Seven days in medicine: 17-23 June 2020
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2501 (Published 25 June 2020) Cite this as: BMJ 2020;369:m2501
Covid-19
Review preparedness for second wave, leaders urge
A group of medical, public health, and nursing leaders including The BMJ’s editor in chief, Fiona Godlee, wrote an open letter to the UK government calling for a rapid cross party review of what needs to be done to prevent and prepare for a second wave of covid-19. The letter argues that an “immediate assessment of national preparedness” is required to give the public confidence that the virus can be contained. Policy areas needing rapid attention include governance, procurement, coordination of existing structures, the disproportionate burden on ethnic minority individuals and communities, and international collaboration.
UK’s alert level falls from 4 to 3
The UK’s coronavirus alert level was lowered from 4 to 3 after a recommendation from the Joint Biosecurity Centre. Under level 4, transmission is “high or rising exponentially,” whereas under level 3 the virus is in “general circulation.” In a joint statement the chief medical officers for England, Scotland, Wales, and Northern Ireland warned, “It does not mean the pandemic is over. The virus is still in general circulation, and localised outbreaks are likely to occur.”
Saliva test pilot scheme starts in Southampton
A new coronavirus saliva test will be trialled in Southampton, UK, aiming to be accurate and more acceptable than the current swab test. The pilot scheme will involve 14 000 GPs, essential key workers, university staff, and their households. Participants will be asked to spit into a sample pot, which will be sent off or collected. The tests will be carried out weekly for four weeks. The trial also aims to find out whether routine at-home testing could pick up cases of the virus earlier.1
Leading scientist calls for UK covid tsar
Peter Piot, director of the London School of Hygiene and Tropical Medicine, called on the prime minister to appoint a coronavirus tsar at cabinet level, with “authority to keep the country safe from covid-19 for the next few years.” Speaking on the BBC’s Andrew Marr Show, he said that the tsar should be able work across all departments and organise future logistics for combating the spread of the virus. He said that he was optimistic about finding a new vaccine but that this was unlikely to be available before 2021.
Doctors “may quit” with poor post-pandemic support
The UK government must create a national plan to give doctors the mental wellbeing support they will need after the covid-19 pandemic, the Medical Protection Society warned. Without support and time to recuperate, many doctors may leave the profession or suffer in silence with psychological injuries, the defence body said. It called on the government to invest in local initiatives such as counselling services and to fund fast tracked research into the pandemic’s impact on doctors’ mental wellbeing. (Full story doi:10.1136/bmj.m2476)
Child health
Paediatricians urge plan for reopening schools
An open letter, signed by 1633 paediatricians and the Royal College of Paediatrics and Child Health, called on the UK government and the Northern Ireland Executive to publish a clear plan for getting children back to school. It also urged them to deliver recovery plans for young people. The letter, addressed to Boris Johnson, said that the interruption to schooling due to the covid-19 pandemic “risks scarring the life chances of a generation of young people.” (Full story doi:10.1136/bmj.m2458)
Regulation
CQC will restart routine inspections in autumn
Routine inspections of healthcare providers that were suspended during the covid-19 crisis will restart in the autumn, the Care Quality Commission (CQC) announced. The regulator said that it would also conduct inspections of higher risk providers over the summer. On 16 March all routine inspections of hospitals, GP surgeries, and care providers were stopped to allow services to focus on the covid-19 crisis. In the interim period the CQC has been checking up on providers remotely through its emergency support framework. (Full story doi:10.1136/bmj.m2467)
Mental health
Covid may worsen inequality “for a generation”
The covid-19 pandemic could widen inequalities in mental health for a generation unless action is taken, the Centre for Mental Health warned. The UK charity said that the lockdown would put greater pressure on groups whose mental health was already poor before covid-19, such as women and children experiencing violence and abuse, as well as ethnic minorities. The charity’s report is backed by 12 mental health charities and the Royal College of Psychiatrists. (Full story doi:10.1136/bmj.m2466)
Clinical guidelines
NICE publishes covid guidance on renal transplant
Patients scheduled for a living donor kidney transplant and their donor must self-isolate for 14 days before the transplant, along with members of their household, the National Institute for Health and Care Excellence recommended. If a patient needs dialysis in the meantime this must be done in a covid-19 secure environment. The new rapid guidance said that patients with covid-19 should be temporarily removed from the waiting list until they recover.2
Training
Flexibility in medical pathway is announced
Health Education England announced plans to provide greater flexibility to trainees by extending its “out of programme pause” plan to include all specialties. This allows trainees to pause their training to work in the NHS or similar patient facing roles in the UK. It aims to support trainees’ wellbeing and give them the opportunity to gain competencies they may have missed during the covid-19 pandemic. The offer is available immediately and is open for applications for one year: see https://www.hee.nhs.uk/our-work/doctors-training/flexibility-medical-training-pathway.
Prescribing
Unsafe methotrexate prescribing “is still common”
National guidelines advise GPs to prescribe only 2.5 mg methotrexate tablets and avoid 10 mg tablets, to minimise the risk of accidental overdose. Researchers from Oxford University analysed data from 7349 general practices in England and found that 1689 (23%) had prescribed both 2.5 mg and 10 mg tablets to the same patient. However, prescribing of 10 mg tablets had fallen over the preceding seven years, the study in the British Journal of General Practice found.3
Drug development
UK launches scheme for new antibiotic research
The UK launched a subscription-style payment model to incentivise drug companies to invest in researching and developing new antibiotics in the face of growing antibiotic resistance. It will see drug companies receive upfront payment for their product, based on the value it provides to the NHS rather than how much is used. The government has said that it is particularly interested in antibiotics that can provide alternative treatment options for bloodstream infections, sepsis, and hospital acquired pneumonia. The first two antibiotics will be selected and evaluated next year. (Full story doi:10.1136/bmj.m2468)