Latest clinical news updates
Government urges all non-essential contact with others to be avoided
In his first daily press briefing, Prime Minister Boris Johnson said that all "non-essential" travel and contact with others should be avoided to prevent the spread of coronavirus.
He also said that people should work from home where possible and people over the age of 70 and vulnerable people must also begin self-isolating within days.
The UK is now approaching "the fast growth part of the upward curve" in the number of cases and is likely to be "more like three weeks" behind Italy.
Chief Medical Officer Professor Chris Whitty said: "The group of people who we would want to take this advice particularly seriously are older people above 70, people who in adult life would normally be advised to have the flu vaccination, so these are people with chronic diseases such as chronic heart disease or chronic kidney disease, and also - as a precautionary measure because we are early in our understanding and we want to be sure - women who are pregnant.
"Those are the groups we want to take particular care to minimise their social contact which of course will have very significant risks for them."
He said these measures could last for months, but it could go on for longer, adding that the country had to be prepared for restrictions to be in place for "the long haul".
WHO: every suspected case should be tested
The World Health Organisation said it has a simple message for all countries: test, test, test. Test every suspected case.
Director General, Tedros Adhanom Ghebreyesus, said that in the past week, there has been a rapid escalation of cases of COVID-19 with more cases and deaths now reported in the rest of the world than in China.
He added: "We have also seen a rapid escalation in social distancing measures, like closing schools and cancelling sporting events and other gatherings. But we have not seen an urgent enough escalation in testing, isolation and contact tracing – which is the backbone of the response.
"All countries must take a comprehensive approach. But the most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate.
"You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected."
WHO advises that all confirmed cases, even mild cases, should be isolated in health facilities, to prevent transmission and provide adequate care. Countries should prioritise older patients and those with underlying conditions.
He added: "This is a serious disease. Although the evidence we have suggests that those over 60 are at highest risk, young people, including children, have died.
"This is the defining global health crisis of our time. The days, weeks and months ahead will be a test of our resolve, a test of our trust in science, and a test of solidarity. We’re all in this together. And we can only succeed together."
New adult social care plans to protect older patients
The new guidance covers a variety of scenarios relating to care homes, staff, and providers who care for people in their own homes to ensure older people and those with pre-existing conditions and care needs who receive support are best protected.
Elderly people and those with underlying health conditions are much more likely to develop serious complications. Anyone who is suspected of having COVID-19, with a new continuous cough or high temperature, should not visit care homes or people receiving home care, and should self-isolate at home.
People receiving care will be isolated in their rooms if they have symptoms of coronavirus. To ensure they can continue to receive the care they require, care staff will use protective equipment to minimise the risk of transmission.
BMA seeks reassurances for doctors
Ministers have been urged to implement a wide range of measures to safeguard and help doctors and medical students fight COVID-19 following the decision to move to the ‘delay’ phase in the UK.
These should include safeguards for retired doctors who the Government suggests could be asked to join the NHS for the battle against the virus.
BMA council chair Chaand Nagpaul said the move to the delay phase would "undoubtedly put more pressure on the NHS and our members as the country works to halt the spread of the virus.
"Doctors must have the confidence to help plan and treat patients," he added. "They need adequate protection from the risks of workplace infections as well-resourced as possible to care for patients. At present, such confidence is lacking."
Letter from the Intensive Care Unit
In a poignant letter published in the BMJ, a critical care doctor tells patients who are elderly, frail, vulnerable, or with serious underlying health conditions that doctors have not forgotten about them.
Matt Morgan, honorary senior research fellow at Cardiff University, consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, said: "It must be so hard listening to endless news reports that end with “don’t worry, this illness mainly affects the elderly, frail, vulnerable, or those with serious underlying health conditions.” What if that is you?
"Our passion as an intensive care community is fixing problems that can be fixed. Yet we often meet patients like you who have problems that cannot simply be fixed. As this virus continues to impact on the world, we will meet many more of you."
He said as difficult as this is, staff will be honest. "We will continue to use all of the treatments that may work and may get you back to being you again. We will use oxygen, fluid into your veins, antibiotics, all of the things that may work. But we won’t use the things that won’t work. We won’t use machines that can cause harm. We won’t press on your chest should your heart stop beating. Because these things won’t work. They won’t get you back to being you."
He adds: "And If these things are still not enough, we will sit with you and with your family. We will be honest, we will hold your hand, we will be there. We will change our focus from cure but most importantly we will continue to care. We have not forgotten about you."
What happens next for Italy?
A analysis from the Department of Management Information and Production Engineering, University of Bergamo, Dalmine, Italy has been published in the Lancet.
It says that in theory, Italy is in a better position than many other countries to react to the current outbreak. However, an aggressive approach needs to be taken with patients who are critically ill with SARS-CoV-2, often including ventilatory support. The system’s capacity to respond to changing circumstances has been under enormous pressure, at least in the Lombardy region, where two clusters have already emerged since Feb 21.
It predicts that if the exponential trend continues for the next few days, more than 2,500 hospital beds for patients in intensive care units will be needed in only one week to treat ARDS caused by SARS-CoV-2-pneumonia in Italy.
The government is preparing to pass legislation that will enable the health service to hire 20,000 more doctors and nurses and to provide 5,000 more ventilators to Italian hospitals.
The authors said: "These measures are a step in the right direction, but our model tells us that they need to be implemented urgently, in a matter of days. Otherwise, a substantial number of unnecessary deaths will become inevitable. Intensive care specialists are already considering denying life-saving care to the sickest and giving priority to those patients most likely to survive when deciding who to provide ventilation to.
"Our doctors and nurses are modern heroes in an unexpected war against a difficult enemy. In the near future, they will have no choice. They will have to follow the same rules that health-care workers are left with in conflict and disaster zones. We hope that the present analysis will help political leaders and health authorities to move as quickly as they can to ensure that there are enough resources, including personnel, hospital beds, and intensive care facilities, for what is going to happen in the next few days and weeks."
Other news round up
- Italy reports 349 new deaths.
- Germany closes the border it shares with five other countries.
- US authorities advise against gatherings of more than 50 people
- Wales reports its first death.
- Education Secretary Gavin Williamson is expected to meet with school leaders to discuss the implications of school closures.
- Cases outside of China have surpassed those inside.