UK COVID-19 Daily: 'Doctors Gagged Over PPE Shortages'

Tim Locke

March 31, 2020

These are the UK coronavirus stories you need to know about today.

Doctors Gagged Over PPE Shortages

The Independent reported on doctors who've been told not to speak out over PPE shortages. Others were stopped from using PPE they'd bought themselves.

The Independent said one GP was barred from working in a community hospital in Ludlow after commenting on the lack of equipment,

President of the Doctors' Association UK, Dr Samantha Batt-Rawden, commented:

"Many have told us they have tried to raise concerns through the proper channels but have been warned against taking these concerns further. At this time when we desperately need every single doctor on the frontline, some have had their careers threatened, and at least two doctors have been sent home from work. This is unacceptable.

"Doctors have a moral duty to make their concerns regarding COVID-19 public if these cannot be resolved locally. We owe that to our patients. At this time of national crisis it is vital that we have a 'Learn Not Blame' culture."

In the Downing Street briefing, Jenny Harries, England's deputy CMO was asked about promises on PPE delivery not matching all doctors' experiences.

"I have to admit I stood here, I think about 10 days ago, and said, very probably optimistically… we've solved the PPE position.

"So my apologies because 48 hours later, I think, our distribution issue had popped back in again.

"The distribution element has been a little bit tricky at times," she said.

"PPE should go to match where the critical clinical risk is," she said, and it should be "proportionate to the risk exposure that you have."

She was also asked about concerns over whether doctors feel protected: "Just as it does for the rest of the public this can feel quite frightening at the moment and if you are continuously seeing patients coming through the door, that is particularly the case.

"We're very attuned to this and what we have been doing over the last few days is reviewing our guidance to see if, although we're quite satisfied with the technical basis of it, if we can make some small tweaks, if you like, to ensure that people feel safer in what they're doing, and we're addressing that over the current period."

Death in Service

The BMA has written to the Chancellor to ask for enhanced death in service cover for all frontline NHS staff.

Dr Chaand Nagpaul, BMA council chair, wrote: "Retired doctors returning to the NHS (who were members of the 1995 section of the NHS Pension Scheme) to provide public service at this time of national need cannot re-join the scheme so their families would not receive a death in service lump sum. 

"There are also issues for junior doctors and medical students that are being brought into premature working. As they are new joiners to the scheme, they will have less than 2 years’ experience and very little in the way of accrued pension to date. Therefore, even if they were an active member in the NHS pensions scheme, not only is the amount payable upon death to their family extremely low but no partner or dependant’s pension is payable." 
 

Statistics

The daily UK COVID-19 statistics from Public Health England announces deaths of hospitalised patients who tested positive. Today the rise was the biggest yet in a day, 381 bringing the total to 1789.

Prof Jim Naismith, Rosalind Franklin Institute and Oxford University, commented: "It does appear deaths from previous days are only now being reported, this will have artificially decreased the previous daily totals and have increased today’s totals. Scientists have consistently warned that we cannot judge our progress in curbing the epidemic by a single day's reported number of deaths."

For the first time today, out-of-hospital deaths for England and Wales compiled by the Office for National Statistics (ONS) were released. These include every case where COVID-19 was suspected and mentioned on the death certificate but not necessarily confirmed by testing.

This added 40 deaths to the existing figures up to March 20th - a 20% rise.

There's at least a 5 day lag in the ONS statistics due to the death registration process. They'll be reported weekly on Tuesdays.

In a blog, ONS head of mortality analysis, Sarah Caul, said: "Using the complete death certificate allows us to analyse a lot of information, such as what other health conditions contributed to the death. We will start publishing more detailed breakdowns of the figures as soon as possible."

Commenting via the Science Media Centre,  Prof Sheila Bird, formerly programme leader, MRC Biostatistics Unit, University of Cambridge, said: "The number of COVID-19-mention deaths in England & Wales that were registered in Week 12 (ends 20 March 2020: 103, with 108 registered in or before week 12, of whom:

  • 1 was younger than 45 years

  • 7 were aged 45-64 years

  • 21 aged 65-74 years

  • 34 aged 75-84 years

  • and 45 aged 85+ years). 

"Since around 18% of our population is aged 65+ years, the early toll in registered COVID-19-mention deaths had been around 12 times higher per million of population for the over 65s than for younger persons. 

"Safeguarding of the older population may change this in the weeks to come."

Cabinet Office Minister Michael Gove told the daily Downing Street briefing: "Overall, 10,767 people in England have been admitted to hospital with COVID-19 symptoms, the largest number of those is in London with 3915 people in hospital care. While in the Midlands, the number of those hospitalised is now 1918 and accelerating upwards."

Stephen Powis, national medical director of NHS England, said: "The pressure is building on London we are seeing increases every day. But we still have headroom and we still have surge capacity to move into."

Today's partly positive message came from Stephen Powis. He described "green shoots" in the latest data, which he later clarified: "I very specifically use the term green shoots because they are just green shoots, and winter could come, and those green shoots could turn out to be not the hopeful green shoots that we thought they might be."

He said: "We're not out of the woods, we're very much in the woods."

On missed testing targets, the briefing was told 12,700 patient and staff tests a day were being done as the NHS "ramps up" towards its 25,000 a day target. A global demand for chemical test reagents was given as one of the issues faced.

Postal tests are being checked to make sure they are accurate and samples don't degrade in transit.

Funeral Guidance

Public Health England issued advice on funeral safety.

The guidance came after discussions with faith leaders.

  • Mourners should be restricted to the deceased person's household or immediate family

  • Mourners should keep at least 2 metres apart at all times

  • Anyone with possible COVID-19 symptoms should not attend

Practices or rituals that involve close personal contact with a body should be discouraged because of "a small but real risk of transmission". If these do still take place, such as ritual washing, protective equipment should be worn.

In a statement, Professor Jim McManus, Director of Public Health for Hertfordshire, said:

"It may be felt as an additional cruelty that such physical closeness, while providing solace for our loss, may spread the virus still further."

More News in Brief

  • Scotland published its proposed emergency powers - The Coronavirus (Scotland) Bill. Measures will apply to the justice system, public services, and businesses. Constitution Secretary Michael Russell said in a statement:  "It is important for democracy that we tell the people of Scotland regularly when and how it is being used and be fully accountable for our actions."

  • The Home Office has announced that around 2800 doctors, nurses and paramedics with visas due to expire before 1st October will have them automatically extended for a year. Restrictions are also lifted on the amount of hours student nurses and doctors can work in the NHS.

  • The MHRA said there is no evidence from clinical or epidemiological studies to support claims that angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) might worsen COVID-19 infection, Univadis from Medscape reported. The regulator was reacting to a study published in The Lancet Respiratory Medicine which suggested patients with cardiac diseases, hypertension or diabetes who are treated with ACE-2-increasing drugs are at higher risk for severe COVID-19 infection.

  • The Government is planning to release a smartphone app to help with COVID-19 contact tracing when the lockdown is lifted, according to Sky News. The opt-in service from NHSX will use Bluetooth to record who is nearby. If a user tests positive, they can alert contacts anonymously.

  • There is such a thing as a free meal. A crowdfunding website is taking donations to pay for meal deliveries to NHS staff on shift. The site was set up by a group of London-based tech workers and entrepreneurs who were stuck at home due to the lockdown. Donations are now close to £500,000.

  • Police have been told to take a "consistent" approach to enforcing the lockdown, the BBC reported. There'd been criticism of some measures, including using drones to shame walkers in the Peak District, and using black dye to make a lake look less appealing to tourists.

See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.

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