BMJ: Lessons in contact tracing from Germany

BMJ (2020) | Lessons in contact tracing from Germany | BMJ |369| m2522 | doi: https://doi.org/10.1136/bmj.m2522


A new editorial in the BMJ explains how Germany built on existing local infrastructure to get ahead of the covid-19 pandemic. The pandemic situation in Germany is often compared favourably with that in other European countries, particularly the UK. According to the World Health Organization, the rate of infection reported in Germany by 23 June was almost half the rate reported in the UK (230 cases/100 000 population v 451/100 000), and the reported mortality from covid-19 was a sixth of that in the UK (10.7/100 000 v 63.2/100 000).

Care must be taken when comparing data from different countries,1 and various reasons may explain the observed differences. But from a public health perspective, experience with SARS suggests that Germany’s intensive system of testing, contact tracing, and quarantine were critical to successful control of the outbreak, especially given the role of super spreading events that seem to shape the current epidemic in Germany, with the most recent ones in meat plants.

Germany is organised into 16 federal states, which hold responsibility for health. Outbreak investigation and management, including contact tracing, is the responsibility of local health authorities at city or county level, with support from state health departments and the national institute for public health, the Robert Koch Institute, when necessary.

Lessons in contact tracing from Germany

NIHR: Public health messages on alcohol need to consider how and why people drink, not just how much

NIHR | June 2020 | Public health messages on alcohol need to consider how and why people drink, not just how much

Public health messages about alcohol could be more effective if they reflect how and why patients drink, rather than simply focusing on how much alcohol is being consumed. There may be a need for more relevant public health campaigns to raise awareness of the long-term consequences of heavy drinking.  

Study author

I found patients’ perspectives on alcohol guidelines interesting, in terms of how flexibly they were interpreted in everyday life. Public health messages around risk are incredibly complicated to communicate.

We would suggest investing in well-designed social marketing campaigns that reinforce current drinking guidelines. It is also important to look into the various reasons for increased alcohol consumption during the COVID-19 pandemic, and the best preventive advice to give in this context.

Amy O’Donnell, Senior Research Associate, Population Health Sciences Institute Faculty of Medical Sciences, Newcastle University

GPs can help patients reduce their drinking by providing brief advice during a routine appointment. But the majority of people who regularly drink more than 14 units a week (the recommended limit in the UK) have never received advice on alcohol from their doctor. 

Many people are not aware of the health risks linked to heavy drinking such as cancer or heart disease. During the COVID-19 crisis, there is concern that some people are drinking more than usual.

What’s the issue?

People tend to reduce the amount of alcohol they drink if they receive advice from their GP. But fewer than one in ten heavy drinkers say they have been given advice on alcohol from a doctor or nurse. 

Several studies have explored the challenges that GPs and nurses experience when delivering advice on alcohol. They suggest that lack of time and training are problems. But there is less understanding of how patients feel when they are asked about their drinking and what kind of advice they find most useful.

What’s new?

Researchers interviewed 22 adults between 25 and 75 years of age in North East England. They had all previously been asked about their drinking or received alcohol advice from their GP or nurse. The researchers looked for key themes in what their interviewees said. They aimed to understand what people think about discussing alcohol in a routine appointment, and whether they feel the alcohol advice provided is useful.  

The researchers found that many people had little understanding of the long-term health risks of heavy drinking, such as cancer and heart disease. Patients were aware that UK guidelines recommend no more than 14 units of alcohol a week. But they often did not think of themselves as problem drinkers even if they regularly exceeded this limit.  They believed that the limit should depend on the individual drinker’s age, gender or size.  They thought harmful drinking was less about the quantity consumed and more about a person’s emotional relationship with alcohol. They associated problem drinking with ‘needing’ to drink and drinking to become ‘drunk’. 

Patients did not mind being asked about their alcohol consumption by a nurse or GP, but they did not always find the advice helpful. Patients were more likely to discover tips and techniques to reduce their drinking for themselves, via friends and family, rather than from medical advice.   

Why is this important?

Patients were generally happy to discuss alcohol with their GP or nurse and to be given advice on drinking. Doctors and nurses may benefit from training on how to give alcohol advice to ensure they are providing patients with practical tips. Questions about how and why patients drink rather than simply focusing on how much may be helpful. Healthcare professionals could talk with the patient about when they are most likely to drink heavily and suggest ways to reduce their alcohol consumption in these situations. During the COVID-19 crisis, suggestions to limit heavy drinking in the home may be particularly important.  

Patients remain unaware of the health risks of heavy drinking. More relevant public health campaigns to raise awareness around alcohol harm, such as the link between drinking and cancer, may be needed.

What’s next?

One in three (36%) furloughed workers are drinking more since lockdown began, according to charity Drinkaware. Researchers want to better understand how the pandemic is affecting people’s drinking habits and how GPs can help.

New research could explore what triggers drinking during the pandemic and whether alcohol advice can be delivered as effectively via video or telephone appointments as when delivered face-to-face. Dr Amy O’Donnell is contributing to an ongoing Europe-wide survey led by researchers in Germany and Spain to investigate alcohol consumption during the pandemic.  

Research into the most effective types of alcohol advice would be useful. Further work using voice and video recordings of GP-patient consultations could help determine which tips are most likely to be taken on board (Source: NIHR). 

NIHR Public health messages on alcohol need to consider how and why people drink, not just how much

Full paper available from BMC Family Practice

COVID-19: guidance for households with possible coronavirus infection #covid19rftlks

Public Health England | April 2020 | COVID-19: guidance for households with possible coronavirus infection

Public Health England’s stay at home guidance for households with possible coronavirus (COVID-19) infection.

Stay at home: guidance for households with possible coronavirus (COVID-19) infection

What to do if someone you share your home with has signs of coronavirus: an easy-read guide

Coronavirus (COVID-19): an easy-read guide

More details from Public Health England

 

One in five of the public unsure about getting coronavirus vaccine, if available #covid19rftlks

Royal Society for Public Health | April 2020|One in five public unsure about getting coronavirus vaccine, if available 

Polling of the UK public under lockdown, conducted by RSPH, has revealed that if a coronavirus vaccine were available, almost a fifith (19%) either would not get the jab (4%) or are not sure if they would (15%).

injection.jpg

This finding is set against a context of declining vaccine coverage rates in the UK in recent years and worrying levels of mistrust in the safety of vaccines globally.

Among the 81% of respondents who said they would get the vaccine, the main reasons given were as expected – to protect themselves and others – but for the remaining 19% a variety of different explanations were given. These concerns will become clearer over time as the crisis progresses and deeper research is conducted, but the major theme was a lack of trust. Respondents had concerns around the safety, contents and efficacy of a vaccine – either due to the short timeframe and rigorous testing required, or pre-existing nervousness about side effects from vaccines.

Other explanations given by the 19% who did not say yes included:

  • feeling that they have immunity already, as they believe they have had the virus
  • a lack of understanding over whether they would be eligible, for example if they don’t ordinarily get offered the flu jab
  • wanting other people to have the vaccine before them
  • having encountered rumours about the vaccine on social media, for example that it will be contaminated with the virus

More in-depth research into perceptions of a potential Covid-19 vaccine is required to understand the prevalence and strength of any specific concerns amongst the public. It is crucial that, when any vaccine currently in development is eventually made available, public confidence in the stringent development process and final product is as high as possible, to ensure wide-spread uptake among the population (Source: Royal Society for Public Health).

Full unedited news release from Royal Society for Public Health

COVID-19: guidance for commissioners and providers of services for people who use drugs or alcohol

This guidance outlines COVID-19 advice for commissioners and service providers involved in assisting people who are dependent on drugs or alcohol or both| Public Health England and Department of Health and Social Care

  • drug and alcohol services do not need to close at the current time and are important to keep operating as they protect vulnerable people who are at greater risk from coronavirus (COVID-19) and help reduce the burden on other healthcare services
  • services should keep face-to-face contacts between staff and service users to a minimum and minimise the use of biological drug testing and breathalysers, where safe to do so
  • follow up-to-date guidance for infection prevention and control, including hand-washing, surface-cleaning, isolating people and sending staff home
  • arrangements for prescribing and dispensing of medicines used in drug and alcohol treatment will need to be changed to take account of service and pharmacy closures, staff unavailability, patients having to maintain social distance or self-isolate, including the most vulnerable being shielded and the need to reduce the spread of COVID-19
  • measures to reduce drug and alcohol-related harm, such as needle and syringe programmes (NSP), take-home naloxone, thiamine, advice on gradual reduction of alcohol consumption and e-cigarettes should all be increased where possible
  • drug and alcohol treatment staff are included in the government’s definition of key workers whose children can – if they cannot be kept safe at home – continue to attend school
  • usual expectations on services for local monitoring and reporting, contract and performance management and contract re-tendering can all be scaled back to enable services to focus on delivery.

Full detail: COVID-19 guidance for commissioners and service providers for those dependent on drugs or alcohol

Long-term health consequences of responses to Coronavirus

Recessions And Health: The Long-Term Health Consequences Of Responses To Coronavirus | Institute for Fiscal Studies

This briefing note outlines how worsening economic conditions and disruptions to NHS services could have important and far-reaching consequences for the health of the broader population. The coronavirus pandemic is putting the NHS under unprecedented strain and leading to cancelled operations and disruptions to non-coronavirus emergency care. The briefing concludes that this will disproportionately affect older individuals, and those from less affluent backgrounds, both in the short and the medium term.

Public health grants to local authorities: 2020 to 2021

The public health allocations and monetary conditions for local authorities to improve health in local populations | Department of Health and Social Care

Local authorities are responsible for improving the health of their local population and reducing health inequalities. In the financial year ending 2021, local authorities will receive a £3.279 billion public health grant for their public health duties for all ages.

This local authority circular sets out the allocations and conditions for using the grant.

Full detail at Department of Health and Social Care

Physical activity – prevention and management of Long-Term Conditions

A professional resource for local authorities and healthcare professionals on physical activity for the prevention and management of long-term conditions | Public Health England

This edition of Health Matters focuses on the benefit of physical activity for the prevention and management of long-term conditions in adults.

One in 3 adults in England live with a long-term health condition and they are twice as likely to be amongst the least physically active. However, evidence shows that regular physical activity can help prevent or manage many common conditions such as type 2 diabetes, cardiovascular disease and some cancers. It also helps keep symptoms under control, prevent additional conditions from developing, and reduce inequalities.

activity
Image source: https://www.gov.uk/

Regular physical activity provides a range of physical and mental health, and social benefits, many of which are increasing issues for individuals, communities and society. These include:

  • reducing the risk of many long-term conditions
  • helping manage existing conditions
  • ensuring good musculoskeletal health
  • developing and maintaining physical and mental function and independence
  • supporting social inclusion
  • helping maintain a healthy weight
  • reducing inequalities for people with long-term conditions

Full detail at Public Health England

Public health reforms: an independent assessment

This report, commissioned by the Local Government Association, assesses the success of the 2013 reforms to public health in England, which were part of the Coalition government’s wider health reform programme | The Kings Fund

These reforms, which saw the responsibility for many aspects of public health move from the NHS to local government, involved transition of staff and services and required the formation of new relationships to ensure public health was embedded across local government services.

The report looks at the effects of the reforms in both the short and longer term and looks at the impact of the changes, which have brought opportunities for innovation and integration, as well as challenges, at a time when funding for public health has been cut. The author then takes a look into the future and the implications for public health in the context of the NHS long term plan, the government’s prevention consultation and the wider shift to population health systems.

Full report: The English local government public health reforms: an independent assessment | The Kings Fund