Skip to main content

Posts

Showing posts from 2020

The NHS must be fully supported in rolling out the Covid-19 vaccination programme

The news today that the MHRA has approved the AstraZeneca adenoviral ChAdOx1 nCoV-190 vaccine for use in the UK is excellent news for the Covid-19 vaccination programme. The results of the vaccine trial published in the Lancet earlier in December were encouraging, even if the overall efficacy of 70% was lower than the 90-95% being reported for mRNA vaccines from Pfizer-BioNTech and Moderna. The vaccine still prevented serious cases of illness amongst the recipients. The AstraZeneca vaccine is cheaper than the mRNA vaccines and can be stored in a conventional vaccine fridge. Hence, it is an easier vaccine to use in primary care and community settings, including in low and middle income countries. The most commonly reported adverse reactions from the vaccine were fatigue, headache, feverishness, and myalgia. More serious adverse events were rare and not believed to be directly related to the vaccine. One caveat for all the Covid-19 vaccines is that we don’t yet know how long the immunity

Vitamin D supplementation for the prevention and treatment of Covid-19

During the Covid-19 pandemic, various treatments and management strategies are being examined to see if they can either help prevent Covid-19 or improve outcomes once people are infected. There are suggestions from some studies that Vitamin D could improve outcomes in people with Covid-19. The National Institute for Health and Care Excellence (NICE) recently assessed assess the role of Vitamin D in Covid-19. In its evidence review, NICE concluded that there was currently insufficient evidence to recommend Vitamin D for the prevention and treatment of Covid-19. NICE did recommend, however, that people in the UK should follow government guidance on taking Vitamin D supplements; particularly people from groups at higher risk of Vitamin D deficiency. The panel also conclude that there was a need for further research on Vitamin D supplementation for preventing and treating Covid-19. Larger prospective studies with sufficient power to look at key outcomes, and also to examine outcomes in su

How to cut Christmas Day coronavirus risk - from presents to games and dinner

  In a Daily Mirror article published on Christmas Eve, Matt Roper and I discuss ways to stay safe this Christmas when the UK is in the midst of a pandemic, with Covid-19 cases rising across the country. The key action is to minimise mixing indoors with people from other households. Think carefully before you socialise, particularly if this will be with people at higher risk of death and complications from Covid-19, such as the elderly and those with long term health problems. How often should we wash or sanitise our hands? You should aim to get into a routine for handwashing. I would recommend handwashing around every two hours during the daytime. You should also wash your hands before and after any activity that might increase the risk of infection, such as handling food or when you have been in contact with other people. Using soap and water is fine, and there is no need to use expensive hand sanitiser unless soap and water are not readily available. Should we keep the window

Covid-19 in London

The Covid-19 situation in London is now very serious, with the number of Covid-19 cases doubling in the past to week to around 50,000. Infection rates are highest in the North-East of London, with increases seen all across the city.  The number of hospital patients with Covid-19 has increased to around 3,000 compared with around 1,600 one month ago. The number of patients requiring ventilators has increased by 100 over the last week to around 360. There are also pressures on other parts of the NHS, such as GP, mental health, and community services. The new strain of SARS-CoV-2 is now becoming the most commonly identified strain in London and the South-East of England. It appears to be more infectious than other strains, and this will drive up the number of cases, people requiring hospital treatment and deaths. The latest statistics show how rapidly the situation can change. From a period around one month ago, when case numbers were falling and NHS pressures were sustainable, we are now

What are the priorities for the NHS during the period when tight Covid-19 restrictions are in place?

People in many areas of the United Kingdom will be living under tight Covid-19 restrictions for the next few months. In London and the South-East of England, for example, this means being placed under Tier 4 restrictions.  For the NHS, there will be two main priorities during this period. The first will be to rapidly implement the Covid-19 vaccination programme. This is our best hope of bringing the pandemic under control and allowing life to start to return to normal. But success requires working on a speed and scale not seen before for any public health programme in the United Kingdom. Adequate supplies of vaccine must be secured and the infrastructure put in place to administer vaccines rapidly to tens of millions of people.  The second priority will be to ensure that people with non-Covid illnesses receive the care they need. This will be very challenging in the middle of a pandemic. We have already seen a large backlog of NHS work build up in 2020. The NHS must ensure that people

London and South-East England Move to Tier 4 Restrictions

 After a period from mid to late November in which the number of people with a positive Covid-19 test in the UK declined, in recent weeks we have unfortunately seen a rise in Covid-19 cases, with over 28,000 cases reported in the UK on 18 December. This rise in case numbers has been particularly high in parts of London and South-East England, leading today to these areas being placed into a new Tier 4 Level. Infection rates are also increasing in other parts of the UK, such as Wales. Despite the enthusiasm and optimism generated by the Covid-19 vaccination programme, the number of people being vaccinated is well-below the level needed to start to reduce infection rates in the community. Without a very rapid escalation in the Covid-19 vaccination programme, which in turn depends on further vaccines being licensed for use in the UK and very quickly obtaining a much large supply of vaccines than we have available now, it will be sometime (perhaps several months, depending on vaccine avail

Changes in Covid-19 Tiers in England

After a period from Mid-November onwards in which the number of people with a positive Covid-19 test in the UK declined, in recent days we have unfortunately seen a rise in Covid-19 cases, with over 25,000 cases reported in the UK on 16 December. This rise in case numbers has been particularly high in parts of London and South-East England, leading to more areas of England being placed in Tier 3.  Despite the enthusiasm and optimism generated by the Covid-19 vaccination programme , the number of people being vaccinated is well-below the level needed to start to reduce infection rates in the community. Without a very rapid escalation in the Covid-19 vaccination programme, which in turn depends on very quickly obtaining a much large supply of vaccines than we have available now, it will be sometime (perhaps several months, depending on vaccine availability) before enough people in England and elsewhere in the UK are vaccinated to have an impact on Covid-19 infection rates.  For the time

Measuring the long-term safety and efficacy of Covid-19 vaccines

The news that two UK recipients of the Covid-19 Pfizer-BioNTech mRNA vaccine suffered allergic reactions illustrates the need for accurate recording of any adverse events following administration of Covid-19 vaccines. As these vaccines are new, we don’t yet have long-term data on their safety and efficacy. This data is essential to help build public confidence in these vaccines and ensure take-up of the vaccines is high; not just in the UK but globally as well. The data will also help identify how frequently vaccination is needed to ensure vaccine recipients retain their immunity to Covid-19.  The UK is well-placed to collect this data. We have a National Health Service that has developed computerised medical records for use in general practices on a population of around 67 million people. These electronic medical records provide longitudinal data on people’s health and medical experiences. They can now also be linked to other data; such as hospital admissions records and mortality r

Curbing the spread of COVID-19 in the fragile settings of the Global South

Globalisation impacts the epidemiology of communicable diseases, threatening human health and survival globally. The ability of coronaviruses to spread, quickly and quietly, was exhibited with Severe Acute Respiratory Syndrome in 2002–2003 and, more recently, with COVID-19. Not sparing any continent, the World Health Organization declared a COVID-19 pandemic on 11 March 2020. In an article published in the Journal of Royal Society of Medicine , we discussed how higher income countries can support the response to Covid-19 in low income countries. Despite high-income countries being inordinately impacted, due to the increasing number of COVID-19 cases, SARS-CoV-2 continues to represent a looming threat to the Global South, leading the World Health Organization to previously state that ‘Our biggest concern continues to be the potential for COVID-19 to spread in countries with weaker health systems’ and that Africa could become the next epicentre.  However, while academics, public health e

Clinical effectiveness and cost effectiveness of mental health workers colocated within primary care

Mental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. In a paper published in the journal BMJ Open , we reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices. Fifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. The interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care. We concluded that while there

The AstraZeneca adenoviral Covid-19 vaccine: What potential role does it have?

The results of the AstraZeneca adenoviral ChAdOx1 nCoV-190 vaccine trial published in the Lancet today are encouraging, even if the overall efficacy of 70% is lower than the 90-95% being reported for mRNA vaccines from Pfizer-BioNTech and Moderna; and from the Russian Sputnik adenoviral vector vaccine.  The AstraZeneca vaccine is cheaper than the mRNA vaccines and can be stored in a conventional vaccine fridge. Hence, it is an easier vaccine to use in primary care and community settings, including in low and middle income countries. The most commonly reported adverse reactions were fatigue, headache, feverishness, and myalgia. More serious adverse events were rare; none of which were thought to be due to either of the vaccines used in the study.  Based on these results, once the vaccine is approved by the MHRA, I would like to see it rapidly adopted by the NHS. The vaccine is highly suited for use in UK primary care as it can be stored in general practices and given to patients either

Covid-19 vaccination - separating fact from fiction

Covid-19 vaccinations will kick off within days but it seems some people need a sharp dose of facts first. In an article published in the Daily Mirror , Matt Roper and I debunk some of the common myths and misconceptions about vaccines. Scepticism about vaccines has been growing throughout the pandemic and a recent survey found that one in five British adults may refuse to take a coronavirus jab – even though it is probably our only hope of a return to normality.   1. MYTH: A vaccine produced so quickly can’t be safe Most vaccines take years to develop, test and approve for public use but, says Dr Majeed, a global effort has meant scientists have been able to work at record speed. He says: “Covid-19 vaccines have to go through the same process of approval as other vaccines. Funding was made available immediately and studies set up rapidly. "There have been a lot of technological developments that allow vaccines to be developed much more quickly.”   2. MYTH: I might

Vaccinating the UK against Covid-19

The global Covid-19 pandemic has led to over 50,000 deaths in the United Kingdom, disrupted health services for many other conditions, and has had enormous economic impacts that have led to massive increases in unemployment and government debt.[1,2,3] With the United Kingdom’s failure to implement an effective test, trace and isolate programme as we have seen in countries such as South Korea and New Zealand, a vaccination programme offers us the best way to finally bring this pandemic under control[4]. It is therefore essential that the Covid-19 vaccination programme is implemented well and that we do not repeat the many mistakes we have seen in the government’s response to Covid-19, such as in the Test and Trace programme.[5] Primary care should be at the heart of the delivery of the UK’s vaccine programme. With around 7,000 general practices in England, for example, they are easy for patients to access and their staff are generally well-trusted by the public.  Unfortunately, a decade

Was the government right to announce an easing of Covid-19 restrictions during Christmas?

  1. Was the government right to announce an easing of Covid-19 restrictions during Christmas? When the current lockdown in England ends, it’s likely the government will introduce a new system of tiered restrictions. My view is that these restrictions should remain in place through the Christmas and New Year period, based on the local community infection rate. Easing the restrictions too quickly risks undoing all the gains we have made during the lockdown. Greater social mixing indoors over the Christmas and New Year holidays will inevitably lead to an increase in Covid-19 infections.   2. Could allowing mixing of households actually mean people will die as a result? Most person to person transmission of Covid-19 infection occurs within households. This is the rationale for the government’s policy of stopping different households from mixing with each other indoors. Allowing mixing of households indoors will inevitably lead to an increase in infections, which would be very seri

Characteristics of children who are frequent users of emergency departments in England

Increasing pressures on emergency departments present a considerable challenge worldwide, particularly during winter. Before the COVID-19 pandemic, serious infectious disease incidence had fallen with the success of vaccination programmes. However, amidst the ongoing global pandemic pressure on hospital EDs are stretched to their limit. This can strain health resources and budgets and can result in poor clinical outcomes. Increasing demand for EDs may be driven by rising morbidity in an ageing population, poor access to primary care and increase in patient expectations. In England, in 2017/2018, there were 23.8 million  emergency department attendances, an increase of 22% since 2008/2009; rises were higher in the under-5 (28%–30%), and one-third of all British children visit an  emergency department each year. Such increases pose immense challenges to the National Health Service (NHS) amidst significant cuts in funding, given that that nearly half of the health budget is spent on emerg

The failure of England’s Test and Trace system means we will be in and out of lockdowns for some time

Whether we will come of the 4-week lockdown on schedule will depend on how low the government’s Covid-19 strategy brings the R-value for the country. The R value is the average number of people that each new case of Covid-19 infects. If the R value for England is less than one, the daily number of cases will start to fall; and if the R value is greater than one, the daily number of cases will continue to increase. Once the R value is below one, and the daily number of cases start to fall, the number of people being admitted to hospital and the number of deaths will also start to fall. There is though a lag before the number of hospital admissions and deaths begin to fall. This is because it can take 1-2 weeks from becoming infected before a person is unwell enough to need hospital treatment. There is then as further period of time before death. Hence, case numbers start to fall first, followed by the number of people admitted to hospital and then finally, the number of people dying fro

COVID-19, seasonal influenza and measles: potential triple burden and the role of flu and MMR vaccines

Policy interventions aimed at reducing person-to-person transmission of SARS-CoV-2 (such as hand hygiene, physical distancing and wearing face coverings) were implemented globally to minimise healthcare burden, and to allow more time for an effective treatment and successful vaccine. After months of ‘lockdown’, many countries started to ease these measures recently only to see a surge in COVID-19 cases and deaths. During the winter of 2020–2021, we face the prospect of a dual burden of a COVID-19 pandemic and a seasonal influenza epidemic. However, what’s not being currently discussed is that the burden on healthcare could be further compounded by a potential surge of measles and rubella cases. This is due to: (1) a declining trend in Measles-Mumps-Rubella vaccine coverage accompanied by an increasing trend in Measles-Mumps-Rubella cases since 2016; and (2) disruption and suspension of Measles-Mumps-Rubella vaccination campaigns in 23 countries to cope with the COVID-19 pandemic. Our a

Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London

The COVID-19 pandemic is imposing a profound negative impact on the health and wellbeing of societies and individuals, worldwide. One concern is the effect of social isolation as a result of social distancing on the mental health of vulnerable populations, including older people. Our findings were published in the journal Frontiers in Psychiatry . Within six weeks of lockdown, we initiated the CHARIOT COVID-19 Rapid Response Study, a bespoke survey of cognitively healthy older people living in London, to investigate the impact of COVID-19 and associated social isolation on mental and physical wellbeing. The sample was drawn from CHARIOT, a register of people over 50 who have consented to be contacted for aging related research. A total of 7,127 men and women (mean age=70.7 [SD=7.4]) participated in the baseline survey, May–July 2020. Participants were asked about changes to the 14 components of the Hospital Anxiety Depression scale (HADS) after lockdown was introduced in the UK, on 23r

Data-driven, integrated primary and secondary care for children: moving from policy to practice

Despite the best efforts of clinicians, traditional healthcare models often struggle to meet the increasingly complex needs of children and young people under the age of 18 years, as well as 21st century challenges such as obesity and mental health problems. Policy makers and clinical leaders have argued that greater integration of primary and secondary care has the potential to meet the ‘Quadruple aim’ of better population health outcomes, patient and family satisfaction, provider satisfaction and reduced costs. More integrated services and improved data sharing across organisations are key enablers of child health improvement. However, there is sparse literature on how more integrated care for children and young people might work in practice or contribute to achieving these goals. We present the experience of developing a new model for integrated care delivery for children and young people in North West London, based on a common system of clinical records or dashboards across all pro

Preliminary Outcomes of a Digital Therapeutic Intervention for Smoking Cessation in Adult Smokers: Randomized Controlled Trial

Tobacco smoking remains the leading cause of preventable death and disease worldwide. Digital interventions delivered through smartphones offer a promising alternative to traditional methods, but little is known about their effectiveness. Our objective was to test the preliminary effectiveness of Quit Genius, a novel digital therapeutic intervention for smoking cessation. Our research was published in the journal JMIR Mental Health . We used a 2-arm, single-blinded, parallel-group randomized controlled trial design. Participants were recruited via referrals from primary care practices and social media advertisements in the United Kingdom. A total of 556 adult smokers (aged 18 years or older) smoking at least 5 cigarettes a day for the past year were recruited. Of these, 530 were included for the final analysis. Participants were randomized to one of 2 interventions. Treatment consisted of a digital therapeutic intervention for smoking cessation consisting of a smartphone app delivering

Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review

There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. We aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. The research was published in the Journal of Medical Internet Research . In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis,

Maximising the impact of social prescribing on population health in the era of COVID-19

Our new paper in the Journal of the Royal Society of Medicine discusses social prescribing, the process of referring people to non-clinical community services; such as exercise classes and welfare advice, with the aim of improving mental, physical and social wellbeing.  Social prescribing has been increasingly adopted across high-income countries including the UK, United States of America, Canada and Finland. The UK’s Department of Health first introduced the term ‘social prescribing’ in 2006 to promote good health and independence, especially for people with long-term conditions. Over a decade later, in 2019, NHS England committed to funding social prescribing through link workers. Link workers receive referrals, mainly from general practitioners, and are attached to primary care networks with populations of 30–50,000 people. In the paper, we examine the impact of different social prescribing schemes in England, from a population health perspective, that focus on individuals, communi

Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?

My new paper published in the Journal of the Royal Society of Medicine discusses excess mortality during the Covid-19 pandemic. The scale of the COVID-19 pandemic has forced policy-makers to operate with limited evidence for the relative success of different control measures.  Excess mortality is one key outcome measure. The highest excess mortality per million population is seen in Spain, followed by England and Wales. The majority of these excess deaths are caused by COVID-19, but a significant proportion are not directly related to COVID-19. In measuring the impact of COVID-19, mortality is however only one of many important outcomes. Even in ‘mild’ cases not requiring hospitalisation, symptoms can be long-lasting, and heart and lung complications are common, affecting quality of life and ability to work. Beyond the effects on health, the pandemic has disrupted all aspects of society – many countries have experienced record economic recessions, while school closures affect children

The impact of COVID-19 on academic primary care and public health

The COVID-19 pandemic has had a dramatic effect on people’s lives globally. For academics working in fields such as primary care and public health, the pandemic led to major changes in professional roles as I discuss in an article published in the JRSM. Universities across the United Kingdom closed their campuses in March 2020 and switched to remote working. Staff began to work from home and teaching of students moved online. University staff rapidly had to put in place systems for teaching, monitoring and assessing students remotely. For many universities, these changes will be in place until the end of 2020, with no return to a more normal mode of working until January 2021 at the earliest. DOI:  https://doi.org/10.1177/0141076820947053  

COVID-19 presents opportunities and threats to transport and health

The ‘lockdown’ of the United Kingdom on 23 March had pronounced impacts on travel patterns as we discussed in our recent JRSM paper. As many millions of people moved to either working at home or were furloughed from their jobs, there were large decreases in trips to workplaces alongside even steeper decreases in recreational journeys. Transport is an often overlooked influence on the health of populations and health inequalities, affecting physical activity, road traffic incidents and air pollution, in addition to being a major contributor to climate change. There is ongoing uncertainty around the longer-term trajectory of COVID-19, including risks of a second wave, meaning that the medium-term changes to transport and society are hard to predict. Nevertheless, the current easing of the lockdown in England presents both opportunities and threats to the health impacts of transport. DOI:  https://doi.org/10.1177/0141076820938997

Identifying naturally occurring communities of NHS primary care providers

Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that PCNs should represent ‘natural’ communities of general practices (GP practices) collaborating at scale and covering a geography that fits well with practices, other healthcare providers and local communities. Our study published in BMJ Open aims to identify natural communities of GP practices based on patient registration patterns using Markov Multiscale Community Detection, an unsupervised network-based clustering technique to create catchments for these communities. With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital to recognise how PCNs represent their communities. Our method may be used by policymakers to understand the populations and geography shared between networks. DOI:  10.1136/bmjopen-2019-036504

The primary care response to COVID-19 in England's National Health Service

In a recent article , I discuss the primary care response to Covid-19 in England. The first case of COVID-19 in England was identified at the end of January 2020. Cases increased during February, and by early March, it became apparent that England faced a large COVID-19 epidemic. This led to the Department of Health and Social Care and NHS England (the bodies that respectively fund and manage the NHS in England) to recommend radical changes to the provision of NHS primary care services. For most general practices, these changes began to be implemented in the week beginning 16 March 2020. As a first step, general practices switched from the traditional model of face-to-face service provision to one where all patients were initially assessed through a telephone or a video call. Patients were encouraged to register for online booking of these appointments if they had not already done this.  All patients requesting advice spoke first to a health professional, usually general practitioners.

Can the UK emulate the South Korean approach to Covid-19?

My editorial in the British Medical Journal compares the response to Covid-19 in South Korea and the UK. Early adoption of a “test, trace, isolate and treat” strategy was the key to South Korea’s success in suppressing Covid-19. On 29 February 2020, South Korea, a country of similar population size to England, recorded 909 news cases of COVID-19. Only 55 new cases of COVID-19 were recorded in England on 29 February. By mid-May, despite several weeks of a “lockdown” and although numbers had declined from the peak in April 2020, the United Kingdom was still recording over 3,000 news cases each day. The key difference between the United Kingdom and South Korea was the rapid adoption by South Korea of a “test, trace, isolate and treat” strategy whereby suspected cases were tested; contacts identified; strict isolation enforced; and free treatment given to those infected.  Read the full article in the British Medical Journal . doi: https://doi.org/10.1136/bmj.m2084  

Health inequalities: the hidden cost of COVID-19

My article in the Journal of the Royal Society of Medicine discusses the wider impact of COVID-19 on health systems and the potential for changes to health services to increase health inequalities. We report a 44% decrease in emergency department attendances in England in March 2020. We must not overlook the importance of good infection control for outsourced NHS staff such as cleaners, security guards and caterers. They can acquire COVID-19, thereby putting themselves at risk, and transmit COVID-19 to patients and other NHS staff. Read the full article in the J ournal of the Royal Society Medicine . DOI:  https://doi.org/10.1177/0141076820925230

Protecting healthcare workers during the COVID-19 pandemic

My editorial in the British Journal of General Practice discusses how we can protect healthcare workers during the Covid-19 pandemic. Some of the key steps we can take include: 1. Maximise remote working 2. Implement good infection control 3. Use PPE effectively. 4. Risk assessment for staff based on age and medical history Too many health and care workers have died and we must take urgent action to protect them. When we protect staff, we also protect patients because we reduce the risk of hospital acquired infection. Read the full article in the British Journal of General Practice . DOI: https://doi.org/10.3399/bjgp20X709925

Protecting older people from COVID-19: should the United Kingdom start at age 60?

National and global spread of COVID-19 is accelerating. To reduce COVID-19-related hospitalisations, intensive care unit admissions and deaths, we recommend that those aged between 60 and 69 years are particularly stringent when implementing public health measures such as social distancing and personal hygiene. In the absence of government guidance, people in this group can make their own informed decisions on how to minimise their risks of COVID-19 infection. This can include using precautionary measures to reduce the risk of infection in a similar manner to that recommended by the UK government for people aged 70 years and over. Read the article in the Journal of the Royal Society of Medicine . DOI:  https://doi.org/10.1177/0141076820921107

Testing for Covid-19 Infection

Testing people for Covid-19 infection is an essential component of our strategy to control the global Covid-19 pandemic. These tests come in two main groups: antigen tests and antibody tests. The antigen test is to determine if you currently have Covid-19 infection. This requires swabs to be taken from your nose and throat to look for the presence of the SARS-CoV-2 virus that causes Covid-19 infection. In the UK, this test is mainly limited to hospital patients and NHS staff. There are now plans to extend testing to staff working in care homes. We will also need to expand testing to people in the community who do not require hospital treatment. The antibody test to determine if you have had a previous Covid-19 infection. This is done through a blood test that is then assessed for the presence of antibodies to SARS-CoV-2. We believe that once people have been infected and develop antibodies, they should be protected from a repeat infection. Because Covid-19 is a new disease, we d

The Importance of Childhood Immunisation During the Covid-19 Pandemic

During the Covid-19 pandemic, parents may be concerned about taking their children to a general practice or child health clinic to receive their immunisations. If your child is due for their immunisations, please do attend for this. Immunisation is a safe and effective procedure that protects your children from vaccine-preventable disease.

Covid-19 (Coronavirus) Epidemic in the UK - Update 20 March 2020

How will the Covid-19 (coronavirus) epidemic in the UK develop? In February 2020, there were sporadic cases across the UK and in March 2020, we saw a more sustained increase in cases. Based on current trends, the total cumulative number of cases of COVID-19 in UK could reach 47,989 (95% CIs 33,961 to 67,743) in another 10 days, using data published on 19 March 2020. We have assumed that each day's cases are a fixed proportion of the total cases up to the day before. It is also assumed the rate will not change in the next 10 days; e.g., it is not going to be influenced by new interventions, increased self-isolation and other factors. To estimate confidence intervals, we used the prediction confidence intervals from the linear regression model (using logarithm of "cumulative number of cases" as response) to perform Monte Carlo simulations to generate samples from the corresponding normal distribution. Subsequently, we applied the reverse transformation (exponential)

Covid-19 (Coronavirus) Epidemic in the UK - Update 16 March 2020

How will the Covid-19 (coronavirus) epidemic in the UK develop? In February 2020, there were sporadic cases across the UK and in March 2020, we saw a more sustained increase in cases. Based on current trends, the total cumulative number of cases of COVID-19 in UK could reach  21,264 (95% CIs: 14881 to 30459 ) in another 10 days, using data published on 15 March 2020. We have assumed that each day's cases are a fixed proportion of the total cases up to the day before. It is also assumed the rate will not change in the next 7 days; e.g., it is not going to be influenced by new interventions, increased self-isolation and other factors. To estimate confidence intervals, we used the prediction confidence intervals from the linear regression model (using logarithm of "cumulative number of cases" as response) to perform Monte Carlo simulations to generate samples from the corresponding normal distribution. Subsequently, we applied the reverse transformation (exponential)

Covid-19 (Coronavirus) Epidemic in the UK - Update 15 March 2020

How will the Covid-19 (coronavirus) epidemic in the UK develop? In February 2020, there were sporadic cases across the UK and in March 2020, we saw a more sustained increase in cases. Based on current trends, the total cumulative number of cases of COVID-19 in UK could reach 17,240 (95% CIs: 11,823 to 25,270) in another 10 days, based on data published on 14 March. We have assumed that each day's cases are a fixed proportion of the total cases up to the day before. It is also assumed the rate will not change in the next 7 days, e.g., it is not going to be influenced by new interventions, increased self-isolation and other factors. To estimate confidence intervals, we used the prediction confidence intervals from the linear regression model (using logarithm of "cumulative number of cases" as response) to perform Monte Carlo simulations to generate samples from the corresponding normal distribution. Subsequently, we applied the reverse transformation (exponential) to

How will the Covid-19 (coronavirus) epidemic in the UK develop?

How will the Covid-19 (coronavirus) epidemic in the UK develop? In February 2020, there were sporadic cases across the UK and in March 2020, we saw a more sustained increase in cases. Based on current trends, the total cumulative number of cases of COVID-19 in UK could reach 5,895 (95% CIs: 4,046 to 8,400) in another 7 days. We have assumed that each day's cases are a fixed proportion of the total cases up to the day before. It is also assumed the rate will not change in the next 7 days, e.g., it is not going to be influenced by new interventions, increased self-isolation and other factors. To estimate confidence intervals, we used the prediction confidence intervals from the linear regression model (using logarithm of "cumulative number of cases" as response) to perform Monte Carlo simulations to generate samples from the corresponding normal distribution. Subsequently, we applied the reverse transformation (exponential) to the simulated samples and calculated th

Improving workplace health in the NHS

As one of the largest organisations in the world, employing around 1.5 million people, and the provider of publicly funded healthcare in the UK, the National Health Service (NHS) should be a role model in workplace health. It should be providing employers with guidance and good practice that can be replicated elsewhere. However, currently the NHS performs poorly on many measures of staff health. For example, sickness absence rates among NHS staff are higher than the average for both the UK public sector and private sector. The health of NHS staff is a key factor in determining how well the NHS provides healthcare to patients. Improving workplace health and the support available to staff with health problems — such as enabling them to return to work after absence due to sickness — should be priorities for the NHS. The importance of good working environments in the NHS was emphasised in a 2019 General Medical Council report. The report noted that workplace pressures are associated w

Coronavirus infection: the importance of good personal hygiene in reducing infection risk

The Covid-19 (Coronavirus) infection is spreading more widely. The best way to protect yourself, your family and your work colleagues is through preventive actions such as regular handwashing, using disposable tissues when you cough and sneeze, and staying at home when you are unwell. Remember also not to touch your nose, mouth or eyes unless you have washed your hands recently. Many of my patients are informing me they are unable to buy hand sanitizer because pharmacies and supermarkets have no stock as people have been buying large amounts because of concerns about coronavirus (Covid-19) infection. Don’t bother buying hand sanitizer. Use soap and warm water instead. Washing your hands with soap and water is usually more effective than using hand sanitizers at removing germs, and is also better at preserving the "good" bacteria on your hands. Soap and water is also a lot cheaper than sanitizer. Finally, one person has recently died from coronavirus infection in the UK.

Case fatality in Covid-19 (Coronavirus) infection

We have seen varying estimates of the case fatality rate from Covid-19 (Coronavirus) infection. The case fatality rate is the percentage (or proportion) of patients with a disease who die. We should be cautious about accepting the estimates that have been published in medical journals as valid because many people will have undiagnosed infections. This is particularly likely in children, who often have mild symptoms (or no symptoms) when they contract a viral infection. Hence, the reported case fatality rates we have seen published in medical journals will overestimate the true death rate. As testing for Covd-19 infection becomes more widespread, we will get better estimates of the true infection rate in the population from the virus, and hence better estimates of the complication rate and death rate from the illness. In England, the new testing programme in people with respiratory tract infections announced by Public Health England will provide some of ths information.