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‘Covid is affecting all of acute care – so the system sludges up’ | Nick Scriven



“Hospitals in the north of England are incredibly busy now, in particular because of Omicron. At the hospital where I work we’ve gone from 26 Covid inpatients on Boxing Day to 104 now.

Unlike previous waves of Covid, only four people are being cared for in ICU, whereas in previous waves we were maxed out at 20 people in ICU. That’s good from the patients’ point of view. But it does stress the rest of the system, including the bit of the system I work in – acute medicine.

That’s because the system sort of sludges up because of the infection control procedures we have to operate to keep patients safe, and keep Covid and non-Covid patients separated. Those are particularly necessary just now, given how easily Omicron is spread.

Covid patients need to be kept in single rooms as far as possible or isolated in areas for them, which can reduce the number of beds for other patients to go into. Do we have enough single rooms for them all? No, not at all. And if a non-Covid inpatient in a four-bedded bay tests positive for it then you can lose the other three beds, because segregation is so important.

If there aren’t enough beds for other patients then you cannot get patients in to have an elective procedure, because urgent patients have filled up the elective beds. That means that we can’t get as many patients in for elective procedures as we would like.

The numbers of patients we are treating now – both Covid and non-Covid – is quite incredible. Our acute medicine team is staffed to look after 45 patients but this morning we had 62. Ten of those 62 have got Covid and the others have a mixture of all the medical conditions that land people in hospital – pneumonias, strokes, heart attacks, liver disease. My colleagues on the respiratory wards are the same. They’re staffed for 45 and have got 58. Covid is affecting all the acute specialties.

We’ve got more non-Covid patients than we’ve ever been looking at before in the first week of January, and we’ve got Covid on top of that. It’s not the worst year ever, but it’s on a par with that.

This is my fourth wave of Covid. Staff are mentally tired from making so many decisions all the time without a break. But this time myself and colleagues aren’t thinking ‘here we go again’. It’s more ‘we have to do this, we will look after these people, it’s something we have to do’. No one’s happy. No one’s enjoying it. But it’s sort of heads down and do our utmost for these people.

You do always feel a bit of anxiety, though, coming in every morning to see how many patients are waiting for you in A&E, who haven’t got a bed. How long have they been there?

Omicron-driven staff sickness is not affecting my hospital too badly. We’ve had some junior doctors off, but only a few consultants, and nursing-wise we are coping. But I know that parts of other hospitals in the north have been really ravaged, decimated, because of horrendous staff shortages.

You know an NHS trust is in trouble when they’re sending out group texts saying ‘can anybody come in and do a few hours?’ Loads of NHS staff up and down the country will be getting those messages now from their workforce department. They are messages to doctors and nurses saying basically ‘please can anyone spare a few hours to come in and help?’ They’re seeking help in all the frontline departments – A&E, medical admissions, surgical admission and respiratory medicine. They’re the ones that are really busy and need extra staff.

Are people answering the call? Mostly people are now just too tired. Some answer and do come in. Maybe they’ve got a few days off and choose to come in, at whatever risk to themselves.

But I talk to people who say: ‘Yeah, I got the text, but I’m just too tired. My choice is either doing the extra hours or doing my shift tomorrow. And I’ll stick with my shift tomorrow’.”

* Dr Scriven is a former president of the Society for Acute Medicine, which represents doctors who specialise in acute medicine and look after patients who do not need surgery, including many who are Covid+

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Solar storms may cause up to 5500 heart-related deaths in a given year



In an approximate 11-year cycle, the sun blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field, which may disrupt our body clock and ultimately affect our heart


17 June 2022

A solar storm

Jurik Peter/Shutterstock

Solar storms that disrupt Earth’s magnetic field may cause up to 5500 heart-related deaths in the US in a given year.

The sun goes through cycles of high and low activity that repeat approximately every 11 years. During periods of high activity, it blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field.

These so-called solar storms can cause glitches in our power grids and bring down Earth-orbiting satellites. A handful of studies have also hinted that they increase the risk of …

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UK Covid infection rate rising, with more than a million cases in England | Coronavirus



Coronavirus infections are rising in the UK, figures have revealed, with experts noting the increase is probably down to the more transmissible BA.4 and BA.5 Omicron variants.

The figures from the Office for National Statistics (ONS), based on swabs collected from randomly selected households, reveal that in the week ending 11 June an estimated one in 50 people in the community in England are thought to have had Covid – around 1.13 million people.

The figure is even higher, at one in 45, in both Wales and Northern Ireland, while it was highest in Scotland where, in the week ending 10 June, one in 30 people are thought to have been infected.

While the figures remain below the peak levels of infection seen earlier this year, when around one in 13 people in England had Covid, the findings are a rise on the previous week where one in 70 people in England were thought to be infected. Furthermore, the data reveals increases in all regions of England, except the north-east, and across all age groups.

Experts say that a key factor in the increase is probably the rise of the Covid variants of concern BA.4 and BA.5.

“Infections have increased across all four UK nations, driven by rising numbers of people infected with the BA.4 and BA.5 Omicron variants,” said Kara Steel, senior statistician for the Covid-19 Infection Survey.

While Steel said it remained too early to say if this was the start of another wave, others have warned it may already have begun, with increased mixing and travelling among other factors fuelling a rise in cases.

Among concerns scientists have raised are that BA.4, BA.5 and another variant on the rise, BA.2.12.1, replicate more efficiently in human lung cells than BA.2.

Prof Azra Ghani, an epidemiologist at Imperial College London, said the latest figures were not surprising, and might rise further.

“This increase in infection prevalence is likely due to the growth of the BA.4 and BA.5 Omicron subvariants, which as we have seen elsewhere in Europe, appear to be able to escape immunity generated from previous Omicron subvariants,” she said.

“It is therefore possible that we will continue to see some growth in infection prevalence in the coming weeks and consequently an increase in hospitalisations, although these subvariants do not currently appear to result in any significantly changed severity profile. This does however serve as a reminder that the Covid-19 pandemic is not over.”

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NHS to offer women in England drug that cuts recurrence of breast cancer | Breast cancer



Thousands of women in England with breast cancer are to benefit from a new pill on the NHS which reduces the risk of the disease coming back.

The National Institute for Health and Care Excellence (Nice) has given the green light to abemaciclib, which cuts the chance of breast cancer returning after a patient has had surgery to remove a tumour.

Trials showed that patients who had the drug with hormone therapy had a more than 30% improved chance of their cancer not coming back after surgery, compared with hormone therapy alone.

“It’s fantastic thousands of women with this type of primary breast cancer will now have an additional treatment option available on the NHS to help further reduce the risk of the disease coming back,” said Delyth Morgan, the chief executive of charity Breast Cancer Now.

“The fear of breast cancer returning or spreading to other parts of their body and becoming incurable can cause considerable anxiety for so many women and their loved ones.

“New effective treatments such as abemaciclib, which can offer more women the chance to further reduce the risk of the disease recurring, are therefore extremely welcome and this is an important step change in the drug options available for this group of patients.”

The twice-a-day pill is suitable for women with hormone receptor-positive, HER2-negative, node-positive early breast cancer at high risk of recurrence who have had surgery. About 4,000 women will benefit initially, Nice said.

Helen Knight, the interim director of medicines evaluation at Nice, said the draft recommendation came less than a month after abemaciclib received its licence.

“The fact that we have been able to produce draft recommendations so quickly is testament to the success of our ambition to support patient access to clinically and cost effective treatments as early as possible,” said Knight. “Until now there have been no targeted treatments for people with this type of breast cancer.

“Abemaciclib with hormone therapy represents a significant improvement in how it is treated because being able to have a targeted treatment earlier after surgery will increase the chance of curing the disease and reduce the likelihood of developing incurable advanced disease.”

Abemaciclib works by targeting and inhibiting proteins in cancer cells which allow the cancer to divide and grow. It normally costs £2,950 for a packet of 56 150mg-tablets, but the manufacturer, Eli Lilly, has agreed an undisclosed discounted price for NHS England.

“Thanks in part to this latest deal struck by NHS England, NHS patients will be able to access another new targeted drug for a common and aggressive form of breast cancer,” said Prof Peter Johnson, the cancer director of NHS England.

“Abemaciclib, when used alongside a hormone therapy, offers a new, doubly targeted, treatment option, helping to increase the chances of beating the cancer for good, as well as meeting the NHS’s commitment to delivering improved cancer care under our long-term plan.”

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