Search the hub

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

The “hazardous” use of personal protective equipment (PPE) required because of COVID-19 is contributing to the spread of secondary infections in intensive care units and other hospital settings, a leading expert has told HSJ. Infection Prevention Society vice president Professor Jennie Wilson, said: “[PPE] has been used to protect the staff, but the way it has been used has increased the risk of transmission between patients. The widespread use of PPE particularly in critical care environments has exacerbated the problem (of patient to patient transmission). Unless we tackle the approach to PPE we will continue to see this major risk of transmission of infections between patients.” Professor Wilson warned this was espeically worrying as the risk includes spreading antibiotic resistant infections among ICU patients. There is increasing concern these are developing more often in covid patients due to widespread use of broad spectrum antibiotics in the early days of the pandemic, she added. Read full story (paywalled) Source: HSJ, 3 July 2020

Health leaders are calling for an urgent review to determine whether the UK is properly prepared for the "real risk" of a second wave of coronavirus. In an open letter published in the BMJ, ministers were warned that urgent action would be needed to prevent further loss of life. The presidents of the Royal Colleges of Surgeons, Nursing, Physicians, and GPs all signed the letter. It comes after Boris Johnson announced sweeping changes to England's lockdown. Following the prime minister's announcement, health leaders called for a "rapid and forward-looking assessment" of how prepared the UK would be for a new outbreak of the virus. "While the future shape of the pandemic in the UK is hard to predict, the available evidence indicates that local flare-ups are increasingly likely and a second wave a real risk," they wrote in the letter. "Many elements of the infrastructure needed to contain the virus are beginning to be put in place, but substantial challenges remain." The authors of the letter, also signed by the chair of the British Medical Association, urged ministers to set up a cross-party group with a "constructive, non-partisan, four nations approach", tasked with developing practical recommendations. "The review should not be about looking back or attributing blame," they said, and instead should focus on "areas of weakness where action is needed urgently to prevent further loss of life and restore the economy as fully and as quickly as possible". Read full story Source: BBC News, 24 June 2020

National leaders have said healthcare workers must do better on social distancing amid growing evidence that staff-to-staff transmission is the significant factor in the spread of coronavirus throughout hospitals. NHS England national clinical director for trauma Dr Chris Moran, said: “I’ve witnessed and I’m sure you’ve all witnessed that actually healthcare workers are not necessarily been the best at managing social distancing. We know when directly managing patients that it [social distancing] is impossible, that’s what PPE is for to protect both sides of the equation. But I think in the staff-only areas we could do quite a lot better in some of the places that I’ve visited.” National director for acute care Keith Willett added: “The evidence we’ve seen coming through suggests the infection risks from staff to patients or patients to staff seems very low but the risks to staff of infection, COVID-19 infection, within hospitals is much, much, much higher between staff and staff, and patients and patients.” The warning comes after NHS England’s patient safety director Dr Aidan Fowler said he was concerned about the rates of "nosocomial spread within our hospitals”. Following national guidance designed to facilitate an increase in elective operations and other routine work, NHS trusts have been asked to set up “covid free” green zones and blue zones with a higher COVID-19 risk. Read full story Source: HSJ, 21 May 2020

Shop workers and other essential staff should be provided with face masks to control the spread of coronavirus, according to the British Medical Association (BMA). The doctors’ union is also calling on the government to ask all members of the public to cover their mouths and noses while outside their homes. “Common sense tells you that a barrier between people must offer a level of protection, however small,” said Dr Chaand Nagpaul, BMA council chairman. “The government must pursue all avenues of reducing the spread of infection. “This includes asking the public to wear face coverings to cover mouths and noses when people leave home for essential reasons.” Read full story Source: The Independent, 26 April 2020

The coronavirus can linger in patients’ eyes for several weeks and could act as a way of spreading the COVID-19 disease, according new study from Italy. Scientists at Italy’s National Institute for Infectious Diseases hospital in Rome studied the symptoms of an unnamed 65-year-old woman who developed the virus after travelling from the Chinese city of from Wuhan. When the woman developed conjunctivitis – an eye infection causing redness and itchiness – doctors decided to take regular swabs from her eye. They discovered the virus remained present in “ocular samples” up to 21 days after she was admitted to hospital. The team said the findings, published in the Annals of Internal Medicine, indicated that eye fluids from coronavirus patients “may be a potential source of infection”. The study authors said: “These findings highlight the importance of control measures, such as avoiding touching the nose, mouth, and eyes and frequent hand washing.” Read full story Source: The Independent, 24 April 2020

Concerns have been raised that updated government guidance on personal protective equipment (PPE) could put hospital staff and patients at risk. Healthcare workers have been advised to reuse gowns or wear different kit if stocks in England run low. Unions representing doctors and nurses have expressed concerns about the updated Public Health England guidance. Healthcare staff treating patients with Covid-19 have previously been advised to wear long-sleeved disposable fluid-repellent gowns. But Public Health England changed its guidance on Friday, outlining three options if the gowns are not available as "some compromise is needed to optimise the supply of PPE in times of extreme shortages". Read full story Source: BBC News, 18 April 2020

Singapore plans to open source a smartphone app its digital government team has developed to track citizens' encounters with coronavirus carriers. The app, named TraceTogether, and its government is urging citizens to run so that if they encounter a Coronavirus carrier, it’s easier to trace who else may have been exposed to the virus. With that info in hand, health authorities are better-informed about who needs to go into quarantine and can focus their resources on those who most need assistance. The app is opt-in and doesn’t track users through space, instead recording who you have encountered. To do so, it requires Bluetooth and location services to be turned on when another phone running the app comes into range exchanges four nuggets of information - a timestamp, Bluetooth signal strength, the phone’s model, and a temporary identifier or device nickname. While location services are required, the app doesn't track users, instead helping to calculate distances between them. Read full story Source: The Register, 26 March 2020

Hospitals should allow parents to be with children who are being treated for the coronavirus, NHS England has confirmed, after a 13-year-old boy died without any family members beside him. Under its national guidance to hospitals, parents are considered essential visitors, but hospitals do have discretion to suspend visitors if it is “considered appropriate”. Anyone who has symptoms of COVID-19 should not be allowed to visit a hospital. NHS England confirmed the position after 13-year-old Ismail Mohamed Abdulwahab died at King’s College Hospital in south London in the early hours of Monday without any family members present. A statement by his family suggested he was alone because of the risk of infection. On its website the hospital repeated the guidance sent to trusts by NHS England that states children are allowed one parent or carer as a visitor, but declined to explain why his family were not with him. The end-of-life charity Marie Curie has also called on doctors to allow families to be with their loved ones, describing it as an “important part of their duty of care”. Read full story Source: The Independent, 2 April 2020

NHS staff who have contracted coronavirus but remain at work because they show no symptoms are probably infecting patients, a public health official admitted yesterday. Doctors said they were worried about becoming “part of the problem” owing to a lack of testing and a shortage of protective equipment, particularly outside hospitals. Masks, gloves and visors can help stop people infecting others and stop them becoming infected. The British Medical Association said that staff testing was urgently needed so that doctors and nurses knew if it was safe for them to see patients. Read full story (paywalled) Source: The Times, 27 March 2020

A family from East Sussex may have been Britain’s first coronavirus victims, catching the virus in mid-January after one of them visited an Austrian ski resort that is now under investigation for allegedly covering up the early outbreak. If confirmed by official tests, it would mean the outbreak in Britain started more than a month earlier than currently thought. As things stand, the first recorded UK case was on January 31, and the earliest documented incidence of transmission within Britain occurred on 28 February. Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh, said cases like this demonstrated the need for widespread antibody and viral genome sequencing testing. These tests can show who has and has not been exposed to the virus, and therefore help epidemiologists trace the history and spread of the illness. "A really significant unknown in this epidemic is whether or not the cases that are symptomatic are simply the tip of the iceberg," he said. "If there are hidden cases in large numbers, then it tells us that the infection is more difficult to control than we thought… but it also suggests that there is a possibility herd immunity may have built up." Read full story Source: The Telegraph, 25 March 2020

Criticism is mounting in Sweden of the government’s approach to Covid-19, with academics warning that its strategy of building broad immunity while protecting at-risk groups – similar to that initially adopted by the UK – amounted to “Russian roulette” and could end in disaster. The prime minister, Stefan Löfven, on Sunday night called on all Swedes to accept individual responsibility in stopping the rapid spread of the virus as the number of patients in intensive care in Stockholm continued to rise sharply. Read full story Source: 23 March 2020, The Guardian