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People in Liverpool will be offered regular COVID-19 tests under the first trial of whole city testing in England. Everyone living or working in the city will be offered tests, whether or not they have symptoms, with follow-up tests every two weeks or so. Some will get new tests giving results within an hour which, if successful, could be rolled out to "millions" by Christmas, the government says. Liverpool has one of the highest rates of coronavirus deaths in England. The latest figures show the city recorded 1,754 cases in the week up to 30 October. The average area in England had 153. The pilot aims to limit spread of the virus by identifying as many infected people as possible, and taking action to break chains of transmission. It is thought around four-fifths of people who are infected with coronavirus show no symptoms. Read full story Source: BBC News, 3 November 2020

NHS staff and their families accounted for one in six patients in hospital with Covid, due in part to inadequate personal protective equipment (PPE), new research suggests. A study of hospitals from March to June revealed that healthcare workers in patient-facing roles were around three times more likely to be hospitalised with the virus than the general population. Writing in the BMJ, the study's authors called for an urgent focus on how COVID-19 spreads around hospitals to prevent a similar toll in future waves of the pandemic. They also call for hospitals to consider re-deploying staff with vulnerable family members away from high-risk zones. Read full story Source: The Telegraph, 29 October 2020

Hospital hotspots for COVID-19 have been highlighted in a new report by safety investigators. The report by the Healthcare Safety Investigation Branch (HSIB) makes a series of observations to help the health service reduce the spread of coronavirus in healthcare settings. Hospital hotspots for COVID-19 included the central nurses’ stations and areas where computers and medical notes were shared, the HSIB found. The investigation was initiated after a Sage report in May which found that 20% of hospital patients were reporting symptoms of Covid-19 seven days following admission – suggesting that their infection may have been acquired in hospital. In response to the report, NHS England and NHS Improvement confirmed they would publish nosocomial – another term for hospital acquired infections – transmission rates from trusts, the HSIB said. Read full story Source: Express and Star, 28 October 2020

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

Levels of protective antibodies in people wane "quite rapidly" after coronavirus infection, say researchers. Antibodies are a key part of our immune defences and stop the virus from getting inside the body's cells. The Imperial College London team found the number of people testing positive for antibodies has fallen by 26% between June and September. They say immunity appears to be fading and there is a risk of catching the virus multiple times. More than 350,000 people in England have taken an antibody test as part of the REACT-2 study so far. In the first round of testing, at the end of June and the beginning of July, about 60 in 1,000 people had detectable antibodies. But in the latest set of tests, in September, only 44 per 1,000 people were positive. "Immunity is waning quite rapidly, we're only three months after our first [round of tests] and we're already showing a 26% decline in antibodies," said Prof Helen Ward, one of the researchers. The fall was greater in those over 65, compared with younger age groups, and in those without symptoms compared with those with full-blown COVID-19. The number of healthcare workers with antibodies remained relatively high, which the researchers suggest may be due to regular exposure to the virus. There have been very few confirmed cases of people getting Covid twice. However, the researchers warn this may be due to immunity only just starting to fade since the peak infection rates of March and April. The hope is the second infection will be milder than the first, even if immunity does decline, as the body should have an "immune memory" of the first encounter and know how to fight back. The researchers say their findings do not scupper hopes of a vaccine, which may prove more effective than a real infection. One of the researchers, Prof Graham Cooke, said: "The big picture is after the first wave, the great majority of the country didn't have evidence of protective immunity. The need for a vaccine is still very large, the data doesn't change that." Read full story Source: BBC News, 27 October 2020

Women aged 50-60 are at greatest risk of developing “long Covid”, analysis suggests. Older age and experiencing five or more symptoms within the first week of illness were also associated with a heightened risk of lasting health problems. The study, led by Dr Claire Steves and Prof Tim Spector at King’s College London, analysed data from 4,182 COVID Symptom Study app users who had been consistently logging their health and had tested positive for the virus. In general, women were twice as likely to suffer from Covid symptoms that lasted longer than a month, compared with men – but only until around the age of 60, when their risk level became more similar. Covid vaccine tracker: when will a cor Increasing age was also associated with a heightened risk of long Covid, with about 22% of people aged over 70 suffering for four weeks or more, compared with 10% of people aged between 18 and 49. For women in the 50-60 age bracket, these two risk factors appeared to combine: They were eight times more likely to experience lasting symptoms of Covid-19 compared with 18- to 30-year-olds. However, the greatest difference between men and women was seen among those aged between 40 and 50, where women’s risk of developing long Covid was double that of men’s. “This is a similar pattern to what you see in autoimmune diseases,” said Spector. “Things like rheumatoid arthritis, thyroid disease and lupus are two to three times more common in women until just before menopause, and then it becomes more similar.” His guess is that gender differences in the way the immune system responds to coronavirus may account for this difference." Read full story Source: The Guardian, 21 September 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

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

From the moment coronavirus reached UK shores, public health advice stressed the importance of washing hands and deep-cleaning surfaces to reduce the risk of becoming infected. The advice was informed by mountains of research into the transmission of other respiratory viruses: it was the best scientists could do with such a new pathogen. But as the pandemic spread and data rolled in, some scientists began to question whether the focus on hand hygiene was as crucial as it seemed. The issue has resurfaced after Monica Gandhi, a professor of medicine at the University of California, San Francisco, told the US science magazine Nautilus that the easiest way to catch the virus was through droplets and aerosols sprayed from an infected person’s mouth or nose. “It’s not through surfaces,” she said. “We now know the root of the spread is not from touching surfaces and touching your eye. It’s from being close to someone spewing virus from their nose and mouth, without in most cases knowing they are doing so.” Gandhi’s is not a lone voice. Her comments follow a prominent paper in the Lancet from Emanuel Goldman, a professor of microbiology at Rutgers University in New Jersey. He was sceptical about the relevance of scientific studies that showed the virus could survive on surfaces for days at a time. “In my opinion,” he wrote, “the chance of transmission through inanimate surfaces is very small, and only in instances where an infected person coughs or sneezes on the surface, and someone else touches that surface soon after the cough or sneeze.” He defined soon as within one to two hours. Dr Julian Tang, an honorary associate professor of respiratory sciences at the University of Leicester, thinks hand washing should stay but agrees the risk from contaminated surfaces has been overplayed. He points to documents from the UK government’s Scientific Advisory Group for Emergencies (Sage) that estimate hand washing can reduce acute respiratory infections by only 16%. Meanwhile, he adds, the World Health Organization has warned about surfaces being a likely route of transmission while conceding there are no reports demonstrating infection this way. Tang believes that a preoccupation with contaminated surfaces distracted countries from taking airborne transmission seriously and played down the necessity of wearing masks. “What we’ve always said is that the virus transmits by all routes. There might be some transmission by hand and fomites and we’re not opposed to hand washing, but the emphasis is wrong,” he told the Guardian. Read full story Source: 5 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

Covid infection rates among doctors, nurses, and other hospital and care home staff have risen more than fivefold over the past month in London, scientists have discovered. The figures – provided by the Francis Crick Institute – have triggered considerable concern among scientists, who fear similar increases may be occurring in other regions of the UK. Increasing numbers of infected healthcare workers raise fears that the spread of COVID-19 into wards and care homes – which triggered tens of thousands of deaths last spring – could be repeated unless urgent action is taken. “It is very, very worrying,” said Professor Charles Swanton, who helped set up the institute’s Pipeline testing service. “Keeping hospitals and care homes free of the virus is crucial but these figures suggest we are heading in the wrong direction.” The Francis Crick Institute – one of Britain’s leading biomedical research centres – decided in March to use its array of powerful laboratory devices to set up a Covid testing service for hospital and care home staff in central and north London. Many other UK academic institutions offered to start similar services but were discouraged by the Department of Health and Social Care which said it wanted to centralise testing operations. Read full story Source: The Guardian, 3 October 2020

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

A leading health expert has suggested ministers have “lost control of the virus”, after the UK recorded it’s largest 24-hour spike in COVID-19 cases since 23 May. Government figures showed there have been a further 2,988 lab-confirmed cases of coronavirus in the UK as of 9am on Sunday. This brings the total number of confirmed cases in the UK to 347,152. Sunday's figure is the highest since May 22 when 3,287 cases were recorded, and is also the first 24-hour period when cases passed 2,000 since the end of May. The tally was an increase on Saturday's figures of 1,813 new cases. Prof Gabriel Scally, a member of the Independent Sage group and a former NHS regional director of public health for the south-west, warned that government ministers had “lost control of the virus”. “It’s no longer small outbreaks they can stamp on,” he told The Guardian. “It’s become endemic in our poorest communities and this is the result. Shadow health secretary Jonathan Ashworth called upon the government to respond to the sharp spike. He added that it was “a stark reminder that there is no room for complacency in tackling the spread of the virus”. “This increase, combined with the ongoing testing fiasco where ill people are told to drive for miles for tests, and the poor performance of the contact tracing system, needs an explanation from ministers,” he said on Sunday. Read full story Source: The Independent, 7 September 2020

A home care worker who did not wear protective equipment may have infected a client with a fatal case of coronavirus during weeks of contradictory government guidance on whether the kit was needed or not, an official investigation has found. The government’s confusion about how much protection care workers visiting homes needed is detailed in a report into the death of an unnamed person by the Healthcare Safety Investigation Branch (HSIB), which conducts independent investigations of patient safety concerns in NHS-funded care in England. It was responding to a complaint raised by a member of the public in April. The report shows that Public Health England published two contradictory documents that month. One advised care workers making home visits to wear PPE and the other did not mention the need. The contradiction was not cleared up for six weeks. The government’s guidance had been a shambles that had placed workers and their vulnerable clients at risk, the policy director at the United Kingdom Homecare Association, Colin Angel, said on Wednesday. The association also accused the government of sidelining its expertise and publishing new guidance with little notice, sometimes late on Friday nights, meaning that it was not always noticed by the people it was intended for.

At least 6,500 health and care workers may have been infected with coronavirus through their work, including 100 who died, according to data from the Health and Safety Executive (HSE). The regulator told The Independent it was reviewing each case and could launch investigations under the Health and Safety at Work Act if hospitals or care homes are suspected of not taking adequate steps to protect staff from infection. This could result in a hospital or care home being prosecuted. The latest data from the HSE shows between 10 April and 10 August there were a total of 3, 382 healthcare workplace infections, including 50 fatal incidents. In residential care there were 3,168 infections reported to the watchdog with 48 fatal cases. The results of the review, first revealed earlier this month by The Independent, is being kept secret but where a medical examiner finds a worker may have died as a result of a workplace infection the death will have to be reported to the HSE for possible investigation. Coroners may also hold inquests into deaths. It will also make it easier for families to claim compensation from the government’s additional death in service payments of £60,000 which was announced by health secretary Matt Hancock in April. Read full story Source: The Independent, 25 August 2020

A new study has highlighted the number of NHS staff who can be infected with coronavirus but be completely unaware they are a risk to their colleagues and patients. The research by doctors at University College London Hospitals (UCLH) found a third of staff working in two maternity departments at UCLH and St George’s Hospital tested positive for the virus but had no symptoms. Overall, one in six staff who had not previously been diagnosed with the virus were tested for COVID-19 antibodies and were found to be positive for infection. Prof Keith Neal, emeritus professor of epidemiology of infectious diseases at the University of Nottingham, who was not involved in the research, said: “Asymptomatic healthcare workers with COVID-19 pose a risk of spreading the virus depending on the personal protective equipment in use. We know many cases were acquired in hospital. “Regular testing of healthcare workers is clearly warranted.” Read full story Source: The Independent, 12 August 2020

Over 8 out of 10 (84%) of members of the Medical Protection Society thinks a face covering should be mandatory when attending any healthcare setting. This was the finding of a survey including 562 of the GP indemnity providers' members, out of which 473 said masks should be mandated by law as they are on public transport and in shops. Effective from 13 July, PHE guidance says all clinical and non-clinical staff as well as patients should wear a face mask in areas of GP practices that cannot be made 'Covid-secure' through social distancing, optimal hand hygiene, frequent surface decontamination, ventilation and other measures. But NHS England has said GPs cannot refuse to treat patients who present at the practice without a face covering because they are not legally required to wear them. In response to its member survey, MPS has urged political leaders to ‘reconsider’ this decision. Medicolegal lead for risk prevention Dr Pallavi Bradshaw stressed that ‘it cannot be right’ for frontline healthcare workers to be put at ‘unnecessary risk by patients who refuse to wear a face mask’. Read full story Source: Pulse, 8 August 2020

Dr Rebecca Fisher gives the lowdown on why maintaining general practice as a ‘front door’ to the NHS that is safe for both GPs and patients is not easy. It’s fair to say that Matt Hancock’s pronouncement that henceforth all consultations should be “teleconsultations unless there’s a compelling reason not to”, has not been universally welcomed in general practice. In my surgery, practicing in a pandemic has seen us change our ways of working beyond imagination. In March, like many other practices, we shifted overnight to a “telephone first” approach. And whilst at peak-pandemic we kept face-to-face consultations to a minimum, we’re now seeing more and more patients in person again. Although many consultations can be safely done over the phone, we’re very clear that there are some patients – and some conditions and circumstances – where a patient needs a face-to-face appointment with a GP. NHS England have also been clear that all practices must offer face-to-face consultations if clinically appropriate. But maintaining general practice as a “front door” to the NHS that is safe for both GPs and patients is not easy. Options to quarantine and pre-test patients set out in national guidance and intended to help protect secondary care cannot be deployed in primary care. Other national guidance – for example regarding wearing masks in clinical sites – often seems to be issued with secondary care in mind, with little or delayed clarity for primary care. Measures like maintaining social distancing are also likely to be harder in general practice, where the ability of a surgery to physically distance staff from each other, and patients from each other and staff, is in part dependent on physical factors. Options to quarantine and pre-test patients set out in national guidance and intended to help protect secondary care cannot be deployed in primary care Things like the size and layout of a practice, or the availability of a car park for patients to wait in are hard to change quickly. Stemming from those challenges are ones related to staffing; how to keep practice staff safe from covid-19? NHS England and the British Medical Association have stated that staff should have rigorous, culturally sensitive risk assessment and consider ceasing direct patient contact where risks from covid-19 are high. The risk of catching COVID-19 – or dying from it – is not equally distributed amongst GPs. Age, sex, ethnicity, and underlying health conditions are all important risk factors. New Health Foundation research finds that not only are a significant proportion of GPs at high or very high risk of death from covid-19 (7.9 per cent), but one in three single-handed practices is likely to be run by a GP at high risk. If those GPs step back from face-to-face consultations we estimate that at least 700,000 patients could be left without access to in-person appointments. Even more concerningly, there’s a marked deprivation gradient. If GPs at high risk from COVID-19 step back from direct face-to-face appointments, and gaps in provision aren’t plugged, the patients likely to be most affected are those in deprived areas – the same people who have already been hardest hit by the pandemic GPs at high risk of death from covid are much more likely to be working in areas of greater socioeconomic deprivation. And single-handed practices run by GPs classed as being at very high risk from covid are more than four times as likely to be located in the most deprived clinical commissioning groups than the most affluent. If GPs at high risk from COVID-19 step back from direct face-to-face appointments, and gaps in provision aren’t plugged, the patients likely to be most affected are those in deprived areas – the same people who have already been hardest hit by the pandemic. Where do solutions lie? Ultimate responsibility for providing core general practice services to populations lies with CCGs. In some areas, collaborations between practices (such as GP federations and primary care networks), may be able to organise cross-cover to surgeries where face-to-face provision is not adequate to meet need. But these collaborations have not developed at equal pace across the country, have many demands on their capacity and may not be sufficiently mature to take on this challenge. These local factors – including the availability of locums – will need to be considered by commissioners. It’s vital that CCGs act quickly to understand the extent to which the concerns around GP supply highlighted by our research apply in their localities. In some cases, additional funding will be needed to enable practices to ‘buy in’ locum support for face-to-face consultations. This should be considered a core part of the NHS covid response. Face-to-face GP appointments remain a crucial NHS service, and must be available to the population in proportion with need. Just as in secondary care, protecting staff, and protecting patients in primary care will require additional investment. Failure to adequately assess the extent of the problem, and to provide sufficient resource to engineer solutions is likely to further exacerbate existing health inequalities. Original Source: The HSJ

The hospital trust which has been recording the largest number of covid deaths for several weeks has asked NHS England and NHS Improvement for help with infection control. East Kent Hospitals University Foundation Trust is also getting help from the Kent and Medway Clinical Commissioning Group, including a senior infection control and prevention nurse who is now working with the trust. It has seen persistently high numbers of covid deaths at a time when most other trusts have seen them dwindle to nothing or almost nothing. In the week to 10 July, it had 18 deaths – 9.5% of the national total. In a statement to HSJ yesterday the trust said it had “recently asked for support from NHS England and NHS Improvement to strengthen our infection prevention and control resource”. It said it had also introduced “a strict ‘front door’ policy, limiting the number of people on site, taking temperature checks before people enter the building, providing face masks and hand washing facilities”; begun testing asymptomatic staff; and regularly testing asymptomatic patients. Read full story (paywalled) Source: HSJ, 16 July 2020

Spain's large-scale study on the coronavirus indicates just 5% of its population has developed antibodies, strengthening evidence that a so-called herd immunity to COVID-19 is "unachievable," the medical journal the Lancet reported on Monday. The findings show that 95% of Spain's population remains susceptible to the virus. Herd immunity is achieved when enough of a population has become infected with a virus or bacteria – or vaccinated against it – to stop its circulation. The European Center for Disease Control told CNN that Spain's research, on a nationwide representative sample of more than 61,000 participants, appears to be the largest study to date among a dozen serological studies on the coronavirus undertaken by European nations. "In light of these findings, any proposed approach to achieve herd immunity through natural infection is not only highly unethical, but also unachievable," said the Lancet's commentary authors, Isabella Eckerle, head of the Geneva Centre for Emerging Viral Diseases, and Benjamin Meyer, a virologist at the University of Geneva. Read full story Source: CNN, 6 July 2020