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Government seeks urgent PPE audit amid widespread shortages

The government has ordered an urgent national audit of personal protective equipment (PPE), body bags, swabs and infection control products, HSJ can reveal. 

Local resilience forum planners were earlier this week asked to share stock levels and daily consumption rates of the items at ambulance, acute trusts and in primary care and other services by 9pm on Tuesday.

They were asked to indicate whether each figure represented a “major” or “minor” supply problem, or no problem at all, in an email seen by HSJ.

As well as trusts, resilience forum staff were asked to share stock levels among adult social care services, numbers of mortuary staff, other local authority staff, police, prisons, fire and rescue services and funeral directors.

The email also asked planners if local services had access to PPE supplies above their immediate need and whether local authorities were in discussions with any private PPE suppliers.

The email noted the Department of Health and Social Care wanted to develop a “systematic days of supply picture” for all PPE at all providers.

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Source: HSJ, 1 April 2020

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GPs contacting patients about ‘do not resuscitate’ forms

GPs are having end of life conversations with their patients because of concerns over a lack of intensive care beds during the coronavirus crisis.

Multiple GPs have told HSJ they are talking to patients who are older or in very high risk groups about signing “do not attempt to resuscitate” forms in case these patients were to go on to contract the virus.

Some practices have also sent letters to patients requesting they complete the forms, it is understood.

One leader of a primary care network, who asked not to be named, told HSJ: “Those in the severe at-risk group and those over 80 are being told they won’t necessarily be admitted to hospital if they catch coronavirus.”

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Source: HSJ, 1 April 2020

 

 

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Coronavirus: Special body recovery teams set up for those who die at home

Special body recovery teams have begun work to deal with suspected coronavirus victims who die in their homes.

Small units of police, fire and health service staff will confirm death and the identity of the dead and remove their bodies to a mortuary.

Known as Pandemic Multi-Agency Response Teams, or PMART, they will be dispatched when victims die outside hospitals and there is a high probability they had COVID-19.

The teams have been set up, initially in London, to relieve pressure on hospitals overwhelmed with coronavirus emergency cases.

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Source: Sky News, 1 April 2020

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Covid-19: Doctors are told not to perform CPR on patients in cardiac arrest

Healthcare staff in the West Midlands have been told not to start chest compressions or ventilation in patients who are in cardiac arrest if they have suspected or diagnosed covid-19 unless they are in the emergency department and staff are wearing full personal protective equipment (PPE).

The guidance from the University Hospitals Birmingham NHS Foundation Trust says that patients in cardiac arrest outside the emergency department can be given defibrillator treatment if they have a “shockable” rhythm. But if this fails to restart the heart “further resuscitation is futile,” it says.

If a patient with suspected covid-19 is in cardiac arrest they should be given cardiac compressions and be ventilated only if they are in the emergency department and the person attending them is wearing aerosol generating procedures (AGP) PPE. That means wearing an FFP3 mask, full gown with long sleeves, gloves, and eye protection.

The advice rests on the premise that performing cardiac compressions risks virus particles being released into the air that could infect staff.

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Source: BMJ, 29 March 2020

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Coronavirus: NHS doctors ‘gagged’ over protective equipment shortages

Frontline doctors have told the Independent they have been gagged from speaking out about shortages of protective equipment as they treat coronavirus patients – with some claiming managers have threatened their careers.

Staff have been warned not to make any comments about shortages on social media, as well as avoiding talking to journalists, while NHS England has taken over the media operations for many NHS hospitals and staff.

The Independent has seen a series of emails and messages warning staff not to speak to the media during the coronavirus outbreak.

One GP has been barred from working in a community hospital in Ludlow after making comments about the lack of equipment, while another in London said they were told to remove protective equipment they had purchased themselves.

NHS England confirmed it was controlling media communications, which it said was part of its national emergency incident planning to ensure the public received “clear and consistent information”. 

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Source: The Independent, 1 April 2020

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In trenches of New York's coronavirus crisis, nurses beg, borrow and steal precious masks

Amid growing shortages of vital protective equipment in New York hospitals, healthcare workers are desperately scrounging to find facemasks, hiding supplies from colleagues in other departments, and sometimes even pilfering for themselves.

The novel coronavirus has infected nearly 45,000 across New York, and more than 550,000 globally. Nurses in New York City were shaken on Tuesday, when Kious Kelly, a nurse manager at a Mount Sinai Health System hospital, died after being infected.

Nurses who would normally use masks and other protective gear only once are keeping them for entire shifts or longer to conserve supplies.

"Masks disappear," said Diana Torres, a Mount Sinai nurse. "We hide it all in drawers in front of the nurses' station. We hide masks, we have to hide chucks for beds," she said, referring to incontinence pads.

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Source: MedScape Nurses, 30 March 2020

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Coronavirus: GP surgery apology over 'do not resuscitate' form

A GP surgery has apologised after sending a letter asking patients with life-limiting illnesses to complete a "do not resuscitate" form.

A letter, from Llynfi Surgery in Maesteg, asks people to sign to ensure emergency services would not be called if their condition deteriorated due to coronavirus.

"We will not abandon you.. but we have to be frank and realistic," it said.

Cwm Taf health board issued an apology from the surgery, the Guardian reports.

The letter says in an "ideal situation" doctors would have had this conversation in person but had written to them due to fears they were carrying the virus and were asymptomatic.

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Source: BBC News, 1 April 2020

 

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Coronavirus: Paramedic protective kit 'only fit for making sandwiches'

A paramedic in the London Ambulance Service (LAS) has claimed the kit workers have been given to protect them from coronavirus would be more suitable for people making sandwiches.

The south London medic, who did not want to be identified, said the basic apron, gloves and masks were not sufficient protection from infection.

"It feels like every day I'm exposing myself and potentially my family to this virus," he told the BBC.

In a document seen by the BBC, LAS has told its paramedics to wear basic PPE - a plastic apron, gloves and a surgical mask - for most call-outs.

The advanced PPE - including a white boiler suit, FFP3 mask, and goggles - is reserved only for confirmed cases of coronavirus, and in situations where paramedics have to perform invasive procedures such as full CPR.

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Source: BBC News, 31 March 2020

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UK poll finds young people's mental health hit by coronavirus

More than 80% of young people with a history of mental ill health have found their conditions have worsened since the coronavirus crisis began in the UK, a survey has found.

In a study by the mental health charity YoungMinds, 2,111 people aged under 25, who had a history of mental health needs, were asked how the pandemic had affected them.

Of the 83% who said the pandemic had made their mental health worse, 32% said it had made it “much worse” and 51% said it had made it “a bit worse”.

Among the respondents who were accessing mental health support leading up to the crisis – including from the NHS, school and university counsellors, charities, helplines and private providers – 74% said they were still receiving support and 26% said they were unable to access support.

Emma Thomas, the chief executive of YoungMinds, said the pandemic was a “human tragedy that will continue to alter the lives of everyone in our society. The results of this survey show just how big an impact this has had, and will continue to have, on the mental health of young people.”

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Source: Guardian, 31 March 2020

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Coronavirus: Home abortions approved during outbreak

Patients in England can now have home abortions during the COVID-19 outbreak, the government in England has said.

Abortion policy has changed several times during the current pandemic. Women and girls wanting to terminate an early pregnancy were first told the service would be available but that decision was then retracted.

Now, the government has decided patients can take two pills at home instead of going to a clinic to avoid exposure to coronavirus.

Charities had been worried that women who want an abortion but have underlying health conditions would put themselves at risk to have the procedure or turn to dangerous alternatives.

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Source: BBC News, 31 March 2020

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"I’m losing the will to live, god help us all": despair of NHS procurement chief

Gowns for front-line staff were not included in the national pandemic stockpile of personal protective equipment, procurement chiefs have been told.

Trust procurement leads have raised concerns over dwindling gown supplies. Health Care Supply Association chief officer Alan Hoskins tweeted he could not order the products through NHS Supply Chain, even after escalating the matter to NHS England.

Mr Hoskins’ tweet on Sunday, which has since been deleted, said: “What a day, no gowns NHS Supply Chain. Rang every number escalated to NHS England, just got message back — no stock, can’t help, can send you a PPE pack. Losing the will to live, god help us all.”

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Source: HSJ, 30 March 2020

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Mental issues sparked by pandemic could be 'silent killer': Red Cross

The Red Cross called Friday for increased psychological support to health workers and others fighting the COVID-19 pandemic, warning of rising suicides as a result of pressure and isolation.

Countries around the world have taken dramatic measures to try to halt the spread of the virus, which first emerged in China late last year, with more than three billion people now living under lockdown.

The demand for psycho-social support has "increased significantly" since the start of the crisis, said Jagan Chapagain, the Secretary-General of the International Federation of Red Cross and Red Crescent Societies (IFRC).

In an interview with AFP, he said he understood that providing mental health support "may not be very high on the agenda as we are trying to contain the virus," but stressed that the issue is important and "impacts millions and millions of people."

"I think that could be the big silent killer if sufficient attention is not paid to psychosocial needs and mental health needs," he said.

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Source: Agence France-Presse, 28 March 2020

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Webinar today @ 1pm: Responding to voices from the healthcare frontline

Join Animah Kosai, Founder of Speak Up at Work, Roger Kline, Trustee Patients First UK, and Kernan Manion Executive Director, Center for Physician Rights as we explore essential crisis communication principles to ensure staff safety, healthcare team cohesion, and effective care delivery. 

Few in our local and national communities have ever experienced a pandemic causing complete shutdown and emergency isolation measures.

With such an immense and unparalleled global catastrophe, despite play-acting disaster drills,  few corporations are truly prepared for the emergency response demands and the accompanying requirement for a Crisis Response Mindset and its communication principles. 

Fortunately, wisdom gleaned from knowledge-based science and on-the-ground experience in prior epidemics and natural catastrophes is available to guide us through this very unfamiliar turf.

A particular focus is on intra-organisational crisis management and communication with an aim toward sharing best practices.

Further information

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Trusts told to test staff who are in quarantine

Acute trusts have been told to set aside 15% of their daily coronavirus tests for NHS key workers who are quarantining at home with others.

New guidance for NHS trust chief executives on covid-19 testing has been published after NHS England chief executive Sir Simon Stevens announced hundreds of frontline staff would be given antigen tests from next week.

The guidance from NHSE said acute trusts should prioritise testing staff working in critical care, emergency departments and ambulance services, along with “any other high priority groups you determine locally”.

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Source: HSJ, 30 March 2020

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Coronavirus: Mercedes F1 to make breathing aid

A breathing aid that can help keep coronavirus patients out of intensive care has been created in under a week.

University College London engineers worked with clinicians at UCLH and Mercedes Formula One to build the device, which delivers oxygen to the lungs without needing a ventilator.

Continuous Positive Airway Pressure (CPAP) devices are already used in hospitals but are in short supply. China and Italy used them to help Covid-19 patients.

Forty of the new devices have been delivered to ULCH and to three other London hospitals. If trials go well, up to 1,000 of the CPAP machines can be produced per day by Mercedes-AMG-HPP, beginning in a week's time.

The Medicines and Healthcare products Regulatory Agency (MHRA) has already given its approval for their use.

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Source: BBC News, 30 March 2020

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Coronavirus crisis hits pregnant women as clinics shut

Hundreds of thousands of pregnant women face a crisis as maternity and abortion services shut their doors because of the coronavirus outbreak.

One MP this weekend warned that pregnant women were being treated like “second-class citizens” with the closure of NHS services and a lack of government guidance for those in need of urgent care.

The NHS faces a severe shortage of midwives with the number of unstaffed positions doubling to one in five since the virus arrived in Britain. 

A fifth (22%) of senior midwives said their local maternity units had shut indefinitely because of staff self-isolating or being deployed elsewhere.

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Source: The Times, 29 March 2020

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Chaos and panic': Lancet editor says NHS was left unprepared for Covid-19

The NHS could have prevented “chaos and panic” had the system not been left wholly unprepared for the pandemic, the editor of the BMJ has said.

Numerous warnings were issued but these were not heeded, Richard Horton wrote in the Lancet. He cited an example from his journal on 20 January, pointing to a global epidemic: “Preparedness plans should be readied for deployment at short notice, including securing supply chains of pharmaceuticals, personal protective equipment, hospital supplies and the necessary human resources to deal with the consequences of a global outbreak of this magnitude.”

Horton wrote that the government’s Contain-Delay-Mitigate-Research plan had failed. “It failed, in part, because ministers didn’t follow WHO’s advice to ‘test, test, test’ every suspected case. They didn’t isolate and quarantine. They didn’t contact trace."

“These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The result has been chaos and panic across the NHS.”

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Source: Guardian, 28 March 2020

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National chiefs: Ventilators will follow ‘most immediate need’

National and regional NHS chiefs will seek to share out scarce ventilators to ”areas with the most immediate need, on a fair share basis relative to patient ventilation need," they have told hospital chiefs, who are increasingly concerned about what they will receive and when.

Many are expecting demand for ventilated beds to outstrip what they have as the number of patients seriously ill with covid-19 ramps up.

Trust leaders yesterday told HSJ they were growing increasingly worried about the lack of information over when the machines would be sent to their trusts. Some are worried London, and other regions which see their demand spike first, will get more supply.

A letter from NHS England and Improvement to trust chiefs late on Wednesday told them that as “extra ventilators become available we will coordinate distribution via regional teams who will work with local health systems”.

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Source: HSJ, 27 March 2020

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Covid-19: “Illogical” lack of testing is causing healthy staff to self-isolate, BMA chief warns

The absence of COVID-19 testing for NHS staff is causing huge workforce shortages by forcing doctors to self-isolate even if they do not have the virus, the head of the BMA has warned.

The government’s advice is for people with COVID-19 symptoms to stay at home for seven days, but for all other household members who remain well to isolate for 14 days. The BMA council chairman, Chaand Nagpaul, said that the lack of testing for staff was “counter-intuitive” as it was likely to be forcing more staff than necessary to stay away from hospitals and GP surgeries because they do not know if they are infected.

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Source: BMJ, 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: '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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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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Mobilizing to Respond to COVID-19: Special IHI Virtual Learning Hour Today!

Join the Institute for Healthcare Improvement's (IHI's) President Emeritus and Senior Fellow, Donald M. Berwick MD, MPP, FCRP and IHI President and CEO, Derek Feeley for a special Virtual Learning Hour today on Mobilizing to Respond to COVID-19. 

In this hour-long call, Don and Derek will share key learnings, innovations, and revelations they’ve been gathering and gleaning from health care leaders and improvers across the globe.

The call will also serve as an opportunity for listeners to share the struggles, stories, and bright spots they are seeing in this unprecedented time.

Register

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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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