Seven days in medicine: 26 Aug to 1 Sep 2020BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3373 (Published 03 September 2020) Cite this as: BMJ 2020;370:m3373
Government will expand trained vaccine workforce
The UK government will expand the trained workforce who can administer covid-19 and flu vaccines to boost access, as part of a raft of measures designed to facilitate the safe future mass roll-out of a covid-19 vaccine. The government said that it would clarify the scope of protection from civil liability among the additional workforce who could be allowed to administer vaccinations. It also pledged to reinforce safeguards to support the Medicines and Healthcare Products Regulatory Agency to grant temporary authorisation for the use of a new covid-19 vaccine, provided it meets the highest safety and quality standards. (Full story doi:10.1136/bmj.m3375)
England will test 150 000 every two weeks
The Office for National Statistics (ONS) will expand its infection survey to 150 000 people a fortnight in England by October, up from 28 000 now, to provide more information about the spread of covid-19 in the community and to help identify local outbreaks. The aim is to eventually enrol 400 000 people in England, and the ONS will also extend the survey to Scotland, Wales, and Northern Ireland. The survey started as a pilot in May to track infection rates outside of hospitals and care homes, regardless of whether a person has symptoms. (Full story doi:10.1136/bmj.m3269)
High risk areas get payments for self-isolating
The UK government will offer a payment for people with low incomes in areas with high rates of covid-19 who need to self-isolate and cannot work from home. Eligible people who test positive for covid will receive £130 (€146; $173) for a 10 day period of self-isolation. Other members of their household who have to self-isolate for 14 days will be entitled to £182. Non-household contacts who are advised to self-isolate through NHS Test and Trace will also be entitled to as much as £182, depending on the length of their isolation. The scheme will be trialled in Blackburn with Darwen, Pendle, and Oldham.
US approves emergency use of convalescent plasma
The US Food and Drug Administration approved convalescent plasma for emergency use in hospital patients who have covid-19, after it concluded that plasma from recovered patients “may be effective” in treating the virus and that the “potential benefits of the product outweigh the known and potential risks.” The move came despite the absence of results from randomised controlled trials. To date, only a preprint paper on the effects on covid-19 inpatients has been published.1 Experts warned that, although early findings showed promise, there was not enough evidence to show that the treatment worked. (Full story doi:10.1136/bmj.m3327)
£8.4m will fund new immune response research in UK
UK Research and Innovation and the National Institute for Health Research committed £8.4m (€9.5m; $11.2m) to fund three new studies examining immune responses to covid-19. Two studies will focus on key questions surrounding covid-19 immunity—including how long it lasts, cross immunity, and the role of antibodies in immunity. A third will examine the impact of covid-19 on vital organs. The aim is to help researchers develop better tests to define immunity and understand why some people get severe, life threatening covid-19 while others have mild or asymptomatic infections but can still transmit the virus.
Care homes in Belgium and Spain had “alarming living conditions”
A report on the global response to coronavirus outbreaks heavily criticised “alarming living conditions” in Belgian and Spanish care homes, the former being described as a “true humanitarian crisis.” The report by Médecins Sans Frontières documented the first phase of the organisation’s global covid-19 response from March to May. During that time it had committed “substantial resources” both to developing dedicated covid-19 projects and to maintaining essential healthcare in its existing programmes worldwide, including interventions in Italy, Spain, Belgium, and France. (Full story doi:10.1136/bmj.m3271)
More patients are offered diet to reverse diabetes
Five thousand more patients with recently diagnosed type 2 diabetes in 10 areas in England will be offered access to the NHS “soup and shake” weight loss plan to try to reverse their condition. The plan gives patients a liquid diet of just over 800 kcal/day for three months, alongside support to increase their exercise levels. A pilot programme was launched in November 2018, and results from one trial showed that almost half of people who went on the diet achieved remission after one year.2
Parents can challenge NICE guidance in court
The parents of a 3 year old boy with severe epilepsy were given permission to mount a landmark High Court challenge to guidance from the National Institute for Health and Care Excellence (NICE) regarding cannabis prescribing on the NHS. Matt and Alison Hughes argue that the guidance is so restrictive that it could effectively be barring hundreds of children from accessing the cannabis treatment they need on the NHS. The family has legal aid for the judicial review case. (Full story doi:10.1136/bmj.m3304)
“Dysfunctional” working at Basildon hospital led to risks
Basildon University Hospital in England was rated inadequate for its maternity services and given a formal warning after an anonymous whistleblower alerted the Care Quality Commission (CQC) to six serious incidents. The CQC carried out a surprise inspection after learning of the cluster of six cases in March and April 2020, in which babies were born in poor condition and transferred out for cooling therapy. “There had been a lack of learning from previous incidents and actions put in place were not embedded,” the inspectors said. (Full story doi:10.1136/bmj.m3314)
Project tackles skin tones in medical education
A new collaborative project was launched to tackle the lack of skin tone diversity in paediatric medical education images. The Skin Deep initiative is led by an international medical education team, Don’t Forget the Bubbles, and the Royal London Hospital. Its aim is to develop a free, open access bank of high quality photographs of medical conditions featuring a range of skin tones, for use by healthcare professionals and the public. Contributions from hospitals, organisations, and individuals are being welcomed.
Female, minority, and rural doctors struggle for research involvement
A survey3 from the Royal College of Physicians (RCP) reported inequalities in access to research among female doctors, doctors from minority ethnic backgrounds, and those working in rural areas. The RCP surveyed 1137 of its members and fellows in England, Wales, and Northern Ireland in January and February 2020. Almost 60% said that they wanted to be more involved in research. A lack of time was the biggest obstacle to more research participation (cited by 53%), followed by funding, a perceived lack of skills, and a lack of supportive culture at respondents’ organisations.
Africa is declared free of wild polio
In a milestone announcement, Africa was declared free from wild polio by the independent Africa Regional Certification Commission after four years without a case. Previously, Nigeria was the last African country to be declared free from wild polio. Afghanistan and Pakistan are now the only two countries worldwide that continue to see wild poliovirus transmission. Tedros Adhanom Ghebreyesus, the World Health Organization’s director general, said, “Ending wild polio virus in Africa is one of the greatest public health achievements of our time and provides powerful inspiration for all of us to finish the job of eradicating polio globally.”
NHS leaders call for action on stigma and funding
A report by NHS Providers called for immediate action to tackle stigma and underfunding in services for people with learning disabilities and autism. The group, which represents NHS trusts, identified a “longstanding inequity in the development, commissioning and delivery of services,” which it said had harmed the health and wellbeing of vulnerable people, resulting in reduced life expectancy and an increased risk of abuse in extreme cases. The report highlighted a significant increase in the proportion of wards in facilities run by the private sector that had been rated inadequate by regulators in the past nine months.