I hope this email finds you in continuing good health. 

We are taking stock while coming through a “peak ” of hospitalisations and set to enter the second phase in the NHS’s response to Covid-19. 
On April 29th we heard from the NHS CE and CEO about:-

• ​Increased Covid-19 testing capacity – a pilot followed by roll out of regular testing to asymptomatic staff, guided by PHE and clinical advice.  
• NHS to step up non-Covid19 urgent services as soon as possible with attention to infection prevention and control and start of some routine non-urgent elective care. 
• Provisional plans to factor-in the availability of associated medicines, PPE, blood, consumables, equipment and other needed supplies.
• Expanded winter flu vaccination campaign alongside a school immunisation ‘catch up programme’.

Now more than ever a safety and learning culture is vital. BSPGHAN has been working with the RCPCH, PHE and  NHS E this week to:- 
1. identify which patients should be recommended to still  “shield” (or stay at home with stringent social distancing) once lockdown restrictions are lifted and 
2. understand more about the impact of delayed presentations to healthcare or delayed delivery of care within our speciality
3. consider recovery and restoration plans of our routine activity for children and young people.

I would like to hear from members about these issues and what your current concerns are.  I will email out a survey monkey very soon. It should only take a few minutes to complete and I would be very grateful if you would return it straight away if possible and by Tuesday May 6th at the latest please. Thank you.

NICE Covid-19 rapid guideline: children and young people who are immunocompromised- published May 1st 2020 NICE guideline [NG174] https://www.nice.org.uk/guidance/NG174
This guideline is designed to be used alongside our professional guidance.  It aims to maximise the safety of children, protect staff from infection and enable services to make best use of resources during the pandemic. It can be updated as necessary. 

Children with a systemic inflammatory response – be aware and notify https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf
Most children are asymptomatic or exhibit mild symptoms from COVID-19 infection. However in the last two months a small number of children have been identified who develop a significant systemic inflammatory response which may be associated with COVID-19.

COVID-19 and the gastrointestinal tract: emerging clinical data https://fg.bmj.com/content/early/2020/04/27/flgastro-2020-101507​
– prevalence of virus in the stool is important, impacting on endoscopy provision. 
​- clinical importance of continued presence of RNA in the stool is uncertain.
– the likelihood of faeco-oral transmission is low. 
– data on outcomes of adult patients undergoing surgeries during the incubation period of COVID-19 infection​ –  should  testing prior to surgery become routine?

Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study. https://gut.bmj.com/content/early/2020/04/30/gutjnl-2020-321411
– Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. 
– Preventing acute IBD flares in patients with IBD is important.

BSG Guiding principles on restoration of endoscopy services.   https://mailchi.mp/fb3ebe293ed0/welcome-to-the-august-edition-of-the-bsg-e-newsletter-12317385?e=12419cdbd5
– Consensus opinion and review of the available evidence.
– Some data is not yet available; some data is inconclusive: in this guidance, therefore, the safety and wellbeing of patients and staff is taken as paramount​. 

The pressure will remain in these uncertain times. Look after each other and be aware that enhanced and active support from your NHS employer is there to ensure your wellbeing and safety.

Please take a few minutes to report back in the anonymised survey. It asks about your concerns about your personal wellbeing and that of your patients as well as your answers to the questions above (1). THANK YOU. 

Best wishes
Sue
BSPGHAN President May 3rd 2020  e-mail President@bspghan.org.uk