this week CIRCUIT BREAK page 381 • EXPERTS DIVIDED page 382 • BMA CONFERENCE page 385 TOLGA AKMEN/GETTYIMAGES TOLGA New measures to curb UK infection rate The prime minister has set out new national of COBRA, the government’s emergency All staff in restaurants, bars, measures designed to halt the current rise committee, Johnson said the new measures and pubs will now have to in covid-19 cases. were likely to be in place for six months. wear masks, as will customers Boris Johnson told MPs that, in England, “We always knew that, while we might whenever they are not eating or drinking at a table hospitality venues, including pubs, bars, have driven the virus into retreat, the and restaurants, will have to shut by 10 pm prospect of a second wave was real. I’m from 24 September and will be legally sorry to say that, as in Spain and France permitted to provide table service only. and many other countries, we’ve reached a He added that masks will be compulsory perilous turning point,” he said. for staff in shops, drivers and people using Scotland and Northern Ireland—whose taxis, and staff and customers in indoor leaders attended the COBRA meeting—have hospitality venues, except when seated at both announced that households will be a table to eat or drink. Fines for breaking banned from mixing. Wales is expected these rules will increase. People are also to announce further restrictions, after advised to work from home if possible. imposing a series of local lockdowns. Guidelines for the retail, leisure, tourism, Johnson said the threat of covid had LATEST ONLINE and other sectors will become legal not disappeared since the fi rst national GP is restored to obligations, and the maximum number of lockdown. “If we fail to act together medical register at people at weddings will be reduced from 30 now, we not only put others at risk but second attempt to 15 from 28 September. jeopardise our own futures with the more “Mass The fresh restrictions came after the drastic action that we will inevitably be hysterectomies” four UK chief medical offi cers announced forced to take.” are carried out on on 21 September that the UK’s alert level Saff ron Cordery, deputy chief executive migrants in US was being raised from level 3 to 4, as the of NHS Providers, which represents NHS detention centre incidence of the infection was “high or trusts, said, “No one doubts the impact of Patient groups rising exponentially.” That day 4368 daily these restrictions on people’s lives. But the failed to cases were reported in the UK, and cases consequences of failing to act and failing to disclose are doubling every seven to eight days. protect the NHS would be even worse.” £14m from Announcing the changes in the House of Gareth Iacobucci, The BMJ drug companies Commons on 22 September after a meeting Cite this as: BMJ 2020;370:m3712 the bmj | 26 September 2020 379 SEVEN DAYS IN New indicators will track doctors’ careers to expose racism NHS England has launched a set of indicators to expose ethnic disparities in the medical workforce, with data set to be presented to trusts later this year. The Medical Workforce Race Equality Standard (MWRES) will capture “several issues” particular to doctors that are not picked up by the general NHS staff WRES introduced in 2015. Around two fi ft hs (41%) of NHS doctors are from ethnic minority groups, and evidence shows they are less likely to be treated favourably than their white colleagues and have poorer experience and progression opportunities. The new indicators include the percentage of ethnic minority people in each medical and dental subgroup in NHS trusts and clinical commissioning groups; consultant recruitment; and complaints received. Diff erential attainment in medical schools and diff erential pass rates in postgraduate examinations will also be looked at, as well as experiences of harassment, bullying, or abuse from patients, relatives, or other staff . Mala Rao, chair of the working group that created the indicators, said, “The MWRES is a world fi rst in creating an evidence base to expose racism in the medical workforce at a national level. It will enable the NHS to translate that evidence into meaningful action.” MARK THOMAS/SPL Elisabeth Mahase , The BMJ Cite this as: BMJ 2020;370:m3659 Covid-19 people who are infected, public winter peak of the pandemic, Lithium product “must Moonshot pr oject faces health measures such as face said MPs and peers on the Joint stay on market” legal challenge coverings, physical distancing, Committee on Human Rights. Pharmacists, GPs, psychiatrists, The government’s Moonshot and quarantine for those who They also urged the government and patients urged the project, which could spend as may have contact with an infected to ensure that care homes were government to ensure that much as £100bn to increase person continue to be very not implementing blanket bans Priadel, a brand of lithium costing covid-19 testing capacity to important.” on visiting, saying that any £4.02 for a pack of 400 mg 10 million people a day, is facing restrictions “must take into tablets, remains available to a legal challenge. The move is Point-of-care test reports account the risks to the person’s patients. Essential Pharma, which the latest in a series of High Court 94% sensitivity emotional wellbeing and mental owns the rights to Priadel, has challenges from the Good Law The CovidNudge test—which health of not having visits.” announced it will withdraw the Project, a not-for-profit group, the government plans to roll brand next April and has raised over the government’s handling out nationwide—can provide Prescribing the price of the other main brand of the pandemic. The group results in 90 minutes, with 94% “Allow minor substitutions” of the drug, Camcolit, to £48.18 sent a letter before action to the sensitivity and 100% specificity in drug shortages per pack of 400 mg tablets. government’s lawyers, claiming when compared with standard Leaders from the BMA, the Royal In direct drug costs alone it is that the project was unlawful polymerase chain reaction College of General Practitioners, estimated that the change will because it ignored scientific testing, found a study by the pharmacy organisations, and cost the NHS around £15m a year. evidence and committed a vast manufacturers published in the patients’ group National sum of public money with no Lancet Microbe . But the study’s Voices wrote to England’s health Public health transparency about how the lead author, Graham Cooke, and social care secretary, Matt Paying GP clinics to provide decisions were made. emphasised the test was not Hancock, calling for pharmacists LARCs cuts abortions likely to be used at crowded to be allowed to make minor A 2009 Universal screening is events because the machine can substitutions for a GP’s scheme likely to miss cases process only one test at a time, prescription in a drug shortage, paying GPs to One time screening for SARS- with a daily maximum of 15 tests particularly after Brexit. Currently, offer patients CoV-2 in apparently healthy per machine. pharmacists are legally obliged to information people is likely to miss those refer back to the prescriber before on long who are infected, concluded a MPs and peers say lessons making even a minor adjustment, acting reversible contraceptives rapid review of 22 studies by the from deaths must be learnt which “can cause delays resulted in an extra 4.53 Cochrane Library. Lead author The government should in access to medicines prescriptions per 1000 women Meera Viswanathan, from RTI immediately organise a quick and takes up health above what would be expected International in North Carolina, interim review into deaths from professionals’ time, without the scheme by 2013-14, said, “We are unsure whether covid-19—making deaths in care which could be used a study in PLOS Medicine found. combined screenings, repeated homes a priority—to ensure elsewhere to Abortions fell by 38% beyond symptom assessment, or rapid that lessons are support patient what was expected in the same laboratory tests are useful. learnt before a care,” they period—equivalent to 95 170 Because screening can miss new autumn or wrote. fewer abortions in the UK. 380 26 September 2020 | the bmj SIXTY SECONDS MEDICINE ON . CIRCUIT BREAK Surgery Exercise can help Perioperative care can cut reduce complications complications by 80% after surgery by up to IS THIS A PHYSICS LESSON? An evidence review by the 80%, said the study of No, it’s just the government’s latest Centre for Perioperative Care—a perioperative care covid-19 buzz phrase. It refers to a proposal, partnership between the Royal apparently under consideration by ministers, to tighten restrictions for a short period to try College of Anaesthetists, other to halt the current surge in England. medical and nursing royal colleges, and NHS England— HOW WOULD IT WORK? found that good perioperative The BBC reports that the government’s care could reduce the length Scientifi c Advisory Group for Emergencies of stays in hospital by an has suggested rewiring the current set-up so average of two days across A&E that parts of the hospitality industry could be different types of surgery. It Pilot scheme tests NHS 111 COVID-19 closed or asked to close early for a couple of weeks, while schools and workplaces would also reduced the need for for booking urgent care Between 18 March intensive care and improved Twenty five trusts will receive remain open. and 21 September communication between a share of £150m to expand ARE WE HEADING FOR ANOTHER patients and clinicians.