Latest clinical news updates
Epidemic suppression is the only viable strategy at the current time
The UK Government’s decision to ramp up interventions to curtail the spread of coronavirus followed a warning from scientists at Imperial College London that a quarter of a million people could die in a "catastrophic epidemic".
The report by Imperial College’s COVID-19 Response Team - Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand – looked at two different strategies.
The first is mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection. The second is suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely.
It said: "We conclude that epidemic suppression is the only viable strategy at the current time. The social and economic effects of the measures which are needed to achieve this policy goal will be profound. Many countries have adopted such measures already, but even those countries at an earlier stage of their epidemic (such as the UK) will need to do so imminently.”
UK's public health response must be transparent
With the UK increasingly becoming an outlier globally in terms of its minimal social distancing population level interventions, transparency is key, according to a letter published in the Lancet from a group of UK scientists and doctors
It said that our country’s response to COVID-19 is demonstrably different from how most other countries are responding globally, including elsewhere in Europe. As the government has stressed, it is imperative to delay and flatten the epidemic curve to ensure the National Health Service can cope.
This is particularly essential for the UK, which only has 2.5 hospital beds per 1,000 population, fewer than in Italy (3.2 per 1,000), France (6.0), and Germany (8.0). Initial data from Italy have shown that 9–11% of actively infected patients with COVID-19 required intensive care during the first 10 days of March, 2020.
It said it is not clear how the UK’s unique response is informed by the experiences of other countries, particularly those that have achieved relative control over the virus as a result of widespread testing, contact tracing, and state-imposed social distancing measures, such as Singapore, Hong Kong, Taiwan, and South Korea.
The letter added: "Time is a luxury we simply do not have as we face this critical public health crisis. As we have already seen in other countries, a matter of a few days can prove critical in terms of saving lives and avoiding health system collapse. As the UK was not the first country to face a COVID-19 outbreak, knowledge of the disease and evidence pertaining to effective public health interventions is increasingly available.
"However, this is only advantageous if we incorporate the best available evidence from observations elsewhere and use the time this affords us to refine a comprehensive response based on input and scrutiny from a broad base of scientific experts."
Elective, non-urgent surgery to be suspended
NHS Chief Executive Simon Stevens has confirmed that all non-urgent operations in England will be postponed from 15 April to free up 30,000 beds to help tackle coronavirus.
The emergency policy will be in place for at least three months.
He said: “we are going to be taking concerted action across the whole of the NHS, to free-up up to a third of general acute beds”
Northern Ireland GPs freed from QOF requirements
GPs in Northern Ireland are to be freed from meeting the requirements of the QOF (quality and outcomes framework).
QOF is a series of annual targets used to measure the performance of practices and the decision to suspend them has been welcomed by Northern Ireland’s GPs, with practices assured they will face no financial detriment as a result of the decision.
BMA Northern Ireland GPs committee chair Alan Stout said Stormont’s decision to support GPs in meeting the health demands posed by the COVID-19 pandemic by freeing them from the burden of QOF showed "early and definitive" action.
He said: "This news will come as a huge relief to practices who have been noticing the strain with increased concern and activity associated with COVID-19.
"The early and definitive decision by our health minister shows an understanding and a determination to deal with the unprecedented situation and we are committed to working with him and his department to ensure safe and effective care to the public in Northern Ireland."
Three clusters of COVID-19 and implications for surveillance
The Lancet has published an investigation of three clusters of COVID-19 in Singapore looking at the implications for surveillance and response measures.
The three clusters of coronavirus disease were linked to a tour group from China, a company conference, and a church were identified in Singapore in February, 2020.
The researchers gathered epidemiological and clinical data from individuals with confirmed COVID-19, via interviews and inpatient medical records, and field investigations to assess interactions and possible modes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Open source reports were obtained for overseas cases.
Of these, 36 cases of COVID-19 were linked epidemiologically to the first three clusters of circumscribed local transmission in Singapore. 425 close contacts were quarantined. Direct or prolonged close contact was reported among affected individuals, although indirect transmission (eg, via fomites and shared food) could not be excluded.
The median incubation period of SARS-CoV-2 was four days (IQR 3–6). The serial interval between transmission pairs ranged between three days and eight days.
It found that SARS-CoV-2 is transmissible in community settings, and local clusters of COVID-19 are expected in countries with high travel volume from China before the lockdown of Wuhan and institution of travel restrictions. Enhanced surveillance and contact tracing is essential to minimise the risk of widespread transmission in the community
Halt to routine CQC inspections 'sensible'
The Royal College of General Practitioners has said the suspension of routine CQC inspections of general practices is a sensible place to start in freeing up time and capacity in general practice to deliver patient care.
Professor Martin Marshall, Chair of the Royal College of GPs, said: "Covid-19 is set to test the NHS for weeks and months to come and GPs and our teams will increasingly be at the forefront of tackling it, but we are already a profession under pressure and we will need to start doing some things differently.
"We need to think seriously about what tasks to prioritise over others, and what we can stop doing while we focus on patients who have or who are worried about Covid-19 – and it is right that these conversations start with our more administrative and bureaucratic duties.
"The College has been calling for a suspension of routine CQC inspections of general practice as preparing for these can be a huge amount of work for GPs and our teams and we are pleased that the CQC has taken heed of this."
Other news round up
- Britons advised against non-essential foreign travel for 30 days.
- Brazil reports first death.
- £3.2m of emergency funding to help rough sleepers self-isolate to prevent the spread of coronavirus.
- Euro 2020 has been postponed until 2021 according to the Norwegian FA.
- Archbishop of Canterbury suspends public worship.
- Iran has temporarily freed about 85,000 prisoners.