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Coronavirus: 'Mix-up' over EU ventilator scheme

The government says a communications mix-up meant it missed the deadline to join an EU scheme to get extra ventilators for the coronavirus crisis.

Ministers were earlier accused of putting Brexit before public health when Downing Street said the UK had decided to pursue its own scheme.

But No 10 now says officials did not get emails inviting the UK to join and it could join future schemes.

The party's shadow Health Secretary Jonathan Ashworth said: "Given the huge need for PPE, testing capacity and crucial medical equipment including ventilators, people will want to know why on Monday ministers were saying they had 'chosen other routes' over the joint EU procurement initiatives but now they are claiming that they missed the relevant emails.

"We need an urgent explanation from ministers about how they will get crucial supplies to the frontline as a matter of urgency."

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Source: BBC News, 27 March 2020

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Lack of testing means NHS staff are infecting patients

NHS staff who have contracted coronavirus but remain at work because they show no symptoms are probably infecting patients, a public health official admitted yesterday.

Doctors said they were worried about becoming “part of the problem” owing to a lack of testing and a shortage of protective equipment, particularly outside hospitals. Masks, gloves and visors can help stop people infecting others and stop them becoming infected.

The British Medical Association said that staff testing was urgently needed so that doctors and nurses knew if it was safe for them to see patients.

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Source: The Times, 27 March 2020

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Coronavirus: NHS uses tech giants to plan crisis response

Data collected via the NHS's 111 telephone service is to be mixed with other sources to help predict where ventilators, hospital beds, and medical staff will be most in need.

The goal is to help health chiefs model the consequences of moving resources to best tackle the coronavirus pandemic.

Three US tech firms are aiding the effort - Amazon, Microsoft and Palantir - as well as London-based Faculty AI.

The plan is expected to be signed off by Health Secretary Matt Hancock.

"Every hospital is going to be thinking: Have we got enough ventilators? Well we need to keep ours because who knows what's going to happen - and that might not be the optimal allocation of ventilators," explained a source in one of the tech companies involved.

"Without a holistic understanding of how many we've got, where they are, who can use them, who is trained, where do we actually have patients who need them most urgently, we risk not making the optimal decisions."

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Source: BBC News, 26 March 2020

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UK patient zero? East Sussex family may have been infected with coronavirus as early as mid-January

A family from East Sussex may have been Britain’s first coronavirus victims, catching the virus in mid-January after one of them visited an Austrian ski resort that is now under investigation for allegedly covering up the early outbreak.

If confirmed by official tests, it would mean the outbreak in Britain started more than a month earlier than currently thought.

As things stand, the first recorded UK case was on January 31, and the earliest documented incidence of transmission within Britain occurred on 28 February.

Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh, said cases like this demonstrated the need for widespread antibody and viral genome sequencing testing. These tests can show who has and has not been exposed to the virus, and therefore help epidemiologists trace the history and spread of the illness.

"A really significant unknown in this epidemic is whether or not the cases that are symptomatic are simply the tip of the iceberg," he said. "If there are hidden cases in large numbers, then it tells us that the infection is more difficult to control than we thought… but it also suggests that there is a possibility herd immunity may have built up."

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Source: The Telegraph, 25 March 2020

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Coronavirus: 'Frailty score' plan angers special needs parents

New guidelines for assessing people with coronavirus who go to hospital were amended after an outcry from parents of children with special needs.

The emergency guidelines published by the National Institute for Health and Care Excellence (NICE) are designed to help determine how much treatment a patient will receive.

Those deemed "completely dependent for personal care for whatever reason" will be offered end-of-life care rather than restorative treatment.

This now excludes people with learning difficulties or cerebral palsy.

In a statement NICE said the system was "not perfect" but was designed to support hospital medics "during this very difficult period of intense pressure". "We welcome the recent clarification that the Clinical Frailty Score should not be used in certain groups," it said.

The updated guidelines now state that it "may not perform as well in people with stable long-term disability" and suggests that it is not used in those cases.

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Source: BBC News, 26 March 2020

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Doctors and nurses walk out of Zimbabwe hospitals over protective equipment shortage

Hundreds of healthcare professionals in Zimbabwe have refused to work without protective equipment, beginning strike action in a standoff with the government as the nation begins to see its first impacts of coronavirus.

With the risk of an outbreak increasing day by day, industry chiefs in the country have warned doctors face inadequate supplies of gloves, masks and gowns.

The president of the Zimbabwe Hospital Doctors Association, Tawanda Zvakada, said doctors would return to the frontlines of the battle against the virus when adequate protection was provided. 

"Right now we are exposed and no one seems to care," he said, adding that doctors have inadequate stocks of gloves, masks and gowns.

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Source: Independent, 26 March 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: GPs demand 'clarity' over protective gear guidance

GPs are demanding "urgent clarification" from the government on whether they should now wear protective equipment to examine all patients.

Family doctors now wear it if they see a patient with suspected coronavirus. But the Royal College of General Practitioners (RCGP) has written to Health Secretary Matt Hancock to ask if GPs should wear it for all face-to-face consultations. It says patients with the virus but no symptoms could still infect staff.

The BBC understands GPs in some surgeries have decided to wear personal protective equipment (PPE) for all face-to-face consultations, but this is not currently recommended by Public Health England.

In the letter, Prof Martin Marshall, chairman of the RCGP, wrote: "GPs across the country have never been more concerned, not just for the safety of themselves and their teams, but for patients too. They are unsure as to whether they have enough supplies [of PPE], either now, or as the crisis deepens".

"They are not confident that the current guidance provides the necessary clarity about whether GPs are using the right type of equipment, at the right times," he said.

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Source: BBC News, 26 March 2020

 

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Swedish PM warned over 'Russian roulette-style' Covid-19 strategy

Criticism is mounting in Sweden of the government’s approach to Covid-19, with academics warning that its strategy of building broad immunity while protecting at-risk groups – similar to that initially adopted by the UK – amounted to “Russian roulette” and could end in disaster.

The prime minister, Stefan Löfven, on Sunday night called on all Swedes to accept individual responsibility in stopping the rapid spread of the virus as the number of patients in intensive care in Stockholm continued to rise sharply.

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Source: 23 March 2020, The Guardian

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"They don’t hide from the coronavirus, they confront it"

As the world writhes in the grip of Covid-19, the epidemic has revealed something majestic and inspiring: millions of health care workers running to where they are needed, on duty, sometimes risking their own lives. In his article in the New York Times, Don Berwick says he has never before seen such an extensive, voluntary outpouring of medical help at such a global scale. Millions of health care workers are running to where they are needed, sometimes risking their lives.

Intensive care doctors in Seattle connect with intensive care doctors in Wuhan to gather specific intelligence on what the Chinese have learned: details of diagnostic strategies, the physiology of the disease, approaches to managing lung failure, and more. 

City by city, hospitals mobilise creatively to get ready for the possible deluge: bring in retired staff members, train nurses and doctors in real time, share data on supplies around the region, set up special isolation units and scale up capacity by a factor of 100 or 1000.

"We are witnessing professionalism in its highest form, skilled people putting the interests of those they serve above their own interests."

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Source: New York Times, 23 March 2020

 

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The three vital lessons Italian hospitals have learned in fighting COVID-19

Protection for staff, clean covid-negative wards, and enforcing social isolation are the three take home messages from Italy’s fight against COVID-19, according to rapid findings shared exclusively with HSJ.

By 6 March 2020, Italy had recorded 4,636 cases and 197 deaths attributable to COVID-19. On 20 March, two weeks later, the UK announced 3,983 cases and 177 deaths due to the novel coronavirus.

Models put us two weeks behind Italy and on the same trajectory. PanSurg.org, an international collaborative created at Imperial College London, organised a series of webinars to rapidly share experiences and learning around the pandemic amongst the global healthcare community. Nearly 1,000 healthcare professionals from around the world took part in these events, and several important messages emerged.

1) Protect your staff: full PPE (including, FFP3 masks) for COVID-19 suspected or COVID-19 positive areas. This is both for them and to keep your workforce numbers intact.

2) Treat everyone as if they could haveCOVID-19, as they may do and “fear the covid negative ward”.

3) Enforce social isolation and contact tracing and place a significant focus on testing.

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Source: HSJ, 25 March 2020

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Practices asked to help identify patients most vulnerable to Covid-19

GP practices should review 1.5 million patients identified by NHS England as the most vulnerable to the coronavirus.

NHS England will send a standard letter to these patients asking them to stay at home at all times and avoid any face-to-face contact for at least 12 weeks.

GPs will be able to access a report on which patients will be contacted with specific advice, with NHS England directing GPs to review the list and provide additional support to patients.

The patients, who are at ‘the highest risk of severe illness that would require hospitalisation from coronavirus’, include those who have had an organ transplant; people with specific cancers; people with severe respiratory conditions; people with rare diseases; people on immunosuppression therapies; and pregnant women with significant heart disease.

In a letter to GPs, NHS England said: "We ask that you review this report for accuracy and, where any of these patients have dementia, a learning disability or autism, that you provide appropriate additional support to them to ensure they continue receiving access to care."

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Source: Management in Practice, 24 March 2020

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'System failure' on personal protective equipment

If there is a public inquiry over the handling of the coronavirus, the provision of personal protective equipment (PPE) to front-line staff could be a major theme.

The government has been put under major pressure by staff over the past four days because of delays to the delivery of vital equipment. This left them at risk as they dealt with a flood of covid-19 cases described as “all-consuming” by one hospital chief executive (while another major trust declared a critical incident).

The last two weeks have prompted a mammoth effort from local and national procurement teams to make sure clinicians have the PPE they need.

But, sadly, the bigger picture was what the Health Care Supply Association called a “system” failure (although it did not blame staff).

Numerous trusts, some of them very large, have turned to alternative suppliers to source this vital kit, in some cases spending hundreds of thousands of pounds. The situation has apparently been so dire in recent days that, over the weekend, the HCSA asked DIY shops to donate their PPE to local trusts.

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Source: HSJ, 24 March 2020

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We face a pandemic of mental health

Currently we have a frightening, deadly viral pandemic, but there will another plague, one we are not hearing nearly enough about from our leaders, which will arrive in a wave just behind it, reports Paul Daley in the Guardian. 

There will be a pandemic of severe depression and anxiety that will sweep over the world as the unemployment rate pushes into previously unseen digits, families who’d prefer to be socially distant are thrust together and young people are denied the certainty and structure of school.

We will need to support – medically, financially, emotionally and psychiatrically – those who are going to do it hardest. Psychiatric support services will need to be dramatically bolstered to fight this mental health pandemic

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Source: The Guardian, 24 March 2020

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Frantic action to stop London ‘running out of beds in four days’

Details of a massive ramp-up in intensive care beds have been circulated to NHS bosses in London, amid concerns from national leaders that they are four days away from full capacity.

In a call with local leaders, the NHS’ national director for mental health, Claire Murdoch, spoke about the intense pressures facing the acute system due to the coronavirus outbreak.

According to several people on the call, she said London “runs out of [ICU] beds in four days” if urgent action is not taken. She also warned the need for intensive care beds will now double every three days, the sources said.

The capital’s hospitals are frantically planning to try to quadruple their “surge capacity” in intensive care over the next fortnight, from around 1,000 surge beds over the weekend just passed, to more than 4,000 in two weeks’ time. 

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Source: HSJ, 24 March 2020

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Covid-19: medical students should not work outside their competency, says BMA

Medical students who are employed in the NHS as part of efforts to swell staff numbers to tackle covid-19 should not be expected to “step up” and act outside of their competency, says the BMA in new guidance.

This is the first set of guidance released by the BMA specifically for medical students, who have had placements and exams cancelled and are uncertain about how they might be employed in the NHS in the current crisis. It says that any employment should be voluntary and within the competency of the student, who should have adequate access to personal protective equipment.

The BMA refers to General Medical Council guidance that states that plans are not currently in place to move provisional registration forward from the normal August date. It warns that there are concerns around the boundaries of practice and the level of supervision that students who take on roles in the NHS would have, which could lead to unsafe working practices. The BMA is in talks to negotiate a safe national contract for such roles.

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Source: BMJ, 24 March 2020

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Government buys 3.5m tests and promises staff checks ‘online soon’

The government has bought 3.5 million coronavirus antibody tests — with more widespread testing of NHS workers coming “online soon”, the health secretary has said.

Matt Hancock also told a press conference this evening that a new testing facility had been opened in Milton Keynes as the government aims to “ramp up” the number of antibody tests — which will determine whether people have had the virus and can therefore return to work.

Mr Hancock also said the government had shipped 7.5 million pieces of personal protective equipment over the last 24 hours, following major shortages, and confirmed the conversion of east London’s Excel centre into a huge temporary hospital facility, with between 500 to 4,000 beds.

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Source: HSJ, 24 March 2020

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GP given masks with expiry dates that have passed

A GP has criticised the practice of giving doctors surgical masks with expiry dates that have passed.

Dr Kate Jack said doctors felt "like cannon fodder" after discovering the paper masks had expired in 2016. A box delivered to her Nottingham surgery had a 2021 label placed over the original date of 2016.

The Department of Health and Social Care (DHSC) said equipment underwent "stringent tests" and was given a "new shelf-life" where appropriate.

"I don't feel protected at the moment," said Dr Jack, a GP of 22 years. "They are really not designed for prevention of infection and are practically useless."

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Source: BBC News, 25 March 2020

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Staff in ‘near revolt’ over protective gear crisis

Lack of staff testing, workforce shortages and running out of personal protective equipment (PPE)are the three biggest concerns for trusts fighting the coronavirus outbreak, according to an HSJ chief executive survey conducted over the last 36 hours.

Thirteen of the 34 trust chief executives who responded to the snap survey, who were from trusts across England, also warned they would run out of intensive care capacity by next week as the number of coronavirus cases continue to rise.

The survey also revealed some trusts were already being forced to dilute safe staffing ratios and ration facilities. One chief warned: “We are preserving ventilation capacity by ensuring that only those who may survive are considered.”

However, the majority of respondents were supportive of system leaders’ guidance so far. Several respondents praised the “impressive pace and detail of the advice."

The three biggest areas of concern raised by the chiefs surveyed were:

  • Lack of staff testing, raised by 26 of the 34 respondents (77%);
  • Staff shortages, raised by 26 of the 34 respondents (77%); and
  • PPE shortages, raised by 23 of the 34 respondents (68%.

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Source: HSJ, 24 March 2020

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"There have been stories of doctors having to go to Screwfix to find themselves masks"

UK doctors fighting coronavirus still say they don't have personal protective equipment (PPE). 

Jon Snow spoke to Dr Jenny Vaughan, a leading member of the Doctors’ Association  who have written to the government to demand better personal protective equipment for medical staff.

He asked her whether the PPE equipment promised by the government was starting to reach the medical staff on the frontline, and what kinds of problems medical personnel had been encountering.

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Source: Channel 4 News, 23 March 2020

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UH partners with Masimo to pilot remote patient monitoring tool to aid COVID-19 response efforts

University Hospitals has partnered with medical technology company Masimo to pilot a telehealth solution, Masimo SafetyNet, that is designed to help clinicians care for patients remotely with a finger sensor and phone app.

The demand for remote monitoring and patient engagement in different settings has "significantly increased" during the COVID-19 pandemic. To help prepare for a surge in COVID-19 patients and protect other patients and providers, the tool allows University Hospitals and other hospitals to expand patient monitoring to the home or other locations (for instance, a skilled nursing facility or an under-utilised med-surg floor) that are temporarily set up to address increased demand.

Guidelines from the World Health Organization suggest monitoring the oxygen saturation, respiration rate and temperature of suspected or confirmed COVID-19 patients. Adapting this existing technology aims to offer a secure remote solution.

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Source: Crain's Cleveland Business, 23 March 2020

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Top NHS doctor warns frontline staff battling coronavirus are "lambs to the slaughter"

A leading NHS doctor has warned frontline medical staff dealing with Britain’s coronavirus outbreak feel like “cannon fodder” and "lambs to the slaughter".

Dr Rinesh Parmar, chairman of the Doctor's Association UK, is battling the disease on an intensive care ward at a city hospital in Birmingham.

The Anaesthetic Registrar begged Boris Johnson to provide better Personal Protective Equipment (PPE), describing the current crisis the "calm before the storm"

Doctors and nurses fear a lack of masks, gloves, aprons and protective suits is putting them at risk as they care for patients diagnosed with Covid-19.

Speaking after a night shift on the ward, Dr Parmar told The BBC's Andrew Marr Show: "We have had doctors tell us they feel like lambs to the slaughter, that they feel like cannon fodder. GPs tell us that they feel absolutely abandoned."

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Source: The Sun, 23 March 2020

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Intensive care staffing ratios dramatically diluted

The staff-to-patient ratios for intensive care are being dramatically reduced as the NHS seeks to rapidly expand its capacity to treat severely ill covid-19 patients, HSJ has learned.

Acute trusts in London have been told to base their staffing models for ICU on having one critical care nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants. 

Trusts have also been told by NHS England and NHS Improvement’s regional directorate to plan for one critical care consultant per 30 patients, supported by two middle grade doctors. The normal guidance is the consultant-to-patient ratio “should not exceed a range between 1:8-1:15”.

Nicki Credland, chair of the British Association of Critical Care Nurses, confirmed the plans had been agreed today nationally.

She told HSJ: “There will absolutely be a lot of concern about this in the profession, but it’s the only option we’ve got available. We simply don’t have the capacity to increase our staffing levels quickly enough."

“It will dilute the standard of care but that’s absolutely better than not having enough critical care staff. There’s also a massive issue around the ability of critical care nurses not only to care for their patients but also monitor what the non-specialists in their teams are doing.”

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Source: HSJ, 24 March 2020

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