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Covid-19: We need to understand the risks to tackle them

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3790 (Published 01 October 2020) Cite this as: BMJ 2020;371:m3790

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  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}bmj.com
    Follow Fiona on Twitter @fgodlee

The emergence of dexamethasone as an effective treatment for people seriously ill with covid-19 has been a welcome sign that we are starting to get a handle on this disease that has so quickly and radically changed all our lives. The BMJ’s rapid recommendation on dexamethasone has been produced in partnership with MAGIC and WHO.1 Based on a “living” network meta-analysis,2 it and the linked infographic will be regularly updated to include new data on direct comparisons with other treatments.

Meanwhile, the world has passed the milestone of a million covid-19 deaths, and Europe is experiencing the predicted resurgence in cases. Whether deaths will rise as sharply remains to be seen, but it’s vital that we understand and properly communicate the risks, writes David Speigelhalter.3 This can best be done in terms of how they compare with “normal” risks, he says, with the risk of contracting and dying from covid-19 varying hugely with age and comorbidity.

Such wide variation in risk is clearly evident in the 4C Mortality Score.4 Developed from data from 260 UK hospitals, its eight variables include age, sex, comorbidity, and clinical metrics. It predicts with reasonable accuracy the risk of in-hospital death in patients admitted with covid-19 and should help to inform clinical decisions. So too should US data on the likelihood of survival from in-hospital cardiac arrest among covid-19 patients in intensive care.5 Outcomes were poor, especially in older people.

Similar research is urgently needed into “long covid.” Paul Garner continues his series of reflections on how to live with and recover from prolonged post-covid illness.6 But the chair of the UK’s All Party Parliamentary Group on Covid-19 has received no reply from the prime minister to her letter calling for a working group to tackle the needs of people experiencing long covid, including how to help them gradually return to work.7

And people do need to get back to work, to stave off the damaging effects on health and wellbeing of unemployment and economic decline.8 So protecting workers from exposure to covid-19 is yet another urgent challenge for governments and employers.9 The thousands of cases of occupational exposure in the UK alone, not least among health and care workers, are among many things warranting urgent rapid review and a full and public inquiry.10

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