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COVID-19 Evidence alert - 12th 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. 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 update is intended to provide a brief update on the evidence base since the scan e.g. new areas of focus; changes in recommendations; consistency with earlier evidence. 

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.

Analytical Collaboration for COVID-19 

The Strategy Unit is one of five organisations (the Health Foundation; King’s Fund; Nuffield Trust; and two specialist NHS analytical teams, Imperial College Health Partners and the Strategy Unit) collaborating to provide analytical support to the health and care system to help in the fight against COVID-19.  Through the collaboration, the organisations are supporting ad hoc immediate questions raised by national bodies but are also using their expertise to focus on questions that the NHS may lack the immediate resources to look at, which may be more medium-term, cut across sectors, or benefit from independent analysis.  The collaboration has just published the following briefings:  

Residential facilities

Our searches in the last week have identified several commentaries on the implications for residential facilities, in particular, about monitoring and strategies for testing and delivery of non-Covid care.  The emphasis still seems to be on care homes; however, there is a new paper, from the US, sharing the experience of a coordinated approach to manage infection risk in residential facilities for people with learning disabilities.   

Impacts of lifting restrictions

Since our initial rapid scan on 14th May and last week’s alert, there has been updated guidance on the use of masks.  There is further emerging evidence on the efficacy of lockdown measures and effects of non-pharmaceutical interventions with projections of impact, including the recently published Lancet modelling study projected burden of clinical cases and deaths due to COVID-19 in the UK by December 2021, consistently recommending ‘intensive interventions’ and ‘extreme measures’ for the remainder of the year.  Further studies and WHO recommendations strongly emphasising the vital role of contact tracing / case finding in containment.     

Long term rehabilitation needs

As the pandemic progresses and more knowledge emerges about the medium to long term impacts for COVID-19 survivors, there are more findings emerging from small cohort studies.  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.  NHS England has issued guidance on aftercare needs of COVID patients, addressing physical, cognitive and psychological needs.  This is consistent with findings from a systematic review, exploring longer term impairments in MERS and SARS patients, suggesting that if COVID-19 patients follow a similar course, impairments could include pulmonary dysfunction, reduced exercise tolerance, and psychological problems.  A small study from UCL London suggests that delirium in older COVID patients may be associated with functional impairment in the medium term.    

Screening and testing

Searches in the last week have identified new guidance from UNICEF on the implications of digital contact tracing.  There is a new rapid review comparing policies on testing and tracing, including lessons from Taiwan.  There is increased interest in the scaling up of testing, including a paper from the Francis Crick Institute on a possible model.  Papers are emerging on policies and practice for testing patients prior to procedures and healthcare workers to prevent infection spread in hospitals and other healthcare sites.  The Health Foundation shares findings from a survey on public attitudes towards tracing apps which highlights notable challenges for implementation.  Issues regarding the implementation and ethics of policies are also addressed in several commentaries. 

Health outcomes

Since our initial rapid scan on 29th May, more evidence has emerged on the wider adverse impacts of COVID-19 in the general population, older adults, children and young people, healthcare workers and those with pre-existing conditions and chronic illness. However, fewer studies were identified with relevance to the broader impacts of COVID-19 upon long-term conditions.  

The evidence base is largely concentrated towards the broader impacts of COVID-19 upon mental health and wellbeing outcomes. It is also consistent with the findings of previous evidence, indicating higher levels of depressive, post-traumatic, anxiety and insomnia symptoms as an indirect result of COVID-19. Social isolation and loneliness appear to be prominent risk factors for adverse mental health outcomes in context to COVID-19, particularly for children and young people, and older adults. Some studies also highlight that adverse impacts upon mental health outcomes may arise in relation to the wider economic and financial consequences of COVID-19. A limited number of qualitative studies have emerged on the experiences of older adults and the impact of restriction measures upon physical activity; as well as the experience of those caring for individuals with COVID-19.  

Increasingly, guidance, emerging evidence and commentaries consider what provision might be necessary to mitigate the short and long-term mental health impacts of COVID-19 on multiple population groups. Particularly for high risk groups such as front-line healthcare workers. While sources highlight a need for early intervention, this is caveated with consideration for limiting the harms and unintended consequences which may arise from inappropriate provision.   

Impact on non-Covid care

The evidence base continues to emerge since our initial rapid scan on 29 May. Evidence spans the extent of the impact of covid on non-covid services e.g. number of operations cancelled, the challenges to the management of non-covid patients / services during this time, and solutions for delivering non-covid care during the pandemic. Key updates include: 
  • New themes emerging in primary care include the use of social prescribing to help reduce additional GP workload and support vulnerable patients during this time. Extended members of the primary care team such as social prescribers and pharmacists may need to consider virtual models of care. 

  • International research shows that telemedicine and triaging are the mitigation strategies most often used to overcome disruptions to care for people with long-term conditions. Rehabilitation has been shown to be the most commonly disrupted service which will potentially lead to consequences in the future. 

  • The emerging evidence continues to report on telehealth solutions for outpatient care to minimise reduction to services. Examples span urology, orthopaedics, dermatology, neurology, ophthalmology, and palliative care and hospice services. 

  • Various surveys have been conducted to explore the impact on orthopaedic surgery; substantial disruptions to orthopaedic have been reported in numerous countries. Decreases in renal transplantation in the UK has also been reported as a concern with more active patients now on the kidney-alone waiting list. This will result in additional patients on dialysis who would otherwise have been transplanted.  

  • A UK study reports delays in cancer surgery are likely to cause a significant number of attributable deaths per year in England. 

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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