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Sam

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  1. Sam
    The UK's chief medical officers have defended the Covid vaccination plan, after criticism from a doctors' union.
    The UK will give both parts of the Oxford and Pfizer vaccines 12 weeks apart, having initially planned to leave 21 days between the Pfizer jabs.
    The British Medical Association said cancelling patients booked in for their second doses was "grossly unfair".
    But the chief medical officers said getting more people vaccinated with the first jab "is much more preferable".
    Pfizer has said it has tested the vaccine's efficacy only when the two vaccines were given up to 21 days apart.
    But the chief medical officers said the "great majority" of initial protection came from the first jab.
    "The second vaccine dose is likely to be very important for duration of protection, and at an appropriate dose interval may further increase vaccine efficacy," they said.
    "In the short term, the additional increase of vaccine efficacy from the second dose is likely to be modest; the great majority of the initial protection from clinical disease is after the first dose of vaccine."
    Read full story
    Source: BBC News, 1 January 2021
  2. Sam
    England’s chief nurse has said that NHS and care staff are working incredibly hard to cope with record numbers of COVID-19 patients, amid concern that frontline staff are close to burnout.
    Ruth May pleaded with the public to follow the coronavirus advice to help relieve the pressure on hospital staff, after two days of record hospital admissions.
    Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, told BBC Breakfast that health employees were “tired, frustrated and fed up”.
    He said: “What is it going to be like over the next couple of months? I don’t know, I am worried. We are very much at battle stations.
    “There will be short-term surges of morale but people are tired, frustrated and fed up, as everybody is, whether they work in hospital or not. The people who go into emergency medicine expect it to be tough from time to time.
    “There is a real worry about burnout.”
    Read full story
    Source: BBC News, 1 January 2021
  3. Sam
    COVID-19 vaccinations should now be “immediately” rolled out to frontline staff, NHS England has told trust leaders.
    New instructions from the national body follow the approval today of the Oxford/AstraZeneca coronavirus vaccine, which NHS England said will “substantially to accelerate vaccine delivery”. Until now, only limited quantities of the Pfizer/BioNTech vaccine have been available.
    NHS staff are in the second priority category for covid vaccines, behind care home residents and alongside over 80s. But there have been complaints from clinicians around the country that they have been unable to get the jab, as well as uncertainty about how the vaccine deliveries should be divided between the priority groups.
    A letter to local leaders from NHS England says that until now, healthcare workers who have been identified at highest risk of serious illness from covid-19 have been given the vaccine in unfilled appointment slots.
    The letter, from chief executive Sir Simon Stevens and senior officials, now states: “Increased supply means that vaccination can also now immediately be expanded to frontline health and social care workers.”
    Read full story (paywalled)
    Source: HSJ, 31 December 2020
  4. Sam
    Plans to delay giving the second dose of a Covid vaccine to more than 500,000 people who have received the first jab have caused outcry among doctors who say cancelling appointments wastes time, causes confusion among patients and is potentially unethical.
    On Wednesday the government announced a change to its Covid vaccination strategy, saying second doses of the newly approved Oxford/AstraZeneca vaccine and the previously approved Pfizer/BioNTech jab would now be given up to 12 weeks after the first dose.
    The move applies to people scheduled to have their second dose of the Pfizer jab after 4 January, as well as those yet to receive either jab. The government said it hoped the approach would mean as many people as possible soon have some protection against the disease.
    However, the announcement caused controversy, with Pfizer and BioNTech warning that two doses of their vaccine were required for maximum protection against Covid and that they did not have evidence that the first dose alone offered protection after three weeks.
    Now doctors have said cancelling appointments for the second dose will take huge amounts of time and could lead to confusion.

    Read full story
    Source: The Guardian, 31 December 2020
  5. Sam
    Frontline doctors have testified to deteriorating conditions in hospitals in London and the south east as the NHS deals with a surge in COVID-19 cases.
    Speaking to the Independent SAGE group of experts on 30 December, Jess Potter, a respiratory doctor in east London, told how she and colleagues were afraid of resources running out.
    “My greatest fear is having a patient that I cannot provide lifesaving treatment to,” she said. “We had one of our largest medical intakes yesterday, the vast majority with coronavirus. What do we do when we run out of resources, and who is going to provide that guidance? It will harm our patients and our staff, because we have a set of values by which we practise, and we will have to reduce the level of care we deliver.”
    She added, “Back in April I never saw a case where we didn’t provide a bed to a patient who needed it in intensive care, and decisions were taken as if in normal times. Now I hear from medics across the country that things are very bad, and the situation is the same as in April, if not worse. We are afraid of what will happen if we don’t act now.”
    Sonia Adesara, a doctor in London, spoke to Independent SAGE after a set of night shifts at her trust and told of a chronic shortage of continuous positive airway pressure (CPAP) capacity.
    “In the past few days, despite my hospital significantly increasing intensive and critical care capacity, our intensive care unit has been full, and there is no spare CPAP capacity. Medics are spending shifts trying to closely monitor all of our patients who are on the highest level of oxygen that we can give with a normal mask, assessing who is most unwell and unstable—and then frequently checking on patients who are on CPAP and then swapping people [around]."
    Read full story
    Source: BMJ, 31 December 2020
  6. Sam
    People with allergies and pregnant women can now be given the country’s two approved COVID-19 vaccines, the medical regulator said on Wednesday.
    Previous advice from the Medicines and Healthcare products Regulatory Agency (MHRA) said people with a range of allergies to food and medicines should not be given the Pfizer vaccine.
    Dr June Raine, the MHRA’s chief executive, said growing evidence from a pool of at least 800,000 people in the UK and around 1.5 million people in the US who have had the vaccine has "raised no additional concerns".
    This, she continued, "gives us further assurance that the risk of anaphylaxis can be managed through standard clinical guidance and an observation period following vaccination of at least 15 minutes.
    Read full story
    Source: The Independent, 30 December 2020
  7. Sam
    Deaths from COVID-19 in England in the first half of 2021 could exceed those seen in the whole of 2020 unless the vaccination programme is vastly increased and a national lockdown implemented—with educational settings closed for at least a month—researchers have warned.
    In a preprint released on 24 December, researchers from the London School of Hygiene and Tropical Medicine used modelling to compare the effects of varying COVID-19 restrictions on the virus spread, hospital and intensive care admissions, and deaths from 15 December 2020 to 30 June 2021. The model took account of the new variant spreading rapidly in southern England, which it estimated to be 56% more transmissible than non-variant COVID-19.
    The study, which has yet to be peer reviewed, said that control measures similar to the November national lockdown would be “unlikely to reduce the effective reproduction number to less than 1, unless primary schools, secondary schools, and universities are also closed.” It added that it would be necessary to “greatly accelerate vaccine rollout to have an appreciable impact in suppressing the resulting disease burden.”
    Read full story
    Source: BMJ, 29 December 2020
  8. Sam
    Concerns are mounting over the number of coronavirus patients being admitted to hospitals in London as another NHS trust in the capital issued an urgent warning over its oxygen supplies.
    On Tuesday afternoon, the North Middlesex University Hospital Trust warned clinicians the numbers of coronavirus patients it was treating “was putting a strain” on the oxygen system, sparking several alarms.
    The trust currently has around 200 patients using oxygen with the trust consuming 2,400 litres of oxygen a minute. It normally uses around 1000 litres a minute and has a limit of 3,000 above which the system could cut out.
    It is only the latest hospital to face the problem – which is caused by the sheer demand for oxygen by sick Covid patients, which is more than the hospital piping can physically deliver.
    Read full story
    Source: The Independent, 30 December 2020
  9. Sam
    The Oxford-AstraZeneca vaccine has been approved for use in the UK, with the first doses due to be given on Monday amid rising coronavirus cases.
    The UK has ordered 100 million doses - enough to vaccinate 50 million people.
    This will cover the entire population, when combined with the full order of the Pfizer-BioNTech jab, Health Secretary Matt Hancock said.
    It comes as millions more people in England are expected to be placed under the toughest tier four restrictions.
    On Tuesday, 53,135 new Covid cases were recorded in the UK - the highest single day rise since mass testing began - as well as 414 more deaths within 28 days of a positive test.
    Read full story
    Source: BBC News, 30 December 2020
  10. Sam
    A major incident has been declared in Essex amid fears the number of COVID-19 cases could overwhelm the county's health services.
    The Essex Resilience Forum (ERF) said "growing demand" was putting stress on hospitals and social care settings.
    On Tuesday Mid and South Essex NHS Trust placed all three of its hospitals on critical alert.
    All of Essex is in tier four and the south of the county has some of the worst-affected districts in England.
    Essex Police Chief Constable BJ Harrington, who is co-chairman of the ERF, said declaring a major incident allowed it "to seek further support from the government to address the severe pressures which the health system is under".
    The forum said the number of patients being treated for Covid in the county had exceeded the levels seen at the peak of the first wave and "these levels are likely to increase further in the coming days".
    The ERF - comprised of health services, blue light responders and councils - said issues included "critical care and bed capacity, staff sickness/self-isolation levels and the system's ability to discharge patients quickly into safe environments".
    Mr Harrington urged the public to continue only dialling 999 or attending A&E in an emergency.
    Read full story
    Source: BBC News, 30 December 2020
  11. Sam
    The flagship Nightingale hospital is being dismantled as medics warn that there are not enough staff to run the facilities despite the NHS being at risk of being overwhelmed by coronavirus.
    Amid surging virus case numbers, elective surgery is being cancelled as the number of patients in hospitals in England passes the peak of the first wave in April. 
    Although the NHS is "struggling" to cope, the majority of the seven Nightingale hospitals, created at a cost of £220 million, have yet to start treating COVID-19 patients during the second wave. The Exeter Nightingale has been treating Covid patients since mid-November. 
    The facility at London's Excel centre has been stripped of its beds and ventilators.
    The NHS has told trusts to start preparing to use the overflow facilities in the coming weeks, but bosses have failed to explain how they will be staffed.
    Read full story (paywalled)
    Source: The Telegraph, 28 December 2020
  12. Sam
    All vulnerable people will have been offered a coronavirus vaccination by “late spring” the head of NHS England has said as he warned the health service was “back in the eye of the storm.”  
    In a New Year message, Sir Simon Stevens described 2020 as the “toughest year” and he paid tribute to nurses, doctors, therapists and other NHS staff including hospital cleaners, carers and volunteers as well as care home staff.
    Sir Simon visited a new vaccination centre on Monday saying: “We think that by late spring with vaccine supplies continuing to come on stream we will have been able to offer all vulnerable people across this country Covid vaccination. That perhaps provides the biggest chink of hope for the year ahead.”
    His comments came as the NHS in London was said to be “teetering on the edge” as latest data showed the numbers of hospital admissions in the capital jumped more than 200 per cent since the end of lockdown on 2 December.
    Read full story
    Source: The Independent, 29 December 2020
  13. Sam
    Cases of anorexia and other eating disorders have quadrupled in some areas during the coronavirus pandemic, doctors say.
    The Royal College of Paediatrics and Child Health (RCPCH) issued an alert to parents, saying the Christmas and new year period can be stressful for young people who struggle with disordered eating.
    That comes on top of massive disruption to schooling and other areas of life due to Covid-19 which has led to a loss of physical and social activity, plus money worries and bereavement for some.
    “In our tier 4 under 13s mental health inpatient unit we have seen a three- to fourfold increase in children referred to our service with eating disorders, and they are just the tip of the iceberg.” Dr Nancy Bostock, a consultant in Cambridge, said in a statement provided by the college.
    Read full story
    Source: The Independent, 29 December 2020
  14. Sam
    Health workers are "back in the eye of the storm" as coronavirus cases continue to rise, NHS England's chief executive Simon Stevens has said.
    It has been the "toughest year" for the NHS, which has treated 200,000 severely ill Covid-19 patients, he added.
    Hospitals in England are currently treating more Covid patients than at the peak of the first wave in April.
    A government scientific adviser has warned national restrictions are needed to prevent a "catastrophe".
    On Monday, a record 41,385 new Covid cases were reported in the UK, though it is thought the infection rate was higher during spring when testing was much more limited.
    NHS England said 20,426 people were being treated for the virus in hospitals in England on Monday, which is higher than the previous peak of about 19,000 in April.
    Read full story
    Source: BBC News, 29 December 2020
  15. Sam
    With the excitement of the Covid vaccine’s arrival, it may be easy to forget and ignore those of us with “long Covid”, who are struggling to reclaim our previous, pre-viral lives and continue to live with debilitating symptoms. Even when the NHS has managed the herculean task of vaccinating the nation, COVID-19 and the new mutant variants of the virus will continue to circulate, leaving more people at risk of Long Covid. Data from a King’s College London study in September suggested as many as 60,000 people in the UK could be affected, but the latest statistics from the Office for National Statistics suggest it could be much higher.
    Joanna Herman is a consultant in infectious diseases. "Long Covid' is anything but a mild illness". Nine months on from having the virus, she is seriously debilitated. She explains how the new NHS clinics need to help the thousands of people with Long Covid.
    Read full story
    Source: The Guardian, 27 December 2020
  16. Sam
    New planning guidance asks local NHS organisations to prepare for a major waiting-list catch-up by seeking “top quartile performance in productivity”, but also to “safely mobilise all… available surge capacity over the coming weeks” as the service battles rising covid levels “in almost all parts of the country”. 
    An end-of-year planning letter was issued by NHS England to local NHS chief executives last night.
    It warns: “With covid-19 inpatient numbers rising in almost all parts of the country, and the new risk presented by the variant strain of the virus, you should continue to plan on the basis that we will remain in a level 4 incident for at least the rest of this financial year and NHS trusts should continue to safely mobilise all of their available surge capacity over the coming weeks.
    “This should include maximising use of the independent sector, providing mutual aid, making use of specialist hospitals and hubs to protect urgent cancer and elective activity and planning for use of funded additional facilities such as the Nightingale hospitals, Seacole services and other community capacity.”
    Read full story (paywalled)
    Source: HSJ, 24 December 2020
  17. Sam
    Staff at a teaching hospital which has struggled with emergency care pressure this winter have warned that patient safety is being compromised as crowding is becoming “normalised”.
    A letter sent by a group of clinical staff at Cambridge University Hospitals Foundation Trust to the trust board calls for immediate action to tackle concerns.
    It says: “The normalisation of crowding, the lack of effective flow management and the lack of effective escalation policies and procedures are resulting in patient safety, dignity and comfort being repeatedly and seriously compromised.”
    Details of the letter were shared with HSJ but it is unclear how many and which staff it is signed by.
    Read full story (paywalled)
    Source: HSJ, 23 December 2020
  18. Sam
    NHS England has told hospitals to begin planning for the use of Nightingale Hospitals as the numbers of coronavirus patients in hospitals is expected to surge in coming weeks.
    In a letter sent on Wednesday night hospitals were told to activate all of their emergency capacity to cope with the expected pressures over the coming weeks.
    This is likely to mean the mass redeployment of staff and designating wards, surgical theatres and recovery areas as makeshift intensive care units for patients.
    NHS England did not explain how the Nightingale Hospitals would be staffed if the decision was made to activate them.
    Read full story
    Source: The Independent, 24 December 2020
  19. Sam
    More than a quarter of a million patients living with heart failure could be eligible for a new drug that reduces deaths and hospitalisation after medical regulators gave it the greenlight.
    The National Institute for Health and Care Excellence (Nice) has approved dapagliflozin, made by AstraZeneca, for use on the NHS.
    It can help treat patients with a form of chronic heart failure that means their blood does not pump blood out to the body as well as it should.
    It is estimated almost one million people are living with heart failure in the UK which causes an estimated 65,000 unplanned hospital admissions a year. Around half of patients will die within five years of being diagnosed.
    Evidence from a clinical trial shows that adding dapagliflozin to standard care lowers the risk of dying from heart disease and decreases hospitalisation or an urgent outpatient visit because of heart failure by 26% compared with standard care alone.

    Read full story
    Source: The Independent, 24 December 2020
  20. Sam
    An ambulance crew had to wait seven hours to hand over a patient in the West Midlands, it has been revealed.
    The case on 11 December was highlighted in the West Midlands Ambulance Service's in-house magazine, which said average waits had "ballooned".
    It said average waits at one hospital were running at nearly three hours in early December.
    The ambulance service said it hoped to put another 40 crews on the road by January.
    Delays in hospitals taking over care of patients is considered "risky", NHS England said, because it not only delayed patients receiving specialist assessment and treatment, but also reduced the number of ambulances available to respond to emergencies.
    The West Midlands trust's weekly briefing magazine, published on 17 December, said only the East of England trust had experienced a similar level of "horrendous" delays. It added that another four hospitals in the West Midlands had average delays of about two hours.
    The "knock-on" effect it said was some high-risk patients were waiting longer for an ambulance than they should.
    Meanwhile, some staff had to work late beyond their shifts and missed meal breaks.
    Read full story
    Source: BBC News, 23 December 2020
  21. Sam
    Women are undergoing “painful and distressing” diagnostic tests as doctors use the COVID-19 pandemic as an excuse not to offer them their choice of pain relief, HSJ has been told.
    At least 70 women who have had hysteroscopies this year in English NHS hospitals said they were left in extreme pain following the procedures, with many suffering trauma for several days, according to a survey by the Campaign Against Painful Hysteroscopies group.
    Some women claimed doctors used COVID-19 as an “excuse” not to offer sedation or general anaesthetic. Others said they were offered an inpatient appointment with general anaesthetic, but were also told it would be a long wait and would likely be cancelled due to covid pressures.
    Women also said they were told an outpatient procedure would reduce the time spent in hospital and consequently reduce the risk of contracting covid. The only pain relief on offer was often just ibuprofen and some women said facilities like recovery rooms were unavailable.
    The vast majority of the women surveyed — more than 90% — said they were traumatised for a day or longer by the pain from the procedure,
    A RCOG spokeswoman said: “We are concerned to hear that women are going through painful and distressing hysteroscopy procedures and that they feel COVID-19 is being used as an excuse not to offer a choice of anaesthetic."
    “The covid-19 pandemic has put incredible strain on the health services, and the risk of transmission of the virus has meant they’ve had to adapt their procedures. Whilst all women should be offered a choice of anaesthesia and treatment settings for hysteroscopic procedures, an outpatient setting avoids hospital admission and reduces the risk of exposure to the virus."
    “The RCOG guidance on this is very clear — all pain relief options should be discussed with women, as well as the risks and benefits of each. Women should be given the choice of a local or general anaesthetic. If the procedure is still too painful, no matter what anaesthetic options are chosen, it must be stopped and a further discussion of pain relief options should then take place. It’s vital that women are listened to and their choice is fully supported.”
    Read full story
    Source: HSJ, 21 December 2020
  22. Sam
    A major London trust’s critical care staff have urged leaders to review elective work targets amid serious concerns over workload, safe staffing and burnout, HSJ  has learned.
    In a letter to Guy’s and St Thomas’ Foundation Trust’s board, staff represented by trade union Unite said they had “repeatedly” raised concerns about the provider’s approach to elective work, as well as winter pressures and second wave planning, and the implications this has had for “the health, safety and wellbeing of both staff and patients”. 
    The letter — which was also addressed to the trust’s health and safety committee and has been seen by HSJ —  said: “Our primary concern is that the trust’s endeavours, and understandable need to square these circles, may be unrealistic given the current pressures on staffing and the high rates of sickness and burnout the trust is continuing to experience.
    “This is especially in critical care, where we are concerned this may compromise patient safety and is already damaging staff wellbeing and morale.”
    Read full story (paywalled)
    Source: HSJ, 18 December 2020
  23. Sam
    Think 2020 has been awful for the NHS? Next year is shaping up to be far worse – and most of the huge hole it’s in was dug long before Covid. The virus has merely finished off the job.
    The health service does not have the beds, staff or equipment to recover the ground it lost during the first two waves of the coronavirus pandemic, but the government is blocking desperately needed improvements, and another round of organisational upheaval is on its way.
    Roughly one in 11 clinical posts are vacant, and it would hardly be a surprise to see many staff rush for the retirement door once the worst of the pandemic is behind us. The NHS can’t solve the problem without long-term certainty over funding for staff.
    Around 140,000 patients in England have been waiting more than a year for surgeries such as a hip replacements, up a hundredfold from a year ago. With the whole system beset by delays long before we had even heard of coronavirus, the lack of spare capacity means it will take years to help many patients.
    Unprecedented interruptions and delays to cancer tests and treatments have been exacerbated by the pitiful state of diagnostic equipment. Access to CT and MRI scanners is far behind countries with a fraction of our wealth, such as Slovenia and Slovakia. Y
    In the midst of all this turmoil, the NHS in England faces another round of legislative and organisational upheaval next year, the likely arrival of a new chief executive, and a potential fight with Downing Street over the extent of political control.
    Read full story
    Source: The Guardian, 18 December 2020
  24. Sam
    The year 2020 has been extraordinary. It would have been inconceivable 12 months ago that the process of developing and testing medicines would be a topic of intense political and public interest. The UK pharmaceutical sector has taken centre stage, with more support than ever before for Britain’s gold-standard regulatory framework. 
    After a difficult year, this winter has seen a steady drumbeat of positive news about COVID-19 vaccines, demonstrating that the pharmaceutical industry can deliver world-leading clinical research at pace and at scale within the UK’s regulatory system.
    As the crisis of the COVID-19 pandemic hopefully eases over the coming months and the transition period for Britain’s exit of the EU comes to an end, we must seize the opportunity to strengthen this framework.   
    Read full story
    Source: New Statesmen, 14 December 2020
  25. Sam
    Research by a group of doctors has found ‘major deficiencies’ around infection control within hospitals in the North West region.
    The study looked at trusts’ adherence to Public Health England guidance around limiting the spread of COVID-19 within orthopaedic services.
    The study found patients were routinely being allocated to hospital beds before they had been confirmed as covid-negative, “thus allowing spread of COVID-19 not only between patients but also between nursing and medical staff”.
    Fewer than half of patients were nursed with the appropriate screens in place, while it was uncommon for doctors to be tested regularly.
    Separate statistics published by NHS England suggest almost 20 per cent of new covid cases in North West hospitals from August to December were likely to be nosocomial, meaning they were acquired on the wards.
    This was a higher proportion than any other region.
    Read full story
    Source: HSJ (paywalled), 16 December 2020
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