Covid-19: Surviving the long road aheadBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1840 (Published 07 May 2020) Cite this as: BMJ 2020;369:m1840
All rapid responses
Re: Covid-19: Surviving the long road ahead. Physical inactivity as a side effect of the COVID-19 crisis: a call to action
The coronavirus disease (COVID-19) outbreak begun in Wuhan (China) in December 2019 and has been rapidly spreading worldwide. While searching for an effective vaccine, and in the context of an extremely fast transmission rate, many countries have progressively approved pertinent laws to force their citizens to stay at home (i.e., confinement) to break the transmission chain and prevent hospitals collapse. As a result, half of the world’s population (i.e., 90 countries) has been committed to stay at home for an undetermined period of time, inevitably disrupting their daily routines.
It is expectable that citizens eventually re-allocate time from physical activity or exercise to inactive, sedentary and unhealthy behaviours during the home confinement period. Considering that half of the world’s population is currently confined due to the COVID-19 phenomenon, inactivity rates could reach >1,1 billion people . Provided that 6% of coronary heart disease, 7% of type-2 diabetes, 20% of breast and colon cancer, and 9% of premature mortality are attributable to physical inactivity , and that the yearly cost of physical inactivity for the worldwide health-care systems was ~53,8 billion dollars in 2013 , the potential damage societies are likely to face as side effects of this pandemic is massive.
Another major issue associated with physical inactivity and lack of sufficient exercise is the associated reduction of cardiorespiratory fitness and muscular strength, which are powerful markers of health from childhood to old age. Low levels of fitness are associated with high incidence of cardiovascular disease, cancer, and all-cause mortality across the lifespan . Moreover, only two weeks of inactivity (i.e. reducing activity more than 80% to ~1500 steps/day) in young healthy people can significantly reduce muscle mass and cardiorespiratory fitness, produce metabolic disturbances and increase central and liver fat, leading to an increased risk of developing chronic diseases . However, the effects of confinement might even be substantially more concerning in patients with chronic conditions and particularly in the elderly, where inactivity periods such as hospital stays of at least overnight are a major contributor to disability .
In addition to all the aforementioned problems, it is very likely that people during quarantine will increase the time spent watching TV, playing online games or using mobile phone for social media, and tend to increase unhealthy eating habits. Evidence of increased screen time is supported by the Internet Exchange Center Operator that on March broke a world record for data transfer. Of note, the substantial rise in total sitting time by the whole population in many countries during this outbreak period may result in increased rate not only of obesity, cardiovascular disease, cancer, diabetes and all-cause mortality , but also in other psychological issues such as stress, anxiety, and/or depression , among others.
Compelling evidence suggests that increasing physical activity and exercise at home during COVID-19 crisis could counteract all the above-mentioned health-related consequences derived from physical inactivity and sedentarism. Pedersen et al.  revealed that exercise has protective effects against at least 26 chronic diseases. Moreover, regular bouts of moderate to vigorous intensity exercise are beneficial for enhancing the immune system and likely lower the risk of respiratory infection/illness . With this in mind, a number of practical recommendations are presented with the major aims of avoiding prolonged periods of sedentary time and physical inactivity, and the ultimate goal of preserving physical fitness throughout the COVID-19 confinement:
• Meeting physical activity guidelines (i.e., 180 min/day for children under 5 years, 60 min/day for children and adolescents, and 30 min/day for adults over 18 years) or walk along the day to accumulate ≥ 7,500 steps/day
• Breaking prolonged periods of sedentary time (e.g., stand up and walk every 20-30 minutes sitting)
• Undertaking resistance exercises to preserve muscular strength and muscle mass including multi-joint exercises (e.g. squat, deadlift, push and press movement patterns)
• Using circuit training routines or aerobic exercise involving major muscle groups to increase heart rate and ventilation and preserve cardiorespiratory fitness.
In conclusion, home-based physical activity and exercise training represent unique tools that might undoubtedly contribute to overcoming the massive health-related consequences of the COVID-19 confinement worldwide.
Conflict of interest: Cadenas-Sanchez C, Jiménez-Pavón D, and Soriano-Maldonado A. declare that they have no conflict of interest.
Funding: CC-S and DJ-P are supported by the Spanish Ministry of Science and Innovation (FJC2018-037925-I, and RYC-2014-16938, respectively).
1. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet (London, England). England; 2012;380:247–57.
2. Lee I-M, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet (London, England). 2012;380:219–29.
3. Ding D, Lawson KD, Kolbe-Alexander TL, Finkelstein EA, Katzmarzyk PT, van Mechelen W, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet (London, England). England; 2016;388:1311–24.
4. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. United States; 2009;301:2024–35.
5. Bowden Davies KA, Sprung VS, Norman JA, Thompson A, Mitchell KL, Halford JCG, et al. Short-term decreased physical activity with increased sedentary behaviour causes metabolic derangements and altered body composition: effects in individuals with and without a first-degree relative with type 2 diabetes. Diabetologia. Germany; 2018;61:1282–94.
6. Gill TM, Gahbauer EA, Han L, Allore HG. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. BMJ. 2015;350:h2361.
7. Yang L, Cao C, Kantor ED, Nguyen LH, Zheng X, Park Y, et al. Trends in Sedentary Behavior Among the US Population, 2001-2016. JAMA. 2019;321:1587–97.
8. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet [Internet]. Elsevier; 2020;395:912–20. Available from: https://doi.org/10.1016/S0140-6736(20)30460-8
9. Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. Denmark; 2015;25 Suppl 3:1–72.
10. Simpson RJ, Campbell JP, Gleeson M, Krüger K, Nieman DC, Pyne DB, et al. Can exercise affect immune function to increase susceptibility to infection? Exerc Immunol Rev. Germany; 2020;26:8–22.
Competing interests: No competing interests
While COVID-19 mortality grows, the global impact of the ‘lockdown’ response - from mass unemployment to threatened famine - becomes increasingly stark. The phrase ‘but it has to be done’, repeated by governments and media, is threatening decades of norms on human rights and up-ending livelihoods. It has focused whole countries, the world, on one problem and one outcome.
Dispassionate discussion of COVID-19 can be difficult, but we owe it to the public to constantly review our approach, calmly and honestly. Rapid spread, poor data and poor preparedness may once have justified terms such as ‘rampaging’ or ‘catastrophe’, to catalyze a public response to reduce COVID-19 mortality. However, alarmism is becoming increasingly tenuous from a public health viewpoint. Emphasizing COVID-19 mortality isolated from context becomes is poor practice as it denies the public, the client, the opportunity to judge.
In Iceland where extensive testing and high quality care are in place, COVID-19 mortality rate is well below 0٠5%.  The recent Santa Clara study suggests far lower figures,  while mortality of those under 40 years was below 0٠1% in China.  The United States’ total COVID-19 mortality is now equivalent to the yearly toll of drug overdose, but only 12% that of cancer. Globally, it’s now at about 16% of that other respiratory pandemic - tuberculosis. So, when told that the COVID-19 response requires mass unemployment and recession, but drug overdose and tuberculosis do not, do the public really grasp these comparisons? Stating that COVID-19 mortality in the US has reached 1 in 4000, or 1 in 3000 in the UK, is stating ’70,000’ or ’30,000’ dead, but with context.  Noting the advanced age and underlying poor health of most cases is being honest, [3,4] not minimizing tragedy.
In public health we weigh other health interventions in terms of life-time costs and benefits. The evidence is clear that pushing millions into unemployment, reducing their ‘social capital’, will substantially reduce average life expectancy.  Delaying evidence-based health checks will do likewise. Mean life-years lost from middle-aged suicides or missed breast lumps dwarf those of CVOID-19. However harsh such calculations seem, they are standard public health practice, assuming an equal right to a decent life. Such clarity on the ‘collateral damage’ considered acceptable from the COVID-19 response should accompany any advocacy for extending lock-downs. ‘Waiting for the global vaccine’ advocacy should clarify the size of famine and rise in child malaria mortality deemed acceptable. [6,7] The bases for these figures exist and can readily be modelled alongside COVID-19 outcomes. They help the public to better understand, not necessarily negate, these arguments.
In public health emergencies, criticism is cheap. With COVID-19, decision makers are damned if they do, and damned if they don’t. Many people will tragically die, whatever path we take. But good public health approaches weigh costs and present data in context. They must involve the public in decision-making, not by scaring them, but by providing facts. More so as few public health professionals will lose career or income from all this. That burden is not shared equally.
So how to ensure that the public health values we held dear in 2019 still hold sway? We could:
• Insist on giving numbers in context (COVID-19 mortality versus ….)
• Ensure that modelling always includes all costs
• Avoid the demonstrably false premise that this is about lives versus money. Money saves lives.
Politics and name-calling are the People’s prerogative. We should inform them. Even at the risk that they may disagree with us. We have lives to save, economies to support and democracies to nurture. That was, and is, public health.
1. Johns Hopkins University Corona Virus Resource Center, Johns Hopkins University. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). (https://coronavirus.jhu.edu/map.html). Accessed 5 May, 2020.
2. Bendavid E, Mulaney B,Sood N et al. COVID-19 Antibody Seroprevalence in Santa Clara County, California. medRxiv 2020.04.14.20062463;
3. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020 Mar 30:S1473-3099(20)30243-7.
4. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. Epub: April 22, 2020
5. Kivimäki M, Batty GD, Pentti J, et al. Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study. Lancet Pub Hlth. 2020; 5(3):e140-e149.
6. ACHA Services. WFP Chief warns of hunger pandemic as COVID-19 spreads (Statement to UN Security Council). Originally published 21 Apr 2020. Relief Web. OCHA Services. United Nations. New York. USA. April 27, 2020. (https://reliefweb.int/report/world/wfp-chief-warns-hunger-pandemic-covid...). Accessed 5 May 2020.
7. WHO. The potential impact of health service disruptions on the burden of malaria: A modelling analysis for countries in sub-Saharan Africa. Geneva, Switzerland. World Health Organization. 2020. (https://www.who.int/publications-detail/the-potential-impact-of-health-s...). Accessed 5 May 2020.
Competing interests: No competing interests
Covid-19 Moral Injury
Moral injury entered the medical lexicon in the 1990s.  Before that it was a military term describing a soldier’s reaction to having crossed or witnessing the crossing of a moral red line.  In the general and philosophical/theological literature moral injury implicates conscience and the universal reality of a moral view of life. The concepts of right and wrong underpin morality and injury occurs when this conviction is assaulted. Conscience is widely accepted as the human faculty that identifies and rewards or punishes our moral decisions and behaviour. As such morality and its injury are as old as man him/herself.
Enter Covid-19. The war on the virus often recruits military parlance with terms such as quarantine, lock-down, strategy, etc, and is frequently compared to the impacts of World Wars on the population. The military and psychiatric literature have copious reports of moral injury in soldiers returning from wars.  The source of this injury is their having carried out unfortunate (but possibly necessary) acts, having witnessed such acts, or having doubts and misgivings about the legitimacy of their roles. Similar reactions are being reported for Covid responders. Health professionals are altruistic and want the best for their patients. When faced with shortages of necessary resources with resultant deaths; when they are exhausted and cannot cope with the deluge of patients requiring their help; and when they knowingly put their own health at risk and that of their beloved, they become conflicted and grieve for the loss of their moral sense.
The signature mental injury due to military combat is posttraumatic stress disorder.  This is well defined and a DSM diagnosis. The associated moral injury may contribute to it but remains ill-defined and is not classified mental illness. It really exists and sufferers are numbed emotionally, confused cognitively and unsure about the morality of their own behaviour, that of institutions they work for and that of their colleagues.  Health workers are increasingly exposed to this phenomenon during this pandemic. The guiding principle “you can never do wrong that good may come of it” or “the end never justifies the means” can help in difficult moral situations. Covid is demanding the best of health workers in clinical war theatres and they are meeting the call admirably. Serious moral injury should not be with the foot soldiers but with the generals responsible for putting their charges undefended in the firing line.
1. Friedman MJ. Post-Vietnam syndrome: recognition and management. Psychosom (1981) 22:931–43. 10.1016/S0033-3182(81)73455-8
2. Litz BT, Stein N, Delaney E et al. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev2009;29:695-706. doi:10.1016/j.cpr.2009.07.003 pmid:19683376
3. Koenig HG, Youssef NA, Pearce M. Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review. Front Psychiatry. 2019;10:443. Published 2019 Jun 28. doi:10.3389/fpsyt.2019.00443
4. Groer MW, Kane B, Williams SN, Duffy A. Relationship of PTSD Symptoms With Combat Exposure, Stress, and Inflammation in American Soldiers. Biol Res Nurs. 2015;17(3):303‐310. doi:10.1177/1099800414544949
5. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020;368:m1211. Published 2020 Mar 26. doi:10.1136/bmj.m1211
Competing interests: No competing interests
You discuss the long road ahead after covid-19. Is this an opportunity to re-imagine health care and forge a 'new normal' for medicine and the NHS. After the most extraordinary few weeks of our professional lives, WB Yeats’s memorable line comes to mind: “All changed, changed utterly.” Normally complex changes such as telemedicine and major service reconfigurations have occurred in the NHS at a breath-taking pace (1). Traditional barriers, institutional inertia, and red tape were overcome. We have seen unparalleled levels of clinical leadership, motivation, collaboration, and a ‘can-do’ culture. A shining example of success is the Recovery Trial, one of the most significant and largest clinical trials in England that has already recruited 6000 patients within five weeks (2). The way NHS hospitals managed the ‘surge’ has been widely praised.
How has this happened? What are the ingredients of success? Can we use this momentum to shape the post-COVID-19 world? We suggest that this is a big moment in the history of medicine to reimagine healthcare. Many clinicians have mentioned that they do not wish to back to ‘old ways.’
Let us look at what has happened: The systematic use of telemedicine and triage (telephone, online and video consultations) in all sectors; rapid hospital ward reconfigurations including cohorting of patients; stronger collaboration between primary and secondary care; more visible, impactful clinical leadership with rapid decision making; relaxation of red tape with enabling governance; flexible deployment of workforce including medical students and returning doctors; systematic support for vulnerable patients; most if not all meetings are taking place virtually; and a focus on wellbeing, self-care, and healthy lifestyles.
There is a lot to celebrate, and it is a fertile field for evaluation and research. There have of-course been significant concerns, to reflect and learn from: such as a large number of deaths, the experience of care homes; the problems with PPE; deaths amongst health and care staff; the massive reduction of demand due to people staying away from the NHS where this has unintended consequences and the impact of the lockdown on the wider determinants of health.
We, therefore, propose that the work on ‘restoration, recovery and reset’ (3) incorporates learning (4) from covid-19 and presents a unique opportunity to forge a ‘new normal’. This will also support efforts to reduce global warming by reducing unnecessary patient and clinician journeys.
Covid-19 has been a call to action to clinicians, and they have stepped up to the plate superbly and with the courage to deal with the surge. Clinicians feel much empowered to make change in a culture that feels enabling and where excellence can flourish. Let us not lose this.
Professor Mayur Lakhani* CBE
GP Principal, Highgate Medical Centre,
Chair of the Faculty of Medical Leadership and Management
Dr. Sonam Lakhani BSc, MBBS, DRCOG
Dr. Priyanka Lakhani MRCP (UK) MRCP (London)
Core Medical Trainee
Northwick Park Hospital
Address for correspondence:
DOI. Past Chair and President of the Royal College of GPs, Chair of the Faculty of Medical Leadership and Management (FMLM). This article is written in a personal capacity and does not represent the views of any organisations
1. How clinicians are leading service configurations. BMJ 2020;369:m1444
2. Sixty Seconds on The Recovery Trial. BMJ 2020;369:m1573
4. https://collaboratecic.com/covid-19-why-and-how-organisations-can-learn-... (accessed 29.4.2020)
Competing interests: Mayur Lakhani is Chairman of the Faculty of Medical Leadership and Management
We read with interest this article and overwhelmingly agree with the sentiments for the way forward in dealing with a global pandemic where to date there has been anything but consensus of opinion. The pandemic has evoked a hyperdrive of change with experimentation in clinical practice, development of guidelines that need revision almost before the ink dries and a rapidly evolving and everchanging face of disease. Media and scientific papers endlessly churn out volumes of information that go beyond the limits of our cognitive capacity and saturation to the point that the only thing we are certain about COVID-19 is the uncertainty. “Business as New” as we would like to propose will also need to be “Business as Better” post COVID-19. What we retain in terms of change to clinical practice needs to be selective, sustainable and truly innovative, in that it must be better.
The intense focus we have had on the acute management of this disease and protection of healthcare workers has left little room for consideration of the many physical and mental needs of staff and patients, their families as well as their eventual return as functioning members of society. Timely and accurate communication between hospitals and primary care has always been challenging but has probably never felt so desperately needed. The craving for information and clear directions on how to continue the care for patients with COVID-19 has never been so great. Technology will inevitably become our best friend, greatest instrument and the perfect catalyst all in one as globally we will have to come together and transform the way “we do business” in healthcare.
Finally, the old saying may have been “all roads lead to Rome”. With the ending of the current pandemic, let us hope that the different roads we have taken will have led us to a better world, better healthcare systems and better understanding - Business as New.
Competing interests: No competing interests
As the article clearly outlines, recovering from the COVID-19 pandemic will be a long and difficult journey. The medical consequences of the pandemic will lead to an increasing number of patients with chronic multi-morbidities; some of them are young and far under the age of having these chronic conditions. A multi-disciplinary care plan needs to be designed and laid out for survivors of the pandemic. As learned from SARS in 2003, many survivors in China have suffered from not just the side effects of high-dose steroids or post-traumatic stress disorders, their familial and social lives are greatly disrupted as well.1
Yet, there is another group of patients who are also heavily impacted by the pandemic. As the first line workforce is stretched for caring the COVID-19 patients, routine services for patients who need long-term treatments have been suspended. For example, in Hong Kong, since WHO’s declaration of the COVID-19 outbreak as pandemic on 11 March 2020,2 Hong Kong Hospital Authority (HA) announced to suspend non-essential health care services including rescheduling surgery, postponing diagnostic procedure, replacing outpatient follow-up by medication refill, and holding up outreach community services that support post-discharge patients. It was not until 5 May 2020 when no local case of COVID-19 was found for 14 days that the HA announced to gradually resume non-essential services.3 During the two months of lockdown of routine services, it is not hard to imagine the barriers and anxieties faced by these routine patients.
COVID-19 pandemic may take months to fight against, mitigate and recover from; and it might become a seasonal flu as a norm. It is therefore important to think about how to re-structure our healthcare systems at multiple levels to maintain operations of healthcare services for both COVID-19 and routine patients. One possible solution is to include more telediagnosis and teletreatment infrastructures during the re-structuring process. In UK and China, such virtual health technology has been adopted for patients with COVID-19.4 But to make it as an alternative way in healthcare service delivery model, it requires a collaboration among multiple stakeholders from multiple sectors directed by multiple perspectives, including early investment in facilities, building trust in healthcare workers and shifting the ingrained patient culture that heavily rely on face-to-face health care.
It is equally important to strengthen the public-private partnership, especially in countries where heavy reliance on the public healthcare system may cause serious challenges to public health emergency. Some countries, such as the US, have initiated such partnership to accelerate COVID-19 treatment options and vaccine. However, it is urgent to consider a long-term, full-scale reform that takes in multilateral public-private partnership from multiple domains at both local and global levels. Such multi-ness nature of combating the pandemic, as outlined above, calls for new theories and frameworks in restructuring the current healthcare system in both short and long run. While there is a long road ahead, this road may lead toward hope if we all discard unilateralism, antagonism, and isolationism.
Eliza LY Wong*
Professor, JC School of Public Health and Primary Care, The Chinese University of Hong Kong
Postal Address: Rm418, 4/F, JC School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, N.T., Hong Kong
Professor, JC School of Public Health and Primary Care, The Chinese University of Hong Kong
Research Assistant Professor, JC School of Public Health and Primary Care, The Chinese University of Hong Kong
Postal Address: Rm419, 4/F, JC School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, N.T., Hong Kong
1. South China Morning Post ‘Don’t repeat the mistakes of Sars’, survivors’ group urges Hong Kong government as it wrestles with China coronavirus outbreak. https://www.scmp.com/news/hong-kong/health-environment/article/3047616/d... (25 Jan 2020)
2. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. Accessed at https://www.who.int/dg/speeches/detail/who-director-general-s-opening-re.... (11 Mar 2020)
3. South China Morning Post. Coronavirus: Hong Kong records no new cases on Sunday, marking 14 straight days without any local infection. https://www.scmp.com/news/hong-kong/health-environment/article/3082640/c... (May 5 2020).
4. Webster P. Virtual health care in the era of COVID-19. The Lancet 2020; 395(10231): 1180-1181.
Competing interests: No competing interests
The Government statistics that are being used to set policy are based exclusively on deaths of diagnosed cases in hospitals. Care homes have belatedly been taken into consideration because of the numbers of residents dying in a short period of time. What is missing is the hidden part of the iceberg that is not immediately visible.
We are beginning to learn that a lot of infection does not follow the classic pattern of fever and dry cough, but the tools are not available to follow this up. As a GP in inner London I have had several phone calls with, and have occasionally seen, patients who have a persistent malaise or whose children have it. The condition is most similar to post viral fatigue syndrome. The concern is that the symptoms have persisted for 6-8 weeks, and some patients known to have been infected do have a prolonged recovery period. These would have been amongst the first cohort who would have been infected but, of course, were not eligible for testing.
Before we decide that the worst is over we need to look at persistent morbidity to make sure we are still protecting the most vulnerable, even if their clinical picture is unhelpful.
Competing interests: No competing interests
We read this article with interest and commend the advice of “good pacing, refreshment, and support” to help the NHS and its workforce survive the long road ahead. In light of this recommendation, we feel it is important to highlight the role and skills of trainee healthcare scientists, an often-overlooked group, in achieving this goal.
As the global pandemic, COVID-19, has taken its toll on workforces in all sectors of healthcare provision, trainees and students have been integral to bolstering the national response. Consequently, the structure of the NHS workforce has rapidly evolved. (1) Temporary/ emergency registers have been created and extended clinical placements have been made available for those wishing to join the fight against COVID-19. Valiant efforts from students, apprentices, and trainees across healthcare professional disciplines has contributed time and skills to this surge emergency response. Notably, trainee healthcare scientists in their final year are being temporarily registered with the Health and Care Professions Council enabling them to practise as registered professionals. (2)
The role of the healthcare scientist has proven to be particularly vital to efforts against COVID-19 in the UK. These scientists are involved in services across all frontline areas: contributing to the processing of tests for COVID-19, decontaminating and managing ventilators, imaging patients and, so much more. (3)
It is imperative that the role of trainee healthcare scientists, as well as those already in post, is recognised and their services in supporting the COVID-19 response is acknowledged and further utilised. Those on healthcare science training programmes (in a similar fashion to nursing and medical students) have much to offer in their basic and transferable skills, thereby allowing specialists and consultants in their field to focus on the more complex duties of their discipline. In some instances, trainees have already been actively contributing to the COVID-19 response. Many have been upskilled and redeployed to critical care or COVID-19 wards, or to the Nightingale hospitals. In other cases, trainees have reported working across hospitals acting in roles, such as family liaison officers.
Health Education England (HEE) has accredited training programmes which ensure that healthcare science trainees can be flexible in their application of knowledge and skills across specialties to ensure that the highest level of patient care is achieved through successful teamwork. (4)
Training programmes are available for healthcare scientists who are employed by NHS Trusts as apprentices; post-graduate scientific specialist trainees as well as doctoral level scientists (who are eligible for consultant posts in their area of specialty). These programmes are designed to ensure healthcare scientists are equipped with an all-rounded scientific training, in addition to acquiring specialism-specific knowledge and skills. The trainees’ evidence of proficiency across a range of basic scientific modules enables them to offer invaluable general transferable skills in this pandemic response. Furthermore, trainees’ movement through rotations during their programme enhances their flexibility and knowledge transferability across different settings.
All trainees enrolled with HEE’s National School of Healthcare Science have essential skills, (5) as outlined in the list below.
List of general and transferable skills of healthcare scientist trainees:
1. Data handling
- Data entry
- Record keeping
- Accessing, registering and inputting patient data into digital systems
- Audit, research and development
- Data analysis
- Colleague support and debrief
- Excellent communication with patients and their families
- Supporting informed consent
- Communication of information to authorised personnel
3. Patient care and management
- Gathering a patient history
- Competent in basic life support
- Prepare and support individuals for healthcare activities
- Patient liaison and support
- Administering appointments
- Observations (blood pressure, temperature, respiratory rate, pulse oximetry)
- Patient pathway management
- Healthcare support worker tasks
4. Equipment management
- Donning and doffing of personal protective equipment
- Cleaning and disinfection of medical devices
- Basic mask ventilation skills
- Technical support for computerised medical devices
- Maintain stocks of resources, equipment and consumables
- Inspection, assessment and unpacking of medical devices
- IT tasks
- Creating testing pack kits
5. Safe practice
- Adheres to and supports infection control practices
- Self-assesses and practices within own scope of competence and refers to seniors as appropriate
- Sterile technique
- Health and safety trained
- Manual handling trained
- Waste management and sharps awareness
- COSHH awareness
- Removal and disposal of PPE
- Cleaning and disinfecting
- Second check of drugs and patient identification
- Risk management
- Laboratory quality assurance
6. Sample handling
- Handling of (high-risk) samples
- Booking in samples
- Preparing sample for pre-analytical testing
- Storing (high-risk) samples appropriately
- Preparing culture media and solutions
- Swabbing to provide point-of-care testing
- Documentation for transport of samples
7. Laboratory Testing
- Development of new tests
- Validation of new tests
- Rapid translation of new technologies and platforms
As noted in the editorial, General Practitioners will need support as they work through the post-lockdown long haul where they are supporting patients and families through a “new wave of problems”. Indeed, there is likely to a considerable workload for services and departments across the whole healthcare sector, particularly where routine activities were paused creating a backlog leading to extended waiting lists.
If the staffing and provision of care on the “long road ahead” of us is to be achieved to the best standard possible, it is essential that the role of trainee healthcare scientists is recognised and their skills are utilised appropriately. As outlined in this article, trainee healthcare scientists have a broad scientific skillset which can be applied to many of the tasks that are and will continue to be in demand. Not only this, this transferable skillset can extend to a variety of clinical settings supporting the NHS survival post-COVID-19.
1. Willan J, King A, Jeffery K, Bienz N. Challenges for NHS hospitals during covid-19 epidemic. BMJ. 2020:m1117. doi:10.1136/bmj.m1117
2. National School of Healthcare Science. HCPC COVID-19 temporary register for 3rd year STP trainees — Coronavirus (COVID-19) Information. NSHCS. https://nshcs.hee.nhs.uk/coronavirus-covid-19-information/hcpc-covid-19-.... Published 2020. Accessed April 28, 2020.
3. Deploying the healthcare science workforce to support the NHS clinical delivery plan for COVID-19. England.nhs.uk. https://www.england.nhs.uk/coronavirus/publication/deploying-the-healthc.... Published 2020. Accessed April 28, 2020.
4. Health Education England. Health Education England. https://www.hee.nhs.uk/. Published 2020. Accessed April 28, 2020.
5. National School of Healthcare Science. Your curriculum — Scientist Training Programme. NSHCS. https://nshcs.hee.nhs.uk/programmes/stp/trainees/your-curriculum/. Published 2020. Accessed May 7, 2020.
Competing interests: All authors are employees of the National School of Healthcare Science at Health Education England.