COVID-19 ain’t what it used to be

As the COVID-19 pandemic has swept through various epidemic waves each characterised by a different variant, the trend has been towards more transmissibility but less virulence of SARS-CoV-2. The emergence of the Omicron variant continued this trend, and we are now seeing some data to compare the clinical outcomes of COVID-19 with other variants. A huge Lancet study (1.5m patients!) demonstrates clearly that the risk of hospital attendance, hospitalisation, and death is significantly lower with Omicron compared with Delta. This is important because the consequences of SARS-CoV-2 acquisition are an important factor in deciding on our management strategy – as a hospital group and in general.  

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Everybody’s talking about the Lancet Commission on COVID-19

The Lancet has published a hard-hitting piece on lessons learned from the COVID-19 pandemic. The report includes a blow-by-blow account of the pandemic and the lessons that have emerged, and some important recommendations from a global public health viewpoint. Unsurprisingly, this piece has generated a lot of interest and people are talking about it, which is no bad thing!

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Beware reusable PPE!

A new JHI study highlights the dangers associated with reusable PPE, and related to PPE doffing in general. The study used a clinical simulation suite to monitor the spread of fluorescent material added to the outside of an N95 respirator during routine care for mannequin adult patients (with COVID-19!). Whilst some modes of PPE reuse were better than others, all of the clinicians involved in the study ended up contaminating the clinical environment with fluorescent material originating from the mask.

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COVID-19 – what have we learned?

I did a talk at an IPC conference the other day trying to summarise what we’ve learned from the COVID-19 pandemic. You can see my slides here. I think (hope) we have learned a lot – and still have more to learn – about (in no particular order): PPE, transmission routes, testing and laboratory factors, vaccination, organizational transformation, guidelines and policy development, regulatory framework, outbreaks, non-COVID pathogens, antimicrobial stewardship, digital transformation, applied research, and the mental health of our workforce.

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Lateral flow or PCR?

As England moves away from confirmatory PCR testing following a positive lateral flow test in the absence of COVID-19 symptoms, it’s a good time to look at what these two different testing strategies can offer us. There’s an excellent short review in NEJM combined with a case study to help illustrate the impact of pre-test probability plays out. Both lateral flow testing and PCR testing have their place, and in some ways lateral flow testing is a better correlate for infectivity (as well as being cheaper and easier!).

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Omicron: things are moving quickly and looking better…but we’re not there yet

My last post on Omicron was on 22/12/2021, 15 days ago, which seems like a lifetime ago! Back then, there was a great deal of uncertainty about how Omicron would manifest clinically, and how this would translate into hospitalisations and deaths. We now known more, but there is still considerable uncertainty. The latest technical briefing from UKHSA provides additional epidemiological updates. And the latest ONS study on prevalence in the UK gives us some eye-watering figures: in the week ending 31/12/2021, 1 in 25 people in England were infected with COVID-19, and 1 in 15 people in London. There’s a lot of it about. Overall, the outlook is looking better, but it’s going to be a very bumpy ride for those working in healthcare over the next month or so.

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What is the evidence for droplet transmission for SARS-CoV-2?

A guest post from Dr Evonne Curran

The disputed airborne mode of transmission in this pandemic requires further scrutiny. Researchers have thus far focused on presenting a case for airborne transmission1 rather than disputing that the ‘primary’ mode of transmission for SARS-CoV-2 is via droplets2.

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Omicron: buckle up for a bumpy ride

I’ve been meaning to write an update on the Omicron variant of concern for a few weeks’ now and it’s now or never, so here we go! The Omicron variant has a host of mutations compared with previous variants, which seems to have given it the ability to spread much more rapidly. This may well be due in part to the ability to side-step antibody mediated immunity obtained through previous infection and vaccination. Omicron is spreading rapidly in the community. We don’t yet know what impact the current rapid community spread will have on hospitalisations and ultimately deaths, so time will tell.  

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Monoclonal antibodies to prevent household transmission of SARS-CoV-2

A remarkable new NEJM study has shown that the prophylactic administration of monoclonal antibodies reduces the risk of household contacts developing symptomatic or asymptomatic infection with SARS-CoV-2. For those who did develop symptomatic infection, monoclonal antibodies reduced to duration of disease and the duration of high viral load. This study opens up the possibility of a new tool to prevent the spread of SARS-CoV-2 to vulnerable patients in our hospitals. Is the future of managing hospital contacts of SARS-CoV-2 the prophylactic administration of monoclonal antibodies?

Visual abstract from the study
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To FFP or not to FFP: variation in national guidelines on respiratory protection during the COVID-19 pandemic

Probably the most contentious aspect of the COVID-19 pandemic has been PPE for staff. And within that, the most contentious aspect of PPE has been respiratory protection when caring for patients with confirmed or suspected COVID-19: to FFP or not to FFP? I have been involved in a review of international guidelines to identify variation and track the changes in the guidelines over time. Things have changed as evidence has emerged, but international guidelines still disagree on where and when FFP respirators should be worn when caring for patients with suspected or confirmed COVID-19. The review also tracked variation and changes in recommendations about what should be considered an AGP.

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