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Almost half of hospital patients have been discharged without receiving the results of their coronavirus test – including some patients who were sent to care homes, new research from Healthwatch and British Cross has revealed. Independent national patient body Healthwatch England said it had learned many patients were discharged from hospitals between March and August this year without proper assessments with many vulnerable people sent home without medication, equipment or the care they needed. At the start of the pandemic thousands of patients were discharged to care homes as NHS England instructed hospitals to free up 15,000 beds ahead of the first wave of coronavirus. Approximately 25,000 patients were sent to care homes with some not tested, sparking fears this helped seed care homes with the virus. There have been around 16,000 care home deaths linked to COVID-19. According to a survey of almost 600 discharged patients and interviews with 60 NHS staff, Healthwatch England said it had found serious flaws with the way hospitals had followed NHS England’s instructions. Read full story Source: The Independent, 24 October 2020

There is growing distrust for the NHS and government in communities that are of fundamental importance to the national effort to counter covid, according to research by NHSX. People in so-called “hard to reach” communities are faced with stigma and racism due to the covid pandemic but have dwindling trust in the health service, the research found. They are worried about how their personal data will be used by the NHS and other state bodies. They are particularly concerned that their details will be passed on to the police or immigration services. Read full story (paywalled) Source: HSJ, 20 October 2020

More than 200 people who went through hotel quarantine in Victoria, Australia, must be screened for HIV amid fears of cross-contamination from incorrect usage of blood glucose test devices. Several such devices were used on multiple people in quarantine between 29 March and 20 August, necessitating screenings for blood-borne diseases such as hepatitis B and C and HIV. These monitors, which take a small sample of blood from a fingertip, are intended for repeated use by only one person. While the needle is changed between usages, microscopic traces of blood can remain within the body of the machine, creating a low clinical risk of cross-contamination and infection. Safer Care Victoria, the state’s healthcare quality and safety agency, has assured the public there is no risk of COVID-19 spread as the disease is not transmitted by blood. These devices have since been taken out of circulation. In a statement, a spokesman for the agency said they have identified 243 people who had been tested by one of the shared machines during the timeframe in question, and will be contacted for screening. Everyone “who had conditions or episodes that may have required the test will also be contacted as a precaution”. The Victorian premier, Daniel Andrews, labelled the incident a “clinical error that was made some time ago”. “Safer Care Victoria have made some announcements in relation to a clinical error that was made some time ago, very low risk, but you can’t take any risks with these things. You have to follow them up properly and that’s exactly what has happened,” he said at a press conference on Tuesday. Read full story Source: The Guardian, 20 October 2020

Ministers have denied care home inspectors access to weekly testing for coronavirus – despite fears they could contribute to the spread of COVID-19 as cases rise across the country, The Independent can reveal. The Care Quality Commission (CQC) was told by the Department of Health and Social Care last month it could not have access to regular testing for inspection teams as the watchdog prepares for 500 inspections of care homes during the next six weeks. Officials said the teams, who are assessing care conditions for the vulnerable and elderly, did not get close enough to people to present a risk. During the first wave of the virus, after Public Health England initially said there was no risk to care homes, an estimated 16,000 residents died from the virus. At the height of the crisis up to 25,000 NHS patients were discharged to care homes by the NHS, with many not having been tested for the virus. Labour MP Barbara Keeley said: “The refusal of the Department of Health and Social Care to treat CQC inspectors in the same way as other staff going into care homes puts lives at risk.” Read full story Source: The Independent, 20 October 2020

Leaking vials and suspected contamination were identified in a batch of more than 500,000 test tubes produced for the NHS Covid test and trace operation over the summer, whistleblowers have said. The test tubes were provided by a small UK-based company, Life Science Group (LSG), which produces materials for the diagnostics industry. According to the whistleblowers, there have been repeated problems with test tubes filled by LSG leaking. Stocks of some 600,000 test tubes were inspected in August as a result, and records seen by the Guardian describe the discovery of what looked like hair and blood contamination. It is understood firms in the supply chain concluded that the contamination was not hair or blood, following inspections. However, records seen by the Guardian suggested at least one bag of LSG test tubes thought to be contaminated “cannot now be found”. The whistleblowers said that rather than rejecting the entire potentially compromised batch, as would be normal safety protocol with NHS supplies, only part of the batch with visible problems was removed from use. They said they had blown the whistle because they were concerned for public safety. Read full story Source: The Guardian, 16 October 2020

The introduction of weekly covid tests for NHS staff in ‘high risk areas’ will mean other groups missing out or waiting longer, well-placed sources have told HSJ. There is also understood to be a standoff between NHS England and Test and Trace over the regular testing of asymptomatic staff, which was announced for the North of England on Monday. NHS trust labs don’t have enough capacity to test all their staff; and there is not enough spare in “pillar two” commercial labs to carry out hundreds of thousands of additional tests. National bodies are said to be in disagreement over who should do it. NHSE believes they should be provided by T&T, and T&T says NHS labs should expand their capacity to carry them out themselves, HSJ has been told. A senior source involved in the testing programme said there would have to be “trade-offs” for T&T to meet the new NHS demand, with supply having to be cut for others who want tests — mostly the general population, or care home staff. At present the NHS has agreed to carry out 100,000 daily tests by the end of the month, as part of the T&T’s overall 500,000 target. It has been encouraged to do more by T&T, but any expansions may face shortages of equipment and supplies such as reagents, as well as staff and space. Read full story (paywalled) Source: HSJ, 13 October 2020

Senior doctors specialising in infectious diseases have written an open letter expressing "concern" about the rapid increase in COVID-19 cases in Northern Ireland. The letter is signed by 13 medics from hospitals across Northern Ireland. It calls for the public to stick to government guidance on reducing social interactions and also warns against "stigmatising people and areas with high levels of infection." The letter reads: "We need to support people who test positive. This pandemic requires us to work together to bring it under control urgently. We need to reduce the potential for transmission to protect our health service, and we need to fix our test and trace system to try and gain better control of this virus in our community." On Monday, 616 new cases of COVID-19 were identified in Northern Ireland, bringing the total during the pandemic to 14,690. The number of deaths recorded by the Department of Health remains at 584. Among those who have signed the letter are Dr Claire Donnelly, a consultant physician who specialises in infectious diseases; consultant virologist Dr Conall McCaughey and consultant paediatrician Dr Sharon Christie. Entitled an "appeal to people to adhere to Covid public health guidance", the letter lays bare the stark reality of the infections rates. The letter adds: "Worryingly the number of cases is increasing rapidly in many areas over the last week, indicating that we have widespread community transmission in many parts of Northern Ireland." Read full story Source: BBC News, 6 October 2020

A technical glitch that meant nearly 16,000 cases of coronavirus went unreported has delayed efforts to trace contacts of people who tested positive. Public Health England (PHE) said 15,841 cases between 25 September and 2 October were left out of the UK daily case figures. They were then added in to reach Saturday's figure of 12,872 new cases and Sunday's 22,961 figure. PHE said all those who tested positive had been informed. But it means others in close contact with them were not. The issue has been resolved, PHE said, with outstanding cases passed on to tracers by 01:00 BST on Saturday. The technical issue also means that the daily case totals reported on the government's coronavirus dashboard over the past week have been lower than the true number. Read full story Source: BBC News, 5 October 2020

The stress and anxiety caused to patients by "poor communication" from NHS bodies in England during the covid pandemic has been criticised by MPs. While recognising the huge burden placed on the NHS, their report said cancelled treatments and surgery had left some "in limbo" and others "too scared" to seek medical help. The report also questioned why weekly testing of NHS staff had not yet begun. And it called for their mental and physical wellbeing to be supported. Jeremy Hunt, who chairs the Health and Social Care Committee, which compiled the report, praised the "heroic contribution" made by front-line NHS staff during the pandemic, which had saved many lives. But he said the pandemic had "massively impacted normal NHS services" and this situation could have been improved with clearer communication to patients and better infection control measures in hospitals. The report, based on evidence from doctors, nurses, patient groups and NHS leaders, said the case for routine testing for all NHS staff in all parts of the country was "compelling" and it should be introduced as soon as possible before winter to help reduce the spread of the virus. The government and NHS England told the committee they wanted to bring in routine testing of staff but any plans depended on the capacity available. Read full story Source: BBC News, 1 October 2020

When Sarah found herself suffering sudden bouts of breathlessness in May, she took herself to hospital. But after her COVID-19 swab test came back negative, doctors said she was probably anxious, and sent her home. Despite this, Sarah’s symptoms continued to worsen. A week later, she was rushed to hospital in an ambulance. Paramedics told her that based on her clinic observations, she should be in a coma. Then came more surprising news: She had tested positive for coronavirus Sarah’s story – given to a patient safety charity under a pseudonym – is one that resonates with Dr Claudia Paoloni, president of the Hospital Consultants and Specialists Association. She detailed another case in which a patient tested negative twice: once when she was first admitted to hospital and once later in her hospital stay. She finally tested positive on her third test – by which time she was on a ventilator in intensive care. Paolini believes COVID-19 swab tests produce a troublingly high rate of false negative results, and the problem lies in the reliance on a single test. “To use as a one-off test in any capacity to exclude someone from having COVID-19 is a folly.” If you want to exclude someone from having the virus, Paoloni said, you must do multiple tests and collect multiple negative results. “If the test and tracing system is not working, which is the case here, transmission will continue unabated in the community.” The most recent data published by the Office for National Statistics says the test’s sensitivity - which it says can tell us how likely it is to return a false-negative result, may be somewhere between 85% and 98%. Dr Deenan Pillay, Professor of Virology at University College London and member of Independent Sage, a group of scientists providing transparent advice during the crisis, said a significant number of self-administered tests could be coming back negative for people who do in fact have the virus. “The single biggest reason why a swab from someone who has COVID-19 comes up as negative is the quality of the swab that is taken,” Dr Pillay said. “Swabbing your nose and throat in a way that will pick up the virus means really scraping down the side of the wall of the nose or back of the throat to get cells from the lining of the throat. That’s not a pleasant thing to do.” This is of course true for at-home testing, which relies on the patient or a family member to collect the swab. But it could be true at testing centres, too. Tom, a 29-year-old from London whose name has been changed for this story, said there were no medical staff on site when he visited a Covid testing centre in London. The only people he interacted with were staff from a third-party contractor paid to carry out testing. “The man simply handed me a test, read out the instructions to self-administer the test, and asked me to do it myself,” he said. Pillay agrees that testing methods are likely to have an impact on false negative results. “I have seen the documentation given out at testing centres and it is very confusing,” he said. “Centres often expect you to administer the test yourself or get someone else in your car to administer it for you, all of which creates difficulties.” Pillay believes the solution lies in having medically trained staff at testing centres. “The way the system is developed at the moment, outsourced to private companies like Deloitte and Lighthouse Labs, is just woeful,” he said. “The whole system is failing at the moment. And it’s happening just as the numbers of infections are starting to rise,” Dr Pillay said. Read full story Source: Huffpost, 27 September 2020

Tens of thousands of people infected with coronavirus were incorrectly given the all clear by England’s Lighthouse Laboratories, a High Court trial will be told next week. Court documents seen by The Independent show the labs are accused of unfairly selecting software that was shown in a test to produce significant numbers of errors and false negatives, samples that should have been positive or classed as needing to be re-taken. The two companies behind the Lighthouse Labs in England – Medicines Discovery Catapult Ltd and UK Biocentre Ltd – are accused of treating British company, Diagnostics.ai unfairly and giving preferential treatment to Belgian company UgenTec, despite the British firm’s software performing better in the test. The case, first revealed by The Independent in June, also includes a judicial review of the procurement decision against health secretary Matt Hancock – one of the first court hearings over the procurement processes followed by the government since the start of the pandemic. The Independent understands lawyers for Diagnostics.ai will accuse the laboratories of choosing a software solution that went on to produce tens of thousands of incorrect results which will have led to infected people going about their normal lives while at risk of spreading the virus. In June, UgenTec chief executive Steven Verhoeven told The Independent the suggestion its software had made errors was “incorrect”. The Department of Health refused to comment on the legal action but said in June that the UgenTec software had been used for several months and was subject to quality assurance processes, though it did not give any further details. Mr Justice Fraser will hear opening arguments in the case on Monday at the High Court. Read full story Source: The Independent, 25 September 2020

NHS hospitals have been banned from launching their own coronavirus testing for staff and patients who have symptoms – despite a nationwide shortage in tests. Leaked NHS documents, passed to The Independent, show the Department of Health and Social Care (DHSC) has now capped funding for COVID-19 testing in the health service, even though the lack of tests has left hospital doctors, nurses, teachers and other key workers forced to stay at home. The diktat warned hospitals that, if they did choose to go ahead, the six figure costs would have to come from their own budgets. The warning was sent just a day after testing tsar Baroness Dido Harding admitted to MPs that demand for coronavirus tests is three to four times the number available. One senior NHS director told The Independent that NHS trusts had the ability to buy Covid-19 test capacity in local laboratories but now faced the risk of not getting the money to pay for it. They said: “This is just barmy at a time when we have cases rising and we need to get test results for staff and patients who are isolating at home waiting for results. Read full story Source: The Independent, 18 September 2020

A lack of coronavirus tests for NHS staff is leading to staff absences and services being put at risk, hospital bosses have warned. NHS Providers, which represents hospital trusts in England, said staff are having to self-isolate rather than work because they cannot get tests for themselves or family members. It comes after widespread reports of people struggling to get tested. The home secretary defended the system, saying capacity was increasing. The government's testing system - part of its test, track and trace operation which Prime Minister Boris Johnson promised would be "world-beating" - has faced criticism in recent weeks. An increase in demand for coronavirus tests has led to local shortages - with some people being directed to test sites hundreds of miles from their homes. One doctor working in a coronavirus hotspot said she applied for a test for herself and her partner after they developed coughs and fevers. After refreshing the website for five hours, she managed to get an appointment but on arrival was told no booking had been made. She had taken screenshots of a confirmation code but was not sent a QR code to scan. "I showed the screenshots but I was told that the appointments weren't happening," she said. "I have to say I burst into tears. I was meant to be seeing patients and I feel guilty." Dr Rachel Ward, a GP in Newbury, told BBC Breakfast she was seeing a lot of patients who were struggling to get tests, saying a lot of families were "at the end of their tether" as it was "very stressful when you are faced with two weeks off work". She said if the staff at her practice were unable to get tests and had to self-isolate it would have a "huge impact" on patients as some of their healthcare workers are booked in to administer 100 flu jabs in a day. Read full story Source: BBC News, 14 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

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

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

During the COVID pandemic, it was clear that Emergency Departments across the UK needed to adapt and quickly, with my trust not exempt from this. We have increased capacity, increased our nursing and doctors on the shop floor, obviously with nurse in charge being responsible for all areas. We have different admission wards in terms of symptoms that the patient has, but also have a different type of flow, which i am getting my head around to be able to share I have seen departments split into 2 and various other ideas coming out from various trusts. Which got me thinking about patient safety and how well this is managed. So.... How is your department responding to the pandemic? Do you have any patient safety initiatives as a result of the response? Is there a long term plan? The reason why i am asking this, is so we can share practice and identify individual trust responses.

COVID-19 patients have active and prolonged gut viral infection, even in the absence of gastrointestinal symptoms, scientists in Hong Kong showed. The coronavirus may continue to infect and replicate in the digestive tract after clearing in the airways, researchers at the Chinese University of Hong Kong said in a statement Monday. The findings, published in the medical journal GUT, have implications for identifying and treating cases, they said. SARS-CoV-2 spreads mainly through respiratory droplets -- spatters of virus-laden discharge from the mouth and nose, according to the World Health Organization. Since the first weeks of the pandemic, however, scientists in China have said infectious virus in the stool of patients may also play a role in transmission. The finding “highlights the importance of long-term coronavirus and health surveillance and the threat of potential fecal-oral viral transmissions,” Siew Chien Ng, associate director of the university’s Centre for Gut Microbiota Research, said in the statement. Read full story Source: Bloomberg, 7 September 2020

Testing people twice for the coronavirus, with a nasal swab followed by an antibody finger prick test, would catch most of those people who fail to get the right COVID-19 diagnosis, researchers believe. Nose and throat swabs miss around 30% to 50% of infections, say the University of Cambridge team, as the virus can disappear from the upper respiratory tract into the lungs. But they say adding an antibody test can plug that gap. Antibodies show up from about six days after infection. A team at Addenbrooke’s hospital in Cambridge has piloted the use of combined tests for patients arriving at the hospital. Many arrive with flu-like symptoms and need an accurate diagnosis to ensure they are put on the right wards, so that there is no risk of COVID-19 patients infecting others. Read full story Source: The Guardian, 2 September 2020