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News Article
Damage to multiple organs recorded in 'long Covid' cases
Patient Safety Learning posted a news article in News
Young and previously healthy people with ongoing symptoms of COVID-19 are showing signs of damage to multiple organs four months after the initial infection, a study suggests. The findings are a step towards unpicking the physical underpinnings and developing treatments for some of the strange and extensive symptoms experienced by people with “long Covid”, which is thought to affect more than 60,000 people in the UK. Fatigue, brain fog, breathlessness and pain are among the most frequently reported effects. On Sunday, the NHS announced it would launch a network of more than 40 long Covid specialist clinics where doctors, nurses and therapists will assess patients’ physical and psychological symptoms. The Coverscan study aims to assess the long-term impact of COVID-19 on organ health in around 500 “low-risk” individuals – those who are relatively young and without any major underlying health complaints – with ongoing Covid symptoms, through a combination of MRI scans, blood tests, physical measurements and online questionnaires. Preliminary data from the first 200 patients to undergo screening suggests that almost 70% have impairments in one or more organs, including the heart, lungs, liver and pancreas, four months after their initial illness. “The good news is that the impairment is mild, but even with a conservative lens, there is some impairment, and in 25% of people it affects two or more organs,” said Amitava Banerjee, a cardiologist and associate professor of clinical data science at University College London. Read full story Source: The Guardian, 15 November 2020- Posted
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Content Article"When good science is suppressed by the medical-political complex, people die." Kamran Abbasi believes politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible, as Abbasi explores in this BMJ Editorial.
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Wall Street Journal: How the Swiss Cheese Model can help us beat COVID-19
Clive Flashman posted a news article in News
No single solution will stop the virus’s spread, but combining different layers of public measures and personal actions can make a big difference. It’s important to understand that a vaccine, on its own, won’t be enough to rapidly extinguish a pandemic as pernicious as Covid-19. The pandemic cannot be stopped through just one intervention, because even vaccines are imperfect. Once introduced into the human population, viruses continue to circulate among us for a long time. Furthermore, it’s likely to be as long as a year before a Covid-19 vaccine is in wide-spread use, given inevitable difficulties with manufacturing, distribution and public acceptance. Controlling Covid-19 will take a good deal more than a vaccine. For at least another year, the world will have to rely on a multipronged approach, one that goes beyond simplistic bromides and all-or-nothing responses. Individuals, work-places and governments will need to consider a diverse and sometimes disruptive range of interventions. It helps to think of these in terms of layers of defence, with each layer providing a barrier that isn’t fully impervious, like slices of Swiss cheese in a stack. The ‘Swiss cheese model’ is a classic way to conceptualize dealing with a hazard that involves a mixture of human, technological and natural elements. This article can be read in full on the WSJ website, but is paywalled. The illustration showing the swiss cheese pandemic model is hyperlinked to this hub Learn post. -
Content ArticleNearly a year into the global coronavirus pandemic, scientists, doctors and patients are beginning to unlock a puzzling phenomenon: For many patients, including young ones who never required hospitalisation, COVID-19 has a devastating second act. Many are dealing with symptoms weeks or months after they were expected to recover, often with puzzling new complications that can affect the entire body—severe fatigue, cognitive issues and memory lapses, digestive problems, erratic heart rates, headaches, dizziness, fluctuating blood pressure, even hair loss. What is surprising to doctors is that many such cases involve people whose original cases weren’t the most serious, undermining the assumption that patients with mild COVID-19 recover within two weeks. Doctors call the condition “post-acute Covid” or “chronic Covid,” and sufferers often refer to themselves as “long haulers” or “long-Covid” patients. “Usually, the patients with bad disease are most likely to have persistent symptoms, but Covid doesn’t work like that,” said Trisha Greenhalgh, professor of primary care at the University of Oxford and the lead author of an August BMJ study that was among the first to define chronic Covid patients as those with symptoms lasting more than 12 weeks and spanning multiple organ systems. Other viral outbreaks, including the original SARS, MERS, Ebola, H1N1 and the Spanish flu, have been associated with long-term symptoms. Scientists reported that some patients experienced fatigue, sleep problems and joint and muscle pain long after their bodies cleared a virus, according to a recent review chronicling the long-term effects of viral infections. What differentiates COVID-19 is the far-reaching nature of its effects. While it starts in the lungs, it often affects many other parts of the body, including the heart, kidneys and the digestive and nervous systems, doctors said. “I haven’t really seen any other illness that affects so many different organ systems in as many different ways as Covid does,” said Zijian Chen, medical director for Mount Sinai Health System’s Center for Post-Covid Care. Read the full article in the Wall Street Journal.
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Content ArticleThe global coronavirus (COVID-19) pandemic has taken a dramatic toll on virtually all aspects of life, from the economy, to employment, relationships, public health, and personal health. In the United States, more than 200,000 individuals have died of the coronavirus. As of October, hundreds of thousands of Americans are filing unemployment claims each week. For all of us, the pandemic has become a time marked by uncertainty, fear, and grief. According to a survey conducted by the Centers for Disease Control and Prevention (CDC), about 40 percent of US adults reported struggling with mental health or substance use issues. Although much of the general population has admitted to feeling more anxious and depressed during the pandemic, those with substance use and mental health issues face unique challenges.
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Content ArticleNew analysis by the Health Foundation shows there were 4.7 million fewer people referred for routine hospital care – for things like hip, knee and cataract surgery – between January and August 2020 compared to the same period in 2019, representing a potential hidden backlog of unmet care needs. The research highlights the scale of the challenge facing the NHS as it looks to resume services following the disruption caused by the first wave of COVID-19. The number of patients in hospital with COVID-19 is growing as we head into winter, a time when the NHS always experiences greater pressures from flu and other seasonal illnesses. If the virus is not controlled and emergency pressures surge, even more routine treatment will need to be postponed which will only add to the challenge of recovering from the pandemic.
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Event
Deteriorating Patient Summit
Patient Safety Learning posted an event in Community Calendar
The Deteriorating Patient Summit focuses on recognising and responding to the deteriorating patient through improving the reliability of patient observations and ensuring quality of care. The conference will include National Developments including the recent recommendations from the Royal College of Physicians on NEWS2 and COVID-19, and implementing the recommendations from the Healthcare Safety Investigation Branch Report Investigation into recognising and responding to critically unwell patients. The conference will include practical case study based sessions on identifying patients at risk of deterioration, improving practice in patient observations, responding to the deteriorating patient, improving escalation and understanding success factors in escalation, sepsis and COVID-19, involving patients and families in recognising deterioration, and improving the communication and use of NEWS2 in the community, including care homes, and at the interface of care. Follow the conference on Twitter #deterioratingpatient Register -
News Article
Thousands still being denied PPE for procedures with ‘high covid risk’
Patient Safety Learning posted a news article in News
Thousands of frontline workers delivering treatments where the risk of transmitting coronavirus is heightened are still being denied personal protective equipment (PPE), according to multiple unions and professional bodies. Eleven organisations, including Unison and the British Association of Stroke Physicians, believe numerous procedures have been “wrongly excluded” from the list of 13 “aerosol generating procedures” that require PPE, despite the NHS now having adequate supplies. They say their members are “facing illness and even death” while performing procedures such as chest physiotherapy, introducing feeding tubes, and assessing whether a patient can swallow safely. The unions have formed an alliance to lobby on the issue, and its chair Dr Barry Jones told HSJ: “We’ve asked ministers and the Department of Health and Social Care again and again to take action and provide PPE to frontline NHS staff carrying out procedures which are not currently listed as AGPs but which the scientific evidence shows should be. Read full story Source: HSJ, 13 November 2020- Posted
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Content ArticlePatients from ethnic minority groups are disproportionately affected by Coronavirus disease (COVID-19). Sze et al. performed a systematic review and meta-analysis to explore the relationship between ethnicity and clinical outcomes in COVID-19. They found that individuals of Black and Asian ethnicity are at increased risk of COVID-19 infection compared to White individuals; Asians may be at higher risk of ITU admission and death. These findings are of critical public health importance in informing interventions to reduce morbidity and mortality amongst ethnic minority groups.
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News Article
Black and Asian people ‘up to twice as likely to be infected with Covid’
Patient Safety Learning posted a news article in News
Black and Asian people are up to twice as likely to be infected with COVID-19 compared to those of white ethnicities, according to a major new report. The risk of ending up in intensive care with coronavirus may be twice as high for people with an Asian background compared to white people, data gathered from more than 18 million individuals in 50 studies across the UK and US also suggests. The report, published in the EClinicalMedicine by The Lancet, is the first-ever meta-analysis of the effect of ethnicity on patients with COVID-19. The scientists behind it said their findings should be of "importance to policymakers" ahead of the possible roll out of a vaccine. Read full story Source: The Independent, 12 November 2020 -
News Article
Covid deaths for people with learning disability in England six times average
Patient Safety Learning posted a news article in News
People with learning disabilities are dying of coronavirus at more than six times the rate of the general population, according to “deeply troubling” figures that have prompted a government review. A report from Public Health England (PHE) found that 451 in every 100,000 people registered as having learning disabilities died after contracting Covid-19 in the first wave of the pandemic, when the figures were adjusted for age and sex. Because not all Covid deaths among people with learning disabilities are registered as such, the true figure is likely to be 692 in every 100,000, or 6.3 times the UK average, the report estimated. Campaigners said the figures showed the government had failed to protect the most vulnerable. The report found that Covid deaths among those with learning disabilities were also more widely spread across age groups, with far greater mortality rates among younger adults. Those aged 18-34 were 30 times more likely to die with the virus than their counterparts in the general population. The higher death rate is likely to reflect the greater prevalence of health problems such as diabetes and obesity among those with learning disabilities, the report said. It also noted that some learning disabilities, such as Down’s syndrome, can make people more vulnerable to respiratory infections. People with learning disabilities are also likely to have difficulty recognising symptoms and following advice on testing, social distancing and infection prevention, the report said. It may also be harder for those caring for them to recognise symptoms if these cannot be communicated, it added. Read full story Source: The Guardian, 12 November 2020 -
Content ArticleIn this short video, Respiratory Consultant, Dr Catherine Monaghan from North Tees and Hartlepool NHS Foundation Trust, talks about the complexity of coronavirus. She emphasises that this is a very real and dangerous virus that presents in a huge variety of ways. She urges people to take all precautions possible and not to 'play Russian roulette' with their health, as the virus can have devastating consequences with young, fit people also very much at risk.
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News ArticleThe number of people waiting over a year for hospital treatment in England has hit its highest levels since 2008. Patients are meant to be seen within 18 weeks - but nearly 140,000 of the 4.35 million on the waiting list at the end of September had waited over a year. Surgeons said it was "tragic" patients were being left in pain while they waited for treatment, including knee and hip operations. And others warned the situation could become even worse during winter. In recent weeks, major hospitals in Bradford, Leeds, Nottingham, Birmingham and Liverpool, which have seen high rates of infection, have announced the mass cancellation of non-urgent work. Read full story Source: BBC News, 12 November 2020
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Content ArticleThe Royal College of General Practitioners have put together guidance for those working in primary care.
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Content ArticleLecture presentation slides from Professor Carl Philpot, University of East Anglia, on losing your sense of smell with coronavirus.
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Content ArticleLarge numbers of people are being discharged from hospital following COVID-19 without assessment of recovery. Mandal et al. followed 384 patients who had tested positive and had been treated at Barnet Hospital, the Royal Free Hospital or UCLH. Collectively the average length of stay in hospital was 6.5 days. The team found that 54 days after discharge, 69% of patients were still experiencing fatigue, and 53% were suffering from persistent breathlessness. They also found that 34% still had a cough and 15% reported depression. In addition 38% of chest radiographs (X-rays) remained abnormal and 9% were getting worse. The study has identified persisting symptoms and radiological abnormalities in a significant proportion of subjects. These data may assist with the identification of people outside expected recovery trajectories who could benefit from additional rehabilitation and/or further investigation to detect post-COVID complications.
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News ArticlePatients, including those with the coronavirus, are being kept “head to toe” on trolleys in accident and emergency departments in Manchester, with some forced to wait up to 40 hours for a bed. The “dangerous” situation has sparked warnings from the president of the Royal College of Emergency Medicine over the “potentially lethal” crowding of patients in A&Es across the country this winter. Katherine Henderson said she was “absolutely terrified” by what was happening in some departments. She said she had warned NHS England about the dangers of crowding patients in A&E but that not enough action had been taken. She told The Independent: “Crowding in A&E is unsafe, but with coronavirus it is potentially lethal. We have said this endlessly to NHS England." “Everyone agrees crowding is bad, but what they’re not doing is translating that into action.” After hearing of the situation in Manchester, she added: “Exactly what we said should not happen is happening. I am absolutely terrified by this. What more can I do? I have highlighted this risk everywhere I can over the past few months.” Read full story Source: The Independent, 11 November 2020
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Russian Covid vaccine shows encouraging results
Patient Safety Learning posted a news article in News
Early results from trials of a Covid vaccine developed in Russia suggest it could be 92% effective. The data is based on 20 cases of COVID-19 from 16,000 volunteers given the Sputnik V vaccine or a dummy injection. While some scientists welcomed the news, others said the data had been rushed out too early. It comes after Pfizer and BioNTech said their vaccine could prevent 90% of people getting Covid-19, based on a study of 43,500 people. Although the Sputnik data is based on fewer people being vaccinated and fewer cases of Covid developing during the trial, it does confirm promising results from earlier research. The Sputnik V vaccine, developed at the National Research Centre for Epidemiology and Microbiology in Moscow, is currently going through phase III clinical trials in Belarus, UAE, Venezuela and India. So far there are no safety issues, with Russian researchers saying there were "no unexpected adverse events" 21 days after volunteers received their first of two injections. Read full story Source: BBC News, 11 November 2020 -
Content ArticleThe National Institute for Health and Care Excellence (NICE) is developing the COVID-19 guideline: management of the long-term effects of COVID-19 and has published the final scoping document and associated project papers. The Royal College of General Practitioners (RCGP) has produced a summary and included some top tips to aid the care of your patients whilst waiting for the national guidance to be produced.
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EventThis Westminster Health Forum conference will focus on key issues for clinical negligence in the NHS and priorities for NHS resolution. The discussion is bringing together stakeholders with a range of key policy officials who are due to attend from DHSC; the Government Legal Department; HM Treasury; the MOJ and the NAO. The discussion at a glance: a patient safety culture - assessing progress and next steps in its development in the context of the NHS Patient Safety Strategy and the publication of the first Annual progress report COVID-19 - the impact on clinical negligence risk and increased clinical negligence claims the workforce - priorities for support through a period of unprecedented pressure legal costs - options for mitigation and policy. Register
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News ArticleA new NHS treatment programme targeting young people with eating disorders has been launched amid a rise in numbers needing treatment during the coronavirus pandemic. Recent NHS data showed record numbers of children and young people are currently being treated across England for eating disorders while waiting times in some places are dangerously long. On Monday, children’s charity NSPCC warned that counselling sessions for eating and body image disorders rose by 32% after lockdown was introduced in March. The new scaling up of intervention services for those with eating disorders such as anorexia and bulimia will mean young people can gain access to rapid specialist NHS treatment across England. The service will be rolled out to 18 sites, building on a successful trial model at King's College London, where one patient described the treatment as the “gold standard” of care. Nadine Dorries, Minister for Health, said: “Eating disorders can have a devastating impact on individuals and their families – and can very sadly be fatal. I am committed to ensuring young people have access to the services and treatment they need which can ultimately save lives." Read full story Source: The Independent, 10 November 2020
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News ArticleStudy finds 54 days after discharge, 69% of patients still had fatigue, and 53% were suffering from persistent breathlessness. Almost seven out of 10 patients hospitalised due to coronavirus still suffer from debilitating symptoms more than seven weeks after being discharged, according to a new study. Researchers from the University College London (UCL) division of medicine, in collaboration with with clinicians at the Royal Free London (RFL) and UCL, followed 384 patients who had tested positive and had been treated at Barnet Hospital, the Royal Free Hospital or UCLH. Collectively the average length of stay in hospital was 6.5 days. The team found that 54 days after discharge, 69% of patients were still experiencing fatigue, and 53% were suffering from persistent breathlessness. They also found that 34% still had a cough and 15% reported depression. In addition 38% of chest radiographs (X-rays) remained abnormal and 9% were getting worse. Dr Swapna Mandal, an honorary clinical associate professor at UCL division of medicine, said the data shows so-called long COVID is a real phenomenon and that further research is needed to understand how the symptoms of COVID-19 can be treated over an extended period. She said: "Patients whose COVID-19 illness is serious enough for them to require hospital care often continue to suffer significant symptoms for many weeks after their discharge." Read full story Source: Sky News, 11 November 2020
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Content ArticleThe COVID-19 Evidence Network to support Decision-making (COVID-END) helps: those supporting decision-making about COVID-19 to find and use the best available evidence (i.e. to support the evidence-demand side of the pandemic response) researchers to avoid waste by reducing duplication in and better coordinating the COVID-19 evidence syntheses, technology assessments and guidelines being produced (i.e., to support the evidence-supply side of the pandemic response). COVID-END is a time-limited network that brings together more than 50 of the world’s leading evidence-synthesis, technology-assessment and guideline-development groups around the world. It covers the full spectrum of the pandemic response, from public-health measures and clinical management to health-system arrangements and economic and social responses. It also covers the full spectrum of contexts where the pandemic response is playing out, including low-, middle- and high-income countries.
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Content ArticleDr John Campbell, a retired A&E nurse, discusses the current news, research and evidence on COVID-19 in the US and UK, the new coronavirus cases linked to mink farms, and free supplies of vitamin D to care home residents and clinically extremely vulnerable people in England.
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Content ArticleOn the same day that the nation went into a second lockdown, the Government published revised guidance on Visiting Arrangements for Care Homes. Whereas previous versions of this guidance had adopted a more neutral approach, the steer from the Government is now clear; the expectation is for care homes to be facilitating visits wherever possible. This Bevan Brittan article looks at what the law says, what the new guidance says and what care homes should be doing.
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