The Public Health Agency (PHA) is reminding everyone of the dangers associated with the misuse of illicit and prescription drugs, particularly given some of the challenges which the lockdown presents...
Dr Gail Johnston, Programme Manager, HSC Research & Development Division, discusses the importance of clinical research in the fight against COVID-19. To view our complete series of COVID-19 blogs, click here.
Today, 20 May, is International Clinical Trials Day. It is the anniversary of the day that James Lind started the first clinical trial to treat the disease of scurvy amongst his ship’s crew through a diet oranges and lemons. HSC R&D Division, and our HSC partners, have been highlighting the importance of research through public awareness campaigns. The ‘Be Part of Research’ Campaign, led by the National Institute of Health Research, aims to encourage patients, carers, public and staff to find out more about what research is taking place in Health and Social Care and the different ways they might get involved. This could be by sharing information about a study, participating in a study or helping to plan and design a study.
Researchers from all over the world, including Northern Ireland, have come together over the last several weeks in a global race to look for new drugs, treatments, vaccines, therapies and surveillance techniques to help combat COVID-19. The role of research in helping us to develop new ways of living and adjusting to life in lockdown, as well as the easing of restrictions, has become vital to informing government strategies in every country.
Recently, the four UK Chief Medical Officers, including Dr McBride, jointly stated the importance of clinical trials and the urgent need for participants to be recruited to research studies both locally and nationally. In Northern Ireland, there are currently over 100 patients recruited on COVID-19 related trials and several other projects have started to look at the physical and psychological impact on staff working at the frontline, as well as the effects of loneliness and isolation in the general population as a result of social distancing. The results of these will help us manage the longer term effects of the pandemic as well as improving the outcomes for those who may be affected in the future.
At the same time, research into other illnesses still remains important. While some of this has been put on hold due to researchers having to return to the front line, efforts are now being made across the UK to ensure that this work is restarted and continues.
In 2018/2019 over one million people took part in research. Public participation has helped provide valuable knowledge to help people live healthier and better lives now and in the future. This research helps improve health and social care provided by the HSC and others. It also helps advance medicine to find new cures and better treatments for future generations. This treatment could be a medicine, a vaccine, surgery, radiotherapy, physical and psychological therapies and methods of diagnosing disease.
This year, HSC R&D Division, Public Health Agency, has joined with the Patient Client Council to develop a register of people interested in taking part in research in Northern Ireland. This will help us match people interested in becoming involved in research with local researchers. You can register here: https://patientclientcouncil.hscni.net/get-involved/join-our-membership-scheme
To find out more about clinical trials that are happening in Northern Ireland and the rest of the UK and opportunities to take part please visit https://www.bepartofresearch.nihr.ac.uk
To find out more about the work of HSC R&D Division and Personal and Public Involvement in research, please visit, www.research.hscni.net
To view our complete series of COVID-19 blogs, click here.
To be able to deal with challenges of parenthood, we need to be kind to ourselves. Practise self-compassion, self-care and self-forgiveness when you fail to live up to your own expectations. Your...
Brendan Bonner, Public Health Agency, discusses how a positive self-perception is a key resilience factor in dealing with COVID-19. To view our complete series of COVID-19 blogs, click here.
Whereas much of the headlines around COVID19 are focused on the association with age and morality risk factors linked to the COID19 illness, people like 100 year old Colonel Tom Moore who raised over £32m for the NHS COVID-19 campaign and 107 year old Dutch woman Cornelia Ras, who on the 9April 2020 became the oldest survivor of COVID-19, have challenged the perceptions many have had around the issue of ageing, resilience and surviving COVID-19.
Learning from the Spanish experience
Research led by Andras Losada-Baltar and colleagues at University Rey Juan Carlos Madrid, has indicated that older people with a positive self-perception of ageing appear to have much higher resilience in dealing with the challenges of COVID-19.
The findings were from a study undertaken in Spain, recently published in the Journal of Gerontology, which targeted 1,310 people (aged 18-88 years) who were self-isolating as part of the COVID-19 lockdown response in March 2020. A series of self-reporting questions which addressed social and demographic factors as well as in-depth investigations into issues of stressors, family support, personal resources, loneliness and psychological distress was undertaken.
One of the key findings from the analysis was that younger women with a higher negative self-perception about ageing, who consumed more COVID-19 news articles and had more contact with other relatives outside of the home, appeared to experience fewer daily positive emotions, had poorer sleep quality and reported higher levels of loneliness than many of their older counterparts. These findings challenge perceptions many would have had around resilience, age and protective/risk factors on emotional wellbeing.
Resilience of older populations
The Spanish study reported a lower reactivity to stress in older adults was in line with work that had previously been done by the likes of Birditt, Fingerman and Almeida 2005, which indicated that those older people who had a more positive association with ageing had built up better resilience and were better resourced to deal with the stressors that were presented as part of COVID-19.
These findings were also reported by previous study by Levey and Myers 2004, which found that positive self-perception of ageing was related to engagement and more preventative health behaviours.That complemented a study Bellintier and Neupert (2018), which found that older adults with more negative attitudes towards their age reported increased emotional activity to stressors in their life.
Adopted a positive policy approach
Such findings would challenges us question how we should be actually be supporting older people in terms of dealing with the challenges of COVID-19.
Previous work by the Centre for Policy in Ageing in 2014, indicated that resilience in older age was the ability to stand up to adversity and able to bounce back to a state of equilibrium following adverse episode in their life. It acknowledges that whilst there is no universal agreed definition of or indeed measure of resilience due to the range of variations that are used to measure it, there are common factors that can be associated with the ability to be resilient. Their findings indicated that resilience is not age related and that older people were at least if not more resilient than younger adults.
Potentially the absence of, or the inability to use technology, does limit older peoples exposure to negative news on COVID-19 compared to their younger counterparts which in turn is having a major impact on expressed anxiety and emotions. A literature review undertaken by Stephanie MacLeod et al in 2016, published in Geriatric Nursing looked at the impact of resilience amongst older people. They found that the key characteristics in resilience around adults aged 65 and over included a higher health literacy understanding of mental, social and physical factors. They suggested coping styles around optimism and hopefulness, positive emotions, social support and community involvement as well as active activities of daily living that promoted independence, including being physically active all had strong associations with high resilience and appeared most frequently in their study.
So in addressing future waves of COVID19 we need to take a positive and proactive approach to supporting older people now to help build their resilience moving forward.
To view our complete series of COVID-19 blogs, click here.
Everyone’s mental health and emotional wellbeing remains a key priority for Health and Social Care and our partners in the community, voluntary and independent sector during the COVID-19 pandemic and...
Dr Diane Anderson of the Public Health Agency discusses the information sources the public use to understand the COVID-19 pandemic. To view our complete series of COVID-19 blogs, click here.
There is a flood of information about COVID-19 being made available to the general public. It is released by a wide range of government, media, private and community organisations, not to mention private individuals, in a variety of formats from newspapers to online platforms. But what exactly does the public know and where do they go to get their information?
Main sources of information
Recent survey results, such as the weekly ones produced by the Office of Communications (Ofcom), have explored where the public look for information about COVID-19 and what information they are absorbing. The most recent Ofcom survey shows that traditional media sources (broadcasters, newspapers, radio) are the most-used source of news and information about COVID-19 (89%). They are also the most important source of news and information to users (64%). Of these sources, the BBC is the most used (77%) and the most important source of information (50%).
The NHS is the most trusted source for information on COVID-19. Nine in ten adults who use it for information say they trust it (92%). Most people using official sources trust the information provided by official scientists (91%), local health services (84%), the World Health Organization (WHO) (81%) and the government (78%).
Challenges in understanding the information
The main challenges described by people surveyed were ineffective communication in terms of either access to information or information overload, conflicting guidance and misinformation.
More than a third of people (38%) said they find it hard to know what is true and what is false aboutCOVID-19. Nearly half of people (47%) said they have come across false or misleading information about COVID-19 in the last week. This ranged across theories linking the origins or causes of COVID-19 to 5G technology, drinking more water and gargling with saltwater. All of which are untrue.
Most of the UK countries and the Republic of Ireland have now published their individual recovery/lockdown exit plans (the Northern Ireland Executive Office published its Approach to Decision Making on 12 May 2020). Scotland’s will be issued next week.
Downing Street has changed the strategy slogan for England to “stay alert, control the virus and save lives”. The new slogan is not being adopted by the other UK nations, which are sticking with “stay at home, protect the NHS, save lives”. It’s possible that the diverging approaches and their messaging may cause confusion. The BBC has provided a useful comparisonbetween the Northern Ireland, England and Republic of Ireland recovery plans.
The survey findings discussed in this blog are from studies which are focused largely on England, Scotland and Wales and have little input from the Northern Ireland public.
However, the Northern Ireland Statistical and Research Agency (NISRA) have launched a survey which will capture our local knowledge and opinions. If you have been contacted about participating in this, please do get involved – the more people that complete the survey, the better our government organisations will understand the impact of COVID-19 on our lives and the better they are able to plan what they can do to help.
If you would like to read more about the surveys described in this blog, they can be found as follows:
Deirdre McAliskey, National Children’s Bureau, and Brendan Bonner, PHA, explain why understanding teenagers’ brains can help us to support them during COVID-19. To view our complete series of COVID-19 blogs, click here.
What we’re asking of teenagers and young adults right now goes against everything their brain is expecting of them.
The brain re-wires during adolescence. It works through all of its experiences, abilities and aspirations to date and decides which to take forward in life to make it unique and independent… of parents and caregivers! Typically, this development goes on until around age 24 or 25.
Peer relationships are the priority. Connection with ‘like’ others, testing boundaries and exploring creative ways to make a mark in the world are all ways in which the teenage brain naturally evolves to become ‘adult’. Therein lies the problem with lockdown. However lockdown also allows us the opportunity to provide meaningful support and guidance to our young people.
Teenagers’ close friendships need to be maintained. They’re linked to increased feelings of self-worth and decreased symptoms of anxiety and depression in the short term. In the longer term, they are linked to better management of social and emotional development and healthy relationships. Working together to agree new, more relaxed rules about screen and phone time can help compensate for reduced opportunities to socialise in person, and demonstrate to teenagers that their feelings are valid.
Reassure and redirect
It is important to keep our communications with teenagers open and honest. Start with the basic principle that anxiety is completely normal and indeed a healthy function. It alerts us to threats and helps us take measures to protect ourselves. During the COVID-19 pandemic it helps us ensure to keep others safe as well.
Acknowledging and allowing feelings in a safe and supported way means we are less likely to ‘bottle things up’ to a point where those feelings seem less manageable.
Young people may be dealing with disappointment, upset and frustration through social distancing or isolation. It’s ok to feel sad, and if you can let yourself be sad, you’ll start to feel better faster. Everything is temporary.
The key to recovery is how young people are supported to process their feelings. This will vary depending on their personality and nature. For some, creative writing in a diary could help. For others, talking online with friends and using their shared sadness can be a way to feel connected at this time. Practicing mindfulness, allowing thoughts and feelings to come and go, knowing they are temporary can be a powerful tool to help us accept and validate our feelings. Practicing gratitude and showing kindness to others are also proven mood boosters. What’s important is to do what feels right for you.
Redirecting some attention and energy away from the virus and from lockdown is critical. Making plans, physical exercise, supporting younger siblings, calling grandparents, trying new things (even learning to use the washing machine!) can all help the world feel a little bit bigger than it otherwise might. If young people are interested in following the news, encourage them to develop critical thinking skills by fact checking the information they’re consuming, being curious about the positive impacts of social distancing on containing the virus and building up a short list of reliable sources for themselves and their peers.
Support independence and responsible decision making
Young people have a right to be involved in decisions which affect them and to sufficient information to support them in forming their opinions. The adolescent brain is, however, a strong opponent in an argument! It is thinking and feeling for itself, developing perspective and practicing decision making. Many of its early decisions however can be risky, ill-informed and even selfish. Becoming independent can be a very vulnerable time for young adults. Supporting that journey can be challenging for them and for us.
During lockdown, we’re all limited in our choices. Engaging teenagers in routine and rule setting can buffer stress and support brain development. Agreed schedules could include learning time, rest/reward time, household chores, family meal time and plenty of time to connect with friends. Enabling young people to exercise some control over that schedule will help them stick to it. Offering exclusive use of the kitchen or living room, even for half an hour, could boost feelings of independence.
Healthy habits include at least 60 minutes of moderate-vigorous exercise per day, nutritious meals and a reasonable limit on screen time. These improve mental wellbeing for teenagers. Sufficient sleep is key to overall mood and resilience to stress. The natural circadian rhythms of young adults are more nocturnal than those of children. Young adults will be alert much later in the evening than those they share a home with! Waking them up early in the morning can’t and won’t reset that clock. It typically just results in a shorter sleep! Teenagers need around 9-11 hours of good quality sleep to consolidate the memory and learning they need to engage in positively with others and, particularly, with education. Accommodating a 10am or even 11am start to their day - trading off for some chores and study time - is an attractive proposition to explore while we have the chance. Consider it the silver lining of these strange and challenging times!
Professor Hugo Van Woerden, PHA Director of Public Health and Dr Damian Bennett, Consultant in Public Health Medicine explain reporting differences by the Public Health Agency and the Northern Ireland Statistics and Research Agency for COVID-19 related deaths. To view our complete series of COVID-19 blogs, click here.
Professor Hugo Van Woerden, PHA Director of Public Health
Understandably, there has been some confusion regarding COVID-19 death reporting by different organisations. This blog describes what is collected on a daily basis by the Public Health Agency (PHA) and some of the differences with what is reported weekly by the Northern Ireland Statistics and Research Agency (NISRA). We recognise that the details of data flows is a niche topic, and not one that keeps everyone awake at night! But here goes.
NISRA reports
The traditional method for examining the number of deaths, and the range of causes of death, takes information from death certificates that are handed into the Registrar’s Office. However, a family may take up to five days after a loved one has died to hand in the certificate. There may also be a delay between the time of a death and a laboratory results taken on that patient, which may affect whether a death is recorded in the short term as a suspected or confirmed COVID-19 death.
The death certificate contains two parts. Part 1 describes the immediate causes of death and Part 2 provides information on related conditions that may also have contributed to death. The number of deaths from COVID-19 can either be reported on the basis of a reference to COVID-19 in Part 1, or both Part 1 and Part 2.
NISRA do not report on deaths that have occurred in the preceding week because of some of these factors and their requirement to have an ‘official’ figure.
Daily reports
There are similar but different challenges with the data collected by the PHA, as we are also dependent on receiving reports of each death before we collate our daily figures, usually at 10am each day. Hospital and community recording systems were not designed to deliver in such a tight daily timeframe. The need for a new computer system to help modernise records is well recognised by the government and a new national system is planned. This will make a difference when it is installed, but such a system may take a number of years to build and the process is still in its infancy.
In summary, there is a time lag in deaths reported to the PHA as well as a time lag in the deaths reported to NISRA. This affects the completeness of any methods for ‘next day’ reports.
PHA records are normally used for internal planning purposes, where the focus is on a timely report rather than a focus on record completeness. The epidemiologists involved have a clear understanding that the short term spikes or dips may in part reflect bottlenecks in the reporting system, rather than real changes in the trend. For example, some deaths that have occurred over a weekend may not be reported until the middle of the following week, as ward clerks and other staff catch up on tasks left over by a smaller team on duty at the weekend during the rest of the week. So, totals by date of death, particularly for recent prior days, are likely to need to be updated at a later date.
Examining average deaths over a 7 day period and excluding the last few days gives a better idea of the trend in daily deaths as can be seen in the graphs below (Figures 1 and 2).
Figure 1. Reported deaths by date of death, 7 day moving average, up to 5th May (provisional)
In the graph above (Figure 1) we can see a drop in the 7 day average at the right of the graph, suggesting that reported deaths have dropped in the last few recorded days (dashed line). However, this is often due to a delay in reporting rather than real changes in the trend.
Figure 2. Reported deaths, by date of death, 7 day moving average, up to 2nd May (with axis extended to 5 May)
If we look at Figure 2 above, where we have excluded the most recent four days, we see that the 7-day average remains at an approximate steady state of about 10 deaths per day. Continued monitoring of COVID mortality data is required to see if the reduction in deaths is sustained.
An international reporting problem
This situation is not unique to Northern Ireland, and inevitably most countries will display a difference between daily reported “COVID-19 related deaths”, and “registered deaths”. There will also be differences between countries depending on their testing regimes and whether a country only reports on hospital deaths.
Adding a report on deaths from community settings can have a large impact. An example of this occurred in France on 2 April 2020, when the government announced a huge increase in the recorded deaths of 1,353 over a 24 hour period. This increase included 884 fatalities that had occurred in nursing homes in weeks preceding the announcement, but were only been formally notified on 2 April, making the large increase that day potentially misleading. Similarly, the inclusion of care home deaths in England from 29 April (which had previously only included hospital deaths) also led to a sudden jump in total daily reported COVID-19 associated deaths. In general the public health advice would be that one should avoid interpreting daily figures and should use trends instead.
Complex definitions
The definition of “COVID-19 associated death” is complex and difficult to understand. Most countries are reporting daily figures using laboratory confirmed deaths. The definition that is used for daily reporting by the PHA is: ‘any individual meeting the confirmed case definition (laboratory confirmed infection, regardless of symptom status) who has died in the 28 days after the specimen date for which a positive test result was received, whether or not COVID-19 was the cause of death’.
Gathering information to meet this definition is complex. There will be individuals who have died as a consequence of COVID-19 but who have not had a positive laboratory result. This is inevitably not picked up in the daily figures collected by the PHA, but will be recorded in the later weekly NISRA report of all certified deaths, as the NISRA reports use a different definition and a different source of information.
The daily report
The daily report draws on a variety of sources and there are several steps in collecting this data. PHA sources include reports by healthcare workers using an online form that is completed by staff in Health and Social Care Trusts and GPs. It may also occasionally include deaths reported through phone calls or email correspondence by, for example, care home managers. One source of potential inaccuracy of the data is the fact that on occasion clinical staff may be so busy that they cannot complete the online report of a death, or may take more than a day to do so.
To get the final figure that the PHA collate, the reported deaths have to be linked up to positive COVID-19 laboratory results. Again, the laboratory results can be problematic. The name used by the laboratory may be different from that given when reporting the death. For example, the form received by a laboratory may use a colloquial first name such as James, Jimmy, Jonny, or Jack, whereas a report of a death might use a more formal first name such as John. Differences such as these can make it complex and time consuming to link different data sources.
The laboratory results are not always received within a time frame that allows them to be captured in a daily report. This can mean that earlier data has to be updated. There can occasionally be difficulty with dates, for example, clarifying that the laboratory test was taken within the preceding 28 days, as the date that the sample was taken may be different from the day that the sample was received by the laboratory, which may be the one recorded in a computer system. Lots more could be said, but this perhaps illustrates some of the problems that there are working with this kind of data.
Conclusion
In summary, both the NISRA data and the data collated by the PHA on deaths rely on complex pathways and busy front line staff who may naturally prioritise urgent clinical care over some aspects of form filling. Timely data is helpful, but the result of seeking to be very timely, as the PHA does, is that such data always needs to be interpreted with caution, and needs to be regularly revised and updated.
The General Register Office (GRO) data are the most reliable source of information on deaths, including those due to COVID-19. However, it is not available in as timely a fashion.
Daily reporting on deaths from COVID-19 is primarily a guide, aiming to help inform planning systems about the spread and impact of the virus.
For those who are interested, this complex topic is also covered in a BBC piece on why COVID-19 death data can be difficult and in a report by FactCheckNI.
If you are interested in data you may want to check them out!
To view our complete series of COVID-19 blogs, click here.
Looking after our physical and mental health is really important and any activity you can do will help. Daily activity will help your wellbeing, help manage stress, promote positive feelings and sleep1 - and is a chance to have some fun! To view our complete series of COVID-19 blogs, click here.
Many of us may well be feeling anxious and finding the coronavirus outbreak stressful. With social distancing you may be experiencing cabin fever, or you may have been unwell and are wondering how much physical activity you can be doing.
Dr Charlie Foster has gone from being a PE teacher in a secondary school to one of the world's leading experts in the field, regularly advising the Government on how best to get the UK moving and in turn improve our health.
Charlie and his colleagues from the Centre for Exercise, Nutrition and Health Sciences at Bristol University have developed the following advice2 and shared it with us:
Taking daily exercise is one of the four reasons the government has advised that it's fine to leave your household for.
You can do one form of exercise outside each day, for example a walk, run, or cycle – alone or with members of your household.
While you’re out, always keep at least two metres away from anyone outside of your household. This will stop the virus spreading.
Minimise time outside and wash your hands when you return home.
There are lots of online resources that have been made available for free to help you to keep active in your home, or in your garden if you have one.
If you’re self-isolating (for example if you’re over 70, pregnant or have an underlying health condition) but feel well, you can also go outside with the same caveat of keeping your distance from others.
If you’re self-isolating because you have symptoms, or someone in your household has them, or you're defined as extremely vulnerable on medical grounds3, you shouldn't leave home but that doesn't mean you should stop moving. It's really important to use movement and activity as a way of breaking up your routine, but only if you feel well enough.
If you’re unwell, use your energy to get better and don't try to be active. If you can get out of bed, then do so, but don't try to do too much.
Finally, if you’re feeling better after having had the virus, return to your normal routine very gradually and make sure to have additional rest periods during and after exercise.
For some people, strenuous activities will not be suitable. If that is the case for you, even taking a short break from sitting is of value. By doing 3-4 minutes of light intensity physical movement, such as walking or stretching, you can help ease your muscles and improve blood circulation and muscle activity4. If you have mobility issues, some ideas are given below.
Government restrictions to protect us from coronavirus have led to some innovative approaches to help us become and/or stay active, from delivery of physical activity sessions remotely to the home, to video channels reaching a greater audience than ever before, to social media tips and web pages on everyday activities that count.
Sport NI offer ideas at www.sportni.net/physical-activity-at-home and are encouraging people to share the best ideas they find online using the hashtag #SportSafeStrong
The NHS website www.pha.site/workout has a range of options including:
Breastfeeding is safe and the benefits of breastfeeding your baby will long outlast the COVID-19 pandemic.
To view our complete series of COVID-19 blogs, click here.
Even if you have suspected or confirmed COVID-19, breastfeeding is still recommended. The Royal College of Obstetricians and Gynaecologists have reassured mums that the benefits outweigh any risk of your baby catching the virus from your breastmilk and in fact there is currently no evidence1 that the virus is passed on in breastmilk.
This is an anxious time for everyone, not least parents of infants. It is worth knowing that breastfeeding can relax you and your baby by releasing helpful hormones (oxytocin and prolactin).
A further help during COVID-19 is that breastmilk is free and avoids a trip to the shops!
You may find that lockdown means less visitors than you would have had, and more time to just ‘be’ with your baby. Make the most of this time, with skin–to-skin contact – it helps keep a good milk supply, as does breastfeeding frequently and responsively (including through the night).
Keep an eye on your baby’s wet and dirty nappies to know that things are going well. For more information on what to expect, see ‘Off to a Good Start’ (link below).
If you have suspected or confirmed Covid-19, the following precautions1 are recommended:
Wash your hands before touching your baby, breast pump or bottles
Try to avoid coughing or sneezing on your baby
Consider wearing a face mask while breastfeeding, if available
Follow recommendations for pump cleaning after each use
Ask your partner or consider asking someone who is well to feed your expressed breast milk to your baby.
This may sound like a lot of effort, but bottle-feeding would also mean similar precautions to prevent spreading the virus.
Support during COVID-19
Even though home visits from health professionals are reduced or will have stopped, you aren’t on your own.
Your Trust will have provided you with telephone numbers for community midwives and health visitors. You may also have a breastfeeding peer support volunteer who is available over the phone or via text.
You can get ‘attachment and positioning’ information at www.breastfedbabies.org which offers helpful videos and pictures.
The National Breastfeeding Helpline is available 7 days a weekfrom 9:30am to 9:30pm - 0300 100 0212. They also offer a web chat www.breastfeedingnetwork.org.uk/chat/ breastfeeding support service for mums and their supporters in the UK. It is a confidential one-to-one secure online chat with a trained breastfeeding supporter. It works like instant messaging – it’s just typing, there are no webcams, and the only people who can see the chat are the user and the volunteer supporter.
If you’ve recently stopped breastfeeding
It is possible to return to breastfeeding if you have recently (within the past few months) stopped and breastfeeding was well established. Speak to your health professional if this is something that you would like to re-establish.
And a final note
The longer you breastfeed the better. Remember the benefits for you and your baby will long outlast the COVID-19 pandemic.
The World Health Organisation recommends that babies are exclusively breastfed until around 6 months, and then after solid foods are introduced, that breastfeeding continues into the 2nd year of life and beyond.
So keep your baby close, enjoy this time together and reach out for help if you need it.
Information on breastfeeding support during COVID-19 is also available from UNICEF UK Baby Friendly Initiative https://www.unicef.org.uk/babyfriendly/covid-19/
The Public Health Agency (PHA), Diabetes UK and the Diabetes Network are urging parents and carers not to ignore the signs of type 1 diabetes during the COVID-19 pandemic, and are reassuring them that...
