How much did the Covid-19 shielding policy cost in Wales? A Retrospective Cost analysis within the EVITE Immunity study (preprint)

Background: The EVITE Immunity study investigates the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, UK, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of implementing shielding in Wales. Methods: The number of people shielding was extracted from the Secure Anonymised Information Linkage Databank. Resources supporting shielding between March and June 2020 were mapped using published reports, web pages, freedom of information requests to Welsh Government and personal communications (e.g. the office of the Chief Medical Officer for Wales). Results: At the beginning of shielding, 117,415 people were on the shielding list. The total additional cost to support those advised to stay home during the initial 14 weeks of the pandemic was £13,307,654 (£113 per person shielded). This included the new resources required to compile the shielding list, inform CEV people of the shielding intervention and provide medicine and food deliveries. The list was adjusted weekly over the 3-month period (130,000 people identified by June 2020) therefore the cost per person shielded lies between £102 and £113. Conclusion: This is the first evaluation of the cost of the measures put in place to support those identified to shield in Wales. However, no data on opportunity cost was available. The true cost of shielding including its budget impact and opportunity costs need to be investigated to decide whether shielding is a worthwhile policy for future health emergencies.

Global Evidence on the Rapid Adoption of Telemedicine in Primary Care During the First Year of the COVID-19 Pandemic: a Scoping Review Protocol. (preprint)

Background: Before the declaration of the COVID-19 pandemic in March 2020, primary care relied on face-to-face consultations, with relatively limited use of telemedicine. The rapid uptake that occurred following the onset of the pandemic in countries such as the United Kingdom, Canada and New Zealand prompts questions around the drivers and extent of this transformation in clinical practice at global level.  The purpose of this scoping review is to explore the global evidence surrounding the rapid adoption of telemedicine in primary care settings during the first year of the COVID-19 pandemic. Methods: A draft protocol was tested through an initial search on Ovid Medline, Web of Science and Google Scholar with additional searches on the Cochrane Database. This informed the final selection of terms which will be use to search Ovid, Web of Science, Google Scholar, PROSPERO and Cochrane Library, filtering for studies from the pandemic declaration onwards. Additional grey literature reports will be sourced through simplified searches on appropriate search engines in widely spoken languages. Duplicates will be removed by screening titles. Abstracts and grey literature text extracts will be screened based on pre-set eligibility criteria by an automated tool and further screened by the lead researcher. Abstracts (and extracts in the case of grey literature) will be mapped against the domains of the Non-adoption, Abandonment, and challenges to Scale-up, Spread and Sustainability (NASSS) framework. Data will be presented in table format. Discussion: This review will map the current literature to identify current gaps in evidence related to the adoption of telemedicine after the declaration of the pandemic in March 2020. The use of simplified searches in the most spoken languages in the world is aimed at capturing more immediate non-academic reflections and experiences on this major service change at a global level.Systematic review registration: Study has been registered on Open Science Framework and can be accessed through the following URL: https://osf.io/4z5ut/

Community end-of-life care during the COVID-19 pandemic: Initial findings of a UK primary care survey (preprint)

Background Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. Aim To understand the views of general practitioners and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. Design and Setting A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks during September and October 2020. Method Responses were analysed using descriptive statistics and an inductive thematic analysis. Results Valid responses were received from 559 individuals (387 community nurses, 156 General Practitioners (GPs) and 16 unspecified role), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. Conclusion Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.