Latest clinical news updates
WHO: we are not at the mercy of this virus
In a press conference yesterday, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that it was ‘troubling that so many people and countries have been affected, so quickly' as the number of global reported cases crossed 100,000 in 100 countries. He added that “now that the virus has a foothold in so many countries, the threat of a pandemic has become very real but it would be the first pandemic in history that could be controlled.
“The bottom line is: we are not at the mercy of this virus.”
He said that the great advantage we have is that the decisions we all make – as governments, businesses, communities, families and individuals – can influence the trajectory of this epidemic. And we need to remember that with decisive, early action, we can slow down the virus and prevent infections. Among those who are infected, most will recover.
How to triage effectively in a pandemic?
The BMJ published an opinion piece from Christina Pagel, Professor of Operational Research (a branch of applied mathematics) at University College London (UCL) and Director of the UCL Clinical Operational Research Unit. As 6%-10% of infected people are likely to be critically ill, most of whom will require ventilation support in an intensive care environment, the NHS urgently needs to address the question of how access to intensive care is determined when there are not sufficient resources to treat everyone.
This comes as Italy is already experiencing extreme stress on its intensive care system and in a matter of weeks the UK too may be facing a situation where demand for intensive care exceeds capacity.
She said that pragmatically, a first-come first-served approach to access will be hard to escape although in practice it might well disadvantage the more vulnerable in society with the worst access to healthcare. While triage may be an effective way to increase population survival, this is not guaranteed and any protocol should be carefully thought through.
Any triage protocol will lead to tragic choices for some. This should not be left as the responsibility of individual clinicians without guidance from the NHS, the Royal Colleges, and Professional Societies to ensure consistency, equity and transparency. She said that there is no single right answer, but if containment and delay measures fail then the NHS needs to find an answer and soon.
Incubation period of COVID-19 is five days
A study in the Annals of Internal Medicine looked to estimate the length of the incubation period of COVID-19 and describe its public health implications.
Using pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020 (using news reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China) it found that a median incubation period for COVID-19 was approximately five days, similar to SARS.
The results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases.
Nurses to be brought out of retirement
The nursing regulator is working with the government on potential legislation to make it easier to bring nurses out of retirement during a coronavirus outbreak.
The Nursing and Midwifery Council confirmed that while no emergency measures were yet in place it is being considered.
Professor Geraldine Walters, director of education and standards for the NMC, told Nursing Times: “While we do not currently have emergency powers to reinstate those who have recently left the register, we’re working closely with the government on potential legislation that would allow us to do so if needed.”
Lack of proper A&E isolation facilities
Chris Moulton, consultant in emergency medicine at the Royal Bolton Hospital and former vice president of the Royal College of Emergency Medicine, said the vast majority of NHS emergency departments in England do not have adequate isolation facilities.
He told the BMJ he visited and observed around 80 emergency departments and there was a lack of proper isolation cubicles with an anteroom where you can get changed, wash your hands, and then go into the main cubicle. He added that while some emergency departments had enough space to isolate people, only around half of those he had observed were properly designed.
Key risk factors associated with higher risk of death from COVID-19
Being of an older age, showing signs of sepsis, and having blood clotting issues when admitted to hospital are key risk factors associated with higher risk of death from the new coronavirus (COVID-19).
The data is from a new observational study of 191 patients with confirmed COVID-19 from two hospitals in Wuhan, China, and was published in The Lancet.
According to co-author Dr Zhibo Liu from Jinyintan Hospital, China: “Older age, showing signs of sepsis on admission, underlying diseases like high blood pressure and diabetes, and the prolonged use of non-invasive ventilation were important factors in the deaths of these patients. Poorer outcomes in older people may be due, in part, to the age-related weakening of the immune system and increased inflammation that could promote viral replication and more prolonged responses to inflammation, causing lasting damage to the heart, brain, and other organs.”
Other news round up
- Iran reports 54 deaths, its highest figure yet over a 24-hour period
- Major European sports games to be held behind closed doors due to coronavirus fears
- The two-week quarantine at a hotel in Tenerife has come to an end
- First day of Italy's lock down. Travel is restricted across Italy and public gatherings are forbidden throughout the country
- Financial relief for Royal Bank of Scotland customers as it announces it will allow deferment of mortgage and loan repayments for up to three months for customers impacted by the coronavirus
- Lebanon reports first coronavirus death
- Chinese President Xi Jinping is visiting Wuhan for the first time since the outbreak began
- Cruise ship Grand Princess where 21 tested positive for coronavirus will disembark today in California
- Donald Trump will ask Congress to pass emergency economic relief to provide help to business affected by stock market slump
- South Korea cases slow down