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News Article
The millions of people stuck in pandemic limbo
Patient Safety Learning posted a news article in News
When the coronavirus pandemic began, Emily Landon thought about her own risk only in rare quiet moments. An infectious-disease doctor at the University of Chicago Medicine, she was cramming months of work into days, preparing her institution for the virus’s arrival in the United States. But Landon had also recently developed rheumatoid arthritis—a disease in which a person’s immune system attacks their own joints—and was taking two drugs that, by suppressing said immune system, made her more vulnerable to pathogens. Normally, she’d be confident about avoiding infections, even in a hospital setting. This felt different. “We didn’t have enough tests, it was probably around us everywhere, and I’m walking around every day with insufficient antibodies and hamstrung T-cells,” she said. Two years later, Covid-19 is still all around us, everywhere, and millions of people like Landon are walking around with a compromised immune system. A significant proportion of them don’t respond to Covid vaccines, so despite being vaccinated, many are still unsure whether they’re actually protected—and some know that they aren’t. Much of the United States dropped COVID restrictions long ago; many more cities and states are now following. That means policies that protected Landon and other immunocompromised people, including mask mandates and vaccination requirements, are disappearing, while accommodations that benefited them, such as flexible working options, are being rolled back. This isn’t a small group. Close to 3% of US adults take immunosuppressive drugs, either to treat cancers or autoimmune disorders or to stop their body from rejecting transplanted organs or stem cells. That makes at least 7 million immunocompromised people. In the past, immunocompromised people lived with their higher risk of infection, but COVID represents a new threat that, for many, has further jeopardised their ability to be part of the world. From the very start of the pandemic, some commentators have floated the idea “that we can protect the vulnerable and everyone else can go on with their lives.” Seth Trueger, who is on immunosuppressants for an autoimmune complication of cancer, said. “How’s that supposed to work?” He is an emergency doctor at Northwestern Medicine; he can neither work from home nor protect himself by avoiding public spaces. “How am I supposed to provide for my family or live my life if there’s a pandemic raging?” he said. Read full story Source: The Atlantic, 16 February 2022 Further reading Read further Covid-19 blogs and stories from staff on the frontline -
News Article
England to offer Covid jab to five to 11-year-olds
Patient Safety Learning posted a news article in News
Children aged between five and 11 in England will be offered a low-dose Covid vaccine, the government says. Official scientific advice concludes the move would help protect the "very small" number of children who become seriously ill with Covid. Health Secretary Sajid Javid says the rollout will be "non-urgent", with an emphasis on parental choice. Northern Ireland also said on Wednesday it will be following Wales and Scotland in offering young children the vaccine. Children are at a much lower risk of becoming severely ill from a Covid infection, so the health benefits of vaccinating them are smaller than in other age-groups. Also, many will have some protection from already having caught the virus. So the scientists on the Joint Committee on Vaccination and Immunisation (JCVI), which advises governments across the UK, have been weighing up the evidence for immunising five to 11-year-olds. It concluded vaccination should go ahead to prevent a "very small number of children from serious illness and hospitalisation" in a future wave of Covid. Prof Wei Shen Lim, from the JCVI, said: "We're offering this to five to 11-year-olds now in order to future-proof their defences against a future wave of infection." He suggested parents consider getting their children vaccinated during school holidays to minimise disruption to their education from any flu-like side effects of the jab. Read full story Source: BBC News, 16 February 2022 -
News Article
Is it time to live with COVID-19? Some scientists warn of ‘endemic delusion’
Patient Safety Learning posted a news article in News
As surges of COVID-19 cases driven by the highly infectious Omicron variant recede, parts of the United States, Canada, and Europe are moving swiftly to lift constraints on a pandemic-fatigued public. Sweden, Denmark, and Norway have abolished nearly all COVID-19–related restrictions in recent weeks, and the United Kingdom announced it would do the same this month, dropping even the legal requirement that people quarantine after testing positive for SARS-CoV-2. In the United States, despite persistently high numbers of COVID-19–related deaths and busy hospitals, 10 governors, many known for being cautious in their pandemic response, last week announced immediate or impending ends to their states’ indoor or school mask mandates. Some of those moves came with assertions that it’s time to “live with the disease” and treat the coronavirus as endemic—a stable, enduring figure in the panoply of human pathogens, alongside cold viruses and influenza. That suggestion troubles many scientists, who warn it is eroding governments’ commitment to tracking and responding to the pandemic—which could leave countries flying blind and unprepared for any new variant. “Endemic delusion is probably what captures it the best,” says Kristian Andersen, an infectious disease researcher at Scripps Research who has been especially critical of recent moves by his home country of Denmark, which include an announcement that as of this month COVID-19 would no longer be categorised as a “socially critical disease” even though related death and hospitalisation rates were still climbing there. In the United States, governors cited various metrics to justify recent decisions to lift or let expire indoor mask mandates. California Governor Gavin Newsom noted stable hospitalisation rates and a 65% reduction in cases since Omicron’s peak in announcing the state’s mandate would end this week. But leaders also face political and economic pressures. States’ moves may be driven largely by the public’s impatience with restrictions, says epidemiologist Dustin Duncan of Columbia University. “Even people who recognize the importance of masking, social distancing, all that stuff, may be more amenable to take more risk,” he says. “At the same time, to me, going maskless just seems egregious.” Read full story Source: Science, 15 February 2022 -
News Article
Lassa fever: Patient who died in UK ‘was newborn baby’
Patient Safety Learning posted a news article in News
A patient who died from Lassa fever last week was a newborn baby, according to reports. The UK Health Security Agency (UKHSA) confirmed on Friday that an individual with the Ebola-like disease had died in Bedfordshire, and that two other people were infected. All three cases were linked to recent travel in West Africa. The BBC said the fatality had been an infant at Luton and Dunstable Hospital, quoting an email sent to staff by Cambridge University Hospitals NHS Trust. Hundreds of frontline workers at the hospital, as well as at Addenbrooke’s Hospital in Cambridge, were reportedly told to isolate after being identified as potential contacts. Lassa fever is an acute viral infection endemic in parts of Africa, and the UKHSA has assured the public that the risk of further infections in the UK remains “very low”. Read full story Source: The Independent, 15 February 2022 -
News Article
Lack of hospital beds makes Covid spread 'inevitable'
Patient Safety Learning posted a news article in News
A lack of beds in Welsh hospitals meant it was "inevitable" Covid patients would come into contact with others, a doctor has said. "Seeing patients in bed at the time of admission is becoming a rarity," Dr Nicky Leopold said. Some patients, including those with Covid, have had to spend nights on chairs in A&E due to a lack of beds. The Welsh government said it aimed to deliver 12,000 more staff by 2024-25. Health Minister Eluned Morgan and the chief executive of the Welsh NHS are due to give evidence to the Senedd's health committee on winter pressures.. Dr Leopold, a consultant geriatrician, who is a member of the BMA union in Wales, said there had been recent improvements since the number of NHS staff testing positive for Covid fell, but the flow of patients through hospital was still a problem. She said: "So many patients are stranded in hospital and that's very difficult and frustrating. There just aren't the staff in the community to support the increased level of need." Outpatient appointments had also been affected by shortages, she added. A lot of patients were in "dire need" and staff were "desperately" trying to keep clinics running. Read full story Source: BBC News, 10 February 2022 -
News Article
Government plans to remove all remaining restrictions in England
Patient Safety Learning posted a news article in News
The government plans to end all remaining covid restrictions in England—including the legal obligation to self-isolate—ahead of schedule later this month, the prime minister, Boris Johnson, has said. The current restrictions, including the requirement that anyone who tests positive for Covid-19 must self-isolate for at least five days, are due to expire on 24 March. But Johnson, addressing MPs during prime minister’s questions on 9 February, said that the remaining rules could end early if recent trends in the data continued. In response to the prime minister’s statement healthcare leaders said that they understood the importance of wanting to return to normal but called for a cautious approach. Chris Hopson, chief executive of NHS Providers, said, “It is important to remember that Covid-19 has not gone away. Though cases have fallen significantly in recent weeks and the NHS’s very successful booster campaign has made a massive difference to the numbers of seriously ill patients, the number of people testing positive for Covid-19 remains high by previous standards." “Any steps to de-escalate our precautionary approach—including ending requirements for self-isolation for positive tests—must be proportionate to the risks.” Matthew Taylor, chief executive of the NHS Confederation, said, “Around 40% of NHS staff absences are due to covid currently, and so removing the self-isolation requirements could bolster capacity significantly at a time when the service is committed to tackling its waiting lists—but we have to be mindful that it could also lead to higher rates of transmission, which could then lead to more admissions into hospital alongside more ill health in the community." “The government must take a cautious approach as we move onto the endemic stage of covid, be guided by the evidence, engage the NHS appropriately, and be prepared to review its decision if new threats emerge.” Read full story Source: BMJ, 9 February 2022 -
Content ArticleThis qualitative study in Antimicrobial Resistance & Infection Control aimed to identify institutional actions, strategies and policies related to healthcare workers’ safety perception during the early phase of the Covid-19 pandemic at a tertiary care centre in Switzerland. The authors interviewed healthcare workers from different clinics, professions, and positions. The study identified transparent communication as the most important factor affecting healthcare worker's safety perceptions during the first wave. This knowledge can be used to help hospitals better prepare for future infectious disease threats and outbreaks.
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Content ArticleIn this personal narrative, Dr Ahmed Khalafalla describes his experience of the Covid-19 pandemic as a general practitioner in Saudi Arabia. He describes new mental health issues that he has witnessed in his clinic as a result of infection prevention and control measures, and asks questions about the ongoing impact of the pandemic on the health needs and behaviour of the general population.
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Content Article
The Health Foundation Covid-19 policy tracker
Patient-Safety-Learning posted an article in Coronavirus (COVID-19)
This resource by The Health Foundation provides a timeline of national policy and health system responses to Covid-19 in the UK. Themes include: Policy narrative Measures to limit spread Health and social care response Research and development Broader policy Policy history -
Content ArticleThis study in the BMJ Open examines the links between between adverse childhood events and trust in Covid-19 health information, attitudes towards and compliance with Covid-19 restrictions and vaccine hesitancy. The study found correlations between adverse childhood events and: low trust in NHS Covid-19 information feeling unfairly restricted by government supporting removal of social distancing and ending of mandatory face coverings breaking Covid-19 restrictions vaccine hesitancy. The authors concluded that as adverse childhood events are common across many populations, there is a need to understand how they impact trust in health advice and uptake of medical interventions. This could play a critical role in the continuing response to Covid-19 and approaches to controlling future pandemics. In addition, as individuals with adverse childhood events suffer greater health risks throughout life, better compliance with public health advice is another reason to invest in safe, secure childhoods for all children.
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Content ArticleThis study in Scientific Reports aimed to understand the current situation of occupational exposure to blood-borne pathogens in a women's and children's hospital in China. The authors analysed the causes of exposure to provide a scientific basis for improving occupational exposure prevention and control measures.
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Content ArticleCovid-19 has infected more than 278 million people globally, with at least 5.4 million deaths recorded by the World Health Organization as of 26 December 2021. The omicron (B.1.1.529) variant of concern is spreading rapidly. Some countries view infection as a net harm and pursue strategies ranging from suppression to elimination. They seek to sustain low infection rates through a combination of vaccination, public health measures, and financial support measures (vaccines-plus). Other countries implemented mitigation strategies that aim to prevent health systems from being overwhelmed by building population immunity through a combination of infection and vaccination. These countries rely on a vaccines-only approach and seem willing to tolerate high levels of infection provided their healthcare systems can cope. In an open letter by a group of public health experts, clinicians, scientists, they suggest a vaccines-plus approach should be adopted globally.
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News Article
What are the new Covid rules for English care homes and are they safe?
Patient Safety Learning posted a news article in News
The self-isolation period for positive cases is being cut and the limit on visitors lifted from next week. Residents who test positive will have to self-isolate for up to 10 days, with a minimum isolation period of five full days followed by two sequential negative lateral flow tests – as is already the case for the rest of the population. Isolation periods for those having care after an emergency hospital visit will also be reduced to a maximum of 10 days, while a requirement for residents to test or self-isolate after normal visits out will be removed. Care homes will have to follow outbreak management rules for 14 rather than 28 days, and by 16 February care workers will need to use lateral flow tests before work rather than taking a weekly PCR test. The limit on visitors to care homes will be lifted. Visitors should still obtain a negative lateral flow test result earlier in the day of their visit, and guidance on the use by visitors of PPE such as face masks remains unchanged. Read full story Source: The Guardian, 27 January 2022 -
News Article
Growing number of trusts defy system leaders on FFP3 guidance
Patient Safety Learning posted a news article in News
Over 30 trusts are now mandating FFP3 masks are used beyond settings stipulated in national rules, amid calls for system leaders to clarify the national position on the key staff and patient safety issue. Fresh Air NHS, a group of frontline staff who campaign for better protection against Covid-19, said it now knows of 32 trusts which have already introduced enhanced infection prevention control policies that mandate FFP3 use beyond national guidance. News that a growing number of trusts are mandating more stringent PPE use comes amid fresh confusion around the national guidance after small but potentially significant alterations were made last week. A new line has been added to guidance which says:: “FFP3 respirator or equivalent must be worn by staff when caring for patients with a suspected or confirmed infection spread by the airborne route.” David Tomlinson, consultant cardiologist and also a member of Fresh Air NHS, said NHS trusts were “in fear of going beyond the guidance and allowing non-ICU staff to wear FFP3 respirators”. “The guidance doesn’t mandate respirators for staff in highest risk of transmission areas, for example, medical wards housing symptomatic patients at a time in their disease when they are releasing greatest amounts of infectious aerosols,” Dr Tomlinson said. “Real world data has consistently shown far greater rates of SARS2 infection comparing non-ICU healthcare workers to those on ICU.” Alison Leary, chair of healthcare and workforce modelling at London Southbank University, said: “Trusts choosing to implement evidence based safety interventions is a positive move towards workforce safety.” Read full story Source: HSJ, 27 January 2022 -
Content ArticleIn this article for Nature, Aris Katzourakis, Professor of Evolution and Genomics at the University of Oxford, highlights misconceptions around the word 'endemic' that have arisen during the Covid-19 pandemic. He defines an endemic infection as "one in which overall rates are static — not rising, not falling," and highlights that we have come to associate this with less harmful illnesses such as the common cold, when in fact it can also be applied to deadly diseases including malaria, polio and tuberculosis. He argues that the word has been misused by policymakers to indicate that the virus poses less threat and therefore no action needs to be taken. In order to tackle the ongoing threat of Covid-19, the author suggests the following four actions: Set aside lazy optimism Be realistic about the likely levels of death, disability and sickness. Targets set for reduction should consider that circulating virus risks giving rise to new variants Use the weapons we have available, globally: effective vaccines, antiviral medications, diagnostic tests and a better understanding of how to stop an airborne virus through mask wearing, distancing, and air ventilation and filtration Iinvest in vaccines that protect against a broader range of variants
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Content ArticleThis qualitative study in Research in Social and Administrative Pharmacy examined how staff working in UK community pharmacy during the first waves of the Covid-19 pandemic in 2020 responded and adapted to new pressures on their services to maintain patient safety. From responses gathered from 23 community pharmacy staff in England and Scotland, the authors identified five themes: Covid-19, an impending threat to system Patient safety stressors during the first waves of Covid-19 Altering the system, responding to system stressors Monitoring and adjusting Learning for the future. They found that pharmacy staff responded and adapted to the evolving situation, monitoring the success of measures and protocols adopted in response to the pressures of the pandemic.
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Content ArticleThere is great disparity in the way we think about and address different sources of environmental infection. Governments have for decades promulgated a large amount of legislation and invested heavily in food safety, sanitation, and drinking water for public health purposes. By contrast, airborne pathogens and respiratory infections, whether seasonal influenza or COVID-19, are addressed fairly weakly, if at all, in terms of regulations, standards, and building design and operation, pertaining to the air we breathe. We suggest that the rapid growth in our understanding of the mechanisms behind respiratory infection transmission should drive a paradigm shift in how we view and address the transmission of respiratory infections to protect against unnecessary suffering and economic losses. It starts with a recognition that preventing respiratory infection, like reducing waterborne or foodborne disease, is a tractable problem.
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Content ArticleThis systematic analysis in The Lancet used data covering 471 million individual records from systematic literature reviews, hospital systems, surveillance systems and other sources. The authors, an international research collective called the Antimicrobial Resistance Collaborators, used this data to estimate deaths and disability-adjusted life-years (DALYs) that have come about as a result of bacterial antimicrobial resistance (AMR). They estimated that, in 2019, 1.27 million deaths were directly attributable to AMR, with the three primary infections involved being lower respiratory and thorax infections, bloodstream infections and intra-abdominal infections. Their analysis shows that AMR death rates were highest in some lower- and middle-income countries, making AMR not only a major health problem globally, but a particularly serious problem for some of the poorest countries in the world.
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News ArticleLeading charities have spoken out against the government’s scrapping of COVID-19 measures warning that clinically vulnerable people have been made “collateral damage for political considerations.” Those representing thousands of clinically vulnerable people have warned the government’s decisions to scrap COVID-19 restrictions leaves people “marginalised” and warned there was a risk to 5-11 year old vulnerable children who are yet to be vaccinated. The removal of COVID-19 restrictions next week will mean masks are no longer mandatory and the government will no longer ask people to work from home. Blood Cancer UK has called for the government to do more to support immunocompromised people such as giving them priority testing. Alzheimer's Society has said it is too early to drop basic measures, such as mask wearing, which help protect vulnerable members of society. Charlotte Augst, chief executive for the charity National Voices said clinically vulnerable people had now become “collateral damage in political considerations.” She said: “The pandemic has obviously been difficult for everyone, but it’s been the most difficult for people who are vulnerable to the virus, and some of these people have never really come out of 22 months of lockdowns. “There are obviously infection control measures that are harmful to society and lockdown is one of them - it causes harm. But there are some infection control measures which are not and which enable people to get on with their lives - wearing masks, improving ventilation. “Why would we not do this? When we understood that dirty water caused illness, we cleaned up the water. It cannot be a political statement to say we should clean up the air this is just fact-based decision making, but the situation] has now become all about politics. Read full story Source: The Independent. 21 January 2022
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News ArticleAntimicrobial resistance poses a significant threat to humanity, health leaders have warned, as a study reveals it has become a leading cause of death worldwide and is killing about 3,500 people every day. More than 1.2 million – and potentially millions more – died in 2019 as a direct result of antibiotic-resistant bacterial infections, according to the most comprehensive estimate to date of the global impact of antimicrobial resistance (AMR). The stark analysis covering more than 200 countries and territories was published in the Lancet. It says AMR is killing more people than HIV/Aids or malaria. Many hundreds of thousands of deaths are occurring due to common, previously treatable infections, the study says, because bacteria that cause them have become resistant to treatment. “These new data reveal the true scale of antimicrobial resistance worldwide, and are a clear signal that we must act now to combat the threat,” said the report’s co-author Prof Chris Murray, of the Institute for Health Metrics and Evaluation at the University of Washington. “We need to leverage this data to course-correct action and drive innovation if we want to stay ahead in the race against antimicrobial resistance.” Read full story Source: The Guardian, 20 January 2022
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News Article
Hundreds of dementia care homes found to be substandard in England
Patient Safety Learning posted a news article in News
Hundreds of care homes in England are providing substandard care to dementia patients, analysis by the Guardian has found. One in five homes specialising in dementia are rated “inadequate” or “requires improvement” by the Care Quality Commission (CQC), inspection reports show. Some pose such a serious risk to people with dementia – including filthy conditions, poor infection control and untrained staff – that inspectors have ordered them to be placed into special measures. Altogether, 1,636 care homes are failing patients in findings described by charities and campaigners as “appalling”. They said urgent action was needed to tackle the “unacceptable” state of dementia care across the country. Zoe Campbell, the director of operations at the Alzheimer’s Society, said: “It’s appalling to hear that one in five care homes specialising in dementia are delivering substandard care. Every person with dementia deserves to live in a safe, secure place and to be treated with compassion and respect.” Campbell said the revelations meant staff recruitment and dementia training must be prioritised in the government’s social care proposals. Read full story Source: The Guardian, 18 January 2022 -
Content ArticleIn this article for the Patient Safety Network, the authors highlight ways in which the Covid-19 pandemic initiated drastic modifications to the way in which health services are delivered across care settings, in particular in hospital emergency departments and inpatient units. They examine particular challenges highlighted by patient safety organisations (PSOs), including increases in safety incidents relating to pressure sores, sepsis, infections and communication issues. The article also highlights innovations to support safety that have been developed during the pandemic.
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Content ArticleThere is no longer any scientific doubt about how Covid spreads through the air. Covid spreads like any other airborne respiratory disease. The virus is carried in tiny particles called aerosols, which we breathe out constantly — especially when speaking loudly or singing. The particles stay in the room air like smoke, and if someone has Covid, their exhaled aerosols contain the virus and can infect someone who breathes them in. We stop the disease spreading by stopping people inhaling infected aerosol. In this article for the Guardian, Dr Adam Squires and Prof Christina Pagel detail what we can do to protect ourselves from the airborne spread of Covid. “Filtering facepiece respirator” masks, social distancing and opening windows are short term solutions. Additionally, much can be done by cleaning the air in the room, removing infectious aerosol before it can be inhaled through ventilation and supplement the clean air by filtering out the respiratory aerosol particles using small portable HEPA (“High Efficiency Particle Air”) filter unit.. Longer term, new developments in ultraviolet (UV) technology can safely and efficiently kill airborne pathogens in large spaces such as canteens, gyms or theatre. Infrastructure upgrades and new builds, necessary for zero carbon targets, can combine more energy-efficient ventilation with filtration to lower pollution. In the classroom and the workplace, clean fresh air has wider benefits on health and wellbeing far beyond our current airborne pandemic.
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Content ArticleThe evidence for preventing COVID-19 is lost in translation, writes Dancer et al. in a BMJ Editorial. The world is finally coming to terms with the realisation that transmission of SARS-CoV-2 is airborne. While keeping your distance, wearing a mask, and getting vaccinated have provided much protection, one intervention that would have a significant impact is adequate indoor ventilation. Healthcare, homes, schools, and workplaces should have been encouraged to improve ventilation at the very beginning of the pandemic, but tardy recognition of the airborne route by leading authorities in 2020 stalled any progress that could have been made at that stage.This was compounded by controversies over the terms “droplet” and “aerosol,” as the definition of these dictates different infection prevention strategies, including type of mask. Inserting the term “ventilation” into a COVID-19 policy document might appease readers, but ensuring people get enough fresh air in indoor environments seems to have fallen by the wayside. Why is this? Can we establish the reasons for this seemingly lethargic response to improving indoor air quality?
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Content ArticleIn this article for The BMJ, Ingrid Torjesen looks at new data from Japan that suggest patients with the omicron variant of Covid-19 shed virus for longer after symptoms emerge, than with other Covid-19 variants. This has a potentially significant impact on hopes of shortening the period of isolation for people testing positive. The article examines new evidence from Japan that suggests that with omicron, the peak of virus shedding may be two or three days later than with other variants. It also looks at the relative value of self-isolation in the UK while omicron is circulating so widely in the community, with up to two-thirds of cases now undetected by testing.
