Especially in adversity, we need fresh thinking

ABSTRACT

While offering secondary care at home may suit some, and could reduce costs, it is clear that virtual wards need adequate staffing, and careful planning and evaluation, and cannot fully replace traditional hospital wards. A summary of research from NIHR tracks the uptake of mastectomy and bilateral salpingo-oophorectomy among healthy women who carry BRCA1 or BRCA2 genes and are at high risk of cancer (doi10.1136/bmj.o258).3 Although most women opted to proceed with surgery, others did not, suggesting that more work is needed to understand their reasons and to examine alternative strategies. Claire Johnston and colleagues use available evidence on infectivity and covid-19 to help doctors share pragmatic and straightforward advice with patients and the public (doi10.1136/bmj-2020-061402).4 Their work comes at a time when covid is re-exerting its pressure on health systems, with rising case numbers having an impact on hospital beds and staffing levels (doi10.1136/bmj.o1638).5 In such a climate, complaints about clinical care, delays, overcrowding, staffing, and supply problems are likely to rise.