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Medics demand government releases plans for how the NHS should get ready for second Covid wave

Professor Martin Marshall, chair of the RCGP, said the College needed reassurances immediately that staff and patients would be protected if the crisis spirals back out of control

Doctors have demanded ministers set out a clear strategy to prevent a second Covid-19 wave amid fears it could kill triple the number of Brits as the first outbreak.

A report this morning done on behalf of  Number 10’s chief scientist Sir Patrick Vallance warned of at least 120,000 more deaths this winter in a ‘reasonable worst-case scenario’. 

But the grim prediction only looked at hospital deaths and did not factor in fatalities in care homes – which have accounted for a third of the near-45,000 lab-confirmed coronavirus deaths so far. 

The report laid out 20 steps the UK Government must take to mitigate the chance of the deadly resurgence – including stocking up on PPE, vaccinating millions more Britons against the flu and rapidly improving contact tracing.

But the Royal College of GPs claimed medics have been left in limbo without clear guidance about how they should get ready for a second influx of coronavirus patients.

Professor Martin Marshall, chair of the RCGP, said the College needed reassurances immediately that staff and patients would be protected if the crisis spirals back out of control. 

He added: ‘The College has been advocating for comprehensive planning to ensure the UK is prepared for a potential second wave or local peaks of the Covid-19 virus.

‘We will do what is necessary, in the best interests of patient care, but we need to know what the plans are and have the appropriate guidance and resources to swiftly respond to a second wave of the virus, mitigating its potential severity and helping to keep patients and their wider communities safe.’ 

Liberal Dem MP Layla Moran today backed the RCGP’s calls for mitigation plans, adding: ‘There is simply no time to waste. I urge the Government to look closely at the recommendations made in the report and act without delay.’

It comes after parliament’s spending watchdog warned last week that ministers still do not have a clear strategy to acquire and distribute PPE in the event of another wave.

MPs on the cross-party public accounts committee said they were ‘extremely concerned’ that the Government had not ironed out plans to replenish current stocks if there was another outbreak.

More than 300 healthcare workers have died from Covid-19 so far and NHS staff groups say shortages of masks, gloves and aprons played a key role in exposing them to the virus. 

Modelling by the Academy of Medical Sciences estimates more than 120,000 people could die from coronavirus this winter in a 'reasonable worst-case scenario'

Modelling by the Academy of Medical Sciences estimates more than 120,000 people could die from coronavirus this winter in a ‘reasonable worst-case scenario’

The modelling presumed the R - the average number of people each Covid-19 patient infects -would rise to 1.7

The modelling presumed the R – the average number of people each Covid-19 patient infects -would rise to 1.7

Professor Marshall said: ‘Winter is always a busy time for general practice, as it is across the NHS, as GPs and our teams deal with many patients suffering from flu and other common winter illnesses in the community. 

‘A second wave of Covid-19, on top of these challenges, would put the NHS under considerable pressure, so it’s sensible to look at potential worst case scenarios, as this report does, so that we can plan and put mitigating measures in place.

‘The College has been advocating for comprehensive planning to ensure the UK is prepared for a potential second wave or local peaks of the Covid-19 virus. 

UK DOES NOT HAVE CLEAR PPE STRATEGY FOR SECOND WAVE, MPS WARN 

There is no plan in place to acquire and distribute PPE to protect healthcare and care home workers during a second wave of Covid-19, parliament’s spending watchdog has warned.

The public accounts committee said they were ‘extremely concerned’ by the lack of clear strategy.

More than 300 healthcare workers have died from Covid-19 so far and NHS staff groups say shortages of masks, gloves and aprons played a key role in exposing them to the virus.

There were reports of some health and care workers forced to use rubber gloves and bin liners while treating patients with the disease at the height of the epidemic. 

Meg Hillier MP, the chair of the committee, demanded to see the Government’s plans to buy in protective equipment in advance.

She said: ‘The Government conducted a large pandemic practice exercise in 2016 but failed to prepare. The previous committee warned on the lack of plans to ensure access to medicines and equipment in the social care sector in the event of a no-deal Brexit, but, again, the Government failed to prepare. 

‘There must be total focus now on where the problems were in procurement and supply in the first wave, and on eradicating them.’

The committee’s report, published last Wednesday, said it remained concerned that there had been a failure to acknowledge previous PPE shortages.

The report said:  ‘The department [of health and social care] says that it buys the vast majority of its PPE on international markets and will continue to do so. Although the department says it is committed to building up stocks to meet longer-term demand, we were not convinced that it was treating the matter with sufficient urgency,.’

‘We recently co-signed a letter with other medical organisations calling for a rapid forward-thinking review to reflect on our initial response and using learnings from this to plan for the future.

‘We need to recognise that a second wave of Covid-19, during the time when the NHS is busiest, will be incredibly disruptive for all sectors of the health service, and for patients at any stage of illness. 

‘Amongst other things, we need to ensure that the NHS is prepared to protect our most vulnerable patients and staff; that procurement and supply of appropriate PPE is secured; and that communication channels between national and local NHS services are optimal and resources are distributed where they are most needed.

‘GPs and our teams have shown during this pandemic that we can be flexible and quickly change the way we do things in order to keep our patients safe, and play our part in tackling the virus. 

‘We will do what is necessary, in the best interests of patient care, but we need to know what the plans are and have the appropriate guidance and resources to swiftly respond to a second wave of the virus, mitigating its potential severity and helping to keep patients and their wider communities safe.’ 

It comes after a report published this morning warned more than 120,000 Britons could die from Covid-19 in hospital this winter.

Leading academics were asked to predict a ‘reasonable worst-case scenario’ of how a second wave of coronavirus could hit Britain by Number 10’s chief scientist Sir Patrick Vallance.  

The group — from the Academy of Medical Sciences — found 3,000 people may die every day in hospitals during the worst of the outbreak in December and January.   

They modelled what would happen if the UK’s R rate – the average number of people each Covid-19 patient infects — climbed to 1.7.

Data suggested 119,900 Covid-infected patients would die in NHS hospitals between September and next June, if the virus sees a resurgence this winter. 

But the report did not look at care home deaths, which have accounted for a third of the near-45,000 lab-confirmed coronavirus deaths so far. 

The group of 37 experts behind the report said the combination of Covid-19 and flu, as well as a huge backlog of patients on waiting lists, could overwhelm the NHS.

And the academics called for urgent action, saying now presents a ‘critical window’ to help us prepare for ‘the worst that winter can throw at us’.

Modelling by the AMS suggested there would be a peak in hospital admissions and deaths in January and February 2021, which would coincide with a period of peak demand on the NHS.

It estimates the number of Covid-19-related hospital deaths, excluding care homes, could be as high as 120,000.

The number of patients suffering from respiratory conditions from August until March surges, data from the British Lung Foundation shows

The number of patients suffering from respiratory conditions from August until March surges, data from the British Lung Foundation shows

Government scientists have ‘strong evidence’ the virus survives TEN TIMES longer in the cold 

Ministers have been told to prepare for a surge in coronavirus cases this winter that could trigger a second national lockdown.

The Government’s scientific advisers now have ‘strong’ evidence that the virus flourishes at an optimal temperature of around 4C (39F).

They say this, combined with annual pressures on the NHS caused by seasonal flu, means the UK is heading for a ‘difficult winter’.

One senior official said: ‘We can get away with a lot at the moment because it is summer.

‘It is really important that people get ready for the challenges that winter will undoubtedly bring.’

Ministers are aiming to manage any resurgence of the virus through local lockdowns, such as the one imposed in Leicester last week.

But a senior official said: ‘If the overall numbers increase, then I would expect to have to reimpose some national measures.’

The official added that the Government’s much-maligned test and trace strategy must be working ‘absolutely faultlessly’ by the autumn.

Another lockdown would have devastating economic consequences. It could also hamper Boris Johnson’s plans for all children to return to school although experts on the Scientific Advisory Group for Emergencies (Sage) have stressed reopening schools should be a ‘priority’.

Officials said that it is ‘significant’ that the city of Melbourne in Australia, where it is currently winter, had to impose a second lockdown on its five million residents this week. 

But the figures do not do not take into consideration future lockdowns or the recent success of a trial of the steroid dexamethasone, which slashed death rates in Covid-19 patients.

Both of these could substantially reduce the number of coronavirus deaths in the UK, the researchers conceded. 

Writing in the report, published today, the scientists warned that even if the R rate climbs to between 1.1 and 1.5 this will ‘likely stretch the NHS’.

They have laid out a series of measures that could further reduce the risk of another coronavirus outbreak.

The experts called for the Government to rapidly improve its track and trace system so that all Britons with Covid-19 symptoms that overlap with flu are tested.

Currently the programme is still failing to track a quarter of patients who test positive for coronavirus, official figures show.

Scientists have warned contact tracers need to catch at least 80 per cent of infections to ensure the spread of the virus is contained.

The report also calls for private hospitals to be maintained as Covid-19-free zones so patients with cancer and other life-threatening illnesses can be treated safely,

Adequate PPE and stringent infection control measures must also be maintained throughout hospitals and care homes, the scientists said.

And there must be a good uptake in flu vaccines in the autumn to mitigate a potential influenza outbreak from occurring at the same time as another Covid-19 epidemic.

Professor Stephen Holgate, a respiratory specialist from University Hospital Southampton NHS Foundation Trust, who chaired the report, said: ‘This is not a prediction, but it is a possibility.

‘The modelling suggests that deaths could be higher with a new wave of Covid-19 this winter, but the risk of this happening could be reduced if we take action immediately.

‘With relatively low numbers of Covid-19 cases at the moment, this is a critical window of opportunity to help us prepare for the worst that winter can throw at us.’

Health bosses fear 10million people in England alone could be waiting for treatment and tests due to Covid-19 disrupting services this year.

People spend more time indoors during the colder months, where infectious illnesses like the coronavirus and the flu find it easier to spread.

A lack of the immune system-boosting vitamin D, made by the body when it’s exposed to sunlight, also makes illnesses more common. 

Professor Dame Anne Johnson, vice president of the Academy of Medical Sciences, said: ‘Every winter we see an increase in the number of people admitted to hospital and in the number of people dying in the UK. 

‘This is due to a combination of seasonal infections such as flu, and the effects of colder weather, for example, on heart and lung conditions.

‘This winter we have to factor in the likelihood of another wave of coronavirus infections and the ongoing impacts of the first wave. We have to be prepared that we might also experience a flu epidemic this year.

‘Faced with these potential challenges, and after an already tough year, it would be easy to feel hopeless and powerless. 

‘But this report shows that we can act now to change things for the better. We need to minimise coronavirus and flu transmission everywhere, and especially in hospitals and care homes. 

‘We need to get our health and social care, and the track, trace and isolate programme ready for winter. This can be done, but it must be done now.’

HOW TO PREVENT A SECOND WAVE: THE 20 STEPS HIGHLIGHTED IN THE REPORT 

Minimising community transmission and impact of Covid-19

  • Developing effective policies to maximise population engagement in essential control measures. These include: physical distancing; wearing face coverings in settings where physical distancing is not possible; regular hand and respiratory hygiene; high levels of hygiene in the home; heating and ventilation of homes; self-isolation and participation in the test, trace and isolate (TTI) programme when symptomatic, or following contact with a COVID-19 case. Identifying and addressing structural and socio-economic barriers to adherence will require engagement with target communities, and national and local consideration of a wide range of incentivising levers (including financial). 
  • Launching an extensive public information campaign in the autumn, co-produced and optimised by members of target communities working together with professional organisations to minimise transmission and improve levels of population resilience/health. A local and multi-ethnic focus will be key.   
  • Tailoring guidance for commercial, public and domestic properties on optimising indoor environments (temperature, humidity and ventilation) to reduce virus transmission indoors. Specific consideration of those most vulnerable to COVID19 who are also likely to have the poorest quality housing, highest levels of overcrowding and be least able to heat their homes adequately in winter.
  • Significantly expanding the capacity of the TTI programme to cope with increasing demands over the winter and ensure that it can respond quickly and accurately. Testing should harness partnerships between the NHS, academia and industry. Multiplex influenza and SARS-CoV-2 testing would distinguish the cause of influenza-like illnesses – essential to informing recommendations on quarantine (and clinical management). Working with communities and groups, and developing options (including financial), to overcome barriers to engagement, particularly by vulnerable groups.

Organising health and social care settings to maximise infection control and ensure that COVID-19 and routine care can take place in parallel. 

  • Prioritising system-wide infection prevention and control measures across the health and care systems to minimise nosocomial infection. Ensuring timely reporting, investigation and root-cause analysis of hospital acquired infection in both patients and staff. 
  • Adequate provision, training in, and use of personal protective equipment (PPE) and other infection prevention and control measures across health and social care. 
  • Minimising agency/multi-site staffing and staff movements between sites/hospitals. 
  • Using point-of-care multiplex testing to inform cohort selection and clinical management.
  • Maximising the use of remote consultations for hospital and community care. 
  • Cohorting staff to limit physical overlap and movement between zones. 
  • Stratifying entire healthcare settings (or zones within settings) into ‘hot’ and ‘cold’ areas. Considering the optimum use of Nightingale hospitals (subject to workforce capacity) and private healthcare settings, including for ‘step-down’ COVID-19 care or isolation. 
  • Testing and quarantining of patients being discharged into the community or into institutional care. 
  • Prioritising the backlog of clinical care strictly by clinical need, not waiting times. Primary care should target acute care, prevention and screening of those whose physical and mental health is most at risk. 
  • Establishing services to support rehabilitation of a growing number of patients with post-COVID-19 conditions. A better understanding of these conditions is urgently required. 

Improving public health surveillance for COVID-19, influenza and other winter disease.

  • Maintaining a comprehensive, population-wide, near-real-time, granular health surveillance system to ensure rapid identification, investigation and management of local COVID-19 outbreaks across community, work, and health and social care settings. This should integrate the data available through Public Health England (PHE), the NHS, the Office for National Statistics (ONS) (and their equivalents in the devolved administrations), and other sources, including from research, and enable public health bodies to work closely with local Directors of public health departments and health protection teams. 
  • Conducting large-scale population surveys to inform estimates of infection prevalence and incidence, as well as effective control measures. Targeted surveys of populations where COVID-19 incidence is high or unknown should be prioritised to monitor for early evidence of a resurgence in cases.
  • Ensuring that comparable data are collected for surveillance in hospitals and the community, TTI and outbreak investigations using standardised tools and definitions, to maximise their applications and usefulness. Information must be shared quickly and intelligence exchange between local and national systems should be optimised, and made available to the research community. 
  • Maintaining an adequately resourced central overarching body (such as the recently announced Joint Biosecurity Centre) to oversee and coordinate data, collection, processing and distribution, as well as to engage effectively with local public health bodies that should also be appropriately resourced. 

Minimise influenza transmission and impact.

  • Maximise the uptake of influenza vaccination by health and social care workers and other priority groups identified by guidelines. This will require creative approaches to delivering the programme while minimising the risk of transmission and ensuring an adequate supply of vaccines. 
  • Effective implementation of guidelines for the use of antivirals to mitigate the impact of influenza, particularly in high risk groups. This might be informed by point-of-care-testing (POCT).

Read more at DailyMail.co.uk


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