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Cancer treatment delayed as patient priority lists drawn up

Delays have begun to cancer treatments, as patients are reprioritised ahead of capacity becoming overwhelmed by the coronavirus crisis.

In three separate developments:

  • A London trust announced it was cancelling chemotherapy and routine cancer operations for a fortnight due to coronavirus pressure;
  • An NHS England covid-19 guidance document indicated palliative care cancer patients will be less likely to receive appropriate treatment; and
  • Cancer waiting times guidance has been changed to provide for some urgent referrals for suspected cancer to be sent back to GPs without diagnosis.

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Source: HSJ, 23 March 2020

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Coronavirus: The new inventions inspired by a pandemic

A new ventilator, a virus-killing snood and a hands-free door pull are just some of the innovations coming out of Wales to tackle coronavirus.

Since the outbreak, doctors, scientists and designers have been working on ideas to stop the virus spreading.

The ventilator has already successfully treated a Covid-19 patient and has been backed by the Welsh Government.

Mass production of the snood-type mask is under way while a 3D design of the handle has been widely circulated.

Plaid Cymru leader Adam Price, who was part of the impetus to get the ventilator into mass production, said the innovations put Wales "on the front foot" in the battle against the pandemic.

"It shows that Wales, as a small nation, can get things done quickly as we face the biggest challenge of our generation," he said.

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Source: BBC News, 24 March 2020

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Protect NHS workers from coronavirus urgently, says Hunt

The NHS must ensure that doctors have proper protective equipment, Jeremy Hunt, the former health secretary, has urged.

NHS chiefs say that there are no problems with national stock levels of items including masks, gowns and gloves and that local supply issues should have been resolved over the weekend.

However, hospital staff say that they are still experiencing shortages, with nurses going to DIY shops to stock up or even refusing to work without the right equipment. One London doctor said: “Every time the government is asked they say the equipment is there, and it is just not true.”

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Source: The Times, 23 March 2020

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FDA approves first bedside COVID-19 test by Danaher’s Cepheid

A Covid-19 test can deliver results in less than an hour has been approved under an FDA emergency authorization, marking the first test that clinicians can use at the bedside.

Cepheid, a Silicon Valley molecular diagnostics company that’s a unit of Danaher Corp., announced Saturday it received an emergency authorisation from the U.S. Food and Drug Administration to use the test, making it the 13th Covid-19 test the agency has allowed on the market as long as the public health emergency exists.

But it’s the first one that can be used at the point of care, meaning providers don’t have to send patient samples to a separate lab to be processed and then come back to the hospital or provider’s office. Cepheid said it expects to start shipping tests next week.

“An accurate test delivered close to the patient can be transformative — and help alleviate the pressure that the emergence of the 2019-nCoV outbreak has put on healthcare facilities that need to properly allocate their respiratory isolation resources,” said David Persing, Cepheid Chief Medical and Technology Officer.

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Source: Bloomberg, 21 March 2020

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WHO Health Alert brings COVID-19 facts to billions via WhatsApp

WHO has launched a messaging service with partners WhatsApp and Facebook to keep people safe from coronavirus.

This easy-to-use messaging service has the potential to reach 2 billion people and enables WHO to get information directly into the hands of the people that need it.

From government leaders to health workers and family and friends, this messaging service will provide the latest news and information on coronavirus including details on symptoms and how people can protect themselves and others. It also provides the latest situation reports and numbers in real time to help government decision-makers protect the health of their populations.

The service can be accessed through a link that opens a conversation on WhatsApp. Users can simply type “hi” to activate the conversation, prompting a menu of options that can help answer their questions about COVID-19.

The WHO Health Alert was developed in collaboration with Praekelt.Org, using Turn machine learning technology.

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Source: World Health Organization, 20 March 2020

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Mental health charity slams Government's ‘irresponsible’ coronavirus bill

A mental health charity has branded as “irresponsible” the Government’s coronavirus bill which would grant single doctors the power to detain the mentally ill.

The Government wants to relax legal safeguards in the Mental Health Act in order to free up medical staff to deal with the COVID-19 pandemic. If passed, the bill would reduce the number of doctors needed to approve detaining individuals from the current minimum of two, to just one.

In addition, it would temporarily allow time limits in the Mental Health Act to be extended or removed altogether. This would mean patients currently detained in mental health facilities could be released into the community early, or be detained for longer.

Akiko Hart, Chief of National Survivor User Network (NSUN), a UK mental health charity, said: “Whilst we understand that these are unprecedented times, any legislative change must be proportionate and thought through, and should protect all of us. Minimising some of the safeguards in the Mental Health Act and extending its powers, is a step in the wrong direction.”

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Source: The London Economic, 19 March 2020

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Coronavirus: Doctors given new guidelines on choosing which patients to treat in critical care

New guidelines have been published to help doctors and nurses decide how to prioritise patients during the coronavirus pandemic.

The advice from the National Institute for Health and Care Excellence (NICE) was produced amid concerns that the NHS would be overwhelmed by the demand for intensive care beds and ventilators.

The three new NICE guidelines, which have been drawn up within a week rather than the usual timescale of up to two years, cover patients needing critical care, kidney dialysis and cancer treatment.

They say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”.

Decisions about admitting patients to critical care should consider how likely they are to recover, taking into account the likelihood of recovery “to an outcome that is acceptable to them”.

Doctors are advised to discuss possible “do not resuscitate” decisions with adults who are assessed as having increased frailty, such as those who need help with outside activities or are dependent for personal care.

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Source: Independent, 22 March 2020

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Machine 'could quadruple' heart and lung transplants

The number of heart and lung transplants could quadruple thanks to a "reanimation" machine used in a pioneering operation, a hospital says.

The device, developed at Royal Papworth Hospital in Cambridge, managed to pump oxygenated blood into both organs in a world-first procedure. The machine can revitalise deteriorating organs allowing "donation after circulatory death" (DCD).

Hospital surgeon Pedro Catarino said it was like "recharging the batteries".

"It is reanimation and then it replenishes the energy stores of the heart, what we call reconditioning, which allows it be transplanted," he said. "We think it could at least double and perhaps quadruple the number of [heart and lungs] available for transplant."

He said it was desperately needed, adding: "Patients die on the waiting list every day."

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Source: BBC News, 23 March 2020

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Coronavirus: Hancock admits ‘challenges’ over NHS equipment

The health secretary has acknowledged there have been "challenges" with the supply of personal protective equipment to NHS staff in England - but added he is determined to rise to them.

Last week, NHS staff said the lack of protective gear was putting them at risk during the coronavirus outbreak.

Matt Hancock said a million face masks had been bought over the weekend and he was taking the issue "very seriously".

From this week, the Army will play a part in helping to distribute supplies.

"I am determined to ensure that the right kit gets to the right hospital, the right ambulance service, the right doctors' surgery, right across the country," said Mr Hancock.

"There have been challenges and I can see that. We're on it and trying to solve all the problems."

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Source: BBC News, 23 March 2020

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Nurses treating coronavirus spat at and called ‘disease spreaders’

Nurses caring for patients in the community have been spat at and called ‘disease spreaders’ by members of the public, according to England’s chief nurse and the Royal College of Nursing (RCN).

The nursing union urged members of the public to support the UK’s “socially critical” nursing workforce during the coronavirus outbreak.

The RCN said it had received anecdotal reports of community nurses receiving abuse while working in uniform. Separately, England’s Chief Nurse Ruth May said she had heard reports of nurses being spat at.

Susan Masters, the RCN’s director of policy, said abuse of nurses was “abhorrent behaviour”. She said a number of nurses had raised concerns about abuse on forums used by members to talk confidentially.

Describing one incident she told The Independent: “These were community nurses who had to go into people’s homes and were in uniform. Members of the public who saw them called out to them and said they were ‘disease spreaders’.”

She added: “We don’t know how big this problem is, it is anecdotal, but it is absolutely unacceptable.

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Source: The Independent, 21 March 2020

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Coronavirus: Doctors urge conversations about dying

Palliative care doctors are urging people to have a conversation about what they would want if they, or their loved ones, became seriously unwell with coronavirus.

We should discuss all possible scenarios - even those we are not "comfortable to talk about", they said. Medics said the virus underlined the importance of these conversations.

New guidelines are being produced for palliative care for Covid-19 patients, the BBC understands.

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Source: BBC News, 21 March 2020

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Hospital’s critical care unit overwhelmed by coronavirus patients

A major London hospital has declared a “critical incident” due to a surge in patients with coronavirus, with one senior director in the capital calling the development “petrifying”.

In a message to staff, Northwick Park Hospital in Harrow said it has no critical care capacity left and has contacted neighbouring hospitals about transferring patients who need critical care to other sites.

The message, sent last night and seen by HSJ, said: “I am writing to let you know that we have this evening declared a ‘critical incident’ in relation to our critical care capacity at Northwick Park Hospital. This is due to an increasing number of patients with Covid-19.

“This means that we currently do not have enough space for patients requiring critical care.

“As part of our system resilience plans, we have contacted our partners in the North West London sector this evening to assist with the safe transfer of patients off of the Northwick Park site”

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Source: HSJ, 20 March 2020

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Efforts to reduce stillbirths, deaths, and injuries in babies have failed, finds review

A campaign to reduce stillbirths, brain injury, and avoidable deaths in babies has failed to have any effect in the past three years, findings from the Royal College of Obstetricians and Gynaecologists show.

The president of the college, Edward Morris, has urged maternity units across the UK to learn from the latest report and act on its recommendations. “We owe it to each and every person affected to find out why these deaths and harms occur in order to prevent future cases where possible,” he said.

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Source: BMJ, 19 March 2020

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Trusts criticise ‘completely chaotic’ covid-19 supply response

Several trust procurement leads have expressed frustration with the government’s response to covid-19, with HSJ being told of shortages of crucial personal protective equipment, unpredictable deliveries and a lack of clarity from the centre

NHS Supply Chain, which procures common consumables and medical devices for trusts, has been “managing demand” for an increasing number of PPE and infection control products for since the end of February to ensure “continuity of supply”. Some products, like certain polymer aprons, are unavailable altogether because of the increased demand and disrupted supply caused by the covid-19 outbreak. 

One procurement lead told HSJ: “They aren’t supplying enough, they aren’t fulfilling orders. It’s completely chaotic.” Another said his trust had “just enough to manage for the time being.”

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Source: HSJ, 20 March 2020

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UK government must recognise care workers are on the coronavirus frontline too

Social care has a vital part to play in the fight against Covid-19, but without proper support more lives will be put at risk, says Vic Rayner, Executive Director of the National Care Forum.

"We are working round the clock to keep the people we care for safe and happy and to protect our staff. We know the COVID-19 situation is moving fast – but the care sector can only effectively play its part with more direct support from the government."

Social care providers, like many across the country, are working hard to prepare for the escalation of COVID-19. This includes refresher training on infection control, robust measures to ensure any visitors to care services are safe to enter, planning for how to keep going in the face of significant workforce shortages, and ensuring the people they care for and their staff are kept safe and well.

However, it is clear that social care is in urgent need of help, more directly and more quickly, to meet the needs of the most vulnerable, or to ensure that their staff are adequately protected.

The issue of protection is never far from care providers’ minds, and the lack of personal protective equipment (PPE) for care staff remains a pressing problem.

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Source: The Guardian, 20 March 2020 

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New coronavirus stable for hours on surfaces

COVID-19 is stable for several hours to days in aerosols and on surfaces, according to a new study from National Institutes of Health, CDC, UCLA and Princeton University scientists in The New England Journal of Medicine.

The scientists found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. The results provide key information about the stability of SARS-CoV-2, which causes COVID-19 disease, and suggests that people may acquire the virus through the air and after touching contaminated objects.

The findings affirm the guidance from public health professionals to use precautions similar to those for influenza and other respiratory viruses to prevent the spread of SARS-CoV-2:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

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Source: National Institutes of Health, 17 March 2020

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UK failures over Covid-19 will increase death toll, says leading doctor

A “collective failure” to appreciate the enormity of the coronavirus pandemic and enact swift measures to protect the public will lead to unnecessary deaths, according to a leading doctor who says the UK ignored clear warning signs from China.

Richard Horton, the Editor-in-Chief of the Lancet, rounded on politicians and their expert advisers for failing to act when Chinese researchers first warned about a devastating new virus that was killing people in Hubei eight weeks ago.

The team from Wuhan and Beijing reported in January that the number of deaths was rising quickly as the virus spread in China. They urged the global community to launch “careful surveillance” in view of the pathogen’s “pandemic potential”.

Horton said nothing in the science had changed since January. “The UK’s best scientists have known since that first report from China that Covid-19 was a lethal illness. Yet they did too little, too late,” he said.

While the UK was now taking the right actions to quell the outbreak, Horton said, in due course “there must be a reckoning” where difficult questions would have to be asked and answered. “We have lost valuable time. There will be deaths that were preventable. The system failed,” he said.

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Source: The Guardian, 18 March 2020

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Surgeon suspended over treatment concerns

A doctor who worked at the same private healthcare firm as rogue breast surgeon Ian Paterson has been suspended, it has emerged.

Spire Healthcare said Mike Walsh – a specialist in trauma and orthopaedic surgery – was suspended in April 2018 over concerns about patient treatment. Almost 50 of his patients from its Leeds hospital had been recalled.

The details emerged following an independent inquiry into Paterson, who is serving a 20-year jail sentence.

Earlier this month, an inquiry into the breast surgeon found that a culture of "avoidance and denial" had allowed him to perform botched and unnecessary operations on hundreds of women.

Spire said in a statement that it acted after concerns were raised about Mr Walsh's work at its hospital in Leeds in 2018. The company, which contacted the Royal College of Surgeons to assist with its investigation, said it had reviewed the notes of fewer than 200 patients, of which "fewer than 50" had been invited back for a follow-up appointment.

"Where we have identified concerns about the care a patient received, we have invited the patient to an appointment with an independent surgeon to review their treatment," a spokesman for Spire Healthcare said. "This is a complex case and the review is ongoing."

It said that Mr Walsh, who was immediately suspended after the concerns were raised, was no longer working with Spire Healthcare. The company said any patients at its Spire Leeds Hospital who had concerns about their treatment under Mr Walsh should contact the hospital. It said its findings had also been shared with the Care Quality Commission and the General Medical Council (GMC).

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Source: BBC News, 17 February 2020

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Faculty of Medicine to lead drug trial into treatment of COVID-19

Southampton researchers are trialling an inhaled drug that could prevent worsening of COVID19 in those most at risk.

The trial, led by Tom Wilkinson, Professor of Respiratory Medicince in the Faculty of Medicine and a consultant in respiratory medicine at University Hospital Southampton, will involve 100 patients at Southampton and up to ten other NHS hospitals taking part.

Those patients will receive the best current COVID19 care, whilst inhaling either a placebo or SNG001, a special formulation of the naturally occurring antiviral protein interferon beta 1a (IFN-β), for 14 days.

The trial will be undertaken with Synairgen, a drug development company founded by University of Southampton Professors Stephen Holgate, Donna Davies and Ratko Djukanovic.

Professor Wilkinson said, “COVID19 cis presenting a major challenge to vulnerable patients, the health service and wider society whilst a vaccine will be key, that could some time away. Right now we need effective frontline treatments to give doctors the tools to treat the most vulnerable and  to help patients recover quickly as the pressure on health systems mounts."

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Source: University of Southampton, 18 March 2020

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NHS staff 'at risk' over lack of protective gear

NHS staff say they are being put at risk during the coronavirus outbreak because of a lack of protective gear.

One doctor told the BBC that frontline healthcare workers felt like "cannon fodder" as they do not have access to equipment such as face masks. Health workers also expressed concerns that not enough of them were being tested for the virus.

Prime Minister Boris Johnson said the UK had "stockpiles" of personal protective equipment (PPE). But Dr Samantha Batt-Rawden, from lobbying group the Doctors' Association, said she had heard from doctors who had not got access to PPE - or it had expired or run out.

"All these doctors are worried that that's increasing their likelihood of contracting the virus and then ultimately spreading it to patients," she said.

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Source: BBC News, 18 March 2020

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Coronavirus testing: What is the UK government's plan?

Prime Minister Boris Johnson has announced plans to test more people for coronavirus.

At the moment only people in hospital are being routinely tested, so if you have symptoms and you are not sure if you have the virus, you may well never know.

As of 18 March, 56,221 people in the UK had been tested for coronavirus. The number of tests has been rising from just over 1,000 a day at the end of February, when testing began, to more than 6,000 per day by mid-March.

The government plans to increase this to 10,000 a day initially, with a goal of reaching 25,000 tests a day. But it has been criticised by some experts for not testing widely enough, and people have been complaining online about not having access to tests despite having symptoms.

Public Health England says it will do some surveillance testing on a local level if clusters of cases are identified, using a network of 100 designated GP surgeries. This is to try to get a sense of how many milder cases there are in the community that do not result in hospitalisation.

But the UK is not currently doing any mass surveillance testing or actively tracing people who have come into contact with known cases

The Director General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, said he had a "simple message" for all countries: "Test, test, test."

He added: "We cannot stop this pandemic if we do not know who is infected."

The UK's chief scientific officer Sir Patrick Vallance told a group of MPs that "we simply don't have mass testing available for the population now", and that "when you only have capacity to do a certain number of tests" you have to prioritise the most vulnerable groups.

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Source: BBC News, 19 March 2020

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London begins major COVID-19 reconfiguration

St Bartholomew’s Hospital is to be the emergency electives centre for the London region as part of a major reorganisation to cope with the coronavirus outbreak.

Senior sources told HSJ the London tertiary hospital, which is run by Barts Health Trust, will be a “clean” site providing emergency elective care as part of the capital’s covid-19 plan.

It is understood the specialist Royal Brompton and Harefield Foundation Trust will also be taking some emergency cardiac patients.

The news follows NHS England chief executive Sir Simon Stevens telling MPs on Tuesday that all systems were working out how best to optimise resources and some hospitals could be used to exclusively treat coronavirus patients in the coming months.

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Source: HSJ, 18 March 2020

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NHS COVID-19 live impact assessment tool launched

Draper & Dash, a leading predictive patient flow provider, has launched a COVID-19 live hospital planning and demand impact assessment tool.

The company said it has been working around the clock to deliver its vital tool to support impact assessment. It allows trusts to view and analyse national Hospital Episode Statistics (HES) data, alongside a number of live data sources on COVID-19 cases by the minute, as they emerge across the globe.

The system models the impact of increased volume and complexity at a local and system level, providing visibility of ICU, theatres, and overall bed impact, and connects this live information to each trust’s clinical workforce. The tool shows immediate impacts on beds and staff under a range of selected scenarios.

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Source: Health Tech Newspaper, 18 March 2020

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Coronavirus spread has ‘kicked NHS forward in adopting digital solutions’

The rapid spread of coronavirus has given the NHS a “kick forward” in the need to accelerate technology and ensure staff are digitally prepared, a GP has said.

Neil Paul, a Digital Health columnist and GP in Ashfields, said the need to reduce face-to-face appointments to prevent the potential transmission of Covid-19 has forced the NHS, particularly in primary care, to adopt already available technologies.

He said practices “still in the stone ages” and “technophobes” were less prepared for the current situation, but that it would force them to move into the digital age.

“It’s absolutely made my surgery go ‘right, how do we do online consults’. I think it actually has given people a real kick forward,” he told Digital Health News.

“I think in six months’ time my surgery might be very different in that actually we will be doing a lot of online and telephone consults where previously we may have been a bit reluctant."

GP practices across the country have been advised to assess patients online or via telephone and video appointments to mitigate the potential spread of coronavirus.

In a letter to GPs last week, NHS England urged Britain’s 7,000 GP surgeries to reduce face-to-face appoints for patients displaying symptoms of Covid-19. The preemptive move means millions of patients will now be triaged online, via telephone or video and contacted via text messaging services.

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Source: Digital Health News, 13 March 2020

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Covid-19: Ibuprofen should not be used for managing symptoms, say doctors and scientists

Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of COVID-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition.

The minister, Oliver Veran, tweeted on Saturday 14 March that people with suspected COVID-19 should avoid anti-inflammatory drugs. “Taking anti-inflammatory drugs (ibuprofen, cortisone . . .) could be an aggravating factor for the infection. If you have a fever, take paracetamol,” he said.

Jean-Louis Montastruc, Professor of Medical and Clinical Pharmacology at the Central University Hospital in Toulouse, said that such deleterious effects from NSAIDS would not be a surprise given that since 2019, on the advice of the National Agency for the Safety of Medicines and Health Products, French health workers have been told not to treat fever or infections with ibuprofen.

Experts in the UK backed this sentiment. Paul Little, Professor of Primary Care Research at the University of Southampton, said that there was good evidence “that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used—both respiratory or septic complications and cardiovascular complications.”

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Source: BMJ, 17 March 2020

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