Getting it right in the pandemic

In a research paper that warrants close scrutiny by hospital administrators everywhere, Min Liu and colleagues find that none of 420 healthcare workers deployed to a hospital in Wuhan were infected with the virus, despite caring for severely ill patients and performing aerosol generating procedures over 6-8 weeks.3 The workers wore surgical masks and N95 respirators as well as protective suits and gowns, goggles, gloves, and face shields. The US and the UK missed the just right "Goldilocks zone” of hospital capacity by building temporary hospitals that remained mostly empty.6 How did this happen? "Bad modelling based on insufficient data,” says one expert. Missing the Goldilocks zone of hospital capacity during covid-19.

Recognising value

Conducted in the US Veterans Affairs system, this large study shows benefits from the antiviral drug nirmatrelvir when used early in patients with SARS-CoV-2 (doi:10.1136/bmj-2022-073312).3 Deaths and hospital admissions were reduced in patients who received treatment. Ma and colleagues followed more than 15 000 US nurses and health professionals with type 2 diabetes for several decades, updating information on beverage intake every two to four years (doi:10.1136/bmj-2022-073406).5 The onset of cardiovascular disease and death from diabetes, as well as overall mortality, were higher in those who consumed more sugar sweetened beverages. For patients with diabetes, for example, one disease and climate friendly recommendation might be to "use your feet for transport.” Since 2021 patients in the US have had free and immediate access to their medical records, thanks to passage of the 21st Century Cures Act.

Improving social justice in observational studies: protocol for the development of a global and Indigenous STROBE-equity reporting guideline.

BACKGROUND: Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. METHODS: We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. DISCUSSION: Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.

Among the failures, credit is due

Mary Dixon-Woods has harsh words for the East Kent Hospitals University NHS Foundation Trust (doi:10.1136/bmj.o2755).1 An investigation into its maternity services concluded that outcomes would have been better in roughly half of the cases reviewed if minimum standards of care had been achieved. Most of the maternal and neonatal deaths were judged preventable. Bullying, harassment, and unprofessional behaviour by consultants were common and tolerated. These issues had been identified in a 2014 investigation, yet nothing has changed. Dixon-Woods condemns the trust’s decade long failure to tackle these problems as particularly egregious. The failures were cultural and institutional, she says, and solutions must be as well. “Diagnoses are useless unless effective treatment follows—and that requires leadership commitment and sound systems, both of which East Kent lacked.”

Improving our chances of a healthier future

What should we do now to improve health in the future? For women with gestational diabetes, adherence to five healthy lifestyle habits over a quarter century of follow-up was associated with a 90% lower risk of developing type 2 diabetes, when compared with women who had none of these habits (doi:10.1136/bmj-2022-070312).1 Gestational diabetes is a strong marker of future illness, associated with a meaningful increase in later cardiovascular and cerebrovascular disease. Some though not all of the risk is due to the subsequent development of diabetes (doi:10.1136/bmj-2022-070244).2 Quite obviously, then, women with gestational diabetes are especially likely to benefit from public health measures aimed at helping them implement healthy habits.

Blame game: apportioning responsibility for bad outcomes is difficult and fraught

Where does responsibility lie for the highest death rate from covid-19? The world watched in horror as deaths from the virus surged again in Hong Kong earlier this year. Scenes associated with the early phase of the pandemic—over-run hospitals, corpses in makeshift morgues—were once again common on the nightly news. Even worse, this occurred despite ample supplies of effective vaccines and government campaigns to encourage vaccination.

Ten Eleven Things Not to Say to Healthcare Professionals During the Coronavirus Disease 2019 Pandemic.

On March 11, 2020, the infection caused by the coronavirus disease 2019 (COVID-19) virus was declared a pandemic. Throughout this pandemic, healthcare professionals (HCPs) have experienced difficulties stemming from poor communications, resource scarcity, lack of transparency, disbelief, and threats to the safety of their loved ones, their patients, and themselves. As part of these hardships, negative statements have been heard repeatedly. This paper describes 11 scenarios of unhelpful and dysfunctional messages heard by the authors and their colleagues during the COVID-19 pandemic, reported to us by a combination of peers, administrative leadership, and the public. We explain why not to use such messaging, and we suggest more helpful and compassionate expressions based upon recommendations published by scientific organizations and well-established psychological principles. The first 10 scenarios discussed include (1) lack of understanding regarding the extent of the pandemic; (2) shaming over not seeing patients in person; (3) lack of clear and consistent communication from leadership on pandemic-related practice changes; (4) opinions that personal protective equipment (PPE) use by HCPs causes fear or is unnecessary; (5) forcing in-person care without appropriate PPE; (6) the risk of exposure to asymptomatic individuals as it relates to opening clinics; (7) media gag orders; (8) pay and benefit reductions; (9) spreading of misinformation about the COVID-19 pandemic; and (10) workload expectations. The 11th scenario addresses HCPs' psychological and physical reactions to this challenging and prolonged stressful situation. We close by discussing the need for support and compassion at this difficult and unpredictable time and by offering suggestions to foster resilience and feelings of self-efficacy among HCPs.

Getting it right in the pandemic

The pandemic is far from over, but it’s already obvious some countries have done better than others. Germany is one, with fewer infections and lower mortality from covid-19 than many of its European neighbours. Well timed lockdown measures and an extensive, community based system of testing and contact tracing have paid off, says Ralph Reintjes.1 There’s still time to get this right in the UK, argue Peter Roderick and colleagues.2 They emphasise the need to “think local” and reintegrate testing and contact tracing into established regional systems. Meanwhile, the current centralised approach and reliance on commercially run tests mean that results are not reliably communicated to patients’ GPs or those doing local contact tracing. Another example of getting …