this week COVID INFLUENCERS page 87 • FRAILTY AND VACCINATION page 88 • VENTILATION page 90 VICTORIA JONES/PA VICTORIA Hancock bars extra legal cover for doctors England’s health secretary has rejected a the same time feel vulnerable to the risk of With the threat of ICUs being call to bring in emergency legislation to prosecution for unlawful killing.” overwhelmed, doctors fear protect doctors from “inappropriate” legal NHS d octors are covered by state being subjected to criminal action amid fears that the NHS will be indemnity for clinical negligence and by an investigations if a care decision based on resources overwhelmed by the covid-19 pandemic. additional scheme that covers pandemic leads to a patient’s death Doctors are worried that not only will they responses. The GMC has also said the covid be forced to choose which patients to treat context will be taken into account when it but they could be vulnerable to a criminal considers complaints. But the groups’ letter investigation should a patient die in such said they did not address their concerns. circumstances. Their fears follow a warning Asked by The BMJ about the letter, on 6 January that hospitals were less than Hancock said intensive care capacity was a two weeks from being overwhelmed. “very serious concern.” But he added, “I am The doctors’ plea for emergency very glad to say we are not in a position that legislation came in a letter to Matt Hancock, doctors have to make these sorts of choices signed by seven organisations, including the and very much hope that we don’t get into LATEST ONLINE Medical Protection Society, BMA, Doctors’ that situation. It is not necessary at this Association UK, Hospital Consultants and point to change the law on this matter.” Spain to become Specialists Association, and the British A day later, on 19 January, the Royal the sixth country Association of Physicians of Indian Origin. London Hospital reported that all its ICU to allow euthanasia The letter said that guidance available to beds—recently expanded from 44 to 150— and assisted suicide doctors on administering and withdrawing were occupied. treatment does not provide legal protection Jane Dacre, president of the Medical What covid variants and does not consider covid-19 specifi c Protection Society, was disappointed with are emerging, and how are they being factors such as surges in demand for Hancock’s response. “Healthcare staff investigated? resources temporarily exceeding supply. It need this legal protection now. It would added that health professionals should not enable doctors to focus on doing the best Government using lateral fl ow tests “suff er from the moral injury and long-term for their patients without fear of unfair to keep children psychological damage that could result investigations,” she said. in schools against from having to make decisions on how Clare Dyer , The BMJ regulator’s advice limited resources are allocated, while at Cite this as: BMJ 2021;372:n164 the bmj | 23 January 2021 85 SEVEN DAYS IN Doctors’ leaders call for revised PPE guidance Medical leaders have urged Public Health England to strengthen its guidance on personal protective equipment to reflect the more transmissible forms of SARS-CoV-2. Current guidance says that higher grade FFP3 masks should be provided to staff who are involved in aerosol generating procedures, but other staff looking aft er patients with covid-19 are only required to wear fluid resistant surgical masks. In a letter to PHE sent on 13 January, BMA council chair Chaand Nagpaul said that, in light of the new variant of SARS-CoV-2, increased spread of the virus, and growing evidence of aerosol transmission, it should review its recommendations on PPE usage “so that a more precautionary approach is adopted to the provision of respiratory protective equipment (RPE) to ensure staff are protected from aerosol transmission.” He wrote: “There are signifi cant and growing concerns about the role of aerosol transmission of covid-19 in healthcare settings, and the need for wider use of RPE (for example, FFP3 respirators) outside of those procedures designated as aerosol generating. We are therefore calling on [PHE] to support the wider use of RPE in other high risk settings across primary and secondary care.” NEIL HALL/PA Gareth Iacobucci , The BMJ Cite this as: BMJ 2021;372:n146 Covid-19 trials are necessary to know ( https://covidskinsigns.com ) David Williams (below) of the Many ICU staff whether convalescent plasma is after finding an association Harvard School of Public Health; in England report PTSD beneficial. One such trial from between skin rashes and a Michael Marmot of the UCL Nearly half of 700 intensive care India, published in The BMJ positive swab Institute of Health Equity; Donna and anaesthetic staff surveyed in November, found that test result (odds Kinnair, chief executive of the in six English hospitals last June it did not reduce disease ratio 1.67 (95% Royal College of Nursing; Kevin and July reported symptoms progression or mortality confidence interval Fenton, London regional director consistent with a probable from all causes. 1.41 to 1.96)), from for Public Health England; and diagnosis of post-traumatic data on 336 847 UK Chaand Nagpaul, chair of council stress disorder (PTSD), severe Japan’s suicide rate users of the Covid at the BMA. depression, anxiety, or problem falls then rises Symptom Study drinking. The preprint, from Monthly suicide rates in app. Reporting in Patient safety researchers at King’s College Japan declined by 14% the British Journal Government will appoint London, also reported that 13.4% in the first five months of the of Dermatology , they also found commissioner in England of respondents had had thoughts pandemic (February to June 2020) that among 11 546 survey The government plans to appoint that they would be better off but increased by 16% in the respondents 17% of SARS-CoV-2 a patient safety commissioner to dead or of hurting themselves. second wave (July to October), positive cases reported skin oversee healthcare in England, The BMA’s mental health lead, showed a study published in rashes as the first presentation in response to the Cumberlege Andrew Molodynski, said that a Nature Human Behaviour that and 21% as the only covid-19 review into treatments that supportive workplace culture and covered Japan’s entire population clinical sign. caused avoidable harm. But high quality wellbeing support of 120 million. It found that it rejected calls to set up an were vital. suicide rates rose the most Inequalities independent redress agency among women (up 37%) and NHS Race and Health for the people harmed or to Trials needed into children and adolescents (up Observatory board named appoint a taskforce to implement convalescent plasma 49%). The authors argue that The NHS Race and Health the recommendations of the An observational study in the the results are consistent with Observatory, set up in May review, which examined pelvic New England Journal of Medicine other studies showing the crisis 2020 to investigate mesh, Primodos, and sodium found that convalescent plasma disproportionately affected the effects of race and valproate. The government seemed to be of most benefit female dominant industries ethnicity on people’s was still considering whether to patients who received and that stay-at-home orders health, appointed doctors’ financial and non- transfusions containing high magnified mothers’ burdens. some of the world’s pecuniary interests should levels of antibodies early in the leading experts be declared, but course of covid infection. Death Skin rash is present in on health Nadine Dorries, within 30 days of transfusion 17% of positive covid cases inequalities health minister, occurred in 22.3% of the high titre Researchers from King’s College to its board of indicated that group, as compared with 29.6% London compiled a catalogue non-executive this would be in the low titre group. Experts of images of the most common directors. implemented in say that results of randomised skin manifestations of covid-19 They include the future. 86 23 January 2021 | the bmj SIXTY SECONDS MEDICINE ON . COVID Research news INFLUENCERS Fried food links to major heart and stroke risk PARDON? An analysis from studies involving Get with the programme, Grandad. more than 1.3 million people Influencers are very . influential these found that the highest category of days. And they don’t just encourage people on social media to buy things they weekly fried food consumption, don’t need. when compared with the lowest, was associated with a 28% raised Consumption of fried food was REALLY? WHAT ELSE DO THEY DO? Help spearhead public health campaigns, it risk of major cardiovascular linked to raised risk to the heart events, a 22% raised risk of seems. The fact checking organisation Full coronary heart disease, and a Fact did some digging and found that the 37% raised risk of heart failure. ago by Simon Wessely, former government paid £63 000 to 42 social media With each extra 114 g weekly president of the Royal College of VACCINES influencers to promote the national NHS test and trace service last year. This equates to serving these risks substantially Psychiatrists. The Department of A survey of 11 700 increased by 3%, 2%, and 12%, Health and Social Care has said roughly £1500 per influencer on average. British adults respectively, researchers reported changes needing legislation will TOUGH GIG in the journal Heart . be in a draft Mental Health Bill for found that vaccine Indeed. Not only were they trying to promote consultation next year. hesitancy was a troublesome brand (sorry, Dido) but Parliament highest among influencing people isn’t as easy it sounds. Lords act to combat forced UK “will miss targets” black people, with Only a select few people with very large harvesting of organs without urgent action social media followings—such as Love Island The House of Lords passed an The government will miss key 72% saying contestants Shaughna Phillips (below) and Josh Denzel, and professional hockey player amendment to the Medicines and targets to improve healthy they were unlikely Medical Devices Bill that aims ageing unless it acts urgently, an Henry Weir—were deemed fi t for this task.