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Sam

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  1. Sam
    Hospital chiefs in the South West have warned the region will not avoid the extreme pressures felt by other parts of the NHS amid rapidly rising numbers of COVID-19 inpatients.
    The region was the least affected area of England during the pandemic’s first wave, but the medical director of two acute trusts yesterday predicted a “tidal wave” of COVID-19 coming to the West Country.
    Adrian Harris, medical director at Royal Devon and Exeter Foundation Trust and Northern Devon Healthcare Trust (NDHT), said the region faced an “absolute crisis” and individual trusts would be “hanging on by their fingernails”.
    His comments, made at NDHT’s board meeting, came on the same day HSJ revealed the South West region now has the fastest growth in COVID-19 inpatients. Although the region is England’s least densely populated, it also has the lowest hospital capacity per capita in the country.
    Dr Harris said: “We hope and we pray that the lockdown has come in time for Devon. My personal view — and of my colleagues around the country — is that there’s a tidal wave of COVID-19 coming to the West Country."
    “We are preparing to be hit as hard as the East of England. If we are hit as hard, we will be hanging on by our fingernails and we are planning accordingly.”
    Read full story (paywalled)
    Source: HSJ, 8 January 2021
  2. Sam
    The Pfizer/BioNTech vaccine can still target a key mutation that has emerged in two new variants of coronavirus, laboratory studies show. 
    However, this is only one of many mutations that are found in the new forms of the virus. So while the study has been welcomed, it is not being seen as definitive scientific evidence about how the vaccine will perform.
    New variants have been detected in the UK and South Africa. Both forms of the virus are spreading more quickly and this has raised questions over what level of protection vaccines can offer against them.
    The widely held view is that vaccines will still work, but researchers are on the hunt for proof.
    Read full story
    Source: BBC News, 8 January 2021
  3. Sam
    Patients calling NHS 111 in London could face a 30-hour wait before being admitted to a hospital bed, the capital’s ambulance service has warned.
    Slides presented by London Ambulance Service Trust at a webinar with NHS London this week showed “category three” patients faced long delays at all stages of the process.
    The length of each stage was said to be as follows: having calls answered at 111 centres (20 mins); the “revalidation” of the call before it is passed to 999 (two hours); 10 to 12 hour waits for an ambulance; and similar waits in emergency departments before being admitted to a bed.
    Category three calls are considered urgent, but not immediately life-threatening. The calls could involve abdominal pain, uncomplicated diabetic issues and some falls. Category three patients are among those the NHS is encouraging to call first, rather than going straight to accident and emergency, as part of the flagship “111 first” drive designed to produce pressure on emergency care. 
    Normally, the pathway from a 111 call being made to a patient being admitted to a bed would take nine hours with a faster response at all stages, the slides suggest. But the pressure across the NHS from covid cases is leading to much longer waits.  
    Read full story (paywalled)
    Source: HSJ, 8 January 2021
  4. Sam
    The Moderna COVID-19 vaccine has become the third to be approved by the UK.
    The US pharmaceutical company’s jab was given the green light by Britain’s regulator and doses will be available in the spring.
    The announcement comes as the rollout of the Pfizer and Oxford vaccines is scaled up to meet Boris Johnson’s target of immunising all care-home patients by the end of the month, with 1,000 vaccination centres expected to be operational by Sunday. 
    The government has also purchased an additional 10 million doses of the Moderna vaccine on top of its previous order of 7 million, taking the total to 17 million.
    Supplies will begin to be delivered to the UK once Moderna expands its production capability, the Department of Health and Social Care said.
    The Medicines and Healthcare products Regulatory Agency (MHRA) accepted the recommendation of the Commission on Human Medicines and authorised the Moderna vaccine following months of rigorous clinical trials and extensive analysis of the vaccine’s safety, quality and effectiveness.
    The jab is 94% effective in preventing disease, including in the elderly.
    Read full story
    Source: The Independent, 8 January 2021
  5. Sam
    Two more life-saving drugs have been found that can cut deaths by a quarter in patients who are sickest with Covid.
    The anti-inflammatory medications, given via a drip, save an extra life for every 12 treated, say researchers who have carried out a trial in NHS intensive care units.
    Supplies are already available across the UK so they can be used immediately to save hundreds of lives, say experts. The UK government is working closely with the manufacturer, to ensure the drugs - tocilizumab and sarilumab - continue to be available to UK patients.
    As well as saving more lives, the treatments speed up patients' recovery and reduce the length of time that critically-ill patients need to spend in intensive care by about a week.
    Both appear to work equally well and add to the benefit already found with a cheap steroid drug called dexamethasone.
    Read full story
    Source: BBC News, 7 January 2021
  6. Sam
    The chief inspector of hospitals has called for honesty about the impact of the coronavirus pandemic on patients warning poor care could become normalised.
    Professor Ted Baker told The Independent it was vital staff continued to report incidents and revealed the Care Quality Commission had seen a 60% rise in whistleblowing concerns during the last national lockdown in November.
    He said staff must report incidents and be free to speak up about any concerns as well as being transparent with families where things have gone wrong.
    He emphasised that where a patient was unable to get the care they clinically needed because of the demand on services, this would amount to a notifiable patient safety incident.
    Professor Baker’s comments follow multiple anonymous leaks from NHS staff to The Independent in recent weeks, showing how bad the situation has become in some hospitals. Many staff have only spoken out on condition of anonymity.
    Many hospitals have declared major incidents, cancelled operations and been forced to stretch staffing ratios to unsafe levels to cope with the increasing numbers of COVID-19 patients.
    Read full story
    Source: The Independent, 7 January 2021
  7. Sam
    A hospital in the South East today declared a level of critical care alert meaning that it may be forced into ‘refusal or withdrawal of critical care due to resource limitation’ because it has been ‘overwhelmed’ — but later claimed it was an ”administrative error”.
    Data from an internal NHS dashboard for critical care, seen by HSJ, showed today Darent Valley Hospital, near Dartford in Kent, declared it was at “CRITCON level four”. 
    CRITCON level four declarations are extremely rare. In guidance they are known as “Triage - emergency” and defined as: “Resources overwhelmed. Possibility of triage by resource (non-clinical refusal or withdrawal of critical care due to resource limitation).”
    The definition continues: “This must only be implemented on national directive from [NHS England] and in accordance with national guidance.”
    Dartford and Gravesham Trust, which runs the hospital, replied to HSJ more than five hours after it was contacted, and after publication of the story, to say: “This was a purely administrative error which was quickly rectified.” The level has not however been changed so far on the live dashboard, HSJ has confirmed.
    Read full story (paywalled)
    Source: HSJ, 7 January 2021
  8. Sam
    "There can be no debate: this is now much, much worse than the first wave", says a NHS consultant.
    "Truly, I never imagined it would be this bad.
    Once again Covid has spread out along the hospital, the disease greedily taking over ward after ward. Surgical, paediatric, obstetric, orthopaedic; this virus does not discriminate between specialities. Outbreaks bloom even in our “clean” areas and the disease is even more ferociously infectious. Although our local tests do not differentiate strains, I presume this is the new variant.
    The patients are younger this time around too, and there are so many of them. They are sick. We are full."
    Read full story
    Source: The Guardian, 7 January 2020
  9. Sam
    In a Letter to the Editor published in The Times yesterday, the All Party Parliamentary Group on First Do No Harm Co-Chair Baroness Julia Cumberlege argues in favour of the work of the Independent Medicines and Medical Devices Safety (IMMDS) Review and its report 'First Do No Harm'.
    "Inquiries are only as good as the change for the better that results from their work."
    Read full letter (paywalled)
    Source: The Times, 5 January 2021
  10. Sam
    An experimental treatment involving stem cells from umbilical cords could significantly reduce deaths and quicken recovery time for patients suffering the most severe form of COVID-19, a study suggests.
    US researchers reported a 91% survival rate in seriously ill patients given the stem cell infusion, compared to 42% in a second group who did not receive the treatment.
    Researchers said the treatment also appeared to be safe, with no serious adverse reactions reported.
    Read full story
    Source: The Independent, 5 January 2021
  11. Sam
    Hundreds of people a day across London are waiting hours for an emergency ambulance to get to them, as paramedics warn that patients are dying as a result of delays.
    Patients in emergency calls classified as category two, such as those involving a suspected stroke or chest pains, should be seen by paramedics within an average of 18 minutes but are being forced in some cases to wait up to 10 hours.
    Even life-threatening calls where patients are in cardiac arrest and should be reached within seven minutes have experienced delays, with data suggesting one such call was waiting 20 minutes on Monday.
    Internal data shared with The Independent shows that London Ambulance Service is holding hundreds of open 999 calls for hours at a time with the service’s boss acknowledging in an email to staff that the service is struggling to maintain standards. Experts warned that the problems in the capital were reflected in ambulance services across the country.
    One paramedic told The Independent: “Patients desperately requiring ambulances aren’t getting them and, anecdotally, people are deteriorating and dying whilst waiting. Our poor dispatchers have to stare at screens of held calls, working out who gets the next available resource and who waits, suffers or dies.”
    Read full story
    Source: The Independent, 5 January 2021
  12. Sam
    Overseas-trained nurses have been told they can join the temporary coronavirus register without undertaking a formal “clinical assessment” in an attempt to bolster the NHS workforce as the third covid wave surges.
    The Nursing and Midwifery Council confirmed on Tuesday that it has invited the additional nurses in a bid to “strengthen workforce capacity in the immediate period and coming weeks”.
    It comes as the number of covid inpatient admissions rises sharply across the country, with London and the South East of England badly hit. At the start of the pandemic last year, the NMC asked former nurses who had left within the last three years to join the emergency covid register as cases grew.
    Unison union’s national nursing officer Stuart Tuckwood believed the move will help deal with “severe” staffing shortages, but warned they must be “supported and supervised” by fully registered nurses to ensure patient safety.
    Read full story (paywalled)
    Source: HSJ, 6 January 2021
  13. Sam
    Potentially life-saving cancer operations have been put on hold at a major London NHS trust because of the number of beds taken by Covid patients.
    King's College Hospital Trust has cancelled all "Priority 2" operations - those doctors judge need to be carried out within 28 days.
    Cancer Research UK said such cancellations did not appear to be widespread across the country.
    And surgery has not been stopped on the same scale as during the first wave.
    Rebecca Thomas, who has had her bowel cancer surgery at King's College Hospital "cancelled indefinitely", told the BBC she felt like she had been left "in limbo".
    Until she has surgery her tumour cannot be studied to see how aggressive it is, and so she won't know until then how significant this wait will turn out to be.
    A spokesperson for the Trust, which mainly serves patients in south London, said: "Due to the large increase in patients being admitted with COVID-19, including those requiring intensive care, we have taken the difficult decision to postpone all elective procedures, with the exception of cases where a delay would cause immediate harm.
    "A small number of cancer patients due to be operated on this week have had their surgery postponed, with patients being kept under close review by senior doctors."

    Read full story
    Source: 5 January 2021
  14. Sam
    Twenty-three hospital trusts had more than a third of their core bedbase occupied by COVID-19 patients on Tuesday, and occupancy is still rising at all but one.
    Three trusts (North Middlesex in north London, as well as Medway and Dartford and Gravesham in Kent) had more than half of general and acute beds occupied by patients who had the virus, and others were not far behind.
    Several trusts saw their covid occupancy share up by more than 10 percentage points in a week — a rate of growth which would soon see them entirely filled by covid patients, a situation with radical consequences for emergency hospital care in those areas.
    London as a whole had a third of these beds occupied by patients with COVID-19.
    HSJ has analysed data published for the first time by NHS England last night. The data concerns the status of adult general and acute beds, which make up the large majority of the acute bedbase. They do not include intensive care, which is also now under huge pressure in London, the south east and the east of England. Most hospitals in these areas are stretching IC capacity above normal levels.
    Such high covid occupancy in both intensive care and the core bedbase is putting severe strain on hospitals’ ability to treat other patients. Most or all of the trusts under the greatest pressure have now cancelled routine planned surgery, and many are struggling with crowding, delays getting patients into and out of emergency departments due to the space available, and a lack of staff.
    Read full story (paywalled)
    Source: HSJ, 1 January 2021
  16. Sam
    The UK's chief medical officers have defended the Covid vaccination plan, after criticism from a doctors' union.
    The UK will give both parts of the Oxford and Pfizer vaccines 12 weeks apart, having initially planned to leave 21 days between the Pfizer jabs.
    The British Medical Association said cancelling patients booked in for their second doses was "grossly unfair".
    But the chief medical officers said getting more people vaccinated with the first jab "is much more preferable".
    Pfizer has said it has tested the vaccine's efficacy only when the two vaccines were given up to 21 days apart.
    But the chief medical officers said the "great majority" of initial protection came from the first jab.
    "The second vaccine dose is likely to be very important for duration of protection, and at an appropriate dose interval may further increase vaccine efficacy," they said.
    "In the short term, the additional increase of vaccine efficacy from the second dose is likely to be modest; the great majority of the initial protection from clinical disease is after the first dose of vaccine."
    Read full story
    Source: BBC News, 1 January 2021
  17. Sam
    England’s chief nurse has said that NHS and care staff are working incredibly hard to cope with record numbers of COVID-19 patients, amid concern that frontline staff are close to burnout.
    Ruth May pleaded with the public to follow the coronavirus advice to help relieve the pressure on hospital staff, after two days of record hospital admissions.
    Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, told BBC Breakfast that health employees were “tired, frustrated and fed up”.
    He said: “What is it going to be like over the next couple of months? I don’t know, I am worried. We are very much at battle stations.
    “There will be short-term surges of morale but people are tired, frustrated and fed up, as everybody is, whether they work in hospital or not. The people who go into emergency medicine expect it to be tough from time to time.
    “There is a real worry about burnout.”
    Read full story
    Source: BBC News, 1 January 2021
  18. Sam
    COVID-19 vaccinations should now be “immediately” rolled out to frontline staff, NHS England has told trust leaders.
    New instructions from the national body follow the approval today of the Oxford/AstraZeneca coronavirus vaccine, which NHS England said will “substantially to accelerate vaccine delivery”. Until now, only limited quantities of the Pfizer/BioNTech vaccine have been available.
    NHS staff are in the second priority category for covid vaccines, behind care home residents and alongside over 80s. But there have been complaints from clinicians around the country that they have been unable to get the jab, as well as uncertainty about how the vaccine deliveries should be divided between the priority groups.
    A letter to local leaders from NHS England says that until now, healthcare workers who have been identified at highest risk of serious illness from covid-19 have been given the vaccine in unfilled appointment slots.
    The letter, from chief executive Sir Simon Stevens and senior officials, now states: “Increased supply means that vaccination can also now immediately be expanded to frontline health and social care workers.”
    Read full story (paywalled)
    Source: HSJ, 31 December 2020
  19. Sam
    Plans to delay giving the second dose of a Covid vaccine to more than 500,000 people who have received the first jab have caused outcry among doctors who say cancelling appointments wastes time, causes confusion among patients and is potentially unethical.
    On Wednesday the government announced a change to its Covid vaccination strategy, saying second doses of the newly approved Oxford/AstraZeneca vaccine and the previously approved Pfizer/BioNTech jab would now be given up to 12 weeks after the first dose.
    The move applies to people scheduled to have their second dose of the Pfizer jab after 4 January, as well as those yet to receive either jab. The government said it hoped the approach would mean as many people as possible soon have some protection against the disease.
    However, the announcement caused controversy, with Pfizer and BioNTech warning that two doses of their vaccine were required for maximum protection against Covid and that they did not have evidence that the first dose alone offered protection after three weeks.
    Now doctors have said cancelling appointments for the second dose will take huge amounts of time and could lead to confusion.

    Read full story
    Source: The Guardian, 31 December 2020
  20. Sam
    Frontline doctors have testified to deteriorating conditions in hospitals in London and the south east as the NHS deals with a surge in COVID-19 cases.
    Speaking to the Independent SAGE group of experts on 30 December, Jess Potter, a respiratory doctor in east London, told how she and colleagues were afraid of resources running out.
    “My greatest fear is having a patient that I cannot provide lifesaving treatment to,” she said. “We had one of our largest medical intakes yesterday, the vast majority with coronavirus. What do we do when we run out of resources, and who is going to provide that guidance? It will harm our patients and our staff, because we have a set of values by which we practise, and we will have to reduce the level of care we deliver.”
    She added, “Back in April I never saw a case where we didn’t provide a bed to a patient who needed it in intensive care, and decisions were taken as if in normal times. Now I hear from medics across the country that things are very bad, and the situation is the same as in April, if not worse. We are afraid of what will happen if we don’t act now.”
    Sonia Adesara, a doctor in London, spoke to Independent SAGE after a set of night shifts at her trust and told of a chronic shortage of continuous positive airway pressure (CPAP) capacity.
    “In the past few days, despite my hospital significantly increasing intensive and critical care capacity, our intensive care unit has been full, and there is no spare CPAP capacity. Medics are spending shifts trying to closely monitor all of our patients who are on the highest level of oxygen that we can give with a normal mask, assessing who is most unwell and unstable—and then frequently checking on patients who are on CPAP and then swapping people [around]."
    Read full story
    Source: BMJ, 31 December 2020
  21. Sam
    People with allergies and pregnant women can now be given the country’s two approved COVID-19 vaccines, the medical regulator said on Wednesday.
    Previous advice from the Medicines and Healthcare products Regulatory Agency (MHRA) said people with a range of allergies to food and medicines should not be given the Pfizer vaccine.
    Dr June Raine, the MHRA’s chief executive, said growing evidence from a pool of at least 800,000 people in the UK and around 1.5 million people in the US who have had the vaccine has "raised no additional concerns".
    This, she continued, "gives us further assurance that the risk of anaphylaxis can be managed through standard clinical guidance and an observation period following vaccination of at least 15 minutes.
    Read full story
    Source: The Independent, 30 December 2020
  22. Sam
    Deaths from COVID-19 in England in the first half of 2021 could exceed those seen in the whole of 2020 unless the vaccination programme is vastly increased and a national lockdown implemented—with educational settings closed for at least a month—researchers have warned.
    In a preprint released on 24 December, researchers from the London School of Hygiene and Tropical Medicine used modelling to compare the effects of varying COVID-19 restrictions on the virus spread, hospital and intensive care admissions, and deaths from 15 December 2020 to 30 June 2021. The model took account of the new variant spreading rapidly in southern England, which it estimated to be 56% more transmissible than non-variant COVID-19.
    The study, which has yet to be peer reviewed, said that control measures similar to the November national lockdown would be “unlikely to reduce the effective reproduction number to less than 1, unless primary schools, secondary schools, and universities are also closed.” It added that it would be necessary to “greatly accelerate vaccine rollout to have an appreciable impact in suppressing the resulting disease burden.”
    Read full story
    Source: BMJ, 29 December 2020
  23. Sam
    Concerns are mounting over the number of coronavirus patients being admitted to hospitals in London as another NHS trust in the capital issued an urgent warning over its oxygen supplies.
    On Tuesday afternoon, the North Middlesex University Hospital Trust warned clinicians the numbers of coronavirus patients it was treating “was putting a strain” on the oxygen system, sparking several alarms.
    The trust currently has around 200 patients using oxygen with the trust consuming 2,400 litres of oxygen a minute. It normally uses around 1000 litres a minute and has a limit of 3,000 above which the system could cut out.
    It is only the latest hospital to face the problem – which is caused by the sheer demand for oxygen by sick Covid patients, which is more than the hospital piping can physically deliver.
    Read full story
    Source: The Independent, 30 December 2020
  24. Sam
    The Oxford-AstraZeneca vaccine has been approved for use in the UK, with the first doses due to be given on Monday amid rising coronavirus cases.
    The UK has ordered 100 million doses - enough to vaccinate 50 million people.
    This will cover the entire population, when combined with the full order of the Pfizer-BioNTech jab, Health Secretary Matt Hancock said.
    It comes as millions more people in England are expected to be placed under the toughest tier four restrictions.
    On Tuesday, 53,135 new Covid cases were recorded in the UK - the highest single day rise since mass testing began - as well as 414 more deaths within 28 days of a positive test.
    Read full story
    Source: BBC News, 30 December 2020
  25. Sam
    A major incident has been declared in Essex amid fears the number of COVID-19 cases could overwhelm the county's health services.
    The Essex Resilience Forum (ERF) said "growing demand" was putting stress on hospitals and social care settings.
    On Tuesday Mid and South Essex NHS Trust placed all three of its hospitals on critical alert.
    All of Essex is in tier four and the south of the county has some of the worst-affected districts in England.
    Essex Police Chief Constable BJ Harrington, who is co-chairman of the ERF, said declaring a major incident allowed it "to seek further support from the government to address the severe pressures which the health system is under".
    The forum said the number of patients being treated for Covid in the county had exceeded the levels seen at the peak of the first wave and "these levels are likely to increase further in the coming days".
    The ERF - comprised of health services, blue light responders and councils - said issues included "critical care and bed capacity, staff sickness/self-isolation levels and the system's ability to discharge patients quickly into safe environments".
    Mr Harrington urged the public to continue only dialling 999 or attending A&E in an emergency.
    Read full story
    Source: BBC News, 30 December 2020
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