this week NEED FOR RECOVERY page 213 • SECOND WAVE page 214 • NW NIGHTINGALE page 216 KING/PA JACOB Mass covid testing rolled out in Liverpool Liverpool has become the fi rst city in of a new national lockdown starting on Army personnel will be sent England to roll out mass testing of its 5 November. to the city to help process the population for covid-19. Prime minister Boris Johnson said the mass testing, as they did in Since 6 November all people living or pilot testing scheme, which has been Leicester over the summer working in Liverpool can take a covid- backed by local leaders, would help to 19 test regardless of whether they have identify many asymptomatic people who symptoms, under a government pilot could still infect others without knowing. scheme that will screen as many as half a “Dependent on their success in Liverpool, million people in the city. we will aim to distribute millions of these The pilot will test the feasibility of new rapid tests between now and Christmas the government’s ambitious plans for and empower local communities to use mass population screening throughout them to drive down transmission,” he said. England, as The BMJ fi rst revealed in the “It is early days, but this kind of mass testing leaked Operation Moonshot documents in has the potential to be a powerful new LATEST ONLINE September. The army will provide logistical weapon in our fi ght against covid-19.” support, with 2000 deployed personnel. People will be able to book tests online, Covid-19: Study Several types of tests will be used in the in person, or by invitation from the local fi ndings strongly pilot (see box, p 214), including existing authority, and testing will take place support use of polymerase chain reaction (PCR) swab at various sites, including hospitals, pooled testing, say tests, new lateral fl ow swab tests that can care homes, schools, universities, and researchers turn around results without the need to workplaces, or at home. Any positive test Training: BMA be processed in a laboratory, and LAMP results will be collected and published by expresses concern technology that will be used in Liverpool the national NHS Test and Trace system. over changes to specialty University Hospitals Trust for NHS staff . Commenting on the rollout, Alexander recruitment Liverpool has one of the highest numbers Edwards, associate professor in biomedical of cases of covid-19 in England (410.4 per technology at the University of Reading, US nutritionists call for dietary 100 000 for 18-25 October) and was the fi rst said, “As a pilot study, there are plenty of guideline limits area of England to be placed under very high potential benefi ts if we can learn about real on saturated fat alert last month, more than three weeks world performance of mass testing intake to be lifted before the government’s announcement (Continued on page 214) the bmj | 7 November 2020 211 SEVEN DAYS IN Government faces legal challenge over appointments during the pandemic The government is facing criticism over how it has fi lled key public sector roles during the pandemic. In a legal challenge, the Good Law Project and Runnymede Trust have accused the government of appointing people personally or politically connected with senior members of the Conservative Party without an open competition or proper process. This was indirect discrimination (contrary to the Equality Act 2010), they said, and a breach of the public sector equality duty. Dido Harding, appointed head of the NHS Test and Trace service and then interim head of the National Institute for Health Protection, is named in the claim. She is married to the Conservative MP John Penrose (both left ). Mike Coupe, Gareth Williams, Ben Stimson, and Paul de Laat, all appointed to senior positions at NHS Test and Trace, have also been named. Halima Begum, Runnymede Trust director, said, “When a recruitment process is not open and fair, it discriminates against those who are not connected to the decision makers. This has a serious detrimental impact on equality and on the diversity of the people at the top of organisations. This is always important, but even more so now so many lives depend on it. We are calling on the government to ensure a proper process is followed and for NHS bodies to be truly representative of the people they protect.” Elisabeth Mahase , The BMJ Cite this as: BMJ 2020;371:m4254 Covid-19 in England. They found that Obesity antenatal appointments than Healthcare workers no routine data were collected NICE recommends new currently recommended could report rise in abuse on how well requests for 14 treatment option reduce the odds of stillbirth. Over a third (35%) of 1250 day isolation were adhered to, NICE issued draft guidance Jane Brewin, chief executive of UK healthcare professionals making it impossible to know how recommending liraglutide the charity Tommy’s, said, “The surveyed by the Medical effective NHS Test and Trace is in (Saxenda) for adults with non- complex relationships identified Protection Society said that reducing covid-19 transmission. diabetic hyperglycaemia who here between stillbirth and social they had experienced verbal or They also found a lack of data have a body stresses make it clear that the physical abuse from patients, on people who needed or were mass index of government’s prevention strategy or patients’ relatives, during receiving support. at least 35 and must extend beyond the NHS to the pandemic. A further 7% a high risk of tackle these deeper underlying had received verbal or physical Ethnic minorities need cardiovascular issues within society.” abuse from a member of the better protection disease, after public outside a medical setting, In a review commissioned by the a discount was FGM and some had been sworn at Labour Party, Doreen Lawrence negotiated with the manufacturer, Kenyan girls are paraded for using the NHS queue at the (below) called for a wider package Novo Nordisk. Prefilled injection as control collapses supermarket. Pallavi Bradshaw of immediate measures to tackle pens will be prescribed in About 2800 girls from of the Medical Protection the disproportionate effects secondary care by a specialist southwestern Kenya’s Kuria Society described the findings of the pandemic on the black multidisciplinary tier 3 weight community who recently as “deplorable” and called for and minority ethnic population, management service. Treatment underwent female genital more concrete commitment to including further steps to protect should be discontinued if at least mutilation have been paraded implementing the NHS people frontline staff and improve 5% of body weight has not been through town centres, as plan, which sets out support public health communication. lost after 12 weeks, and for others reduced police vigilance during initiatives for staff. Lawrence, a life peer whose son it should not exceed two years. the covid-19 pandemic has died in a racist attack in 1993, allowed the practice to spike. Official data on England said that the government should Obstetrics Kenya is a regional leader in the found to be “patchy” confirm that employers have a Tackle social factors to cut fight against FGM, imposing Researchers developed an duty to report occupational stillbirth, say researchers prison sentences of up to three interactive dashboard, infections of, and Pregnant women who years since 2011 on people the i-sense COVID deaths from, covid-19 experience psychological stress, convicted of aiding in mutilation. Response Evaluation and should introduce domestic abuse, deprivation, “Covid-19 has taken us back,” Dashboard ( covid.i- a legal requirement or unemployment are more said Domtillah Chesang, an sense.org.uk ), to for employers likely to have a stillborn baby, anti-FGM activist. “There is provide fuller data to publish their showed a study published in misinformation in villages that on how “find, test, covid-19 risk the British Journal of Obstetrics covid-19 will never end and [that] track, isolate, and assessments on & Gynaecology . Researchers people should cut their girls and support” is working a central portal. also found that attending more marry them off.” 212 7 November 2020 | the bmj SIXTY SECONDS MEDICINE ON . Climate crisis Trusts have NEED FOR Hospitals fail to act on been urged RECOVERY single use plastics to cut back on single More than half (57%) of hospital YAWN, POINT ME TO THE REST AREA use plastics trusts in England and 88% in You’re not the only medic in search of a Wales do not have a policy on how breather. A 2019 survey of 4000 British and Irish emergency department doctors found to reduce their consumption of their median need for recovery (NFR) score single use plastics, said a report was 70—against an average of between 36 from the BMA on how the NHS and 44 reported in the literature. The trainee can reduce its carbon footprint. led evaluation of inter-shift recovery in This is despite single use plastics the emergency department (TIRED study), making up about a quarter of all ill, mentally competent adults in published in BMJ Open on 2 November, is the NHS waste in England and Wales, the final months of life to request BIRTHS fi rst time the scale has been evaluated. and a pledge in NHS England’s assistance from a medical long term plan last year to cut professional to end their life. From 1 April THERE’S NO CHANCE OF SLEEP UNTIL back on such plastics. The BMA to 1 July 2020 I KNOW MORE. WHAT’S THE NFR? called for nine recommendations, General practice caesarean section It’s an indirect measure of work intensity including for trusts and boards Appointments are up one and fatigue that uses 11 statements with yes births in the or no answers to assess the time it takes to to publish consistent and million on a year ago North West of recover from the physical and psychological detailed reporting on their carbon Figures from NHS Digital showed eff ects of work, providing a score from 0 footprint and to have targets to 26.7 million appointments in England carried to 100.