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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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Respiratory patients still avoiding A&E

Emergency attendances for several conditions are still well below their normal levels, despite a steady increase in overall activity since the peak of the coronavirus outbreak.

Weekly data from Public Health England suggests overall A&E attendances increased to around 105,000 in the last week of May, which was an increase from 98,813 over the previous seven days.

Data from the 77 A&E departments included in the research suggests that overall attendances are up to an average of 15,000 day, compared to around 10,000 at the peak of the pandemic and the long-term trend of just under 20,000. However, attendances for bronchitis, acute respiratory infections, respiratory, pneumonia, asthma, gastroenteritis are still far below their normal levels.

It did not offer an explanation for why attendances for these conditions have remained low, while those for cardiac, influenza, myocardial Ischaemia, and gastrointestinal problems have returned to normal levels or above.

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Source: HSJ, 5 June 2020

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Michael Seres, an influential patient who hacked together a ‘smart’ ostomy bag, dies at 51

Michael Seres, an entrepreneur, patient advocate, husband and father of three, died on Saturday in Orange County, California, of a sepsis infection. He was 51. 

Seres was widely considered to be one of the first and most prominent “e-patients,” a term which has become popular to denote patients who are informed and engaged in their health, often sharing their experiences online. He is also one of a small number of patient inventors who helped design and build a medical device – a digitally enhanced ostomy bag – that got FDA clearance in 2014. His invention eased the suffering of millions of people with bowel injuries, chronic gut illnesses and cancer.

Source: CNBC, 2 June 2020

Read more about Michael and his innovative patient work in our hub blog

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BMA urges plan to tackle backlog of patients awaiting non-covid treatment

The government urgently needs to set out a plan to reduce the huge backlog of patients waiting for NHS treatments unrelated to COVID-19 in the wake of the pandemic, the BMA has said.

The call came as the BMA released the results of its latest survey of over 8000 doctors. It found that more than half (3754 of 7238) were either not very confident or not confident at all that their department would be able to manage patient demand as NHS services resumed.

“The government must be honest with the public about the surge to come and start meaningful conversations with frontline clinicians about how we can, together, begin to tackle the backlog,” said the BMA’s chair of council, Chaand Nagpaul. “Covid-19 has brought with it the worst health crisis in a century. The NHS must not return to its previous perilous state.”

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Source: BMJ, 4 June 2020

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Extra 10,000 dementia deaths in England and Wales in April

There were almost 10,000 unexplained extra deaths among people with dementia in England and Wales in April, according to official figures that have prompted alarm about the severe impact of social isolation on people with the condition.

The data, from the Office for National Statistics, reveals that, beyond deaths directly linked to COVID-19, there were 83% more deaths from dementia than usual in April, with charities warning that a reduction in essential medical care and family visits were taking a devastating toll.

“It’s horrendous that people with dementia have been dying in their thousands,” said Kate Lee, chief executive officer at Alzheimer’s Society. “We’ve already seen the devastating effect of coronavirus on people with dementia who catch it, but our [research] reveals that the threat of the virus extends far beyond that.”

The charity thinks the increased numbers of deaths from dementia are resulting partly from increased cognitive impairment caused by isolation, the reduction in essential care as family carers cannot visit, and the onset of depression as people with dementia do not understand why loved ones are no longer visiting, causing them to lose skills and independence, such as the ability to speak or even stopping eating and drinking.

Another factor may be interruptions to usual health services, with more than three-quarters of care homes reporting that GPs have been reluctant to visit residents.

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Source: The Guardian, 5 June 2020

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Patient restraint spikes as covid measures spark ‘frustration’

Several mental health trusts have reported spikes in incidents of physical restraint or seclusion on patients, driven by COVID-19 restrictions, HSJ has learned.

Concerns have been raised nationally about the potential for incidents to increase during the pandemic, due to temporary measures which have had to be introduced such as visiting restrictions and communication difficulties due to personal protective equipment.

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Source: HSJ, 5 June 2020

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'Tens of thousands' of heart procedures delayed by pandemic

The postponement of tens of thousands of hospital procedures is putting the lives of people with long-term heart conditions at risk, according to the British Heart Foundation.

The coronavirus pandemic has created a backlog which would only get larger as patients waited for care, it said.

People with heart disease are at increased risk of serious illness with COVID-19, and some are shielding.

The BHF estimates that 28,000 procedures have been delayed in England since the outbreak of coronavirus in the UK. These are planned hospital procedures, including the implanting of pacemakers or stents, widening blocked arteries to the heart, and tests to diagnose heart problems.

People now waiting for new appointments would already have been waiting for treatment when the lockdown started, the charity said, as it urged the NHS to support people with heart conditions "in a safe way".

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Source: 5 June 2020

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NASA and other innovators work to redesign ventilators for COVID-19 patients

NASA scientists as well as other innovators are busy developing alternatives to the traditional ventilator being used worldwide to treat severe cases of COVID-19.  The movement is in response to growing evidence that in some cases ventilators can cause more harm than good in some patients with low oxygen levels. Statistics tell the story: 80% of patients with the coronavirus die on such machines.

Its VITAL machine is tailored for COVID-19 patients and is focused on providing air delicately to stiff lungs — a hallmark symptom of the virus.

Eight U.S. manufacturers have been selected to make the ventilator that was made in 37 days by engineers at NASA’s Jet Propulsion Laboratory.

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Source: CNBC, 30 May 2020

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New rapid coronavirus test dramatically reduces hospital stay time

A new rapid coronavirus testing device has been shown to reduce the average stay for patients on a COVID-19 holding ward at a UK hospital by almost half.

The Samba II portable machines can diagnose the virus in less than 90 minutes and have been trialled at Addenbrooke’s Hospital in Cambridge.

The average length of stay for patients on a coronavirus holding ward, before they were either discharged or could progress with treatment, fell from 58.5 hours to 30 hours, according to the Cambridge University study.

Researchers said the devices “could make all the difference” in freeing up hospital capacity as the NHS faces a mounting backlog of operations due to the pandemic.

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Source: The Independent, 3 June 2020

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Johnson and Johnson pays hundreds of women in Scotland harmed by mesh implants

The pharmaceutical giant Johnson and Johnson has agreed to pay an undisclosed sum to settle a legal action by hundreds of Scottish women who claimed they suffered serious injuries from the company’s pelvic mesh implants.

The settlement came as four lead cases brought by women who suffered pain and other serious side effects from the implants, made by Johnson and Johnson subsidiary Ethicon, were about to reach court in Edinburgh.

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Source: BMJ, 2 June 2020

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Test and trace chief warned lack of transparency on performance could ‘destroy confidence’

The head of NHS test and trace has refused to give MPs any data on the first six days of the new service, leading health committee chair Jeremy Hunt to warn that a lack of transparency could “destroy confidence” in its work.

Baroness Dido Harding, who is leading the new effort, said she was working to validate performance data, which relies on people with COVID-19 symptoms isolating and being called by a team of tracers to identify others they have been in contact with.

MPs had wanted to know how many patients had been contacted within 24 hours as well as how many were willing to share their contacts, and the compliance with self-isolation advice.

But Baroness Harding said she would not share the information until the UK Statistics Authority was happy with the data and could ensure it can be trusted. The UKSA criticised the government earlier this week over its public use of test results data.

Chair of the committee and former health secretary Jeremy Hunt said he was “disappointed” with her refusal and said it was hard for the committee to scrutinise services if it did not have the data, which she had been pre-warned it would ask for.

Leaked information on Tuesday suggested only two-fifths of coronavirus patients and one-third of their contacts were identified and contacted by the tracing service.

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Source: The Independent, 3 June 2020

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Asymptomatic care workers unknowingly spread coronavirus

Large numbers of staff could have been unknowingly spreading coronavirus through care homes, according to the UK's largest charitable care home provider.

Data from MHA shows 42% of its staff members who recently tested positive were not displaying symptoms. Nearly 45% of residents who had a positive test were also asymptomatic.

MHA operates in England, Scotland and Wales and has fully tested staff and residents in 86 of its 90 homes so far.

A Department for Health and Social Care spokesperson said: "Our priority is to ensure care workers and those receiving care are protected, and the latest statistics show over 60% of care homes have had no outbreak at all.

"We've set out a comprehensive support package for residents and staff, including a £600m infection control fund, testing regardless of whether you have symptoms, and a named clinical lead to support every care home."

In total, 7% of MHA staff and 13% of residents received a positive test result. Routine testing is not yet under way.

MHA CEO Sam Monaghan told BBC Newsnight: "It is not difficult to imagine that a lot of people may not have ended up dying if we'd had earlier testing and we'd been therefore better able to manage infection control in our homes."

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Source: BBC News, 3 June 2020

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Coronavirus: Ibuprofen tested as treatment for breathing difficulties in hospital patients

A trial has been launched in the UK to test whether ibuprofen can help with breathing difficulties in COVID-19 hospital patients.

Scientists hope a modified form of the anti-inflammatory drug and painkiller will help to relieve respiratory problems in people who have more serious coronavirus symptoms but do not need intensive care unit treatment.

Half the patients participating in the trial will be administered with the drug in addition to their usual care, while the other half will receive standard care to analyse the effectiveness of the treatment.

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Source: The Independent, 3 June 2020

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Pandemic is having “severe” impact on non-communicable disease care, WHO survey finds

The COVID-19 pandemic has dramatically curtailed the provision of health services for non-communicable diseases, says a survey of 155 countries by the World Health Organization conducted over three weeks in May.

In the survey poorer countries were the most likely to report disrupted services, but some 94% of responding countries had reassigned health ministry staff from work on NCDs to dealing with the pandemic. Hypertension treatment has been partially or completely disrupted in 53% of the countries surveyed, diabetes treatment in 49%, cancer treatment in 42%, and cardiovascular emergency responses in 31% of countries, the survey found.

In the Netherlands, new cancer diagnoses have fallen by 25% since the pandemic lockdown began. In rural India, 30% fewer cardiac emergencies reached health facilities in March 2020 than the previous year.

Rehabilitation services, which are often key to a healthy recovery after severe COVID-19, have been disrupted in 63% of countries surveyed. Screening campaigns have been put on hold in more than half.

WHO’s director general, Tedros Adhanom Ghebreyesus, said, “The results of this survey confirm what we’ve been hearing from countries for a number of weeks now. Many people who need treatment for diseases like cancer, cardiovascular disease, and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”

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Source: BMJ, 3 June 2020

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ECT depression therapy should be suspended, study suggests

The use of electroconvulsive therapy (ECT) to treat depression should be immediately suspended, a study says. ECT involves passing electric currents through a patient's brain to cause seizures or fits.

Dr John Read, of the University of East London said there was "no place" for ECT in evidence-based medicine due to risks of brain damage, but the Royal College of Psychiatrists said ECT offers "life-saving treatment" and should continue in severe cases.

The National Institute for Health and Care Excellence (NICE) currently recommends the use of ECT for some cases of moderate or severe depression as well as catatonia and mania. However, peer-reviewed research published in the journal Ethical Human Psychology and Psychiatry concludes "the high risk of permanent memory loss and the small mortality risk means that its use should be immediately suspended".

In response to the study, the Royal College of Psychiatrists said ECT should not be suspended for "some forms of severe mental illness".

Dr Rupert McShane, chair of the college's Committee on ECT and Related Treatments, said there was evidence showing "most people who receive ECT see an improvement in their condition".

"For many, it can be a life-saving treatment," he said.

"As with all treatments for serious medical conditions - from cancer to heart disease - there can be side-effects of differing severity, including memory loss."

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Source: BBC News, 3 June 2020

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Government censored BAME covid-risk review

The government removed a key section from Public Health England’s review (published Tuesday) of the relative risk of COVID-19 to specific groups, HSJ has discovered.

The review reveals the virus poses a greater risk to those who are older, male and overweight. The risk is also described as “disproportionate” for those with Asian, Caribbean and black ethnicities. It makes no attempt to explain why the risk to BAME groups should be higher.

An earlier draft of the review which was circulated within government last week contained a section which included responses from the 1,000-plus organisations and individuals who supplied evidence to the review. Many of these suggested that discrimination and poorer life chances were playing a part in the increased risk of COVID-19 to those with BAME backgrounds. HSJ understands this section was an annex to the report but could also stand alone.

Typical was the following recommendation from the response by the Muslim Council of Britain, which stated: “With high levels of deaths of BAME healthcare workers, and extensive research showing evidence and feelings of structural racism and discrimination in the NHS, PHE should consider exploring this in more detail, and looking into specific measures to tackle the culture of discrimination and racism. It may also be of value to issue a clear statement from the NHS that this is not acceptable, committing to introducing change.”

One source with knowledge of the review said the section “did not survive contact with Matt Hancock’s office” over the weekend.

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Source: HSJ, 2 June 2020

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Coronavirus: Durham County Council accused of 'increasing' deaths

At least 25 people have died at a care home amid claims from an industry body that a council's actions "caused" or "increased COVID-19 deaths".

Melbury Court in Durham is thought to be the care home with the highest number of deaths in the UK. County Durham has had the highest number of care home deaths in England and Wales.

Durham County Council said it "strongly refuted" the claim by the County Durham Care Home Association (CDCHA).

Some patients went from the nearby University Hospital of North Durham to Melbury Court without being tested for coronavirus or after a positive test.

A BBC investigation has discovered that in a conference call in late March, council officials were told plans to move hospital patients into care homes without testing would be disastrous.

The CDCHA offered to find a specific home or homes where COVID-19 positive or untested people could be cared for rather than have them spread around the network, but this was never acted on and now the CDCHA has calculated there has been an outbreak of coronavirus in 81 of the county's 149 care homes.

Maria Vincent, who runs Crosshill Care Home in Stanhope, told the council in March that care homes were not set up to accept COVID-19 patients, and described it as "neglect pure and simple".

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Source: BBC News, 2 June 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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Increase in learning disability deaths during the coronavirus outbreak

The Care Quality Commission (CQC) have looked at how the number of people who have died during the coronavirus outbreak this year compares to the number of people who died at the same time last year.

They looked at information about services that support people with a learning disability or autism in the 5 weeks between 10 April to 15 May in 2019 and 2020. These services can support around 30,000 people. They found that in that 5 weeks this year, 386 people with a learning disability, who may also be autistic, died. Data for the same 5 weeks last year found that 165 people with a learning disability, who may also be autistic, died. This information shows that well over twice as many people in these services died this year compared to last year. This is a 134% increase in the number of death notifications this year.

This new data should be considered when decisions are being made about the prioritisation of testing at a national and local level.

Kate Terroni, Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) said: "Every death in today's figures represents an individual tragedy for those who have lost a loved one."

"While we know this data has its limitations what it does show is a significant increase in deaths of people with a learning disability as a result of COVID-19. We already know that people with a learning disability are at an increased risk of respiratory illnesses, meaning that access to testing could be key to reducing infection and saving lives."

"These figures also show that the impact on this group of people is being felt at a younger age range than in the wider population – something that should be considered in decisions on testing of people of working age with a learning disability."

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Source: Care Quality Commission, 2 June 2020

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How could watchdogs fail so spectacularly to keep care home residents and staff safe?

Care homes are the focus of the COVID-19 outbreak in England and Wales. At least 40% of all coronavirus deaths have occurred in the very places dedicated to keeping people safe in their later years.

The under-reporting of deaths, the lack of personal protective equipment (PPE) and testing available to staff, and the total focus on the NHS at the expense of the social care sector have all contributed to an estimated 22,000 deaths in care homes – places that government had originally advised were “very unlikely” to experience infection.

But how could care homes have been failed so badly, and what checks and balances should have been in place to prevent this?

Care homes in England are regulated by the Care Quality Commission (CQC). One of its key responsibilities is to carry out inspections and visits to ensure providers meet fundamental standards of quality and safety; however, as of 16 March, the regulator stopped all routine inspections to “focus on supporting providers to deliver safe care during the pandemic”.

Had the CQC continued its inspections, it would have been in a position to challenge cases where PPE was being diverted away from care homes to the NHS, and to aid struggling homes in their battle to secure tests for staff and residents. Instead, care homes have effectively been left to fend for themselves.

On top of this, the CQC joined similar bodies in Wales, Scotland and Northern Ireland in refusing to publish detailed data on care home deaths, arguing instead for a need to “avoid confusion” and to protect “the privacy and confidentiality of those who have died and their families”.

Families and the wider public have a right to know when and where COVID-19 outbreaks are happening, and this lack of transparency is deeply troubling.

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Source: The Guardian, 1 June 2020

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Applications are now open for DigitalHealth.London’s Accelerator programme

DigitalHealth.London is helping health and care professionals turn the idea of digital innovation into tangible improvements in experience and outcomes for patients. Our work is instrumental in giving health and care stakeholders across London insight into the best digital health interventions and tools on the market.

DigitalHealth.London is a collaborative programme delivered by MedCity, and London’s three Academic Health Science Networks – UCLPartners, Imperial College Health Partners, and the Health Innovation Network.

Closing date: Midnight, Sunday 5 July 2020

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Coronavirus: 'More than two million' waiting for cancer care in UK

About 2.4 million people in the UK are waiting for cancer screening, treatment or tests, as a result of disruption to the NHS during the past 10 weeks, according to Cancer Research UK.

It estimates 2.1 million have missed out on screening, while 290,000 people with suspected symptoms have not been referred for hospital tests. More than 23,000 cancers could have gone undiagnosed during lockdown.

Chief executive Michelle Mitchell said COVID-19 has placed an "enormous strain on cancer services". "The NHS has had to make very hard decisions to balance risk," she said.

"...there have been some difficult discussions with patients about their safety and ability to continue treatment during this time. Prompt diagnosis and treatment remain crucial to give people with cancer the greatest chances of survival and prevent the pandemic taking even more lives."

To ensure no-one is put at risk from the virus now that cancer care is returning, Cancer Research UK said "frequent testing of NHS staff and patients, including those without symptoms" was vital.

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Source: BBC News, 1 June 2020

 

 

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Global healthcare needs infection control reform, say experts

World leaders in infection control and disease prevention convened online at the inaugural iClean 2020 conference on 28 May to discuss innovative infection control reform in hospitals and aged-care facilities in the wake of the COVID-19 crisis.

Keynote speaker Professor Didier Pittet* said there has never been a more pertinent time to address infection control in our healthcare systems.

“During this devastating COVID-19 pandemic, up to one in five people who contracted the virus globally are healthcare workers, and we saw similar numbers in the SARs and MERS outbreaks."

“Furthermore, aged-care residents accounted for 29% of COVID-19-related deaths in Australia, and this rate is even higher in Europe, the United States and the United Kingdom, who have been hardest hit by the pandemic,” Professor Pittet said.

“We are therefore calling for urgent reform in our approach to cleaning and disinfection in hospitals and aged-care homes.”

Professor Pittet explained that Clean Hospitals — an initiative aiming to create better procedures, training, auditing and management processes — would allow cleaning and infection control managers around the world to improve quality and outcomes.

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Source: Hospital Healthcare, 1 June 2020

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NHS ordered to rush out ‘meaningless’ covid antibody tests ahead of PM’s deadline

NHS pathology labs were given just two days to roll out thousands of antibody tests, amid a push to reach a COVID-19 testing target set out by Boris Johnson.

Earlier this month the Prime Minister set a target of having a testing capacity of 200,000 per day by the end of May. Capacity currently stands at 161,000, Matt Hancock has said.

Until now there has been very limited use of antibody tests, with most capacity used to deliver PCR tests that indicate whether someone currently has the virus. Antibody tests are intended to identify whether someone has previously had the virus.

On 27 May, NHS England and Improvement wrote to local leaders giving them two days’ notice to put in place testing capacity for, and deliver, thousands of antibody tests of staff and patients. 

In one letter to leaders in the south east, seen by HSJ, the regulator said labs were expected to establish capacity and deliver 6,000 tests daily by 29 May. A senior source from London confirmed to HSJ the region had also been given a target of 6,000. There are seven local regions in the NHS, which would indicate around 42,000 tests per day, which if PCR testing continued at the current levels, could enable the government to meet the 200,000 target.

One head of pathology at a trust said: “There is one obvious answer as to why there is suddenly such an urgency to roll this out. While it will be interesting to have the results, there is nothing meaningful we can do with this test data at the moment.”

Another trust director involved in the scheme described the antibody tests as having “no clinical value”.

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Source: HSJ, 29 May 2020

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COVID-19: Millions of women and children at risk as visits to essential services plummet

The coronavirus pandemic is a “magnifier of inequality” that threatens the wellbeing of women, children, and adolescents worldwide, a roundtable of influential female leaders has heard.

The United Nations has predicted that 47 million women could lose access to contraception resulting in 7 million additional unintended pregnancies over the next six months1 because of “deadly and disabling” COVID-19, the virtual event was told.

There could also be 31 million additional cases of gender based violence in low and middle income countries. Policy makers have a clear duty to protect the most vulnerable and disadvantaged and to tackle the root causes of inequality with targeted policies and resources, the participants concluded.

Henrietta Fore, executive director of Unicef, said that, in countries with already weak health systems, COVID-19 was disrupting medical supply chains and straining financial and human resources. Visits to healthcare centres are declining owing to lockdowns, curfews, and transport disruptions, and as communities remain fearful of infection. 

She cited recent research that indicated there could be an increase in child deaths amounting to an additional 6000 a day over the next six months, and 56 700 more maternal deaths. “This is a statistic we want to avoid. We are concerned about access to services,” she said.

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Source: BMJ, 29 May 2020

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