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News Article
Growing number of trusts defy system leaders on FFP3 guidance
Patient Safety Learning posted a news article in News
Over 30 trusts are now mandating FFP3 masks are used beyond settings stipulated in national rules, amid calls for system leaders to clarify the national position on the key staff and patient safety issue. Fresh Air NHS, a group of frontline staff who campaign for better protection against Covid-19, said it now knows of 32 trusts which have already introduced enhanced infection prevention control policies that mandate FFP3 use beyond national guidance. News that a growing number of trusts are mandating more stringent PPE use comes amid fresh confusion around the national guidance after small but potentially significant alterations were made last week. A new line has been added to guidance which says:: “FFP3 respirator or equivalent must be worn by staff when caring for patients with a suspected or confirmed infection spread by the airborne route.” David Tomlinson, consultant cardiologist and also a member of Fresh Air NHS, said NHS trusts were “in fear of going beyond the guidance and allowing non-ICU staff to wear FFP3 respirators”. “The guidance doesn’t mandate respirators for staff in highest risk of transmission areas, for example, medical wards housing symptomatic patients at a time in their disease when they are releasing greatest amounts of infectious aerosols,” Dr Tomlinson said. “Real world data has consistently shown far greater rates of SARS2 infection comparing non-ICU healthcare workers to those on ICU.” Alison Leary, chair of healthcare and workforce modelling at London Southbank University, said: “Trusts choosing to implement evidence based safety interventions is a positive move towards workforce safety.” Read full story Source: HSJ, 27 January 2022 -
News Article
Period changes after Covid jabs are short-lived
Patient Safety Learning posted a news article in News
Small changes to periods can follow a Covid vaccine but they quickly return to normal, a leading UK menstruation expert has said. Dr Victoria Male, from Imperial College London, called studies from the US and Norway which tracked women's cycles "reassuring". And she blamed misinformation for fuelling concerns over infertility. The Medicines and Healthcare products Regulatory Agency (MHRA) says there is no evidence Covid vaccines affect the ability to have children. The MHRA has received more than 37,000 reports of unexpected vaginal bleeding, heavier and delayed periods after a Covid jab. It has always said there is no evidence of a link to the vaccine, because women's cycles vary naturally - but scientists called for more research. Dr Male said: "Changes to the menstrual cycle do occur following vaccination - but they are small compared with natural variation and quickly reverse." Women's concerns arose "from misinformation that Covid-19 vaccines cause female infertility", she said. And more studies of pregnancy rates in couples trying to conceive were needed to make it clear they do not. A Covid infection, however, "may reduce sperm count and quality" - and understanding more about that would mean patients could be given the right advice. Read full story Source: BBC News, 27 January 2022 -
Content ArticleIn this article for Nature, Aris Katzourakis, Professor of Evolution and Genomics at the University of Oxford, highlights misconceptions around the word 'endemic' that have arisen during the Covid-19 pandemic. He defines an endemic infection as "one in which overall rates are static — not rising, not falling," and highlights that we have come to associate this with less harmful illnesses such as the common cold, when in fact it can also be applied to deadly diseases including malaria, polio and tuberculosis. He argues that the word has been misused by policymakers to indicate that the virus poses less threat and therefore no action needs to be taken. In order to tackle the ongoing threat of Covid-19, the author suggests the following four actions: Set aside lazy optimism Be realistic about the likely levels of death, disability and sickness. Targets set for reduction should consider that circulating virus risks giving rise to new variants Use the weapons we have available, globally: effective vaccines, antiviral medications, diagnostic tests and a better understanding of how to stop an airborne virus through mask wearing, distancing, and air ventilation and filtration Iinvest in vaccines that protect against a broader range of variants
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News Article
NHSE calls on systems and maternity leads to vaccinate more pregnant women
Patient Safety Learning posted a news article in News
An NHS England letter has warned of “significant variation” in the uptake of the COVID-19 vaccine amongst pregnant women, and called on systems to enable more “spontaneous” antenatal vaccination. In the letter, sent to integrated care system vaccination programme leads, ICS maternity leads and other NHS clinical directors, NHS England said that while the rates of women who had received at least two doses of the vaccine before giving birth was on the rise, there was “significant variation in uptake between regions and systems and in every system, between women of different ethnicities, decile of deprivation in their local area, and age groups”. The letter asks that covid vaccines are made available within antenatal clinics “to maximise uptake” and that partially vaccinated women “are offered vaccine confidence conversations and advised antenatally on the nearest available walk-in vaccinations”. Vaccination programme and maternity service leads have also been told to make use of resources and funding available to drive uptake in at-risk groups. It said: “Vaccination and maternity leads should discuss how this resource could be used to provide in-reach clinics within every maternity service, without creating additional burden on midwifery staff.” Read full story (paywalled) Source: HSJ, 26 January 2022 -
Content ArticleThis qualitative study in Research in Social and Administrative Pharmacy examined how staff working in UK community pharmacy during the first waves of the Covid-19 pandemic in 2020 responded and adapted to new pressures on their services to maintain patient safety. From responses gathered from 23 community pharmacy staff in England and Scotland, the authors identified five themes: Covid-19, an impending threat to system Patient safety stressors during the first waves of Covid-19 Altering the system, responding to system stressors Monitoring and adjusting Learning for the future. They found that pharmacy staff responded and adapted to the evolving situation, monitoring the success of measures and protocols adopted in response to the pressures of the pandemic.
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News ArticleNearly half of patients with blood cancer are insufficiently protected against the Omicron variant after three vaccine doses, according to a new study. Experts from the Francis Crick Institute and the Royal Marsden NHS Foundation Trust said their research highlights the need for a fourth jab among these vulnerable people. As part of the ongoing Capture study, scientists have been monitoring the antibody response of hundreds of patients with different types of cancer, after one, two and three vaccine doses. Specifically, the researchers measured levels of neutralising antibodies which identify, attack and block the Omicron variant from infecting the body’s cells. Patients with solid tumours appeared to generate antibody responses similar to people without cancer. But among patients with blood cancer who had three doses of a Covid-19 vaccine, only 56 per cent generated neutralising antibodies, according to the study, which has been published as a research letter in The Lancet. This means that 44% of patients with blood cancer did not generate a sufficient antibody response. The study supports the need for four jabs among these immunocompromised groups of people. “We found that a third vaccine dose boosted the neutralising response against Omicron in patients with cancer, but the effect was blunted in patients with blood cancer compared to those with solid cancer,” the authors wrote. Read full story Source: The Independent, 25 January 2022
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News Article
Unvaccinated man denied heart transplant by Boston hospital
Patient Safety Learning posted a news article in News
A US hospital has rejected a patient for a heart transplant at least in part because he is not vaccinated against COVID-19. DJ Ferguson, 31, is in dire need of a new heart, but Brigham and Women's Hospital in Boston took him off their list, said his father, David. He said the Covid vaccine goes against his son's "basic principles, he doesn't believe in it". The hospital said it was following policy. Brigham and Women's Hospital told the BBC in a statement: "Given the shortage of available organs, we do everything we can to ensure that a patient who receives a transplanted organ has the greatest chance of survival." A spokesman said the hospital requires "the Covid-19 vaccine, and lifestyle behaviours for transplant candidates to create both the best chance for a successful operation and to optimise the patient's survival after transplantation, given that their immune system is drastically suppressed". The hospital's carefully worded statement may suggest other factors lie beyond the patient's unvaccinated status for his ineligibility, but it refused to discuss specifics, citing patient privacy. Dr Arthur Caplan, head of medical ethics at NYU Grossman School of Medicine, told CBS News that after any organ transplant a patient's immune system is all but shut down and even a common cold can prove fatal. "The organs are scarce, we are not going to distribute them to someone who has a poor chance of living when others who are vaccinated have a better chance post-surgery of surviving," said Dr Caplan. Read full story Source: BBC News, 26 January 2022 -
News Article
Public urged to sign up for Covid drug trial
Patient Safety Learning posted a news article in News
Over-50s and younger adults with underlying health conditions are being urged to participate in a study of life-saving treatments for COVID-19. The study is open to those who test positive for Covid and had symptoms develop in the previous five days. Volunteers will be given pills to take at home. The study will help decide how antiviral drugs will be used, Prof Sir Jonathan Van-Tam, the deputy chief medical officer for England, said. Health Secretary Sajid Javid asked everyone eligible to "step forward" and "help us to learn more about medicines which could save thousands of lives". Antivirals were "part of our approach as we learn to live with Covid, by preventing the most vulnerable from being hospitalised", he said. The UK regulator has licensed both for treating Covid, with molnupiravir the first to be given the green light, in November. Both have completed clinical trials and shown promising results at reducing the risk of serious illness or death. Launched in December, it already has 4,500 people signed up but needs 6,000 more as soon as possible. You can sign up at the study website now or your GP may contact you to ask you to participate if you test positive for Covid. Read full story Source: BBC News, 25 January 2022 -
Content ArticleThe single worst stressor on healthcare workers is the gap between what their patients need and what they can deliver. The covid-19 pandemic is making this divide wider than ever, writes Esther Choo in this BMJ article.
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News ArticleNew data from the US Centers for Disease Control and Prevention (CDC) has revealed that unvaccinated adults infected with Covid-19 who are 65 and older are 49 times more likely to need hospitalisation compared to those who have received booster doses. The CDC also found that in December, unvaccinated adults in that same age group experienced a rate of Covid-related hospitalisation 17 times higher than those who are fully vaccinated. For unvaccinated adults between 50 and 64, they are 44 times more likely to require hospitalisation compared with those who are immunised. In that same age group, unvaccinated adults were also 17 times more likely to experience Covid-related hospitalisation. According to the CDC, adults who are 65 and older and have received both doses of either the Pfizer or Moderna vaccine showed a 94% reduced risk of Covid-related hospitalisations. “Getting very sick means that older adults with Covid-19 might need hospitalization, intensive care, or a ventilator to help them breathe, or they might even die. The risk increases for people in their 50s and increases in 60s, 70s, and 80s. People 85 and older are the most likely to get very sick,” the CDC said on its website. “Get vaccinated as soon as possible,” the agency added. Read full story Source: The Guardian, 21 January 2022
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Content ArticleThere is great disparity in the way we think about and address different sources of environmental infection. Governments have for decades promulgated a large amount of legislation and invested heavily in food safety, sanitation, and drinking water for public health purposes. By contrast, airborne pathogens and respiratory infections, whether seasonal influenza or COVID-19, are addressed fairly weakly, if at all, in terms of regulations, standards, and building design and operation, pertaining to the air we breathe. We suggest that the rapid growth in our understanding of the mechanisms behind respiratory infection transmission should drive a paradigm shift in how we view and address the transmission of respiratory infections to protect against unnecessary suffering and economic losses. It starts with a recognition that preventing respiratory infection, like reducing waterborne or foodborne disease, is a tractable problem.
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Content ArticleThe serious and growing workforce crisis in the NHS and social care is the biggest, most pressing threat to the viability of services for people who need them. COVID-19, Brexit, and points based immigration rules have accelerated issues around recruitment, retention, workload, and wellbeing that were already affecting the workforce even before the pandemic. What we need is a relentless focus on implementing solutions, resourcing them properly, and reporting progress, writes David Oliver in this BMJ article.
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Content Article
BMJ: Raining in Los Angeles (14 January 2022)
Patient Safety Learning posted an article in Blogs
Amid climbing covid case numbers and with scarce resources, Tara Vijayan describes what it has been like in the US to triage treatments that aim to prevent patients being hospitalised with COVID-19 -
Content ArticleAfter nearly two years of pandemic, 5,000 inpatients and 1,000 deaths, the staff of one of the largest hospitals in north-west England are frustrated and exhausted. While ministers talk of encouraging signs that the Omicron wave may be receding in parts of England, staff at the Royal Preston are struggling to keep their heads above water. The hospital has seen a near four-fold increase in Covid patients since Christmas Day, rising to 103 last week. It is one of the largest hospitals in a region with the highest infection levels in the UK and two neighbouring NHS Trusts have declared critical incidents. Despite a recent slowdown in admissions, the “horrendous” levels of staff absence means the pressure is ratcheting up.
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News Article
Babies at risk’ as NHS faces losing nearly one in 10 midwives over mandatory jabs
Patient Safety Learning posted a news article in News
The NHS could be forced to dismiss almost 2,000 midwives by the government’s mandatory vaccination policy, amid warnings from a former chief nurse of England that mothers and babies will be put at risk. Well-placed senior sources have told HSJ around 1,700 midwives remain unvaccinated nationally, according to the latest data from trusts. Based on official headcount data that would amount to between 6.5-8% of the workforce, depending on whether it counts full time equivalent or total staff numbers. However, they are mostly in London, with the latest estimate in the city said to be about 680 (representing between 12 and 14% of the workforce), several well placed sources told HSJ, meaning its maternity services could be seriously destabilised. A former chief nurse of England, Sarah Mullally, who now sits in the House of Lords as the Bishop of London, said she believed about 12.5% of London’s midwives were unvaccinated, and called on the government to delay the mandatory health worker vaccination policy. Speaking in Parliament yesterday, she warned mothers and babies would be put at risk, “in order to implement a policy that has been superseded by the evolution of the virus”. She added: “I would strongly encourage everyone, including NHS staff and health care workers, to get fully vaccinated. However, having heard from midwives myself this week, I can see the anxiety that the requirement for mandatory vaccination is causing, as well as the potential risks to the heath service and its patients. Read full story (paywalled) Source: HSJ, 21 January 2022 -
News ArticleLeading charities have spoken out against the government’s scrapping of COVID-19 measures warning that clinically vulnerable people have been made “collateral damage for political considerations.” Those representing thousands of clinically vulnerable people have warned the government’s decisions to scrap COVID-19 restrictions leaves people “marginalised” and warned there was a risk to 5-11 year old vulnerable children who are yet to be vaccinated. The removal of COVID-19 restrictions next week will mean masks are no longer mandatory and the government will no longer ask people to work from home. Blood Cancer UK has called for the government to do more to support immunocompromised people such as giving them priority testing. Alzheimer's Society has said it is too early to drop basic measures, such as mask wearing, which help protect vulnerable members of society. Charlotte Augst, chief executive for the charity National Voices said clinically vulnerable people had now become “collateral damage in political considerations.” She said: “The pandemic has obviously been difficult for everyone, but it’s been the most difficult for people who are vulnerable to the virus, and some of these people have never really come out of 22 months of lockdowns. “There are obviously infection control measures that are harmful to society and lockdown is one of them - it causes harm. But there are some infection control measures which are not and which enable people to get on with their lives - wearing masks, improving ventilation. “Why would we not do this? When we understood that dirty water caused illness, we cleaned up the water. It cannot be a political statement to say we should clean up the air this is just fact-based decision making, but the situation] has now become all about politics. Read full story Source: The Independent. 21 January 2022
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Content ArticleThere has been a lot of discussion about whether the NHS will be overwhelmed this winter, if it is already overwhelmed, or if it is just having yet another “normal” winter crisis and will get through, as it always has, despite the additional pressures from omicron. The sight of the army being deployed in hospitals and ambulance services should be a clue that all is not well, but we are on a “war footing” after all. But can we be more precise about our current state?, writes Katherine Henderson, President of the Royal College of Emergency Medicine, in this BMJ opinion piece. Is the healthcare system delivering the needed level of patient care? The problem of the elective backlog—known and unknown—is well documented. Individual patients have lost months, or even years of good health. They have anxiety, pain, and debilities that limit their ability to engage fully with their families and society. But how about the ability of the NHS to provide safe and effective emergency care to the most seriously ill, distressed, or injured—the emergency part of the urgent and emergency care pathway? What service should we be delivering, and how do we match up to those standards at the moment?
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News Article
Health department warning over vaccine mandate for NHS staff in England
Patient Safety Learning posted a news article in News
Ministers have been issued with a stark warning over mandatory Covid vaccines for NHS workers in England, with a leaked document saying growing evidence on the Omicron variant casts doubts over the new law’s “rationality” and “proportionality”. Two jabs will become compulsory for frontline NHS staff from 1 April after MPs voted on the legislation last month. But the document, drawn up by Department of Health and Social Care (DHSC) officials and seen by the Guardian, said the evidence base on which MPs voted “has changed”, creating a higher chance of objections and judicial review. The effectiveness of only two vaccine doses against Omicron, and the lower likelihood of hospitalisations from the milder variant, are cited. More than 70,000 NHS staff – 4.9% – could remain unvaccinated by 1 April, the document says. NHS trusts in England are preparing to start sending dismissal letters from 3 February to any member of staff who has not had their first dose by then. Amid significant pressures on the NHS, last week groups including the Royal College of Nursing urged Sajid Javid, the health secretary, to delay the legislation, known as “vaccination as a condition of deployment” (VCOD2). On Tuesday the Royal College of Nursing said the leaked memo should prompt ministers to call a halt to the imposition of compulsory jabs, which it called “reckless”. “The government should now instigate a major rethink”, said Patricia Marquis, the RCN’s England director. “Mandation is not the answer and sacking valued nursing staff during a workforce crisis is reckless.” Read full story Source: The Guardian, 18 January 2022- Posted
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Content ArticleDecision makers should apply insights learnt from people living with chronic illness to collectively managing covid, says Charlotte Augst in this BMJ opinion article.
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Content ArticleAdverse events are among the most heavily scrutinised parts of the covid-19 vaccine process. But India’s system was woefully unprepared for this, leaving families confused, sowing vaccine hesitancy in communities, while robbing the system of valuable data, reports Priyanka Pulla in this BMJ feature.
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News ArticleGiving repeated booster doses of existing CovidD-19 vaccines in developed countries is not a sustainable global strategy for tackling the pandemic, the World Health Organization has said. Instead, WHO argues that the focus should shift towards producing new vaccines that work better against transmission of emerging variants. In a statement, published on 11 January, the WHO Technical Advisory Group on Covid-19 Vaccine Composition said, “A vaccination strategy based on repeated booster doses of the original vaccine composition is unlikely to be appropriate or sustainable.” The expert group, which is assessing the performance of Covid-19 vaccines, said that to deal with emerging variants such as omicron, new vaccines needed to be developed that not only protect people against serious illness but against infection. “Covid-19 vaccines that have high impact on prevention of infection and transmission, in addition to the prevention of severe disease and death, are needed and should be developed,” the group said. Vaccines also need to be more effective at protection against infection, “thus lowering community transmission and the need for stringent and broad reaching public health and social measures,” the group said. Read full story Source: BMJ, 17 January 2022
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Content ArticleSouth Wales pharmacist, Geraint Jones, contracted COVID-19 in April 2020. He shares an insight to his experiences over the last year after he was later diagnosed with Long Covid.
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News Article
Mum tells of heartbreak at baby loss in Covid coma
Patient Safety Learning posted a news article in News
A woman has spoken of her "devastation" after losing a baby delivered while she was in an induced coma with Covid. Rachel, from Wolverhampton was admitted to hospital over the summer in the 19th week of pregnancy. She said uncertainty about whether pregnant women should have the Covid vaccine had put her off getting it. Her condition deteriorated and she said she was so ill she did not realise at first son Jaxon was stillborn. "I was heavily sedated a lot of the time and from what I'm told by my family, my chances weren't looking very good," the 38-year-old said. "They were trying to get the baby to survive to 28 weeks but unfortunately, at 24 weeks, my son was born stillborn." Rachel, who said she had planned to have the vaccine after giving birth, is now urging others to get the jab, particularly women from minority backgrounds, for whom uptake is lower. Read full story Source: BBC News, 15 January 2022 -
Content ArticleThere is no longer any scientific doubt about how Covid spreads through the air. Covid spreads like any other airborne respiratory disease. The virus is carried in tiny particles called aerosols, which we breathe out constantly — especially when speaking loudly or singing. The particles stay in the room air like smoke, and if someone has Covid, their exhaled aerosols contain the virus and can infect someone who breathes them in. We stop the disease spreading by stopping people inhaling infected aerosol. In this article for the Guardian, Dr Adam Squires and Prof Christina Pagel detail what we can do to protect ourselves from the airborne spread of Covid. “Filtering facepiece respirator” masks, social distancing and opening windows are short term solutions. Additionally, much can be done by cleaning the air in the room, removing infectious aerosol before it can be inhaled through ventilation and supplement the clean air by filtering out the respiratory aerosol particles using small portable HEPA (“High Efficiency Particle Air”) filter unit.. Longer term, new developments in ultraviolet (UV) technology can safely and efficiently kill airborne pathogens in large spaces such as canteens, gyms or theatre. Infrastructure upgrades and new builds, necessary for zero carbon targets, can combine more energy-efficient ventilation with filtration to lower pollution. In the classroom and the workplace, clean fresh air has wider benefits on health and wellbeing far beyond our current airborne pandemic.
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Content ArticleThe evidence for preventing COVID-19 is lost in translation, writes Dancer et al. in a BMJ Editorial. The world is finally coming to terms with the realisation that transmission of SARS-CoV-2 is airborne. While keeping your distance, wearing a mask, and getting vaccinated have provided much protection, one intervention that would have a significant impact is adequate indoor ventilation. Healthcare, homes, schools, and workplaces should have been encouraged to improve ventilation at the very beginning of the pandemic, but tardy recognition of the airborne route by leading authorities in 2020 stalled any progress that could have been made at that stage.This was compounded by controversies over the terms “droplet” and “aerosol,” as the definition of these dictates different infection prevention strategies, including type of mask. Inserting the term “ventilation” into a COVID-19 policy document might appease readers, but ensuring people get enough fresh air in indoor environments seems to have fallen by the wayside. Why is this? Can we establish the reasons for this seemingly lethargic response to improving indoor air quality?
