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COVID-19 Evidence alert - 17th June 2020
 
Welcome
COVID-19 Evidence alert is a weekly update highlighting emerging evidence on the following key topics identified as useful in supporting Covid recovery planning:
  1. Residential settings
  2. Impacts of lifting restrictions
  3. Long term rehabilitation needs
  4. Screening and testing
  5. Broader impacts on health outcomes
  6. Impact on non-Covid care
This update follows on from a series of rapid evidence scans on these key topics, with corresponding evidence trackers providing details of relevant papers. 

The evidence scans and corresponding evidence trackers can be found here: https://www.strategyunitwm.nhs.uk/covid19-and-coronavirus (see ‘Evidence - Helping you to keep up to date’).

Here you will also find details of the evidence that has been used to inform this weekly update

We are also working on other key areas of interest such as impacts on inequalities and marginalised groups, which will be added to the alert once completed.

Residential facilities

Earlier searches identified a wave of papers on the impact of the pandemic in care homes.  There have been fewer papers on the impact in other residential facilities.  Two papers identified this week focus on the management of the outbreak in homeless shelters – the papers are from Canada and the US but some of the learning may be transferable to an NHS context. The European Centre for Disease Control and Prevention has also issued guidance for detention centres.

Impacts of lifting restrictions

Analysis from the European Centre for Disease Prevention and Control compares the risks of Covid-19 across Europe.  Papers evaluating the impact of non-pharmaceutical interventions are emerging, sharing findings on the impact of lockdown and other interventions. A commentary on the “false dichotomy” of public health and economic considerations is also included.     

Long term rehabilitation needs

As the pandemic progresses, more knowledge emerges about the medium to long term impacts for COVID-19 survivors.  Whilst caution should be exercised, as sample sizes are small and papers often not peer reviewed, such findings can give an insight into potential implications for health services.  A paper from Italy shares the experience of setting up a rehabilitation facility and a related paper suggests that the resourcing of Covid rehabilitation may need multidisciplinary involvement and may be resource-intensive.   Principles for reconfiguring services are discussed in a paper exploring the components of an approach to manage Covid rehabilitation alongside restarting other services.

Screening and testing

New guidance has been published from the Royal College of Pathologists, UNICEF and the European Centre for Disease Prevention and Control.  A rapid review, from Canada, explores the use of voluntary smartphone apps for contact tracing.  As health services restart, there is emerging evidence on the approaches to testing and screening of patients and workforce alongside commentaries debating current approaches.  A reference to a useful resource, simulating different testing scenarios is also included.

Broader impacts on health outcomes

There is continued concern of the impact of the pandemic and restrictions on mental health, both in the general public and for those with pre-existing conditions.  A new rapid review explores the impact on older people who are shielding for extended periods.  Findings on the impact on existing service users suggests a growing concern for increased inequalities.  Commentaries on the risks to mental health and of domestic violence are included.  We have also identified a paper, from New Zealand, which explores the impact on incidence of accidents in children during lockdown.

Impact on non-Covid care

As lockdown restrictions ease, there are an increasing number of papers and commentaries exploring the impact on different services.  We share commentaries from the Health Foundation, Nuffield Trust and King’s Fund, which explore perspectives of the general public and the workforce, respectively.  New guidance on restarting endoscopy services is referenced.  The Royal College of Physicians has published emerging findings from a survey of the workforce.  Emerging evidence on the impact on outpatient services, elective care and emergency care are included. Commentaries on primary care, long term conditions management, outpatient care, elective care, public health, mental health services and end of life care also feature. 

This update forms part of a national evidence update service, provided by the Strategy Unit, as part of a collaboration to provide analytical support to the health and care system to help in the fight against COVID-19. For more information, visit: https://www.strategyunitwm.nhs.uk/covid19-and-coronavirus or 
contact our Covid Evidence team on: mlcsu.covidevidence@nhs.net.
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