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Content ArticleEarlier this month The BMJ and the Nuffield Trust hosted a roundtable discussion about the workforce crisis. It took in a wide range of perspectives, but the message was clear: the workforce crisis is urgent, it is affecting staff morale and wellbeing, it is damaging patient care, and it requires immediate action. It’s not just a UK problem; it’s a global crisis, but some countries are better at recognising the relation between staff morale and wellbeing, better patient care and economic growth. Simply put, your economy won’t grow if your population is unhealthy; your population won’t be healthy if your health professionals are demoralised and unwell.
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News ArticleCovid hospitalisations will continue to rise for at least two weeks, England’s government’s chief medical officer warned on Wednesday as Britain’s daily cases breached 100,000 for the second time this month. Professor Sir Chris Whitty said the country’s Covid crisis “is not over” and that new variants of the disease could arise at any time. He pointed to the latest data showing that the number of people with Covid in hospitals has been rising, and said this would likely continue for at least two weeks. The current rise in cases is “currently being driven by Omicron rather than new variants”, he told an audience at a Local Government Association conference, but added: “We need to keep a very close eye on this, because at any point new variants could emerge anywhere in the world, including the UK, obviously, as what happened with the Alpha variant.” Another 194 Covid deaths were reported on Wednesday, up 27% on last week. Prof Whitty said that death rates were fortunately still low but that hospitalisations meant there was still pressure on the NHS. Asked about the end of free testing for the public on 1 April, Sir Chris said it was a “trade-off between disparities, because the effects of free testing are probably going to be differential across society, and [there are] very substantial sums that are going into it, which otherwise would be going into other public health issues." However, he said that testing for staff within health and social care was “slightly different” as the risks are greater, and those who are in hospital or care homes are more vulnerable. His comments come on the second anniversary of the day the UK announced a national lockdown. Read full story Source: The Independent, 23 March 2022
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Content ArticleAll big experiences in our lives have two realities. There is what really happened. And there is the narrative, the story we tell ourselves and each other about what happened. Of the two, psychologists say it’s the narrative that matters most. Creating coherent stories about events allows us to make sense of them. It is the narrative that determines our reactions, and what we do next. Two years after the World Health Organization (WHO) finally used the word “pandemic” in its own story about the deadly new virus from Wuhan, narratives have multiplied and changed around the big questions. How bad is it? What should we do about it? When will it be over? The stories we embraced have sometimes been correct, but others have sown division, even caused needless deaths. Those stories aren’t finished – and neither is the pandemic. As we navigate what could be – if we are lucky – Covid’s transition to a present but manageable disease, it is these narratives we most need to understand and reconcile. What has really happened since 2020? And how does it still affect us now?
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News Article
‘Disproportionate’ infection control holding back electives, say NHS bosses
Patient Safety Learning posted a news article in News
Infection control rules in hospitals are ‘now disproportionate to the risks’ posed by covid and should be relaxed, some of the NHS’s most senior leaders have warned. The government rules – such as not allowing covid-positive staff to work, and separating out services for covid, non-covid and covid-contact patients – make a big dent in hospital capacity and slows down services. Glen Burley, who is chief executive of three Midlands trusts and involved in national-level discussions on elective matters, told HSJ: “Pretty much every pathway has a covid and non-covid route, which slows down flow and staff productivity. “There is a growing argument that these rules are now disproportionate to the risks. With covid cases in the community also rising now, we may have to question again the relative risks of continuing to isolate staff.” NHS Confederation director of policy Layla McCay told HSJ: “Healthcare leaders are concerned the current [IPC] measures are having a serious knock-on effect on capacity and that the measures in their current form are reducing efficiency and capacity within healthcare settings. “We need more clarity on if and how current measures can be safely adjusted so [the NHS] can further increase bed capacity and patient throughput, as well as the ability to transport patients more quickly and efficiently.” But NHS Providers, which has previously said relaxing the IPC guidance would not enable a “rapid” increase in the NHS’ capacity to tackle the elective care backlog and could pose significant “risks”, remains more cautious. Read full story (paywalled) Source: HSJ, 21 March 2022 -
Content ArticleLast month, Boris Johnson argued that the downward trends in Covid cases and hospitalisations meant that it was time to scrap restrictions. Now both are rising. But the government is ending testing and most surveillance studies. Sajid Javid, the health secretary, said that the rise was “to be expected” – though this foresight did not extend to having a plan to deal with the increase in infections. Instead, he dismissed the concern about the new Deltacron variant. The health secretary seemed nonchalant about the threat the virus now posed. Sajid Javid may be right that the country has weathered the worst of the pandemic, but Covid is not yet in retreat. It makes no sense to withdraw funding from a series of studies that allow the spread of the virus to be mapped in detail. Without the data, experts won’t be able to effectively monitor the disease. The country will be less effective in responding and adjusting to future waves of infection. Individuals will be less able to make informed choices about the risks involved. The clinically vulnerable face being cut off from everyday life. “It is like turning off the headlights at the first sign of dawn,” Stephen Reicher, a psychologist at the University of St Andrews, told the Guardian. “You can’t see what’s coming and you don’t know when it makes sense to turn them on again.”
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News Article
US health officials monitor the rising cases of UK Covid hospitalisations
Patient Safety Learning posted a news article in News
US health officials are monitoring an unusual situation in the UK, where COVID-19 cases and hospitalisations are simultaneously climbing due to the BA.2 subvariant, CNN reports. COVID-19 cases were up 52% in the UK last week compared with the week prior, and hospitalisations were up 18%t over the same period, according to the UK Coronavirus Dashboard. The seemingly in-tandem ascent of cases and hospitalisations is unusual, given that increases in COVID-19 cases preceded increases in hospitalisations by about 10 days to two weeks in previous waves. "So we're obviously keenly interested in what's going on with that," Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told CNN. Dr Fauci said in conversation with his U.K. counterparts, they attribute the rising cases and hospitalisations to three things, listed in order of contribution: the BA.2 variant, which is more transmissible than the original omicron; the opening of society, with people socializing indoors without masks; and waning immunity from vaccination or prior infection. Hospitalisations in the U.K. raise questions, given that BA.2 doesn't appear to cause more severe disease. "The issue with hospitalization is a little bit more puzzling, because although the hospitalizations are going up, it is very clear their use of ICU beds has not increased," Dr. Fauci said. "So are the numbers of hospitalizations a real reflection of COVID cases, or is there a difficulty deciphering between people coming into the hospital with COVID or because of COVID?" Read full story Source: Becker Hospital Review, 16 March 2022 -
News Article
Somerset care home staff continue working with Covid
Patient Safety Learning posted a news article in News
Some care homes have "no choice" but to allow workers who have Covid to deliver care, a public health official said. According to Public Health England cases are rising the fastest in Somerset. As a result, care homes in the county are struggling to safely staff their services and schools are seeing a rise in staff sickness. Somerset Council said ensuring vulnerable residents received care was "lower risk" than them being infected. Health officials advised care workers to continue working only if they wore PPE and felt well enough. Council public health consultant Alison Bell said: "In some cases, we have no choice but to have people who are testing positive delivering care to people in Somerset. "That risk is actually less than that person not receiving care." She said the Omicron variant was more transmissible and people were getting re-infected with it, some within a matter of weeks. Read full story Source: BBC News, 16 March 2022 -
News Article
Covid-19: Countries in the Americas are warned not to lower their guard
Patient Safety Learning posted a news article in News
Covid-19 is on the retreat across the American continents but it is too early for the region to let its guard down, warned the Pan American Health Organisation, the World Health Organization’s regional office for the Americas, on 9 March. Reported cases of Covid-19 fell by 26% in the past week and deaths by nearly 19%, as the omicron wave of infections tailed off. But ongoing transmission and future variants could expose the region’s public health priorities once more, said PAHO’s director, Carissa Etienne. A total of 2.6 million people have died from Covid-19 in the Americas, the highest number of any region of the world and almost half of the global total, despite being home to only 13% of its population. “This is a tragedy of enormous proportions, and its effects will be felt for years to come,” said Etienne on the second anniversary of the pandemic. Patchy vaccination coverage has left countries vulnerable to current and future variants of SARS-CoV-2. Around 248 million people in Latin America and the Caribbean are yet to receive a single dose of a covid vaccine, with vaccination rates particularly low in hard-to-reach rural areas. In the first two months of 2022 the Americas accounted for 63% of the world’s new cases. Despite a general fall in incidence across the region, new cases rose by 2.2% in the Caribbean, while Bolivia and Puerto Rico reported an increase in deaths in the past week. Michael Touchton, head of the University of Miami’s Covid-19 policy observatory for Latin America, said, “Latin America is perhaps the most vulnerable region in the world to the emergence of a new variant. Vaccine delays have a greater impact in Latin America due to concentrated urban populations, chronic disease burden, and low capacity health systems. Taken together, Latin America is likelier to fare worse than other similarly low and middle income regions.” Read full story Source: BMJ, 14 March 2022 -
News ArticleA leading figure in the World Health Organisation Foundation has criticised the UK’s move to dismantle its Covid testing programme as the disease surges in other parts of the world. Mr Anil Soni, chief executive of the WHO Foundation, said in an interview with The Independent that maintaining surveillance over Covid-19 was “incredibly important” and the “dismantling of the testing infrastructure here strikes me as very worrying.” The WHO Foundation chief warned people were “looking the other way” from counties where there is low vaccine coverage to maintain the hope that Covid is over. He warned low vaccine coverage is a “petri dish” for future variants to breed and that the acute phase of the pandemic could not be over until this is addressed. When asked about the UK’s plans to end its NHS Test and Trace programme Mr Soni said: “I’m very concerned about it. “What we’ve seen is, it’s incredibly important to maintain surveillance, and countries in southern Africa should be applauded for detecting Omicron as quickly as they did. Those surveillance systems need to be in place around the world. “We also want to make sure that testing is widely available so that people, when they become infectious, can be aware of their status and keep others safe. For testing not to be available and for us to be moving too quickly to normalcy creates risk.” Mr Soni said the world’s position with Covid was “precarious” and highlighted the surge being seen in Hong Kong, where “health centres are at the verge of collapse, because of how many people are sick”. Read full story Source: The Independent, 10 March 2022
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Content ArticleGovernment must take a cautious and evidence-based approach to exiting the pandemic, factoring in six key elements for a fail-safe exit strategy.
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Content Article
Blog - Learning from HSIB Covid-19 reports (27 January 2022)
Patient-Safety-Learning posted an article in Blogs
This blog summarises investigations about Covid-19 and its impact on the healthcare system carried out by the Healthcare Safety Investigation Branch (HSIB). It highlights learning from five HSIB reports: COVID-19 transmission in hospitals: management of the risk – a prospective safety investigation Early warning scores to detect deterioration in COVID-19 inpatients Oxygen issues during the COVID-19 pandemic Treating COVID-19 patients using continuous positive airway pressure (CPAP) Personal protective equipment (PPE): care workers delivering homecare during the COVID-19 response -
News ArticleSenior doctors say the government’s “Living with Covid” plan will hamper the ability of the NHS to provide care. Michelle Drage, chief executive of the Londonwide Local Medical Committee, which represents the majority of practices in the city, has said the government’s changes may discourage vulnerable patients to seek care when they need it, while David Nicholl, a neurologist and spokesperson for Doctors’ Association UK, said it could exacerbate health inequalities. It comes as the legal requirement to isolate after testing positive is lifted from Thursday, while free Covid testing ends on 1 April. NHS England sent a letter to all healthcare providers confirming workers would have to continue with current rules and not come into work after testing positive. Staff were told they should continue to carrying out regular testing, and access this through national routes until 31 March, but were not given guidance on testing requirements beyond this. Dr Drage said the changes in isolation and testing rules could put off vulnerable patients. “We may well see people not being able to access the services they need to because they’re afraid to attend,” she said. “Then to make people pay for those tests for what looks like a fiver a pop, when the people that can least afford it and the people who can least afford to take time off... suggests to me we’re increasing the risk of inappropriate transmission.” “It’s a perfect storm that could be brewing that will have a further impact on the ability of patients to be properly cared for… It feels like, yet again, the government gambling with people’s health to sustain the economy.” Read full story Source: The Independent, 25 February 2022
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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 -
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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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 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 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.
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Content ArticleThe National Care Forum (NCF) represents not-for-profit organisations providing care and support services to adults in the UK. The NCF conducted a survey of its members over a five day period from 5-10 January 2022, considering the impact of the Covid-19 Omicron variant. Its results highlighted increased pressure faced by the care sector in this period, with staff absence being compounded by existing high vacancy rates and difficulties and delays with testing.
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Content ArticleIn this article for The Conversation, the authors discuss their latest research findings regarding Covid-19 transmission, outlining the likelihood of catching Covid-19 in different indoor and outdoor scenarios. They demonstrate that speaking, shouting, singing and heavy exercise all increase the likelihood of transmission, and illustrate the impact of ventilation, face coverings and number of people on the risk of catching the virus. The article includes an table summarising their findings and a link to the Covid-19 Aerosol Transmission Estimator developed by the authors. View the full research paper
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News Article
A quarter of inpatients at mental health trust have Covid
Patient Safety Learning posted a news article in News
More than one in four inpatients at one of England’s largest mental health trusts were reported as covid-positive this week, according to data seen by HSJ. Around 160 inpatients across South London and Maudsley (SLAM) Foundation Trust’s sites, or 28% of its total open beds, were reported as positive at the beginning of the week. Several other London mental health trusts have seen high rates of covid cases in recent weeks, as there has been enormous spread of the omicron variant in the capital, although rates have not been as high as at SLAM. SLAM told HSJ that infection rates rose and fell in a reflection of community transmission, with covid-positive people being admitted, and there being spread within inpatient units. While no wards have been closed and all of the trust’s services are open, visiting was suspended in mid-December due to what the organisation described on its website as a “high number of [covid] outbreaks”. Several sources in the sector told HSJ there had been widespread omicron outbreaks in mental health units across England. They said the nature of psychiatric wards and use of restraints meant adhering to stringent social distancing measures, in the face of a highly infectious variant, was more difficult than in other settings. Read full story (paywalled) Source: HSJ, 6 January 2022 -
Content ArticleHealthcare workers (HCWs), particularly those from ethnic minority groups, have been shown to be at disproportionately higher risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) compared to the general population. However, there is insufficient evidence on how demographic and occupational factors influence infection risk among ethnic minority HCWs. Researchers analysed data from 10,772 HCWs who worked during the pandemic to identify demographic and household factors that contributed to infection risk. Results from the UK-REACH study, co-funded by the NIHR and UK Research and Innovation, showed that healthcare workers' risk of catching coronavirus increased in correlation with the level of exposure to COVID-19 patients. Other risk factors included a lack of PPE access and sharing living or working environments with other key workers. Geographical differences were also seen, with healthcare workers in Scotland and South West England at lower risk of infection compared with those in the West Midlands. Intensive care unit staff were also at lower risk than those in other hospital settings.
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News Article
Suspected Covid outbreaks in UK hospitals double in a week
Patient Safety Learning posted a news article in News
Suspected Covid outbreaks in hospitals across the UK have doubled in a week, official figures reveal – though the number of people admitted to wards with the virus is falling across much of England. As parts of the NHS battle to cope with a surge in infected staff and patients, UK Health Security Agency (UKHSA) data show there were 66 acute respiratory infection incidents in UK hospitals in the seven days to 16 December. Coronavirus was confirmed in most of these incidents, according to a UKHSA document reviewed, by the Guardian. It represents a doubling in outbreaks compared with the previous week (33) and is the highest total recorded since the third week of January 2020. Most of the outbreaks happened in London, with 28 recorded in the last week, almost half of all those in England (62). Nine were recorded in West Midlands hospitals, six in the east of England and five in the east Midlands. Hospitals are scrambling to try to stop the highly transmissible Omicron variant spreading between patients and staff, NHS leaders said, while trying to cope with more pressure than last year. Saffron Cordery, deputy chief executive of NHS Providers, said: “The safety of staff and patients is a key priority of trust leaders, and trusts are doing everything they can to keep nosocomial [hospital-acquired] infections to a minimum, including following stringent infection control measures and social distancing rules.” Read full story Source: The Guardian, 22 December 2021
