this week ROTATIONS page 254 • HOSPITAL ACQUIRED COVID-19 page 256 • AFTER ICU page 259 MPs demand evidence for testing policy A cross party group of MPs has said that inadequate for most of the pandemic so far, A letter to Boris Johnson from Public Health England’s failure to publish arguing that “capacity drove strategy rather the Science and Technology the evidence behind its decision to than strategy driving capacity.” Committee calls the lack discontinue community testing at the start The letter detailed 10 key lessons the of transparency over the decision to stop community of the covid-19 outbreak is “unacceptable.” government should learn from the fi rst testing “unacceptable” In a 19 page letter to the prime minister, months of the epidemic, on the basis the Science and Technology Committee of evidence given to the committee by called for publication of the evidence base scientists and other experts. informing PHE’s decision to concentrate The MPs urged the government to testing for covid-19 in a limited number of regularly update the public list of members its own laboratories and to expand testing of the Scientifi c Advisory Group for gradually, rather than surging capacity Emergencies (SAGE) and to publish the through a large number of laboratories in papers on which the group draws its advice, research institutes and universities. as well as the scientifi c advice that has This led to the government announcing informed government decisions. They also on 12 March that testing would stop in the called on the government to “urgently” LATEST ONLINE community and would occur principally build up capacity for contact tracing and set US food and drink in hospitals—a decision that was “one out a clear approach for managing the risks industry sought to of the most consequential made during around asymptomatic transmission. infl uence scientists, [the] crisis,” the MPs said. “It meant that The committee chair, Greg Clark, said, emails show residents in care homes—even those with “Greater transparency around scientifi c Alarm bells ring symptoms—and care home workers could advice; putting capacity in place in advance for patient data not be tested at a time when the virus was at of need, such as in testing and vaccines; and privacy in the its most rampant.” collecting more data earlier; and learning covid-19 goldrush The letter continued, “The failure of PHE from other countries’ approaches are some Rest and PPE to publish the evidence on which its testing of the early lessons that are relevant to reassurance are policy was based is unacceptable for a further decisions that will need to be taken needed before decision that may have had such signifi cant during the weeks and months ahead.” NHS services can consequences.” Jacqui Wise, London restart, MPs hear It said that testing capacity had been Cite this as: BMJ 2020;369:m2022 the bmj | 23 May 2020 253 SEVEN DAYS IN R otation of foundation an d medical training posts to restart in August Health Education England has announced that all trainees in foundation and core medical training posts will rotate as usual at the start of August. Planned rotations have been cancelled for May, June, and July as a result of covid-19. In England, 19 medical specialties involving more than 40 000 trainees will rotate in August. But HEE said that, because of covid-19, other programmes would have later start dates, though trainees and employers would have at least eight weeks’ notice. It added it was working with the devolved nations, GMC, and royal colleges to enable trainees to progress by increasing the flexibility of training programmes. Guidance is being developed to inform progression decisions being made by annual review of competency progression (ARCP) panels, HEE said. Sheona Macleod, HEE’s acting medical director, said it wanted to minimise any disadvantages for trainees. “Our priorities are to protect the education and training of our future workforce, to enable junior doctors and others to ensure the continued delivery of services, and to maintain the quality and safety of patient care during a summer period that is likely to be busier than usual.” Abi Rimmer , The BMJ Cite this as: BMJ 2020;369:m1998 Convalescent plasma we are now confident enough to A&E criteria for ending lockdowns No evidence that treatment recommend this new measure. Drop in numbers is a such as falling rates of infection. is safe or effective The individual’s household “ticking time bomb” As the US passes 85 000 reported A Cochrane review found much should also self-isolate for 14 Attendances at emergency deaths, Fauci warned that uncertainty as to whether days as per the current guidelines departments in England totalled “needless suffering and death” convalescent plasma was and the individual should stay at 917 000 in April, down 56.6% would ensue if lockdowns were effective in people admitted to home for seven days, or longer on the same month last year and lifted prematurely. hospital with covid-19, because if they still have symptoms other the lowest since data collection all eight studies, with a total of 32 than cough or loss of sense of began in 2010, NHS figures Schools patients, had a high risk of bias smell or taste.” showed. Nick Scriven, immediate and the reporting quality was low. past president of the Society Lise Estcourt, head of NHS Blood Testing for Acute Medicine, described and Transplant’s clinical trials RCGP calls for joined-up the drop in attendances as a unit, said a trial of convalescent testing strategy “time bomb” that would be plasma for adults Martin Marshall, chair of the exacerbated by other pressures admitted to Royal College of General as hospitals tried to resume intensive care in Practitioners, wrote to normal services. Keeping people England (REMAP- England’s health and with covid-19 separate from other BMA: keep schools closed CAP) was ongoing social care secreatary, patients would be a challenge, he to avoid second spike and that researchers hoped to Matt Hancock, to demand a said, as would the resilience of The BMA warned that the open a trial in all inpatients, in joined-up strategy throughout staff who had been “working flat number of coronavirus infections collaboration with the RECOVERY the NHS and social care to ensure out with little time for recovery.” remained too high to allow trial, for people of all ages. “the right people are tested at children back to school safely the right time.” He called for Overseas news and backed teaching unions in Symptom update pathology labs to update GP Trump fumes at adviser urging caution and prioritising Anosmia is added to records with results to help trace over lockdowns testing before reopening schools symptoms for self-isolating positive covid-19 cases, for test Tension between the White on 1 June. In a letter to Kevin The UK’s four chief medical kits to be readily available for House and US public health Courtney, chair of the National officers advised adding anosmia patients with symptoms, officials escalated this week Education Union, Chaand to continuous cough and fever and for clear guidance on after President Donald Nagpaul, BMA chair of council, as a symptom for which people how GPs can help patients Trump openly criticised highlighted the “relatively small should self-isolate because of access tests. He warned his top infectious disease amount of research available” probable covid-19 infection. In that clarity had not been specialist, Anthony Fauci on “the uncharted territory we a statement issued on 18 May sufficient to prevent (left), for testifying in find ourselves in.” Nagpaul they said, “We have been closely a second wave of Congress against the concluded, “Until we have got monitoring the emerging data infections or secure reopening of states case numbers much lower, we and evidence on covid-19 and the overall health of that had not met the should not consider reopening after thorough consideration the population. administration’s schools.” 254 23 May 2020 | the bmj SIXTY SECONDS MEDICINE ON . Global health FOLLOWING P andemic derails UN’s THE SCIENCE development progress WHO fears that the world’s focus on Progress towards the UN’s SOUNDS LIKE A SENSIBLE APPROACH covid-19 will undo the sustainable development goals Evidence based policy does seem rather progress made against is too slow and is being further important during a pandemic. But malaria in recent years “thrown off track” by covid-19, government ministers’ recent parroting of WHO warned. Its World Health the phrase “we’re following the science” has Statistics report showed that raised some concerns. immunisation coverage has SURELY THIS IS AN IMPROVEMENT ON barely increased in recent “WE’VE HAD ENOUGH OF EXPERTS”? years, and malaria gains may be True. But there’s growing concern that the reversed. In 2017 only a third to 16.5% of respondents said they mantra is being used by ministers to deflect a half of the world’s population had been unable to get the PPE NHS 111 scrutiny of their handling of the covid-19 had access to essential health recommended by Public Health Between 18 March pandemic, rather than as a meaningful services. Over half (55%) lacked England in the past two weeks. and 18 May explanation of policy making. access to safely managed sanitation services, and over Research POLITICS’ VERSION OF “NOT ME, GUV”? That’s the nub. At a Science Media Centre a quarter (29%) lacked safely Human genome study to 2 531 228 briefi ng on 18 May the broadcaster and managed drinking water. sequence 20 000 people assessments conducted physicist Brian Cox (below) said that, while A study of the genetic basis for science should inform policy, it’s not its job Digital NHS the varied outcomes of covid-19 through NHS 111 to decide it.