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Content ArticleIn this Medscape article, nephrologist F Perry Wilson explains the findings of a binational cohort study using the universal electronic health record systems of South Korea and Japan. Data from more than 20 million individuals living in these countries from 2020 to 2021 was used to investigate the effect of Covid-19 on long-term risk for incident autoimmune rheumatic diseases (AIRD) such as rheumatoid arthritis, lupus and vasculitis, over various follow-up periods. The study authors found that, compared with those infected with flu, those infected with Covid-19 were more likely to be diagnosed with any autoimmune condition, connective tissue disease, and in Japan, inflammatory arthritis. Wilson observes that although we can't draw causal conclusions from the results, the study highlights that Covid-19 has very different long term effects to other respiratory viruses.
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News Article
Covid patients wrongly issued with ‘do not resuscitate’ orders, watchdog finds
Patient Safety Learning posted a news article in News
Doctors made do-not-resuscitate orders for elderly and disabled patients during the pandemic without the knowledge of their families, breaching their human rights, a parliamentary watchdog has said. In a new report on breaches of the orders during the pandemic, the Parliamentary Health Service Ombudsman (PHSO) found failings from at least 13 patient complaints. The research, carried out with the charity Dignity in Dying, found “unacceptable” failures in how end-of-life care conversations are held, and in particular with elderly and disabled patients. Following a review of complaints in 2019 and 2020 the PHSO found evidence in some cases that doctors did not even inform the patient or their family that a notice had been made and so breached their human rights. The report calls for health services in Britain to improve the approach by medics in talking about death and end-of-life care. In examples of cases reviewed, the PHSO revealed the story of 58-year-old Sonia Deleon who had schizophrenia and learning disabilities and a notice which was wrongly applied during the pandemic. In 2020, she was admitted to Southend University Hospital after contracting Covid-19 at age 58. On three occasions a notice was made but her family were never informed. Following Sonia’s death her family found out the reasons given by doctors for the DNAR which “included frailty, having a learning disability, poor physiological reserve, schizophrenia and being dependent for daily activities.” Sonia’s sister Sally-Rose Cyrille said: “I was devastated, shocked and angry. The fact that multiple notices had been placed in Sone’s file without consultation with us, without our knowledge, it was like being hit with a sledgehammer. Read full story Source: The Independent, 14 March 2024 -
Content ArticleMore than 3 years after the onset of the Covid-19 global pandemic, a wave of evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to postacute sequelae in pulmonary and broad array of extrapulmonary organ systems—including increased risks and burdens of cardiovascular disorders, neurologic and mental health disorders, metabolic disorders (diabetes and dyslipidemia), kidney disorders and gastrointestinal disorders. However, up until now, evidence is mostly limited to the first year postinfection. Bowe et al. built a cohort of 138,818 individuals with SARS-CoV-2 infection and 5,985,227 noninfected control group from the US Department of Veterans Affairs and followed them for 2 years to estimate the risks of death and 80 prespecified postacute sequelae of Covid-19 (PASC) according to care setting during the acute phase of infection. They found that the increased risk of death was not significant beyond 6 months after infection among nonhospitalised but remained significantly elevated through the 2 years in hospitalised individuals. Within the 80 prespecified sequelae, 69% and 35% of them became not significant at 2 years after infection among nonhospitalised and hospitalised individuals, respectively. In summary, while risks of many sequelae declined 2 years after infection, the substantial cumulative burden of health loss due to PASC calls for attention to the care needs of people with long-term health effects due to SARS-CoV-2 infection.
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Content Article
In this blog, I discuss the limitations associated with FFP3 (Filtering Face Piece) tight-fitting masks as respiratory protective equipment (RPE) for the healthcare sector during the ongoing Covid pandemic. I highlight inequalities in the distribution of effective RPE among healthcare workers (HCWs) and also draw attention to the underlying reasons for the shortage of RPE that has beset our healthcare services since the start of the pandemic. -
Content ArticleSome studies suggest a higher incidence of diagnosis of autoimmune inflammatory rheumatic diseases (AIRDs) among patients with a history of Covid-19 compared with uninfected patients. This binational cohort study of patients in Korea and Japan aimed to investigate the effect of Covid-19 on long-term risk for incident AIRD over various follow-up periods. The authors found that Covid-19 infection was associated with increased risk for incident AIRD compared with matched patients without Covid-19 infection or with influenza infection. The risk for incident AIRD was higher with greater severity of acute Covid-19.
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Content ArticleThis study compared the blood of patients with confirmed Covid-19 infection with that of uninfected controls. The authors found that there were changes to serum proteins in the blood of patients experiencing Long Covid. This indicates activation of the immune system’s complement cascade, altered coagulation and tissue injury. At the cellular level, Long Covid was linked to aggregates comprising monocytes and platelets. These findings provide knowledge of potential biomarkers for diagnosis and may inform directions for treatments.
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Content Article
Long Covid and return to work – What works? (August 2022)
Patient-Safety-Learning posted an article in Guidance
This paper provides a summary of a webinar entitled “Long Covid and return to work support - what works?” held in March 2022. The webinar was organised because of the multiple different approaches being taken to the management of Long Covid across the UK and elsewhere. The paper aims to provide guidance to occupational health providers, employers, workers, people with Long Covid, HR personnel, managers, healthcare professionals and unions about the identification and management of Long Covid, particularly relating to return to work. It argues that a multi-disciplinary approach is essential to help retain and support people affected by Long Covid to return to work. It includes information on: Universal first-line screening assessment in Long Covid Red flags and specialist referral Treatment which can help function and recovery Rehabilitation Specific Fitness for Work considerations after Covid-19 infection Examples of workplace adjustments for Long Covid Prevention of infection: risk management in the workplace Workplace public health messages -
News ArticleNearly 70 healthcare workers with Long Covid will take their fight to the High Court later to sue the NHS and other employers for compensation. The staff, from England and Wales, believe they first caught Covid at work during the pandemic and say they were not properly protected from the virus. Many of them say they are left with life-changing disabilities and are likely to lose income as a result. The Department of Health said "there are lessons to be learnt" from Covid. The group believe they were not provided with adequate personal protective equipment (PPE) at work, which includes eye protection, gloves, gowns and aprons. In particular, they say they should have had access to high-grade masks, which help block droplets in the air from patient's coughs and sneezes which can contain the Covid virus. But the masks they were given tended to be in line with national guidance. Rachel Hext, who is 36, has always insisted that she caught Covid in her job as a nurse in a small community hospital in Devon. "It's devastating. I live an existence rather than a life. It prevents me doing so much of what I want to do. And it's been four years." Her list of long Covid symptoms includes everything from brain fog and extreme fatigue to nerve damage, and deafness in one ear. Solicitor Kevin Digby, who represents more than 60 members of the group, describes their case as "very important". He says: "It's quite harrowing. These people really have been abandoned, and they are really struggling to fight to get anything. "Now, they can take it to court and hope that they can get some compensation for the injuries that they've suffered." Read full story Source: BBC News, 6 March 2024 Related reading on the hub: Healthcare workers with Long Covid: Group litigation – a blog from David Osborn The pandemic – questions around Government governance: a blog from David Osborn
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Content ArticleThis report describes the findings of a study that collected stories of the working lives of Black and Brown healthcare staff during the Covid-19 pandemic. The study asked them to reflect on their experiences and highlight the changes they would like to see. It highlights a number of issues around victimisation, access to PPE, speaking up and risk assessments. The authors argue that the report confirms previous studies that identify the entrenched nature of racism in healthcare systems and highlights how systemic cultures of racism contributed to the disproportionate impact of Covid-19 on health and care workers from minority ethnic backgrounds.
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Content ArticleAs the USA's largest health insurer, the Centers for Medicare & Medicaid Services (CMS) has established quality standards, metrics, and programmes to improve healthcare not just for the 170 million individuals supported by its programmes, but for all Americans. The 2024 National Impact Assessment of CMS Quality Measures Report (Impact Assessment Report) assesses the quality and efficiency impact of measures endorsed by the consensus-based entity and used by CMS.
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News Article
USA: Care quality, safety 'worse than expected' during Covid-19 pandemic
Patient Safety Learning posted a news article in News
A new CMS report reveals disparities in care quality and patient safety within US hospitals before and during the pandemic, finding "a large proportion of measures had worse than expected performance." CMS released its 2024 National Impact Assessment Feb. 28, which is released every three years and evaluates the measures used in 26 CMS quality and value-based incentive payment programs. This edition of the report compares quality measure scores pre-COVID-19 with hospitals' results in 2020 and 2021, the initial years of the COVID-19 public health emergency. Here are eight findings from the 72-page assessment: 1. During 2020 and 2021, a large proportion of measures had worse than expected performance, including significant worsening of key patient safety metrics. 2. Half or more of the performance measures in five priorities had worse results in 2021 than expected from the 2016–2019 baseline. Priorities with the highest proportions of worse-than-expected results in 2021 were wellness and prevention (69%), behavioural health (55%), safety (54%), chronic conditions (52%), and seamless care coordination (50%). 3. Specific to safety, standardised infection ratios worsened significantly in hospitals for central line–associated bloodstream infections (94% worse), MRSA (55% worse) and CAUTI (34% worse). Before the Covid-19 PHE (2015–2019), 34,455 fewer healthcare-associated infections (HAIs) were reported in acute care settings. 4. More than 35% of measures in two priorities had better results in 2021 than expected from 2016–2019 baseline trends. Those priorities are seamless care coordination (50%) and affordability and efficiency (38%). 5. Specific to affordability and efficiency, emergency department visits for home health patients fared 1.4 percentage points better, and acute care hospitalization in the first 60 days of home health in 2021 was 1.5 percentage points better. 6. Accountable entities with the highest proportions of worse than expected results in 2021 were clinicians (64%), accountable care organizations (54%), and acute care facilities (54%). 7. Wellness and prevention had the highest percentage of measures showing health equity disparities; notable examples include pneumococcal and influenza vaccinations among racial and ethnic groups. 8. Comparison racial and ethnic groups fared worse than the White reference group on 40 of 45 (88.9%) affordability and efficiency measures and 32 of 41 (78%) chronic conditions measures. For example, disparities were recorded for Black or African American patients in 32, or 71%, of the affordability and efficiency measures, mostly related to readmissions. Read full story Source: Becker Hospital Review, 29 February 2024 -
Content ArticleThe South East London Long Covid programme has released 10 short animated films to help people with their recovery. The films offer guidance, tools, and tips on how to help manage symptoms and reduce the risk of ongoing issues.
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Content ArticlePoor memory and difficulty thinking or concentrating (commonly referred to as “brain fog”) have been implicated in syndromes occurring after Covid-19 — a situation that has led to suggestions that Covid-19 may have lasting cognitive consequences. However, objective data on cognitive performance are largely lacking, and how long such deficits may persist and which cognitive functions are most vulnerable are unclear. In this observational study, Hampshire et al. invited 800,000 adults in a study in England to complete an online assessment of cognitive function. The authors estimated a global cognitive score across eight tasks. They hypothesised that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating (“brain fog”). They found that participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain.
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News ArticleThe medical regulator failed to sound the alarm over Covid vaccine side effects and should be investigated, MPs have said. The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for approving drugs and devices and monitors side effects caused by treatments. But the all-party parliamentary group (APPG) on pandemic response and recovery, an influential group of MPs, has raised “serious patient safety concerns”. It has claimed that “far from protecting patients” the regulator operates in a way that “puts them at serious risk”. Some 25 MPs across four parties have written to the health select committee asking for an urgent investigation. In reply, Steve Brine, the health committee chairman, has said an inquiry into patient safety is “very likely”. In a letter to Mr Brine, the APPG said that there was reason to believe that the MHRA had been aware of post-vaccination heart and clotting issues as early as February 2021, but did not highlight the problems for several months. Read full story (paywalled) Source: The Telegraph, 27 February 2024 Related reading on the hub: Interview with Charlet Crichton, founder of UKCVFamily
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News Article
Wales Covid families want answers as inquiry arrives
Patient Safety Learning posted a news article in News
Accountability is top of the wishlist from the Covid inquiry as it comes to Wales, say bereaved families and those charged with protecting vulnerable people. Over the next three weeks the focus will largely be on the decisions made by the Welsh government during the pandemic. From the timings of lockdowns to the rationale of doing things differently to the UK government, the hearings will scrutinise actions taken in Wales. For many, it will be a chance to hear the justifications for policies that they say left them feeling unsupported and alone. Ann Richards did not get to say a final goodbye to her husband Eirwyn before he died from hospital-acquired Covid in January 2021. Ann still wonders if non-urgent healthcare had been fully up and running, could Eirwyn have been discharged sooner, or perhaps even avoided a hospital admission altogether? Additional rules put in place to reduce the spread of the virus meant there were delays in getting a purpose-built wheelchair – delaying his discharge from hospital. "I understand there had to be rules in place," said Ann. "But it's the wellbeing of the patients I think they lost a lot of." Read full story Source: BBC News, 26 February 2024 -
Content ArticleBrain fog is one of the most common, persistent complaints in patients with Long Covid, affecting up to 46% of patients, many of whom also deal with other cognitive concerns like memory loss and difficulty concentrating. This Medscape article looks at new research suggesting these symptoms may be the result of a viral-borne brain injury that causes cognitive and mental health issues that persist for years. This may offer new options for treating brain fog and other cognitive symptoms associated with Long Covid.
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Content ArticleThis descriptive and cross-sectional study in the Journal of Patient Safety aimed to examine the impact of nurses’ fear of Covid-19 on their nursing care behaviour during the pandemic. 450 nurses providing one-on-one care to Covid-19 patients between January and March 2021 took part in the study. The results showed that nurses providing care to patients during the pandemic feared Covid-19, that their care behaviours were generally at a good level, and that the care behaviours of nurses with a high degree of fear were negatively and significantly impacted.
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EventuntilToday, the entire world is working together to address one of history's most terrible public health issues. Humanity has been defeated by a virus and is attempting to restore regular functions while protecting its safety and health. Several tactics and policies have evolved as means of reducing the pandemic's spread and effects, and several are being tested and developed. The information and expertise contained within the field of Public Health are critical in this regard and are regularly revised and updated in the current circumstances. Among the various components of Public Health, Public Health Interventions have become increasingly used in altering public behaviour as a means of limiting disease spread. As a result, the Global Conference on Public Health 2024 (Hybrid Conference) anticipates analysing and evaluating the capabilities of Public Health Interventions in managing the pandemic with the assistance of scholars and specialists in this field. Register
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Content ArticleExtracts of a letter from David Osborn to the UK Covid-19 Public Inquiry Legal Team regarding misleading evidence by Professor Yvonne Doyle, which: Highlights errors in Prof Yvonne Doyle’s evidence to the Inquiry relating to the declassification of Covid‑19 as a high consequence infectious disease. Calls into question Professor Sir Jonathan Van Tam’s evidence to the Inquiry in which he sought to attribute responsibility for the downgrade from FFP3 to FRSM to Public Health England. The letter sets out his involvement in the issue of the 4-Nations IPC guidance version 1.0 which implemented that downgrade. Further reading on the hub: Healthcare workers with Long Covid: Group litigation – a blog from David Osborn
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News Article
Italy announces inquiry into its handling of Covid-19 pandemic
Patient Safety Learning posted a news article in News
Italy will carry out an inquiry into its handling of the coronavirus pandemic in a move hailed as “a great victory” by the relatives of people killed by the virus but criticised by those who were in power at the time. Italy was the first western country to report an outbreak and has the second highest Covid-related death toll to date in Europe, at more than 196,000. Only the UK’s death toll is higher. The creation of a commission to examine “the government’s actions and the measures adopted by it to prevent and address the Covid-19 epidemiological emergency” was approved by the lower house of parliament after passing in the senate. Consuelo Locati, a lawyer representing hundreds of families who brought legal proceedings against former leaders, said: “The families were the first to ask for a commission and so for us this is a great victory. The commission is important because it has the task, at least on paper, to analyse what went wrong and the errors committed so as not to repeat the massacre we all suffered.” Read full story Source: The Guardian, 15 February 2024 -
Content ArticleA forthcoming three-part ITV drama Breathtaking, set in a fictionalised London hospital, tells the devastating impact of the Covid-19 pandemic through the eyes of Acute Medical Consultant Dr Abbey Henderson. The series is based on Dr Rachel Clarke’s book of the same name. She worked on Covid wards and is also one of the writers on the series. Rachel joins Women's Health host Emma Barnett to discuss it. Listen from 1:40
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Content ArticleHow does it feel to confront a pandemic from the inside, one patient at a time? To bridge the gulf between a perilously unwell patient in quarantine and their distraught family outside? To be uncertain whether the protective equipment you wear fits the science or the size of the government stockpile? To strive your utmost to maintain your humanity even while barricaded behind visors and masks? Rachel is a palliative care doctor who looked after some of the most gravely unwell patients on the Covid-19 wards of her hospital. Amid the tensions, fatigue and rising death toll, she witnessed the courage of patients and NHS staff alike in conditions of unprecedented adversity. For all the bleakness and fear, she found that moments that could stop you in your tracks abounded. People who rose to their best, upon facing the worst, as a microbe laid waste to the population.
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Content Article
In December 2022, a newly formed group called 'Long Covid Doctors for Action' (LCD4A) conducted a survey to establish the impact of Long Covid on doctors. When the British Medical Association published the results of the survey, the findings were both astonishing and saddening in equal measure.[1] The LCD4A have now decided that enough is enough and that it is now time to stand up and take positive action. They have initiated a group litigation against those who failed to exercise the ‘duty of care’ that they owed to healthcare workers across the UK during the pandemic. In this blog, I summarise how and why I feel our healthcare workers have been let down by our government and why, if you are one of these healthcare workers whose life has been effected by Long Covid, I urge you to join the group litigation initiative. -
Content ArticleThis Lancet article highlights new evidence from analysis of population-based electronic health records for almost the entire population of the UK. The analysis showed that, as of 1 June 2022, a high proportion of the population had received fewer than the recommended number of Covid-19 vaccinations: 45·8% in England, 49·8% in Northern Ireland, 34·2% in Scotland and 32·8% in Wales. Combining the results across countries suggests that a substantial number of severe Covid-19 outcomes, including hospital admissions or deaths from Covid-19, might be prevented if recommended vaccination schedules were fully implemented. These findings reinforce the message that the role of vaccination in Covid-19 is to mitigate the severity of the illness, reducing the risk of complications and mortality, rather than avoiding all Covid-19 infections.
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Content ArticleThis population-based cohort study from Sweden and Norway aimed to explore whether exposure to mRNA Covid-19 vaccination during pregnancy increases the risk of adverse events in newborn infants. The cohort included 94,303 infants exposed to Covid-19 vaccination during pregnancy and 102,167 control infants born between June 2021 and January 2023. The authors found that vaccination during pregnancy was associated with lower odds of neonatal intracranial haemorrhage, cerebral ischemia and hypoxic-ischemic encephalopathy, and neonatal mortality.
