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Content ArticleThis special Patient Safety Network Perspective compiles findings and insights into a series of case studies from interviews and written responses from leaders at three different health systems who had to increase their telehealth capacities in response to the COVID-19 pandemic.
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Content ArticlePatient Safety Movement's Dr Donna Prosser is joined by Dr Steven Deeks, Professor of Medicine, University of California, San Francisco, and Dr Jake Suett, Staff Grade Anaesthetist and Intensive Care Doctor, UUK, to discuss the long term implications of COVID-19 from clinical and personal perspectives. Dr Deeks shares the research around long COVID-19 symptoms and Dr Suett provides a personal anecdote of his experience with symptoms that have lasted months. Dr. Suett shares information about the COVID symptom study, which consists of an international mobile app to track COVID-19 symptoms over time.
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Content ArticleAsaf Bitton, is Executive Director of Ariadne Labs and a global expert on primary care policy and delivery. In this interview with the Institute for Healthcare Improvement (IHI), Bitton talks about both the losses and the opportunities presented by COVID-19 and the rapid expansion of telehealth.
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Content ArticlePhysicians and patients have concerns associated with a shift toward virtual medicine. This interview with a Dr Paul Hyman, a primary care physician, highlights how the loss of physical touch and in-person communication could negatively affect care and the patient/physician relationship.
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Content ArticleThis toolkit has been produced by the National Tracheostomy Safety Project in collaboration with the Academic Health Science Networks in response to the COVID-19 pandemic, to support healthcare staff who are looking after this very vulnerable group of patients. Primarily it is for those working in hospitals. However, much of the material is also applicable to primary and community care settings. Wherever it is used, the toolkit’s key objective is the same: to ensure that healthcare staff caring for patients with tracheostomies in these challenging circumstances are able to do so safely.
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Ms Cath Rennie, ENT Consultant Surgeon, and Lizzie Bullock, Rhinology Clinical Nurse Specialist, discuss Post Viral Olfactory Loss, COVID-19 and the impact it has on smell and taste. Lizzie shares her personal experiences and talks with Cath about medical treatments, access to care and self-management tools. Fifth Sense are hosting a programme of online conversations and webinars on a range of topics to support people affected by smell and taste disorders. -
Content ArticleProviders deliver: Resilient and resourceful through COVID-19 is the third report from NHS Providers which celebrate and promote the work of NHS trusts and foundation trusts in improving care for patients and service users. Here is a case study from the University Hospitals of North Midlands NHS Trust. It shows: Deployed thermal imaging cameras to identify people with high temperature. Developed effective guidance for staff. Boosted public confidence in safety of hospital.
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Content ArticleDoctors who contracted COVID, and thought the symptoms would be over in weeks, tell Jennifer Trueland about their continuing pain, exhaustion and – sometimes – struggle to be believed
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Content ArticleThe COVID-19 pandemic has had far-reaching effects upon people’s lives, health care systems and wider society. As yet there is little research into the number of people at risk of developing ongoing COVID-19. Early attention has been on the acute illness generated by the virus, but it is becoming clear that, for some people,COVID-19 infection is a long term illness. This rapid and dynamic review authored by Dr Elaine Maxwell draws on the lived experience of patients and expert consensus as well as published evidence to better understand the impact of ongoing effects of COVID19, how health and social care services should respond, and what future research questions might be.
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Content ArticleIn this letter, Jeremy Hunt, Chair of the Health and Social Care Committee, welcomes recent announcements regarding future support for Long COVID patients but raises a number of continuing concerns. Hunt makes several calls for action, as the number of people suffering continues to increase.
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Content ArticleAn open letter has been published in the Nursing Times from infection prevention and control experts, together with interested and concerned individuals and organisations, about the restrictions enforced in nursing, care and residential homes. Restrictions are being imposed in relation to COVID-19 across too many nursing, care and residential homes in the UK and beyond, in the name of infection prevention and control. A number of experts in this field, led by Jules Storr, independent global health consultant and former Infection Prevention Society (IPS) president, summarise in an open letter why infection prevention and control should be an enabler not a barrier to safe, compassionate human interaction in nursing, care and residential homes. By adding their voice their intention is to accelerate action to end this uncompassionate treatment of people in homes as well as for their families and other loved ones.
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Content ArticlePatients collectively made Long Covid – and cognate term ‘long-haul Covid’ – in the first months of the pandemic. Patients, many with initially ‘mild’ illness, used various kinds of evidence and advocacy to demonstrate a longer, more complex course of illness than laid out in initial reports from Wuhan. Long Covid has a strong claim to be the first illness created through patients finding one another on social media: it moved from patients, through various media, to formal clinical and policy channels in just a few months. This initial mapping of Long Covid – by two patients with this illness – focuses on actors in the UK and USA and demonstrates how patients marshalled epistemic authority. Patient knowledge needs to be incorporated into how COVID-19 is conceptualised, researched, and treated.
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Content ArticleFrom acute delirium to long term fatigue, COVID-19 has serious neuropsychiatric effects. Viral infections of the respiratory tract can have multisystemic effects, including on the central nervous system (CNS), and thus may precipitate a spectrum of psychiatric and neurological disorders. Some patients with COVID-19 are now known to develop various CNS abnormalities with potentially serious and long term consequences, including stroke and isolated psychiatric syndromes. As COVID-19 cases rise again worldwide, Butler et al. review what we know and don’t know about the acute and chronic neuropsychiatric sequelae and their potential mechanisms.
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Content ArticleThis report, written in collaboration with the Royal College of Nursing (RCN), sets out proposals to reduce the number of preventable natural deaths in prisons. It identifies how natural deaths occurring in prison might be prevented, where possible, and end-of-life care managed with dignity and compassion.
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Content ArticlePeople aged under 60 who are hospitalised with COVID-19 are more likely than expected to experience severe psychiatric symptoms. Research found that altered mental states such as psychosis are being reported in these younger patients. It confirmed that strokes and other neurological symptoms are common in severe COVID-19. The authors are gathering and analysing more detailed clinical information about the patients reported in this study, and others reported since (540 are now included). They are seeking funding for a further study to include more clinical investigations such as analysis of spinal fluid, blood and brain imaging. Author Benedict Michael is co-chairing a World Health Organization commissioned task force which will consider how to use the information from the ongoing research project in guidance for clinicians. The task force will consider whether people with new-onset altered mental state or another acute neurological problem should be tested for COVID-19. Some patients with few respiratory signs present with this symptom. They will consider which tests and investigations people with COVID-19 and neurological symptoms should undergo. Doctors need to be sure COVID-19 is the cause of the symptoms, and to know how patients should be managed.
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Content ArticleThe number of publicly reported deaths from coronavirus disease 2019 (COVID-19) may underestimate the pandemic’s death toll. Such estimates rely on provisional data that are often incomplete and may omit undocumented deaths from COVID-19. Moreover, restrictions imposed by the pandemic (eg, stay-at-home orders) could claim lives indirectly through delayed care for acute emergencies, exacerbations of chronic diseases, and psychological distress (eg, drug overdoses). This study from Woolf et al. estimated excess deaths in the early weeks of the pandemic and the relative contribution of COVID-19 and other causes.
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Content ArticleApproximately 10% of patients with COVID-19 experience symptoms beyond 3–4 weeks. Patients call this 'long covid'. Greenhalgh et al. sought to document the lived experience of such patients, their accounts of accessing and receiving healthcare, and their ideas for improving services. They held 55 individual interviews and 8 focus groups with people recruited from UK-based long Covid patient support groups, social media and snowballing. Participants were invited to tell their personal stories and comment on other stories.
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Content ArticleNeurological symptoms are seen in patients with COVID-19 and can persist or re-emerge after clearance of SARS-CoV-2. Recent findings suggest that antibodies to SARS-CoV-2 can cross-react with mammalian proteins. Focusing on neurological symptoms, Kreye et al. discuss whether these cross-reactive antibodies could contribute to COVID-19 disease pathology and to the persistence of symptoms in patients who have cleared the initial viral infection.
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Content ArticleA study of more than a half-million people in India who were exposed to the novel coronavirus SARS-CoV-2 suggests that the virus’ continued spread is driven by only a small percentage of those who become infected. Furthermore, children and young adults were found to be potentially much more important to transmitting the virus — especially within households — than previous studies have identified, according to a paper by Laxminarayan et al. in the journal Science. Lead researcher Ramanan Laxminarayan, a senior research scholar in PEI, said that the paper is the first large study to capture the extraordinary extent to which SARS-CoV-2 hinges on “superspreading,” in which a small percentage of the infected population passes the virus on to more people. The researchers found that 71% of infected individuals did not infect any of their contacts, while a mere 8% of infected individuals accounted for 60% of new infections. “Our study presents the largest empirical demonstration of superspreading that we are aware of in any infectious disease,” Laxminarayan said. “Superspreading events are the rule rather than the exception when one is looking at the spread of COVID-19, both in India and likely in all affected places.”
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NHS e-Review platform
Patient Safety Learning posted an article in Regulatory bodies/standards/guidance
A national bespoke system, called NHS e-Review, has been developed and launched as part of the NHS Covid Incident Recovery programme. The online system has been developed to support clinicians record the clinical priority of patients on a waiting list and to identify alternative pathways for patients if required. -
Content ArticleHalf of COVID-19 patients who received a heart scan in hospital showed abnormalities in heart function, according to new research funded by the British Heart Foundation. In this study, Dweck et al. describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography.
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Content Article"Cancel everything” has trended as a hashtag during the coronavirus disease 2019 (COVID-19) pandemic, and for good reason. The pandemic has touched virtually every aspect of society, substantially altering, and at its onset halting, the very ways nearly every person in the United States works, learns, lives, and maintains health. The practice of surgery has not been immune, with emergency declarations by many states to suspend elective procedures and office visits in mid-March. While only temporary, this abrupt cessation of surgery has had far-reaching implications that can inform future approaches in the context of both crisis and uncertainty as Meredith et al. reflect on in this JAMA article.
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The BMJ interview: Anthony Fauci on COVID-19
PatientSafetyLearning Team posted an article in Coronavirus (COVID-19)
There are few better known authorities on the covid-19 pandemic than Anthony Fauci. One of the world’s most respected infectious disease experts, he spoke with The BMJ’s editor, Fiona Godlee, about the pressures of advising the US president, the challenging nature of the new coronavirus, and how the pandemic might end. -
Content ArticleTrusts and frontline staff are working flat out to restore those services which were necessarily interrupted to cope with the first peak of the pandemic. NHS Providers' Restoring services: NHS activity tracker highlights detailed examples of the innovations trusts and their staff developing to improve capacity, and respond to unmet demand despite the constraints created by COVID-19, and the need to prepare for additional winter pressures.
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Content ArticleSlow-lane logistics shouldn’t stymie fast-track science, says head of UK government’s Vaccine Taskforce, Kate Bingham, in this Nature article. Kate was appointed chair of the UK Vaccine Taskforce in May. The main job of this Taskforce is to identify, manufacture and develop the most promising pandemic vaccines and deliver them rapidly to the populations that need them. COVID-19 is an opportunity to create a permanent system for supplying vaccines for future pandemics, quickly and safely; this process must become as routine and reliable as crafting the yearly influenza vaccine, says Kate. Time and again, outstanding science has been slowed down by the ‘boring stuff’ — practicalities. That includes delays in manufacturing scale-up and legal approvals slowing pivotal US trials of one of my UK company’s potentially life-saving drugs, or progress hampered by logistics, regulatory disagreements and inadequate data disclosure. Often, the problem is not the science or the clinical trials, but the infrastructure. We must take pains now to make sure this does not stall future pandemic vaccines.
