumers know which health apps they can trust. 

As a free to use resource, the site includes reviews of health apps across a range of health conditions relevant to the COVID-19 pandemic, including reviews of COVID-19 apps launched to date.

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Source: ORCHA, 6 April 2020

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Mental health hotline for NHS staff

The NHS is launching a hotline to support and advise healthcare staff during the coronavirus pandemic.

Volunteers from charities including Hospice UK, the Samaritans and Shout, will listen to concerns and offer psychological support.

The phone line will be open between 07:00 and 23:00 every day, while the text service will be available around the clock.

The phone number is 0300 131 7000 or staff can text FRONTLINE to 85258.

It comes as staff face increasing pressure to care for rising numbers of patients who are seriously ill with the virus.

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Source: BBC News, 8 April 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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