NICE | COVID-19 rapid guideline: children and young people who are immunocompromised [NG174]| (updated 21st May 2020)
The purpose of this guideline is to maximise the safety of children and young people who are immunocompromised during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.
On 21 May 2020, we highlighted that immunosuppressant medicines should be reviewed if a patient may have COVID-19 or there are other medical concerns.
The guideline covers children and young people (aged 17 and under). It may also be relevant for newborn babies under 72 hours, and 18 to 24 year olds using healthcare services.
Children and young people who are immunocompromised include those with:
- primary immunodeficiencies
- secondary or acquired immunodeficiencies because of their condition
- secondary or acquired immunodeficiencies because of immunosuppressive treatment
- chronic disease associated with immune dysfunction (such as organ dysfunction or failure or severe inflammatory disease).
This guideline focuses on what you need to stop or start doing during the pandemic. Follow the usual professional guidelines, standards and laws (including those on equalities, safeguarding, communication and mental capacity), as described in making decisions using NICE guidelines.
This guideline is for:
- health and care practitioners
- health and care staff involved in planning and delivering services
The recommendations bring together
- existing national and international guidance and policies
- advice from specialists working in the NHS from across the UK. These include people with expertise and experience of treating children and young people who are immunocompromised during the current COVID-19 pandemic.
NICE has also produced COVID-19 rapid guidelines for children, young people and adults on:
NICE has developed these recommendations in direct response to the rapidly evolving situation and so could not follow the standard process for guidance development. The guideline has been developed using the interim process and methods for developing rapid guidelines on COVID-19. The recommendations are based on evidence and expert opinion and have been verified as far as possible. We will review and update the recommendations as the knowledge base and expert experience develops.
Full details available from NICE COVID-19 rapid guideline: children and young people who are immunocompromised
A guest editorial published in the journal Nurse Education in Practice underlines how the COVID-19 pandemic may put the mental wellbeing of trainees at risk; hopelessness, helplessness and burnout are important to be aware of. They also highlight the need to foster an open culture of trust and support, and to promote resilience in colleagues/trainees where possible.
Read the full editorial in the Nurse Education in Practice
Why are improvements in life expectancy slowing in the United Kingdom and across Europe? | The Kings Fund
International monitoring and co-operation can be invaluable in tackling global health problems because often the drivers and solutions are common across national boundaries. This is vital and done routinely in the context of infectious disease, as evident currently in the Covid-19 (coronavirus) context, but it can be important also in the context of non-communicable diseases.
Centre for Evidence-Based Medicine| April 2020 | Does BCG vaccination protect against acute respiratory infections and COVID-19? A rapid review of current evidence
There is systematic review evidence with low to moderate risk of bias that BCG vaccination prevents respiratory infections (pneumonia and influenza) in children and the elderly. These non-specific effects are mediated by induction of innate immune memory (trained immunity).
There is a lack of evidence that BCG vaccine protects against COVID-19. Currently, two clinical trials are ongoing to determine if BCG vaccination protects healthcare workers during the COVID-19 pandemic.
Read the full rapid review from CEBM
Royal College of Psychiatrists | May 2020 |COVID-19 Eating disorder services
The Royal College of Psychiatrists have published guidance for eating disorder services during the COVID-19 epidemic. It covers outpatient and inpatient services as well as the effect of COVID-19 on eating disorders patients and infection control in services.
Although those with eating disorders are not included as one of the ‘shielded’ groups, there does need to be increased monitoring/awareness as patients with ED may have atypical COVID-19 presentation.
Those who are severely malnourished, and people with significant comorbidities, such as asthma or diabetes, should consult their treatment team about the best strategy to avoid infection (such as shielding) to reduce the risk of infection and other physical health complications while also considering the potential impact on their mental health and eating disorder of such approaches. The following indicators may be helpful when advising patients about shielding (we will update the advice as new evidence emerges):
- severe malnutrition (BMI less than 15 in adults, or below 5th centile in children and young people)
- severe obesity (BMI more than 40)
- electrolyte imbalances due to purging
- bone marrow suppression (including low lymphocyte levels)
- physical comorbidities, such as severe asthma, diabetes, kidney disease, pancreatitis
- male gender (due to the higher risk of severe COVID-19 presentation among men)
- potential risks of mental health harms caused by isolation of shielding.
Full details from Royal College of Psychiatrists
NICE| May 2020| NICE joins international collaboratives to respond to the COVID-19 pandemic
Knowledge-sharing initiatives such as the Evidence Collaborative for COVID-19 established by the World Health Organisation, the International Network of Agencies for Health Technology Assessment, and the European Network for Health Technology Assessment are working to identify the rapidly emerging evidence on the prevention, diagnosis and treatment of COVID-19.
NICE is sharing its work on COVID-19 with these partners, and is helping select priority areas for research through the Cochrane collaboration’s rapid reviews on COVID-19. Our rapid COVID-19 guidelines have also been made available for access without our normal licencing fee.
NICE NICE joins international collaboratives to respond to the COVID-19 pandemic
NICE | April 2020| Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
This guideline covers diagnosing and managing venous thromboembolic diseases in adults. It aims to support rapid diagnosis and effective treatment for people who develop deep vein thrombosis (DVT) or pulmonary embolism (PE). It also covers testing for conditions that can make a DVT or PE more likely, such as thrombophilia (a blood clotting disorder) and cancer.
Full details from NICE