[NICE COVID-19 rapid guideline] Children and young people who are immunocompromised #covid19rftlks

NICE  |  May 2020 |COVID-19 rapid guideline: children and young people who are immunocompromised NICE guideline [NG174]

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.

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. Use it alongside your usual professional guidelines, standards and laws (including equalities, safeguarding, communication and mental capacity).

This guideline is for:

  • health and care practitioners
  • health and care staff involved in planning and delivering services
  • commissioners

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.

See NICE for further details

 

Coronavirus (COVID-19): verification of death in times of emergency #covid19rftlks

Department of Health and Social Care | May 2020 |Coronavirus (COVID-19): verifying death in times of emergency

Clarifying existing practice for verifying deaths outside of hospitals and providing a framework for safe verification of death during the coronavirus emergency.

This guidance is for all cases outside hospital when verification of death may be completed by people who have been trained to do so in line with their employer’s policies, including:

  • medical practitioners
  • registered nurses
  • paramedics

It’s also for other non-medical professionals, usually and normally independent of family members, who are verifying death using remote clinical support.

Coronavirus (COVID-19): verifying death in times of emergency

[NICE rapid guideline] COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital #covid19rftlks

NICE  |  May 2020 | COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital

The purpose of this guideline is to ensure the best antibiotic management of suspected or confirmed bacterial pneumonia in adults in hospital during the COVID‑19 pandemic. This includes people presenting to hospital with moderate to severe community-acquired pneumonia and people who develop pneumonia while in hospital. It will enable services to make the best use of NHS resources.

See a 2-page summary of the prescribing tables to guide decision making about antibiotic choice.

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Image source: nice.org.uk

Full details from NICE

 

 

BMJ: Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis #covid19rftlks

BMJ 2020369 doi: https://doi.org/10.1136/bmj.m1642

A team of researchers undertook a rapid review of the psychological effects on clinicians working in past outbreaks and measures that successfully managed these effects.  This rapid review identifies the psychosocial outcomes, predisposing factors and helpful strateiges for prevention and managemetn of the psychological impact of virus outbreaks on healthcare workers. 

Abstract

Objective To examine the psychological effects on clinicians of working to manage novel viral outbreaks, and successful measures to manage stress and psychological distress.

Design Rapid review and meta-analysis.

Data sources Cochrane Central Register of Controlled Trials, PubMed/Medline, PsycInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to late March 2020.

Eligibility criteria for study selection Any study that described the psychological reactions of healthcare staff working with patients in an outbreak of any emerging virus in any clinical setting, irrespective of any comparison with other clinicians or the general population.

Results 59 papers met the inclusion criteria: 37 were of severe acute respiratory syndrome (SARS), eight of coronavirus disease 2019 (covid-19), seven of Middle East respiratory syndrome (MERS), three each of Ebola virus disease and influenza A virus subtype H1N1, and one of influenza A virus subtype H7N9. Of the 38 studies that compared psychological outcomes of healthcare workers in direct contact with affected patients, 25 contained data that could be combined in a pairwise meta-analysis comparing healthcare workers at high and low risk of exposure. Compared with lower risk controls, staff in contact with affected patients had greater levels of both acute or post-traumatic stress (odds ratio 1.71, 95% confidence interval 1.28 to 2.29) and psychological distress (1.74, 1.50 to 2.03), with similar results for continuous outcomes. These findings were the same as in the other studies not included in the meta-analysis. Risk factors for psychological distress included being younger, being more junior, being the parents of dependent children, or having an infected family member. Longer quarantine, lack of practical support, and stigma also contributed. Clear communication, access to adequate personal protection, adequate rest, and both practical and psychological support were associated with reduced morbidity.

Conclusions Effective interventions are available to help mitigate the psychological distress experienced by staff caring for patients in an emerging disease outbreak. These interventions were similar despite the wide range of settings and types of outbreaks covered in this review, and thus could be applicable to the current covid-19 outbreak.

Full article available from The BMJ

Wellcome research: COVID-19 – exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study #covid19rftlks

Hanlon, P. et al (2020). COVID-19 – exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study  [version 1; peer review: awaiting peer review]. Wellcome Open Research.

This research is published pre-print ahead of peer-review, it finds that among patients dying of COVID-19, there appears to be a considerable burden in terms of years of life lost, commensurate with diseases such as coronary heart disease or pneumonia. While media coverage of the pandemic has focused heavily on COVID-19 affecting people with ‘underlying health conditions’, adjustment for number and type of LTCs only modestly reduces the estimated YLL due to COVID-19 compared to estimates based only on age and sex. Public health agencies and governments should report on YLL, ideally adjusting for the presence of underlying LTCs, to allow the public and policy-makers to better understand the burden of this disease.

Abstract

Background: The COVID-19 pandemic is responsible for increasing deaths globally. Most estimates have focused on numbers of deaths, with little direct quantification of years of life lost (YLL) through COVID-19.  As most people dying with COVID-19 are older with underlying long-term conditions (LTCs), some have speculated that YLL are low. We aim to estimate YLL attributable to COVID-19, before and after adjustment for number/type of LTCs.
Methods: We first estimated YLL from COVID-19 using standard WHO life tables, based on published age/sex data from COVID-19 deaths in Italy. We then used aggregate data on number/type of LTCs to model likely combinations of LTCs among people dying with COVID-19. From these, we used routine UK healthcare data to estimate life expectancy based on age/sex/different combinations of LTCs. We then calculated YLL based on age, sex and type of LTCs and multimorbidity count.
Results: Using the standard WHO life tables, YLL per COVID-19 death was 14 for men and 12 for women. After adjustment for number and type of LTCs, the mean YLL was slightly lower, but remained high (13 and 11 years for men and women, respectively). The number and type of LTCs led to wide variability in the estimated YLL at a given age (e.g. at over or equal to 80 years, YLL was more than 10 years for people with 0 LTCs, and less than 3 years for people with more than or equal to 6).
Conclusions: Deaths from COVID-19 represent a substantial burden in terms of per-person YLL, more than a decade, even after adjusting for the typical number and type of LTCs found in people dying of COVID-19. The extent of multimorbidity heavily influences the estimated YLL at a given age. More comprehensive and standardised collection of data on LTCs is needed to better understand and quantify the global burden of COVID-19 and to guide policy-making and interventions

Specification for Rapidly Manufactured CPAP System to be used during the coronavirus (COVID-19) outbreak #covid19rftlks

Medicines and Healthcare products Regulatory Agency | 5 May 2020| Specification for Rapidly Manufactured CPAP System to be used during the coronavirus (COVID-19) outbreak

This guidance is for devices which are most likely to confer therapeutic benefit on a patient requiring CPAP because of respiratory failure caused by the virus, used in the initial care of patients requiring urgent support.

MHRA have set out the clinical requirements based on the consensus of what is ‘minimally acceptable’ performance in the opinion of the anaesthesia and intensive care medicine professionals and medical device regulators given the emergency situation.

Specification for Rapidly Manufactured CPAP System (RMCPAPS)

 

How to have urgent conversations about withdrawing and withholding life-sustaining treatments in critical care #covid19rftlks

The Faculty of Intensive Care Medicine | May 2020| How to have urgent conversations about withdrawing and withholding life-sustaining treatments in critical care

The Faculty has released ‘How to have urgent conversations about withdrawing and withholding life-sustaining treatments in critical care’. This rapidly produced guidance encompasses urgent phone or video call conversations about withholding, or withdrawing life-sustaining treatments in critical care, in the context of the UK COVID-19 pandemic, between professionals and people close to the patient – usually family members. This guide is based on existing best practice guidance and research. Daily review of goals and preferences of treatment, in the context of the patient’s ongoing clinical condition should take place with the team, and should be a multi-disciplinary discussion. The aim is to provide a rapid access document to support phone and video calls, although many points also apply to face-to-face conversations.
The documents also offers some suggestions for wording of statements and questions

How to have urgent conversations about withdrawing and withholding lifesustaining treatments in critical care – including phone and video calls

Children in lockdown: What coronvairus means for UK children #covid19rftlks

Unicef | May 2020 | Children in lockdown: What coronvairus means for UK children

Unicef UK reaches 2 million children in the UK every year through its work with schools, hospitals and local authorities.. The charity, has produced a briefing paper which lays out the complex issues facing children and their rights, and the multi-layered way in which the coronavirus presents a growing crisis for the worst affected families.

The risks to children’s health, wellbeing and futures are profound:

  • Education: 700 million days of education could be lost this school year
  • Nutrition: More children in the UK will face food insecurity as job losses take their toll on family finances
  • Health: A stretched health system means children have less access to healthcare and other essential services
  • Protection: Thousands of children are at greater risk of abuse in their homes and online
  • Participation: Across the board, the voices of children and young people have been absent from decisions made about their lives. (Source: Unicef)

Summary report: Children In Lockdown

BAME COVID-19 DEATHS – What do we know? Rapid Data & Evidence Review, CEBM #covid19rftlks

Razaq, A. et al. 2020. BAME COVID-19 DEATHS – What do we know? Rapid Data & Evidence Review. Centre for Evidence-Based Medicine

The Centre for Evidence-Based Medicine (CEBM) has conducted a rapid data and evidence review into BAME COVID-19 deaths. The review finds early observational evidence to suggest that COVID-19 hospital deaths among the general population in England are greater in BAME groups compared to White British groups.

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Image source: cebm.net

Summary

Clinical characteristics and determinants of outcomes for hospitalised COVID-19 patients in the UK are important to guide the national response to this current pandemic and emerging evidence suggests ethnic minorities might be disproportionately affected. We describe the characteristics and outcomes of patients hospitalised for COVID-19 in three large London hospitals with a multi-ethnic catchment population.

We performed a retrospective cohort study on all patients hospitalised with laboratory-confirmed SARS-CoV-2 infection at Imperial College Healthcare NHS Trust between February 25 and April 5, 2020. Outcomes were recorded as of April 19, 2020. Logistic regression models, survival analyses and cumulative competing risk analyses were performed to evaluate factors associated with COVID-19 hospital mortality.
Verdict
Evidence indicates markedly higher mortality risk from COVID-19 among Black, Asian and Minority Ethnic (BAME) groups, but deaths are not consistent across BAME groups. Similarly, adverse outcomes are seen for BAME patients in intensive care units and amongst medical staff and Health and Care Workers. The exact reasons for this increased risk and vulnerability from COVID-19 in BAME populations are not known. There may be a number of contributing factors in the general population such as overrepresentation of BAME populations in lower socio-economic groups, multi-family and multi-generational households, co-morbidity exposure risks, and disproportionate employment in lower band key worker roles. For Health and Care workers, there are increased health and care setting exposure risks.

Read and download the review in full from CEBM 

Clinical characteristics and predictors of outcomes of hospitalised patients with COVID-19 #covid19rftlks

WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Division of Digestive Diseases, Department of Metabolism Digestion and Reproduction, Department of Infectious Diseases, Dr Foster Unit, NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, Imperial College London| April 2020 | Report-17 Clinical characteristics and predictors of outcomes of hospitalised patients with COVID-19

Clinical characteristics and determinants of outcomes for hospitalised COVID-19 patients in the UK are important to guide the national response to this current pandemic and emerging evidence suggests ethnic minorities might be disproportionately affected. We describe the characteristics and outcomes of patients hospitalised for COVID-19 in three large London hospitals with a multi-ethnic catchment population

The experts performed a retrospective cohort study on all patients hospitalised with laboratory-confirmed SARS-CoV-2 infection at Imperial College Healthcare NHS Trust between February 25 and April 5, 2020.

Of 520 patients in this cohort (median age 67 years, (IQR 26) and 62% male), 302 (68%) had been discharged alive, 144 (32%) died and 74 (14%) were still hospitalised at the time of censoring. Increasing age (adjusted odds ratio [aOR] 2·16, 95%CI 1·50-3·12), severe hypoxia (aOR 3·75, 95%CI 1·80-7·80), low platelets (increase in aOR 1·54, 95%CI 1·18, 2·04, for every x109/L), reduced estimated glomerular filtration rate (aOR 4·11, 95%CI 1·58-10·69), bilirubin more than21mmol/L (aOR 2·32, 95%CI 1·05- 5·14) and low albumin (increase in aOR 1·30, 95%CI 0·99, 1·69, for every g/L) were associated with
increased risk of in-hospital mortality.

Click to access 2020-04-29-COVID19-Report-17.pdf

The experts find that older age, male sex and admission hypoxia,
thrombocytopenia, renal failure, hypoalbuminaemia and raised bilirubin are associated with increased odds of death. Ethnic minority groups were over-represented in their cohort and, compared to whites, people of black ethnicity may be at increased odds of mortality. They emphasise that further research is urgently needed to investigate these associations on a larger scale.

Alternatively download the full research here