The medicolegal landscape through the lens of COVID-19:time for reform

The COVID-19 pandemic has brought out the best of the health and social care workforce globally, as acknowledged by the public. But the clapping has now stopped. Over 50,000 people who tested positive for coronavirus in the UK have died, a tragic figure that is more than double the UK Government's early ‘best case scenario’ estimate. Each death represents a life lost too soon, leaving behind grieving family and friends. At the same time, doctors and other healthcare professionals are exhausted and anxious, fearing both the implications of a second wave, and possible repercussions from decisions made under the strain of the pandemic.There has been polarised debate around whether doctors should be granted immunity from civil and criminal negligence claims and regulatory proceedings arising from treatment provided during COVID-19.1,2 Here, we argue that this focus on temporary statutory immunity is a distraction from pre-existing concerns that several aspects of the current medicolegal system are not fit for purpose – for doctors or for patients. Areas where there is no ‘quick fix’ include: the need for reform of the clinical negligence system; concerns in relation to regulatory proceedings; and the potential for BAME (black, Asian, and minority ethnic) doctors (and patients) to be disproportionately impacted in both areas. These issues are critical, since they each have a direct impact on multiple stakeholders, including on those who deliver and receive healthcare. However, there has been a tendency for these to be considered from single-minded viewpoints; accordingly, we aim in this paper to provide a more holistic view. Rather than pursuing immunity legislation, we say that the time is right for more comprehensive action, including an independent Public Inquiry to scrutinise these issues, taking into account all of the interests engaged (Figure 1)

The medicolegal landscape through the lens of COVID-19:time for reform

The COVID-19 pandemic has brought out the best of the health and social care workforce globally, as acknowledged by the public. But the clapping has now stopped. Over 50,000 people who tested positive for coronavirus in the UK have died, a tragic figure that is more than double the UK Government's early ‘best case scenario’ estimate. Each death represents a life lost too soon, leaving behind grieving family and friends. At the same time, doctors and other healthcare professionals are exhausted and anxious, fearing both the implications of a second wave, and possible repercussions from decisions made under the strain of the pandemic.There has been polarised debate around whether doctors should be granted immunity from civil and criminal negligence claims and regulatory proceedings arising from treatment provided during COVID-19.1,2 Here, we argue that this focus on temporary statutory immunity is a distraction from pre-existing concerns that several aspects of the current medicolegal system are not fit for purpose – for doctors or for patients. Areas where there is no ‘quick fix’ include: the need for reform of the clinical negligence system; concerns in relation to regulatory proceedings; and the potential for BAME (black, Asian, and minority ethnic) doctors (and patients) to be disproportionately impacted in both areas. These issues are critical, since they each have a direct impact on multiple stakeholders, including on those who deliver and receive healthcare. However, there has been a tendency for these to be considered from single-minded viewpoints; accordingly, we aim in this paper to provide a more holistic view. Rather than pursuing immunity legislation, we say that the time is right for more comprehensive action, including an independent Public Inquiry to scrutinise these issues, taking into account all of the interests engaged (Figure 1)

The Selective Influence of Rhythmic Cortical versus Cerebellar Transcranial Stimulation on Human Physiological Tremor

The influence of central neuronal oscillators on human physiological tremor is controversial. To address this, transcranial alternating current stimulation (TACS) was delivered at peak tremor frequency to 12 healthy volunteers in a 2 × 2 crossover study. Two sites were stimulated [contralateral primary motor cortex (M1), vs ipsilateral cerebellum] while participants performed two types of tasks designed to probe the different manifestations of physiological tremor of the hand-kinetic and postural tremor. Tremor was measured by accelerometry. Cortical coherence with the accelerometry signal was also calculated in the absence of stimulation. The phase synchronization index, a measure of the phase entrainment of tremor, was calculated between stimulation and tremor waveforms. The amplitude modulation of tremor was similarly assessed. There was significant phase entrainment that was dependent both on tremor type and site of stimulation: M1 stimulation gave rise to phase entrainment of postural, but not kinetic, tremor, whereas cerebellar stimulation increased entrainment in both cases. There was no effect on tremor amplitude. Tremor accelerometry was shown to be coherent with the cortical EEG recorded during postural, but not kinetic, tremor. TACS modulates physiological tremor, and its effects are dependent both on tremor type and stimulation site. Accordingly, central oscillators play a significant role in two of the major manifestations of tremor in health.</p

COVID-19, SARS and MERS:A neurological perspective

Central to COVID-19 pathophysiology is an acute respiratory infection primarily manifesting as pneumonia. Two months into the COVID-19 outbreak, however, a retrospective study in China involving more than 200 participants revealed a neurological component to COVID-19 in a subset of patients. The observed symptoms, the cause of which remains unclear, included impaired consciousness, skeletal muscle injury and acute cerebrovascular disease, and appeared more frequently in severe disease. Since then, findings from several studies have hinted at various possible neurological outcomes in COVID-19 patients. Here, we review the historical association between neurological complications and highly pathological coronaviruses including SARS-CoV, MERS-CoV and SARS-CoV-2. We draw from evidence derived from past coronavirus outbreaks, noting the similarities and differences between SARS and MERS, and the current COVID-19 pandemic. We end by briefly discussing possible mechanisms by which the coronavirus impacts on the human nervous system, as well as neurology-specific considerations that arise from the repercussions of COVID-19.</p

COVID-19, SARS and MERS:A neurological perspective

Central to COVID-19 pathophysiology is an acute respiratory infection primarily manifesting as pneumonia. Two months into the COVID-19 outbreak, however, a retrospective study in China involving more than 200 participants revealed a neurological component to COVID-19 in a subset of patients. The observed symptoms, the cause of which remains unclear, included impaired consciousness, skeletal muscle injury and acute cerebrovascular disease, and appeared more frequently in severe disease. Since then, findings from several studies have hinted at various possible neurological outcomes in COVID-19 patients. Here, we review the historical association between neurological complications and highly pathological coronaviruses including SARS-CoV, MERS-CoV and SARS-CoV-2. We draw from evidence derived from past coronavirus outbreaks, noting the similarities and differences between SARS and MERS, and the current COVID-19 pandemic. We end by briefly discussing possible mechanisms by which the coronavirus impacts on the human nervous system, as well as neurology-specific considerations that arise from the repercussions of COVID-19.</p