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Content Article'Virtual wards' have existed for a number of years, but Covid-19 has led to further research and pilot schemes exploring their use. How have they been used during the pandemic and what does the future hold? This explainer by Holly Walton and Naomi Fulop provides some answers.
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Content ArticleLast month, Boris Johnson argued that the downward trends in Covid cases and hospitalisations meant that it was time to scrap restrictions. Now both are rising. But the government is ending testing and most surveillance studies. Sajid Javid, the health secretary, said that the rise was “to be expected” – though this foresight did not extend to having a plan to deal with the increase in infections. Instead, he dismissed the concern about the new Deltacron variant. The health secretary seemed nonchalant about the threat the virus now posed. Sajid Javid may be right that the country has weathered the worst of the pandemic, but Covid is not yet in retreat. It makes no sense to withdraw funding from a series of studies that allow the spread of the virus to be mapped in detail. Without the data, experts won’t be able to effectively monitor the disease. The country will be less effective in responding and adjusting to future waves of infection. Individuals will be less able to make informed choices about the risks involved. The clinically vulnerable face being cut off from everyday life. “It is like turning off the headlights at the first sign of dawn,” Stephen Reicher, a psychologist at the University of St Andrews, told the Guardian. “You can’t see what’s coming and you don’t know when it makes sense to turn them on again.”
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Content Article
UK Covid-19 Public Inquiry (10 March 2022)
Patient Safety Learning posted an article in Covid-19 Inquiry
This is the independent public inquiry to examine the UK’s preparedness and response to the Covid-19 pandemic, and to learn lessons for the future. The Inquiry has been established under the Inquiries Act 2005. This means that the Chair will have the power to compel the production of documents and call witnesses to give evidence on oath. The Chair has been appointed and will set out her vision for the Inquiry’s work in the coming months. The Inquiry has received the draft Terms of Reference from the Cabinet Office, and will open a public consultation tomorrow, Friday 11 March. The consultation will remain open for four weeks, and will be available online. See the UK COVID-19 Inquiry: draft terms of reference. -
Content ArticleThe introduction of remote triage and assessment early in the pandemic raised questions about patient safety. Wieringa et al. sought to capture patients and clinicians’ experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care. Lessons from the pandemic suggest three key strategies are needed to prevent avoidable deaths and inequalities in the next crisis: (1) strengthen system resilience (including improved resourcing and staffing; support of new tools and processes; and recognising primary care’s role as the ‘risk sink’ of the healthcare system); (2) develop evidence-based triage and scoring systems; and (3) address social vulnerability.
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Content ArticleCatherine Villanueva Gardner, Professor of Women’s and Gender Studies and Philosophy at the University of Massachusetts Dartmouth, looks at the material effects on women with Long Covid.
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Content ArticleIt is critical the UK keeps the bones of its world leading data infrastructure so that we can protect ourselves from lingering and future threats, writes Jennifer Beam Dowd. While the UK’s perceived pandemic missteps abound, the country was truly “world beating” in at least one important arena—investment in crucial population data to help us understand the virus. Despite earlier reports that the Coronavirus Infection Survey carried out by the Office for National Statistics (ONS) was at risk of being scrapped, the government's new “Living with covid” strategy has retained the scheme, although it's not yet clear to what extent. While these efforts could rightfully be scaled back from crisis levels, we need to carefully transition surveillance from pandemic to “endemic” to protect ourselves from lingering and future threats.
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Content ArticleUp-to-date registers of clinically vulnerable patients must be created to ensure that those who are most at risk during Covid-19 and any future pandemics are protected and can access the support they need, a report from the All-Party Parliamentary Group (APPG) on Vulnerable Groups to Pandemics has recommended. The report considered vulnerable people’s experiences during the pandemic and makes 16 recommendations on what the government and the health service can do better to plan and prioritise extremely vulnerable patients during further Covid-19 outbreaks and future pandemics.
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Content ArticleThe COVID-19 pandemic placed unprecedented pressure on councils and care providers. A new report from the Local Government and Social Care Ombudsman analyses just how those organisations coped.
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Content ArticleA letter to the Chair of the Commons Health and Social Care Select Committee expressing concern that written evidence provided to the Committee's “Coronavirus: Lessons Learned to Date" inquiry was not properly considered and opportunities to protect healthcare workers from disease were missed.
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Content ArticleAnti-stay-at-home protesters aren’t the only ones with an argument based on individual rights on their side, writes Graham Mooney, associate professor at the Johns Hopkins University School of Medicine.
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Content ArticleWe all knew that this couldn’t go on forever—and who would want it to? But, since the start of the “great reopening” in the middle of 2021, it seems the government has conveniently forgotten about the 1.5 million vulnerable people they were so eager to protect back in early 2020. The shielding programme was paused in April 2021, then quietly dropped a few months later. The Department of Health and Social Care said that the clinically extremely vulnerable should follow the same advice as the rest of the population, but with some additional suggested precautions such as avoiding “enclosed crowded spaces.” And last week, Boris Johnson, UK prime minister, told us that the pandemic is essentially over—all restrictions will end very soon, including the need to self-isolate. Except for the vulnerable, the pandemic isn’t over, writes Ceinwen Giles in this BMJ opinion piece. Life hasn’t returned to normal, and what has been a difficult two years now appears to stretch ever further into the future with no real prospect of “normal” life anytime soon. The government’s message that “vaccinations are the best way to protect yourself” is hollow advice for people, she says.
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Content ArticleEvidence submitted outlining the issues relating to the protection of health and care workers. It explains how surgical masks are not 'protective' against airborne disease and represent a breach of COSHH Regulations.
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Content Article
Open Letter to the Chief Executive, Health and Safety Executive
SafeDavid3 posted an article in Regulatory issues
Letter outlining potential legal non-compliance by persons involved in issuing Infection Prevention and Control Guidance. -
Content ArticleCovid-19 has infected more than 278 million people globally, with at least 5.4 million deaths recorded by the World Health Organization as of 26 December 2021. The omicron (B.1.1.529) variant of concern is spreading rapidly. Some countries view infection as a net harm and pursue strategies ranging from suppression to elimination. They seek to sustain low infection rates through a combination of vaccination, public health measures, and financial support measures (vaccines-plus). Other countries implemented mitigation strategies that aim to prevent health systems from being overwhelmed by building population immunity through a combination of infection and vaccination. These countries rely on a vaccines-only approach and seem willing to tolerate high levels of infection provided their healthcare systems can cope. In an open letter by a group of public health experts, clinicians, scientists, they suggest a vaccines-plus approach should be adopted globally.
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Content ArticleCOVID-19 has highlighted the urgency of addressing violence against women and children, which reports suggest has increased during the pandemic. Often referred to as a “shadow pandemic,” the rise in violence over the past two years has been linked to lockdowns and other restrictions on movement put in place due to COVID-19, which force women and children to remain at home with their abusers. In 2016, the World Health Organization published a global plan of action to address violence against women, children, and girls. It proposed a four-pronged approach: firstly, strengthen health system leadership and governance; secondly, strengthen health service delivery and health workers’ capacity to respond; thirdly, strengthen programming to prevent interpersonal violence; and lastly, improve information and evidence. In this BMJ opinion article, Helga Fogstad discusses why, five years on, these measures are needed more than ever and why it's time to act.
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Content ArticleThis government guidance is intended to prevent transmission of seasonal respiratory viral infections focussing on influenza, SARS-CoV-2, and respiratory syncytial virus (RSV) in health and care settings while continuing to support the recovery of services.
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Content ArticleWhen healthcare worker infections at The Royal Melbourne Hospital in Australia seemed to be spiralling out of control despite strict protocols being adhered to by expertly trained staff, Professor Kirsty Buising and her colleagues took action. To inform future responses in the Australian setting, Kirsty and her colleagues present in this paper a description of healthcare worker infections at their institution and the suite of interventions they used to control the outbreak.
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Content Article
Long Covid Support: Information leaflet
Patient Safety Learning posted an article in Resources for patients
Long Covid can be difficult to diagnose, and some people might not realise their symptoms could be linked to prior COVID-19 infection. There can be more than 200 symptoms. Symptoms can affect anywhere in the body. Symptoms can come and go, and new ones can appear weeks or months later. People may not be aware they had Covid-19: some don’t have symptoms at the time of infection, and test results can be unreliable. Long Covid Support and Long Covid Kids have produced an information leaflet on the symptoms of Long Covid. -
Content ArticleThe purpose of this investigation by the Healthcare Safety Investigation Branch (HSIB) is to help improve patient safety in relation to the management of patients with COVID-19 being treated with non-invasive respiratory support, for example continuous positive airway pressure (CPAP), in non-critical care settings. The HSIB investigation reviewed the experience of Terry, who was admitted to hospital with symptoms of COVID-19 and required support with is breathing using CPAP. On the second day after his admission to hospital, Terry was found on the floor next to his bed, having called for assistance. Terry’s CPAP tubing had become disconnected from his mask, meaning that Terry’s breathing was not supported. Staff attempted to resuscitate Terry, however they were unsuccessful, and he died.
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Content ArticleFinding solutions to long covid will require new ways of thinking across clinical services and research, says in this BMJ Opinion article.
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Content ArticleAs a growing number of hospitals pressed for resources due to the COVID-19 surge suspend elective surgeries, some healthcare professionals want the public to know exactly how important an "elective" procedure can be. The term "elective surgery" does not describe the acuity of the medical condition or necessity of the procedure. Rather, the use of "elective" distinguishes these surgeries that are scheduled in advance from emergency surgeries, such as trauma cases. As Americans learn of elective surgeries once again being postponed, physicians are taking to the web to debunk what can be a misnomer.
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Content ArticleHealthcare workers have had the longest and most direct exposure to COVID-19 and consequently may suffer from poor mental health. Quintana-Domeque et al. conducted one of the first repeated multi-country analysis of the mental wellbeing of medical doctors at two timepoints during the COVID-19 pandemic to understand the prevalence of anxiety and depression, as well as associated risk factors. Rates of anxiety and depression were highest in Italy (24.6% and 20.1%, June 2020), second highest in Catalonia (15.9% and 17.4%, June 2020), and lowest in the UK (11.7% and 13.7%, June 2020). Across all countries, higher risk of anxiety and depression symptoms were found among women, individuals below 60 years old, those feeling vulnerable/exposed at work, and those reporting normal/below-normal health.
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Content ArticleIn this study the authors characterised the dynamics of SARS-CoV-2 transmission within a hospital setting, identifying key differences across the two pandemic waves, as well as the relative contribution of different groups and hospital locations to within-hospital transmission. They found the prevention and control measures that evolved during the COVID-19 pandemic may have had a significant impact on reducing infections between healthcare workers, but were insufficient during the second wave to prevent a high number of patient-to-patient transmissions. As hospital-acquired cases appeared to drive most onward transmissions, more frequent and rapid identification and isolation of these cases will be required to break hospital transmission chains in subsequent pandemic waves.
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Content ArticleEarly in the pandemic, the UK government recognised that certain patients with complex medical conditions, or who were immuno-suppressed through disease or medication, would be most at risk from the complications of COVID-19. These patients were advised to take careful infection control precautions, and were classed as clinically extremely vulnerable (CEV). Among the advice given to them was to “shield” and to facilitate this, they were added to a “Shielding Patients List” (SPL) at their GP practices. Despite GP practices having robust disease registers and arranging seasonal flu vaccine recalls annually for mostly similar patients, NHS England decided to create centrally generated lists for CEV, and sent out letters to these patients. Unfortunately, NHS Digital wrote to many patients who probably should not have been included as CEV (for example those with a history of glandular fever; or with long resolved and fully treated cancers in full remission), and also failed to include many patients who should have been classed as CEV. Simon Hodes and Azeem Majeed look at the UK government's communication of the COVID-19 vaccination programme.
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Content ArticleWhen the history of the COVID-19 pandemic is written, it is likely to show that the mental models held by scientists sometimes facilitated their thinking, thereby leading to lives saved, and at other times constrained their thinking, thereby leading to lives lost. This paper from Trisha Greenhalgh explores some competing mental models of how infectious diseases spread and shows how these models influenced the scientific process and the kinds of facts that were generated, legitimised and used to support policy.
