UK COVID-19 Daily: consultant's death 'a loss to NHS family'

  • Tim Locke, Medscape.com

  • UK Medical News
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

These are the UK coronavirus stories you need to know about today.

Consultant's Death 

ENT consultant Amged El-Hawrani, 55, who had been diagnosed with COVID-19, died at Leicester Royal Infirmary, University Hospitals of Derby and Burton (UHDB) said today. 

Its Chief Executive Gavin Boyle paid tribute, saying: "Mr El-Hawrani, known to his colleagues as Amged, was an extremely hard-working consultant and ear, nose and throat trainer who was well-liked in the Trust and particularly at Queen's Hospital Burton where he worked.

"He was known for his dedication and commitment to his patients. He had also raised funds for the hospitals, including climbing in the Himalayas with a group of friends some years ago. The whole UHDB family are desperately saddened at losing Amged who was such a valued and much-loved colleague.

"On behalf of everyone here at UHDB, including our patients and the communities we serve, I would like to offer our sincere condolences to his family."

Mr El-Hawrani's family issued a statement saying: "His greatest passions were his family and his profession, and he dedicated his life to both." 

The statement continued: "Amged reached the very top of his profession and we know he made a difference to thousands of lives during his career. 

"He viewed his role as a doctor as one of life's most noble pursuits."

The family said hospital staff "worked tirelessly for their patient, as he would have done for his own".

Communities Secretary Robert Jenrick told the daily online Downing Street news briefing: "Can I also give my deepest sympathies to the family of Dr El-Hawrani. We heard the news, just a few moments ago that he very sadly passed away."

Doctors' Association UK said: "Doctors hold a vocation for everything that they do and feel a strong moral duty towards their patients. The dedication of NHS staff in this pandemic knows no bounds. However, the government must recognise this commitment to the NHS and ensure doctors are adequately protected when putting themselves in harm's way."

Dr Jenny Harries, deputy chief medical officer for England, said: "As a medical professional, of course, I'm very saddened by the fact that one of our professional colleagues has passed away. It clearly is a worrying event, it's worrying for the nation because it's another death in our statistics, it's another loss to a family, and it will be a loss to an NHS family as well. 

"I think for NHS staff on the front line, and our caring staff, it's not just in our health services, it's all people who are battling against this virus, they will inevitably be concerned, and some of the work that we're doing around communications, and around personal protective equipment, is to just try and ensure there is a common understanding between us of the support that is there for them. 

"It is in no one's interest that we lose our colleagues on the front line and we really really want to support them."

Also on PPE, she said: "We do have some new guidance coming out for colleagues in the NHS shortly. And I'm hoping that will help to support them in their work on the front line." 

PPE Supplies

Robert Jenrick also addressed continuing concerns over PPE supplies: "I know there is a lot of concern over the provision of personal protection equipment. We simply cannot and should not ask people to be on the front line without the right protective equipment. 

"We have a clear plan to ensure that those serving this country at this time have the right equipment. We've established the national supply distribution response team, and they're supported now by members of the armed forces and other emergency services, who are working around the clock to deliver the equipment to the people who need it most." 

He continued: "To NHS and social care workers, all those who rely on this equipment, and to their families and loved ones watching this afternoon, we understand, and we will not stop until we have got you the equipment that you need." 

Support for Families When Doctors Die From COVID-19

Before the announcement of Mr El-Hawrani's death, Doctors’ Association UK (DAUK) wrote to the Health Secretary Matt Hancock asking him to ensure that doctors' families will be provided for if a doctor dies after treating COVID-19 patients.

DAUK President, Dr Samantha Batt-Rawden, said it was "morally unforgivable that at a time when we are asking UK doctors to put their lives on the line, that many [have] been told their families won’t be provided for in the event of their death." 

This, she said, included those who have returned from retirement, locum doctors, and those who had to leave the NHS pension scheme because of punitive tax changes.

Six Month Lockdown?

The Prime Minister is writing to every household in the UK about coronavirus urging families to "follow the rules".

Boris Johnson released the text of the letter on Twitter from his self-isolation in Downing Street after testing positive for COVID-19 on Friday.

The letter says things will get worse before they get better, and further restrictions beyond the current lockdown are possible: "We will not hesitate to go further if that is what the scientific and medical advice tells us we must do."

Today Dr Harries was asked if the initial 3-week lockdown would be extended: "Those measures have now been in place solidly for a week or 2. We need another couple of weeks to see that through." 

She continued: "If we are successful, we will have squashed the top of that curve which is brilliant. But we must not then suddenly revert to our normal way of living, that would be quite dangerous.

"If we stopped then all of our efforts will be wasted and we could potentially see a second peak. 

"So over time, probably over the next 6 months, we will have a 3-week review, we will see where we're going. We need to keep that lid on, and then gradually we will be able to hopefully adjust some of the social distancing measures, and gradually get us all back to normal. 

"So I think 3 weeks for review - 2 or 3 months to see whether we've really squashed it, but about 3 to 6 months, ideally, and lots of uncertainty in that, but then to see, at which point we can actually get back to normal. And it is plausible that it could go further than that, we just need to wait to see how successful we've been."

She later clarified her remarks: "I don't think I have said we will be in lockdown for 6 months, just to be clear. I also haven't said we'll definitely be in the best place possible in 2-3 weeks. The important thing is this is a moving target."

COVID-19 ICU Audit

The Intensive Care National Audit and Research Centre (ICNARC) released its second weekly report on patients with COVID-19 disease being treated in intensive care units in England, Wales and Northern Ireland.

There was good data on 775 out of 846 admissions:

  • Most cases are still being treated in an ICU (609)

  • 86 patients were discharged from the ICU but some had to be readmitted

  • 76 patients died

  • Over half the survivors were patients who did not require a ventilator so were less severely infected

  • The average patient age was 61

  • There were more male patients (70%) than female

  • The chances of death on the ICU with COVID-19 increased markedly with age, reaching 73% in over 70s

Prof Paul Hunter, professor in medicine, University of East Anglia (UEA), commented: "The value of this report is that it gives a good indication of the likely needs for critical care as the epidemic progresses. It also gives a good indication of those who are likely to do well and those who are likely to do poorly on critical care. Sadly such information may become crucial if social distancing is insufficient to reduce the size of the peak and demand for critical care beds outstrips availability over the coming months. 

"What this report does not do is give an indication of the outcomes for people who are not considered for a critical care bed or cannot access one and we need data to be collected and reported on all patients."

Telemedicine Abortion

The confusion over telemedicine home abortion pill use continued today with the Sunday Times reporting it could be reinstated.

Changes were briefly announced by the Department of Health before being removed from its website, with Matt Hancock later telling the Commons there were no plans for any changes.

Dr Patricia Lohr, medical director at the health charity BPAS (British Pregnancy Advisory Service), said: "We welcome the report that the Government is preparing to reinstate telemedicine for early abortion care but we need clarity as this service must be made available to women as soon as possible. Many women with unwanted pregnancies are currently unable to leave their homes or are having to travel across the country to access care as services buckle, putting themselves and those they come into contact with at needless risk. 

"Every day of delay forces hundreds of women from their homes, including those with underlying health conditions. We can provide treatment to these women safely in their homes but only the Secretary of State has the power to authorise this. We are extremely grateful to the dozens of leaders in public health who made their voices heard on this crucial issue in women’s health at a time of national crisis. Women need help and they need it now."

Domestic Abuse and the Lockdown

Writing in the Mail on Sunday, the Home Secretary Pritti Patel said victims of domestic abuse are able to leave home to seek help at a refuge.

She wrote: "Whilst our advice is to stay at home, anyone who is at risk of, or experiencing domestic abuse, is still able to leave and seek refuge. Refuges remain open, and the police will provide support to all individuals who are being abused - whether physically, emotionally, or otherwise."

Mental Health Support

The NHS is offering online support and guidance for those experiencing mental health issues due to the coronavirus and lockdown. Extra funding has also been given to mental health charities.

Commenting via the Science Media Centre, Professor Andrea Danese, professor of child and adolescent psychiatry at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said: "Beyond the enormous strain on the front line healthcare practitioners and workers that make the country carry on in these times of crisis, the pandemic is affecting and will affect mental health across society.

"While we are all challenged by the circumstances, most of us will not develop psychiatric disorders as a result of the pandemic. However, there are some members of society who are more vulnerable and should be more adequately cared for. Of note, the mental health of children and adolescents is more likely to be affected and to remain unnoticed."

Dr Natalie Ashburner, wellbeing lead for Doctors’ Association UK, commented: "It is encouraging that the need for increased mental health support has been recognised. However, we hope that the concerns of those working in acute mental health services in terms of how to protect both staff and patients when treating coronavirus within mental health settings will be addressed in this guidance."

COVID-19 Care by Text Message

People self-isolating at home with suspected COVID-19 symptoms can now register for daily text messages to check in with them via 111 online.

Professor Jonathan Benger, NHS Digital CMO, said the service would support people who are "playing their part in the battle to save lives and stop the spread of coronavirus by doing the right thing and staying home if they have got symptoms.

"However we know that for many this will be difficult. This new service will help people to get the encouragement, advice and support that they need."

NHS Nightingale Hospital 

The Army tweeted the first official pictures of the two 2000 bed wards being set up at the NHS Nightingale Hospital in London's ExCel Centre.

The tweet said the first patients were "potentially arriving early next week".

Adapted from Medscape UK.