Our proposal for mass testing and tracing in the SW is gaining traction. Time for Devon MPs and councils to act.
- We are NOT pressing for a regional release of the lockdown at this stage.
- What we ARE arguing is for a large-scale return to testing, tracing and monitored quarantining of those who are infectious and their contacts, as advocated by Exeter University’s infectious disease expert Dr Bharat Pankhania.
- This would need not only a lot more tests but also rapid expansion of testing and tracing teams beyond the Public Health team, using district Environmental Health staff, and recruiting many others.
Beer-based Pecorama are making these ear guards, free of charge, to help carers wearing face masks for lengthy periods. They are being used and much appreciated in one local home where a resident has had the virus.
Email me email@example.com if you are a carer or care home manager and would like Peco to supply you with some.
They are based on a design produced by an enterprising school in Scotland and a video explaining them can be found at https://www.youtube.com/watch?v=QVpMvQpwgVM
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According to new information which I have been given, a much larger number of homes are now infected, roughly double the figures mentioned in my previous post. This confirms the desperate urgency of improving PPE for care home staff and ensuring that everyone transferred into a home from hospital is tested first, as the Government has very belatedly promised.
Statement by Devon county councillors calling for a regional public health approach to containing the epidemic in the South West
The RD&E – the death rate from Covid-19 is barely 10% of the rate in the worst affected trusts. We need extensive testing, tracing and quarantining of cases and contacts to control the virus
Statement by County Councillors Hilary Ackland (Exeter), Martin Shaw (Seaton and Colyton) and Claire Wright (Otter Valley):
The South West is experiencing the epidemic in a different way from other regions. We have the lowest levels of hospitalisation and death from Covid-19 in the country. South West councils, MPs and the police have had some success in preventing second-home owners and tourists further spreading the virus.
We therefore support the call by Dr Bharat Pankhania, Exeter University’s infectious disease and public health expert, to take advantage of the lockdown to introduce a regional approach to the epidemic in the South West, with intensive testing, tracing and quarantining to eliminate the virus.
We call on Directors of Public Health in the region to devote all available resources to this approach, and on Devon MPs to press the Government to give the necessary support for this.
While we do not believe the lockdown can be lifted imminently, effective control of the epidemic in the South West would be an important step forward towards a national solution and would enable local leaders to make the case for a regional approach to lifting the lockdown in due course.
Martin Shaw adds:
As of two days ago, 21 people had died of Covid in the RD&E trust, compared to almost 200 in many trusts in other regions. This shows that the epidemic is still very uneven – a patchwork of variable local epidemics, as Dr Pankhania has argued in the BMJ. We should press for an effective SW strategy.
I am hearing new stories of shortages of PPE for care home staff in the local area, along the lines of the story on BBC Spotlight last night. I gather that new national systems are being established for routine supply of PPE to the health and care sector, but these are still not up and running.
Recognising the difficulty, the Local Resilience Forum has had two emergency drops of PPE in the last week, which have been allocated to district councils and also to the CCG for primary care. It has flown out of the door but Devon does have limited supplies available from this resource for homes which have less than two days’ supply left.
In case of emergency, ie less than three days supply remaining, care homes are advised to go to the National Supply Disruption Resource (NSDR) which is managed nationally. However at least one care home were told that care homes would not be supplied through this route.
It seems we are still some weeks away from having a secure source of supply for the care sector. Meanwhile, the disease has been confirmed in 21 out of 400 or so care homes in Devon, which is probably an underestimate of the extent.
The only encouraging thing I have heard is that one patient from a local home was admitted to Intensive Care – contrary to national reports that care home patients are not being admitted – which seems to confirm the impression that the outbreak here is less severe and there is still capacity.
ITALY 5 WEEKS AGO – TOMORROW WESTPOINT. But will older people even get in?
By Greg Wilford in www.thetimes.co.uk
Doctors and other health professionals have been issued with a “clinical frailty scale” to identify “who may not benefit from critical care interventions”, the NHS has confirmed.
Infected people aged 65 or over will be given a points tally based on their age, frailty and underlying conditions. According to the system, if someone scores above eight points they should probably not be admitted to intensive care, according to the Financial Times.
Instead, they should be given “ward-based care” and a trial of non-invasive ventilation, the newspaper said. However, official guidance states that clinical discretion could be used to override the scoring system if a situation requires “special consideration”.
A frontline NHS consultant said: “The scoring system is just a guide. We make the judgment taking into account a lot of information about the current ‘nick’ of the patient — oxygenation, kidney function, heart rate, blood pressure — which all adds into the decision-making. If this was a bacterial pneumonia or a bad asthma attack, then that is treatable and you might send that older patient to intensive care.”
The NHS says the scale has not yet been validated for use with people under 65 or those with learning disabilities. It can currently be used by “any appropriately trained healthcare professional”, including doctors, nurses, healthcare assistants and therapists.
Any patient aged 71-75 will automatically score four points for their age and a likely three for their frailty, taking their total to seven, it was reported. Those with conditions such as dementia, high blood pressure or recent heart and lung disease will be given more points.
An NHS website outlining guidance on the scoring system states that it “is a reliable predictor of outcomes in the urgent care context”. It continues: “Like any decision support tool, it is not perfect and should not be used in isolation to direct clinical decision-making.
“It will sensitise you to the likely outcomes in groups of patients, but clinical decision-making with individual patients should be undertaken through a more holistic assessment, using the principles of shared decision-making.”
The scoring system is included in guidelines on critical care for adults with Covid-19 issued by the National Institute for Health and Care Excellence (Nice). It was originally developed at Dalhousie University in Halifax, Canada. The news emerged after NHS England wrote to all GPs asking them to contact vulnerable patients to ensure that plans for end-of-life decisions were in place.
Ruthe Isden, head of health and care at Age UK, said some elderly patients have felt unsettled and pressured to sign “Do not resuscitate” forms. “Clinicians are trying to do the right thing and these are very important conversations to have, but there’s no justification in doing them in a blanket way,” she said. “It is such a personal conversation and it’s being approached in a very impersonal way.”
Some intensive care wards are now approaching capacity, with about 5,000 Covid-19 cases presenting every day. The NHS and Nice declined to comment last night.
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