national uk programme of community health workers for covid 19 response CORD-Papers-2022-06-02 (Version 1)

Title: National UK programme of community health workers for COVID-19 response
Published: 2020-03-24
Journal: Lancet
DOI: 10.1016/s0140-6736(20)30735-2
DOI_URL: http://doi.org/10.1016/s0140-6736(20)30735-2
Author Name: Haines Andy
Author link: https://covid19-data.nist.gov/pid/rest/local/author/haines_andy
Author Name: de Barros Enrique Falceto
Author link: https://covid19-data.nist.gov/pid/rest/local/author/de_barros_enrique_falceto
Author Name: Berlin Anita
Author link: https://covid19-data.nist.gov/pid/rest/local/author/berlin_anita
Author Name: Heymann David L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/heymann_david_l
Author Name: Harris Matthew J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/harris_matthew_j
sha: fe901de10b1387f77e6a71b9d5a8b02bb1f5b2e6
license: no-cc
license_url: [no creative commons license associated]
source_x: Elsevier; Medline; PMC
source_x_url: https://www.elsevier.com/https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 32220277
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32220277
pmcid: PMC7146683
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146683
url: https://www.sciencedirect.com/science/article/pii/S0140673620307352 https://api.elsevier.com/content/article/pii/S0140673620307352 https://doi.org/10.1016/s0140-6736(20)30735-2 https://www.ncbi.nlm.nih.gov/pubmed/32220277/
has_full_text: TRUE
Keywords Extracted from Text Content: UK cation provider human COVID19. NW London NIHR Applied Research NW London National Institute for Health Research (NIHR) Applied Research Collaboration. Imperial NIHR Biomedical Research Centre volunteers fosphenytoin Women CHW CHWs ConSEPT coronavirus disease 2019 pyramidal blood women infants COVID-19 £2·2 people COVID19 MJH valproate EcLiPSE patients levetiracetam Brazil, People coronavirus 2 NHS phenytoin L12 2AP
Extracted Text Content in Record: First 5000 Characters:an observation that could not be readily explained by the authors. Benefits of ESETT are its doubleblind design and the inclusion of valproate. However, the study did not include infants younger than 2 years, which probably reflects concerns of the potential hepatotoxicity of the drug in this age group. ESETT has a few limitations. The first limitation is the subjective nature of assessing seizure cessation in the absence of electroencephalography, a feature shared by EcLiPSE and ConSEPT. This measure reflects real life and also clinical practice and acumen in an emergency situation. Another potential limitation is the conjoint nature of the primary outcome, clinically apparent seizure and improving consciousness. Such an endpoint might have influenced the primary efficacy outcome, which has been acknowledged by the authors. Additionally, unlike in EcLiPSE and ConSEPT, a seizure is assumed to be a convulsive seizure, which was not made explicit in their results. The ESETT team concluded that levetiracetam, fosphenytoin, or valproate could be used as the first choice, secondline treatment, 7 which mirrors the conclusions of EcLiPSE and ConSEPT (levetiracetam or phenytoin). The ConSEPT team have taken a further leap of faith, and largely into the unknown, suggesting that clinicians should consider the sequential use of levetiracetam and phenytoin (in any order) before progressing to thirdline management of rapid sequence induction with anaesthesia. 9 The inclusion of valproate in a threedrug sequence would inevitably extend the duration of status epilepticus and risk irreversible neurological sequelae. A more rational first step would be a metaanalysis of these and other relevant randomised controlled trials. 10, 11 Such an analysis would subsequently inform a multidisciplinary debate between, and output from, general paediatricians and paediatric specialists in emergency medicine, neurology, anaesthetics, and intensive care. ESETT has substantially improved the evidence base in the secondline management of paediatric convulsive status epilepticus. The collective results of these three trials now demand careful interpretation and application of the evidence. I declare no competing interests. The Roald Dahl Neurophysiology Department, Alder Hey Children's Health Park, Liverpool, L12 2AP, UK The coronavirus disease 2019 (COVID19) pandemic threatens to kill large numbers of people in the UK and to place unprecedented demands on the National Health Service (NHS). The case fatality rate is increased in older people and those with preexisting disease and is reported to be about 20% in people with COVID19 who are older than 80 years, 1 although this does not take into account the underreporting of mildly affected cases. There are about 8·8 million people aged 70 years or older in the UK and many others with health conditions that increase their vulnerability to COVID19. In the face of the rapid spread of severe acute respiratory syndrome coronavirus 2, older people and other vulnerable groups are being asked to selfisolate for a considerable time to reduce the risks of infection, with potential adverse effects on physical and mental health. We propose a largescale emergency programme to train community health workers (CHWs) to support people in their homes, initially the most vulnerable but with potential to provide a longterm model of care in the UK. Experience from Brazil, Pakistan, Ethiopia, and other nations shows how a coordinated community workforce can provide effective health and social care support at scale. [2] [3] [4] To respond to the COVID19 pandemic, we suggest that CHWs would be young people, aged 18-30 years, in whom the likelihood of serious consequences from COVID19 is currently deemed low. 1 This demographic is increasingly likely to have been exposed to COVID19 and therefore have acquired immunity. Largescale unemploy ment as a consequence of the economic impact of this pandemic makes this a group potentially in need of employment opportunities. Despite the UK Government's enormous package of benefits designed to retain people in employment, substantial job losses are likely. Furthermore, up to 30 000 medical and physician associate students could be involved who cannot participate in usual clinical placements, possibly until September, 2020, because clinical attachments are being suspended. In Brazil, CHWs are trained over 4-6 weeks to deliver a wide range of health promotion activities. 4 This model suggests that a 1-2 week basic training programme on COVID19 and on public health surveillance could provide core skills and knowledge, particularly when combined with ongoing training and supervision. Online courses are available from some academic institutions on COVID19 and emergency measures to accredit and certificate these courses to agreed standards could be implemented. Recruitment and training could be overseen by Health Education England, commissioned from a higher edu cation provider or d
Keywords Extracted from PMC Text: People CHWs UK pyramidal CHW patients COVID-19 coronavirus 2 volunteers Brazil, 250 coronavirus disease 2019 people low.1 1–2 £2·2 NHS education.6 blood 18–30 self-isolate Brazil, years,1
Extracted PMC Text Content in Record: First 5000 Characters:The coronavirus disease 2019 (COVID-19) pandemic threatens to kill large numbers of people in the UK and to place unprecedented demands on the National Health Service (NHS). The case fatality rate is increased in older people and those with pre-existing disease and is reported to be about 20% in people with COVID-19 who are older than 80 years,1 although this does not take into account the under-reporting of mildly affected cases. There are about 8·8 million people aged 70 years or older in the UK and many others with health conditions that increase their vulnerability to COVID-19. In the face of the rapid spread of severe acute respiratory syndrome coronavirus 2, older people and other vulnerable groups are being asked to self-isolate for a considerable time to reduce the risks of infection, with potential adverse effects on physical and mental health. We propose a large-scale emergency programme to train community health workers (CHWs) to support people in their homes, initially the most vulnerable but with potential to provide a long-term model of care in the UK. Experience from Brazil, Pakistan, Ethiopia, and other nations shows how a coordinated community workforce can provide effective health and social care support at scale.2, 3, 4 To respond to the COVID-19 pandemic, we suggest that CHWs would be young people, aged 18–30 years, in whom the likelihood of serious consequences from COVID-19 is currently deemed low.1 This demographic is increasingly likely to have been exposed to COVID-19 and therefore have acquired immunity. Large-scale unemployment as a consequence of the economic impact of this pandemic makes this a group potentially in need of employment opportunities. Despite the UK Government's enormous package of benefits designed to retain people in employment, substantial job losses are likely. Furthermore, up to 30 000 medical and physician associate students could be involved who cannot participate in usual clinical placements, possibly until September, 2020, because clinical attachments are being suspended. In Brazil, CHWs are trained over 4–6 weeks to deliver a wide range of health promotion activities.4 This model suggests that a 1–2 week basic training programme on COVID-19 and on public health surveillance could provide core skills and knowledge, particularly when combined with ongoing training and supervision. Online courses are available from some academic institutions on COVID-19 and emergency measures to accredit and certificate these courses to agreed standards could be implemented. Recruitment and training could be overseen by Health Education England, commissioned from a higher education provider or devolved to an organisation such as Public Health England. CHWs could undertake regular review of vulnerable people at home in person or virtually, depending on need, and when patients become ill CHWs could undertake simple assessment of the need for more advanced care, reporting to other members of the primary care team, including to the COVID-19 Health Management Team that is being commissioned. CHWs would need to be provided with personal protective and other equipment and trained to follow protocols to assess temperature, blood pressure, and, with the provision of portable pulse oximeters, early detection of severe illness, thus collecting data for clinical and epidemiological purposes. Similar protocols are already in place and used by CHWs in diverse settings—eg, as part of the Integrated Management of Newborn and Childhood Illness.5 Additionally, home visits for vulnerable people would allow CHWs to assess whether individuals have adequate supplies of food and medicines for long-term conditions, are aware of basic hygiene precautions, and whether they have mental health problems. In future, CHWs might be involved in COVID-19 community testing and possibly supporting vaccine trials. Over time, CHWs might also contribute to the management of long-term conditions through monitoring physical and mental health, and reviewing availability and use of medicines. Entry criteria could include occupations that provide basic training in first aid or assessing medical emergencies, such as flight attendants, or registration on a health professional training programme. Although final year medical students might shortly be deployed in acute hospital settings, other senior medical students could be trained to provide supervision of CHWs. They could be overseen by public health trainees and ultimately by qualified public health professionals in a pyramidal structure, in collaboration with general practitioners and practice pharmacists. Virtual chat rooms could be used for working out solutions to common problems and virtual mentorship. The clinical students could work as volunteers in return for accreditation of valuable experiential learning in community health. This approach would meet a gap in UK undergraduate experience and might become a long-term feature of medical education.6 For a futu
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