Inside Health

Covid-19 damages the lungs, leaving people struggling to get enough oxygen into their body. In the early stages of the pandemic many patients needed a lot of support in intensive care - including artificial ventilation. But there are other ways of boosting oxygen levels in the body - which are being studied in the Recovery-RS trial. Professor Gavin Perkins from the University of Warwick is comparing oxygen delivered by a mask called CPAP with both regular and high-flow oxygen to see which works best. Physiotherapy is one of the hands-on therapies which has been disrupted by the lockdown. Patients who need to do bespoke exercises following a fall or a heart attack might have been offered online sessions instead. But Manchester University researcher Dr Helen Hawley-Hague says these don't suit everyone - including people who don't have access to the internet or a smartphone. We hear from Jennifer and George - both of them have taken part in Helen's studies and have accessed physiotherapy either face-to-face or via a phone app. An Inside Health listener wanted to know if live vaccines like the polio vaccine could protect us against Covid. Oxford University's Andy Pollard explains about the theory behind this idea and how it might help. Dr Margaret McCartney looks at whether it makes a difference if you do a Covid throat and nose yourself - or if it's carried out by a healthcare professional.

Margaret McCartney on National Test and Trace and why households are receiving multiple calls. Beth tells of being contacted many times when her child tested positive and began to think all the family had been separately in contact with different cases, until the penny dropped that the calls were all about the same contact - her daughter. Professor Kate Ardern, director of Public Health in Wigan explains why these calls from the national system aren't joined up. And is there time in a pandemic to do trials for non-drug interventions like pub curfews or social distancing? Professor Paul Glaziou explains that there are currently just 8 such trials globally, while Professor Martin McKee highlights the problems involved. And Margaret hears from Professor Atle Fretheim who is trying to set up a trial in Norway into the impact of school closures on infection control.

The Radio 4 Touch Test included questions about touch in health care. Dr Natalie Bowling who's a psychologist from the University of Greenwich helped to create the test with colleagues at Goldsmith's University. Analysing the data revealed that a positive attitude towards touch in treatment settings increases as we get older. Surprisingly men reported being more likely to feel comfortable with touch in treatment settings - despite women preferring tactile treatments more than men. GPs Margaret McCartney and Ann Robinson agree on the importance of touch in their consulting rooms - both to help tell the difference between constipation and a ruptured appendix - and to place a comforting hand on the shoulder of a distressed patient.Chemotherapy cannot cure 82 year old Anne Townsend who was given a diagnosis of ovarian cancer a year ago - but it's hoped it will help to relieve her symptoms. One side effect has been a loss of her sense of touch - devastating because she loves to sew quilts. She found that reflexology sessions helped - though they stopped because of lockdown and she now uses acupressure techniques which she was taught online by therapists at St Christopher's hospice. Deborah Bowman, Professor of Bioethics at St George's University, also felt calmer and better-prepared for medical procedures when she was having cancer treatment. She explains how she trains medical students to approach their patients in a sensitive way and use touch with care.

The story of one child's recovery from PIMS-TS, the rare new condition that caught doctors by surprise in April. James Gallagher visits specialists at the Evelina London Children's Hospital to hear how they coped with identifying and treating a condition they'd never seen before. Dr Jenni Handforth and Dr Sara Hanna explain how 'they had to reinvent and tweak the rule book' to manage PIMS-TS, where 'the immune system has gone a bit crazy' and treatments worked 'like a fire blanket to dampen down the immune system'. And scientists at the Francis Crick Institute have discovered that children can have Coronavirus-fighting antibodies from before the pandemic started. Dr George Kassiotis explains how kids could have them and what this might mean. And Dr Margaret McCartney unpicks the tricky issue of spotting Covid and cold symptoms in children.

Thromboses - blood clots that form in the circulation - are easily the biggest single killer of British men and women. They affects people of all ages, races and ethnicities. Most strokes and heart attacks are caused by thromboses forming in the arteries supplying the heart or brain. But clots in the veins can be just as lethal, particularly when part of the clot breaks off and travels around the circulation and lodges in the lungs. Recently, the appearance of abnormal micro-clots in the lungs of severely affected Covid patients has highlighted the huge impact even tiny clots can have on our long term health and mortality. What more should be done to protect people from this misunderstood condition?James Gallagher unravels the risks and causes for blood clots, from deep vein thrombosis to clots in the lungs. As he hears from patients, the surprise of a DVT diagnosis and debilitation can be profound. Treating clots is a delicate process with a need to get the balance right between thinning the blood but preventing bleeding. James examines the effectiveness of the latest range of anticoagulants that have a more predictable blood thinning effect, without the need for regular checks to make sure the blood’s not too thick or too thin.The psychological effects of being diagnosed with thrombosis are often under reported. but in up to half the cases severe anxiety, depression and PTSD can arise. We hear of a major new study following the experiences of patients from their diagnosis to follow ups after treatment that explores how effectively they overcame the impact on their mental health of knowing they carried a blood clot.And James Gallagher reports on the newly emerging relationship between Covid and clotting. It was back in April when the alarm was first sounded about abnormal blood clots in severe Covid cases. Research is shedding new light on the causes of the problem - sticky blood. In turn, this knowledge is offering up new ways to treat some of the major complications thrown up by the virus. Presenter: James Gallagher Producer Adrian Washbourne

How will this year's expanded flu vaccine programme be delivered? In addition to usual groups the flu vaccine will be offered to all eleven year olds, any household contacts of vulnerable people told to shield, more health and social care workers and - the biggest change - everyone over 50! Dr Margaret McCartney discusses the difficult logistics for GP practices and pharmacies trying to work out how to immunise around half the population, whilst managing PPE, social distancing and infection control. Dentistry and Covid - Eddie Crouch, Vice Chair of the British Dental Association discusses how practices open since lockdown are coping. And a good news story of how the pandemic has instigated change in the diagnosis of coeliac disease. Dr Hugo Penny, one of the authors of new interim guidance, explains while Radhika tells of her personal experience of coeliac disease. Plus NHS preparations for winter. Trevor Smith, Divisional Director of Medicine at Southampton General Hospital, and Professor Neil Mortensen, President of the Royal College of Surgeons in England, both share their forecasts..

Dr Mark Porter on a new bedside test that differentiates between Covid-19 and other infectious diseases including flu in under an hour. Mark meets Dr Tristan Clark who has already been using the test as part of a trial. And the world's largest study into 'Long Covid' recruiting 10.000 people from 50 different hospitals across the UK who've been hospitalised for Covid to assess their long term recovery. Lead author Professor Chris Brightling discusses the long term symptoms seen in many people recovering from the virus and how research can answer difficult questions such as how long will these continue and what's the best way to help people. And Mark hears from Roz, still recovering from Covid after being admitted to intensive care on May 26th and from physiotherapists Matt and Gemma about how early and long term rehab can help. Plus Professor Sally Singh on the new NHS online rehab service 'Your Covid Recovery'.

As the Government announces GPs should start to prescribe cycling Margaret McCartney examines the evidence for exercise referrals with Harry Rutter, Professor of Global Health at the University of Bath. Temperature checks are popping up in bars, restaurants and receptions but do they work or are they giving false reassurance? Plus while the pandemic progresses Professor Carl Heneghan explains another type of false result, that the chance of false positive tests go up. Navjoyt Ladher, Head of Education at the BMJ, talks us through two highly topical terms - specificity and sensitivity. Amateur choirs have been closed due to Covid-19. Margaret talks to Professor Jackie Cassell who is currently researching what aspect of choirs congregating is particularly dangerous and whether the singing is actually a red herring.Producer: Erika Wright Studio Manager: John Boland

Public health doctors don't dash around hospitals wearing white coats brandishing stethoscopes. The work of this medical specialty is mainly outside of hospitals and it has a very long history. It has a local, national and global reach, an international skeleton charged with the care of populations. And in this pandemic, it is public health which is doing the heavy lifting.In this special edition of Inside Health Dr Margaret McCartney investigates the serious questions being raised about the UK's public health response to trying to stop the spread of the virus, and how tension, over the performance of the government's Test and Trace programme, has spilled out into the open.Margaret hears from Directors of Public Health who feel that their role and expertise in local communities working closely with local Public Health England teams has been overlooked. Instead a new national Test and Trace system has been set up using private companies outside the traditional public health infrastructure. The DPH for Wigan and lead director of public health for the Greater Manchester Combined Authority, Professor Kate Ardern, tells Margaret she believes government didn't understand the role and the experience of local public health teams and so instead of empowering them to oversee test, trace and isolate services, set up a new national system, from scratch, using private companies without public health experience. And the data needed locally to identify and deal with Covid cases, she tells Margaret, just hasn't come through. This is despite the fact that the law is clear; Covid is a notifiable disease and local directors of public health should receive the information.Margaret explores the history of public health with Professor Martin Gorsky from the London School of Hygiene and Tropical Medicine and hears from Professor of Global Health at Queen Mary, University of London, David McCoy, who believes the very structure of public health institutions after the 2012 Health and Social Care fragmented the service, leaving the country vulnerable (as he and 400 other experts warned at the time) to a pandemic. Public Health England's Medical Director, Professor Yvonne Doyle, rejects suggestions that PHE is insufficiently independent from government and insists that both national and local public health teams have pulled together in these unprecedented times.Producer: Fiona Hill

One of the most striking features of the coronavirus pandemic is the disproportionate toll it’s taken on some groups in society. Research by the Office for National Statistics shows black people are nearly twice as likely to have died from coronavirus than white people. And you see a similar pattern of elevated risk in other ethnicities too. Why is this? And to what extent is Covid 19 shedding light on approaches being taken in medicine more generally when assessing and treating people from Black, Asian and Minority ethnic groups?We hear from GP Dr Navjoyt Ladher who’s been navigating the language of race for the British Medical Journal; Dr Rohin Francis, cardiologist and host of the Medlife Crisis podcast, and Prof Kamlish Khunti who’s establishing a detailed Covid risk score to establish exactly who’s at most risk of infection. A major review has found women’s lives have been ruined and babies have been harmed in the womb and yet concerns were dismissed for years as simply “women’s problems”. Those are the findings of the Independent Medicines and Medical Devices Safety Review. It looked at the hormonal pregnancy test Primodos, the epilepsy drug sodium valproate and vaginal mesh implants which are used to treat prolapse and incontinence. Inside Health’s resident GP Margaret McCartney. discusses what needs to change.Presenter: James Gallagher Producer: Adrian Washbourne