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Doctors and carers should look out for signs of confusion or strange behaviour in frail older people because it could be an early warning sign of COVID-19, research suggests. Even if they have no cough or fever, delirium is more common in vulnerable over-65s than other, fitter people of the same age. But it's not yet clear why this extreme confusion or delirium happens. In this King's College London study, data from more than 800 people over the age of 65 was analysed. They included 322 patients in hospital with COVID-19, and 535 people using the Covid Symptom Study app to record their symptoms or log health reports on behalf of friends and family. All had received a positive test result. The researchers found that older adults admitted to hospital who were classified as frail were more likely to have had delirium as one of their symptoms, compared with people of the same age who weren't frail. For one in five patients in hospital with Covid, delirium was their only symptom. The study calls for more awareness of it in hospitals and care homes. Read full story Source: BBC News, 30 September 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

Most operations have been cancelled at a hospital in a COVID-19 hotspot in south Wales after an outbreak of the virus involving more than 80 people. Hospital chiefs said transmission had taken place within the Royal Glamorgan hospital at Llantrisant and some wards where patients and staff had been infected were closed. The hospital, which is within Rhondda Cynon Taf, one of the areas under local lockdown restrictions, said it was trying to speed up the testing of patients and staff. In a statement, it said: “Significant temporary service restrictions will be put in place at Royal Glamorgan hospital from 2pm Wednesday 30 September as increased action is taken to contain a COVID-19 outbreak within the hospital. Teams have been working at pace to implement robust measures to manage the outbreak. However, additional cases linked to transmission within the hospital have been confirmed in recent days with the number of cases currently standing at 82." Andrew RT Davies, shadow health minister for the Welsh Conservatives, called on the Welsh government to explore using field hospitals and other health facilities to alleviate pressure on the Royal Glamorgan. He added: “This is very concerning, particularly as many of the additional cases are linked to transmission within the hospital, and so questions over processes and protocols must be asked.” Read full story Source: The Guardian, 30 September 2020

Clarence Troutman survived a two-month hospital stay with COVID-19, and then went home in early June. But he's far from over the disease, still suffering from limited endurance, shortness of breath and hands that can be stiff and swollen. "Before Covid, I was a 59-year-old, relatively healthy man," said the broadband technician from Denver. "If I had to say where I'm at now, I'd say about 50% of where I was, but when I first went home, I was at 20%." He credits much of his progress to the "motivation and education" gleaned from a new programme for post-covid patients at the University of Colorado, one of a small but growing number of clinics aimed at treating and studying those who have had the unpredictable disease caused by this coronavirus. As the US general election nears, much attention is focused on daily infection numbers or the climbing death toll, but another measure matters: Patients who survive but continue to wrestle with a range of physical or mental effects, including lung damage, heart or neurological concerns, anxiety and depression. "We need to think about how we're going to provide care for patients who may be recovering for years after the virus," said Dr Sarah Jolley, a pulmonologist with UCHealth University of Colorado Hospital and director of UCHealth's Post-Covid Clinic, where Troutman is seen. That need has jump-started post-covid clinics in the US, which bring together a range of specialists into a one-stop shop. One of the first and largest such clinics is at Mount Sinai in New York City, but programmes have also launched at the University of California-San Francisco, Stanford University Medical Center and the University of Pennsylvania. The Cleveland Clinic plans to open one early next year. And it's not just academic medical centres: St. John's Well Child and Family Center, part of a network of community clinics in South Central Los Angeles, said this month it aims to test thousands of its patients who were diagnosed with covid since March for long-term effects. The general idea is to bring together medical professionals across a broad spectrum, including physicians who specialize in lung disorders, heart issues and brain and spinal cord problems. Mental health specialists are also involved, along with social workers and pharmacists. Read full story Source: CNN Health, 28 September 2020

A frailty index is rationing treatment for older and disabled people who catch coronavirus, says Patience Owen. Patience has has a debilitating connective tissue disorder and, like thousands of others with rare conditions, is already in a minority within a minority, marginalised by our NHS, battling increasing disability day by day. Back in March, without consultation and days before the first lockdown, the Clinical Frailty Scale (CFS), a worldwide tool used to swiftly identify frailty in older patients to improve acute care, was adapted by the National Institute for Health and Care Excellence (NICE). It asked NHS staff in England to score the frailty of Covid patients. Rather than aiming to improve care, it seems the CFS – a fitness-to-frailty sheet using scores from one to nine – was used to work out which patients should be denied acute care. Nice’s new guidelines advised NHS trusts to “sensitively discuss a possible ‘do not attempt cardiopulmonary resuscitation’ decision with all adults with capacity and an assessment suggestive of increased frailty”. "Checking the scale, I found I would score five, the 'mildly frail' category, and therefore should I get Covid I could be steered towards end-of-life care. Bluntly, if I catch the virus, the NHS may help me to die, not live," says Patience. By early April, there was a proliferation of illegal “do not resuscitate” (DNR) notices in care homes for people with learning disabilities, and for older people in care homes and in hospitals. Many acutely ill patients stayed at home with Covid symptoms in the belief that they risked being denied care in hospital. Following warnings by the healthcare regulator, the Care Quality Commission, and other medical bodies, that the blanket application of the notices must stop, and legal challenges by charities, exclusions were made to the NICE guidelines. These included “younger people, people with stable long-term disabilities, learning disabilities or autism”. Yet the guidelines remain in place, in spite of the fact that they appear to contravene the Human Rights Act (including the right to life, article 2, and the right to non-discrimination, article 14). A spokeswoman for NICE says it is “very aware of the concerns of some patient groups about access to critical care, and we understand how difficult this feels. Our COVID-19 rapid guideline on critical care was developed to support critical care teams in their management of patients during a very difficult period of intense pressure." “'Difficult' is a hollow word for the feeling of being selected to die," says Patience. "It’s difficult not to conclude that those with long-term conditions and disabilities, like myself, have become viewed as a sacrificial herd." Read full story Source: The Guardian, 29 September 2020

Experts say robust legal protections are needed to inspire public confidence. The UK government has set out plans to amend drug regulations in case it decides that COVID-19 vaccines should be used before they are licensed, in a bid to roll them out more quickly. In a consultation on the proposals that ran from 28 August to 18 September the Department of Health and Social Care for England explained that if a suitable vaccine emerged with strong evidence of safety, quality, and efficacy the government would seek to license it through the usual route but could supply it in the meantime. The document added, “A COVID-19 vaccine would only be authorised in this way if the UK’s licensing authority was satisfied that there is sufficient evidence to demonstrate the safety, quality, and efficacy of the vaccine. ‘Unlicensed’ does not mean ‘untested.” The consultation, and the timeframe in which it was conducted, prompted some people to post their concerns on social media. However, the Human Medicine Regulations 2012 already allow the licensing authority to temporarily authorise the supply of an unlicensed product in response to certain public health threats, including the suspected spread of pathogens. The proposed change would allow conditions to be attached “to ensure product safety, quality, and efficacy” The 2012 regulations also give healthcare professionals and manufacturers immunity from being sued in the civil courts for the use of some unlicensed products recommended by the licensing authority in response to a public health threat. The new regulations would extend the immunity to drug companies that have not manufactured the product but placed it on the market with the approval of the licensing authority, and they clarify the consequences for a breach of conditions imposed by the authority. Social media posts play into existing concerns that many people might not accept the vaccine, as surveys indicate. Lawyers have told the Department for Health and Social Care that to inspire public confidence it must provide redress for the few people who might experience adverse effects. Bozena Michalowska, a partner specialising in product liability at the law firm Leigh Day, said, “I do not believe that people will want to play Russian roulette with their health by taking a vaccine which they know nothing about, especially when they know that the risks they take are just taken by them and not a shared risk and they will not have sufficient protection should things go wrong.” Read full story Source: The BMJ, 28 September 2020

Covid survivor Tam McCue is one of the lucky ones. Earlier in the year he was in intensive care in the Royal Alexandra Hospital in Paisley where he had been on a ventilator for nearly two weeks. At one point Mr McCue, who could barely speak, didn't think he would live. Fast forward five months and Mr McCue, of Barrhead, East Renfrewshire, is back from the brink. He became desperately ill but, thankfully, it only went as far as his lungs. With coronavirus some patients have have suffered multiple organ failure which also affected their heart, kidneys, brain and gut. Mr McCue describes his recovery as a "rollercoaster". He added: "It's a slow process. You think you can do things then the tiredness and fatigue sets in." He said: "It lies in the back of your mind. As years go on, how are you going to be? Is it going to get you again? It does play on you. It definitely does." As part of his recovery Mr McCue is attending the Ins:pire clinic online. It is normally a face-to-face rehabilitation clinic which involves multiple specialties, including pharmacists, physiotherapists and psychologists. Mr McCue is one of the first Covid survivors to take part in the five-week programme, which started earlier this month. Read full story Source: BBC Scotland News, 29 September 2020

The NHS is facing a "triple whammy" of rising COVID-19 cases, a major backlog in treatment and reduced capacity due to infection-control measures, according to health bosses. The NHS Confederation report on the English NHS said more investment was desperately needed. The NHS bosses also called on ministers to be "honest and realistic" about waiting lists for treatment. It comes despite the government promising an extra £3bn this winter. That money - announced over the summer - was intended to help hospitals cope with the extra-infection control measures required and to pay for patients to be treated privately for routine treatment, such as knee and hip replacements. But hospitals are still performing only half the number of routine operations they normally would. Two million patients have already waited longer than 18 weeks for treatment, the highest number since records began, in 2007. And services in other areas, such as cancer care, are running at about three-quarters capacity. Of the more than 250 bosses who responded to the confederation's survey: fewer than one in 10 said the current level of funding allowed them to deliver safe and effective care nearly nine in 10 said a lack of funding would be a significant barrier to achieving waiting-time targets for everything from mental-health care to cancer treatment and routine operations. Read full story Source: BBC News, 29 September 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

Hundreds of people believe the 111 helpline failed their relatives. Now the Guardian reports that they are demanding a full inquiry into the service. When the coronavirus outbreak hit in March, the NHS feared hospitals could be overwhelmed and so patients with suspected symptoms were directed to call the designated 111 helpline. Call volumes were massive and waiting times were often over an hour. The Guardian’s David Conn has spent months talking to bereaved relatives about that difficult time and during his conversations he found many were deeply unhappy about the service they felt had been provided by the 111 helpline. Lena Vincent’s partner Patrick McManus died from the virus in April following a short period in hospital. He had called 111 three times and had not been advised to seek further medical help. Lena tells Anushka she wants to know who is accountable for the service. Listen to the podcast Source: The Guardian, 28 September 2020

When 60-year-old Milind Ketkar returned home after spending nearly a month in hospital battling COVID-19, he thought the worst was over. People had to carry him to his third-floor flat as his building didn't have a lift. He spent the next few days feeling constantly breathless and weak. When he didn't start to feel better, he contacted Dr Lancelot Pinto at Mumbai's PD Hinduja hospital, where he had been treated. Dr Pinto told him inflammation in the lungs, caused by Covid-19, had given him deep vein thrombosis - it occurs when blood clots form in the body and it often happens in the legs. Fragments can break off and move up the body into the lungs, blocking blood vessels and, said Dr Pinto, this can be life-threatening if not diagnosed and treated in time. Mr Ketkar spent the next month confined to his flat, taking tablets for his condition. "I was not able to move much. My legs constantly hurt and I struggled to do even daily chores. It was a nightmare," he says. He is still on medication, but he says he is on the road to recovery. Mr Ketkar is not alone in this - tens of thousands of people have been reporting post-Covid health complications from across the world. Thrombosis is common - it has been found in 30% of seriously ill coronavirus patients, according to experts. These problems have been generally described as "long Covid" or "long-haul Covid". Awareness around post-Covid care is crucial, but its not the focus in India because the country is still struggling to control the spread of the virus. It has the world's second-highest caseload and has been averaging 90,000 cases daily in recent weeks. Dr Natalie Lambert, research professor of medicine at Indiana University in the US, was one of the early voices to warn against post-Covid complications. She surveyed thousands of people on social media and noticed that an alarmingly high number of them were complaining about post-Covid complications such as extreme fatigue, breathlessness and even hair loss. The Centre for Disease Control (CDC) in the US reported its own survey results a few weeks later and acknowledged that at least 35% of those surveyed had not returned to their usual state of health. Post-Covid complications are more common among those who were seriously ill, but Dr Lambert says an increasing number of moderately ill patients - even those who didn't need to be admitted to hospital - haven't recovered fully. Read full story Source: BBC News, 28 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

Hundreds of thousands who survived the virus still have side-effects that range from loss of smell to chronic fatigue. "It started with a mild sore throat. I was in Devon at the beginning of the lockdown, and because I hadn’t been on a cruise ship, gone skiing in Italy or partying with the crowds at Cheltenham races, I didn’t think it could be COVID-19. Then I developed sinusitis. My GP was practical: “This is not a symptom of the virus,” he emailed me. But my sense of smell had disappeared. At first this wasn’t a sign but six months later, I still can’t tell the difference between the smell of an overripe banana or lavender. I can distinguish petrol but not gas, dog mess but not roses, bacon but not freshly cut grass. Everything else smells of burnt condensed milk." Read full story (paywalled) Source: The Times, 23 September 2020

Some 10,000 more deaths than usual have occurred in peoples’ private homes since mid June, long after the peak in Covid deaths, prompting fears that people may still be avoiding health services and delaying sending their loved ones to care homes. It brings to more than 30,000 the total number of excess deaths happening in people’s homes across the UK since the start of the pandemic. Excess deaths are a count of those deaths which are over and above a “normal” year, based on the average number of deaths that occurred in the past five years. In the past three months the number of excess deaths across all settings, has, in the main been lower than that of previous years. However, deaths in private homes buck the trend with an average of 824 excess deaths per week in people’s homes in the 13 weeks to mid-September. Experts are citing resistance from the public to enter hospitals or home care settings and “deconditioning” caused by decreased physical activity among older people shielding at home, for example not walking around a supermarket or garden centre as they might normally. Read full story Source: The Guardian, 24 September 2020

The government and NHS England appear unable to identify units set up to treat ‘long covid’, contrary to a claim by Matt Hancock in Parliament that the NHS had ‘set up clinics and announced them in July’. There are growing calls for wider services to support people who have had COVID-19 and continue to suffer serious follow-up illness for weeks or months. Hospitals run follow-up clinics for those who were previously admitted with the virus, but these are not generally open to those who were never admitted. Earlier this month the health secretary told the Commons health committee: “The NHS set up long covid clinics and announced them in July and I am concerned by reports from Royal College of General Practitioners that not all GPs know how to get into those services.” Asked by HSJ for details, DHSC and NHS England declined to comment on how many clinics had been set up to date, where they were located, how they were funded or how many more clinics were expected to be “rolled out”. However, two charities and support groups — Patient Safety Learning and the Long Covid Support Group — told HSJ they were not aware of dedicated long covid clinics for community patients. An enquiry from Patient Safety Learning to NHS England has not been answered. The number of people affected by long covid is unclear due to a lack of research but there are suggestions it could be half a million or more. Symptoms can include fatigue, sleeplessness, night-time hypoxia, “brain fog” and cardiac problems. It appears to affect more people who were not hospitalised with coronavirus than those who were were. There is some evidence that small clinics have been set up locally on a piecemeal basis, without national funding. HSJ has only been able to identify only one genuine “long covid clinics” open to those who have never been in hospital with covid. Trisha Greenhalgh, an Oxford University professor of primary care health sciences who has interviewed around 100 long covid sufferers, told HSJ: “Nobody I have interviewed had been seen in a long covid clinic but there is an awful lot of people who would like to be referred and who sound like the need to be but they haven’t.” Read full story (paywalled) Source: HSJ, 23 September 2020 Read the letter Patient Safety Learning sent to NHS England hub Community thread - Long Covid: Where are these clinics?

Sweeping bans on visiting at thousands of care homes risk residents dying prematurely this winter as they give up hope in the absence of loved ones, experts in elderly care have warned. More than 2,700 care homes in England are either already shut or will be told to do so imminently by local public health officials, according to a Guardian analysis of new government rules announced to protect the most vulnerable from COVID-19. Care groups are calling for the government to make limited visiting possible, including by designating selected family members as key workers. Since Friday any care homes in local authority areas named by Public Health England for wider anti-Covid interventions must immediately move to stop visiting, except in exceptional circumstances such as end of life. It also halts visits to windows and gardens and follows seven months of restrictions in many care homes that closed their doors to routine visits in March. The blanket bans will result in the “raw reality of residents going downhill fast, giving up hope and ultimately dying sooner than would otherwise be the case”, warned the charity Age UK and the National Care Forum (NCF), which represents charitable care providers. Read full story Source: The Guardian, 23 September 2020

NHS England has been asked for a “clear plan and timescale” for development during covid of its controversial scheme which aims to provide extra support for care homes. In its adult social care winter plan the government has advised NHS England to push forward with the rollout of the “enhanced health in care homes” programme, ensuring that all care homes are assigned to primary care networks by 1 October. The scheme requires GP practices to provide extra clinical support and advice to homes. PCNs should also nominate a clinical lead for the care homes and work with other providers, such as social prescribing link workers, health and wellbeing coaches and care co-ordinators, to provide personalised care. The winter plan responds to a number of recommendations published by the COVID-19 support taskforce, after reviewing the management of the virus in the sector. It asks NHSE to provide a clear plan and timetable for its “enhanced health in care homes” programme. Read full story (paywalled) Source: HSJ, 23 September 2020

Having flu and COVID-19 together significantly increases your risk of death, say government scientists who are urging all those at risk of getting or transmitting flu to get the vaccine in the coming weeks and months. The evidence for the double whammy is currently limited and comes mostly from a study with small numbers – 58 people – carried out in the UK during the early phase of the pandemic. “As I understand it, it’s 43% of those with co-infection died compared with 26.9% of those who tested positive for Covid only,” said England’s deputy chief medical officer, Prof Jonathan Van-Tam. These were people who had been hospitalised and had been tested for both viruses, he said, and so were very ill – but the rate of death from Covid alone in the study between January and April was similar to the known rate of Covid hospital mortality generally of around 25% or 26%. "I think it is the relative difference in size of those rates that’s rather more important than the absolute rate,” he said. The study may have been small and they would be doing further studies this season, but the findings tallied with other work that has been done, he said. “If you get both, you are in some serious trouble, and the people who are most likely to get both of these infections may be the very people who can least afford to in terms of their own immune system, or their risk for serious outcomes. So please protect yourself against flu, this year,” says said Prof Yvonne Doyle, medical director of Public Health England The government has bought 30,000,000 doses of flu vaccine, which is more than ever before. They will arrive in batches, so the elderly – over 65 – and those with medical conditions will be called for immunisation first. Relatives of those who are on the shielding list will also be called up. The letters will begin to go out this week. Because of the threat of Covid and the risk that people with flu could be infected if admitted to hospital, all those aged 50-64 will be offered flu vaccination, but not straight away. They should wait to be called by their GP. Read full story Source: The Guardian, 22 September 2020

Emergency departments across England are reporting ‘dangerous’ overcrowding similar to levels seen pre-covid, and struggling to maintain social distancing, A&E leaders have warned. The Royal College of Emergency Medicine said it was concerned about covid spreading among the most vulnerable patients, as overall transmission rates continue to rise sharply across the UK. It was always anticipated that A&E activity would return to pre-covid levels this winter, following a significant drop-off in A&E activity during the spring and early summer, and that service transformation would be needed to help maintain social distancing. But the emergence of widespread overcrowding so far ahead of winter is of serious concern to system leaders. A&E staff were already being forced to make difficult trade-offs over which patients to isolate, the college’s vice president told HSJ. He also urged NHS leaders not to place unrealistic expectations on the impact a new model involving walk-in patients booking slots by phone could make on addressing overcrowding in emergency departments. RCEM vice president Adrian Boyle said the NHS was “largely back to the pre-covid levels of crowding” but it was “much more dangerous now because of covid”. He said: “We are hearing that most emergency departments can’t maintain social distancing safely and staff are having to make fairly difficult trade-offs about which people need to be isolated. No one can be safely social distanced in a corridor.” Read full story (paywalled) Source: HSJ, 21 September 2020

Hundreds of people believe the helpline failed their relatives. Now they are demanding their voices be heard. Families whose relatives died from COVID-19 in the early period of the pandemic are calling for an inquiry into the NHS 111 service, arguing that many critically ill people were given inadequate advice and told to stay at home. The COVID-19 Bereaved Families for Justice group says approximately a fifth of its 1,800 members – more than 350 people – believe the 111 service failed to recognise how seriously ill their relatives were and direct them to appropriate care. “We believe that in some cases it is likely these issues directly contributed to loved ones dying, due to causing a delay in receiving treatment, or a total lack of treatment leading to them passing away at home,” said the group’s co-founder Jo Goodman, whose father, Stuart Goodman, died on 2 April aged 72. Many families have said they had trouble even getting through to the 111 phone line, the designated first step, alongside 111 online, for people concerned they may have COVID-19. The service recorded a huge rise in calls to almost 3m in March, and official NHS figures show that 38.7% were abandoned after callers waited longer than 30 seconds for a response. Some families who did get through have said the call handlers worked through fixed scripts and asked for yes or no answers, which led to their relatives being told they were not in need of medical care. “Despite having very severe symptoms including skin discolouration, fainting, total lack of energy, inability to eat and breathlessness, as well as other family members explaining the level of distress they were in, this was not considered sufficient to be admitted to hospital or have an ambulance sent out,” Goodman said. Some families also say their relatives’ health risk factors, such as having diabetes, were not taken into account, and that not all the 111 questions were appropriate for black, Asian and minority ethnic people, including a question to check for breathlessness that asked if their lips had turned blue. Read full story Source: The Guardian, 21 September 2020

Covid has brought many hidden tragedies: elderly residents in care homes bereft of family visits, families in quarantine missing loved one’s funerals, and mums forced to go through labour alone. Much of this has been necessary, however painful, but Jeremy Hunt fears we’re getting the balance badly wrong in maternity care. That’s why he is backing The Mail on Sunday’s campaign to end lone births, which has been championed in Parliament by Alicia Kearns. Infection control in hospitals is critically important, but mothers’ mental health can’t be pushed down the priority list. Imagine the agony of a new mum sent for a scan on her own, only to be told that her much longed-for baby has no heartbeat. Or the woman labouring in agony for hours who is told she is not yet sufficiently dilated to merit her partner joining her for moral support. "I have heard some truly heartbreaking stories, which quite frankly should have no place in a modern, compassionate health service. One woman who gave birth to a stillborn baby alone at 41 weeks; another woman who was left alone after surgery due to a miscarriage at 12 weeks," says Jeremy. Perhaps most concerningly of all, there are reports of partners being asked to leave their new babies and often traumatised mothers almost immediately after birth. That means they miss out on vital bonding time and mums lose crucial support to help them recover mentally and physically, in some cases with partners not allowed back to meet their new child properly for several days. "This is a question of basic compassion and decency – the very values that the NHS embodies and the reason we’re all so proud of our universal health service – so we need every hospital to commit to urgent action without delay." Read full story Source: MailOnline, 19 September 2020

A third of coronavirus patients in intensive care are from black, Asian and minority ethnic backgrounds, prompting the head of the British Medical Association to warn that government inaction will be responsible for further disproportionate deaths. Chaand Nagpaul, the BMA Council chair, was the first public figure to call for an inquiry into whether and why there was a disparity between BAME and white people in Britain in terms of how they were being affected by the pandemic, in April. Subsequent studies, including a Public Health England (PHE) analysis in early June, confirmed people of certain ethnicities were at greater risk but Nagpaul said no remedial action had been taken by the government. Nagpaul told the Guardian: “We are continuing to see BAME people suffering disproportionately in terms of intensive care admissions so not acting means that we’re not protecting our vulnerable communities. Action was needed back in July and it’s certainly needed now more than ever. “As the infection rate rises, there’s no reason to believe that the BAME population will not suffer again because no action has been taken to protect them. They are still at higher risk of serious ill health and dying.” Read full story Source: The Guardian, 20 September 2020

Watchdog chief says increasing patient feedback will be the fuel to drive improvements in patient safety Some hospitals and care homes are failing to take action to protect patients from coronavirus as cases rise across the country, the head of the care watchdog has warned. In an interview with The Independent, Ian Trenholm, the chief executive of the Care Quality Commission (CQC), said a series of inspections had revealed a minority of homes and hospitals were not doing enough to prevent infection. He said in one case a care home appeared to have made a “conscious decision” not to follow the rules on wearing masks and gloves and was now in the process of being closed down by the watchdog due to safety fears. Mr Trenholm also revealed the CQC would be looking closely at patients struggling to access services because of the impact of COVID-19 and he warned it would act if some groups were disproportionately affected. The CQC is being forced to move away from its regular inspections of hospitals, care homes and GPs due to the pandemic but Mr Trenholm said it would be redoubling efforts to encourage patients to give feedback on the care they received, adding the watchdog would be more explicit in future about the action it takes. Read full story Source: The Independent, 21 September 2020

A series of hospitals will be designated as coronavirus-free zones during the second wave of the outbreak in a significant policy shift designed to ensure the NHS continues treatment for cancer and other conditions, the Guardian has learned. NHS England is determined not to repeat the widespread suspension of normal service that occurred in the first wave, which doctors and charities have criticised for damaging patients’ health, leading to more deaths and creating a backlog of millions of treatments. In a tacit admission that the March shutdown denied patients vital care, NHS bosses have drawn up plans for certain hospitals – mainly small district generals – to treat no COVID-19 patients and focus instead on common planned operations such as cancer surgery, hip and knee replacements, and cataract removals. Under NHS plans, such “clean” hospitals will as far as possible be kept free of coronavirus patients in a reversal of the approach taken in spring. That should reduce the risk of patients admitted for normal care becoming infected with COVID-19 while on wards. Read full story Source: The Guardian, 21 September 2020

'Long Covid' is leaving people with so-called ‘brain fog’ for months after their initial recovery, NHS experts have revealed. Dr Michael Beckles, consultant respiratory and general physician at The Wellington Hospital, and the Royal Free NHS Foundation, said he has seen a number of patients suffering from ongoing effects of the disease. He said the main symptom being reported is breathlessness, with patients also describing a brain fog. Dr Beckles said: "I'm seeing more and more patients who have had Covid-19 infection confirmed in the laboratory and on X-ray, who have cleared the infection, and are now still presenting with persistent symptoms. "Some of those symptoms are respiratory, such as breathlessness, chronic cough. "And some have other symptoms such as what the patients describe as brain fog, and I understand that to be a difficulty in concentration." "Some still have loss of sense of taste or smell." He added that it can be frustrating for patients because investigations after the infection can be normal, yet the symptoms persist. Dr Beckles is part of a team of specialists at the new post-COVID-19 rehabilitation unit at The Wellington Hospital. Read full story Source: The Telegraph, 21 September 2020