COVID-19 resources

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Coronavirus disease 2019: achieving good mental health during social isolation

British Journal of Psychiatry

The coronavirus disease 2019 pandemic has led to unprecedented disruption to the normal way of life for people around the globe. Social distancing, self-isolation or shielding have been strongly advised or mandated in most countries. We suggest evidence-based ways that people can maintain or even strengthen their mental health during this crisis.

Last updated on hub: 19 August 2020

Mental health and COVID-19: is the virus racist?

British Journal of Psychiatry

COVID-19 has changed our lives and it appears to be especially harmful for some groups more than others. Black and Asian ethnic minorities are at particular risk and have reported greater mortality and intensive care needs. Mental illnesses are more common among Black and ethnic minorities, as are crisis care pathways including compulsory admission. This editorial sets out what might underlie these two phenomena, explaining how societal structures and disadvantage generate and can escalate inequalities in crises.

Last updated on hub: 19 August 2020

COVID-19 outbreak: organisation of a geriatric assessment and coordination unit. A French example

Age and Ageing

Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient’s level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: 1) To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level; 2) To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist. 3) To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.

Last updated on hub: 18 August 2020

COVID-19 in older people: a rapid clinical review

Age and Ageing

Introduction: the COVID-19 pandemic poses a high risk to older people. The aim of this article is to provide a rapid overview of the COVID-19 literature, with a specific focus on older adults. We frame our findings within an overview of the disease and have also evaluated the inclusion of older people within forthcoming clinical trials. Methods: we searched PubMed and bioRxiv/medRxiv to identify English language papers describing the testing, treatment and prognosis of COVID-19. PubMed and bioRxiv/medRxiv searches took place on 20 and 24 March 2020, respectively. Results: screening of over 1,100 peer-reviewed and pre-print papers yielded n = 22 on COVID-19 testing, n = 15 on treatment and n = 13 on prognosis. Viral polymerase chain reaction (PCR) and serology are the mainstays of testing, but a positive diagnosis may be increasingly supported by radiological findings. The current evidence for the effectiveness of antiviral, corticosteroid and immunotherapies is inconclusive, although trial data are largely based on younger people. In addition to age, male gender and comorbidities, specific laboratory and radiology findings are important prognostic factors. Evidence suggests that social distancing policies could have important negative consequences, particularly if in place for an extended period. Conclusion: given the established association between increasing age and poor prognosis in COVID-19, we anticipate that this rapid review of the current and emergent evidence might form a basis on which future work can be established. Exclusion of older people, particularly those with comorbidities, from clinical trials is well recognised and is potentially being perpetuated in the field of current COVID-19 research.

Last updated on hub: 18 August 2020

Frailty in the face of COVID-19

Age and Ageing

Rapidly increasing healthcare demand due to COVID-19 requires clinicians to make difficult medical and ethical decisions about the treatment of older people, models of care and triage systems. Algorithms and scoring systems are being developed to predict risks of mortality in relation to the most limited resources such as mechanical ventilation. Screening of frailty is being proposed as a key tool to assist in this triage process. This commentary argues against the use of screening tools (including the Clinical Frailty Scale (CFS) when used as such) as the sole component to ration access of older people to health care. Instead it recommends that frailty screening tools are implemented as a rapid component of a person-centred approach to assessment that takes account of three key biomedical factors: severity of the presenting acute illness, the likelihood of medical interventions being successful and the degree of frailty. Key points raised in this paper include: the Clinical Frailty Scale is a quick and reliable screening tool for frailty; while the CFS has value in allocation of scarce health resources, it also has limitations; frailty is a continuum rather than a dichotomous variable; the type and severity of the presenting illness are important variables independently associated with the clinical outcome; a person-centred approach should consider the severity of illness and likelihood of success as well as the degree of frailty.

Last updated on hub: 18 August 2020

Delirium: a missing piece in the COVID-19 pandemic puzzle

Age and Ageing

This editorial argues that delirium is an important missing component in the assessment and management of older people for COVID-19. Guidelines should include delirium as a presenting feature, screening should be a standard of care, and non-pharmacological approaches for delirium prevention and management need to be implemented as early and often as possible. Resources to assist healthcare providers should be built into electronic medical records, order sets and protocols. Key points raised in this paper include: older people are most vulnerable to severe COVID-19 infections and mortality; current guidance for diagnosis does not routinely include delirium, which may lead to under-detection of COVID-19; the care home population is particularly at risk, as failure to promptly detect COVID-19 may lead to outbreaks; non-pharmacological approaches to management of delirium may be more difficult to implement but remain the priority.

Last updated on hub: 18 August 2020

Webinar recording: Harnessing the power of data to transform social care

Social Care Institute for Excellence

Webinar co-hosted by SCIE and Xantura about using data to transform adult social care. Includes contributions from local authority partners.

Last updated on hub: 17 August 2020

Voices from lockdown: a chance for change: interim findings report

Agenda

This report focuses on the first three months of lockdown in the UK, looking at the needs and experiences of marginalised women and girls and the implications for the voluntary and community organisations that support them. It provides insights collected from an online survey of 72 organisations working with women and girls at risk, in-depth interviews with professionals from those organisations and interviews with the women and girls who use those support programmes whilst facing multiple disadvantages. The research highlights the challenges faced by this specialist sector, as well as important learnings and innovations being developed. It suggests that two concerning trends are emerging: firstly, that more women and girls are in need of support; and secondly, that their needs are increasingly more complex and urgent. While the demand for services is growing, nearly half, 46 per cent, of organisations reported that their financial position during the lockdown had worsened. Of those organisations that saw their financial position worsen, 30 per cent were small providers, supporting less than 25 women a month, with an income of less than £50,000. The report makes recommendations to ensure four core ambitions for recovery can be achieved and the specialist sector is adequately funded and supported: ensuring equality, insight and transparency to achieve effective commissioning and funding decisions; building respect, dignity and participation, removing the barriers to support services for women and girls; empowering local responses and driving collaboration through funding and commissioning; valuing expertise and growing innovation, harnessing the full potential of the women’s voluntary and community sector.

Last updated on hub: 17 August 2020

Impacts of Covid-19 on the financial sustainability of the voluntary sector working in criminal justice

Clinks

This paper explores the impacts of the Covid-19 pandemic on the sustainability of the voluntary sector working in the criminal justice system. Evidence has been gathered from leading voluntary sector experts, surveys of the voluntary sector working in criminal justice and a series of national regional network events held by Clinks for voluntary sector organisations. Over 1,700 voluntary organisations work specifically in criminal justice, playing a unique and valuable role in prisons and local communities. A further 4,916 voluntary organisations work with people in the criminal justice system by nature of their work. These charities exist to support and advocate for some of the most stigmatised and excluded communities whose needs mainstream services often fail to meet. The paper looks at how long-term trends in funding and commissioning models have impacted on the sustainability of voluntary organisations working in the criminal justice system, and how Covid-19 has both exacerbated existing challenges and brought in new challenges. It makes a number of recommendations to the government, including for: greater use of discretionary public sector grants as low bureaucracy tools to provide sustainable grant funding for core costs; emergency funding to be made available to voluntary organisations to cover their costs where Covid-19 has disrupted their usual means to bridge shortfalls in funding for MoJ/HMPPS contracted services; targeted support to specialist services for people with protected characteristics, with a particular focus on ensuring funding streams for services delivered to and/or led by black, Asian and minority ethnic people; and engagement with voluntary organisations as strategic partners in the design and delivery of services, rather than solely as suppliers.

Last updated on hub: 17 August 2020

Rough sleeping in England: looking beyond 'Everyone In'

St Mungo's

This briefing sets out the actions needed to reduce the impact of the Covid-19 crisis on people ability to find somewhere safe to stay and access the necessary support to rebuild their lives away from the street. At the beginning of the pandemic, the Government charged local authorities with getting ‘Everyone In’, and supporting everyone sleeping rough to move into self-contained accommodation. The paper highlights a number of key challenges that remain to be addressed, including: new people have continued to start sleeping rough during the pandemic; the risk of rough sleeping is increasing as a result of the impact of the lockdown on the economy; a high number of people currently in emergency accommodation will be unable to access ongoing support due to their migration status; difficulty finding move on accommodation due to affordability and access to the right support. To ensure the long-term safety of homeless people the paper recommends: ensuring everyone who is homeless is offered suitable emergency accommodation; suspending the Benefit Cap and lift Local Housing Allowance (LHA) rates in line with average rents; and suspending ‘no recourse’ rules that restrict access to support for non-UK nationals for at least the next 12 months.

Last updated on hub: 17 August 2020

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