Useful Information for Doulas and Doulas in Training Covid 19

Latest Covid-19 Guidance & Resource Update

 

Government (https://www.gov.uk/coronavirus)

*Updated*

Stay at home

  • Only go outside for food, health reasons or work (but only if you cannot work from home)
  • If you go out, stay 2 metres (6ft) away from other people at all times
  • Wash your hands as soon as you get home

Do not meet others, even friends or family.

You can spread the virus even if you don’t have symptoms.

Stay at home guidance for households with suspected Covid-19 infection: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance

Guidance for shielding and protecting the medically vulnerable: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

All households are to receive a letter from the PM explaining that things are expected to get worse before they get better, and a leaflet with advice and guidance.

It was announced frontline hospital staff in England were starting to be tested to see whether they have coronavirus. Workers with symptoms and those who live with people who have symptoms will be checked – starting with hundreds of critical care doctors and nurses. Tests for A&E staff, paramedics and GPs are expected to follow, then social care staff. In Wales, Scotland, and Northern Ireland health workers are already being tested.

Latest update: NHS staff who are self-isolating because somebody in their home is ill are to be tested for Covid-19 first in the hope they can return to work.

NHS (https://www.nhs.uk/conditions/coronavirus-covid-19/)

*No changes*

As above (same as Gov guidance)

To help yourself stay well while you’re at home:

  • stay in touch with family and friends over the phone or on social media
  • try to keep yourself busy – you could try activities like cooking, reading, online learning and watching films
  • do light exercise at home, or outside once a day

Blog – Public Health Matters: Coronavirus (COVID-19) – 5 things you can do to protect yourself and your community: https://publichealthmatters.blog.gov.uk/2020/03/04/coronavirus-covid-19-5-things-you-can-do-to-protect-yourself-and-your-community/

NICE (https://www.criticalcarenice.org.uk/end-of-life-care)

*No changes*

With COVID-19 the same principles outlined in NICE guidance for care of the dying patient apply. Aims of end-of-life care are:

  • To enable a dying patient to have a good natural death
  • Support family through bereavement and grief
  • Support and protect staff from moral distress and burn-out

It is important to remember two key principles:

  • Life has philosophical as well as physiological components and a good death can provide the final part of a complete and fulfilling life. Focus on what is realistic and associated with the least burden of treatment.
  • Care and treatment are not necessarily interchangeable.

Main Considerations for Covid-19

  • COVID-19 patients may be isolated from their families, increasing the risk of exaggerated grief responses (short-term) and complicated grief (long-term). We must be aware of this and provide support. Empathic communications are essential. ‘Little things matter’ to patients and families.
  • Comfort, care and control of symptoms is paramount. In addition to sedatives and analgesics, control of secretions will be prescient. Practical issues involve the availability of anticipatory medications and drug delivery systems.
  • Skin and eye care are also likely to be major issues.
  • Meeting spiritual and religious beliefs.
  • Support for staff: clinical and non-clinical.
  • Microbiology and mortuary advice when handling a COVID-19 infected body.
  • Place of death: thus far most recorded deaths have occurred on intensive care units, but they will also occur on wards and in the community.

Withholding or Withdrawing Treatments

Any treatments that do not advance the aims of a good death should be considered for withholding or withdrawing. Specific guidance exists with respect to withdrawal and withholding artificial nutrition and hydration. Examples to note:

  • Does provision of treatment cause pain, discomfort or distress? E.g. gastric distension, coughing or gagging when being fed, having a swollen arm from extravasation of fluid
  • Does insertion of feeding/ hydration device cause pain and discomfort? 

National Association of Funeral Directors (https://nafd.org.uk/pandemic-planning/)

*No changes*

The Coronavirus Act has been passed and means the following changes:

Registering a death (England and Wales):

MCCD

  • A medical certificate can be accepted from any medical practitioner so long as they are able to state to the best of their knowledge the cause of death.
  • Registrars can accept MCCDs without referral to the coroner, provided it contains an acceptable cause of death, and indicates that a medical practitioner has seen the deceased either within the 28 days prior to death, or after death (this does not need to be the certifying medical practitioner).
  • If it is indicated that a patient was seen in the 28 days prior to death by video link (such as Skype) this should be accepted as seen. This (video link) does not however meet the requirement for seen after death.
  • Any registered medical practitioner can issue a MCCD without having personally attended the deceased, provided they are sufficiently able, from the available information, to ascertain the cause of death.
  • Certifying doctors will amend as necessary the declaration on MCCDs to indicate whether they have been in medical attendance and if not whether another doctor has seen the deceased after death and/or within 28 days prior to death.
  • The after-death requirement will be through the existing ringed boxes on the MCCD.
  • If there is no other reason for the death to be referred to the coroner, the MCCD should be accepted. If possible, registration officers should liaise with their local surgeries and hospitals to ascertain a list of possible signatories and their GMC numbers.

Registration

  • Removal of requirement for a death/still-birth informant to attend and provide details in person and requirement for them to sign the register where a local authority can no longer offer face to face service registrations or where this is needed by way of additional contingency.
  • Registration can be collected by telephone. Registrars should record (in signature box, space 8 of death entry) the full name of the informant followed by the words ‘information given by telephone’. Telephone registration can be done from office or remotely, if remote working secure email links will still be required.
  • Registration can be done manually if no printing facilities available, information still needs to be recorded onto RON. RON entry should be completed after register page signed and designation added, entry can then be locked.
  • Disposal forms can also be completed manually and can be photographed and sent to relevant authority as email attachment, with original being retained.
  • After the emergency period, arrangements should be made to have all original forms sent to the register office to be processed in the normal manner.

Qualified Informants

  • A funeral director acting on behalf of the family may act as a qualified informant, in addition to existing list, family members may still be preferred informants.
  • Where a funeral director does act as informant their designation shall be recorded as “Causing the body………” and the words ‘Funeral Director’ should be recorded after their surname, in the informant surname field.

For changes in Scotland: *link on site is not working*

For changes in Northern Ireland: https://nafd.org.uk/2020/03/27/coronavirus-act-changes-to-death-registration-in-northern-ireland/

Pulse article reporting changes to official guidelines: http://www.pulsetoday.co.uk/clinical/clinical-specialties/respiratory-/gps-can-certify-death-without-attending-under-new-emergency-legislation/20040466.article

Funerals/Crematoriums/Burial Grounds

*No changes*

  • The latest government guidelines mean only immediate family can attend, and funerals are limited to a maximum of 10 people.
  • Under the terms of social distancing, mourners from different households aren’t allowed to comfort each other or touch or kiss their loved one’s coffin, and all service books, hymn books and Bibles have been removed.
  • Wakes or mass gatherings are not allowed to be held afterwards.
  • Families should make funeral arrangements via telephone video link wherever possible. Many funeral providers are exploring video link options to allow wider family members to ‘attend’ the service. This will vary based on providers so families should discuss this with their provider.

Paul Allcock Q&A about funerals and Coronavirus, shared by Kathryn Mannix: https://www.artofdyingwell.org/questions-about-funerals-and-the-coronavirus-covid-19/

Useful ‘Home Funeral Guides and Pandemic Care’ webinar: https://vimeo.com/400666632?ref=fb-share&fbclid=IwAR1nBUDYQFAmgGgW9Km-w9YBbSfvc2aVx-9ecGOTI0ZtiXKxIrC0coG2fbs

Government Travel https://www.gov.uk/guidance/travel-advice-novel-coronavirus

*No changes*

COVID-19 Exceptional Travel Advisory Notice is in place meaning the FCO advises British nationals against all but essential international travel and anyone who is currently abroad is strongly advised to return now – they should contact their airline and travel company now, and travel insurance provider. If you are currently abroad, keep up to date with Worldwide Foreign Office social media accounts for your location: https://www.gov.uk/government/organisations/foreign-commonwealth-office/about/social-media-use#worldwide-foreign-office-social-media-accounts

RCPE (https://www.rcpe.ac.uk/college/covid-19-update)

*Updated*

The RCPE has participated in teleconferences with the Chief Medical Officers (CMO) for England and Scotland regarding coronavirus. Through this process, the College has been advised that Public Health England (PHE) have published a flow chart for management of a suspected case of COVID-19 acute respiratory disease.

Scotland’s role in ‘four nation response’:

  • NHS Scotland on emergency footing for at least next 3 months
  • Bed will be increased
  • Non-urgent elective operations currently suspended, patients to remain on waiting lists
  • Urgent care and cancer treatment continuing
  • NHS Scotland will contact anyone who is immunosuppressed during w/c 23rd March
  • Frontline staff to be tested

The Scottish Government has an online hub(link is external) for the latest news and guidance.

Wales:

Northern Ireland:

Care in the community teams

*No changes*

  • All healthcare staff working in the community should follow NHS advice (as above).  This includes washing their hands when they arrive at a client’s house.

Govt guidance for providers of residential care, supported living, and home care, in the event of a COVID-19 outbreak.

The guidance sets out:

  • how to maintain delivery of care in the event of an outbreak or widespread transmission of COVID-19
  • what to do if care workers or individuals being cared for have symptoms of COVID-19

COVID-19: guidance on home care provision

COVID-19: guidance for supported living provision

COVID-19: guidance on residential care provision

Key points from document above for home care provision:

 

Steps for home care providers to maintain delivery of care

Home care providers are advised to:

  1. review their list of clients, and ensure that it is up to date, including levels of informal support available to individuals. Providers should consider how they could benefit from sharing this information electronically with local partners, if they receive a legitimate request, including what the dataset might be
  2. work with local authorities to establish plans for mutual aid, taking account of their business continuity plans, and consider arrangements to support sharing of the workforce between home care providers, and with local primary and community services providers; and with deployment of volunteers where that is safe to do so
  3. note the arrangements that local authorities,CCGs, and NHS 111 are putting in place to refer vulnerable people self-isolating at home to volunteers who can offer practical and emotional support

Guidance for Care Workers

Care workers should use personal protective equipment (PPE) for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids. Aprons, gloves and fluid repellent surgical masks should be used in these situations. If there is a risk of splashing, then eye protection will minimise risk. New personal protective equipment must be used for each episode of care. It is essential that personal protective equipment is stored securely within disposable rubbish bags. These bags should be placed into another bag, tied securely and kept separate from other waste within the room. This should be put aside for at least 72 hours before being put in the usual household waste bin.

If care workers support the individual with laundry, then they should not shake dirty laundry before washing. This minimises the possibility of dispersing virus through the air.

If the individual being cared for has symptoms of COVID-19

If the individual receiving care and support has symptoms of COVID-19, then the risk of transmission should be minimised through safe working procedures.

Dirty laundry that has been in contact with an ill person can be washed with other people’s items. If the individual does not have a washing machine, wait a further 72 hours after the 7-day isolation period has ended; the laundry can then be taken to a public laundromat. Heavily soiled items should be disposed of with the owner’s consent.

GP practices

*No changes*

  • Due to stay at home guidance from Public Health England – do not go to your GP surgery. If you need to speak to a healthcare professional, call them.
  • GPs are following Gov advice to assess patients online or via telephone wherever possible to mitigate spread of Covid-19.

Prescriptions

*Updated*

  • Due to stay at home guidance from Public Health England – do not go to your pharmacy. If you need to speak to a healthcare professional, call them.
  • If you need to collect a prescription as a matter of urgency, following agreement with your GP, this counts as a medical need to leave the house. If you have symptoms of Coronavirus and are therefore following govt guidelines to self-isolate you must not leave your house for this purpose. You can arrange for someone to collect your prescription on your behalf and leave it at your door (maintaining social distancing rules).
  • Latest update: The government will deliver medicines to those vulnerable/isolated who are without family/friend support via the community pharmacy network/local authorities. These individuals should register their need for this via the link/telephone on the letter they will receive or via the link https://www.gov.uk/coronavirus-extremely-vulnerable

Hospitals

*Updated*

  • Due to stay at home guidance from Public Health England – do not go to your hospital. If you need to speak to a healthcare professional, call them.

If you need help or advice not related to coronavirus:

  • for health information and advice, use the NHS website or your GP surgery website
  • for urgent medical help, use the NHS 111 online service – only call 111 if you’re unable to get help online
  • for life-threatening emergencies, call 999 for an ambulance
  • Most hospitals have also stopped or significantly limited visits. You can check the hospital website to find out their advice. You can search for hospital detailsif you’re not sure what they are.

Hospices (https://www.hospiceuk.org/what-we-offer/clinical-and-care-support/coronavirus-guidance)

*No changes*

Marie Curie guidance for those affected by terminal illness: https://www.mariecurie.org.uk/help/support/coronavirus

Some hospices might not be allowing any visitors, while others may allow a couple of visitors at certain times. The person’s closest family member or friend (next of kin) may be getting updates from the hospice. You should check with the hospice directly. Find information about Marie Curie hospices, including contact details here – hospice website pages. All visitors should follow NHS/govt guidelines to mitigate risk of spreading Covid-19.

Some people who are likely to die in the coming weeks or months may decide that they want to see their family and friends where possible, even if they risk getting coronavirus and becoming seriously ill or dying with it. This is a very personal decision. It’s also a decision that will affect the family members and friends. If you’re not sure someone is able to make a decision themselves, here is information about mental capacity and making decisions from Marie Curie. You and they may be able to get advice from their doctor or nurse. You can also talk through these things with nurses or trained staff on Marie Curie’s free Support Line – 0800 090 2309, or email support@mariecurie.org.uk

Care Homes

*No changes*

As with hospices, some care homes might not be allowing any visitors at this time, while others may allow a couple of visitors at certain times. The person’s closest family member or friend (next of kin) may be getting updates from the care home. You should check with the care home directly. All visitors should follow NHS/govt guidelines to mitigate risk of spreading Covid-19.

Churches

*No changes*

  • Church buildings are closed for public worship, private prayer and all other meetings and activities except for vital community services until further notice.

Government Support for Vulnerable/Isolated *New edit – replaces previous specific heading about food distribution*

*Updated*

Get coronavirus support as a clinically extremely vulnerable person

 

If you have a medical condition which makes you extremely vulnerable to coronavirus (COVID-19), register and tell us whether or not you need support. You may have received a letter from the NHS telling you that you’re clinically extremely vulnerable, or been contacted by your GP or hospital clinician. If this has not happened by Monday 30 March, contact your GP or clinician after you register with this service.

Register via this link: https://www.gov.uk/coronavirus-extremely-vulnerable

Government food and medicine distribution for those isolated 

  • Matt Hancock announcedlast weekend that the government have identified 1.5 million people in England who are most vulnerable to Covid-19 and was advising them to stay at home at all times over the next 12 weeks. He stated that a new system will be set up to deliver food to those who do not have family support.
  • Local authorities have been trying to set up their own food distribution systems to support those most vulnerable/isolated. Some councils have said that they are awaiting government funds for this purpose.
  • The government have also said they are working on a supermarket voucher system for those illegible for free school meals.
  • Food parcels have begun to be delivered tothe most vulnerable people in England who are being told to stay at home for the next three months to protect them from coronavirus

Latest update: The government will deliver food and medicines to those vulnerable/isolated who are without family/friend support via the community pharmacy network/local authorities. These individuals should register their need for this via the link/telephone number above which can be found on the letter they will receive.

The government has agreed measures with telecoms companies to support vulnerable consumers through COVID-19

The UK’s major internet service and mobile providers, namely BT/EE, Openreach, Virgin Media, Sky, TalkTalk, O2, Vodafone, Three, Hyperoptic, Gigaclear, and KCOM have all agreed the following commitments, effective immediately:

  • All providers have committed to working with customers who find it difficult to pay their bill as a result of Covid-19 to ensure that they are treated fairly and appropriately supported.
  • All providers will remove all data allowance caps on all current fixed broadband services.
  • All providers have agreed to offer some new, generous mobile and landline packages to ensure people are connected and the most vulnerable continue to be supported. For example, some of these packages include data boosts at low prices and free calls from their landline or mobile.
  • All providers will ensure that vulnerable customers or those self-isolating receive alternative methods of communication wherever possible if priority repairs to fixed broadband and landlines cannot be carried out.

Other Useful Resources

*Updated*

Facebook post from Kathryn Mannix about questions to ask/how to have a conversation with a loved one about whether they would want to be placed on a ventilator should they become acutely ill with Covid-19 https://www.facebook.com/DrKathrynMannix/photos/a.1791394644216831/2949151441774473/?type=3&eid=ARDj1yMAR2EinU5WtyTlSuCMSYP59jRAcIS2diMkES20B-WJujA4RHQlvfuxjaIC4QoBfTwsHKXo0S1h&ifg=1

Kathryn Mannix also shared this graphic on ‘discussing unwelcome news’ for Covid-19 on Twitter which is from an upcoming set of resources she is helping develop:

Another useful graphic for medical professionals Kathryn shared:

Katrina Taee has shared that she is working on a blog for Marie Curie, and that there are a number of helpful pieces of writing on the talkabout page for those talking to a loved one who is ill or dying: https://www.mariecurie.org.uk/talkabout

Families may have questions about the care that is provided to their loved ones should they become seriously ill with Coronavirus. One such question may be why patients are treated lying on their tummies – this can look to families like their loved one would be uncomfortable. Here is a very helpful 75 second explanation video from Dr Ron Daniels: https://twitter.com/SepsisUK/status/1243236007346163712?s=20

Here is a piece in the BMJ from Trisha Greenhalgh providing advice and guidance to GPs doing remote assessment of patients with suspected Covid-19. Whilst we will not need to follow the guidance specifically ourselves, it provides some useful information https://www.bmj.com/content/368/bmj.m1182

Update from Pushing Up Daisies regarding their events and including useful resources for starting conversations about advance planning: https://mailchi.mp/8c049e218cf6/pud-2020-whos-in-2634057

Useful flow-chart regarding managing deaths in primary care from Covid-19:

The Covid Trauma Response Working Group have put together this rapid guidance document. It collates guidance from research, best practice guidelines and expert clinical opinion and includes some important ‘dos and don’ts’ when supporting staff/colleagues/patients with trauma they have experienced as a result of the Covid-19 pandemic https://232fe0d6-f8f4-43eb-bc5d-6aa50ee47dc5.filesusr.com/ugd/6b474f_5626bd1321da4138b1b43b78b8de2b20.pdf

 

Date:     Monday 30th March   Version Number: 1.2

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