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Bit of a Big one...but how do you think we would look at the current situation if say for example our NHS had maybe 30% more capacity in all areas?
Also our Nightingales remain largely unused? Is it just me that thins this is crazy?
they were always pretty much a hail mary idea - where are the staff to come from to staff them?
5.5% of patients admitted to ITU have been 80+
https://www.icnarc.org/DataServices/Attachments/Download/6167f9f7-ea25-eb11-912b-00505601089b
That proportion has been declining as more people have been admitted to hospital with COVID-19.
Mortality will of course be age-dependent, but an additional factor is treatment. Benefit risk must be considered and routinely admitting the elderly and subjecting them to invasive ventilation may not be in their best interests. This was brought up as a “scandal” in the Sunday Fail a few weeks ago, but is nothing of the sort.
It was suggested that a triage rating scale be used that required 8 points or fewer for ITU admission, where age and comorbidities are factored. Being over 85 gave you 9 points. This scale was worked up but not introduced because healthcare was not overwhelmed.
My point is straightforward, as ITUs are overstretched, harder decisions are needed for those in their 70’s, then their 60’s and so on. Maintaining control of resource is vital.
TiRed, what percentage of people in ITU are there because of Covid, compared to those there for other things but have had a positive test for the virus?
Bit of a Big one…but how do you think we would look at the current situation if say for example our NHS had maybe 30% more capacity in all areas?
Think there would be more people willing to risk opening up. But given the vaccine news looks promising, would suggest that the majority will support restrictions. Having more capacity means you're further away from catastrophic failure, but there's not a lot of public support for allowing 1000's of daily deaths, is there?
Afraid I don’t know, but I am willing to bet that it is an order of magnitude higher than the null hypothesis, which is the population prevalence (I.e., <5%).
There is also the issue of covid+ patients vs covid- patients vs covid unknown patients. We can run theatre lists as usual, but have to seperate all three categories of patient which means separating out theatres and theatre staff and having covid+ wards and covid- wards and testing everyone to attempt to keep them all safe. Some people test positive while in hospital and then have to be moved to the appropriate place.
Many staff are off either with covid or isolating due to contact with covid+ relatives or having worked with other staff who tested +.
Many others are totally and utterly fed up of the whole thing; they've been doing this since March, getting moved around at short notice, ending up working in places they are not used to, with people they don't know.
Would we trade individual freedom/rights for being able to return to mostly normal society? The chances of us being able to run these systems vaguely competently seems pretty slim anyway.
I would gladly make the trade, but agree re competence.
This is a very sobering read
BBC News - Coronavirus doctor's diary: The Yorkshire cemetery struggling to keep up with burials
https://www.bbc.co.uk/news/health-54938735
compared to those there for other things but have had a positive test for the virus
If you’re in ITU for ANYTHING, then having the virus really isn’t good news for you.
compared to those there for other things but have had a positive test for the virus
Throughout the Covid-19 pandemic there has in fact always been ICU capacity available. As the National Audit Office have confirmed, around the peak of Covid-19 hospital admissions on 14 April, NHS providers in England had 6,818 ventilator beds operational, of which: 2,849 (42%) were occupied by Covid-19 patients; 1,031 (15%) were occupied by other patients; and 2,938 (43%) were unoccupied.
Do not confuse COVID-19 the disease with infection with SARS-COV-2 the pathogen. The majority of people infected with the virus may develop symptoms of "COVID"; cough, temperature, aches, loss of taste/smell, but do not go on to develop COVID-19 the pneumonia disease with hypoxia that leads to hospital admissions and perhaps the ITU. Patients in ITU with COVID-19 will be the latter. They'll be diagnosed possibly with a CT scan (ground glass effect), with a differential diagnosis of influenza or other bacterial pathogen, and by PCR test. They have COVID-19 and it is a very serious disease (speaking from personal experience now). About 25% of people admitted to ITU will sadly not come out.
There is a willingness to believe that there is a testing epidemic that is leading to admissions of lots of people with a positive test. In fact that is not true. Patients are being admitted to hospital with SYMPTOMS not a test. The admissions data counts people testing positive within 24hrs because they have their disease confirmed after admission. Since September there has been an increase, notably in the North, of people presenting with shortness of breath and other symptoms. This was much earlier that the conventional influenza season, and they were confirmed to have COVID-19.
[tl:dr] ITU patients with COVID-19 the disease took up about half of all ITU beds, but due to careful management of the NHS (closing all other services) the NHS was not overwhelmed. This time the other services are staying open. People with COVID-19 have symptoms (hypoxia) before a positive test when they are admitted to hospital.
[tl:dr] ITU patients with COVID-19 the disease took up about half of all ITU beds, but due to careful management of the NHS (closing all other services) the NHS was not overwhelmed. This time the other services are staying open. People with COVID-19 have symptoms (hypoxia) before a positive test when they are admitted to hospital.
If things dont change we will exceed the patients in hospital peak of tye first wave very soon, less than a week will we not? I suppise it depends how fast people die or get better. 1.9k admitted today and we are about 5k from first peak max number in hospital.
ITU patients with COVID-19 the disease took up about half of all ITU beds,
Intensive Care capacity in my hospital was doubled in response to the issue.
No extra ITU nurses were recruited because they are not available at such short notice. We also opened a number of non-covid ITU beds to deal with those who didn't need looking after in full PPE.
TL DR: an awful lot of people have worked way above and beyond to provide high quality care to a population who, on occasion, seemed not to appreciate the effort involved.
jim_barclay
Free MemberAlso our Nightingales remain largely unused? Is it just me that thins this is crazy?
OK, you need to understand what the Nightingales are/were. They're the place you put the overflow out of sheer desperation when the normal hospitals can't cope, so that you don't have dead people in the car park. They're not a good choice, if you use them it's because they're the last choice remaining. And of course, if hospitals are flat out, you can't just magic up more doctors- fairly easy to put beds in a conference centre, not easy to staff it.
Mostly they'd have been a place to go to die, so that hospitals could deal with the people who had a better chance to live. They're not a real alternative to a hospital- we can't use them for cancer treatment or whatever, as people keep suggesting. They were, literally, created because they were better than nothing and that was the two options.
But I hate when people say they were a waste of money because they didn't get used. They were there as the last resort, and we never quite needed that. But it's like saying your seatbelt was a waste of money because you never crashed that car.
seemed not to appreciate the effort involved
Most people do. And thanks again Crikey.
Boris has just tested positive for Covid AGAIN!!
Pardon?!?
Edit: the truth is more prosaic… isolating after a close contact tested positive
Scratch that, story just changed to he's been told to isolate after an MP has tested positive. Conveniently.
Isn't Boris self isolating after being in close contact with Lee Anderson MP, who tested positive this morning along with his wife?
Look, look, Track And Trace works! 😆
Look, look, Track And Trace works! 😆
World beating, apparently 🤣
Here’s an easy to understand description of the PCR tests by Dr Adam Rutherford (worth following on Twitter)
https://twitter.com/adamrutherford/status/1327901972419276800?s=21
The replies to that ace Twitter thread… so many patient people playing chess with pigeons.
https://www.bbc.co.uk/news/health-54902908
The Moderna is showing 95% efficacy. Is it the same mRNA approach as the Pizfer one?
What about this Jansen one in Belgium - is that dead virus?
Same type of technology as BioNTech / Pfizer. The announcement is another early Phase 3 one - only based on 95 cases of Covid. Still good news, looks like we'll get lots of different working vaccines.
Moderna = RNA
Janssen (Johnson & Johnson) = non-replicating viral vector
https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccine-tracker
EDIT; Though RNA, they say it is more stable;
"While Pfizer’s vaccine requires ultracold freezing between -70C and -80C from production facility to patient, Moderna said it had improved the shelf life and stability of its own vaccine, meaning that it can be stored at standard refrigeration temperatures of 2C to 8C for 30 days. It can be stored for six months at -20C for shipping and long-term storage, the company said."
As expected from the antibody trials from Lilly and Regeneron, presence of neutralising antibodies protects against severe COVID infection. Confirming this for two mRNA vaccines with pretty much the same response is encouraging, and bodes well for other vaccine candidates.
Of note in the press release - Grade 3 means it might smart a bit...
Grade 3 (severe) events greater than or equal to 2% in frequency after the first dose included injection site pain (2.7%), and after the second dose included fatigue (9.7%), myalgia (8.9%), arthralgia (5.2%), headache (4.5%), pain (4.1%) and erythema/redness at the injection site (2.0%). These solicited adverse events were generally short-lived. These data are subject to change based on ongoing analysis of further Phase 3 COVE study data and final analysis.
Remember that Moderna lowered their dose from the top dose tested in Phase 1, it's possible the Phase 3 dose may also have been too high. I used to work with their CMO.
Do we have an order in for this with Moderna? The cold store requirements make it sound like something we can support next year for more normal pharmacist distribution.
No, its not one of our 6.
Does the Oxford one require ultra cold storage?
No, its not one of our 6.
So, are initial stocks all going to USA, or spread more widely?
So, are initial stocks all going to USA, or spread more widely?
They have contracts with a number of countries. The EU has a very large order and offered us to join the procurement exercise but we declined stating we could secure a contract cheaper and faster....we are still negotiating....
The EU has a very large order and offered us to join the procurement exercise but we declined stating we could secure a contract cheaper and faster….we are still negotiating….
Another inspiring achievement by Johnson-chum Kate Bingham.
From the Guardian:
More than 50 pupils at one of England’s top boarding schools have tested positive for Covid-19.
Sedbergh School in eastern Cumbria said that 53 senior students in four different boarding houses had confirmed cases.
“The vast majority were asymptomatic, and we must therefore assume that a number of pupils across the school have Covid-19,” principal Andrew Fleck wrote in a letter to parents on Monday.
Mobile testing units will test all students and staff on Tuesday and Wednesday, the principal said. Those who test positive will be asked to travel home and isolate for ten days.
Sendd them home to infect their families when they could be isolated in one of the bording houses. madness.
admissions dont seem to be leveling off as fast as we might hope?
we were starting to see an effect after 14 days in lockdown 1
Or are the situations too different to compare & the data too noisey?
https://coronavirus.data.gov.uk/details/healthcare
If you look at cases there was a plateau then a rise too. Half term then back to school? Last week shopping/pub frenzy before lockdown?
https://www.bbc.co.uk/news/explainers-53640249
I tried and struggled to find out about the rest of Europe recently. This article sums it up quite well. On balance, I'm quite happy to be in the UK right now.
Last week shopping/pub frenzy before lockdown?
I think this has been touted as a possibility. Who knew?
admissions dont seem to be leveling off as fast as we might hope?
I mentioned that yesterday, its a worry, the slow down appears to have stopped and its going back to what it was.
excellent visualisation tool of change in weekly cases
theres a zoomable one lower down
https://twitter.com/carlbaker/status/1328364650719817734
https://drive.google.com/file/d/1Rm9BgAIc452nkRrUAt01cji61OlneJtk/view
“The vast majority were asymptomatic, and we must therefore assume that a number of pupils across the school have Covid-19,” principal Andrew Fleck wrote in a letter to parents on Monday.
Is he just stupid or doesn't he understand you can't have asymptomatic Covid-19?
excellent visualisation tool of change in weekly cases
This appears identical to the SARS-CoV-2 testing data?
Is the correlation between the two so good?
Is he just stupid or doesn’t he understand you can’t have asymptomatic Covid-19?
Can't you?
Just had a test in one of the Liverpool test centres. Walked in at 3pm, only people in there apart from the army lads, got the text message results bang on 4pm (negative)
Can’t you?
No. COVID-19 is the disease. SAS-COV2 infection can be asymptomatic, so you can be infected with the virus, shedding and even infectious. But you don't have disease. He meant asymptomatic infection.
https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/#symptoms
It doesn’t help when that explainer NHS page says…
Coronavirus (Covid-19) … and then uses “coronavirus” where it mean Covid-19 … is it any wonder that people think it is the name of the virus?
The WTO did’t help either, as they didn’t want “SARS” mentioned in communications about the virus, so as not scare people in countries hit by the the previous SARS virus in recent years.
So, the public thinking that Covid-19 is the name of the virus can not be undone now. No point getting pedantic about it this far in.
Another inspiring achievement by Johnson-chum Kate Bingham.
Second easiest deal in history.
UK Prime Minister Boris Johnson and six other MPs are self-isolating after they attended a breakfast meeting and one later tested positive
What a bunch of useless wastes of skin. If this were teachers the press would be going mad about the stupidity.