The availability of dialysis equipment used to treat more than a quarter of ventilated COVID-19 patients has reached “critical” levels, HSJ has learned.
Concerns are growing over an “exceptional shortage” of specialist dialysis machines used to treat intensive care patients with acute kidney failure.
Although hospitals are able to deploy alternative machines which are not typically used in intensive care, this is logistically challenging and can carry increased risks for patients.
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Source: HSJ, 22 April 2020
Some seriously ill COVID-19 patients in London may not have been taken to hospital by ambulance because of a system temporarily used to assess people, a BBC investigation suggests.
Patients could have "become very sick or died at home" instead, a paramedic claimed.
One family said they had to plead to get hospital care.
Medical professionals use 'NEWS2', as one way of identifying patients at risk of deteriorating, a check normally used for sepsis patients. Under normal circumstances, ambulance teams would blue-light anyone with a score of five or above to hospital.
But on 18 March, LAS workers were told to apply the NEWS2 check to suspected Covid patients and that many of those with a score up to seven could be "suitable for community care", even if there were issues with breathing rate, oxygen supply and consciousness.
But one paramedic, who wanted to remain anonymous because she did not have permission to speak to the media, said she believed that as a result of the NEWS2 advice, crews went to patients "who may have been seen by ambulance before and then suddenly became very sick or even just dropped dead."
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Source: BBC News, 23 April 2020
Guy's and St Thomas' has received its first delivery of face shields created in a specially developed "3D printing farm", in collaboration with 3D printing companies and enthusiasts.
The face shields will be worn by frontline medical staff tending to patients during the ongoing coronavirus pandemic.
Several 3D printing manufacturers have been brought together at Guy's and St Thomas' supply chain hub in Dartford, with over 200 printers working 24 hours a day to make the face shields. This 3D printing farm can produce roughly 1,500 face shields a day.
The face shields are paired with a visor, assembled by a team of volunteers made up of 3D printing enthusiasts, as well as students and staff from King's College London and Brunel University.
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Source: Guy's and St Thomas NHS Foundation Trust, 21 April 2020
Half of health workers are suffering mental health problems such as stress and trauma as a result of dealing with COVID-19, new research reveals.
The pandemic is having a “severe impact” on the mental wellbeing of NHS personnel as well as agency staff, GPs and dentists, with rates of anxiety and burnout also running far higher than usual.
New YouGov polling for the IPPR thinktank found that 50% of 996 healthcare workers questioned across the UK said their mental health had deteriorated since the virus began taking its toll.
That emerged as the biggest impact on staff, just ahead of worries about their family’s safety because of a lack of testing and protective equipment for NHS workers (49%) and concern about their ability to ensure that patients receive high-quality care when the NHS is so busy (43%).
As many as 71% of younger health professionals, who are likely to be inexperienced and early in their careers, said their mental health had deteriorated. More women were affected than men.
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Source: The Guardian, 23 April 2020
"I have never seen my A&E department so still, so well-staffed and so uncannily calm," says Steven Fabes, an A&E doctor.
Attendances in A&E departments across the country are down, in some cases by up to 80%.
There is an obvious reason for the calm: people are not out and about. Pedestrians are not walking out in front of cyclists. Cyclists are not diving over car bonnets. Asthmatics are not wheezing through the fumes of Oxford Street. But there is something more worrying at play, too – people who need us are not coming in.
"I am worried that people who need us are not coming in, scared that hospitals are vectors for infection rather than cure," says Steven.
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Source: The Guardian, 23 April 2020
Women say the uncertainty surrounding maternity services during the coronavirus outbreak is "making a stressful situation harder".
The Royal College of Midwives says services may need to be reduced due to COVID-19.
Like many areas in the health sector, staff shortages caused by sickness and workers self-isolating are impacting resources, the college adds.
The BBC asked a group of NHS trusts and boards across the UK about the services they are able to provide during the coronavirus pandemic. Nine trusts in England, five boards in Scotland and one trust in both Wales and Northern Ireland responded.
All 16 bodies said one birth partner could be present during labour, but just over a quarter of those asked are allowing partners on the postnatal ward following the birth. Around a third of trusts and boards that spoke to the BBC are now allowing home births.
In the weeks after a birth, midwives and health visitors are now heavily relying on virtual communication to provide families with postnatal support. Home visits are mostly still happening, but one trust in London said it only allows face-to-face contact when it is "absolutely essential".
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Source: BBC News, 24 April 2020
Read Patient Safety Learning's latest blog: Home births, fears and patient safety amid COVID-19
The coronavirus can linger in patients’ eyes for several weeks and could act as a way of spreading the COVID-19 disease, according new study from Italy.
Scientists at Italy’s National Institute for Infectious Diseases hospital in Rome studied the symptoms of an unnamed 65-year-old woman who developed the virus after travelling from the Chinese city of from Wuhan.
When the woman developed conjunctivitis – an eye infection causing redness and itchiness – doctors decided to take regular swabs from her eye. They discovered the virus remained present in “ocular samples” up to 21 days after she was admitted to hospital.
The team said the findings, published in the Annals of Internal Medicine, indicated that eye fluids from coronavirus patients “may be a potential source of infection”.
The study authors said: “These findings highlight the importance of control measures, such as avoiding touching the nose, mouth, and eyes and frequent hand washing.”
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Source: The Independent, 24 April 2020
Several acute trust chief executives have told HSJ they are keen to resume more planned operations, as the peak of new coronavirus cases has passed and many hospital beds remain empty.
Some trust leaders said they believed routine elective surgery could be restarted as early as next week. There is also tension between NHS hospitals — some of which are keen to resume their own planned care, especially the more urgent operations — and a desire to use private hospitals, which have been booked out by NHS England.
The government said yesterday the number of people in hospitals with COVID-19 has fallen by 10% over the last week. Around 42% of acute beds are now unoccupied, according to figures seen by HSJ. The peak of new infection cases in hospitals was at about 3,000 on 1 April — the number is now about half that figure.
However, there will be fears nationally about the NHS seeking to return to normal and being caught out by ongoing COVID-19 pressures, or by a second peak of infections.
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Source: HSJ, 24 April 2020
“I am really angry about this,” said Dr Anna Down, scanning her computer for figures to show how coronavirus has ravaged her patients living in nursing homes.
“One home had 23 deaths, another lost 19, and another 13,” the Ealing GP said. “In two units 50% of residents died in the space of 10 days.”
Down is the clinical lead at a practice with 1,000 residents on its books in 15 privately run nursing homes in the area of west London hit harder than anywhere in Britain by COVID-19 deaths in the first weeks of the outbreak. In a normal month, she might expect to lose around 28 people. In the last month she has lost 125.
Down has a warning to the rest of the country informed by her practice’s experience: reform how social care handles Covid-19 or face rising deaths and a second devastating wave of infection.
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Source: The Guardian, 22 April 2020
Shop workers and other essential staff should be provided with face masks to control the spread of coronavirus, according to the British Medical Association (BMA).
The doctors’ union is also calling on the government to ask all members of the public to cover their mouths and noses while outside their homes.
“Common sense tells you that a barrier between people must offer a level of protection, however small,” said Dr Chaand Nagpaul, BMA council chairman.
“The government must pursue all avenues of reducing the spread of infection.
“This includes asking the public to wear face coverings to cover mouths and noses when people leave home for essential reasons.”
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Source: The Independent, 26 April 2020
Care homes looking after thousands of vulnerable residents have said none of their staff has been tested for coronavirus. Out of 210 care providers spoken to by the BBC, 159 said none of their workers had had a test.
BBC England spoke to care homes and companies across the country, who between them employ nearly 18,000 staff and have almost 13,000 residents. Many said they had seen no testing at all, while others have spoken of struggles to access official test centres after reporting online that they have symptoms. Some have told how staff face long journeys to test centres, with one reporting a three-hour round trip.
On Sunday it was announced that the military will begin testing essential workers in mobile units operating at sites in "hard to reach" areas, including care homes.
Anna Knight runs Harbour House Care Home on the Dorset coast and said getting enough personal protective equipment (PPE) and testing for coronavirus were her biggest challenges.
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Source: BBC News, 26 April 2020
A serious coronavirus-related syndrome may be emerging in the UK, according to an “urgent alert” issued to doctors, following a rise in cases in the last two to three weeks, HSJ has learned.
An alert to GPs and seen by HSJ says that in the “last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK”.
It adds: “There is a growing concern that a [covid-19] related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.”
Little is known so far about the issue, nor how widespread it has been, but the absolute number of children affected is thought to be very small, according to paediatrics sources. The syndrome has the characteristics of serious COVID-19, but there have otherwise been relatively few cases of serious effects or deaths from coronavirus in children. Some of the children have tested positive for COVID-19, and some appear to have had the virus in the past, but some have not.
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Source: HSJ, 27 April 2020
Do you work in paediatrics? Have you seen similar trends emerging? What are your thoughts on the concerns raised? Join the conversation in the hub community area:
A coronavirus patient’s terrifying hospital experience inspired an NHS doctor to create a flashcard system to improve communication with medical staff wearing face masks.
Anaesthetist Rachael Grimaldi founded CARDMEDIC while on maternity leave after reading about a COVID-19 patient who was unable to understand healthcare workers through their personal protective equipment (PPE).
Her system enables medical staff to ask critically ill or deaf coronavirus patients important questions and share vital information on digital flashcards displayed on a phone, tablet or computer.
The idea went from concept to launch on 1 April in just 72 hours and is now being used by NHS trusts and hospitals in 50 countries across the world.
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Source: The Guardian, 25 April 2020
Read the 'Story behind CARDMEDIC', written by Rachael for the hub
We don’t yet know the number of NHS staff who have lost their lives in the battle against COVID-19. On Wednesday, Dominic Raab put the figure at 69, but the true figure is considered to be far greater.
These deaths are not “natural” casualties of the coronavirus pandemic. In fact, they may be the result of a failure in the government’s duty to care for NHS staff, which is why it is vital it is properly investigated under the law.
Since the pandemic reached the UK, we have heard countless reports of doctors and nurses raising the alarm over the lack of personal protective equipment (PPE) when treating COVID-19 patients.
How many of these deaths could have been prevented had sufficient PPE been provided to NHS workers? And if there is a lack of PPE, how did this happen? The health secretary, Matt Hancock, says the biggest challenge is “one of distribution rather than one of supply”. Should more have been done to meet this challenge, and if so what? Does the government have a legal duty to do more to protect the lives of healthcare workers?
There must be investigations into the individual deaths of NHS workers, out of respect to them, and also so that future deaths can be prevented. The evidence appears to be that the government has failed to protect them from risk to their lives, and if that is the case then an investigation will be required by law.
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Source: The Guardian, 25 April 2020
Four in ten people are not seeking help from their GP because they are afraid to be a burden on the NHS during the pandemic, polling by NHS England reveals.
The findings – from a survey of 1,000 people – are the latest in a wave of evidence that fewer people are seeking care for illnesses other than those related to coronavirus during the pandemic.
GP online reported on 20 April that data collected by the RCGP showed a 25% reduction in routine clinical activity in general practice, and figures from Public Health England (PHE) and the British Heart Foundation show that A&E attendances overall and patients going to hospital for heart attacks are down 50%.
Warnings that patients' reluctance to come forward could put them at risk come as leading charities warned that suspension of some routine GP services during the pandemic could also lead to a 'future crisis' if control of conditions such as asthma and COPD deteriorate.
Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges, said: 'We are very concerned that patients may not be accessing the NHS for care because they either don’t want to be a burden or because they are fearful about catching the virus.
'Everyone should know that the NHS is still open for business and it is vitally important that if people have serious conditions or concerns they seek help. This campaign is an important step in ensuring that people are encouraged to get the care they need when they need it.'
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Source: GP online, 25 April 2020
Intensive care units across the country are running out of essentials, including anaesthetics and drugs for anxiety and blood pressure, after a “tripling of demand” sparked by the coronavirus pandemic.
Six senior NHS doctors working on the front line, and drugs industry sources, say that the health service is running out of at least eight crucial drugs. Hospitals in London, Birmingham and the northwest of England have been especially badly hit.
Doctors said they were being forced to use alternatives to their “drug of choice”, affecting the quality of care being provided to COVID-19 patients. They also warned that some second-choice drugs might be triggering dangerous side effects such as minor heart attacks.
Ron Daniels, an intensive care consultant in the West Midlands, said the shortages had become “acute” already. “We don’t know what we’re going to run out of next week,” he said. “Safety isn’t so much the issue — it’s quality. It may be that we’re subjecting people to longer periods of ventilation than we would normally because the drugs take longer to wear off.”
Daniels added that some of the “second-line drugs” being used might be challenging to a patient’s heart: “We might be causing small heart attacks or subclinical heart attacks.”
Ravi Mahajan, president of the Royal College of Anaesthetists, said work was being carried out to “preserve” key drugs for those most in need.
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Source: The Times, 26 April 2020
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