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Several trust procurement leads have expressed frustration with the government’s response to covid-19, with HSJ being told of shortages of crucial personal protective equipment, unpredictable deliveries and a lack of clarity from the centre NHS Supply Chain, which procures common consumables and medical devices for trusts, has been “managing demand” for an increasing number of PPE and infection control products for since the end of February to ensure “continuity of supply”. Some products, like certain polymer aprons, are unavailable altogether because of the increased demand and disrupted supply caused by the covid-19 outbreak. One procurement lead told HSJ: “They aren’t supplying enough, they aren’t fulfilling orders. It’s completely chaotic.” Another said his trust had “just enough to manage for the time being.” Read full story (paywalled) Source: HSJ, 20 March 2020

COVID-19 is stable for several hours to days in aerosols and on surfaces, according to a new study from National Institutes of Health, CDC, UCLA and Princeton University scientists in The New England Journal of Medicine. The scientists found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. The results provide key information about the stability of SARS-CoV-2, which causes COVID-19 disease, and suggests that people may acquire the virus through the air and after touching contaminated objects. The findings affirm the guidance from public health professionals to use precautions similar to those for influenza and other respiratory viruses to prevent the spread of SARS-CoV-2: Avoid close contact with people who are sick. Avoid touching your eyes, nose, and mouth. Stay home when you are sick. Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. Read full story Source: National Institutes of Health, 17 March 2020

A “collective failure” to appreciate the enormity of the coronavirus pandemic and enact swift measures to protect the public will lead to unnecessary deaths, according to a leading doctor who says the UK ignored clear warning signs from China. Richard Horton, the Editor-in-Chief of the Lancet, rounded on politicians and their expert advisers for failing to act when Chinese researchers first warned about a devastating new virus that was killing people in Hubei eight weeks ago. The team from Wuhan and Beijing reported in January that the number of deaths was rising quickly as the virus spread in China. They urged the global community to launch “careful surveillance” in view of the pathogen’s “pandemic potential”. Horton said nothing in the science had changed since January. “The UK’s best scientists have known since that first report from China that Covid-19 was a lethal illness. Yet they did too little, too late,” he said. While the UK was now taking the right actions to quell the outbreak, Horton said, in due course “there must be a reckoning” where difficult questions would have to be asked and answered. “We have lost valuable time. There will be deaths that were preventable. The system failed,” he said. Read full story Source: The Guardian, 18 March 2020

Southampton researchers are trialling an inhaled drug that could prevent worsening of COVID19 in those most at risk. The trial, led by Tom Wilkinson, Professor of Respiratory Medicince in the Faculty of Medicine and a consultant in respiratory medicine at University Hospital Southampton, will involve 100 patients at Southampton and up to ten other NHS hospitals taking part. Those patients will receive the best current COVID19 care, whilst inhaling either a placebo or SNG001, a special formulation of the naturally occurring antiviral protein interferon beta 1a (IFN-β), for 14 days. The trial will be undertaken with Synairgen, a drug development company founded by University of Southampton Professors Stephen Holgate, Donna Davies and Ratko Djukanovic. Professor Wilkinson said, “COVID19 cis presenting a major challenge to vulnerable patients, the health service and wider society whilst a vaccine will be key, that could some time away. Right now we need effective frontline treatments to give doctors the tools to treat the most vulnerable and to help patients recover quickly as the pressure on health systems mounts." Read full story Source: University of Southampton, 18 March 2020

NHS staff say they are being put at risk during the coronavirus outbreak because of a lack of protective gear. One doctor told the BBC that frontline healthcare workers felt like "cannon fodder" as they do not have access to equipment such as face masks. Health workers also expressed concerns that not enough of them were being tested for the virus. Prime Minister Boris Johnson said the UK had "stockpiles" of personal protective equipment (PPE). But Dr Samantha Batt-Rawden, from lobbying group the Doctors' Association, said she had heard from doctors who had not got access to PPE - or it had expired or run out. "All these doctors are worried that that's increasing their likelihood of contracting the virus and then ultimately spreading it to patients," she said. Read full story Source: BBC News, 18 March 2020

Prime Minister Boris Johnson has announced plans to test more people for coronavirus. At the moment only people in hospital are being routinely tested, so if you have symptoms and you are not sure if you have the virus, you may well never know. As of 18 March, 56,221 people in the UK had been tested for coronavirus. The number of tests has been rising from just over 1,000 a day at the end of February, when testing began, to more than 6,000 per day by mid-March. The government plans to increase this to 10,000 a day initially, with a goal of reaching 25,000 tests a day. But it has been criticised by some experts for not testing widely enough, and people have been complaining online about not having access to tests despite having symptoms. Public Health England says it will do some surveillance testing on a local level if clusters of cases are identified, using a network of 100 designated GP surgeries. This is to try to get a sense of how many milder cases there are in the community that do not result in hospitalisation. But the UK is not currently doing any mass surveillance testing or actively tracing people who have come into contact with known cases The Director General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, said he had a "simple message" for all countries: "Test, test, test." He added: "We cannot stop this pandemic if we do not know who is infected." The UK's chief scientific officer Sir Patrick Vallance told a group of MPs that "we simply don't have mass testing available for the population now", and that "when you only have capacity to do a certain number of tests" you have to prioritise the most vulnerable groups. Read full story Source: BBC News, 19 March 2020

Draper & Dash, a leading predictive patient flow provider, has launched a COVID-19 live hospital planning and demand impact assessment tool. The company said it has been working around the clock to deliver its vital tool to support impact assessment. It allows trusts to view and analyse national Hospital Episode Statistics (HES) data, alongside a number of live data sources on COVID-19 cases by the minute, as they emerge across the globe. The system models the impact of increased volume and complexity at a local and system level, providing visibility of ICU, theatres, and overall bed impact, and connects this live information to each trust’s clinical workforce. The tool shows immediate impacts on beds and staff under a range of selected scenarios. Read full story Source: Health Tech Newspaper, 18 March 2020

St Bartholomew’s Hospital is to be the emergency electives centre for the London region as part of a major reorganisation to cope with the coronavirus outbreak. Senior sources told HSJ the London tertiary hospital, which is run by Barts Health Trust, will be a “clean” site providing emergency elective care as part of the capital’s covid-19 plan. It is understood the specialist Royal Brompton and Harefield Foundation Trust will also be taking some emergency cardiac patients. The news follows NHS England chief executive Sir Simon Stevens telling MPs on Tuesday that all systems were working out how best to optimise resources and some hospitals could be used to exclusively treat coronavirus patients in the coming months. Read full story (paywalled) Source: HSJ, 18 March 2020

Who is being tested for coronavirus in the UK? As of last week, when the Prime Minister announced Britain was no longer in the “contain” phase of the pandemic, most testing outside of hospitals stopped. People with symptoms are expected to self-isolate but will not know whether they have COVID-19. That means they will not know if they are immune or still at risk – and a risk to other people. Testing now mostly takes place in hospital. People in intensive care units and those with respiratory illness, especially if it is pneumonia, will get tested for COVID-19. When there is a cluster of infections, such as an outbreak in a care home, those people will also be tested. But the World Health Organization has criticised the approach of countries that are not prioritising testing, with its director general saying “you cannot fight a fire blindfolded … test, test, test”. So why are people with symptoms not being tested? It appears to be a capacity issue, although the Department of Health and Social Care failed to respond to repeated requests for explanation. So far there have been about 44,000 tests in England, which the government’s chief scientific adviser, Sir Patrick Vallance, told the health select committee put it in “the top three or four countries in terms of testing”. Read full story Source: BBC News, 17 March 2020

Scientists in Australia say they have identified how the body's immune system fights the Covid-19 virus. Their research, published in Nature Medicine journal on Tuesday, shows people are recovering from the new virus like they would from the flu. Determining which immune cells are appearing should also help with vaccine development, experts say. "This [discovery] is important because it is the first time where we are really understanding how our immune system fights novel coronavirus," said study co-author Prof Katherine Kedzierska. The research by Melbourne's Peter Doherty Institute for Infection and Immunity has been praised by other experts, with one calling it "a breakthrough". Read full story Source: BBC News, 17 March 2020

Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of COVID-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition. The minister, Oliver Veran, tweeted on Saturday 14 March that people with suspected COVID-19 should avoid anti-inflammatory drugs. “Taking anti-inflammatory drugs (ibuprofen, cortisone . . .) could be an aggravating factor for the infection. If you have a fever, take paracetamol,” he said. Jean-Louis Montastruc, Professor of Medical and Clinical Pharmacology at the Central University Hospital in Toulouse, said that such deleterious effects from NSAIDS would not be a surprise given that since 2019, on the advice of the National Agency for the Safety of Medicines and Health Products, French health workers have been told not to treat fever or infections with ibuprofen. Experts in the UK backed this sentiment. Paul Little, Professor of Primary Care Research at the University of Southampton, said that there was good evidence “that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used—both respiratory or septic complications and cardiovascular complications.” Read full story Source: BMJ, 17 March 2020

Change course or a quarter of a million people will die in a "catastrophic epidemic" of coronavirus – warnings do not come much starker than that. The message came from researchers modelling how the disease will spread, how the NHS would be overwhelmed and how many would die. The situation has shifted dramatically and as a result we are now facing the most profound changes to our daily lives in peacetime. This realisation has happened only in the past few days. However, it is long after other scientists and the World Health Organization had warned of the risks of not going all-out to stop the virus. Read full story Source: BBC News, 18 March 2020

NHS staff are to be given access to testing for covid-19, the government said this morning, but it remains unclear how the policy will be applied. A Department of Health and Social Care spokesman said at lunchtime: “Our testing regime is set up to provide for those who need tests the most. This includes key workers, such as NHS staff. We will set out more details shortly.” It remains unclear how this will be applied. The announcement follows concerns from healthcare professionals they are not being tested for the virus, even if they had been exposed to infected patients. Read full story (paywalled) Source: HSJ, 17 March 2020

Frontline NHS staff are at risk of dying from Covid-19 after the protective gear requirements for health workers treating those infected were downgraded last week, doctors and nurses have warned. Hospital staff caring for the growing number of those seriously ill with the disease also fear that they could pass the infection on to other patients after catching it at work because of poor protection. Doctors who are dealing most closely with Covid-19 patients – A&E medics, anaesthetists and specialists in acute medicine and intensive care – are most worried. A doctor in an infectious diseases ward of a major UK hospital, who is treating patients with Covid-19, said: “I am terrified. I am seriously considering whether I can keep working as a doctor.” Read full story Source: The Guardian, 16 March 2020

Italy has rapidly become the country hit second hardest in the world by the coronavirus pandemic. Marta Paterlini reports in the BMJ on the front lines of a country in total lockdown. The resulting government imposed state of emergency lockdown, which started in northern Italy and has expanded to the whole country, will last until at least 3 April in an attempt to contain a contagion that has, at the time of writing, infected over 24 747 people (including at least 2026 healthcare staff) and killed 1809. The fatality rate of 7.2 is now higher than in China (3.8). Italian doctors describe a warlike scenario in hospitals, with fewer places available than there are patients in critical condition. Lombardy, the region around Milan and the most affected in the country, has around 1000 beds available for patients in need of intensive care, but they are near to saturation. Italy is experiencing a chronic shortage of healthcare workers. On 9 March the government announced a plan to add 20 000 new doctors, nurses, and hospital employees to meet demand.567 Retired doctors may be called on, as well as students who have completed their medical degree and are in the final year of specialist training. Meanwhile, medical authorities are trying to avoid quarantining doctors who have come into contact with coronavirus patients. They are encouraged to work unless they show symptoms of the infection or test positive. Specialist physicians such as gastroenterologists and cardiologists have been asked to work outside of their fields. Read full story Source: BMJ, 16 March 2020

The Prime Minister has said everyone in the UK should avoid "non-essential" travel and contact with others to curb coronavirus as the country's death toll hit 55. Boris Johnson said people should work from home where possible as part of a range of stringent new measures, which include: 1. Everyone of every age should avoid any non-essential social contact and travel. 2. Everyone to avoid pubs, clubs, cinemas, theatres and restaurants etc. 3. Everyone to avoid large gatherings - including sports events. 4. Everyone should work from home where possible. 5. If anyone in a house has CV19 symptoms, everyone in that house has to isolate for at least 14 days 6. Over 70s and those at risk (including pregnant women) to stay home for 12 weeks, which means no going out to shops or collect anything etc., unless there is no other option. Schools will not close for the moment. Read full story Source: BBC News, 16 March 2020

Experts have criticised NHS advice that people self-isolating with Covid-19 should take ibuprofen, saying there is plausible evidence this could aggravate the condition. The comments came after French authorities warned against taking widely used over the counter anti-inflammatory drugs. The country’s health minister, Olivier Véran, a qualified doctor and neurologist, tweeted on Saturday: “The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.” NHS guidance states that people managing Covid-19 symptoms at home should take paracetamol or ibuprofen. “I would advise against that,” said Prof Ian Jones, a virologist at the University of Reading. “There’s good scientific evidence for ibuprofen aggravating the condition or prolonging it. That recommendation needs to be updated.” Read full story Source: The Guardian, 16 March 2020

Channel 4 News says they have seen a Public Health England document indicating that not all healthcare and other essential workers with symptoms will be tested because there simply isn’t the capacity to do so – with testing prioritised in order of clinical need. Public Health England say they won’t comment on the contents of a leaked document and it is still subject to ongoing discussions. View full story Source: Channel 4 News, 15 March 2020

The Care Quality Commission (CQC) has suspended its routine inspections due to the coronavirus outbreak following pressure from system leaders and NHS bosses. The decision to suspend inspections where there are no immediate safety concerns is understood to have been taken by the CQC’s executive team this morning, senior sources told HSJ. Both the NHS Confederation and The Royal College of GPs said the decision had been made. NHS Confederation called the move a “sigh of relief” for front-line staff, while the RCGPs said it would enable GPs to dedicate their time to providing care. NHS Confederation chief executive Niall Dickson said: “Front-line staff will breathe a sigh of relief that CQC has responded to our concerns and will now postpone its inspections where there is no immediate safety concern so that they can gear themselves up to prepare for the huge task ahead in dealing with the coronavirus pandemic.” Read full story Source: HSJ, 16 March 2020

As coronavirus spreads widely across the UK, many of those who fall sick may seek treatment at their GP's surgery. But are family doctors ready to deal with a wave of patients, prevent the spread of the disease and protect the most vulnerable? "This is a massive crisis, probably the biggest crisis the NHS has ever had to face," says Prof Martin Marshall, an east London GP who is also chair of the Royal College of General Practitioners' council. He says not enough has been done yet to prepare family doctors for the epidemic, although he adds: "We need to be a little bit understanding of the pressures that the whole system is under." As the virus circulates in the community, he says we need "urgent action" to protect healthcare workers, give them the information they need and provide technology to allow for more consultations by phone or the internet. Given the pressures the NHS will be under, Prof Marshall says it is vital that doctors and nurses are not taken out of action for seven days of isolation unnecessarily. "We're not saying that health professionals are more important than patients, we're saying that health professionals have a responsibility," he says. "We therefore need to keep them as healthy as possible and we need to get them back into the workforce as quickly as possible. So we're asking that health professionals are tested early." Read full story Source: BBC News, 16 March 2020

Two out of five GPs have still not received any personal protective equipment (PPE) against coronavirus, a Pulse survey suggests. The poll of over 400 GPs saw 41% of respondents say they have not received any PPE, while a further 32% said they had not received enough. Just 15% of GPs said they have sufficient PPE, with the remainder unsure. This comes despite NHS England promising last week that it would ship PPE free of charge to practices. The Welsh Government made the same announcement this week, while in Scotland health boards should be distributing PPE. A GP who has received no proper equipment, Dr Kate Digby, in Cirencester, said she feels "woefully underprepared". She told Pulse: "I'm becoming increasingly concerned at the lack of resources being provided for frontline primary care". Read full story Source: Pulse, 2 March 2020

Frontline medics are juggling fears about a lack of beds, a crisis in staffing and worries about their own personal safety as the threat of a large-scale coronavirus outbreak looms, HuffPost UK has learned. With public health officials warning that, in the worst-case scenario, up to 80% of the UK population could be infected with coronavirus, NHS staff said such a scenario would be a “disaster” for the health service. Meanwhile, medics working in the community have warned they are not getting consistent advice on how to protect their own health. Dr Punam Krishan, a GP in Glasgow, told HuffPost UK that while the NHS deals with thousands of cases of cold, flu and norovirus each year, the threat of Covid-19 is still worrying. “Obviously as frontline workers we are most at risk,” she said. “So I’m not going to lie, yes – it does provoke anxiety. Particularly because the signs don’t show immediately – there’s an incubation period that’s up to 14 days.” This means that someone who has unknowingly been in contact with a coronavirus patient and is not yet showing symptoms of the virus could come into the practice. That thought “can trigger a bit of panic”, Krishan said. Read full story Source: HuffPost UK, 11 March 2020 Are you concerned? Do you feel prepared? Join in our online hub poll

A leading public health expert has launched a devastating critique of the government’s handling of the coronavirus outbreak in the UK, saying it is too little too late, lacks transparency and fails to mobilise the public. Prof John Ashton, a former regional director of public health for north-west England, lambasted a lack of preparation and openness from the government and contrasted Britain’s response to that of Hong Kong. “Right at the beginning of February, they [Hong Kong] adopted a total approach to this, which is what we should have done five weeks ago ourselves. They took a decision to work to three principles – of responding promptly, staying alert, working in an open and transparent manner,” he told the Guardian. “Our lot haven’t been working openly and transparently. They’ve been doing it in a (non) smoke-filled room and just dribbling out stuff. The chief medical officer only appeared in public after about two weeks. Then they have had a succession of people bobbing up and disappearing. Public Health England’s been almost invisible." Read full story Source: The Guardian, 12 March 2020

NHS England is commissioning a “COVID-19 home treatment service” of primary and community healthcare for self-secluding patients. It is introducing “urgent primary care services to patients diagnosed with COVID-19” who are self-secluded at home. The service will care for patients’ symptoms relating to COVID-19 as well as other conditions until they are discharged from home isolation and referred back to their GP. “There is likely to be a gradual handover of patients to CHMS providers as they come onstream to provide the service,” according to a letter from NHSE’s primary care directors sent to GPs today. “As soon as the new service is up and running in your area, your clinical commissioning group will be able to tell you who will be providing care for patients in your locality.” Read full story (paywalled) Source: HSJ, 11 March 2020

System leaders are telling hospitals to prepare for a potential suspension of all non-emergency elective procedures which could last for months, as they get ready for a surge in coronavirus patients. Senior sources told HSJ NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity. HSJ understands trusts have been told to firm up their plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life saving” procedures such as cancer treatment. An announcement is expected soon, with patients affected given at least 48 hours notice. It has not been decided how long it might last for, as the duration of any surge in cases and acute demand is unknown. But HSJ has been told it could stretch out for several months, with three or four months discussed, which would potentially mean tens of or even hundreds of thousands of cancelled operations. Read full story (paywalled) Source: HSJ, 12 March 2020