Starship Corona: Captain’s Log

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April 26, 2020 | 22 Comments

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  1. Beam them up and see how well society manages without a lot of them. Calling Captain Tom to steer the ship. I reckon there are many psychiatrists, therapists/counsellors and others becoming ‘nervous wrecks’ How many of them are included in the statistics for increased prescriptions?. How many taking them secretly. How many committing suicide due to seeing their businesses crashing . Most importantly how many will admit to having serious adverse effects to the drugs they prescribe each other? They’d have to admit it of course
    APRIL 16, 2020
    How is COVID-19 changing private practice?
    Resilient, resourceful and adaptable, but struggling to stay afloat. Apprehensive about the future of our profession and practices. Still retaining some optimism, but under no illusions about the challenges that face us.- in response to a survey about how COVID-19 is affecting private practice therapy.
    As I write, it is now just over four weeks since I saw my last face to face client. It feels much longer. The chairs in my counselling room feel like a reminder of a bygone age. Long ago, far away.
    My practice comprises clients who self-refer and who also come via Employee Assistance Programmes (EAP’s). Some clients are face to face, some I work with via phone, others online. As the COVID-19 pandemic started to make itself felt in the UK, I had a fantasy that in working in this way, I might find myself more insulated from its worst impacts than colleagues who work only in private practice and/or face to face.
    Twitter and Facebook started to hum with tales of practices shutting up shop overnight, and client referrals evaporating. The level of distress has been palpable, and it’s not going away any time soon.

    ………. we were keen to know how private practitioners have been affected.
    The survey explores how the COVID-19 pandemic is currently impacting on therapists in private practice. Given the rules in force on social distancing, maintaining any level of ongoing contact with clients is requiring those of us ‘non-essential’ practitioners to find alternatives to seeing clients face to face. This development is one that some of us may be better prepared than others to face. Hence, our questions focused on three main areas:

    1. Before the pandemic
    How have practitioners been providing therapy, specifically in face to face (F2F), phone and online modes? What are practitioners views of the relative effectiveness of each of these modes, and what are their attitudes towards them?

    2. Since the pandemic
    Are respondents continuing to practice, and if so, in what ways? What proportions of F2F clients have they been successful in migrating to phone or online modes? How have they and their clients experienced the transition, and has it been more or less challenging that they anticipated? Having made the transition, to what extent have attitudes towards non-F2F working changed?

    3. In the future
    What has happened to new client enquiries and referrals, both private and via EAP’s? To what extent have referrals via each channel increased or decreased? Are respondents now more or less optimistic about their professional futures than previously, and what informs this view?

    Thus far, we’ve received 61 responses to the survey, 57 of which have been from practitioners within the UK. The results are summarised below.

    Before the pandemic
    Question: Before the arrival of COVID-19 which best describes your view of the effectiveness of face to face v. phone/online working?

    In response to which mode they considered more effective, 72.1% of respondents stated their belief that therapy delivered F2F is more effective than phone or online interventions. 26% believed F2F and phone/online interventions to be equally effective, and just one respondent ventured that F2F working is less effective.
    It would appear that this sample of therapists are broadly holding firm to the view that F2F is more effective, despite a significant body of evidence, previously outlined, that phone and F2F working can be equally effective. Not all, however, and a selection of respondents’ comments highlights the range of views:

    Phone work is not the same as online work. Both are not as effective as f2f work.
    I would prefer F2F-contacts for better interaction and more fine tuning to the client
    Ineffective compared to face to face
    It wasn’t my preferred method and would avoid if I could however for some people it may be the only support they can get, and this is I believe better than no support.
    I am happy to work online as I believe it can be an effective and useful way of working depending on the needs of the client but am led by my clients who predominantly prefer F2F
    While I am new to telephone counselling, I have been really inspired by the effectiveness of this medium
    I’ve been doing both for years, so they feel as natural to me as breathing

    Question: Before the arrival of COVID-19 which modes were you using for your client work?
    Given the high proportion of respondents who expressed the view that therapy F2F is more effective than the other modes, a surprisingly high proportion (47.5%) offer a mixture of F2F and phone or online contact. None, however, work exclusively by phone or online.

    Current state of practice
    Question: Since the arrival of COVID-19, which best describes the current status of your practice?
    Of the 52.5% (n=32) of respondents who have been working only face to face, almost all have migrated some or all of their clients to phone or online contact. Just one stated the intention not to resume till they are able to meet in person once again.

    Question: What proportion of your face to face clients have you switched to phone or video?
    Across all respondents, both those working F2F only and those offering a mix of F2F and phone or online, the proportion of F2F clients that have switched to phone or online varies considerably, as shown below.
    More than a third of respondents have been able to migrate most or all of their clients to phone or online working, with nearly a further fifth achieving a migration of between 60 – 80%. This suggests that significantly more than half of respondents have been able to maintain the larger part of their active caseload in the short term. As we’ll see in a moment, however, the picture moving forward becomes less clear.

    Question: What were your biggest fears about the transition from face to face to phone or online working?
    Respondents biggest concerns about the transition from F2F to phone or online working focused the impact of the transition on the relationship and the ability to remain effective, as well as how well clients might adapt, and whether clients would be lost. The five most commonly expressed concerns, in order, were:
    Experience of the transition
    Question: To what extent has the transition been harder or easier than you feared or expected?
    Almost half of respondents (46.7%) experienced the transition in migrating from F2F to phone or online as moderately or significantly easier than anticipated.
    A similar figure (45%) found the transition about as difficult as they had feared or expected. Only 8.4% experienced it as either moderately or significantly harder than expected.
    Asked about who had found the transition more difficult, they or their clients, 74.6% said that they and their clients had experienced about the same level of difficulty.

    Question: Which best describes your current attitude towards working by phone or online?
    The survey sought to establish respondents’ attitudes to working by phone or online in the light of their recent experiences. Their responses seem to indicate that many feel more favourably disposed to working by phone or online that might previously have been the cas
    44.3% indicated being more favourably disposed to working by phone or online should the need arise. 23.0% went further, suggesting that they might positively embrace this new way of working. Only three (less than 5%) selected the option Phone or online work is not for me and that’s unlikely to change.

    What’s happened to referrals?
    We set out look at the impact of the pandemic on client referrals via the two channels of private practice and EAP’s. Responses show that whatever else may be happening in the world, it’s abundantly clear that the distress evident in our populations is not yet showing up in our therapy rooms.
    Private client referrals
    Of the 60 people who responded to the question of whether private client referrals have increased or decreased, 58 indicated a decrease.
    The scale of the reductions in private practice referrals is stark. Of respondents who indicated that referrals have decreased, and excluding missing data and null values, the reduction on average is estimated at 71%.

    EAP referrals
    A total of 25 people responded to the question of whether referrals from EAP’s have increased or decreased. Of those, all but one indicated that referrals had decreased.
    The scale of reduction in EAP referrals is even more stark than that in private practice referrals. Excluding missing data and null values, the average decrease in referrals across respondents stands at 85%.

    Question: Do you feel more or less optimistic than before about your professional future?
    How have recent developments impacted on our sense of optimism regarding our professional futures? Quite considerably, it would appear. Slightly more than half of us feel marginally or considerably less optimistic, with the latter category accounting for almost one in five of us.

    On a more positive note, however, nearly a third feel much as before, at least for now. There remain some optimists among us still: those who are either marginally or considerably more optimistic than before account for almost one in five (18%) respondents.

    Below is a selection of the views, beliefs and hopes that inform these responses:
    I am down to 1 client. Feels like i will have to start over again
    Lack of new referrals and looming serious financial crisis
    As I am struggling to recover from COVID-19, I haven’t been able to generate enough income to pay my bills. I am going to have to give notice on my office and I don’t know what the future will hold as far as having my own business concerns.
    Therapy is not a priority in people’s hierarchy of needs right now. Money, and lack of privacy (for calling therapist), also huge problems. Likely to be significantly reduced business as long as lockdown is in place.
    I’ve always felt optimistic about the place of counselling and therapy in the world, so this pandemic has confirmed this position but not bolstered it massively.

    Having gained experience in telephone counselling with effective outcomes for clients I envision an increase in referrals in the very near future – particularly as I work with health care staff
    The need for counselling is only going to increase so hopefully this will have a positive impact on the counselling profession and mean it is respected more highly.
    We will adapt to new ways of working as appropriate. Life goes on so people will need to access therapy as before
    I think this is a lull before the storm

    And finally
    We asked people to share any closing thoughts they might have. 41 left us with closing thoughts
    First two weeks – almost a trauma reaction in the rush to adapt whilst keeping clients held and seeming to be business as usual for them.
    I have had no referrals at all, EAP or private, since a while before lockdown.
    Im hoping for an upsurge in clients after it all, if there is an After! –
    You’re certainly not alone in the plummet in referrals. I’ve had one EAP referral and two former clients returning, that’s it.
    many similar experiences and some notable exceptions too in the BAC community

    Private therapists charge about £50-£100 p.h.

  2. A few more numbers from that Express Scripts report, all pretty disconcerting: From 2015 to 2019, antidepressant use rose 15% — it’s now at 11.1% of the population. Women ages 45-64 are the heaviest users, with 21.6% on antidepressants. And while teenagers are not the highest-using group, they are unfortunately the fastest-growing: teen use is up 38.3% since 2015. Among youth ages 13-19, 10.2% of girls and 5.7% of boys are on antidepressants.

    Sad to say, suicide rates are also rising faster among teen girls and middle-aged women than other groups. Some would say the prescription rates merely reflect some sort of greater distress out there. But at the very least it seems like the pills are not solving the problem — if they were, wouldn’t a 38.5% increase in “treatment” lead to at least a small decrease in suicides? At worst, the pills could be helping to fuel the increase.

    As for the Covid-19 Factor, there is one more hazard faced by folks who got their first prescription back in early March: Many of them are losing their jobs — which means they will be losing their insurance too. Possibly they will be broke enough to apply for Medicaid, or an Obamacare subsidy to buy insurance — but even if they are, that process can take weeks or months .

    As a result, they may be forced to go off those new psych meds cold turkey. It’s a painful process that can even be dangerous, and one most doctors don’t understand. This is how many people taking Cymbalta found out they were hooked — they lost their insurance and figured they would simply quit, because the drug was expensive and in many cases they weren’t even sure it was doing them any good. The withdrawal symptoms were entirely unexpected, and truly awful.

  3. Space: the final frontier. These are the voyages of the starship Enterprise. Its five-year mission: to explore strange new worlds. To seek out new life and new civilizations. To boldly go where no man has gone before!

    Kristina K. Gehrki
    @AkathisiaRx

    Teen’s demise & death was precipitated by #telemedicine practiced in violation of the Hippocratic oath w/out informed consent. Are phone docs who prescribe risky @US_FDA black box #SSRIs and #benzos during #covid19 also causing death & disability?

    If you think it’s safe to prescribe risky @US_FDA black box drugs like #zoloft, #prozac & #paxil via #telemedicine, think again. #RememberAmy and Natalie & thousands of others who were prescribed to death.

    Is #telemedicine during #COVID19 putting thousands at risk of prescribed harms? This article states these #pharma products should not be prescribed by “phone docs.”

    #Seroquel, #Zyprexa, #Risperdal #Adderall, #Ritalin, #Xanax #Ambien, #Ativan, #Lunesta

    https://plushcare.com/blog/can-a-phone-doctor-write-a-prescription/

    The Ryan Haight Act is the source of the federal prohibition against controlled substance prescribing via telemedicine. The statute does contain exceptions, including the public health emergency exception that allows for DEA’s position. (The additional exceptions in the Act that are directly for telemedicine are not able to be used because DEA has not yet issued the necessary regulations.) In the meantime, and only during the current emergency, prescribers may prescribe controlled substances based on initial telemedicine visits.

    Telehealth Prescribing & COVID-19: DEA Eases Requirements for Prescribing Controlled Substances

    Health & Life Sciences Alert

    https://www.quarles.com/publications/telehealth-prescribing-covid-19-dea-eases-requirements-for-prescribing-controlled-substances/

    1. Originating site requirement is suspended.
    2. No HIPAA penalties for clinicians during the good-faith provision of telehealth
    3. Established patient requirement not enforced.

    Three federal telehealth rules that no longer apply during the COVID-19 pandemic

    https://www.aafp.org/journals/fpm/blogs/inpractice/entry/telehealth_rules_waived.html
    ..
    Spock on, Johanna

  4. Yesterday I watched a webinar on suicide-prevention and Covid-19, from the American Fdn for Suicide Prevention. A very pharma friendly US nonprofit, although they are smart enough to minimize the “drug talk” in their public-facing programs. The only person who thought the pandemic might be good for some folks’ mental health was the “token consumer” — a volunteer with a peer-led drop-in center in Australia who was actually pretty cool.

    She thought there were two silver linings: One was feeling that you were not alone, and perhaps not sick — because everyone was depressed or anxious in some way, and it was more OK than usual to talk about it openly. The other was the chance to band together and think about others, whether by helping with practical tasks or just keeping each others’ spirits up.

    Floods, earthquakes and even wars give people the chance to react this way, which most of us long to do. But one problem with the way the shutdown has been handled in the US: we’re actively discouraged from leaving home at all. Chicago’s official slogan is “Stay Indoors — Show You Care.” A great deal of energy is wasted heaping judgment on folks who merely sit outside on their front stoop talking to a friend or two (and without crowding in close). It’s divisive, and also unscientific: chatting outdoors is probably far safer than indoors from a contagion perspective. A kind of paranoia is encouraged — is it even safe to touch the box of groceries left by the delivery guy? This makes it damn hard to help your elderly neighbors, or anyone else. Keeping to yourself, and being afraid of everything, are the only public virtues you can take part in, if you’re not a nurse or doctor.

    We have seen a great deal of gathering on Zoom, Skype etc. for book clubs, church services, virtual barbecues and cocktail parties, you name it. It’s good to see people reaching out this way, more than they did pre-Covid in many cases. That’s why I rather liked the “practical” mental-health advice offered in the media. At least it stressed we were all in the same boat. What seems harmful is all the talk from mental-health experts about a wave of PTSD, major depression and other Clinically Significant Disorders that will inevitably spread.

  5. People watching in the UK, we have a Secretary of State who more often than not does the Daily Press Briefing at 5.00pm, flanked usually by a Scientific Advisor (follow the science). His voice cracks with emotion as he delivers the death toll and is defensive about the Care Home and PPE fiascos.
    They have introduced a member of the public question, which he has not seen (game show).

    “When can I hug my grandchildren?”

    On another programme, we had the ‘token suicidal’ person
    Choked interviewer.
    Matter of factly, suicidal person said, I spoke to a mental health person, that is the only reason I am still alive.

    These and other stories are gaining traction
    Doctors and nurses, exhausted and terrified, naked doctors doing a video to show a lack of PPE.

    Evan Davis on BBC PM usually invites his pals, the Wesselys on to the show. Wessely interviewed Evan for one of his podcasts, drawing attention to ‘naughty bits’ when discussing Jeremy Hunt. (old joke)
    Clare Gerada was on PM last night, talking about Care Homes.
    It was wall to wall Wesselys, when she caught the Corona…

    Zooming in on a rather good article relating to the RCP position statement on ‘personalty disorder’, signed off by Dr. Adrian James, the new president, in-waiting..

    Keir Harding
    @Keirwales

    “Psychiatry must decide whether its insistence on calling people disordered is worth the harm and alienation that results”
    My piece in @TheLancetPsych

    Words matter: the Royal College of Psychiatrists’ position statement on personality disorder

    https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30126-7/fulltext

    Everybody’s personalty is under the spotlight as we enter the realms of behavioural sciences during a pandemic; and it rather bursts the balloon as we watch the unfurling of the political personalites, the media personalties, the medical personalites, the science personalities and lastly the good old British Public’s personalities who just may have a ‘Personaltiy Disorder’ thrust upon them along with handfuls of typically unsuitable medications …

    Overplaying the ‘Moral Injury’ Card …

    https://www.bmj.com/content/368/bmj.m1211

    ‘These symptoms can contribute to the development of mental health difficulties, including depression, post-traumatic stress disorder, and even suicidal ideation.’

    Invading our space, with spurious ‘psychiatric’ offerings when most people are keeping their ends up is helping nobody especially when this comes from those who make great play that psychotropic drugs are in the main, harmless …

    The fit and well over 70s are fighting back that they might be discriminated against as the last let-out of lockdown

    Navigating the ‘hot-air’ orbit is – testing..

    • I actually don’t feel a part of this world at all. Since SSRIs damaged my life I’ve felt isolated and apart from the world ever since. Where was the system to help me when all went wrong? Plenty of punishment to be dished out but little help or support. Any help I did get was the wrong help. I feel ive been in self isolation ever since. I’m a non existent person, somebody of no importance, anyone I meet in the system just wants to shoo me off very quickly. I’m broken and not mendable in their eyes so they just fob you off with rubbish give you a smile and hope you close the door on your way out.

      I have no interest in ever seeking help from any mental health services ever again in my life time.

      • Hi Anne-Marie I agree with you. I habe been on Zoloft for many years. I feel all the things you wrote here, but I never put it together that the zoloft that did this to me.

  6. Equally Well – UK …

    MISSD did a lot of work on Akathisia with RCP; ‘Captains’ move on …

    MISSD
    @MISSDFoundation

    In July 2019 MISSD presented #akathisia info to @rcpsych congress to help #psychiatrists better understand serious risks posed by prescriptions.
    @wendyburn we again offer to freely assist RCP in developing akathisia & w/drawal info to help drug prescribers & consumers be safer.

    Telepsychiatry & teleprescribing is increasing despite FDA guidelines that new consumers of #SSRIs & #benzos should be closely monitored. In the US, drugs “for treating depression, anxiety, & insomnia spiked 21% between February 16th-March 15th”

    https://www.businessinsider.com/fda-streamlines-digital-psychiatry-approval-process-2020-4?r=US&IR=T

    recovery&renewal
    @recover2renew

    We’re delighted that @wendyburn has been welcomed as the new Clinical Group Chair of @EquallyWellUK!

    Full story:

    https://www.centreformentalhealth.org.uk/news/equally-well-uk-welcomes-professor-wendy-burn-new-clinical-group-chair

    Equally Well UK, a collaboration working towards equal physical health for people with a severe mental illness, is delighted to announce Prof Wendy Burn as the new Chair of its Clinical Group.

    Equally; Well …

  7. Bit More from Claire Gerada-Wessley=

    Wounded Healer
    Clare Gerada: Understanding burnout
    BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1595 (Published 28 April 2020)

    Unbelievably crass to be talking about her own experience of so called ‘burnout’ decades ago right now. Health workers and what are now being described as ‘essential workers’ are speaking out about lack of PPE and , the lies they have been told -and their anger at the inappropriateness of being described as ‘wounded healers; angels;heroes – it makes many what are highly skilled people cringe .

    ‘High levels of burnout have been linked to a high level of antidepressant medication.
    The covid-19 crisis is putting additional pressure on doctors and the health system in general. An Ipsos MORI poll has reported that half of workers already believe that their mental health has declined in the first two months of the crisis,3 and if covid-19 has even the same psychological impact as other major pandemics a vast number of key workers will need support.

    The strain on the medical profession is already being felt. A BMA survey conducted from 14 to 16 April found that almost half of UK doctors were experiencing burnout, depression, anxiety, or other mental health conditions relating to their work or made worse by it. (Very normal reactions then)

    It’s hard to prevent burnout—but we (We? jump in Claire )have to manage it, recognise it, minimise it, and deal with it when it occurs. We all have ebbs and flows in job satisfaction, and years of being in the psychological trenches with our patients will have an effect. What’s important is recognising when we can’t go on; when negative attitudes turn to loss of compassion; when our sense of futility becomes a feeling of hopelessness and helplessness; when our work loses its sparkle, day in, day out, and we need to remove ourselves from the stressor.
    I was lucky: I worked for a practice that allowed me to take a sabbatical…OMG
    .Has she even noticed what health workers at the coal face are presently dealing with! Musn’t tell too much truth though – could bite the hand that feeds them.

    • Some very sarky comments of pulse med mag re Who knows who? as Calre has been given yet another brief (How does she do it?!) to set upp services for gamblers. Odds on there’s a lot more comments which couldn’t be published.

  8. 2020
    The Duke of Cambridge and The Duchess of Cambridge are supporting Public Health England’s Every Mind Matters platform by voicing a new film to signpost people to NHS expert tips and advice around mental health and wellbeing during the coronavirus pandemic. This follows Their Royal Highnesses chairing a roundtable call with experts …
    ….Voicing the film, the Duke and Duchess of Cambridge, said: “All over the country people are staying at home to protect the NHS and save lives. It’s not always easy. We can feel frustrated, miss loved ones or get anxious. So now, more than ever, Every Mind Matters. There are things we can all do to look after our mental wellbeing at this time. Every Mind Matters can help get you started with your NHS online plan. Showing you simple steps to help deal with stress, boost your mood and feel on top of things. Search Every Mind Matters to get your action plan today. We’re in this together.”

    The film comes as new data shows that over 4 in 5 (85.2%) British people are worried about the effect that coronavirus is having on their life, with over half (53.1%) saying it was affecting their well-being and nearly half (46.9%) reporting high levels of anxiety[i]. With many feeling worried, anxious or isolated during these challenging times, Every Mind Matters highlights there are lots of things we can all do to look after our mental wellbeing and support others, to prevent these concerns from becoming more serious.

    Peter Fonagy, Chief Executive at the Anna Freud National Centre for Children and Families warmly welcomed the initiative from their Royal Highnesses, adding: “There’s never been a more important time to acknowledge the need for us to address the scale of mental health needs. The peak of the crisis in mental health, depression, anxiety and PTSD will come months after the coronavirus infections have subsided. Continued kindness and compassion will help us all to overcome the impact of traumatic experiences and losses, and will enable us energise our communities to reach out and provide the best support we can give to children, young people and their families.”

    Many of the charities reported an increase in the numbers of people reaching out for information and seeking help for their own mental health, indicating that the importance of good mental health is now becoming a prominent issue in the public consciousness. The Anna Freud Centre’s Self Care tools, aimed primarily at young people aged 12-25, have reported a 567% increase in interest since lockdown

    During the call, participants discussed the mental health issues that are arising as a result of the pandemic and highlighted that many of the practical issues that people are facing can also be risk factors for mental health. They agreed that the sector must continue to look at ways to work together to ensure that people are equipped to support their family and friends during these difficult times, and to have conversations about their mental health both during and after the pandemic which they anticipate will have vast and complicated long-term consequences for mental health.

  9. The SAGE cttee has been forced out of the shadows only after it was discovered Cummings sat in on meetings – (Unprecedented!). Why did it take so long? Two very nervous members – Ian Hall and John Edmunds drew short straws and were’told ?’ give interviews on BBC 2 which emphasised they were not responsible for policy decisions. Ian Hall is not on this list – stated he was from Manchester Uni involved with mathematical modelling.Has Sage began a defence in case politicians try to offload all the blame for horrendous outcomes to their joint decisions ?
    The Guardian –
    Who’s who on secret scientific group advising UK government?
    Scientific Advisory Group for Emergencies (Sage) is advising cabinet on coronavirus response

    Revealed: Cummings on secret scientific advisory group

    Fri 24 Apr 2020 18.42 BSTLast modified on Mon 27 Apr 2020
    On Friday the Guardian revealed the 23 attendees of the Scientific Advisory Group for Emergencies (Sage). They comprise 21 scientists and two Downing Street political advisers.

    Sir Patrick Vallance, chief scientific officer
    The government’s chief scientific adviser and former president of research and development at GlaxoSmithKline. In the run-up to the EU referendum he warned that a vote for Brexit would mean uncertainty for future drug development.

    Professor Chris Whitty
    A doctor and epidemiologist with an enormous reputation among colleagues, he has devoted much of his career to malaria research in Africa. Previously chief scientific adviser at the Department for International Development and the Department of Health.

    Prof Jonathan Van-Tam, deputy chief medical officer
    An expert in influenza and respiratory viruses, Van-Tam is a professor of health protection at the University of Nottingham’s school of medicine and sat on Sage during the 2009 swine flu pandemic.

    Prof Stephen Powis, national medical director of NHS …
    A professor of renal medicine at University College London, he was the leading voice calling for former health workers to return to the NHS to help deal with the pandemic.

    Prof Sharon Peacock, director of the National Infection Service at Public Health England (PHE)

    Photograph: David Bishop/UCL
    The professor of public health and microbiology at the University of Cambridge department of medicine told MPs on the science and technology committee in March that antibody testing kits would be available for mass testing within days, but the tests failed quality checks.

    Maria Zambon, director of Reference Microbiology Services at PHE and head of the UK World Health Organization National Influenza Centre
    Zambon is known as a thorough and extremely competent scientist. She is medically qualified and a specialist on RNA viruses, antivirals and vaccines.

    Meera Chand, consultant microbiologist at PHE
    Chand worked on the UK’s response to the Ebola epidemic and has expertise in infectious diseases including influenza, diphtheria, scarlet fever and monkeypox.

    Prof Charlotte Watts, chief scientific adviser to the Department for International Development
    Watts is on secondment from the London School of Hygiene and Tropical Medicine where she is a professor of social and mathematical epidemiology.

    Prof John Aston, Home Office chief scientific adviser
    A specialist in applied statistics, Aston joined the government in 2017 after stepping down as a trustee of the Alan Turing Institute.

    Angela McLean, professor of mathematical biology at Oxford University’s department of ..
    McLean is the government’s deputy chief scientific adviser and chief scientist at the Ministry of Defence. She often speaks at the No 10 press conferences and has said that the number of hospital admissions “is not as bad as it could have been” had lockdown not been put in place.

    Ian Diamond, head of the Government Statistical Service and chief executive of the UK Statistics Authority
    The nation’s statistician, Diamond prompted an investigation over a £282,000 payment when he stepped down as principal at the University of Aberdeen.

    Graham Medley, professor of infectious disease modelling at the London School of Hygiene and Tropical Medicine
    Medley is also chair of the Sage subgroup on pandemic modelling, and director of the centre for the mathematical modelling of infectious diseases. He brings wide expertise not just in modelling but in designing interventions and how political and social factors interact with the spread of epidemics. Medley was one of the first scientists to elaborate on the herd immunity strategy. He told Newsnight he’d like to “put all the more vulnerable people into the north of Scotland … everybody else into Kent and have a nice, big epidemic in Kent, so that everyone becomes immune”.

    Neil Ferguson, professor at Imperial College London faculty of medicine
    Head of the Imperial College modelling team whose work predicted half a million deaths in Britain and is credited with prompting the government to impose the lockdown.

    Prof John Edmunds, specialist in design of control programmes against infectious diseases at the London School of Hygiene and Tropical Medican
    A leader in disease modelling and analysis, Edmunds warned that Italy’s lockdown might prove unsustainable and has argued against banning exercise outdoors on the grounds that it has a negligible impact on the spread of the disease but benefits for mental health and wellbeing.

    James Rubin, reader in psychology of emerging health risks, Kings College London
    Rubin has studied how people respond to all manner of perceived health risks, from nuclear meltdowns and the Ebola outbreak to mobile phone signals and novichok nerve agents.

    Brooke Rogers, professor of behavioural science and security at Kings College London and chair of the Cabinet Office National Risk Assessment Behavioural Science Advisory Group
    Rogers specialises in threat and risk communication, and is a strong advocate of basing interventions on evidence.

    Peter Horby, former professor of infectious diseases and global health at University of Oxford and chair of the government’s New and Emerging Respiratory Virus Threats Advisory Group (Nervtag)
    Horby ran Ebola trials in West Africa and the Democratic Republic of the Congo, and is now heading up the major Recovery trial into drugs for coronavirus.

    Jeremy Farrar, director of the Wellcome Trust
    One of the few members of Sage who has made their membership public. Farrar is a medical researcher and former head of Oxford’s clinical research unit in Ho Chi Minh City. He has said Britain is on course to be among the worst, if not the worst, affected country in Europe

    Andrew Rambaut, member of the Institute of Evolutionary Biology at Edinburgh University’s school of biological sciences
    A leading geneticist who specialises in the evolution of emerging human viruses. His recent work showed that the coronavirus may have spread to humans via pangolins but “clearly” wasn’t created in a lab or purposefully manipulated.

    Emma Reed, director of emergency response and health protection at the Department of Health and Social Care
    Reed worked on the government’s Ebola response and has coordinated programmes to reduce childhood obesity and diabetes.

    Dr Edward Mullins, clinical adviser to the chief medical officer
    Mullins is a clinical lecturer at Imperial College and an obstetrics and gynaecology registrar at Queen Charlotte’s and Chelsea hospital, London. He has previously worked with Dame Sally Davies, England’s former chief medical officer.

    Dominic Cummings
    Former director of the Vote Leave campaign who famously advertised for “weirdos and misfits with odd skills” to advise government.

    Ben Warner, Downing Street adviser on data science
    The Vote Leave campaign’s data specialist joined No 10 after running the private election model that predicted the 2019 landslide victory for the Tories.

    • Seems like old times, Vallance and W(h)itty …

      Come in Costello

      The government’s secret science group has a shocking lack of expertise

      Anthony Costello

      Sage has no molecular virologists, immunologists or intensive care experts. This could have cost thousands of lives

      https://www.theguardian.com/commentisfree/2020/apr/27/gaps-sage-scientific-body-scientists-medical

      But had its membership and details of its decisions been revealed earlier, there would have been a chance for the wider scientific community to offer constructive criticism, maybe in time to save thousands of lives.

      Patrick Vallance, the UK’s chief scientific adviser, had previously said while it’s “eye-catching” to order the cancellation of mass gatherings and sporting events, the chances of contracting the disease by attending such occasions are slim.

      https://www.thecanary.co/discovery/news-discovery/2020/03/13/johnson-slammed-by-who-and-scientists-for-wrong-and-dangerous-coronavirus-strategy/

      Anthony Costello
      @globalhlthtwit

      Doctor, Speaker, Author The Social Edge. Ex-Director, WHO. Professor, University College London

      Political dynamite. If Dominic Cummings was allowed to ask questions, unlike the Scottish, Welsh and N Irish science advisers, and David King says this is without precedent, then Sir Patrick Vallance has to explain why he allowed this to happen.

      I’ve been ambivalent about releasing SAGE names in case the scientists were subjected to unfair abuse. But if this is true and SAGE was politicised then we must know who was attending these meetings.

      “The media felt safe, reassured by two eminent physicians.
      The trouble is, those scientists were wrong.”

      ‘And the next slide please’ …

      • the Independent SAGE

        Sir David King
        @Sir_David_King

        Tomorrow @IndependentSage meets for the first time. We will convene a group of world leading experts to discuss how we can navigate our way out of CV19 with minimal loss of life in the fastest time. We invite you to watch live at 12 on twitter or YouTube

        Top scientists set up ‘shadow’ SAGE committee to advise government amid concerns over political interference

        Former UK chief scientist assembles independent group of experts

        https://www.independent.co.uk/news/uk/politics/coronavirus-sage-dominic-cummings-david-king-a9496546.html

        Top scientists are setting up a shadow version of the government’s Scientific Advisory Group for Emergencies (Sage), amid concerns about “dangerous” political interference in advice to the government.

        Sir David King, a former government chief scientific adviser, has assembled a group of independent experts to look at how the UK could work its way out of the coronavirus lockdown.

        He said the 12-strong committee had been created “in response to concerns over the lack of transparency” from Sage.

        …prompted chief scientific adviser Sir Patrick Vallance to say a partial list of the group’s members would be issued “shortly”.

  10. Is there a hidden agenda behind this Covird-19?
    Just look at the graph above this blog.
    What are we going to do now to undo the damage?
    If the mandatory Covird-19 vaccine come into the equation, the health industry are double dipping especially in regards to creating unnecessary health maladies.
    My concern is how many deaths are being recorded as Covird-19 when it may be another health issue or disease.
    I am very worried about where all this is going?
    Humanity is killing itself with modern technology, iatrogenic medicine and misinformation.
    The virus is not going to kill humanity.
    Freedom of speech and lack of civil liberties are eroding our basic human rights.
    The policies are worse than the disease.

  11. Cite this as: BMJ 2020;369:m1315
    Re: Pregabalin and gabapentin for pain
    Dear Editor
    There is growing evidence that
    gabapentin causes immune modulation leading to a wide variety of immune defects…we can clearly foresee the emerging data may lead to black box warning for this drugs specially in the near future

    There is anecdotal evidence also that COVID-19 cases are more severe in nature in patients taking gabpapentin or its derivatives though it does not prove causalty

    There need to be immune studies to refute or prove this notion
    If we study the history of gabalin, it was used as a toxic agent to kill certain rabid animals…later on its milder compounds were found to be useful in humans for pain.
    Competing interests: No competing interests
    29 April 2020
    aitzaz Rai
    Research fellow
    maimoona siddique
    University of Oxford
    Oxford

  12. How many innocent people are being KIDNAPPED by prescribed medicines?
    The official cause of Freddie Mercury’s death (lead vocalist of Queen), was said to be bronchial pneumonia which was as a result of a damaged immune system by the virus. ~ Is this the real truth?
    He was also kidnapped by big pharma.
    He sadly died of a lethal dose of the AIDS drug, AZT.
    Was his pneumonia drug induced?

    http://mitrinchera.obolog.es/what-killed-freddie-mercury-and-millions-peopler-2436533

    History is repeating itself again, with this Covird-19 but we are always informed that it is the virus that kills.

  13. I don’t know if I am the only person in the universe thinking ‘outside the box’ however, right now at this moment in time, if we don’t start questioning things regarding the Covird-19, we will automatically just accept what the media, politicians and experts are feeding to us, as Gospel.

    If there is such a thing as democracy, we would see the media present healthy debates and discussions, surrounding this Covird-19.
    I have not seen/heard anyone on the radio or on the television, say what they really think!
    Are people being censored?
    I find it quite odd that no one has debated this Covird-19 because I believe that many are being censored.
    Is there an elephant in the room surrounding all this Covird-19?

    The BIGGEST PANDEMIC that is never bought to the attention of people is also prescription meds.
    if I believe the statistics and data, at least 41 people per day, die of prescribed medications.
    In this data, I have no clarity or enlightenment, if this covers: overdose, flawed medicines or a combination of a cocktail of meds.
    In 2017, 70,000 people died (in US alone) as a result of prescribed medicines.
    How many go unreported?
    Which brings me back to the Covird-19 saga. Are we really being told all the truth regarding this Covird-19?

    https://ndarc.med.unsw.edu.au/sites/default/files/Drug%20Induced%20Deaths%20July%202019%20Drug%20Trends%20Bulletin_Final.pdf

    We certainly do not make a fuss about the deaths resulting from prescribed medicines. This pandemic, is very serious and costing so many innocent lives.

    There is just so much ambiguity/fraud relating to falsified data/clinical information pertaining to prescribed medicines (this includes, LA, GA and IV sedations) and too many physicians have too little good information to go on.
    I also must mention that there are some physicians that are mixing too many cocktails at once and there is no excuse for this kind of exploitative prescribing habits.
    If we ‘all want to be in this together’ and ensure that what we are prescribed and ingesting (‘are safe’), we have to demand that there is transparency and a drastic change in the medical culture, on all levels, starting with:
    – pharmaceutical companies disclosing all their data pertaining to each and every medicine
    – A change in physicians prescribing habits
    – No more incentives or enticements given to politicians, physicians, pharmacologists, pharmacists, pharma reps etc
    The only way we can slay the dragon is to get rid of the corruption that harms innocent people in the first place.
    This is a war that has been going on for some time and if we don’t make the necessary changes, we as a universe have no HOPE and we will all be impoverished as a result of standing back and doing nothing!

  14. Wikipedia describes ‘The Borg’ as a modern metaphor:A Juggernaut that mows everything down in it’s path. Their catch phrase of course is ‘Resistance is futile’…They assimilate everything into what they call the collective.
    At times it can feel or seem like trying to resist the lure of P(Harma) money and the allure of power is futile. But in Startrek the good guys always win.

  15. One of the most dangerous places to be in right now..very insecure units

    mental health inpatient units struggled with the lack of central guidance on managing patients who’d been diagnosed with or were suspected of having covid-19, especially those working in secure settings.
    different trusts have interpreted these differently, leading to confusion. The Royal College of Psychiatrists has helpfully issued guidelines for inpatient and high secure settings, but much of it relies on generic guidelines that were initially designed for physical acute services.

    There is intense debate about the apparent lack of appropriate legal frameworks for the situation we’re now in, …..
    Guidelines about these issues are awaited and are needed urgenyly….. should we use antipsychotic or anxiolytic medication in the case of suspected covid-19 when there is a risk of respiratory depression. The National Association of Psychiatric Intensive Care and Low Secure Units (NAPICU) has swiftly produced provisional guidelines for staff. The hope is that this guidance can be an iterative process, with feedback from wards, and that this can help staff in making some of the most difficult clinical and ethical decisions they have faced in their careers. Blah blah….
    Individual trusts should not be expected to produce local policies based on guidelines seemingly written with a different patient group in mind, and when the legal, ethical, and even scientific principles behind them are ambiguous and open to interpretation. Blah….

    Aileen O’Brien
    Competing interests: I am the director of educational programmes for NAPICU (non-financial)

    should we use antipsychotic or anxiolytic medication in the case of suspected covid-19 when there is a risk of respiratory depression. The National Association of Psychiatric Intensive Care and Low Secure Units (NAPICU) has swiftly produced provisional guidelines for staff.Medication use for acute disturbance

    Take Your Pick

    5.22. The choice of medication would follow your own Trust, NICE or Joint BAP NAPICU
    guidance (Patel, Sethi et al. 2018)3 but require some additional consideration to the
    specific contra-indications and side effects (see below) that are known with COVID-19
    and other infections. Importantly, the current physical health of the patient is a key
    factor in the choice.
    5.23. If a patient with suspected or diagnosed COVID-19 is acutely disturbed, and there are
    no signs of respiratory compromise (decreased or increased respiratory rate),
    cardiovascular disease or decreased level of consciousness; then medication can be
    used with caution as the full effects of COVID-19 are still unknown. Consider shortacting medication as a patient’s physical health condition may rapidly deteriorate.
    Ensure the medication for acute disturbance is an effective dose as an ineffective dose
    may lead to the increased need for additional injections.
    5.24. Where possible, oral medication is preferred and should be offered as the first choice.
    Parenteral medication is also more likely to cause dose related side effects such as
    respiratory depression, postural drop, QTc prolongation and extra-pyramidal side
    effects (EPS).

    3 Patel, M.X., Sethi, F. et al. (2018) Joint BAP NAPICU evidence-based consensus guidelines for the
    clinical management of acute disturbance: de-escalation and rapid tranquillisation. Journal of
    Psychiatric Intensive Care, 14: 89–132. https://doi.org/10.20299/jpi.2018.008
    rev.3
    12
    5.25. COVID-19 is known to affect the respiratory function of patients. Psychotropic
    medications, especially benzodiazepines, can cause respiratory depression.
    Benzodiazepines should not be used when a patient has acute pulmonary
    insufficiency.
    5.26. Lorazepam would be the preferred benzodiazepine as it has a shorter half-life.
    Simultaneous injections of olanzapine and benzodiazepines can result in excessive
    sedation and cardiorespiratory depression so must be given at least an hour apart.
    Ensure immediate access to flumazenil is available if benzodiazepines are given.
    5.27. If there is evidence of cardiovascular disease, including a prolonged QTc interval, or
    no recent electrocardiogram (ECG), avoid intramuscular haloperidol combined with
    intramuscular promethazine. Consider intramuscular olanzapine or intramuscular
    lorazepam.
    5.28. Febrile individuals with a history of seizures may have their seizure threshold altered
    by some medications. Medical advice should be sought if there is any doubt.
    5.29. All antipsychotics can cause Neuroleptic Malignant Syndrome (NMS). If NMS occurs,
    immediately discontinue antipsychotics and other drugs that may contribute to the
    underlying disorder, monitor and treat symptoms, and treat any concomitant serious
    medical problems.
    5.30. Inhaled loxapine is contra-indicated in patients with acute respiratory distress or with
    active airways disease and with the current use of medications to treat airways
    disease. Therefore, inhaled loxapine should be avoided in suspected or confirmed
    cases of COCID-19.
    5.31. Physical health monitoring, especially respiratory rate and level of consciousness,
    should be carried out when either oral or parenteral rapid tranquillisation is given.
    Other COVID-19 medication issues
    5.32. At present there is no specific treatment for COVID-19 and treatments are focused on
    alleviating associated symptoms. The position is being further developed as the effects
    of COVID-19 become better understood.
    5.33. There are many different types of treatments in research (lopinavir/ritonavir,
    remdesivir, favipiravir, chloroquine, hydroxychloroquine, nitazoxanide, ribavirin) but so
    far, no strong evidence or licensed preparation has emerged. Many of these agents
    have drug interactions and advice regarding these should be sought from the
    pharmacy team or from http://www.covid19-druginteractions.org.
    rev.3
    13
    5.34. There is currently no strong evidence that ibuprofen can make COVID-19 worse but
    until there is more information, give paracetamol to treat the symptoms of coronavirus,
    unless contra-indicated. If a patient is already taking ibuprofen or another non-steroidal
    anti-inflammatory (NSAID) review the prescription.
    5.35. Other treatments are based on treatment of secondary infections or symptoms and
    may include antibiotics, venous thromboembolism (VTE) therapy, and nebulisers (e.g.
    salbutamol and/or ipratropium) and/or oxygen.
    5.36. Be aware of drug interactions in patients prescribed physical health treatments; e.g.
    clarithromycin can prolong the QTc and should be used with caution with
    antipsychotics.

  16. comment moved from another post

    AB and TW below wonder…..What can pandemics teach us about mental health act admissions? They ‘look forward to the government acting on it’ so who has been illegally detaining people A.B and T W? they are disengenuous enough to point at covid as teaching them anything And With the college of psychs encouraging the idea that zillions of people will need their ‘help’ post covid many will experience harms from the drugs they will be manipulated into taking and the consequences of being detained in the disgraceful Maudsley and other institutions.

    May 15, 2020
    The SARS-Cov-2 pandemic has produced challenges for mental health services, but it also provides opportunities to reassess and improve our mental health care system. When National Health Service England (NHSE) asked service providers to free up inpatient capacity1, many, particularly in London, discharged large numbers with informal reports of up to a fifth of people who were previously detained being discharged. In Lombardy and Madrid mental health beds were closed and wards converted for Covid-19 patients, but clinical colleagues tell us that this was not achieved by discharging people who had been legally detained. If we understand how this discharge rate was achieved, and why it was different to other services in Europe then we might be able to improve services in the future.

    There have been no changes to the detention criteria that could justify why people who pre-covid warranted formal detention, now no longer warranting that detention now the pandemic is upon us. These discharge rates raise questions about whether the threshold for detention was adequately stewarded pre-covid-19. Perhaps we have been depriving people with mental health difficulties of their liberty unjustly?

    More than 50,000 new detentions occurred in 2018-192 and since 2006-7 there has been a 40% increase. Disturbingly there is also a disparity in the rates of detention among ethnic minority groups, with individuals from black ethnic groups being four times more likely to be detained than those from white groups.2 The Mental Health Act (MHA, 1983) defines the legal framework, the individual’s right to assessment and treatment in hospital, and the pathways back into the community. Detention under the Act requires that someone is considered to pose a risk to themselves or to others.

    One driver for these discharges was the NHSE and Chancellor of the Exchequer saying, “Whatever extra resources our NHS needs to cope with coronavirus – it will get”. The purpose of “maximis(ing) capacity where needed across mental health and learning disability and autism services” is to “free up inpatient capacity” and “as providers seek to safely discharge as many patients as possible, those with beds on acute trust campuses should also consider how those will be configured in the context of increasing pressures on critical care”(p4-6).1

    Did these individuals, in fact, pose continuous risks to themselves or others? As these are the grounds for continued detention. If they fared reasonably well on discharge, then how did our clinical judgment become so skewed that we started to detain people unjustly? We also need to understand if these rapid discharge decisions differentially affected people from ethnic minority communities?

    Discharge decisions were made at top speed—how was this possible? The levers included a stringent senior management review and, importantly, lifting economic barriers to discharge allowing suitable accommodation to be found. But financial pressures are not a reason for continuing to detain someone in hospital against their will.

    Investigating discharge effects will not be easy as staff shortages, caused by the pandemic, mean that community follow up has been limited and atypical. Some poor outcomes might be attributed to this limited community support, rather than the appropriateness of the person’s continued formal detention. Quarantine is also associated with stress3 and “lockdown” affects people with pre-existing mental health difficulties disproportionately.4 These effects may lead to spikes in readmission rates which could look like continued detention would have been justified.

    Psychiatric teams may have focused too much on optimising symptom control but many people experience symptoms and yet function well enough if there is adequate provision for their psychosocial needs (housing, employment, health etc). If we are to move mental health services “back to better” then we will need a review of how decisions are made and their consequences.

    An individual’s view of the therapeutic value of inpatient wards also affects the chance of their accepting admission.5 We know that introducing psychological or other evidence-based treatments to inpatient wards improves therapeutic value views of those and is also another part of “back to better”.6

    Mental health services have an opportunity to review health and social care in a holistic and population-based way in a post-covid world. Partnerships across health and social care are no longer an option but an imperative. Investment in these services is critical if we are not to return to old practices. Collaboration with third sector providers, voluntary and faith groups, informal networks, and families and carers needs to take place on a wholly different scale with a shift in the balance of power towards enabling people to make decisions in their own best interest. This is the reason the Mental Health Act was reviewed (The MHA Review, 2018)7 and we look forward to the government acting on it.

    Alison Beck, Head of Psychology and Psychotherapy at South London and Maudsley NHS Foundation Trust.

    Til Wykes, Professor of Clinical Psychology and Rehabilitation, Institute of Psychiatry, Psychology & Neuroscience, King’s College

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