Talk Evidence covid-19 update - lack of testing transparency, how to give good debate
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Welcome back to your Now Weekly Talk Evidence, the show where we bring you a roundup of what's going on in the world of COVID and our understanding of it. Today we're going to be looking at diagnostic tests again and the fact that there are so many of them out there, the way in which we're debating the evidence on COVID and how we do some decision making. As always, joining us are Helen MacDonald, resting GP and UK research editor for the BMJ. Hi, Helen.
Hi, Duncan.
And Carl Hennigan, professor of epidemiological medicine at Oxford, editor of BMJ's EBM journal, and also a GP. Hi, Carl.
Hi, Duncan.
Carl, last week we got you to give us a very quick update on data from England and Wales about the mortality rate at the moment. And this week there has been yet another update on that. Could you give us a very quick summary of what's been going on?
Yes, what we've seen is hospital deaths trending down, but actually in the home and in the care home setting, there are actually more deaths now than there are in hospitals. And importantly, in the home setting, 90% of the deaths were non-COVID. And this was pretty similar in care homes, a bit less, but about 70% of the excess deaths potentially in care homes were actually not COVID. So there are two reasons this could occur. One is it's a reporting issue. We just people are dying. They weren't seen and they died very suddenly and they didn't put Covid. Or second is actually there's something else going on. There's an issue about people are not seeking care or actually other conditions are increasing and increasing dramatically.
I think it's a little bit of both.
That's really interesting you mentioned that, Carl, because one of the first things I wanted to come to in the podcast this week was around how can we better support people with non-COVID related problems to come forward when they need to. And I think we've seen some increasing national awareness and campaigns building around this this week. And it relates to the issue, I think, of mapping out what are the highest value activities that we do in health care to look after people, both to address their acute medical problems, perhaps also to reduce unnecessary admissions or consultations when people are very busy with COVID. And in the longer term, what aspects of more routine care, chronic disease management or screening are most important and valuable to our health care systems?
I was really interested to see a paper, which is perhaps the beginning of this story, which was posted on CBM, Carl. So you may have seen it. So I guess we call it the kind of preprint article. It was authored by Charitini Stavrapoulou at the University of London, working with international colleagues. And it was looking at common conditions linked to preventable admission to hospital. and found that influenza, COPD, heart failure, diabetes, urine infections and cellulitis were some of the top reasons for admission, where there seemed to be scope to reduce admissions from those situations from primary care. But major anti-climax, they're not sure what these are. So I'd be interested to know, Carl, your thoughts on where do you think this evidence about what we should stop or start doing is going to come from?
Well, first off is to say that list sort of fits with we did a systematic overview looking at treatment where there's evidence to show they actually reduce hospital admissions. And so we looked at all the systematic reviews and it's really important and it's interesting. There are lots of treatments that reduce surrogate measures. But actually hard endpoints, there are actually less treatments. And the conditions we found them in were heart failure, coronary disease, asthma, COPD and actually schizophrenia, mental health conditions. So that fits with that common list, if you like. And then a list of treatments that have actually been shown to reduce admission is far less than you consider. So there's that list.
The second issue is I think we need to then go back to NICE now and start stripping out of the NICE guidelines, which actually activities have been shown to actually facilitate reductions in admission and hard endpoints.
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