Sam

The government has now officially recognised the long-term health implications some people can suffer after contracting coronavirus. Lung inflammation, gastrointestinal disturbance, and fatigue are just some of the listed long-term health effects published by Public Health England. But it’s no new revelation - as campaigners made up of politicians, expert clinicians and sufferers have fought hard over the past few months to bring what has become known as ‘long covid’ into the public domain. One of them is Jo Platt, former Labour MP for Leigh, who says the virus hit her ‘like a train’ in the week before lockdown in March - when it wasn’t possible to get a test. She's been left with symptoms months on - although recently tested negative twice for COVID-19. “It was like a train hitting me, like a switch, I felt so unwell for two days. I had general dizziness, fatigue but nothing you could pinpoint. I didn’t have a cough or a temperature, although I felt hot; had gastric trouble; shortness of breath; then it eased and I was okay and thought ‘thank goodness. It must have just been mild’,” Jo said. Two days later the symptoms came back, but that spell of illness lasted for two weeks. Jo said she couldn’t get out of bed, suffered intense headaches and a burning sensation in her lungs, was unable to concentrate and couldn’t read. “I’m not normally an anxious person, but then came anxiety", she said. "I felt a real sense of dread, a heightened pending sense of doom. It continued on and off for months, and particularly worsened at the weekend. The 48-year-old got in touch with her GP who said anxiety was bringing the symptoms on. It wasn’t until a week later when Jo read an article by Professor Paul Garner, of Liverpool School of Tropical Medicine, who talked about his fight with symptoms, that she realised she wasn't alone. “Everything he was saying was the same as what I was going through. I cried and cried. It was all validated. Then the journey began of finding other people - which does make it feel better,” said the mum-of-three. Prof Garner has described coronavirus as a 'very bizarre disease' that left him feeling 'repeatedly battered the first two months' and then experiencing lesser episodes in the subsequent four months with continual fatigue. “Navigating help is really difficult,” he said in a BMJ webinar. With the help of Jo's connections in parliament, Prof Garner, and meetings with the shadow cabinet health team, a support group for long covid sufferers has been formed, which has 20,000 members. They’re calling for recognition, which they finally got from the government on 7 September 7, research and rehab. Matt Hancock said at the Health and Social Care Committee the following day: “The long-term impacts of covid are not very strongly correlated with severity of the initial illness. While we have a significant amount of work going into supporting those who come out of hospital, this is not just about people hospitalised. “In fact, this is especially relevant for now with the latest rise largely among young people, it doesn't matter how serious your infection was the first time, the impact of long covid can be really debilitating for a long period of time, no matter if your initial illness wasn't all that severe.” The Health Secretary, when questioned on calls by the Royal College of GPs for covid clinics, said the NHS has set up clinics, but he is ‘concerned’ that not all GPs know how to ensure people know how to get into those services. “That’s something I am sure we can resolve,” he added. Read full story Source: Manchester Evening News, 13 September 2020

Almost 86% of doctors in England say they expect a second peak of coronavirus in the next six months, according to a new survey, as concern continues to grow over a recent rise in cases. On Friday, new results from a population-based study suggested the R number for England is now at 1.7, with infections doubling every 7.7 days. While the prevalence of the disease remains lower than it was in the spring, an R value above 1 means cases could grow exponentially. Sunday marked the third day in a row that new coronaviruses cases reported for the UK topped 3,000 – the highest figures since May – with 2,837 new cases reported in England alone. While testing has increased over the past months, experts have said this does not fully explain the recent surge. In a poll, the British Medical Association (BMA) asked more than 8,000 doctors and medical students in England what their top concerns were out of five possibilities, from a second peak of coronavirus to sickness and burnout among staff and winter pressures, including a possible flu outbreak. Almost 30% of respondents selected a second peak as their number-one worry. Overall, 86% of respondents said they believed a second peak of coronavirus during the next six months is either “quite likely” or “very likely”. When asked which of a range of factors might risk causing a second peak, almost 90% of respondents agreed or strongly agreed that failures of the test-and-trace system posed a risk, while a similar proportion cited a lack of infection-control measures in places like bars and restaurants, and 86% agreed or strongly agreed confusing messaging on public health measures was a risk. Read full story Source: The Guardian, 14 September 2020

The government has written to care home providers in England to warn them of a rise in new coronavirus infections within the sector. A letter from the Department of Health urged care bosses to take "necessary action to prevent and limit outbreaks". Cases were mainly among staff but risked spreading to residents, it said. It comes as a further 3,330 positive cases were recorded in the UK - the third consecutive day in which cases have been over 3,000. It brings the total number of confirmed cases to 368,504. Friday's letter from the Department of Health and Social Care said testing data had revealed an increase in the number of positive results in care homes and called on the care sector to work with the government. "You will know already that we are experiencing a rise in confirmed Covid-19 cases across the UK population," wrote Stuart Miller, director of adult social care delivery. "I need to alert you to the first signs this rise is being reflected in care homes too." "I am writing at the earliest opportunity, so we can work in partnership to prevent further spread of the disease. The rapid flow of data and information, to and from care providers, is vital to this effort." Mr Miller said the infections had been detected chiefly among staff but had been transmitted to residents in some cases. He went on to stress "the importance of regular testing and consistent use of PPE". Read full story Source: BBC News, 14 September 2020

GP practices are being told they must make sure patients can be seen face to face when they need such appointments. NHS England is writing to all practices to make sure they are communicating the fact doctors can be seen in person if necessary, as well as virtually. It's estimated half of the 102 million appointments from March to July were by video or phone call, NHS Digital said. However, the Royal College of GPs said any implication GPs had not been doing their job properly was "an insult". NHS England said research suggested nearly two thirds of the public were happy to have a phone or video call with their doctor - but that, ahead of winter, they wanted to make sure people knew they could see their GP if needed. Nikki Kanani, medical director of primary care for NHS England, said GPs had adapted quickly in recent months to offer remote consultations and "safe face-to-face care when needed". Prof Martin Marshall, chair of the Royal College of GPs, said general practice was "open and has been throughout the pandemic", with a predominantly remote service to help stop the spread of coronavirus. He said: "The college does not want to see general practice become a totally, or even mostly, remote service post-pandemic. However, we are still in the middle of a pandemic. We need to consider infection control and limit footfall in GP surgeries - all in line with NHS England's current guidance." He said most patients had understood the changes and that clinical commissioning groups had been asked to work with GP practices where face-to-face appointments were not possible - for example, if all GPs were at a high risk from coronavirus. "Any implication that they have not been doing their job properly is an insult to GPs and their teams who have worked throughout the pandemic, continued delivering the vast majority of patient care in the NHS and face an incredibly difficult winter ahead," he said. Read full story Source: BBC News, 14 September 2020 Research from the college indicated that routine GP appointments were back to near-normal levels for this time of year, after decreasing at the height of the pandemic. "Each and every day last week an estimated third of a million appointments were delivered face to face by general practices across the country," added Prof Marshall.

Millions of people who are at risk of serious illness from COVID-19 could be asked to start shielding again if infection rates continue to rise, according to reports. Officials are planning to send out letters telling the most vulnerable either to stay at home or to follow advice specifically tailored to their health conditions. The Daily Telegraph reports that the new programme will initially target those living in areas with dangerous levels of coronavirus but went on to quote an anonymous official as saying it could be applied to the whole of England if necessary. If so, it could affect up to 4.5 million people – more than double the number who were asked to shield at the start of the lockdown in March. The new shielding scheme is reportedly based on a "stratified risk model" which would target individuals based on factors such as their underlying health conditions, age, sex and weight. Read full story Source: 13 September 2020

People across England have told BBC News they are struggling to access coronavirus tests. Health Secretary Matt Hancock said last week that no-one should have to travel more than 75 miles for a test, after the BBC revealed some were being sent hundreds of miles away. But dozens have now reported being unable to book a swab at all. The Department of Health and Social Care (DHSC) said testing capacity was targeted at the hardest-hit areas. A significant rise in demand for testing led the government to reduce the number of appointments available in areas of lower prevalence, to prioritise areas with outbreaks. This in turn led to people applying for tests being directed to centres sometimes hundreds of miles away. But last Thursday Mr Hancock pledged to put in "immediate" solutions to make sure people did not have to travel more than 75 miles, effective from last Friday. Since then, postcodes entered into the government's booking system return a message suggesting there are no testing centres or home kits available - even if you are an essential worker with symptoms. Frances, in Suffolk, tried to apply for a test when her daughter developed a high temperature. She didn't think it was coronavirus but "the rules are the rules". She had understood that anyone with a temperature should apply for a test, and was not able to send either of her children to school until she did. "Their teachers need to be kept safe, their classmates need to be kept safe, we need to do the right thing," she said. But Frances was also not able to get a home kit, and when she tried to get an appointment at a drive-through centre was told no test sites were found. Read full story Source: BBC News, 12 September 2020

Cases of coronavirus in England are doubling every seven to eight days, research has revealed in the latest figures to show a resurgence of COVID-19. The study, known as React-1, is a population surveillance study that began in May and uses swabs from about 120,000 to 160,000 randomly selected people in England across 315 local authority areas each month to track the spread of coronavirus using PCR analysis – the “have you got it now” test. “The prevalence of the virus in the population is increasing. We found evidence that it has been accelerating at the end of August and beginning of September,” said Steven Riley, professor of infectious disease dynamics at Imperial College London and a co-author of the work. The findings came as, elsewhere, the latest R figure for the UK was reported to be between 1.0 and 1.2, with the number of new infections somewhere between shrinking by 1% and growing by 3% every day. Previous rounds of the study revealed a falling prevalence of COVID-19, even as lockdown restrictions were eased: according to data for the period 19 June to 8 July, the prevalence of Covid in the general population was low, and halving every eight to nine days. However, the results from the fourth round of the survey suggest that is no longer the case. While the latest findings from the React study have yet to be peer-reviewed, researchers say out of more than 150,000 swabs collected between 22 August and 7 September, 136 tested positive for coronavirus, suggesting 13 people out of every 10,000 in the general population had COVID-19. Read full story Source: The Guardian, 11 September 2020

A hospital boss championed by Matt Hancock has been told to end “a toxic management culture” after doctors were asked to provide fingerprint samples to identify a whistleblower. The Royal College of Anaesthetists (RCoA) has urged the chief executive of West Suffolk hospital, Steve Dunn, who Hancock described as an “outstanding leader”, to take urgent action to improve the wellbeing of senior clinicians and “thereby the safety of patients”. In a strongly worded letter sent to Dunn in July, seen by the Guardian, the RCoA president, Prof Ravi Mahajan, reminded him that “undermining and bullying behaviour is unacceptable”. Following a three-day review of the hospital, Prof Mahajan’s letter said senior anaesthetists had complained about a “toxic management culture that risks impairing their ability to care safely for patients”. The incident, and other failings in patient safety, contributed to the hospital becoming the first ever to be relegated by Care Quality Commission (CQC) inspectors from “outstanding” to “requires improvement” in January. A spokesman for the trust said: “Ensuring our colleagues work in a supportive, safe environment is good for our staff and means better patient care, which is why we have done extensive work this year to act on feedback about our working culture, including taking action to address the concerns raised by the Royal College of Anaesthetists.” Read full story Source: The Guardian, 11 September 2020

PRESS RELEASE (London, UK, 11 September) – The charity Patient Safety Learning are calling on the NHS to publish details of post-COVID support clinics and clarify how these can be accessed by thousands of ‘Long COVID’ patients. Patient Safety Learning has written to Sir Simon Stevens, Chief Executive of the NHS, calling on him to take steps to publicise the locations and details of these services. This follows Matt Hancock MP, Secretary of State for Health and Social Care, expressing concerns in the Health and Social Care Select Committee on Tuesday that not all GPs know how to access these services. Helen Hughes, Chief Executive of Patient Safety Learning, said: “We have heard from many Long COVID patients that they are not clear on the location of these clinics, what services they offer and who is eligible for support. Some patients have been advised by their GP that there are no post-COVID clinics available within their area. Though the NHS launched the ‘Your COVID Recovery’ online portal for patients recovering from COVID, there is no clear indication of how the clinics fit into this and how patients can access the support they need.” Long COVID patients are those with confirmed or suspected COVID-19 who continue to struggle with prolonged, debilitating and sometimes severe symptoms months later. In their letter, the charity has identified a series of steps needed to provide greater clarity for these patients, including: Publishing a list of all existing post-COVID clinics and contact details. Confirming whether these clinics are accessed by referral from your GP or self-referral. If by GP referral, publish the guidance issued to GPs on this process. Confirming who is eligible for these services, whether they are restricted to those hospitalised by COVID-19 or open to those who are managing their symptoms at home. Confirm what services are available from these clinics. Specifically, whether they can help patients access clinical investigations, as well as treatment and rehabilitation. Clarify whether these services are available to all patients or only those who have had a confirmed positive test for COVID-19. Notes to editors: Patient Safety Learning is a charity, which helps transform safety in health and social care, creating a world where patients are free from harm. We identify the critical factors that affect patient safety and analyse the systemic reasons they fail. We use what we learn to envision safer care. We recommend how to get there. Then we act to help make it happen. For more information: www.patientsafetylearning.org In the Health and Social Care Select Committee on Tuesday 8 September 2020, Matt Hancock commented that “The NHS set up Long COVID clinics and announced them in July. I am concerned by reports this morning from the Royal College of GPs that not all GPs know how to ensure that people can get into those services. That is something I will take up with the NHS and that I am sure we will be able to resolve.” The full transcript can be found here. Patient Safety Learning’s full letter to Sir Simon Stevens can be found here. Patient Safety Learning have previously set out patient safety concerns for Long COVID patients, outlining these issues in more detail. Read more here.

A framework has been developed by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and the Society and College of Radiographers, in partnership with NHS England and NHS Improvement, to support maternity services with the local reintroduction of hospital visitors and individuals accompanying women to appointments. During the pandemic, some Trusts in England have allowed partners to attend antenatal appointments and pregnancy scans, but there has not been a consistent approach across the country, leading to frustration and confusion among pregnant women and their partners. In a recent hub blog, Jules Mckoy, a Specialist Perinatal Mental Health Midwife at University Hospital Southampton, highlighted the huge rise in pregnant women reporting feelings of anxiety because of being isolated from friends and relatives and their concerns for the safety of their baby, themselves and their families. Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: “We welcome the publication of this framework to support Trusts in England safely re-introduce measures enabling partners to attend to antenatal and postnatal appointments, including pregnancy scans. This is an important step for the health and wellbeing of pregnant women and their partners, who have understandably found it difficult not to share the experience of a pregnancy scan, attend important appointments, support women in early labour or spend time with their newborn babies on the postnatal ward." “With the re-introduction of partners in maternity settings, it’s important that anyone attending hospitals and clinics for appointments and scans wears a face covering and ensures they practice social distancing and regular hand washing. These measures are in place to keep pregnant women, partners and staff safe.” Gill Walton, Chief Executive of the Royal College of Midwives, said: “Visiting restrictions during the pandemic have been challenging for everybody, particularly for pregnant women and their families at an incredibly important and transformative time in their lives. These new guidelines are good news for them and for staff. They set out clearly the rules around visiting, providing much needed clarity about who can visit and the precautions they need to take to ensure visits can be done safely for themselves, for the people they are visiting, and for staff." “The guidance will also be welcome by maternity staff who have experienced some aggression from a small minority of visitors, unhappy and confused with varying and changing guidance.” Source: Royal College of Obstetricians and Gynaecologists, 8 September 2020

The number of patients with cancer referred from screening services has fallen to nearly a third of pre-covid levels, new data shows. A total of 2,604 patients had their cancer picked up by screening services between April to July. This compares to 7,204 in the same period last year. The NHS England data covers patients receiving treatment within two months of a referral from screening services. This means the April 2020 data is largely from screening carried out before cOVID-19 saw services being shut down. From May to July this year, 1,243 patients were treated after a referral from screening services, compared to 5,406 in the same period last time. NHS England which commissions screening services from trusts said no central decision had been taken to halt screening at the height of the outbreak but said: “We know that some local providers did take the decision to pause and in those cases plans are in place to get services fully up and running again.” The national screening programmes look for bowel, breast and cervical cancers. Head of policy at Macmillan Cancer Support Sara Bainbridge said: ”Behind every missed target is a real person whose prognosis and treatment options could be severely impacted by these delays. It’s vital that people see their GP if they have symptoms, and anyone who is worried about cancer needs to know that they’ll be seen promptly and safely." “Cancer must not become the forgotten ‘C’ during this pandemic – we urgently need the government to deliver the promised recovery plan and make sure the NHS has all the staffing and resources it needs to get cancer services back on track.” Read full story (paywalled) Source: HSJ, 10 September 2020

The coronavirus pandemic has made a "difficult situation even worse" for women trying to access contraception, a group of MPs and peers has warned. Their inquiry claims years of cuts means patients "have to navigate a complex system just to receive basic healthcare". It warns damage caused by the pandemic could see a rise in unplanned pregnancies and abortions. Sexual health doctors say the service is "overstretched and underfunded". The All Party Parliamentary Group (APPG) on Sexual and Reproductive Health says cuts to public health funding in England have had a wide-ranging impact, including: service closures reduced opening hours waiting lists staff cuts. The impact of these cuts is often felt by the most marginalised groups. The MPs' group is calling for a single commissioning body to improve accountability. Women are said to be "bounced from service to service" - like Louise, 32, who struggled for years to find a contraception which didn't cause adverse effects. In some cases during lockdown, even essential care provision like emergency fittings and removals of devices have been affected. Lisa's coil fitting in March was cancelled because of the pandemic. She is now pregnant. The inquiry says the underfunding of long-acting reversible contraceptives (LARCs) - intrauterine contraception and implants - means GPs are not incentivised to provide these services, which has contributed to a "postcode lottery" when it comes to services. Read full story Source: BBC News, 11 September 2020

COVID-19 may have contributed to the deaths of 18 people who contracted the infection while being treated at Weston general hospital in Somerset, an investigation has found. The layout of the hospital and the proximity of staff and other patients who had Covid but were asymptomatic may have been among the reasons for the 18 people acquiring the virus. The hospital temporarily stopped accepting new patients, including into its A&E department, on Monday 25 May following a Covid outbreak among patients. It fully reopened on 18 June. As part of its investigation, University Hospitals Bristol and Weston NHS foundation trust identified 31 patients who died after contracting Covid while they were in-patients from 5-24 May. A detailed review of each of the cases was undertaken and it concluded that in 18 patients, the infection may have contributed to their death. Dr William Oldfield, the trust’s medical director, said: “We are deeply sorry for this. We are already in contact with the families of these patients and have informed them of the outcome of the review. We have apologised unreservedly and have offered them support." “For each family concerned, we will undertake an investigation into the specific circumstances that led to the death of their loved one. We will invite them to help inform the investigation to ensure that any questions they have are addressed. We recognise that other patients and families may have concerns and we would like to provide reassurance to everyone that the safety of our patients and staff continues to be our main priority.” Read full story Source: The Guardian, 10 September 2020

The emergence of antimicrobial resistance (AMR), including drug-resistant bacteria, or “superbugs”, pose far greater risks to human health than Covid-19, threatening to put modern medicine “back into the dark ages”, an Australian scientist has warned, ahead of a three-year study into drug-resistant bacteria in Fiji. “If you thought Covid was bad, you don’t want anti-microbial resistance,” Dr Paul De Barro, biosecurity research director at Australia’s national science agency, the CSIRO, told The Guardian. “I don’t think I’m exaggerating to say it’s the biggest human health threat, bar none. Covid is not anywhere near the potential impact of AMR. We would go back into the dark ages of health.” WHO warns overuse of antibiotics for COVID-19 will cause more deaths While AMR is an emerging public health threat across the globe, in the Pacific, where the risk of the problem is acute, drug-resistant bacteria could stretch the region’s fragile health systems beyond breaking point. An article in the BMJ Global Health journal reported there was little official health data – and low levels of public knowledge - around antimicrobial resistance in the Pacific, and that high rates of infectious disease and antibiotic prescription were driving up risks. “A challenge for Pacific island countries and territories is trying to curtail antimicrobial excess, without jeopardising antimicrobial access for those who need them,” the paper argued. Read full story Source: The Guardian, 10 September 2020

The UK government is seeking views on proposed changes to the Human Medicine Regulations 2012 to help with the safe and efficient distribution of a COVID-19 vaccine and expanded flu vaccine programme in the UK, along with treatments for COVID-19 and any other diseases that become pandemic. Ministers say there will be no shortcut on safety or effectiveness, and that any vaccine will be approved for the UK only if it meets the highest standards. The deputy chief medical officer for England, Prof Jonathan Van-Tam, said: “If we develop effective vaccines, it’s important we make them available to patients as quickly as possible but only once strict safety standards have been met. The proposals consulted on today suggest ways to improve access and ensure as many people are protected from Covid-19 and flu as possible without sacrificing the absolute need to ensure that any vaccine used is both safe and effective.” What do you think? Are there patient safety concerns here? We'd love to hear your views. Comment below.

The Royal College of GPs (RCGP) has stressed the importance of GPs having rapid access to testing results for patients, as newly-released research highlights the role general practice is playing during the coronavirus pandemic. Released by Queen Mary University of London, and published in the British Journal of General Practice, the research showed GPs and their teams were continuing to deliver frontline care to NHS patients with both Covid and non-Covid conditions. The active role of GPs in the COVID-19 response is nothing new or surprising, though notably the Queen Mary research focused in heavily on ‘suspected’ cases of Covid, due to limited community testing throughout the pandemic, giving a clearer picture of the primary patient group using general practice services. Responding to the research, Professor Martin Marshall, Chair of the RCGP, said: “This data shows the significant role GPs and our teams have played in tackling Covid-19 and delivering care to patients during the pandemic – and how the virus has impacted on all parts of the health and care services. “General practice has been open throughout the pandemic with GPs and our teams continuing to deliver the vast majority of NHS patient care to patients with both Covid and non-Covid conditions." Read full story Source: National Health Executive, 8 September 2020

A London hospital hit by a COVID-19 outbreak that required 70 staff to self-isolate has been ordered to take stringent measures to control infection. Hillingdon Hospital NHS Foundation Trust declared a COVID-19 outbreak in July and revealed that 70 staff members, some of whom had tested positive, were self-isolating. Ambulances were forced to divert patients to other emergency departments. An investigation later found that a nurse who had COVID-19 unwittingly infected 16 others during a training session on 30 June, described by one doctor as a “super spreading event.” The Care Quality Commission (CQC), which carried out an unannounced inspection on 4-5 August, has used its urgent enforcement powers to place conditions on the trust’s registration to protect patients and staff. Nigel Acheson, the CQC’s deputy chief inspector of hospitals, said, “We found a number of concerns relating to infection control and this is why we have taken action to ensure the safety of patients, staff and visitors." “We have imposed urgent conditions upon the trust’s registration and expect the trust to focus on making the required improvements as a matter of priority. We will return to inspect and ensure that action has been taken and that improvements have been made and are being sustained.” The trust has been told it must ensure that staff and patients observe social distancing, must place personal protective equipment (PPE) in easily accessible places, and must make sure that staff wear PPE before going into high risk areas. Read full story Source: BMJ, 9 September 2020

A risk calculator that takes seconds to produce a score indicating a COVD-19 patient’s risk of death could help clinicians make care decisions soon after patients arrive in hospital, according to a large study conducted by a consortium of researchers across the UK. As UK COVID-19 cases rise, schools reopen and the weather gets colder, doctors at UK hospitals are expected to see an influx of coronavirus patients. Patients with COVID-19 behave very differently to patients with other conditions such as flu and bacterial pneumonia, said Dr Antonia Ho of the University of Glasgow, one of the study’s authors, and it is very challenging for doctors managing this unfamiliar disease to accurately identify those who are at high risk of deterioration or who can ride out their illness at home. “So having a tool that … can help clinicians at the front door to accurately group patients who are coming in with COVID-19 into four distinct risk categories – low, intermediate, high and very high risk – is hugely valuable,” she added. “Having an accompanying low-risk score will provide that doctor with increased confidence that the vast majority of people, patients with that low-risk score, will come to no real harm.” Read full story Source: The Guardian, 9 September 2020