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You can find the current article at its original source at https://www.theguardian.com/world/2020/mar/21/nice-issues-emergency-coronavirus-guidelines-for-uk-doctors-and-nurses
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| Version 2 | Version 3 |
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| Nice issues emergency coronavirus guidelines for doctors and nurses | |
| (about 2 hours later) | |
| First three guidelines consider patients in critical care, having kidney dialysis and cancer treatment | First three guidelines consider patients in critical care, having kidney dialysis and cancer treatment |
| Guidelines to help doctors and nurses know the best course of treatment for patients amid the coronavirus pandemic have been published by the National Institute for Health and Care Excellence (Nice). | Guidelines to help doctors and nurses know the best course of treatment for patients amid the coronavirus pandemic have been published by the National Institute for Health and Care Excellence (Nice). |
| The first three “rapid guidelines” consider patients in critical care, those having kidney dialysis and people being treated for cancer. | The first three “rapid guidelines” consider patients in critical care, those having kidney dialysis and people being treated for cancer. |
| There have been concerns the UK does not have enough intensive care beds to cope with the number of people who will fall ill, and that the country could end up in a similar situation to Italy, where doctors have been forced to choose which patients get a bed. | There have been concerns the UK does not have enough intensive care beds to cope with the number of people who will fall ill, and that the country could end up in a similar situation to Italy, where doctors have been forced to choose which patients get a bed. |
| Recent footage from inside the main hospital in Bergamo, the country’s main affected area, showed doctors and nurses rushing between patients in a packed ward, with other people on trolleys in a corridor. | Recent footage from inside the main hospital in Bergamo, the country’s main affected area, showed doctors and nurses rushing between patients in a packed ward, with other people on trolleys in a corridor. |
| Earlier this week, the health select committee chairman, Jeremy Hunt, asked whether the “absolutely heartbreaking” scenes from northern Italy would happen in England and about guidance for medics. | Earlier this week, the health select committee chairman, Jeremy Hunt, asked whether the “absolutely heartbreaking” scenes from northern Italy would happen in England and about guidance for medics. |
| In response, NHS England’s national medical director, Stephen Powis, said the health service and government were doing “everything we possibly can not to get into that circumstance”. | |
| Powis said doctors made clinical decisions every day and “what we want to be able to do is to support doctors to make those continued decisions on the basis that they are currently making them”. | Powis said doctors made clinical decisions every day and “what we want to be able to do is to support doctors to make those continued decisions on the basis that they are currently making them”. |
| The new guidelines, which were published on Saturday and are the fastest ever to be produced by Nice, say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”. | The new guidelines, which were published on Saturday and are the fastest ever to be produced by Nice, say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”. |
| For those who test positive for the virus, decisions about them being admitted to critical care should consider the medical benefit, taking into account the likelihood of the person’s recovery. | For those who test positive for the virus, decisions about them being admitted to critical care should consider the medical benefit, taking into account the likelihood of the person’s recovery. |
| In its guidance on clinical decision-making, Nice advises medics in England and Wales to “base decisions on admission of individual adults to critical care on the likelihood of their recovery, taking into account the likelihood that a person will recover from their critical care admission to an outcome that is acceptable to them”. | |
| For cancer patients, medics will need to balance the risks of the patient not being treated in the usual way against the risk of them becoming seriously ill through coronavirus due to a weakened immune system, the guidelines state. | For cancer patients, medics will need to balance the risks of the patient not being treated in the usual way against the risk of them becoming seriously ill through coronavirus due to a weakened immune system, the guidelines state. |
| Workarounds could include treatment being offered at different locations, patients having longer breaks between treatments and delivering treatments in different forms, the document adds. | Workarounds could include treatment being offered at different locations, patients having longer breaks between treatments and delivering treatments in different forms, the document adds. |
| Kidney dialysis patients suspected of having the virus could have their treatment delayed until their test results are known. | Kidney dialysis patients suspected of having the virus could have their treatment delayed until their test results are known. |
| The guidance also recommends transport services are checked and alternative arrangements made where necessary, if the normal provider refuses to transport patients confirmed to have Covid-19. | The guidance also recommends transport services are checked and alternative arrangements made where necessary, if the normal provider refuses to transport patients confirmed to have Covid-19. |
| Further updated guidelines are expected in the coming weeks on symptom management, radiotherapy patients and those with rheumatoid arthritis. | Further updated guidelines are expected in the coming weeks on symptom management, radiotherapy patients and those with rheumatoid arthritis. |
| Nice said it would make its guidance available online so other countries can see the approach to tackling the virus and care for patients in the NHS in England and Wales. | |
| Paul Chrisp, director of the centre for guidelines at Nice, said the three guides had been produced within a week – when usually one set can take up to two years to compile. | Paul Chrisp, director of the centre for guidelines at Nice, said the three guides had been produced within a week – when usually one set can take up to two years to compile. |
| He said: “We have done these very rapidly so it’s not our usual process, although it’s been as robust as we could in a very short timeframe. | He said: “We have done these very rapidly so it’s not our usual process, although it’s been as robust as we could in a very short timeframe. |
| “The urgency was the critical issue here. The clinicians who we worked with are welcoming them. Having them [the guidelines] all in one place, easily accessible form website, phone, tablet, means they’re easy to get at, easy to update.” | “The urgency was the critical issue here. The clinicians who we worked with are welcoming them. Having them [the guidelines] all in one place, easily accessible form website, phone, tablet, means they’re easy to get at, easy to update.” |
| Duncan Young, professor of intensive care medicine at the University of Oxford, said it was clear the NHS’s critical care staffing levels and beds would be under serious pressure in the weeks ahead. | Duncan Young, professor of intensive care medicine at the University of Oxford, said it was clear the NHS’s critical care staffing levels and beds would be under serious pressure in the weeks ahead. |
| He said: “This advice is written in part for non-critical care doctors and covers when to seek advice from critical care doctors and what information the critical care team will need. | He said: “This advice is written in part for non-critical care doctors and covers when to seek advice from critical care doctors and what information the critical care team will need. |
| “Implicit in this guidance is that human resources (critical care team members) and physical resources (suitably equipped critical beds) will be extremely stretched in the coming weeks.” | “Implicit in this guidance is that human resources (critical care team members) and physical resources (suitably equipped critical beds) will be extremely stretched in the coming weeks.” |
| • This article was amended on 23 March 2020 to clarify that Nice guidelines only officially apply to the NHS in England and Wales, and that Stephen Powis is NHS England’s national medical director. |