Hospitals

Hospital Appointments in Glasgow Being Cancelled to Reduce Road Traffic during COP26

Hundreds of patients in Glasgow are having face-to-face hospital appointments cancelled or rescheduled ahead of the 2021 United Nations Climate Change Conference (COP26) which begins next week in the hope that this will help to clear up the roads. The Herald has the story.

NHS Greater Glasgow and Clyde said it would be increasing the number of virtual consultations and moving some face-to-face consultations to different times of the day in order to accommodate a “temporary increase in population” in the city over the two-week climate summit.

Patients began receiving letters over the past week notifying them of changes to their appointments.

It comes amid warnings that the event itself could trigger a fresh spike in Covid cases, piling preassure on an already overstretched NHS.

Health cheifs at neighbouring NHS Lanarkshire – where the majority of non-urgent elective surgeries have been paused since August – have now escalated its risk status to ‘Black’ and confirmed that a number of cancer procedures will be postponed. These will be rescheduled “as soon as possible”, they said.

One Glasgow patient with long Covid symptoms, who is due to see several specialists, told the Herald their face-to-face appointments had been changed suddenly to telephone consultations after months of waiting. …

[They said] that it was ironic patients were being switched to phone and video appointments to free up roads for climate deligates flying into Scotland who “really should have held their meetings virtually”.

Worth reading in full.

To read more of the article without hitting a paywall, view the cover of today’s Herald here.

Air Filtration/UV Light Can Remove Airborne SARS-CoV-2 From Hospital Wards, Study Finds

In a study published earlier this year, Paul McKeigue and colleagues analysed data on all diagnosed cases of COVID-19 in Scotland, as well as a large number of matched controls. They found that a staggering 30% of severe cases (those that resulted in critical care admission or death) were linked to a recent hospital visit.

This suggests widespread nosocomial transmission of SARS-CoV-2. In other words, a lot of people caught their infections in hospital, and then became seriously ill.

The fact that such a large portion of severe cases were linked to a recent hospital visit is actually not so surprising. After all, people vulnerable to COVID-19 (the elderly and persons with underlying health conditions) are overrepresented among those who make frequent hospital visits.

Nonetheless, it’s rather concerning that hospitals – places where people are meant to come out healthier than they go in – were a major site of SARS-CoV-2 transmission.  

Given that COVID-19 patients, as well as those vulnerable to COVID-19, tend to be concentrated in hospitals, making efforts to reduce nosocomial transmission would seem like a top priority. Indeed, one would expect interventions that did reduce such transmission to have a large benefit/cost ratio.

Which makes a new preprint so interesting. Andrew Conway-Morris and colleagues investigated whether airborne SARS-CoV-2 could be removed from hospital wards using portable devices that filter and sterilise the air.

Their experiment involved two units within an English hospital: an ordinary Covid ward, and an ICU containing Covid patients. The presence of airborne SARS-CoV-2 was measured during three consecutive weeks: one in which the devices were turned off; one in which they were turned on; and one in which they were turned off again.

In addition to measuring the presence of SARS-CoV-2, the researchers measured the presence of various other microbial bioaerosols, such as E. coli and staphylococcus. Their results for the Covid ward are shown in the figure below.

When the devices were turned off, many microbial bioaerosols (including SARS-CoV-2) were detected. Yet when they were turned on, all of these except candida were undetectable. This means the devices were successful in removing not only SARS-CoV-2, but also other potentially dangerous pathogens.

As the authors note, SARS-CoV-2 was detected on “all five days before activation of air/UV filtration, but on none of the five days when the air/UV filter was operational”. The virus was again detected on “four out of five days when the filter was off”.

Interestingly, SARS-CoV-2 was barely detected in the ICU (regardless of whether the devices were turned on). This may be because viral shedding is lower among critically ill patients, or because ICU staff were wearing proper N95 masks.

It’s important to note: the study didn’t show that the devices actually prevent transmission of SARS-CoV-2 in hospitals. However, the results constitute strong circumstantial evidence that they would reduce transmission.

While attempting to halt transmission of SARS-CoV-2 in the community at large is costly at best and futile at worst, attempting to do so in high-risk hospital environments makes a great deal of sense. Further investigation into the efficacy of these devices is clearly warranted.  

The Dangerous Myth of Health Service ‘Collapse’

In the U.K. we are facing threats once again of restrictions and vaccine passports being imposed over winter should the prospect of an ‘overwhelmed’ NHS be sounded by the Government’s medical advisers in the coming weeks.

But how realistic is this threat of health service ‘collapse’? South Korea is currently providing an object lesson in how the concept appears to be very much in the eye of the beholder.

The South East Asian country has been experiencing a spike in reported infections in recent weeks as the Delta variant has become dominant, hitting over 3,000 in one day for the first time on September 24th.

English Hospitals Told They Can Drop Some Covid Measures to Help Reduce Backlog

In a move aimed at helping to cut down long and ever-growing treatment waiting lists, English hospitals have been told they can scrap some of the ‘anti-Covid’ measures they were forced to introduce during lockdown, including testing and isolating patients before planned operations. BBC News has the story.

The changes, recommended by the U.K. Health Security Agency (UKHSA), are aimed at easing pressure on the NHS.

It says testing and isolating patients before planned operations can be dropped and hospitals can return to normal cleaning procedures.

Social distancing can also be reduced from 2m to 1m in some areas.

More than five million people are waiting for NHS hospital treatment in England and hundreds of thousands have been waiting more than a year.

Although the Government has announced an extra £5.4 billion over the next six months to respond to the backlog caused by the pandemic, ministers have warned waiting lists could get worse before they get better, as more people come forward.

UKHSA Chief Executive Dr. Jenny Harries said the new recommendations would help local hospitals plan more elective care.

“This is a first step to help the NHS treat more patients more quickly, while ensuring their safety and balancing their different needs for care,” she said. …

Local hospitals will be left to decide when and how these changes are introduced.

Guidance on which measures can be relaxed in GP surgeries, dentists and for ambulance trusts are still being considered.

The recommendations were based on reviews of evidence and broad agreement from experts in infection prevention and control, the UKHSA said.

Worth reading in full.

NHS Cancer Patient Backlog Could Take Over a Decade to Clear

Almost every day brings more bad news on the cancer patient backlog in the NHS, caused in large part by the “stay at home, protect the NHS” drive. New research suggests that the waiting list could take more than a decade to clear, and backs up a study released earlier this week showing that thousands more will die along the way because of delayed treatment. The Telegraph has the story.

The analysis of NHS statistics by the Institute of Public Policy Research (IPPR) estimates that around 20,000 cancer diagnoses have been missed during the pandemic.

Waiting lists have reached a record high of 5.5 million, with fears they could reach 13 million, as patients come forward after struggling to access services, or from fear of being a burden on the NHS during the pandemic.

It comes amid growing concern about access to face-to-face appointments with GPs.

The Prime Minister said on Wednesday that patients were entitled to see their doctor in person, raising concerns that without the option, deadly symptoms could be missed. 

Before the pandemic, around 80% of consultations took place in a doctor’s surgery – but in July the figure was just 57%.

The new study by the IPPR and CF, a data analytics consultancy, says it could take until 2033 to clear the backlog – and come too late for many of those whose diagnosis was missed or delayed. 

Even this timetable would require a 5% increase in cancer care activity levels above pre-pandemic levels, it says.

However, boosting this to 15%, with a major expansion in diagnostics and staffing, could clear the backlog by next year, the analysis suggests. …

The research shows that in the year following the first lockdown, 369,000 fewer people than expected were referred to a specialist with suspected cancer. …

Concerns about the spread of Covid, and efforts to free hospitals for patients with the virus, resulted in a major reduction in access to diagnostic tests. …

The report said: “Behind these statistics are thousands of people for whom it will now be too late to cure their cancer.”

Worth reading in full.

Extra 10,000 Brits Likely to Die of Cancer Due to Drop in Emergency Referrals during Lockdown, According to New Study

A drop in emergency referrals for cancer over the past year of lockdowns is likely to result in an extra 10,000 deaths from the disease, according to a new study. In particular, the “stay at home, protect the NHS” message is believed to have put people off coming forward and ‘burdening’ the health service for check-ups, meaning their symptoms were not investigated. MailOnline has the story.

University College London researchers said a drop in emergency referrals from GPs last year across the U.K. resulted in around 40,000 late diagnoses of the disease.

These delays and longer waits for NHS treatment – fuelled by the pandemic – mean thousands will die “significantly earlier” from the disease than would have been the case pre-pandemic.

The study of more than 2,000 adults found nearly two thirds of people worried about bothering family doctors with “minor health problems” because of Covid.

And during the first lockdown last year, the NHS moved GP appointments to online and telephone to limit face-to-face consultations. Number 10’s “stay at home, protect the NHS, save lives” messaging put people off coming forward, meaning their symptoms were never investigated. …

Just 57% of GP appointments are now in person compared with 80% before the pandemic. 

A senior coroner in Manchester earlier this month concluded a lack of face-to-face care contributed to at least five deaths in the area during the pandemic. …

23 million appointments, whether face-to-face or otherwise, were also “lost” during the pandemic.

Out of the 2,000 people polled by UCL, those above 65 – the group who require the most healthcare – were the least likely to want to see their doctor remotely.

Some 56% in that age group opposed having more telephone and online consultations, while 24% were in favour of them.

And only 46% of people aged 18 to 24 wanted more remote appointments, with more than a quarter (28%) against them.

Worth reading in full.

England’s NHS Waiting List Hits 5.6 Million

Few will be surprised to read that the number of people in England alone waiting to begin hospital treatment has risen again to a record high. 5.6 million people were waiting to start treatment at the end of July, an increase of almost half a million from the end of April. And the figure will not stop rising yet, with the Institute of Fiscal Studies estimating that the waiting list could reach 14 million by next autumn. The Guardian has more.

A total of 5.6 million people were waiting to start treatment at the end of July, according to figures from NHS England. This is the highest number since records began in August 2007 and includes those waiting for hip and knee replacements and cataract surgery.

The number of people having to wait more than 52 weeks to start treatment stood at 293,102 in July 2021, down from 304,803 in the previous month, but more than three times the number waiting a year earlier, in July 2020, which was 83,203. …

The data shows the total number of people admitted for routine treatment in hospitals in England in July 2021 was 259,642, up 82% from a year earlier (142,818), although this reflects lower-than-usual figures for July 2020, which were affected by the first wave of the Covid pandemic. The equivalent figure for July 2019, before the pandemic, was 314,280.

NHS England said many more tests and treatments had been delivered this summer compared with last, while hospitals cared for thousands more patients with Covid. It said there were 3.9 million diagnostic tests and 2.6 million patients started consultant-led treatment in June and July, compared with 2.7 million tests and 1.6 million treatments over the same time last year. …

NHS England also pointed to data showing that almost half a million people were checked for cancer in June and July, among the highest numbers on record. …

The new data showed that more than 325,000 patients in England had been waiting more than six weeks for a key diagnostic test in July. A total of 325,229 patients were waiting for one of 15 standard tests, including an MRI scan, non-obstetric ultrasound or gastroscopy.

The equivalent number waiting for more than six weeks in July 2020 was 489,797, while pre-pandemic in July 2019 there were 37,206.

Tim Mitchell, the Vice-President of the Royal College of Surgeons, said the overall data showed 7,980 patients waiting more than two years for treatment. The longest waits were for trauma and orthopaedic treatment such as hip and knee replacements, followed by general surgery such as gallbladder removals and hernia operations.

Worth reading in full.

Almost a Quarter of U.S. Hospitals Are Forcing Staff to Get Vaccinated Against Covid

As much as some state leaders are attempting to stop the move to mandatory Covid vaccination for hospital workers (and for employees in other sectors), close to 25% of U.S. hospitals are requiring their staff to get ‘jabbed’ as a condition of employment. More than 96% of doctors have already been vaccinated, according to the American Medical Association, and 45% of those who have not plan to be. MailOnline has the story.

According to the American Hospital Association (AHA), around 1,500 hospitals have set vaccine mandates, reported CNN. 

The vaccine requirements are controversial and have received backlash from employees, unions and even some governments. 

Federally, it is legal for employers to demand their staff to get vaccinated, though individual states can – and have – passed laws banning vaccine mandates in the workplace. 

The first major hospital system to institute this type of mandate was Houston Methodist Hospital system in Texas.

The hospital’s decision was met with backlash from employees, and 117 filed a joint lawsuit against the hospital.

Their effort was in vain with the lawsuit thrown out and more than 100 employees were either fired or resigned.

NewYork-Presbyterian Hospital, in New York City, also set a similar mandate, giving all of its employees until September 1st to get the shots or be terminated. …

These types of mandates are not legal everywhere, however.

In seven states, Arizona, Arkansas, Montana, New Hampshire, North Dakota, Tennessee and Utah, employers are not allowed to force their employees to get the vaccine to keep their jobs.

Advocates of mandatory vaccination for hospital workers employ the usual trick of comparing Covid to other viruses such as polio and smallpox.

“I cannot imagine passing any worse law than [banning vaccine mandates],” John Goodnow, CEO of Benefis Health in Great Falls, Montana, told CNN.

“Imagine if that would have been passed back when we were fighting polio, or smallpox before that.”

Benefis attempted to put a vaccine mandate in place in April, but its attempt was blocked by state legislators.

Worth reading in full.

NHS Waiting List Could Hit 14 Million in England by Next Autumn, According to IFS Report

A new report by the Institute of Fiscal Studies (IFS) says that the NHS waiting list in England could reach 14 million by next autumn and could then continue to increase “as the number joining the waiting list exceeds the number being treated”. And this, according to the author of the report, is just the beginning: “Much longer waiting lists [could] be with us for years to come.” Sky News has the story.

Currently, the number of people waiting to start routine hospital treatment is at a record high – 5.3 million, according to latest figures.

But the IFS has warned in its new report that there is a massive backlog of people still to come forward for treatment, largely caused by Covid [what about lockdown?].

Health Secretary Sajid Javid said the number of people on waiting lists could rise to 13 million in the coming months, but the IFS projects that the total could eventually surpass the Health Secretary’s figure.

“In our first scenario, 80% of the approximately seven million ‘missing’ patients return over the next year, the NHS operates at 90% of its 2019 capacity this year and next, and then at 100% capacity from 2023 onwards,” it says.

“Under this scenario, waiting lists would soar to 14 million by the autumn of 2022 and then continue to climb, as the number joining the waiting list exceeds the number being treated.”

The IFS said while it is unlikely all patients will return due to the fact some will have died and others might have had private treatment, most will probably require treatment at some point soon, especially as virus cases decrease and “people are more willing to seek health care”.

Max Warner, the author of the analysis, said: “There is a real risk that if the NHS cannot find effective ways to boost its capacity – a challenge at the best of times, let alone after a major pandemic – then much longer waiting lists will be with us for years to come.”

Worth reading in full.

Ireland Will Finally Distinguish Between Hospital Patients Actually Ill From Covid and Those Who Simply Test Positive

The Irish Government has announced that it will change the way it collects data on Covid hospitalisations by distinguishing between those who are admitted to hospital because of the virus and those who test positive after being admitted for other reasons. It’s only taken them 17 months! RTÉ has the story.

At present, the Health Service Executive [HSE] Covid hub website states that there are 141 people in hospital who have tested positive for Covid, of whom 22 are in ICU.

A Government spokesperson said it is “seeking better data on hospitalisations in order to better inform decision making.

“This includes details on the total number of positive cases in hospital, the number who contracted Covid while in hospital, and those being treated for Covid specifically.”

RTÉ has also requested this information from the HSE but no data has been forthcoming.

The Government spokesperson added: “Details are also being sought on how many travel-related cases had been fully vaccinated.

“The matter will be discussed further with the National Public Health Emergency Team.”

Last week, HSE Chief Clinical Officer Dr Colm Henry said the “great majority of [Covid patients are in hospital] because they are sick with Covid.

“In some cases there are outbreaks, and in those outbreaks people have been picked up who either who didn’t have symptoms, or very mild symptoms.”

However, Tony Canavan, CEO of the Saolta Hospital Group, told RTÉ’s Morning Ireland last week that “nearly all the [coronavirus] cases” in the group’s hospitals “are being admitted for other reasons” than Covid.

Of those that do test positive for the disease, “the majority are exhibiting mild or moderate symptoms”.

Worth reading in full.