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The three vital lessons Italian hospitals have learned in fighting COVID-19

Protection for staff, clean covid-negative wards, and enforcing social isolation are the three take home messages from Italy’s fight against COVID-19, according to rapid findings shared exclusively with HSJ.

By 6 March 2020, Italy had recorded 4,636 cases and 197 deaths attributable to COVID-19. On 20 March, two weeks later, the UK announced 3,983 cases and 177 deaths due to the novel coronavirus.

Models put us two weeks behind Italy and on the same trajectory. PanSurg.org, an international collaborative created at Imperial College London, organised a series of webinars to rapidly share experiences and learning around the pandemic amongst the global healthcare community. Nearly 1,000 healthcare professionals from around the world took part in these events, and several important messages emerged.

1) Protect your staff: full PPE (including, FFP3 masks) for COVID-19 suspected or COVID-19 positive areas. This is both for them and to keep your workforce numbers intact.

2) Treat everyone as if they could haveCOVID-19, as they may do and “fear the covid negative ward”.

3) Enforce social isolation and contact tracing and place a significant focus on testing.

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Source: HSJ, 25 March 2020

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Practices asked to help identify patients most vulnerable to Covid-19

GP practices should review 1.5 million patients identified by NHS England as the most vulnerable to the coronavirus.

NHS England will send a standard letter to these patients asking them to stay at home at all times and avoid any face-to-face contact for at least 12 weeks.

GPs will be able to access a report on which patients will be contacted with specific advice, with NHS England directing GPs to review the list and provide additional support to patients.

The patients, who are at ‘the highest risk of severe illness that would require hospitalisation from coronavirus’, include those who have had an organ transplant; people with specific cancers; people with severe respiratory conditions; people with rare diseases; people on immunosuppression therapies; and pregnant women with significant heart disease.

In a letter to GPs, NHS England said: "We ask that you review this report for accuracy and, where any of these patients have dementia, a learning disability or autism, that you provide appropriate additional support to them to ensure they continue receiving access to care."

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Source: Management in Practice, 24 March 2020

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We face a pandemic of mental health

Currently we have a frightening, deadly viral pandemic, but there will another plague, one we are not hearing nearly enough about from our leaders, which will arrive in a wave just behind it, reports Paul Daley in the Guardian. 

There will be a pandemic of severe depression and anxiety that will sweep over the world as the unemployment rate pushes into previously unseen digits, families who’d prefer to be socially distant are thrust together and young people are denied the certainty and structure of school.

We will need to support – medically, financially, emotionally and psychiatrically – those who are going to do it hardest. Psychiatric support services will need to be dramatically bolstered to fight this mental health pandemic

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Source: The Guardian, 24 March 2020

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Frantic action to stop London ‘running out of beds in four days’

Details of a massive ramp-up in intensive care beds have been circulated to NHS bosses in London, amid concerns from national leaders that they are four days away from full capacity.

In a call with local leaders, the NHS’ national director for mental health, Claire Murdoch, spoke about the intense pressures facing the acute system due to the coronavirus outbreak.

According to several people on the call, she said London “runs out of [ICU] beds in four days” if urgent action is not taken. She also warned the need for intensive care beds will now double every three days, the sources said.

The capital’s hospitals are frantically planning to try to quadruple their “surge capacity” in intensive care over the next fortnight, from around 1,000 surge beds over the weekend just passed, to more than 4,000 in two weeks’ time. 

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Source: HSJ, 24 March 2020

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Covid-19: medical students should not work outside their competency, says BMA

Medical students who are employed in the NHS as part of efforts to swell staff numbers to tackle covid-19 should not be expected to “step up” and act outside of their competency, says the BMA in new guidance.

This is the first set of guidance released by the BMA specifically for medical students, who have had placements and exams cancelled and are uncertain about how they might be employed in the NHS in the current crisis. It says that any employment should be voluntary and within the competency of the student, who should have adequate access to personal protective equipment.

The BMA refers to General Medical Council guidance that states that plans are not currently in place to move provisional registration forward from the normal August date. It warns that there are concerns around the boundaries of practice and the level of supervision that students who take on roles in the NHS would have, which could lead to unsafe working practices. The BMA is in talks to negotiate a safe national contract for such roles.

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Source: BMJ, 24 March 2020

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Government buys 3.5m tests and promises staff checks ‘online soon’

The government has bought 3.5 million coronavirus antibody tests — with more widespread testing of NHS workers coming “online soon”, the health secretary has said.

Matt Hancock also told a press conference this evening that a new testing facility had been opened in Milton Keynes as the government aims to “ramp up” the number of antibody tests — which will determine whether people have had the virus and can therefore return to work.

Mr Hancock also said the government had shipped 7.5 million pieces of personal protective equipment over the last 24 hours, following major shortages, and confirmed the conversion of east London’s Excel centre into a huge temporary hospital facility, with between 500 to 4,000 beds.

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Source: HSJ, 24 March 2020

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GP given masks with expiry dates that have passed

A GP has criticised the practice of giving doctors surgical masks with expiry dates that have passed.

Dr Kate Jack said doctors felt "like cannon fodder" after discovering the paper masks had expired in 2016. A box delivered to her Nottingham surgery had a 2021 label placed over the original date of 2016.

The Department of Health and Social Care (DHSC) said equipment underwent "stringent tests" and was given a "new shelf-life" where appropriate.

"I don't feel protected at the moment," said Dr Jack, a GP of 22 years. "They are really not designed for prevention of infection and are practically useless."

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Source: BBC News, 25 March 2020

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Staff in ‘near revolt’ over protective gear crisis

Lack of staff testing, workforce shortages and running out of personal protective equipment (PPE)are the three biggest concerns for trusts fighting the coronavirus outbreak, according to an HSJ chief executive survey conducted over the last 36 hours.

Thirteen of the 34 trust chief executives who responded to the snap survey, who were from trusts across England, also warned they would run out of intensive care capacity by next week as the number of coronavirus cases continue to rise.

The survey also revealed some trusts were already being forced to dilute safe staffing ratios and ration facilities. One chief warned: “We are preserving ventilation capacity by ensuring that only those who may survive are considered.”

However, the majority of respondents were supportive of system leaders’ guidance so far. Several respondents praised the “impressive pace and detail of the advice."

The three biggest areas of concern raised by the chiefs surveyed were:

  • Lack of staff testing, raised by 26 of the 34 respondents (77%);
  • Staff shortages, raised by 26 of the 34 respondents (77%); and
  • PPE shortages, raised by 23 of the 34 respondents (68%.

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Source: HSJ, 24 March 2020

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"There have been stories of doctors having to go to Screwfix to find themselves masks"

UK doctors fighting coronavirus still say they don't have personal protective equipment (PPE). 

Jon Snow spoke to Dr Jenny Vaughan, a leading member of the Doctors’ Association  who have written to the government to demand better personal protective equipment for medical staff.

He asked her whether the PPE equipment promised by the government was starting to reach the medical staff on the frontline, and what kinds of problems medical personnel had been encountering.

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Source: Channel 4 News, 23 March 2020

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UH partners with Masimo to pilot remote patient monitoring tool to aid COVID-19 response efforts

University Hospitals has partnered with medical technology company Masimo to pilot a telehealth solution, Masimo SafetyNet, that is designed to help clinicians care for patients remotely with a finger sensor and phone app.

The demand for remote monitoring and patient engagement in different settings has "significantly increased" during the COVID-19 pandemic. To help prepare for a surge in COVID-19 patients and protect other patients and providers, the tool allows University Hospitals and other hospitals to expand patient monitoring to the home or other locations (for instance, a skilled nursing facility or an under-utilised med-surg floor) that are temporarily set up to address increased demand.

Guidelines from the World Health Organization suggest monitoring the oxygen saturation, respiration rate and temperature of suspected or confirmed COVID-19 patients. Adapting this existing technology aims to offer a secure remote solution.

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Source: Crain's Cleveland Business, 23 March 2020

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Top NHS doctor warns frontline staff battling coronavirus are "lambs to the slaughter"

A leading NHS doctor has warned frontline medical staff dealing with Britain’s coronavirus outbreak feel like “cannon fodder” and "lambs to the slaughter".

Dr Rinesh Parmar, chairman of the Doctor's Association UK, is battling the disease on an intensive care ward at a city hospital in Birmingham.

The Anaesthetic Registrar begged Boris Johnson to provide better Personal Protective Equipment (PPE), describing the current crisis the "calm before the storm"

Doctors and nurses fear a lack of masks, gloves, aprons and protective suits is putting them at risk as they care for patients diagnosed with Covid-19.

Speaking after a night shift on the ward, Dr Parmar told The BBC's Andrew Marr Show: "We have had doctors tell us they feel like lambs to the slaughter, that they feel like cannon fodder. GPs tell us that they feel absolutely abandoned."

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Source: The Sun, 23 March 2020

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Intensive care staffing ratios dramatically diluted

The staff-to-patient ratios for intensive care are being dramatically reduced as the NHS seeks to rapidly expand its capacity to treat severely ill covid-19 patients, HSJ has learned.

Acute trusts in London have been told to base their staffing models for ICU on having one critical care nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants. 

Trusts have also been told by NHS England and NHS Improvement’s regional directorate to plan for one critical care consultant per 30 patients, supported by two middle grade doctors. The normal guidance is the consultant-to-patient ratio “should not exceed a range between 1:8-1:15”.

Nicki Credland, chair of the British Association of Critical Care Nurses, confirmed the plans had been agreed today nationally.

She told HSJ: “There will absolutely be a lot of concern about this in the profession, but it’s the only option we’ve got available. We simply don’t have the capacity to increase our staffing levels quickly enough."

“It will dilute the standard of care but that’s absolutely better than not having enough critical care staff. There’s also a massive issue around the ability of critical care nurses not only to care for their patients but also monitor what the non-specialists in their teams are doing.”

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Source: HSJ, 24 March 2020

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Cancer treatment delayed as patient priority lists drawn up

Delays have begun to cancer treatments, as patients are reprioritised ahead of capacity becoming overwhelmed by the coronavirus crisis.

In three separate developments:

  • A London trust announced it was cancelling chemotherapy and routine cancer operations for a fortnight due to coronavirus pressure;
  • An NHS England covid-19 guidance document indicated palliative care cancer patients will be less likely to receive appropriate treatment; and
  • Cancer waiting times guidance has been changed to provide for some urgent referrals for suspected cancer to be sent back to GPs without diagnosis.

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Source: HSJ, 23 March 2020

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Coronavirus: The new inventions inspired by a pandemic

A new ventilator, a virus-killing snood and a hands-free door pull are just some of the innovations coming out of Wales to tackle coronavirus.

Since the outbreak, doctors, scientists and designers have been working on ideas to stop the virus spreading.

The ventilator has already successfully treated a Covid-19 patient and has been backed by the Welsh Government.

Mass production of the snood-type mask is under way while a 3D design of the handle has been widely circulated.

Plaid Cymru leader Adam Price, who was part of the impetus to get the ventilator into mass production, said the innovations put Wales "on the front foot" in the battle against the pandemic.

"It shows that Wales, as a small nation, can get things done quickly as we face the biggest challenge of our generation," he said.

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Source: BBC News, 24 March 2020

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Protect NHS workers from coronavirus urgently, says Hunt

The NHS must ensure that doctors have proper protective equipment, Jeremy Hunt, the former health secretary, has urged.

NHS chiefs say that there are no problems with national stock levels of items including masks, gowns and gloves and that local supply issues should have been resolved over the weekend.

However, hospital staff say that they are still experiencing shortages, with nurses going to DIY shops to stock up or even refusing to work without the right equipment. One London doctor said: “Every time the government is asked they say the equipment is there, and it is just not true.”

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Source: The Times, 23 March 2020

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FDA approves first bedside COVID-19 test by Danaher’s Cepheid

A Covid-19 test can deliver results in less than an hour has been approved under an FDA emergency authorization, marking the first test that clinicians can use at the bedside.

Cepheid, a Silicon Valley molecular diagnostics company that’s a unit of Danaher Corp., announced Saturday it received an emergency authorisation from the U.S. Food and Drug Administration to use the test, making it the 13th Covid-19 test the agency has allowed on the market as long as the public health emergency exists.

But it’s the first one that can be used at the point of care, meaning providers don’t have to send patient samples to a separate lab to be processed and then come back to the hospital or provider’s office. Cepheid said it expects to start shipping tests next week.

“An accurate test delivered close to the patient can be transformative — and help alleviate the pressure that the emergence of the 2019-nCoV outbreak has put on healthcare facilities that need to properly allocate their respiratory isolation resources,” said David Persing, Cepheid Chief Medical and Technology Officer.

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Source: Bloomberg, 21 March 2020

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WHO Health Alert brings COVID-19 facts to billions via WhatsApp

WHO has launched a messaging service with partners WhatsApp and Facebook to keep people safe from coronavirus.

This easy-to-use messaging service has the potential to reach 2 billion people and enables WHO to get information directly into the hands of the people that need it.

From government leaders to health workers and family and friends, this messaging service will provide the latest news and information on coronavirus including details on symptoms and how people can protect themselves and others. It also provides the latest situation reports and numbers in real time to help government decision-makers protect the health of their populations.

The service can be accessed through a link that opens a conversation on WhatsApp. Users can simply type “hi” to activate the conversation, prompting a menu of options that can help answer their questions about COVID-19.

The WHO Health Alert was developed in collaboration with Praekelt.Org, using Turn machine learning technology.

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Source: World Health Organization, 20 March 2020

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Mental health charity slams Government's ‘irresponsible’ coronavirus bill

A mental health charity has branded as “irresponsible” the Government’s coronavirus bill which would grant single doctors the power to detain the mentally ill.

The Government wants to relax legal safeguards in the Mental Health Act in order to free up medical staff to deal with the COVID-19 pandemic. If passed, the bill would reduce the number of doctors needed to approve detaining individuals from the current minimum of two, to just one.

In addition, it would temporarily allow time limits in the Mental Health Act to be extended or removed altogether. This would mean patients currently detained in mental health facilities could be released into the community early, or be detained for longer.

Akiko Hart, Chief of National Survivor User Network (NSUN), a UK mental health charity, said: “Whilst we understand that these are unprecedented times, any legislative change must be proportionate and thought through, and should protect all of us. Minimising some of the safeguards in the Mental Health Act and extending its powers, is a step in the wrong direction.”

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Source: The London Economic, 19 March 2020

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Coronavirus: Doctors given new guidelines on choosing which patients to treat in critical care

New guidelines have been published to help doctors and nurses decide how to prioritise patients during the coronavirus pandemic.

The advice from the National Institute for Health and Care Excellence (NICE) was produced amid concerns that the NHS would be overwhelmed by the demand for intensive care beds and ventilators.

The three new NICE guidelines, which have been drawn up within a week rather than the usual timescale of up to two years, cover patients needing critical care, kidney dialysis and cancer treatment.

They say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”.

Decisions about admitting patients to critical care should consider how likely they are to recover, taking into account the likelihood of recovery “to an outcome that is acceptable to them”.

Doctors are advised to discuss possible “do not resuscitate” decisions with adults who are assessed as having increased frailty, such as those who need help with outside activities or are dependent for personal care.

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Source: Independent, 22 March 2020

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Machine 'could quadruple' heart and lung transplants

The number of heart and lung transplants could quadruple thanks to a "reanimation" machine used in a pioneering operation, a hospital says.

The device, developed at Royal Papworth Hospital in Cambridge, managed to pump oxygenated blood into both organs in a world-first procedure. The machine can revitalise deteriorating organs allowing "donation after circulatory death" (DCD).

Hospital surgeon Pedro Catarino said it was like "recharging the batteries".

"It is reanimation and then it replenishes the energy stores of the heart, what we call reconditioning, which allows it be transplanted," he said. "We think it could at least double and perhaps quadruple the number of [heart and lungs] available for transplant."

He said it was desperately needed, adding: "Patients die on the waiting list every day."

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Source: BBC News, 23 March 2020

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Coronavirus: Hancock admits ‘challenges’ over NHS equipment

The health secretary has acknowledged there have been "challenges" with the supply of personal protective equipment to NHS staff in England - but added he is determined to rise to them.

Last week, NHS staff said the lack of protective gear was putting them at risk during the coronavirus outbreak.

Matt Hancock said a million face masks had been bought over the weekend and he was taking the issue "very seriously".

From this week, the Army will play a part in helping to distribute supplies.

"I am determined to ensure that the right kit gets to the right hospital, the right ambulance service, the right doctors' surgery, right across the country," said Mr Hancock.

"There have been challenges and I can see that. We're on it and trying to solve all the problems."

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Source: BBC News, 23 March 2020

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Nurses treating coronavirus spat at and called ‘disease spreaders’

Nurses caring for patients in the community have been spat at and called ‘disease spreaders’ by members of the public, according to England’s chief nurse and the Royal College of Nursing (RCN).

The nursing union urged members of the public to support the UK’s “socially critical” nursing workforce during the coronavirus outbreak.

The RCN said it had received anecdotal reports of community nurses receiving abuse while working in uniform. Separately, England’s Chief Nurse Ruth May said she had heard reports of nurses being spat at.

Susan Masters, the RCN’s director of policy, said abuse of nurses was “abhorrent behaviour”. She said a number of nurses had raised concerns about abuse on forums used by members to talk confidentially.

Describing one incident she told The Independent: “These were community nurses who had to go into people’s homes and were in uniform. Members of the public who saw them called out to them and said they were ‘disease spreaders’.”

She added: “We don’t know how big this problem is, it is anecdotal, but it is absolutely unacceptable.

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Source: The Independent, 21 March 2020

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Coronavirus: Doctors urge conversations about dying

Palliative care doctors are urging people to have a conversation about what they would want if they, or their loved ones, became seriously unwell with coronavirus.

We should discuss all possible scenarios - even those we are not "comfortable to talk about", they said. Medics said the virus underlined the importance of these conversations.

New guidelines are being produced for palliative care for Covid-19 patients, the BBC understands.

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Source: BBC News, 21 March 2020

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Hospital’s critical care unit overwhelmed by coronavirus patients

A major London hospital has declared a “critical incident” due to a surge in patients with coronavirus, with one senior director in the capital calling the development “petrifying”.

In a message to staff, Northwick Park Hospital in Harrow said it has no critical care capacity left and has contacted neighbouring hospitals about transferring patients who need critical care to other sites.

The message, sent last night and seen by HSJ, said: “I am writing to let you know that we have this evening declared a ‘critical incident’ in relation to our critical care capacity at Northwick Park Hospital. This is due to an increasing number of patients with Covid-19.

“This means that we currently do not have enough space for patients requiring critical care.

“As part of our system resilience plans, we have contacted our partners in the North West London sector this evening to assist with the safe transfer of patients off of the Northwick Park site”

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Source: HSJ, 20 March 2020

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Efforts to reduce stillbirths, deaths, and injuries in babies have failed, finds review

A campaign to reduce stillbirths, brain injury, and avoidable deaths in babies has failed to have any effect in the past three years, findings from the Royal College of Obstetricians and Gynaecologists show.

The president of the college, Edward Morris, has urged maternity units across the UK to learn from the latest report and act on its recommendations. “We owe it to each and every person affected to find out why these deaths and harms occur in order to prevent future cases where possible,” he said.

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Source: BMJ, 19 March 2020

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