The Covid-19 knock-on: public health and the impact of delays in non-urgent treatment and diagnosis

Since the beginning of the pandemic, concerns have been raised about the wider public health impacts of coronavirus. In addition to strains on acute NHS care services on the frontline, there are warnings about the additional public health impacts of delays to preventative healthcare measures like screening and routine medical care in the form of pre-planned operations for long-term chronic and non-urgent conditions.

At the outbreak of the pandemic many hospitals took the decision to delay or stop entirely routine pre-planned surgeries and preventative screening and diagnostics. Some even suspended treatment for more urgent care like cancer treatment on a short term basis. While many of these services have resumed since the beginning of the pandemic, albeit with a backlog of patients now to be seen, significant strain on the NHS as we come into the winter months because of  coronavirus is still anticipated. As a result, many hospitals are not working at full capacity in order to prepare for potential increases in admissions due to coronavirus or staff shortages over the winter.

In many areas this has led to a backlog of care, both for those patients already in the system awaiting routine surgeries, as well as those who are yet to be diagnosed but would have been through preventative screening programmes run by the NHS.

Delays in healthcare and routine screening programmes 

Even before the coronavirus pandemic took hold, many NHS hospital trusts were under criticism because of the significant length of waiting times for people who required routine operations, which in some parts of the UK can be as long as three years. Doctors across the UK are now warning that these delays could be increased further unless the NHS receives additional support to increase capacity across all areas of care  not just urgent care in the coming months.

Data released by NHS England in October 2020 showed the numbers waiting over a year for hospital treatment have hit a 12-year high, with almost 2 million patients waiting more than the target time of 18 weeks for routine care.

It has been suggested that delays in diagnosis and routine treatments could lead to an increased number of hospitalisations further down the line, requiring higher levels of care, longer lengths of stay, and increased hospital readmissions.

A reluctance to visit hospitals and use primary care services

Government messages to ‘protect the NHS’ may have had the unintended consequence of discouraging people from seeking urgent medical care when it was required for fear of using services unnecessarily or for fear of contracting the virus when attending hospital or primary care settings.

Research from the Health Foundation found that there had been a significant reduction in the number of GP consultations since the start of the pandemic which has led to concerns about the care of non-covid patients, patients with long term health conditions and also the potential for delayed diagnosis. Primary care consultations also reduced and have remained low consistently since the beginning of lockdown.

Figures have also shown a reduction in the number of referrals, medical tests, new prescriptions and immunisations. While some of these reductions are the result of advice to delay routine referrals to free up capacity for hospitals to deal with the potentially large number of cases of Covid-19, routine referrals have still not recovered to pre-lockdown levels.

 

A potential future crisis for the NHS and a ticking time bomb for public health

Doctors are now warning that the treatment backlog which has been caused by the coronavirus pandemic, in addition to diagnostic delays and screening programmes, may lead to a future crisis of care or significant delays in care for people waiting to receive more routine treatment.

Delays in care have not only been reported in cases of physical health. There have also been significant delays in referrals for those seeking treatment for a mental health condition, an area of the NHS which was already facing significant delays in referral and transfer of care even before the pandemic. Research suggests that incidence of mental illness during the coronavirus pandemic increased. However, the numbers of people accessing services and being referred for treatment have not increased proportionate to this. People with mental health conditions may have been unable to access appropriate support through primary care pathways, which could potentially impact on their long term health and care.

Finally, concerns have been raised about the wider social determinants of health such as employment and poverty. Public Health England (PHE) published a monitoring tool which looks at the wider impacts of the Covid-19 pandemic on population health, and it is likely that the knock-on impact of the virus could have far reaching consequences for public health in the future as the health implications of lockdown, lack of social interaction and rising unemployment could be significant. 

Where next?

While the challenges of the coronavirus pandemic for the NHS will not be going away anytime soon, it is clear that it will be necessary for the NHS and other supporting services to act now to prevent a longer term public health crisis. It is critical that we not only focus on the acute care of Covid-19 patients, but also proactively manage patients without Covid-19, particularly those with time-sensitive, complex and long term conditions who are postponing their care. We must also consider the knock-on impacts of delayed diagnosis for those people who missed out on routine screening or who were unable or too afraid to visit their GP or hospital. This is important not only to sustain health and life, but to preserve hospital and NHS capacity in the future.


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Domestic violence during quarantine: the hidden crime of lockdown

Domestic violence is often described as a “hidden epidemic” within the UK. Even before Coronavirus forced the country into lockdown, support services faced funding and resourcing challenges, and many people fleeing domestic abuse already faced barriers to accessing support,  but as social distancing has become the dominant policy response to suppress Covid-19, it is clear there have been unintended consequences for domestic abuse victims which have exacerbated the challenges in providing and accessing support.

An increase in reporting of domestic violence

Figures show that calls to domestic abuse services have increased significantly worldwide during the Coronavirus pandemic. Calls and online enquiries to the UK’s National Domestic Abuse line increased by 25% after the UK entered lockdown in March 2020. More than 40,000 calls and contacts were made to the National Domestic Abuse Helpline during the first three months of lockdown; in June, calls and contacts were nearly 80% higher than usual, according to the charity Refuge, who runs the service.

An investigation by the BBC’s Panorama found that three-quarters of victims told them that lockdown had made it harder for them to escape their abusers and in many cases had intensified the abuse they received and research by a team at LSE showed that while the overall level of domestic abuse crimes (not calls) have remained stable when compared with the long-term trend, calls to the Metropolitan Police between March and July which related to reports of domestic abuse increased by 11% compared with the same period in 2019.

This same research from LSE also noted some changes in the characteristics of the cases being reported, with calls more likely to be made by “third parties”, such as neighbours, and that while abuse by ex-partners fell by 9.4%, abuse by current partners and family members increased significantly – by 8.5% and 16.4% respectively.

In early May, the government announced a £76m package to support the “most vulnerable in our society”, including victims of domestic violence and modern slavery, rough sleepers and vulnerable children. However, with many charities which support victims of domestic abuse struggling with the financial fallout from the COVID-19 pandemic and facing a significant rise in demand for their services, concerns are being raised that the availability of specialist support could be reduced, meaning people exposed to domestic abuse may not be able to access the help they need.

Local level support for vulnerable people fleeing violence

Lockdown offered an opportunity for local authorities to think about the support offered to vulnerable people, including those who were homeless due to fleeing violence.

In Greater Manchester GMCA formed partnerships early on to secure accommodation for women fleeing violence to ensure they would have a safe space. The accommodation was intended for women who are homeless or facing homelessness, including rough sleeping or in shared supported accommodation where the service was unable to meet public health guidelines regarding Covid-19. This included women experiencing domestic abuse, trauma, or contact with the justice system as well as other multiple disadvantages. The service delivery model was designed to be a Trauma Responsive Service Model in order to create a safe and secure environment for each resident and to avoid further traumatisation. The process marked a departure from how cases of female homelessness due to domestic abuse would typically have been handled pre lockdown.

Halls of residence at the University of Cambridge were also offered to homeless women and their children after students vacated them early due to the pandemic. St Catherine’s College formed a partnership with Cambridge Women’s Aid to provide over 1000 nights of secure supported accommodation during the lockdown period.

In both instances the partnerships allowed for practical and quick solutions to provide support to vulnerable women, filling the support gap some traditional routes like refuge shelters were unable to fill because Covid 19- restrictions on the mixing of households meant that homeless and refuge centres were operating with a limited capacity.

Final thoughts

People fleeing domestic violence already faced significant barriers to finding the safety offered by refuge services, even before the lockdown imposed by the Coronavirus pandemic. But we know now that the pandemic has made it harder for survivors to leave an abuser or to seek help, that their experiences of abuse were made worse by the conditions imposed by lockdown and that the circumstances gave abusers more control than ever. When the pandemic is over the majority of local services expect to see a spike in people looking to access their life-saving support, but at the same time the pandemic has threatened the sustainability of the network of services which makes up this support, many of whom were already experiencing a funding struggle.

The work being done to help support vulnerable people fleeing abuse and people facing barriers to accessing refuge is more important now than it has ever been, and continuing support from government and effective partnership working will be vital to ensuring these services continue in the future.


If you need help or support in the UK, call the national domestic abuse helpline on 0808 2000 247, or visit Women’s Aid online.

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How the COVID-19 homelessness response shows opportunities for future progress

Before the UK entered lockdown in March 2020, there were already discussions around how the spread of COVID-19 would impact some of the most vulnerable people in our society. There was an acute awareness not only of the significant levels of homelessness in our towns and cities but that the number of people who needed support was growing at an alarming rate. Strategies for prevention and outreach programmes to help break the cycle of homelessness through a network of support systems for homeless people were helping to a certain extent in some areas, but the problem was (is) chronic and the concern among people who worked in, and had experience of, the sector in relation to the potential impact of COVID-19 was growing.

Homelessness during the COVID-19 pandemic

Surprisingly though, in many areas the response to support the UK’s homeless populations was swift, definitive and all encompassing. Partnerships were formed with local hotel chains – the GLA partnership with multiple hotel groups as part of the Pan London Placement scheme is probably the best publicised but individual arrangements have sprung up across the country and people were moved from the street into accommodation which was self-contained and would allow them to effectively isolate if they showed any symptoms of COVID-19.

In March, minister Robert Jennick announced £3.2 million of funding for councils to help them protect local rough sleepers from the pandemic and MHCLG, councils, the voluntary sector and those who work within homelessness outreach specifically have all mobilised to form an effective network of support for many people who had previously been sleeping on the streets.

The response to moving those who were sleeping rough off the streets has been unprecedented, as is the volume of people who have been helped. Many people have been accommodated regardless of their “local connection” or their “recourse to public funds”, something which previously was a significant barrier to many people being housed in temporary accommodation by their local authority.

A new wave of homelessness?

However despite the significant progress made, there are growing concerns about a “second wave of homelessness”- people who become homeless off the back of the stagnation and collapse of some areas of the economy, particularly those in low paid and precarious work i.e. hospitality and retail sector. Additionally, there are signs that some especially vulnerable groups have not engaged with the process or that some people have became homeless after the initial offer of support was rolled out. These include people from migrant backgrounds, and people with acute and severe mental ill health.

Things can’t go back to the way they were

One thing is clear, according to professionals, things can’t be allowed to return to the way they were. In some instances this is for practical reasons, and in other instances because we have been able to see what it is possible to achieve when people co-operate and there is a collective will to progress.

The use of communal shelters, one of the main ways of delivering emergency accommodation for many years may have to stop, or at least be re-organised to avoid multiple people sharing facilities like bathrooms or sleeping in rooms with multiple beds. A move towards more “pod style” contained living may be a way forward, but it will take a shift in design to accommodate people safely in the future.

The response has shown that it is vital to develop links between housing and health, and that the integration of services with public health to create wrap-around care (which is something which is currently being co-ordinated in response to the pandemic) should be maintained going forward.

The pandemic response has also shown that multiple organisations can work well effectively together and that the red tape, perceived layers of bureaucracy and challenges of different ways of working can be overcome if there is collective understanding and will. These barriers can be overcome to create really effective and much needed services and support for some of our most vulnerable citizens.

Concerns have been raised around future funding, and in particular the risks of funding being stopped abruptly or the supply being removed at short notice, for example if hotels re-open and councils then struggle to identify appropriate accommodation for people to transition into. The sector has stressed that councils should be planning for this transition phase to prevent people returning to the streets and dis-engaging with services.

Opportunities to learn lessons

At an online event hosted by the Centre for London, which brought together professionals from within the sector in London to reflect on the response to COVID-19, somewhat surprisingly, the atmosphere was one of optimism that this could be the start of a new way of working. There is hope that a “can do” and “get things done attitude” which had been catalysed by the need for urgency because of the spread of COVID-19 can be harnessed and that this mindset should be embedded into practice going forward.

One of the main questions that appears to be raised is, if we can do it now, with such urgency, why couldn’t we do it before, and what steps need to be taken to ensure that the collective will and the government support doesn’t disappear post COVID-19? This is something local authorities, homeless outreach groups and other partners will have to grapple with over the coming weeks and months.

The response to the pandemic has been unprecedented. It has shown that with understanding, flexibility and effective partnership working to deliver coordinated services (as well as appropriate supply and funding) that tackling homelessness, or at least offering more to our homeless communities in terms of effective long term support, can be achieved.

There is a collective sense within the sector that the steps forward taken as a result of this pandemic should not be allowed to regress in the future, but should be strengthened and built upon to provide more effective support going forward for homeless communities across the UK.


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Read some of our other blogs on housing and homelessness:

Knowledge from a distance: recent webinars on public and social policy

During the national lockdown, it’s been impossible for most of us to attend conferences and seminars. But many organisations have been harnessing the power of technology to help people share their knowledge, ideas and experience in virtual seminars.

In the past few weeks, the research officers at The Knowledge Exchange have joined some of these webinars, and in today’s blog post we’d like to share with you some of the public and social policy issues that have been highlighted in these online events.

The liveable city

Organised by the Danish Embassy in the UK, this webinar brought together a range of speakers from Denmark and the UK to consider how our cities may change post COVID-19, including questions around green space, high street recovery, active travel and density and types of residential living accommodation in our towns and cities.

Speakers came from two London boroughs, architectural design and urban planning backgrounds and gave examples of experiences in Newham, Ealing and Copenhagen as well as other more general examples from across the UK and Denmark. The seminar’s website also includes links to presentations on previous Liveable City events in Manchester, Edinburgh, Bristol and Glasgow.


What next for public health?

“Healthcare just had its 2008 banking crisis… COVID-19 has generated a real seismic shift within the sector and I don’t think we will ever go back”

This webinar brought together commentators and thought leaders from across the digital health and tech sectors to think about how public health may be transformed by our experiences of the COVID-19 pandemic and the significant shift to digital and online platforms to deliver care.

The speakers discussed data, privacy and trust and the need to recognise different levels of engagement with digital platforms to ensure that specific groups like older people don’t feel unable to access services. They also discussed the importance of not being driven by data, but using data to help us to make better decisions. The webinar was organised by BIMA, a community of businesses, charities and academia across the UK.


Green cities

This project, organised by the Town and Country Planning Association (TCPA), included 3 webinars each looking at different elements of green infrastructure within cities, including designing and planning, assessing the quality of different types of green infrastructure and highlighting the positive impacts of incorporating more good quality green spaces for mental and physical health, as well as for environmental purposes.


Rough sleeping and homelessness during and after the coronavirus

Organised by the Centre for London, this webinar brought together speakers from across the homelessness sector within London, including St Mungos, the Greater London Authority (GLA) and Croydon Council to explore how the COVID-19 pandemic was impacting people who are homeless or sleeping rough in the city.

Each speaker brought insights from their own experiences supporting homeless people in the capital (so far) during the COVID 19-pandemic. They highlighted some of the challenges, as well as some of the more positive steps forward, particularly in relation to co-operation and partnership working across different levels of government and with other sectors such as health.

They also commended everyone involved for the speed at which they acted to support homeless people, particularly those who were vulnerable or at risk. However, concerns were also raised around future planning and the importance of not regressing back into old ways of working once the pandemic response tails off.


Poverty, health and Covid-19: emerging lessons in Scotland

This webinar was hosted by the Poverty Alliance as part of a wider series that they are hosting.  It looked at how to ‘build back better’ following the pandemic, with a particular focus upon addressing the long-standing inequalities that exist throughout society.

The event included presentations from Dr Gerry McCartney, Head of the Public Health Observatory at Public Health Scotland, Dr Anne Mullin, Chair of the Deep End GPs, and Professor Linda Bauld, Professor of Public Health at University of Edinburgh.

A key message throughout was that while the immediate health impacts of the pandemic have been huge, there is an urgent need to acknowledge and address the “long-term challenge” – the impact on health caused by the economic and social inequalities associated with the pandemic.

It is estimated that over 10 years, the impact of inequalities will be six times greater than that of an unmitigated pandemic. Therefore, ‘building back better’ is essential in order to ensure long-term population health.


Returning to work: addressing unemployment after Covid-19

This webinar was also hosted by the Poverty Alliance as part of their wider webinar series on the pandemic.

The focus here was how to address the inevitable rise in unemployment following the pandemic – the anticipated increase in jobless numbers is currently estimated to be over three million.

The event included presentations from Kathleen Henehan, Research and Policy Analyst at Resolution Foundation, Anna Ritchie Allan, Executive Director at Close the Gap, and Tony Wilson, Director of the Institute for Employment Studies.

The webinar highlighted the unprecedented scale of the problem – noting that more than half of the working population are currently not working due to the pandemic, being either unemployed, furloughed or in receipt of self-employment support.

A key theme of the presentation was that certain groups are likely to be disproportionately affected by unemployment as the support provided by the government’s support schemes draw to a close later this year.  This includes women – particularly those from BAME groups, the lower paid and migrants – and young people.  So it’s essential that the support provided by the government in the form of skills, training, job creation schemes etc addresses this, and is both gender-sensitive and intersectional.


Supporting the return to educational settings of autistic children and young people

The aim of this webinar, provided by the National Autism Implementation Team (NAIT), was to offer a useful overview of how to support autistic children and young people, and those with additional support needs, back into educational settings following the pandemic.

Currently around 25% of learners in mainstream schools have additional support needs, and it is generally accepted that good autism practice is beneficial for all children.

The webinar set out eight key messages for supporting a successful return, which included making anticipatory adjustments rather than ‘waiting and seeing’, using visual supports, providing predictability, planning for movement breaks and provision of a ‘safe space’ for each child.  The importance of listening to parents was also emphasised.


P1050381.JPG

Ellisland Farm, Dumfries. “P1050381.JPG” by ejbluefolds is licensed under CC BY-NC 2.0

Burns at Ellisland

Our Research Officer, Donna Gardiner has also been following some cultural webinars, including one that focused on the links between Scotland’s national poet and the Ellisland Farm site. The webinar was led by Professor Gerard Carruthers, Francis Hutcheson Chair of Scottish Literature at the University of Glasgow and co-director of the Centre for Robert Burns Studies.

Robert Burns lived at Ellisland Farm in Dumfriesshire between May 1788 and November 1791, and is where he produced a significant proportion of his work – 23% of his letters and 28% of his songs and poems, including the famous Tam O’Shanter and Auld Lang Syne.

The presentation looked at how Robert Burns was influenced by the farm itself and its location on the banks of the River Nith.  It also touched on his involvement with local politics and friends in the area, which too influenced his work.

It was suggested that the Ellisland farm site could be considered in many ways to be the birthplace of wider European Romanticism. The webinar also included contributions from Joan McAlpine MSP, who is chair of the newly formed Robert Burns Ellisland Trust. She discussed how to help promote and conserve this historic site, particularly given the impact of the coronavirus on tourism.


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Getting back to business: creating and managing a COVID-secure workplace

 COVID-19 has changed the world and how we live our lives. As well as being a public health emergency, it has had huge economic implications. At the start of the pandemic, millions of people around the world were instructed to stay at home, either to work or to remain on the payroll with support from the state.

While the lockdown has successfully reduced the number of COVID-19 cases, business cannot remain on hold forever. Gradually, carefully, workplaces are reopening, and workers are preparing to return to their jobs in offices, shops, schools and construction sites.

A new White Paper produced by The Knowledge Exchange looks at how the workplace has to change in response to the COVID-19 pandemic.

A redefined workplace

Before the pandemic, the workplace landscape was already changing. But now it is being totally redefined. Organisations of all shapes and sizes, in all sectors, are facing hard decisions. And how to reopen their workplaces, in a way that protects the health and wellbeing of their employees, is a key challenge.

The White Paper focuses on what employers have to consider when thinking about how to reduce the spread of the coronavirus. The most important challenges concern:

  • social distancing, including areas where this is more difficult, or not possible;
  • organising the workplace, including the location of desks and the installation of additional features, such as screens and hand-drying facilities;
  • cleaning and sanitising, including what needs cleaning, who will do it and when.

As well as complying with guidance, employers have to make sure their staff are confident in the plans for reopening workplaces. A survey for the Chartered Institute of Personnel and Development in May showed that almost half (44%) of respondents were concerned about catching COVID-19 at work.

How businesses can prepare for reopening

Every organisation needs to introduce sensible measures to control risks. Therefore, before reopening a workplace, it is vital to conduct a COVID-19 risk assessment, in line with guidance from the Health and Safety Executive.

A risk assessment should:

  • identify what work activity or situations might cause transmission of the virus;
  • think about who could be at risk – paying attention to whether the people doing the work, or those they live with, are especially vulnerable to COVID-19;
  • decide how likely it is that someone could be exposed;
  • act to remove the activity or situation, or if this isn’t possible, control the risk.

During the risk assessment, it’s essential  to consult with workers and afterwards to share the results. Different industries and sectors may require specific measures. On construction sites, for example, access between different areas may need to be restricted, and high traffic areas may have to be regulated to maintain social distancing. The UK government has published guidance covering a range of different types of work in places such as offices, factories, shops and outdoor working environments.

Actions to make the workplace COVID-secure

The UK government and the Scottish, Welsh and Northern Ireland devolved administrations have provided guidance on how to work safely. This gives practical advice on how the guidance can be applied in the workplace.

In planning to reopen their workplaces, every organisation should translate this guidance into the specific actions it needs to take, depending on the nature of their business. At the same time, employers must also ensure that everyone in the workplace continues to be treated equally. Discrimination against anyone because of a protected characteristic, such as age, sex or disability is against the law, and employers also have particular responsibilities concerning disabled workers and new or expectant mothers.

The White Paper contains a checklist of actions which all organisations need to take. These include

  • developing cleaning, handwashing and hygiene procedures;
  • helping people to work from home;
  • maintaining social distancing;
  • managing transmission risk where social distancing is not possible.

CAFM Explorer: an invaluable support tool for getting back to work

Much of the workload involved in ensuring a safe and effective return to work will be taken on by facilities managers. Keeping workplaces clean, managing shift patterns, ensuring availability of personal protective equipment and creating procedures for inbound and outbound goods are just some of the many considerations to be made.

The White Paper highlights the value of the CAFM Explorer software solution to help organisations manage and consolidate information on the vital elements of a COVID-secure workplace, such as one-way systems, desk spacing, cleaning, staggered hours and hand sanitising stations.

Developed by Idox, a trusted supplier of digital software and services, CAFM Explorer can also trigger work orders as a result of an action – for example, ensuring a desk is cleaned once it has been booked – as well as providing processes to support working at home.

Final thoughts

It is too early to say what lasting effects the coronavirus will have on UK society and business, but it’s likely we will all be living in the shadow of COVID-19 for the foreseeable future. It’s essential, therefore, that organisations make themselves aware of the steps necessary for preparing, implementing and managing the Covid-secure workplace.

To receive your free download of the Getting Back to Business White Paper, please visit the CAFM Explorer page or email marketing@idoxgroup.com.


Further reading: articles on employment and the workplace from
The Knowledge Exchange blog

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The Knowledge Exchange remains open for business and continues to provide current awareness and enquiries services to our clients. If you have any questions, please get in touch.

Digital infrastructure supporting health care during the COVID-19 pandemic

Healthcare is a key frontline service in the response to the COVID-19 outbreak. The NHS has had to react at pace to plan and deliver services in new and innovative ways.

Digital healthcare solutions are at the fore of ensuring not only the delivery of acute care for those patients suffering from COVID-19 but are also supporting the successful continuity of care and the day to day running of a health service which still needs to maintain “normal service” as well as its pandemic response. Digital infrastructure is helping the NHS and other partners to adapt and to meet the demand for health and care in a number of ways.

Supporting the delivery of care

In many ways, the NHS and frontline care in particular were already making inroads towards transitioning to digital and online platforms before the pandemic emerged. Many GP surgeries allow online appointment booking, and where appropriate, monitoring of those with long term conditions can be done remotely through at-home testing facilities, such as home heart monitors or monitors to help people monitor their diabetes.

Many care providers also already offer telehealth solutions for clients, and patient records are now stored online. However, in many ways the COVID-19 pandemic has catalysed uptake of digital solutions to healthcare diagnosis and delivery, with an increase in online consultations, greater use of the NHS Digital and NHS24 online and app platforms and a rise in the development of digital solutions to better support care in the community.

Support and training for frontline staff

In addition to supporting the direct delivery of care to patients, digital health infrastructure is also being adapted and used to deliver training and support to staff on the frontline. Blogs and online forums, including social media groups are enabling people to share experiences and best practice, and to create a sense of community among healthcare workers. In addition, virtual and e-learning opportunities are being developed to enable staff to access educational activities remotely. These include supporting the rapid education of the healthcare workforce in how best to manage the respiratory conditions encountered, as well as providing education to staff who may have been redeployed to other departments or settings as a result of the pandemic response. Online learning has also been used to help train volunteers and help the public to keep up to date with the latest developments across the health service.

Beyond healthcare to support the response to the pandemic

Artificial intelligence and data analytics also have a vital role to play in helping prevent the spread of coronavirus and other infectious diseases as digital solutions look to be developed to help beyond acute healthcare responses.

Predictive analytics and scenario modelling can be used to help identify those populations who are at risk of spreading the virus and of falling most severely ill to help support shielding campaigns and protect vulnerable groups as lockdown measures ease.

A project run by UK firm Biobank is looking to use samples collected by volunteers to map genetic sequencing in order to identify whether certain genetic characteristics make people more predisposed to become seriously ill, or more likely to contract the virus in the first place. This may help in the development of a vaccine and can also help identify those groups who will be most vulnerable when lockdown conditions are lifted so that they can be monitored more effectively.

Modelling and analytics can also be used to try and project any potential “second waves”. It is hoped that AI, analytics and machine learning will be able to help organisations learn from events such as the SARS epidemic, as well as quickly creating new knowledge from the millions of data points being generated in this outbreak.

Final thoughts

The significant humanitarian response to this global pandemic is being underpinned by a digital infrastructure, the extent of which we have never had at our disposal before. This digital support, of care delivery, communication, analytics, and modelling is being used in conjunction with insight from health and scientific specialists to try and help us find a path through this pandemic, deliver care, aid recovery and prevent re-emergence.

Making best use of the data and digital capacity we have throughout our health and care infrastructure will be a key part in preparing and meeting the needs and challenges that communities are facing.


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Further reading: articles on COVID-19 from The Knowledge Exchange blog

Coping with covid: supporting autistic children through and beyond lockdown

The measures put in place to reduce the spread of coronavirus (COVID-19) have impacted almost every aspect of our lives – from our contact with family, friends and loved ones, to how we work, eat, shop, relax and learn.

Adapting to and living with these new measures has been universally challenging.  For autistic people, the changes to daily life associated with the COVID-19 outbreak present a number of additional challenges.  In this blog, we are going to discuss some of these additional challenges, with a particular focus on autistic children and young people.  We also highlight some available supports.

Change of routines

A key feature of autism is the desire to follow certain routines and/or avoid unexpected or unpredictable events. Thus, adjusting to the changes caused by COVID-19 poses particular difficulty for many autistic people, for whom changes to routine may cause additional anxiety, distress and in some cases, emotional overload.

Other autistic people may be distressed because of the lack of structure their day now has – being unable to tell one day from the next, when there are no defining characteristics, can feel particularly disorientating.

Scottish Autism have produced guidance for autistic people and their parents/carers on helping to maintain a routine and the reasons why this is important.  They explain that not only does maintaining a routine provide a sense of security and stability, it can also help to provide a sense of calmness, support emotional self-regulation and encourage health and positive habits.

Many autistic children already use visual schedules and/or calendars to let them know what is happening and what to expect next.  These can be helpful in the current circumstances to help children adapt to new routines at home, and bring some sense of predictability and control to their changed lives.

 Being at home

Another change that COVID-19 has brought about is that more people within the household are at home than is typical – for example, one or both parents/carers may be working from home, along with any siblings/other householders who are usually in education or work.

This may be present challenges for autistic people both in terms of the change to routine and also in terms of sensory issues (e.g. noise).  For example, the household being busier than usual may be more challenging for autistic people as they will subsequently have less time and/or space to themselves, which may be needed in order to self-regulate and/or avoid sensory overload.

Special interests

Many autistic people have special interests that form a large part of their daily routines, and may play a key role in enabling them to relax, self-regulate and recover from sensory overload.

The coronavirus ‘lockdown’ has prevented most outdoors activities from taking place.  Thus many autistic people may have found that their special interest is no longer open to them – from train spotting to bird watching.  The removal of this activity from their life may be experienced as particularly distressing, and make self-regulation more difficult.

School closures

The widespread closure of schools means that many parents of autistic children have found themselves responsible for educating their child at home.

Educating children at home under these new circumstances is challenging for all parents.  However, for parents of autistic children, it presents additional challenges.

Many autistic children require additional support with their learning, and may experience difficulties sustaining concentration.  Autistic children may also have additional support needs such as dyslexia or dyscalculia, which may require the use of specific approaches and/or learning aids.  This presents additional challenges for learning in the home environment for parents that are unaccustomed to providing a full time education for their child.

In school, many autistic children receive additional support in class either in a 1-2-1 or in a small group lesson from practitioners skilled in addressing these additional needs. Replicating this level of support at home is of course challenging for parents who may not be familiar with the techniques used, or skilled in their use.  They may also struggle to provide the necessary 1-2-1 support if they are also expected to work from home themselves, or have other children to care for.

Concern about their child being disproportionately affected by school closures without the skilled support that they receive in schools may also add considerable stress.  For example, the United Nations has recently noted in a briefing paper that children with disabilities and special needs are among those most dependent on face-to-face services and are least likely to benefit from distance learning solutions.

As well as adequately supporting special educational needs, there are also challenges in relation to an autistic child’s ability and/or willingness to undertake schoolwork at home.  Some autistic people have difficulties with what is termed ‘flexible thinking’. This may include, for example, the ability to see something in a new way. Autistic children may be more likely to have a fixed perception of home as distinct from school.  Thus, it may be more difficult for autistic children to accept and adapt to schoolwork being done at home.  Similarly, they may not readily accept the notion that their parent or carer is now also their ‘teacher’, particularly if this person is usually relied upon as being their primary source of comfort and safety when distressed.

Accessible home learning

While this is without a doubt a difficult situation for both autistic people and their parents/carers, the good news is that there is an increasing amount of support and sources of advice available to help support autistic people to adapt and respond to the ‘new normal’ that the coronavirus pandemic has created.

On Twitter, the #accessiblehomelearning hashtag has been trending, with people sharing lots of home learning ideas and support for parents and carers, including tools to support individuals with dyslexia and/or reading and writing difficulties.

Lucy Chetty, Head Teacher at New Struan School has also shared her top tips on education at home.  She notes that different young people will experience the changes to life differently – some will enjoy having more control over their day outside of school, whereas others will miss the routines that they are used to.

According to Lucy, happiness and fun is a key aspect of learning. Thus parents and carers should try to find something that interests and motivates their individual child special interests may be of particular help in this regard.

On a practical level, ensuring clarity is hugely important.  This includes providing clear instructions, and setting out a clear beginning, middle and end to the activity.  Also recommended is ‘chunking down’ activities into smaller pieces so that there are regular breaks, and the use of visual strips and/or timers to help illustrate how long an activity will last.

 Re-opening schools

As we look ahead to the future, there are a number of critical issues that need to be considered to support autistic children and/or adults to transition back out of lockdown.

Transitioning back into the school environment will be challenging for many autistic children, particularly those that have previously found it difficult to attend school, and/or have experience of ‘school refusal’.  For many autistic children, successful school attendance has required a great deal of input from teaching and support staff, parents and the child themselves. This is because the school environment is often experienced as being particularly challenging for a number of different reasons – for example, sensory issues (e.g. noises, smells, lighting), difficulties with processing information, and/or social communication challenges (social skills, etiquette, etc).  Many autistic children also experience heightened levels of anxiety, which is exacerbated by the school environment.

Many autistic children will need additional support with the change of routine back to school days and hours, and also with their anxiety levels – particularly if they have concerns about catching and/or spreading the virus, or if other people within the school are perceived to be ‘not following the rules’.

Additional support for transitioning back into school will be particularly important if the new school environment looks significantly different to that which the child is used to as a result of social distancing measures – for example, by attending different hours or days at school, or having different classroom set ups to allow for social distancing – both of which are options currently being considered by the Scottish Government.

Transitioning out of lockdown

In recognition of the difficulties facing many autistic people and their parents and/or carers, the Scottish Government recently announced new funding to help provide additional support in the form of an extended helpline run by Scottish Autism, and the creation of online social support groups by the National Autistic Society Scotland. 

Researchers at UCL Institute of Education are also currently conducting research into the experiences and needs of parents and carers of autistic children during the pandemic, which will hopefully help inform how they can best be supported as we transition out of lockdown and into the future, where we learn to live alongside coronavirus.

In Scotland, the Education Recovery Group is currently exploring options for stabilising the education of pupils with additional support needs as “an early priority”.

While there is still a degree of uncertainty about how and when lockdown will be eased across the UK, what is certain is that the easing of lockdown – whenever it happens – will present additional challenges for many autistic people and their parents/carers. Listening to the voices of autistic people and their parents and carers will be hugely important if they are to be successfully supported in this transition.


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The economic impacts of the coronavirus outbreak: what the experts are saying

While the coronavirus outbreak is first and foremost a public health emergency, the economic damage caused by the pandemic is also a huge concern. In recent weeks, think tanks and economists have been offering their thoughts on just how badly they believe the economy will be affected by Covid-19, and how long it might take to recover.

With each passing week it’s emerging that the economic impact of the coronavirus could be more severe than first thought. The International Monetary Fund (IMF) has warned that the shutdown of economic activity in the world’s major economies is likely to trigger a far more painful recession than the one following the financial crisis of 2008. The IMF now believes that the world is facing the worst economic downturn since the Great Depression of the 1930s.

In the UK, an equally gloomy prognosis has come from the Office for Budget Responsibility (OBR), the government’s fiscal watchdog. Its stark assessment of the possible economic impact of Covid-19 indicates that the UK economy could shrink by 35% and unemployment could rise to more than two million.

The regional picture

The economic impact of coronavirus is varying significantly across the country. Research by the Centre for Progressive Policy (CPP) has revealed that the decline in economic output is estimated to reach almost 50% in parts of the Midlands and the North West in the second quarter of this year. In terms of decline in Gross Value Added (GVA), Pendle in the North West is estimated to be the hardest hit local authority in the UK, followed closely by South Derbyshire and Corby in the East Midlands.

In Scotland, since the coronavirus outbreak began, the University of Strathclyde’s Fraser of Allander Institute (FAI) has been publishing regular updates about how business is being affected.

The FAI’s most recent survey of Scottish businesses  finds that, while all sectors of the Scottish economy have been severely affected by the crisis in terms of staffing levels, the accommodation and food services sector (which includes hotels, bars and restaurants) has experienced the harshest impacts, with 77% of businesses reducing staff numbers. In addition, 85% of businesses expect growth in the Scottish economy to be weak or very weak over the next 12 months.

On a more positive note, the FAI survey found that more than 95% of businesses which are planning to use the UK government’s  Coronavirus Job Retention Scheme believe it will be ‘very effective/effective’ in supporting their survival during the pandemic.

Business and employment support

The Job Retention Scheme is one of a series of measures introduced by the UK government aiming to limit the impact of the coronavirus, and ensure much of the economy is able to recover when the health crisis is over. While these actions have been widely welcomed, there have been calls for the UK to learn from more innovative measures adopted by other governments.

A report by the Policy Exchange think tank has highlighted Denmark’s wage subsidy, which is differently calibrated to the Job Retention scheme in the UK. While the Danish government is covering 75% of the salaries of employees paid on a monthly basis who would otherwise have been fired, for hourly workers the government will cover 90% of their wages, up to £3,162 per month. The Policy Exchange report notes that this assumes that workers paid by the hour won’t have the savings and support networks that generally better off salaried workers are likely to have.

Household challenges

The bigger economic picture is bad enough. But the real pain of an economic recession will be felt much closer to home. For individual households, social distancing measures aiming to contain the spread of coronavirus are already having significant impacts on spending habits. Research by the Institute of Fiscal Studies (IFS) has highlighted how these changes may be affecting people on different incomes.

The IFS suggests that richer households will be more resilient to falls in income since a considerable proportion of their spending goes on things that are currently not possible, such as eating out and holidays. But because lower-income households spend a higher share of their income on necessities, such as rent and food, the IFS suggests that they will be less resilient to any fall in income.

Exiting lockdown

In recent days, governments in France and Germany have set out plans for easing their lockdown restrictions, while Austria and Italy have already allowed some shops to open.  But the UK government has extended its lockdown to the beginning of May, and has not announced a clear exit strategy.

The uncertainty surrounding the trajectory of the coronavirus makes it exceptionally difficult to see when things might return to normal. But some analysts are becoming concerned about the harm that a prolonged lockdown might do.  A discussion paper published at the beginning of April highlighted some of these dangers:

“A long lockdown will wipe out large swathes of the economy. There will be a negative impact both financially and mentally on too many people. Already the lockdown has seen a surge in domestic violence. How to end the lockdown is key to helping restart the economy.”

The authors of the paper have put forward a strategy for ending the lockdown, suggesting that a phased traffic light approach (red, amber, green) would give everyone a clear sense of direction and address the economic, social and quality of life challenges posed by the lockdown.

After the virus

There is no clear agreement among economists on how the economy might fare once the health emergency has passed. Some economists forecast a sharp recovery, others suggest it will take two or more quarters, while still others forecast an initial boost in activity followed by another dip when the effects of unemployment and corporate bankruptcies start to filter through.

But there is a growing sense that the pandemic will have a fundamental impact on the economic and financial order. And in the UK, Paul Johnson, director of the IFS,  has suggested there will be an economic reckoning:

 “We will need a complete reappraisal of economic policy once the current economic dislocation is behind us. Tough decisions will have to be made which are likely to involve tax rises and higher debt for some time to come. The only other alternative would be another period of austerity on the spending side. That looks unlikely.”


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Guest post: Economic effects of coronavirus lockdowns are staggering – but health recovery must be prioritised

By Pushan Dutt, INSEAD

In all my years as an economist, I have never seen a graph like the one below. It shows unemployment claims in the US – observe the spike for the week ending March 21. The global financial crisis, the dot-com crash, Black Monday, oil price shocks, 9/11, none of these historic shocks are even visible in the graph.

Figures: US Department of Labor

 

The spike in unemployment claims is the proverbial canary in the goldmine. We should expect a swathe of bad economic numbers coming down the pipeline. The head of the St. Louis Fed expects a 30% unemployment rate and a 50% drop in US GDP by summer. More importantly, as the health crisis rises and crests at different times in different parts of the world, the horrifying numbers on GDP growth, unemployment, business closures are not likely to let up in the near term. Multiple countries are in a recession, and eventually, the whole world will fall into a deep recession.

The plunge from prosperity to peril will be as swift as the switch to lockdown protocols in most countries. We cannot even rely on the data we have to reveal the speed and depth of the crisis since this is collected and updated with lags. For instance, the US monthly jobs report for March collects data in the second week of March, failing to capture the massive spike in unemployment claims that appears after March 12.

In the meantime, sources such as restaurant booking website OpenTable can offer some insights into the magnitude of things. The figures below show the recent plummet in diners eating at restaurants in four countries. Observe a sudden stop in the entire restaurant industry by the third week of March.


Annual % change in restaurant diners from end of February to end of March.

Data: OpenTable

 

Combine a black swan event with missing data, and it is not surprising that markets are swinging violently.

Deep freeze

The question is not one of whether we are in a recession – we are. The more pertinent questions are: how long it will last? How deep it will be? Who will be impacted the most? And how swift will the recovery be?

These questions are complicated and even top economists must admit a lack of confidence in their answers. We are not experiencing a standard downturn. Nor is it simply a financial crisis, a currency crisis, a debt crisis, a balance of payment crisis or a supply shock.

We have not seen anything like this since the flu pandemic of 1918. Even there, identifying the effects of the flu is confounded by the first world war that took place at the same time. What we have here is something different. At its heart, we are experiencing a healthcare crisis with various parts of the world succumbing in a staggered fashion.

To slow down this global health crisis (the “flatten the curve” mantra), we have chosen to put the economy into deep freeze temporarily. Production, spending, and incomes will inevitably decline. Decisions to reduce the severity of the epidemic exacerbate the size of the contraction. While the initial decision to reduce labour supply and consumption are voluntary, this will likely be followed by involuntary reductions in both, as businesses are forced to lay off workers or go bankrupt.

Of course, government policies will attempt to mitigate these effects. Some are using traditional monetary and fiscal policies (cutting interest rates, quantitative easing, increasing unemployment insurance, bailouts). Others are trying out non-traditional methods (direct cash transfers, loans to businesses conditional on maintaining unemployment, wage subsidies).

Public health priority

How long the economic impact lasts depends entirely on how long the pandemic lasts. This, in turn, depends on epidemiological variables and health policy choices. But even when the pandemic ends, the resumption of normalcy is likely to be gradual. Countries will persist with a strict containment regime like in China today, and continue to impose travel restrictions to various parts of the world where the disease continues to spread.

The many factors at play in this complex, interlinked crisis that affects both people’s health and the global economy introduces massive uncertainty into anyone hazarding the pace, the depth and the length of the impact. As a result, we should treat any precise estimates (such as “GDP will decline by X%” or “markets have reached their bottom”) with scepticism.

Especially frustrating is the idea that there is a conflict between academic disease modellers and hard-edged economists saying that steps to slow the spread of coronavirus has trade offs. This could not be further from the truth. Among economists there is near unanimity that countries should focus on the healthcare crisis and that tolerating a sharp slowdown in economic activity to arrest the spread of infections is the preferred policy path. In a recent survey carried out by the University of Chicago, respondents universally agreed that you cannot have a healthy economy without healthy people.

The health crisis has naturally created a crisis of confidence. This, in turn, can have damaging long-term effects with continuing uncertainty leading firms and households to postpone investment, production and spending. Restoring confidence requires a singular focus on containing and reversing the spread of COVID-19.

Slowing the rate that people fall ill with COVID-19 is not the end in itself. It is a means to temporarily reduce the pressure on hospitals and give time to identify treatments and a vaccine. In the interim, we must build testing capacity, perform contact tracing, setup the infrastructure for extended quarantines, rapidly expand the production of masks, ventilators and other protection equipment, build and repurpose facilities into hospitals, add intensive care capacity and train, recall and redeploy medical personnel.

All of this is also the way to restore the economy’s health and economic policy must complement it. In the short run, economic policies should mitigate the impact of lockdowns and ensure that the current crisis does not trigger financial, debt or currency crises. It should focus on flattening the recession curve, ensure that the temporary shutdown has only transient effects, and facilitate a quick recovery once the economy is taken out of the deep freeze.

In the meantime, it’s important to also recognise that this is an unprecedented crisis. Everybody has their role to play, but nobody is infallible and uncertainty is inevitable.

Pushan Dutt, Professor of Economics, INSEAD

This article is republished from The Conversation under a Creative Commons license. Read the original article.


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