The findings suggest that heart scans could prove crucial for identifying patients who may benefit from additional treatments to improve their COVID-19 recovery and prevent potential long-term damage to their heart.

Professor Marc Dweck, British Heart Foundation Senior Lecturer and Consultant Cardiologist at the University of Edinburgh, said:

“Covid-19 is a complex, multisystem disease which can have profound effects on many parts of the body, including the heart. Many doctors have been hesitant to order echocardiograms for patients with Covid-19 because it’s an added procedure which involves close contact with patients. Our work shows that these scans are important – they improved the treatment for a third of patients who received them.”

• The coronavirus (COVID-19) pandemic has had a profound impact on people receiving and providing social care in England. Since March, there have been more than 30,500 deaths among care home residents than we would normally expect, and a further 4,500 excess deaths among people receiving care in their own homes (domiciliary care). 
• There has been a greater proportional increase in deaths among domiciliary care users than in care homes (225% compared to 208%). And while deaths in care homes have now returned to average levels for this time of year, the latest data (up until 19 June) shows that there have continued to be excess deaths reported among domiciliary care users.
• Social care workers are among the occupational groups at highest risk of COVID-19 mortality, with care home workers and home carers accounting for the highest proportion (76%) of COVID-19 deaths within this group. 
• During March and April, there was a substantial reduction in hospital admissions among care home residents. Elective admissions reduced to 58% of the 5-year historical average and emergency admissions to 85% of the 5-year historical average. By reducing admissions, care home and NHS teams may have reduced the risk of transmission, but there may have also been an increase in unmet health needs. 
• During March and April, discharges from hospitals to residential care homes were 75% of the historical average, while discharges from hospitals to nursing homes increased to 120% of the historical average. These difficult decisions to discharge patients were made in an urgent and uncertain context but may have played a role in transferring risk to a poorly supported social care system.

1. 44% of respondents are not confident in their hospital’s ability to provide planned surgery safely while managing COVID-19 demand during future surges.
2. Nearly two-thirds of respondents (64%) have, to some extent during the last month, suffered mental distress because of additional work related stress due to COVID-19.
3. Nearly nine in ten trainees (89%) strongly agree that the pandemic is affecting their training opportunities, career and professional development.

Key recommendations:

1. NHS Improvement should publish a new People Plan, with the investment and teeth needed to support staff welfare and wellbeing, build resilience and address inequality.
2. NHS Improvement should identify, train and maintain the skills of cross-specialty ‘reservists’ who can support COVID-19 surges, and escalation plans should rapidly be made, with the support of the Medical Royal Colleges.
3. The Government should make a commitment to additional, and sustainable, investment in the resources, facilities and staff needed to support a return to pre-COVID-19 activity.
4. Hospitals and trusts may need to cohort specialist surgery on a regional basis; and there is merit in a ‘clean hospital’ approach. Other locations for managing planned surgery or COVID-19 care should be considered, with sufficient resources that are separate from those within the NHS.
5. Efforts should be made to support hospitals in ensuring that sufficient numbers of anaesthetic, theatre, perioperative care and ward staff are free to return to their routine work activities.
6. A transparent, flexible, approach to re-scheduling assessments and teaching should be developed, with clear guidance on how missed learning opportunities will be delivered. 

• Clarity about goals of testing.
• Access, effectiveness, and efficiency.
• Acknowledgement and management of the strengths and limitations of the current test.
• Understanding how the test is used in practice and the implications of these uses.
• Clarity in relation to choices about testing both in principle and in practice.
• Clarity about data protection and confidentiality.
• Trustworthiness and legitimacy.
• High quality information and communication about testing.

• 44% of respondents were not confident their hospitals would be able to provide safe COVID and non-COVID services should there be a second surge of infections.
• Over one third (38%) of respondents also cited low or non-existent rapid testing for staff at their hospitals and one-in-five (20%) said there are currently insufficient infection prevention and control measures to prevent staff from infecting surgical patients with COVID-19.
• Results also highlighted the increasing trend in mental distress amongst anaesthetists and the disruption to the training opportunities for anaesthetists in training:
  • nearly two-thirds of respondents (64%) have, to some extent during the past month, suffered mental distress due to the pressures faced during the COVID-19 pandemic
  • over one-third of respondents (34%) reported a low or very low level of team morale, compared with nearly one-in-five (21%) in May
  • nearly nine-in-ten trainees (89%) strongly agree that the pandemic is affecting their training opportunities, career and professional development.

• Wearing PPE posed problems with fit.
• Several human factor/ergonomic issues were reported when working in PPE, including visual difficulties and problems with communication and hearing alarms.
• Hand (fine motor) function was impaired, with additional problems for non‐clinical activities including typing and using electronic interfaces.
• Reaching (gross motor) activities were restricted by both surgical gowns with sleeves and one‐piece coveralls.
• Skin breakdown, musculoskeletal injuries and overheating.

The authors suggest that that more human factor/ergonomic research is needed to improve the functional design of PPE so that healthcare workers are better supported to carry out critical care and other medical treatment.

In their paper in the International Journal for Quality in Healthcare, they propose a five-step strategy and actions through which PS and QI staff can meaningfully contribute during a pandemic by employing their core skills to support patients, staff and organisations.

1. Mandate comprehensive and quality ethnicity data collection and recording as part of routine NHS and social care data collection systems, including the mandatory collection of ethnicity data at death certification, and ensure that data are readily available to local health and care partners to inform actions to mitigate the impact of COVID-19 on BAME communities.
2. Support community participatory research, in which researchers and community stakeholders engage as equal partners in all steps of the research process, to understand the social, cultural, structural, economic, religious, and commercial determinants of COVID-19 in BAME communities, and to develop readily implementable and scalable programmes to reduce risk and improve health outcomes.
3. Improve access, experiences and outcomes of NHS, local government and integrated care systems commissioned services by BAME communities including: regular equity audits; use of health impact assessments; integration of equality into quality systems; good representation of black and minority ethnic communities among staff at all levels; sustained workforce development and employment practices; trust-building dialogue with service users.
4. Accelerate the development of culturally competent occupational risk assessment tools that can be employed in a variety of occupational settings and used to reduce the risk of employee’s exposure to and acquisition of COVID-19, especially for key workers working with a large cross section of the general public or in contact with those infected with COVID-19.
5. Fund, develop and implement culturally competent COVID-19 education and prevention campaigns, working in partnership with local BAME and faith communities to reinforce individual and household risk reduction strategies; rebuild trust with and uptake of routine clinical services; reinforce messages on early identification, testing and diagnosis; and prepare communities to take full advantage of interventions including contact tracing, antibody testing and ultimately vaccine availability.
6. Accelerate efforts to target culturally competent health promotion and disease prevention programmes for non-communicable diseases promoting healthy weight, physical activity, smoking cessation, mental wellbeing and effective management of chronic conditions including diabetes, hypertension and asthma.
7. Ensure that COVID-19 recovery strategies actively reduce inequalities caused by the wider determinants of health to create long term sustainable change. Fully funded, sustained and meaningful approaches to tackling ethnic inequalities must be prioritised.

A total of 2104 patients were randomised to dexamethasone once per day for ten days and were compared with 4321 patients randomised to usual care alone. Among the usual care control group, 28-day mortality was highest in those on ventilators (41%), intermediate in those on oxygen only (25%), and lowest among those who were not receiving any respiratory intervention (13%).

The study, conducted at the University of Oxford and led by Professor Peter Horby and Professor Martin Landray, found that dexamethasone reduced the risk of dying by one-third in ventilated patients and by one fifth in other patients receiving oxygen only. There was no benefit among those who did not need respiratory intervention.

1. Staff being valued and supported.

2. Finally using 21st century tools.

3. With engaged and visible leaders.

4. Making huge efficiency gains over the old world.

5. Working in a joined-up way across local health care.

6. Staff working together brilliantly as real teams.

7. Stepping up to work with professionalism and autonomy.

8. Creating a needs-led care system that acts proactively.

9. Making decisions mutually with patients.

10. Enjoying close community collaboration.

• The review found that the largest disparity found was by age. Among people already diagnosed with COVID19, people who were 80 or older were seventy times more likely to die than those under 40.
• Risk of dying among those diagnosed with COVID-19 was also higher in males than females.
• Higher in those living in the more deprived areas than those living in the least deprived.
• Higher in those in Black, Asian and Minority Ethnic (BAME) groups than in White ethnic groups.

• Over a third of respondents felt pressure to care for individuals with possible or confirmed COVID-19 without adequate protection. This is significantly worse for BAME nursing staff where over half (56%) felt pressure to work without the correct PPE.
• One in five respondents in non-high-risk areas are concerned about the supply of eye/face protection, with a further 12% concerned there are not currently enough for them to use. The situation is worse for BAME respondents where one in four said there was not enough eye/face protection or enough fluid-repellent surgical masks for them to use during their shift
• Twice as many BAME respondents said there were not enough surgical masks, disposable plastic aprons and disposable gloves than white British respondents.
• A third of respondents have not received training on what standard PPE to wear and when they should wear it. Training is more prevalent in hospital settings, than care home and community settings.
• Those working in a care homes were most likely to report that they felt pressured to care for individuals with possible or confirmed COVID-19 without adequate protection (41%) than those working in a hospital (38%) or the community (24%).