text:
Improving the early identification of COVID-19 pneumonia: a narrative review
http://orcid.org/0000-0003-0418-8859Daniel Goyal1,
Matthew Inada-Kim2,3,
Fatam Mansab4,
Amir Iqbal5,
Brian McKinstry6,
Adeeb P Naasan7,
Colin Millar7,
Stephen Thomas8,
Sohail Bhatti4,
Daniel Lasserson9,10 and
Derek Burke11
1Department of Acute Internal Medicine, Gibraltar Health Authority, Gibraltar, Gibraltar
2Department of Infection, Antimicrobial Resistance and Deterioration, NHS England, Redditch, Worcestershire, UK
3Department of Acute Medicine, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK
4Department of Public Health, Gibraltar Health Authority, Gibraltar, Gibraltar
5Department of Covid-19 Remote Monitoring of Patients During Response & Recovery, NHS Grampian, Aberdeen, Aberdeen, UK
6Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
7Department of General Medicine, Islands Hospital, Oban, UK
8Department of Respiratory Medicine, Raigmore Hospital, Inverness, Highland, UK
9Hospital at Home, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
10Department of Ambulatory Medicine, University of Warwick, Coventry, West Midlands, UK
11Department of Clinical Governance, Gibraltar Health Authority, Gibraltar, Gibraltar
Correspondence to Dr Daniel Goyal; daniel.goyal{at}gha.gi
Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To improve the earlier detection of COVID-19 pneumonia in the community we provide a narrative review of current evidence examining the clinical parameters associated with early disease progression. Through an evolving literature review, we examined: the symptoms that may suggest COVID-19 progression; the timing of deterioration; the utility of basic observations, clinical examination and chest X-ray; the value of postexertion oxygen saturations; and the use of CRP to monitor disease progression. We go on to discuss the challenges in monitoring the COVID-19 patient in the community and discuss thresholds for further assessment. Confusion, persistent fever and shortness of breath were identified as worrying symptoms suggestive of COVID-19 disease progression necessitating urgent clinical contact. Importantly, a significant proportion of COVID-19 pneumonia patients appear not to suffer dyspnoea despite severe disease. Patients with this asymptomatic hypoxia seem to have a poorer prognosis. Such patients may present with other signs of hypoxia: severe fatigue, exertional fatigue and/or altered mental status. We found duration of symptoms to be largely unhelpful in determining risk, with evidence of deterioration at any point in the disease. Basic clinical parameters (pulse, respiratory rate, blood pressure, temperature and oxygen saturations (SpO2)) are likely of high value in detecting the deteriorating community COVID-19 patient and/or COVID-19 mimickers/complications (eg, sepsis, bacterial pneumonia and pulmonary embolism). Of these, SpO2 carried the greatest utility in detecting COVID-19 progression. CRP is an early biochemical parameter predictive of disease progression and used appropriately is likely to contribute to the early identification of COVID-19 pneumonia. Identifying progressive COVID-19 in the community is feasible using basic clinical questions and measurements. As such, if we are to limit the mortality, morbidity and the need for complicated, protracted admissions, monitoring community COVID-19 cases for signs of deterioration to facilitate early intervention is a viable strategy.
No data are available.
http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjresp-2021-000911
SARS-CoV-2 is the third respiratory beta-coronavirus to infect humans. There have been over 100 million cases worldwide with over 2 million deaths.1 Although it seems quite plausible that there will be a safe and effective vaccine strategy through 2021, given the expected lag time in achieving significant disruption to viral transmission, the high prevalence of SARS-CoV-2, and the potential difficulties posed by variant strains, the challenge of managing COVID-19 will remain with us for some time.2 If we are to limit the direct and indirect impact, understanding the clinical aspects of SARS-CoV-2 remains pivotal.
Our ability to limit the progression of COVID-19 has improved with our growing knowledge and experience of the disease. Timely administration of optimally delivered oxygen reduces disease progression.3 4 Steroids have been shown to be effective in reducing disease progression,5 shortening hospital stays6 and reducing mortality.7 There are many other aspects of 'best supportive care' that impact disease progression.8
Here, we present the evidence supporting the role of a number of clinical parameters in detecting the deteriorating community COVID-19 patient earlier. We also discuss the challenges in early identification of the progressive COVID-19 patient and make suggestions on how to manage such challenges.
We initially searched literature databases (such as Medline, medRxiv and Google Scholar) for studies reporting on clinical parameters relating to COVID-19. We focused on those clinical parameters that would be easily accessible within the community: symptoms, basic clinical observations (heart rate, blood pressure, oxygen saturations, respiratory rate (RR) and temperature) and clinical examination. An evolving literature search was permitted, and studies were included for review if they had relevant data pertinent to the underlying question of early identification of COVID-19 pneumonia.
We further searched for studies relating to clinical investigations that were accessible from the community and/or would be typically considered in other viral pneumonias: chest X-ray, postexertion oxygen saturations and serum C-Reactive Protein (CRP) levels. Again, an evolving literature search was permitted, and studies were included for review if they had relevant data pertinent to the underlying question.
Following identification of relevant studies, we sought to compare milder COVID-19 cohorts with more severe cohorts to extrapolate potential differences. Cohort severity was determined based initially on the overall cohort mortality rate or the rate of advanced respiratory support required (as described). The data pertaining to these clinical parameters and tests specific to community COVID-19 were insufficient to perform a systematic review or meta-regression analysis, and given the need to infer and extrapolate across studies, we deemed a narrative review as the most appropriate method for reporting such data during this phase of the pandemic.
Identifying disease progression
Sung and colleagues9 provide a useful insight into the transition from mild to severe cases in their retrospective analysis of 3060 cases from South Korea. In the mild group (n=2585), symptoms included cough (40%), fever (30%) and dyspnoea (5%). Cough, history of fever and dyspnoea all increased in prevalence between groups, reaching 70.4%, 57.1% and 70.3% in the critical group, respectively.
While Sung et al provides a useful insight into early symptoms in mild COVID-19, other epidemiological studies provide larger datasets for mixed severity and severe COVID-19 cohorts. Two of these studies together with the South Korean mild cohort have been collated into a table for comparison of symptom trajectory (table 1).
Symptom prevalence across different COVID-19 severity levels
Comparing the three different groups (mild, mixed and severe/inpatient), symptoms that may suggest COVID-19 progression include: shortness of breath, dry cough, fever, fatigue, chest tightness, confusion, diarrhoea, vomiting and abdominal pain. Of these, shortness of breath remains the most predictive of disease progression (summary box 1).
Symptoms that may be associated with disease progression:
Dyspnoea.
Dry cough.
Fever.
Chest tightness.
Diarrhoea.
Vomiting.
Duration of symptoms
There is an association between time from symptom onset to receiving clinical care and disease severity. Within a specified cohort, the longer the delay between symptom onset and admission, the greater the duration of stay and the higher the mortality.10 11 Some patients however, can deteriorate rapidly, requiring intubation within 1 day of symptom onset.12–14
This was highlighted well in a study from Mexico. Data were collected from 65 000 patients who had suspected COVID-19 between January and April 2020, with an overall Case Fatality Rate of 3.32%. The time from initial symptoms to actual clinical suspicion of COVID-19 was recorded and then analysed against medical disposition decision and mortality. Fourteen per cent of patients presented to healthcare within 24 hours of first symptoms and of those nearly half were admitted directly to hospital, with 2.8% being admitted to intensive care unit (ICU). The overall mortality for those presenting within 24 hours of symptom onset was 5.2%. Mortality fell to 2.5% if the patient presented to medical care when the symptom onset was between 1 and 3 days and rose significantly to 3.6% in the 4–7 days group. Where patients were admitted after 7 days of symptoms, mortality rose even further (4.1%). The delayed presentation group had a 59% higher chance of ICU admission if presenting after 7 days versus presentation between 1 and 3 days.15
While there have been reports of a 'second hit' deterioration in patients occurring between 5 and 10 days of symptom onset, the evidence for such a trajectory is limited. It remains feasible that such a 'second hit' merely relates to the delayed presentation of COVID-19 pneumonia and natural evolution of the disease. Regardless of what future research will show, there is clear evidence of sudden and rapid deterioration in a proportion of patients with COVID-19,12–15 and as such, vigilance throughout the illness seems warranted.
Basic observations
Identifying disease progression in COVID-19 has been challenging in part due to the variable symptoms and in part due to the minimal changes that occur in basic observations (blood pressure (BP), temperature (Temp), oxygen saturations (SpO2), heart rate (HR) and RR) despite severely progressive disease.
Even within a relatively severe cohort, the observation changes are modest. Data from the multicentre retrospective inpatient cohort study, International Severe Acute Respiratory and emerging Infection Consortium cohort (ISARIC) (n=122 361), yield an overall mortality rate of 31% (where outcomes are recorded) and mean CRP of ~90 mg/L. Despite this level of severity, the mean observations in the age bracket of 60–69 years at presentation were RR: 22, HR: 91, SpO2: 95%, temp 37.3° and systolic BP: 130 mm Hg (table 2).16
The mean observations from the ISARIC inpatient cohort
Basic observations are of value in identifying COVID-19 complications (eg, pulmonary embolism, secondary bacterial pneumonia and cardiogenic shock) and in detecting an important group: COVID mimickers (sepsis, bacterial pneumonia, etc). As such, monitoring HR in patients under surveillance/evaluation for progressive COVID-19 is useful. Its use in detecting progressive COVID-19 in a timely manner however is likely quite limited.16 17
In a New York cohort (n=3841, mortality 8%), BP at presentation was modestly predictive of disease progression to death. The mean diastolic BP was 71 mm Hg in the non-surviving group (mean age 73) versus 76 mm Hg in the surviving group (mean age 55).17 These effects could however be age related. BP monitoring remains useful for COVID-19 mimickers and COVID-19 complications.
Respiratory rate
In a study evaluating outcomes following the disposition decisions of physicians in Detroit (n=463), RR (at baseline) was marginally predictive of the need for hospital admission in comparison with those who were discharged home (the overall cohort was severe with a mortality rate of 16%). Mean RR in those discharged home was 18 (IQR: 17–18) rising to 20 in those requiring admission (IQR: 18–22).18 In very severe cohorts, RR seems to have value in predicting disease progression. In a London-based cohort (mortality 36%), mean RR was 26 (IQR: 21–32) on admission and was found to have predictive value for intubation or death (HR 1.53 (95% CI 1.38 to 1.71)).19 Similar results were found in a moderately sized Madrid cohort (n=1549, mortality: 21.2%).20 RR may have some value as a marker of severe disease, but the RR threshold for raising concern is probably lower than in other respiratory conditions (see section on 'Oxygen Saturations').
A measured temperature is likely to be of use in capturing some deteriorating patients and certainly of use in monitoring for signs of time critical COVID-19 mimickers such as sepsis. In relation to COVID-19, the classification of an elevated temperature differs from nation to nation. In China, where much of the initial data came from, a fever is classed as anything >37.2°C,21 whereas in the USA, a fever is classed as >38.0°C.22
Even in studies examining more severe cohorts, recorded temperature is not a reliable marker at presentation to hospital. In a New York cohort of 5700 hospital cases of COVID-19 (mortality=21%), the mean presenting temperature was 37.5°C, but only 30% of patients presented with confirmed fever (>38.0°C).22
While an isolated fever is likely of limited use in identifying disease progression, persistent fever—as in most infectious diseases—remains an ominous feature.
Oxygen saturations (SpO2)
Oxygen saturations are the most consistent predictor for disease severity.18 23 24 Oxygen saturations below 95% have been reported to be associated with twice the risk of death in comparison with normoxaemia at presentation.25
While SpO2 seems to have a fairly clear relationship with disease progression, shortness of breath is more complicated. Silent hypoxia is the popular term used to describe patients who have limited sensation of feeling short of breath and/or no increased RR and yet when examined are found to be hypoxic.26 This has been a feature of COVID-19 since the first cases were reported.27 Imaging studies also demonstrate the disconnect between severity of lung pathology and the sensation of breathlessness. In a study from Marseilles, France, 757 (68%) of patients who did not complain of breathlessness had pneumonia on CT.28
The same study investigated the prevalence and consequences of hypoxia without the sensation of dyspnoea and reported 28.1% of patients who did not complain of dyspnoea were in fact hypoxic on blood gas analysis (n=96). The investigators also reported a dramatically increased rate of ICU admission in such patients of 42.6%, compared with 5.7% in dyspnoeic hypoxic patients, the mortality rate being 20.4% versus 5.7%, respectively. Such 'silent hypoxic' patients presented later than others in the group (half after day 5 of symptoms).28
Another useful study examined first responder observations of patients with COVID-19 throughout the first wave of infections in March 2020 in Paris (n=1201). There was a marked disconnect between level of hypoxia (mean SpO2 of 90%) and RR (mean 20), comparing with the previous year where the mean SpO2 was 96%, and RR was 22.29
The inability to rely on the self-reported symptom of breathlessness to identify progressive disease and hypoxia presents a substantive challenge.
Post-exertion oxygen saturations
Postexertion oxygen saturation measurement may help increase the sensitivity of our basic observations. In a recent literature review, the performance and safety of a number of specific exercise tests were analysed across a range of conditions. Both the 1 min sit to stand Test (1STST) and the 6 min walk test performed well in identifying disease severity in chronic lung disease.30
Perhaps the most apt proxy for COVID-19 in this context is interstitial lung disease (ILD), particularly in light of the infrequency of hypercapnoeic hypoxia in COVID-19 and ILD,28 the CT similarities31 and the presence of a more restrictive pattern in COVID-19 on spirometry.32 In a prospective comparative trial, the 1STST performed well against the gold standard test (the 6 min walk test) (n=107). Over two-thirds of ILD patients (n=25) had a reduction in their baseline SpO2 by >3% after the 1STST without adverse effect. The 1STST showed good predictive value for detecting patients with moderate and severe ILD.33
Exertional saturation testing is already in use within the acute medical setting, particularly when considering discharge. Goodacre et al34 conducted a retrospective multicentre observational study of postexertion SpO2 measurements where physicians chose to undertake the test in patients with COVID-19 typically in the emergency department (ED). Out of 817 patients presenting to ED during the period of 26 March to 28 May 2020 who underwent postexertion oxygen saturation monitoring, COVID-19 related adverse events (death or level 2/3 organ support) occurred in only 30 patients (3.7%) with a mortality of 1.1%. This was from within a cohort where overall adverse events were high at 20.9% (mortality 14.8%). Unfortunately, Goodacre et al did not report on disposition outcomes, and no case–control comparison was attempted.
Nonetheless, more than half of patients who eventually suffered a COVID-19 related adverse event were positive on the postexertion test (dropping their SpO2 by 3% or more). In the adverse group, 56% of patients who had a normal resting SpO2 at admission (defined in this study as >93%), with a National Early Warning Score (NEWS) of <3, had a positive postexertion test. Indeed, 41% of those with an adverse outcome dropped their saturations by 5% or more, and almost 1 in 10 dropped their saturations by more than 10%. Goodacre et al reports a positive likelihood ratio of predicting adverse outcomes of 1.76 at the level of a drop in SpO2 of 3% or more.34 While further more controlled data are needed, postexertion SpO2 may well help to detect more cases of progressive COVID-19 earlier. Within the current clinical climate, it seems reasonable to use postexertion oxygen saturations in patients with suspected/confirmed COVID-19 where they are normoxaemic at baseline and it is safe to do so at the discretion of the attending clinician.
Very little has been published on clinical examination findings in COVID-19 pneumonia, beyond the value of basic observations as discussed previously. Reports have suggested certain characteristic features on auscultation (such as 'velcro' crackles, atypical bronchial breathing and basolateral distribution) that may denote underlying COVID-19 pneumonia and correlate with radiological changes. Such findings are subject to observer variation however, and the absence of such signs does not denote absence of disease.35
Inferentially, there is likely to be a demonstrable value in the 'eyeball' clinical assessment of patients with COVID-19. A Danish study compared an established triage system (based on observations and presenting complaint) versus an 'eyeball' assessment by a phlebotomist. The eyeball assessment was significantly superior, particularly in detecting those who may be incorrectly triaged low (green or yellow categories).36 A further study examined physician and nurse predictions of mortality in ED at first assessment. Observations were to hand, but no test results. Both groups performed well, and performance improved with years of experience. When combined (ie, both physician and nurse were in agreement), the predictive value was excellent.37
While formal clinical examination is of unknown value, there is likely significant value in assessment by an experienced healthcare professional.
C reactive protein (CRP)
CRP has been reported as a reliable marker for disease severity and is routinely available including through point-of-care testing.38–40 The optimum cut-off value to indicate significant risk of disease progression remains unknown. It has been previously established, however, that the majority of viral infections we are likely to encounter will rarely raise CRP >30 mg/L, and a CRP of >30 mg/L during a viral illness such as influenza would typically indicate progression of disease and risk of viral pneumonia.41 Further elevations raise the possibility of severe inflammation, a bacterial or other invasive infection.42 Additionally, imaging studies have consistently demonstrated that even a modest CRP rise is associated with infiltrative changes on CT prior to respiratory symptoms.43 In this regard, CRP can be of use in identifying patients with disease progression.
CRP also has some reported use in the hyperacute COVID-19 phenotype. Manson et al14 identified a significant subgroup of patients presenting to two tertiary hospitals in the UK in March 2020, where CRP >150 mg/L or doubling from 50 mg/L within 24 hours was strongly predictive of death or the need for intubation within the following 24 hours. A further analysis from South Korea reported that an admission CRP >80 mg/L had a higher sensitivity for predicting adverse outcome in COVID-19 than a NEWS score of 2 or more.25
There are several limitations with using CRP as a monitor for disease severity, or to detect those patients that require closer follow-up. Primarily, CRP has a lag time before rising. CRP results indicate the severity of inflammation from the previous day (with levels peaking 6–72 hours following an insult).44 This makes the utility of an isolated CRP measurement taken at the point of symptom onset fairly limited. Furthermore, CRP rises in the elderly or those with multiple comorbidities are often blunted. In a multicentre study (although an inpatient high severity cohort), initial CRP measurement correlated with COVID-19 disease severity in all age groups except those in the >75-year-old age group.45 Early changes in CRP in the elderly may still be predictive, although less so.
There are other biochemical parameters that have been associated with deterioration in the patient with COVID-19. Lymphocyte count, lactate dehydrogenase and D-dimer have been quite reliably reported as prognostic markers in the patient with COVID-19, although predominantly in inpatient cohorts. Whether there is clinical utility for monitoring these markers in the community setting remains unknown. Lymphocyte count may provide better prognostication in the elderly and offset the shortcomings of the CRP in this patient group.38 39
Chest X-ray (CXR)
In those cases where there are some concerns of progression but equivocal objective signs, there is a question as to the utility of CXR within the community setting.
Borakati et al produced a useful study exploring this, although in a high-severity cohort (n=763, mortality=24%). More than half of the patients had 'classic' CXR signs of COVID-19, and as such would have confirmed COVID-19 pneumonia (sensitivity 0.56 (95% CI 0.51 to 0.60)). Of considerable note, nearly one-third of PCR negative referrals with 'possible' COVID-19 also had 'classic' COVID-19 features on CXR.46
An urgent care cohort that was likely less severe (n=636) reported around 40% of confirmed cases had a positive CXR, although this was based on a consensus view of 12 radiologists and in the absence of objective disease severity markers.47 A further milder cohort from Hong Kong (n=64, dyspnoea rate=6%) with a mean age of 56 years (SD: 19) reported 69% of chest X-rays were abnormal at baseline (but this also included all consolidations).48
SARS-CoV-2 causes a self-limiting viral infection in the majority of patients. Cough, sore throat, headache, myalgia, fever and other cold/influenza like symptoms are typical, and symptoms begin to resolve within a few days (although cough can persist longer). In some, the illness progresses to a Lower Respiratory Tract Infection, and this is typified as viral pneumonia.49
Time to hospital care in viral pneumonia is known to dictate outcome. Patients who present late have a longer hospital stay, increased ICU requirement and a higher mortality.50 51 The same is true for other pneumonias.9
There are many reasons for an improved outcome with earlier inpatient care. Basic supportive care will include bed rest, appropriate hydration, venous thromboembolism (VTE) prophylaxis, medication review, early identification of complications (pulmonary embolism, acute kidney injury and secondary bacterial pneumonia and sepsis) and the commencement of oxygen at or soon after the onset of hypoxia.52
The early identification and correction of hypoxia is likely one of the key determinants of disease progression. A recent study (n=35 000) demonstrated a substantive mortality benefit when patients spent the majority of time in the optimal oxygen saturations of 94%–98%. Indeed, there was a 50% mortality saving when patients were in the optimum range for 80% of the time versus only 40% of the time.53 One may potentially infer that patients with COVID-19 left hypoxic at home carry a diminishing chance of survival.
Hypoxia (SpO2 <95%) has numerous adverse health effects. In the acute setting, hypoxia increases the risk of fatal arrhythmia and end-organ damage.54 In a subacute setting, hypoxia has been shown to drive pulmonary inflammation and the systemic inflammatory response55 56 and to promote coagulation leading to an increase in thromboembolic events.57 58 Long-term effects of hypoxia include ongoing cognitive impairment.59
Identifying hypoxia early is also important for identifying patients who may benefit from corticosteroids. In April 2020, an observational study reported significant benefit in hypoxic patients who received corticosteroids (equivalent dose of dexamethasone 12–24 mg once daily for 5–7 days) with a reduction in inpatient stay from 12 days to 8 days.6 A further observational trial from New York demonstrated a dose equivalent of dexamethasone 12 mg once daily improved recovery of severely unwell patients (mean CRP >200 mg/L), conferring a substantial reduction in need for ICU admission (adjusted Hazards Ratio 0.16 (95% CI 0.07 to 0.34; p<0.001)).5 While the full report from the randomised controlled Randomised Evalualtion of COVID-19 Therapy trial is still awaited, the preliminary report confirms a mortality benefit for dexamethasone 6 mg once daily in hypoxic patients with COVID-19 pneumonia.7 The optimal dose, timing, patient selection and duration of use remain unknown, but certainly corticosteroids have an impact on COVID-19 pneumonia progression.
VTE prophylaxis is a cornerstone of acute medical management and is initiated in the majority of patients with pneumonia. Evidence is accruing that such an intervention may prevent disease progression and complications in COVID-19, providing yet another reason for identifying the progressive COVID-19 patient earlier.60
Our summary opinion as to the most useful clinical parameters in identifying the progressive COVID-19 patient earlier is presented at table 3.
Summary of recommendations for the early identification of progressive COVID-19 in the community
COVID-19 pneumonia complicates a modest yet significant proportion of patients with SARS-CoV-2 infection. As with all pneumonias, time to intervention in COVID-19 pneumonia affects outcome. There is also the potential to reduce the consumption of healthcare resources and the need for high-intensity care through timely intervention. By doing so, we reduce the direct and indirect impact of the SARS-CoV-2 pandemic.
To achieve improved outcomes in COVID-19, we must understand its clinical features better. In line with this and pending more controlled studies in the community COVID-19 patient, we present the current relevant literature relating to the clinical parameters associated with disease progression. Dyspnoea, confusion, persistent fever, reduced SpO2 (<95%) and later in the illness an elevated RR (>20 BPM) all seem reliable markers of COVID-19 progression. Fatigue and altered mental status may also be present and may be the only symptoms of hypoxia. While the evidence base for postexertion oxygen saturation measurement is lacking, the current evidence suggests it may be useful in detecting COVID-19 pneumonia earlier. CRP remains a useful marker for disease progression in the pneumonic COVID-19 illness.
Overall, it seems sensible and achievable to adopt a proactive clinical posture when monitoring patients with COVID-19 in the community. The presence of 'asymptomatic' hypoxia and the potential for rapid deterioration imposes a necessity for a more vigilant, rule-in approach, whereby patients may require repeated assessment prior to admission or disease resolution.
Ethics statements
Patient consent for publication
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Yufei Y,
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. Utility of the neutrophil-to-lymphocyte ratio and C-reactive protein level for coronavirus disease 2019 (COVID-19). Scand J Clin Lab Invest 2020;80:536–40.doi:10.1080/00365513.2020.1803587pmid:http://www.ncbi.nlm.nih.gov/pubmed/32804580
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Bannaga AS,
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Haran JP,
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. C-reactive protein as predictor of bacterial infection among patients with an influenza-like illness. Am J Emerg Med 2013;31:137–44.doi:10.1016/j.ajem.2012.06.026pmid:http://www.ncbi.nlm.nih.gov/pubmed/22944552
Varble N,
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. CT and clinical assessment in asymptomatic and pre-symptomatic patients with early SARS-CoV-2 in outbreak settings. Eur Radiol 2021;31:1–12.doi:10.1007/s00330-020-07401-8pmid:http://www.ncbi.nlm.nih.gov/pubmed/33146796
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. How C-reactive protein structural isoforms with distinctive bioactivities affect disease progression. Front Immunol 2020;11:2126. doi:10.3389/fimmu.2020.02126pmid:http://www.ncbi.nlm.nih.gov/pubmed/33013897
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. Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study. BMJ Open 2020;10:e042946. doi:10.1136/bmjopen-2020-042946pmid:http://www.ncbi.nlm.nih.gov/pubmed/33158840
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Contributors All authors contributed to the conception and design of the review. All authors provided literature reviews on their relevant areas. DG, FM, AI, CM, BM and APN undertook the majority of the initial write-up. DL, MI-K, SB, ST and DB provided further input at the draft stage. All authors contributed to the discussion, conclusion and final review.


text:
Q: Рекурсивный поиск по маске C++.Необходимо в функцию в качестве параметра передать маску для поиска В качестве аргумента необходимо допилить маску для поиска, ума не приложу как это сделать, ведь если в строку Find = FindFirstFile((dir + "\*").c_str(), &FileData); вписать маску, она будет перекрывать дальнейший поиск в подкаталогах.К примеру добавить счетчик глубины ? Буду безумно благодарен за помощь.
void FindFiles(string dir)
{
    string ster = " "; // path container
    HANDLE hFind;
    WIN32_FIND_DATA FileData;
    hFind = FindFirstFile((dir + "\\*").c_str(), &FileData);

    if (hFind != INVALID_HANDLE_VALUE)
    {
        do
        {
            if (FileData.dwFileAttributes == FILE_ATTRIBUTE_DIRECTORY)
            {
                if (FileData.cFileName[0] == '.')
                {
                    continue;
                }
                else
                {
                    std::cout << "Directory: " << FileData.cFileName << std::endl;
                    FindFiles(dir + "\\" + FileData.cFileName + "\\");
                }
            }
            else
            {
                ster = dir + "\\" + FileData.cFileName + "\\"; // костыль
                ster.erase(ster.end() - 1);
                //if (strinf(text, ster) == 1) return ster;
                std::cout << FileData.cFileName << "                               "
                          << ster << strinf("qwe", ster) << std::endl;
            }
        }
        while (FindNextFile(hFind, &FileData));
    }

    //return "no such files";
}

A: Не понимаю, что вам не нравится - у вас почти полностью работоспособный код.
Вот, после небольшой подчистки (+ добавил вам счетчик глубины рекурсии) вполне работает:
#include <string>
#include <iostream>
#include <windows.h>

using namespace std;

void FindFiles(string dir, int depth) {
    string ster=" ";// path container
    HANDLE hFind;
    WIN32_FIND_DATA FileData;
    hFind = FindFirstFile((dir + "\\*").c_str(), &FileData);
    if (hFind != INVALID_HANDLE_VALUE)
    {
        do
        {
            if (FileData.dwFileAttributes == FILE_ATTRIBUTE_DIRECTORY)
            {
                if (FileData.cFileName[0] == '.')
                {
                    continue;
                }
                else
                {
                    std::cout << "Depth: " << depth << "   Directory: " << FileData.cFileName << std::endl;
                    FindFiles(dir + "\\" + FileData.cFileName,depth+1);
                }
            }
            else
            {
                std::cout << dir << FileData.cFileName << std::endl;
            }
        } while (FindNextFile(hFind, &FileData));
    }
}

int main(int argc, const char * argv[])
{
    FindFiles("c:\\Windows",0);
}

Я не стал поправлять, но учтите, что кроме служебных каталогов . и .. может быть что-то типа .dir, так что ваша проверка не совсем корректна.

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"COMECHINGONIA, Revista de Arqueología" is a periodical publication, with sixmonthly periodicity, aimed to publish original researches in archaeology. It pursues to show numerous aspects of contemporary scientific production in this field. In this respect, there will be included strictly regional topics from Argentina or neighboring countries, as well as theoretical and methodological contributions and specific sub disciplines innovations (zooarchaeology, archaeobotany, geoarchaeology, bioarchaelogy, etc.).
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Title (bold, capital, justified to the left).
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In all cases enumeration of cited pages goes after the year of edition and proceeded by ":".
f) First source documentary materials: (Archivo Histórico de la Provincia de Córdoba, Escribanía 1, Legajo 3, Expediente 1).
1987 The Maya. Thames y Hudson, London y New York.
1971 Dating techniques for the archaeologist. Massachussetts Institute of Technology, Massachussetts.
1972 Archaeological context and sistemic context. American Antiquity 37: 156-165.
1968 Archaeological perspectives. New perspectives in Archaeology (ed. por S.R. Binford y L.R. Binford), pp. 5-32. Aldine, Chicago.
1982 The domestication and exploitation of south american camelids: methods of analysis and their application to circum-lacustrine archaeological sites in Bolvia and Perú. Ph.D. dissertation. Washington University, St. Louis.
· Radiometric datings and years have to be expressed on years BP (AP, in Spanish), followed by the realistic error (+-), and the Lab code (between brackets). Dated materials should be detailed (wood, charcoal, etc.). In the case of calibrated dates, they have to be preceded by Cal. A.C. (B.C, in Spanish) or Cal. d.C. (A.D., in Spanish).
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text:
Жан-Батист Таверньє (Jean-Baptiste Tavernier; 1605–1689) — французький купець, який тримав у своїх руках європейську торгівлю діамантами з Індією.

Життєпис
У торговельних справах зробив п'ять подорожей в Індію, подолавши на своєму шляху більш 240 000 км.

Таверньє народився в Парижі в родині торговців-протестантів з Антверпена. До 16 років він уже об'їхав у торговельних справах прилеглі до Франції країни. На службі у імператорського намісника Угорщини, юний Таверньє був присутній при бойових діях проти турків. Потім перебував на службі в мантуанських герцогів з дому Гонзага.

В 1630 задумав побачити Схід, для чого в компанії трьох місіонерів відплив убік Стамбула. Він проїхав через Ерзурум і Баку до Ісфахана, звідки повернувся через Багдад і Алеппо у Париж (в 1633). Після повернення, ймовірно, пішов на службу до Гастона Орлеанського.

У вересні 1638 р. Таверньє знову відправився на Схід. Досягнувши Персії, він поїхав далі на схід в Індію, де відвідав двір Шах Джахана в Агрі і знамениту своїми алмазними копальнями Голконду. Таверньє скуповував у місцевих князів діаманти для того, щоб перепродати їх зі значним прибутком у Європі. Саме він привіз у Європу знаменитий французький блакитний діамант.

Згодом він чотири рази навідувався в Індію з метою скупки дорогоцінних каменів: в 1651–55, 1657–62, 1664–68 рр. Найбільш відома з цих подорожей друга, під час якої він досяг берегів Яви, а в Європу повернувся, обігнувши мис Доброї Надії. Його торговельними партнерами в цей період були голландці.

Торговельно-посередницька діяльність Таверньє була досить прибуткова. Він був представлений Людовику XIV, отримав дворянський сан і на зібрані кошти придбав титул барона. Після одруження на дочці паризького ювеліра, Таверньє полишив мандрівки і взявся за написання мемуарів, що містять, крім іншого, опис Японії і В'єтнаму за спогадами брата й інших мандрівників.

Наприкінці життя 83-літній торговець, із причин, які дотепер викликають спори істориків, виїхав з Парижа в Копенгаген з наміром звідти проїхати до Персії. Він помер, проїжджаючи через Москву, де, очевидно, й був похований.

Під впливом розповідей Таверньє та його книги з описом індійських алмазів видатний дрезденський золотар Йоганн Дінглінгер створив свій неперевершений шедевр — мініатюру «Королівський двір у Делі в день народження Великого Могола Аурангзеба».

Оцифровані книги Таверньє

 Les Six Voyages de Jean Baptiste Tavernier, écuyer baron d'Aubonne, qu'il a fait en Turquie, en Perse, et aux Indes, pendant l'espace de quarante ans, & par toutes les routes que l'on peut tenir : accompagnez d'observations particulieres sur la qualité, la religion, le gouvernement, les coutumes & le commerce de chaque païs; avec les figures, le poids, & la valeur de monnoyes qui y ont court, Gervais Clouzier, Paris, 1676 Texte en ligne 1  2  Illustrations en ligne 1  2
 Recueil de plusieurs relations et traitez singuliers et curieux de J.B. Tavernier, chevalier, baron d'Aubonne. Qui n'ont point esté mis dans ses six premiers voyages. Divisé en cinq parties. Avec la relation de l'intérieur du serrail du Grand Seigneur suivant la copie imprimée à Paris, Genève, Club des libraires de France, Le cercle du bibliophile, 1970. Texte en ligne  Illustrations en ligne

Інтернет-ресурси

Describing Tavernier's travels in India, including his trade in gems, diamonds and visits to Maharadja's  Tavernier: Travels in India (English Translation), Oxford University Press, Humphrey Milford, Translated by Ball, London 1925.
Tavernier part II + appendices on Koh-I-Noor, diamonds and diamond and gold mining . Both Volumes translated from Le Six Voyages de J. B. Tavernier (2 vols. 4to, Paris, 1676)
 http://www.thefrenchblue.com  . Website:  Novel describing Tavernier's Six Voyages with article on history of the Great Blue diamond and timeline of Tavernier's life
фрагменти в українському перекладі https://staraukraina.blogspot.com/2021/08/i.html

Примітки

Народились 1605
Померли 1689
Французькі мандрівники
Французькі купці
Уродженці Парижа
Померли в Москві

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Many of those facing redundancy in the current round of industry restructurings are the over-45s, who find it more difficult to find new jobs. How can we help them get back to work?
'Greed is good' was the theme of business in the 80s, but more recently the GFC has led to calls for business to rediscover its moral purpose. Now a group of worldwide leaders including Sir Richard Branson have come together to launch the B Team, which aims to 'put people and planet alongside profit'. Can business save the world? And should we all be working towards more altruistic goals?
There are still very few women in top jobs, even though their presence gives companies a strategic advantage. Now a new report has identified ways employers can help them rise through the ranks.


T-TRAK is a modular model railroad system with few rules and thus maximum flexibility. It is the only modular system with specifications for every scale. For more information refer to www.t-trak.org.
The Patrol Leaders' Council of Troop 104, Scotch Plains, NJ.
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Greenwich Security write back to VC — December 24, 2020
Greenwich Security write back to VC
December 24, 2020 /IWGB/Leave a comment
On 15 December, University of Greenwich Vice Chancellor wrote individually to all security staff at UoG, following a series of visits she had made to meet staff individually.
These letters and visits were a response to the launch of the campaign for in-house and equality of terms and conditions by outsourced security officers, cleaners and porters at UoG.
In her letter, the Vice Chancellor made clear she refuses to negotiate with the security staff and our union the IWGB regarding our demands.
Today, the vast majority of the Greenwich security officers have written and signed a collective later in response to the VC, restating our demands and making clear we will not accept her attempts to undermine our union.
Read the security officers' letter here:
And you can read the Vice Chancellor's letter from 15 December here:
Greenwich Security Vote To Strike! — December 23, 2020
Greenwich Security Vote To Strike!
December 23, 2020 December 24, 2020 /IWGB/Leave a comment
After a rapid two-week turnaround ballot, IWGB members at the University of Greenwich have voted resoundingly in favour of strike action.
This is their first major step by Greenwich security officers, porters and cleaners in getting ready to win an END TO OUTSOURCING AT UoG!! 🔥
After years of being mistreated, undervalued and discriminated against, they are now coming together in strength to demand equality with their colleagues directly-employed by the university.
The IWGB has seen victories at UoL, UCL and Goldsmiths, now we're ready to end outsourcing at UoG! ✉📮💪
Strike action is no easy decision for our members to take: as low-paid workers any pay we lose has big effects on our lives. But we know that it is the only way that UoG management will listen 📣
The Greenwich outsourced workers need your support in achieving their aims!
🐤 Retweet the announcement on Twitter
💻 Share the announcement on Facebook
📧 Send this blog to friends and colleagues
💸 Donate to the strike fund
✍ Sign our petition calling for an end to outsourcing at UoG
If you have any ideas or want to get involved and support the campaign in any other ways, please get in touch via email.
We are building a movement to end outsourcing across London's universities. Your support is vital to making that happen. Thank you for everything!
IWGB Universities of London
Greenwich Security Officers Demand In-House from GoBo — November 23, 2020
Greenwich Security Officers Demand In-House from GoBo
November 23, 2020 /IWGB/Leave a comment
Today IWGB Universities of London Branch Secretary Charlotte Powell sent two letters to every member of the University of Greenwich Governing Body on behalf of security officers ahead of their meeting on Tuesday 24 November to demand outsourced staff are brought in-house:
This email contains two letters, and I ask you all to read them both. Below is a collective letter from your security officers at Greenwich which I am passing on to you. Attached to this email is a letter from myself, as an elected trade union representative of your workers, detailing the practical case for bringing your outsourced staff in-house.
As your contract with Sodexo has a break clause in January, and we are preparing for industrial action should the university not agree to bring staff in-house, I urge you to make use of tomorrow's meeting to discuss this urgent matter. I apologise for only sending this to you with only 1 day's notice. However, we were only made aware of your meeting today.
To Ms Bronwyn Hill, as chair: I ask you to ensure that these items are discussed in the meeting tomorrow.
Charlotte Powell
Letter from security officers at Greenwich to the members of the Governing Body:
Dear members of the University Governing Body,
We – the security officers at the University of Greenwich – urge you to listen to us in our demand to be taken In-House under the direct management of the University of Greenwich and to stop us being subcontracted to Sodexo by January 2021.
These are exceptional times and we are essential frontline workers that enable the University to remain open and to be safe. Moreover, recent figures have shown that as security guards we are some of the workers most at risk of dying of Covid-19. Recently the university has praised us as "heroes" for our work, but for too long we have not been treated as such.
We are very proud to work for the University of Greenwich, but like the other facilities staff, such as cleaners and porters, we are very unhappy with the outsourcing arrangement. It seems to us that Sodexo's treatment of us is not in line with the University's values: bullying and intimidatory treatment by Sodexo is frequent and they are rarely held accountable for it. Moreover, we have worse pay, pensions and parental leave entitlement than directly-employed staff.
We also do not understand why we were not paid a bonus for coming into work during the lockdown and for our hard work keeping the University safe throughout the pandemic (and taking on a lot of extra tasks to ensure health and safety). Other workers, such as the porters were given a £300 bonus, and we believe we deserve a bonus too.
Outsourcing is an inherently discriminatory, two-tier system where we are treated worse than direct employees for no good reason. Only bringing us in-house will right this wrong.
While the University is calling us heroes, we would like to kindly ask you to also follow these words with actions by treating us with the respect and dignity we deserve.
We therefore urge you to read the brief from our elected union branch secretary in which we lay out the reasons why everyone would benefit from the solution of bringing our services back in house by January 2021. We stand firm and united in our demands: please show us respect by including us in the University of Greenwich workforce and ending this practice of outsourcing.
We sign this letter as elected representatives of the security guards at the University of Greenwich:
Abdullah Kizito
Shereefdeen Johnson
Kingsley Osadolor
Redon Ceka
Olufemi Ojo
Abiodun Willhelm
Letter to Governing Body members from Charlotte Powell:
As you are aware, the outsourced workers at the University of Greenwich together with their trade union, the Independent Workers Union of Great Britain (IWGB), are campaigning to be brought in-house. At a time when your outsourced security officers are being celebrated as 'heroes' and have the highest coronavirus death toll of any UK profession, it is important that you act urgently and listen to their demands.
You might also be aware that there is a break clause in the contract the University of Greenwich has with Sodexo which allows the University to end the contract by January 2021. Contracts can furthermore be broken in special or exceptional circumstances (such as a pandemic).
It is therefore an urgent matter and golden opportunity to break the contract with Sodexo by January 2021. And we therefore request you to discuss this at your meeting tomorrow.
Several universities in London have already decided to bring their facility services back in-house. The University of Greenwich has an excellent in-house estates and facilities team as well as HR team. As such the University of Greenwich has the capacity to bring the service in-house by January. Due to the TUPE regulations everything would stay in place and if the University is still doubtful about the transition it can task consultants who specialise on these issues to manage the transition. In short, it has been done elsewhere and it can be done at the University of Greenwich by January 2021.
In this brief, we outline the reasons for in-housing the facility services in January in more detail. These are the points covered:
The insourcing of services will either be cost neutral or most likely save money for the University of Greenwich.
There is a trend towards insourcing in London's Universities.
The costs of campaigns and industrial action that not only harm the reputation of the University of Greenwich but also might harm the University financially can be avoided.
Insourcing is cost neutral or saves money:
As universities must pay VAT, the University of Greenwich would be eligible for the UK government's full refund model, Section 41, which means that by insourcing these services the universities would save the cost of VAT. The facility contract with Sodexo is worth £105 million without VAT for a 5 year period. This means that the VAT for this is £21m for a five year period – a significant cost which can be saved if the service is in-sourced.
Several reports have reached the conclusion that insourcing of facility services would indeed be cheaper than outsourcing the service. In the 2016 report that SOAS commissioned from APSE, the following recommendation was made:
"The Mott MacDonald report was commissioned by SOAS Outsourced Contracts Working Group 'partly as a result of pressure from Justice for Cleaners Group in 2013.' In the report it is stated that 'SOAS has asked APSE about the costing for in-house Integrated Facilities Management, which was already analysed as part of the Mott MacDonald Report in 2013; the in-house option was reported to be the lowest cost at that time."
Reviewing the earlier Mott MacDonald report the APSE 2016 report finds that insourcing the services at SOAS should "achieve a cost neutral position".
The cost neutral or cost saving impact of insourcing has been further evidenced by the Association for Public Service Excellence' s 2019 report titled 'Rebuilding Capacity: the case for insourcing public contracts'. This report also outlines exactly how insourcing can be done.
The trend towards insourcing facility services in London's universities:
Insourcing has been successfully implemented at a number of universities and institutions.
The London School of Economics and Political Science (LSE) insourced its cleaning services in Spring 2018.
The School of Oriental and African Studies (SOAS) stopped outsourcing its core support services, namely cleaning; catering; conferencing and events hospitality; portering; security; mechanical and electrical services; post room; helpdesk and reception teams – to private contractors from September 2018 onwards. The insourced workers were guaranteed equal pay and conditions to the existing inhouse SOAS employees, including sick pay, pensions and holiday entitlement. When announcing this decision SOAS stated that putting the 'whole workforce on same terms and conditions reflects our [SOAS] values of social justice and equality'.
King's College London brought its cleaning and security services inhouse in 2019. When announcing the decision to insource cleaning and security services King's College referred to its moral obligation to do so and stated that 'bringing the people who deliver these vital services onto our payroll and properly into the King's community is the right thing to do'.
Goldsmiths, University of London brought its security services in-house this year in February 2020, following the insourcing of its cleaning service in May 2019.
Birkbeck brought its cleaning staff in-house at the beginning of 2020.
This month, November 2020, the University of London brought its cleaners in-house, having previously in-housed security officers, porters & receptionists.
The costs of campaigns and industrial action:
In-housing campaigns can harm the reputation of universities and cost the university money, so it is best to avoid them. Last year, at the University of Greenwich the café workers went on strike, which received national press coverage. In 2018, the University of London received public criticism for spending £415,000 on additional security during protests in support of outsourced workers. By the end of the dispute, it is estimated the University of London spent well over £1,000,000 on additional security measures.
In the last two weeks there has already been growing social media coverage around the institutional discrimination security guards at the University of Greenwich face and the security guards have now announced that they plan to ballot for strike action over in-house.
On a related note, for extra clarification on the point of institutional inequality: Outsourcing is systematic indirect racial discrimination as the outsourced workforce (majority BAME) is denied the better working conditions of in-house staff (majority White, as you know currently only 34.5% employees of UoG are BAME).
In all the insourcing examples stated in section 2, vibrant campaigns by workers and students have preceded the decision to insource these vital services. Such campaigns can cause reputational and financial damages.
For example the 2016 report that SOAS commissioned from the Association for Public Service Excellence (APSE), a not-for-profit local government body which specialises in local authority front line services. APSE carried out an independent review of the SOAS facility management and found that:
'the campaign has taken up a significant amount of time on all sides in recent years and has affected income in relation to the recent student occupation in November 2015. This is estimated to have cost the University £64,600 in terms of loss of conferencing and catering income and costs of relocating customers to external venues.'
By making the just and right decision to insource these vital services the University of Greenwich can avoid the risk that campaigns and industrial actions would negatively impact on the University's image and potentially cause significant extra costs for the university. To avoid the dispute would be in everyone's best interest.
The security officers and their union the IWGB would be happy to meet with representatives of the UoG Governing Body to discuss these matters further.
We wish to make it extremely clear at this point that should you not agree to our extremely reasonable request for outsourced staff to be brought in-house, then we will proceed towards a campaign and industrial action.
Secretary, IWGB Universities of London
Response to the Vice Chancellor: The truth about treatment of security officers at University of Greenwich — November 13, 2020
Response to the Vice Chancellor: The truth about treatment of security officers at University of Greenwich
A letter from IWGB UoL Secretary, Charlotte Powell, to staff and students at University of Greenwich:
You may have read already about the situation of security officers at the University of Greenwich and our campaign against intimidation and discrimination.
Yesterday University of Greenwich Vice-Chancellor Jane Harrington published a statement in response to our campaign which is factually wrong on several points and wilfully misleading on others.
I would like to set the record straight on these points, and clarify the concerns and demands of the security officers, so that together we can push to ensure fair treatment of all workers at the University of Greenwich.
To quote the Vice-Chancellor's statement:
"We are committed to challenging racism and discrimination as a university and we hold all our contractors to the same standard."
At the IWGB we welcome all public commitments by employers to challenge racism and discrimination, but having contacted Jane directly with our concerns on four occasions we received only copy & pasted replies from others on her behalf. We have yet to see any evidence that University management has followed through on a commitment even to investigate racism and discrimination in Sodexo, let alone challenge it. As for the standard to which they are holding contractors, it seems to be a standard of the lowest common denominator, in which University management abnegates responsibility while allowing Sodexo managers to treat workers however they like.
"There is wilful misrepresentation and misinformation circulating about the actions the university has taken, and my personal beliefs, so let me be clear: there is no evidence of discrimination in the way Sodexo have paid their staff.
They have confirmed that recent payments have been made solely on the basis of hours worked during the pandemic. There is no evidence that any payments have been made based on ethnicity."
This is wrong, as I will demonstrate. Moreover it is deeply concerning that, when Black and Brown workers at the university have raised, in good faith, the concern that they believe they have been discriminated against, the Vice-Chancellor should respond in essence by saying "prove it." We have presented our case publicly, after being ignored when raising this directly, the management must take this seriously and transparently demonstrate any evidence to the contrary.
While the security officers were celebrated as 'heroes' for coming in during lockdown and for now ensuring that the University is safe during the pandemic by taking on extra tasks (eg checking that people do not go in without masks and the frequent opening of windows to ensure good air ventilation) they have not been rewarded with Sodexo's bonus scheme, while other workers, such as the porters, have. The security officers who have been coming in during lockdown deserve a bonus too.
The fact that the porters, who are all White British, have been paid while the security officers , the vast majority of whom are BAME, have not is deeply concerning and potentially discriminatory. The fact that the University has refused to clarify the rationale for these decisions by its subcontractor when asked on multiple occasions by myself and other representatives of the workers from the IWGB union also raises serious concerns about their commitment to racial equality in the workplace.
Jane states that the rationale for paying the bonus payment to porters was "solely on the basis of hours worked during the pandemic." However, this is contrary to what the porters were told: that it was a payment for coming in during lockdown; there was never any mention of hours. Moreover, many security officers worked similar hours during the pandemic to porters who received the bonus. We have therefore urged the University to ensure all the outsourced staff who worked during the pandemic receive this bonus and to investigate and provide staff with a breakdown of who has received this bonus so far by race and ethnicity.
It's best to hear this from the workers themselves. Watch this video and read what Abi, a Nigerian security officer has to say:
"I have been working at the University of Greenwich for almost 14 years. During this pandemic period, my life has been placed on the line notwithstanding my health conditions to keep staff and students safe. Nonetheless, the University has denied our requests to give us majority BAME security staff hazard pay for the risks we undertake. Meanwhile, other staff that are LARGELY WHITE BRITISH have been given bonuses for working during the pandemic. Still, we are referred to as "heroes" but we are being used in an expendable manner. When we ask questions or speak out, then intimidation and victimisation tactics are employed against us. We therefore ask to be given the bonus and brought IN-HOUSE for fair treatment and to end racist treatment of us. In these critical times, we protect you and the community at large. We ask you to protect us as well and treat us as the "heroes" that you call us."
Watch this video and read what Clive, a white British porter, has to say. He too has worked for the University of Greenwich for a long time, over 15 years:
"I am a porter currently working at Greenwich university on the Greenwich maritime site. While working through the lockdown from the 23rd of march I was working for Interserve until the 18th of May. For the first two weeks of starting with Sodexo on the 18th may I worked random days approximately 2 days per week on random hours with no fixed hours. After that I was in on a full time basis up to the present and at no stage was I furloughed in this period at all. As regards the £300 I received, I was called by the office and told by my manager that I would receive a £300 pound payment for coming in all through covid and I was being rewarded for my hard work and I received this payment approximately a month later."
You can watch more videos from other security officers here.
In her statement, Jane goes on to write, "there is no evidence of discrimination in the way [Sodexo] are managing allegations of a serious incident involving one of their security officers and one of our students.
This has been subject to a thorough investigation that will shortly conclude. I appreciate that this has taken time, but it is right and fair that such issues are properly looked into, for everyone involved."
Kingsley, one of the security officers, is facing an extremely harsh disciplinary procedure, following a complaint from a student after he tried to physically prevent them from entering the library without a mask. Kingsley maintains he was following the policies given to him, but wishes to apologise for any offence or hurt caused to the student. Kingsley has a clear record and is a dedicated member of the UoG staff. Nonetheless, it appears Sodexo is eager to dismiss him and are acting unreasonably harshly towards him. It seems that they are acting so harshly in order to undermine the collective organising of the security staff more widely. This comes in the context of several smaller incidents that point towards trade union victimisation of active union members by Sodexo.
Given the lack of training provided, the unclear guidance and the amount of pressure that was put on the officers that no student should enter the University without face masks, it is totally disproportionate to dismiss him over this matter.
The "thorough investigation" to which Jane refers is one in which Sodexo has refused to provide key evidence repeatedly requested by Kingsley's trade union representative in advance of his disciplinary hearing. This is a highly concerning breach of Kingsley's rights and brings the legitimacy of the entire disciplinary process into question.
The University is responsible for its subcontractors. It is therefore the university's responsibility to ensure a fair disciplinary process and prevent him being dismissed purely for Sodexo managers' ulterior motive of undermining trade union organising. The Vice-Chancellor's statement yesterday suggests she has full confidence in the actions of Sodexo. If she maintains this position and refuses to intervene in this injustice, then Vice-Chancellor Jane Harrington is enabling trade union victimisation and intimidation.
Jane continues:
"Our contract with Sodexo has enabled us to ensure that contracted staff are paid the Real Living Wage and will provide enhanced training and employment opportunities for our students."
It is disingenuous to imply that outsourcing key workers to a multinational corporation "enables" the university to pay the Real Living Wage, when this wage was only introduced to the outsourced workers after the cafe workers' strike at the University of Greenwich in autumn 2019. Even after the victory of that strike forced a renegotiation of the contract with the university's subcontractor, the wages outsourced staff are paid are lower than the wages these workers could expect elsewhere, for instance security staff at University College London are paid up to £15 per hour dependent on their length of service. These staff deserve better than to be told the University's contract with Sodexo is something they should value.
"We will not shy away from difficult discussions or from challenging discrimination of any kind. This willingness to celebrate our strengths and to face and explore our own weaknesses should not be mistaken for privilege or complacency and neither will we be moved from our course by those who wish to undermine our commitment to this work."
Factual inaccuracies and wilful misrepresentations aside, this conclusion is the most insulting and egregious part of the entire statement. The implication is that the "course" the university is following in "challenging discrimination" is being "undermined" by the campaign of Greenwich's security officers. Simply put, these Black and Brown workers who are concerned that they are being discriminated against, intimidated, and disrespected are the problem. Their campaign, which has escalated in the face of a deafening silence from university management, is undermining the university's work on diversity and challenging discrimination. The University management are suggesting that the university's BAME workers speaking out about their concerns of discrimination is undermining the university's anti-racist work.
Frankly I can't believe that Jane felt able to say this on public record, and I urge her to apologise promptly and publicly to the security officers for making such a remark.
These are the issues at hand over which the security officers have taken the decision to take strike action: the uneven allocation of bonuses, the attack on Kingsley, and their conditions as outsourced workers.
The security officers want to be brought in-house. We welcome the Vice-Chancellor's clear words on challenging racism and discrimination at the Univeristy of Greenwich and believe that, by bringing the outsourced workers (security officers, porters, cleaners, cafe workers and others) in-house, the University of Greenwich can make good on those words.
Outsourcing is indirect discrimination. It systematically denies a group of workers that is, in the large majority, BAME from enjoying the better terms and conditions of in-house staff that is, in the large majority, White. The Vice-Chancellor can break the contract with Sodexo, which has a break clause in January, it is time now that she commits to challenging discrimination and to breaking the contract.
The security officers therefore demand:
that Kingsley's suspension is lifted and that he returns to work
that all security officers that worked during the spring lockdown receive a bonus
that the university breaks the contract with Sodexo by January and brings all outsourced workers in-house
speak out on behalf of Kingsley,
speak out to support bonus payments to our essential workers
donate to the IWGB union Universities of London branch to support their campaign and their strike preparations
To stay informed follow us on twitter @IWGBUoL
IWGB Universities of London Branch
A May Day to remember: security staff brought in house TODAY in second victory for workers' campaign! — May 1, 2020
A May Day to remember: security staff brought in house TODAY in second victory for workers' campaign!
May 1, 2020 May 1, 2020 /IWGB/Leave a comment
All remaining Security Officers on the University of London contract have been brought in-house today, following a vibrant and relentless campaign that led to the in-sourcing of their reception-based colleagues last year.
This is a huge VICTORY for the workers' campaign and gives many families cause for celebration today!
Thanks to the tireless efforts of IWGB's branch organiser Jordi Lopez the workers have also won all of their individual cases relating to the transfer. All IWGB members will now transfer on contracts that accurately represent their hours of work.
Demonstrating the struggle these workers have faced in being passed from company to company and mistreated over the years, one officer brought in-house today said: "At long last the UOL Security staff are free."
Khurram and Jhonny wearing their brand new University of London uniforms
This transfer ensures important material gains for every member of staff: now that the University isn't squandering money on creating profits for outsourcing firms, the workers will receive a pay rise, enhanced annual leave and dignified pensions, bringing them into line with other directly-employed staff at the University of London.
"These rights should have never been denied to outsourced workers," says Jordi. "We are so happy to have helped these workers achieve their victory. But the job is not done!
Cleaners are waiting to go In-House in November, with no date given yet. In the meantime, they remain employed by ruthless subcontractors who during the current crisis are withholding wages from dozens of them. There is still a lot of work to do."
In challenging times for precarious workers, we hope that this victory will bring hope and shows other outsourced workers the path to follow: a path of determination, boldness, unity and solidarity.
Congratulations to Security Officers for winning their struggle! Hasta la victoria siempre!
Your union needs YOU! IWGB calls for volunteers — April 4, 2020
Your union needs YOU! IWGB calls for volunteers
April 4, 2020 /IWGB/Leave a comment
✊ CALLING ALL IWGB MEMBERS, VOLUNTEERS & ACTIVISTS ✊
Want to get involved and help but not sure how? IWGB is mobilising volunteers to help the union's members at this unprecedented time. All sorts of skills are needed, so sign up, come along to the zoom calls and see what you can do!
Join us on our weekly volunteer calls where we hear from volunteer activists, branch updates from the frontline of the crisis, and a weekly guest speaker. This week we have the brilliant Nadia Whittome MP.
Open to all – so GET INVOLVED and sign up below! It is only through powerful trade unions that we can deal with this crisis and build a better world 💪
We have launched a **MASS MOBILISATION OF VOLUNTEERS** in response to COVID-19. Our members are on the sharp edge of this crisis and urgently need your assistance.
If you think you can help, sign up today: https://airtable.com/shrFEzgqh73oBHIjo
Support IWGB member in court TODAY! — January 13, 2020
Support IWGB member in court TODAY!
January 13, 2020 January 13, 2020 /IWGB/Leave a comment
IWGB makes call for solidarity and defence of free assembly as Chair of United Private Hire Drivers' Branch faces charges over use of a megaphone
In a case which could have chilling effects on the right to peaceful protest in the UK, the Chair of one of IWGB's branches, UPHD, faces a criminal charge of 'assaulting' two police officers, allegedly having hurt their ears by using a megaphone at a protest.
IWGB's Executive Committee (EC) has committed £15,000 to support legal costs for the case, following a unanimous vote of support in 2019.
IWGB is now calling on the public to donate to the crowdfund that has been set up in the last few days to find the remainder of the higher-than-expected legal costs. Please see further details of how to donate at:
https://www.crowdjustice.com/case/defend-trade-unionists/
Further details of this shocking case can be found below, in a shortened/amended version of a motion of solidarity passed by the IWGB EC over the weekend.
IWGB wishes James all the best at court today and stands with him in the fight for justice!
IWGB stands in solidarity with James Farrar in his criminal trial for actions that took place while he was undertaking legitimate Trade Union activities. The IWGB Executive Committee (EC) backs James 100%.
We understand that this is a very difficult and personally distressing time for James Farrar and his family and wish to do all we can to support him. This union also notes that this is a case of critical importance for campaign groups, activists and unions across the UK.
In a unanimous motion of support from the EC, IWGB has already allocated £15,000 of central union funds to support the case at trial. A barrister has been retained to represent him, supported by a reputable firm of solicitors that were found by IWGB. IWGB officials and staff plan to attend court en masse in support of their union colleague and fellow activist.
The situation has arisen that the legal costs for this case were underestimated due to (i) a misunderstanding re the legal fees, (ii) the advice that a QC should be retained in addition to the current representation, and (iii) the fact that the case will run for longer than thought. James Farrar therefore stands in need of additional money to support the case at trial for the full four days. The total cost is estimated at around £21,000.*
Whilst organising a UPHD-branch protest on 4 March 2019, UPHD-Branch Chair James Farrar used a megaphone to rally supporters and make statements on behalf of the protest, as is common at IWGB protest events.
Around this time, he made a formal complaint about police behaviour during the demonstration.
Several weeks later, he was himself accused of 'assaulting' two police officers by using the megaphone (it is alleged that the noise hurt the officers' ears). James is now facing a criminal charge and may be imprisoned for up to a year if he loses the case.
The IWGB Executive Committee (EC) has previously passed a motion, with unanimous support, which gave James Farrar IWGB's full support in fighting a case which has the effect of intimidating him and others in IWGB and the wider Trade Union/activist movement from making legitimate, peaceful protests. It is vital that we support his case as strongly as we are able, and that others do likewise.
* Since this motion was passed, it appears the this figure may be inaccurate and may, in fact, be higher. See the crowdfund page for further details.
University of London staff call for equal rights on annual leave — September 12, 2019
University of London staff call for equal rights on annual leave
September 12, 2019 September 12, 2019 /IWGB/Leave a comment
We the undersigned call for staff of all grades at the University of London to be given an equal holiday allowance of 30 days, to end the unfair disparity between levels 1-6 staff and levels 7-10 staff. Continue reading →
Academics urged to support Senate House boycott over treatment of staff — September 3, 2019
Academics urged to support Senate House boycott over treatment of staff
September 3, 2019 September 3, 2019 /IWGB/Leave a comment
Queen Mary University of London post-doc Akshi Singh writes in support of the boycott of Senate House, the administrative centre of the University of London, and calls for solidarity with outsourced workers. "If the people who clean our rooms in our university cannot live with dignity, then our intellectual work is based on exploitation." Continue reading →

redpajama_set_name: RedPajamaCommonCrawl