I’m an ICU Doc in South Wales, our ICU’s are now pretty much full although we haven’t yet started to fill up the extra capacity that has been made but thats going to be happening pretty soon – we are gaining about 3-5 patients a day and they are really sick and not getting better. I’ve never seen an ICU with so many really sick patients, and normally they have a reason that they are there – they have had accidents or cardiac arrest or post operative etc – these are nearly all previously fit and well, or with one or two comorbidities and they are all in their 30s, 40s and 50s and 60s or they are nurses.

Its honestly like nothing I’ve ever seen, and we don’t really know how to treat them effectively. Initially we were adopting an approach like we do in Acute Respiratory Distress syndrome, but that doesn’t seem to be working in the longer term, they are also getting lots microvascular complications, cardiac issues, coagulation issues and renal failure, its really multisystem. Its so odd having a whole ICU where every patient is suffering from the same disease. We spend a lot of time on every shift proning (turning on their face) people – which does seem to help – you look around the unit and nearly half the patients are prone.

I spent a long time looking after a patient who came in with an out of hospital arrest at the wheel of his truck – covid swabs were negative so no enhanced PPE and was placed on the non covid ITU, he then started to get sicker the next day – a bronchial asparate was sent off and comes back with covid so thats another problem that keeps happening – we keep getting exposed through false negative tests.

Sorry thats a bit of an essay, but I enjoyed getting it off my chest

Us mere mortals are in awe of all that you are having to find a way to cope with.

MrsMC is a child protection social worker. All visits were stopped a couple of weeks ago, but DV is on the rise and they are trying to get guidelines on if, when and how they step in. And they have absolutely no access to PPE.

One of her colleagues has had to get a kid placed in the nearest secure unit, 300 miles away. Police did the initial transport, but he had to do a 600 mile round trip yesterday to do statutory visit, nowhere to stay over

Its honestly like nothing I’ve ever seen, and we don’t really know how to treat them effectively. Initially we were adopting an approach like we do in Acute Respiratory Distress syndrome, but that doesn’t seem to be working in the longer term, they are also getting lots microvascular complications, cardiac issues, coagulation issues and renal failure, its really multisystem

That is a rather worrying statement, has there been no guidance and best practises coming down the pipeline from where it has already struck (Italy, China etc? Surely there must be lessons learned that can be applied even as advise to those now at the front-line in what treatments have been effective or not.

I don’t want to disrail the thread by getting too much into politics, but i do despair that with the worldwide focus there has been on this, that frontline medical staff are still in the same position now as those in China were all those months ago.

That is a rather worrying statement, has there been no guidance and best practises coming down the pipeline from where it has already struck (Italy, China etc? Surely there must be lessons learned that can be applied even as advise to those now at the front-line in what treatments have been effective or not.

Yeah we have taken all the advice on board – and we are changing practice daily – problem is there is no magic bullet (at least yet) nothing is really working that well – these people are really sick. The Chinese and the Italians haven’t worked out what to do exactly either yet.

We’re now expecting peak demand to start on the 17th; hopefully the availability of PPE and scrubs will have improved by then

Just done my ICU refresh day. Just played with setting up the ventilator. Working out the predicted settings. Were probably opening up recovery as a clean ICU. Were lucky further west as we’ve had more time to prepare. Waiting to hear when we do 12 hour shifts. We are going to use anaethsetic machines till the new batch of ventilators arrive. Still not that many ffp masks around. Still haven’t been tested.

That is a rather worrying statement, has there been no guidance and best practises coming down the pipeline from where it has already struck (Italy, China etc? Surely there must be lessons learned that can be applied even as advise to those now at the front-line in what treatments have been effective or not.

Good article in the FT on this. CV-19 is really baffling all ITU consultants, they don’t yet know how best to treat patients.

Dialysis machine shortages lay bare wider threat from Covid-19
Memo to senior London doctors points to damage virus can do to other organs and strain on intensive care

April 6 2020
Leading London hospitals are running short of vital equipment in intensive care wards, including blood dialysis machines needed to treat patients suffering from coronavirus-related kidney failure, according to a leaked memo.

The shortages, which go far beyond concerns about the lack of ventilators and protective equipment, emerged from a conference call of some 80 senior National Health Service doctors. They illustrate the way Covid-19 can damage much more than the lungs and respiratory system in patients who become seriously ill — affecting the kidneys, heart and occasionally even the brain.

The 1,000-word memo, seen by the Financial Times, is written by Daniel Martin, head of intensive care for serious infectious diseases at the Royal Free Hospital. It paints a picture of doctors and nurses still scrambling to develop treatments for coronavirus as the shortages bite.

Paul Hunter, professor in medicine at the University of East Anglia, told the FT that, although the public generally views Covid-19 in terms of respiratory failure, hospital doctors are experiencing it as a multi-organ disease. “Once you become really ill, more than your lungs will suffer,” said Prof Hunter. He did not take part in the conference call.

Analysis at the weekend by the Intensive Care National Audit and Research Centre found that of 690 UK patients admitted to critical care with confirmed Covid-19, 25 per cent needed advanced cardiovascular support, 18.5 per cent required renal support and 4.5 per cent received neurological support.

The summary of the NHS hospitals call, which was written by Dr Martin, said Covid-19 is not simply a one-organ disease that attacks the lungs, but is also causing “high rates” of acute kidney failure as a result of complications in treating the disease.

The summary of the call, which was designed to share information about how best to treat coronavirus patients, warned nurse-to-patient ratios are at six-to-one in intensive care wards with hospitals using everyone “from med students to dental hygienists” to absorb the overload.

Dr Martin warned “overzealous” use of diuretics such as Frusemide were leading to “unnecessary” kidney complications and related blood clotting issues.

He also flagged the “higher-than-predicted need” for kidney treatments, while noting that several London hospitals, including King’s College Hospital, are running short of blood-filtration machines.

He wrote that King’s was “running out of” CVVHF blood-filtration machines and an unnamed centre had “run out of pumps” used to administer some drugs.

The note, designed to share insights and develop best practice among colleagues, painted a picture of the pressure on the NHS as hospitals race to train sufficient doctors and staff wards that are already facing shortages.

“Most centres now getting towards 1:6 nursing ratio with high level of support workers on ICU [Intensive Care Unit],” Dr Martin wrote. “Training has largely fallen by the wayside as it is too large a task. People are being trained on the job,” he added.

He also chided colleagues that they need to catch up with other hospitals in seconding staff, and noted some “non-medical staff” were refusing to enter intensive care wards — a practice that needed to be tackled.

“We need one support worker per patient. Other centres are using everyone they have. From med students to dental hygienists. We are behind the curve ‘++’ with this,” he wrote.

“Last time I was on a night shift, theatres were full of non-medical staff refusing to help ICU — this is unacceptable,” he added.

The account of the call emerged as the NHS across London braced itself for the “peak” of Covid-19 admissions, around Easter, with government models expecting this in the next seven to 10 days.

Dr Martin’s note to colleagues also revealed the extent to which doctors are still learning about treatments for the virus, despite all the information being passed back from China and hotspots hit earlier in the pandemic in Europe, such as Lombardy in northern Italy.

He warned, for example, to avoid ventilation too early in the intensive care process as this “may be harmful”, while noting patients were having to go back on to ventilators if taken off too early.

“Not many patients have reached extubation yet in London,” he wrote, before adding “re-intubation seems to be common” and his doctors should “wait longer than usual before extubating”. “An extubation protocol is needed immediately,” he added.

Editor’s note

The Financial Times is making key coronavirus coverage free to read to help everyone stay informed. Find the latest here.
Another evolving area of coronavirus care is the question of “fluid balance” among patients, and how far they should be hydrated. “All centres agreed that we are getting this wrong,” he wrote.

Dr Martin concluded with a final note of uncertainty, arguing that colleagues “desperately need to look at our own data to understand whether we are getting this [treatment] right or not”.

A spokesman for the Royal Free Hospital declined to comment on the communication. A request for an interview with Dr Martin was declined, citing his work commitments in managing the response to the virus.

@catnash – what flow rates are you going to be using on the anaesthetic machines?
Interested to know what the clinicians are being told to use as this will help us estimate condensate levels

Haven’t a clue. I’ll have to ask as the anaethetists were teaching the regular ICU staff whereas I was getting to grips with the draegers. I do know they’re using 2 HME’s per vent and probably SIMV. I do know the scavengers in ICU were being checked for efficiency. I’ll be predominantly in recovery. I’m hoping the regular ventilators will be delivered by then.

@catnash – what flow rates are you going to be using on the anaesthetic machines?
Interested to know what the clinicians are being told to use as this will help us estimate condensate levels

I think they are thinking about 6l on our ones – Drager Primus, although we haven’t got the point of needing to use them yet. I have grave concerns how a circle system is going to cope with minimally sedated spontaneously breathing patients when the time comes to trying to do any weaning. Fine when people are sedated and paralysed.

My sister and BIL both senior (Director and Consultant) for NHS London, both tested positive, out the other side and back on the front line. Really proud of them both.

We have a standard size primus and the smaller ones for the anaethsetic rooms.

If it gets really bad they may use recovery for vented covid patients and the theatres for clean emergencies.

covid swabs were negative so no enhanced PPE and was placed on the non covid ITU, he then started to get sicker the next day – a bronchial asparate was sent off and comes back with covid so thats another problem that keeps happening – we keep getting exposed through false negative tests.

That’s interesting, the first COVID death in our Trust came back negative, only after death was it found to be COVID. At the time (now 3 weeks ago) there was a lot of scrutiny on the Trust for ‘doing something wrong’ with the tests.

We are expecting our spike to hit in the next few days for the next 3 weeks 😔

In the last week or so a number of colleagues have had the virus and been genuinely very sick at home. It really does hit home though when you see a work colleague in a hospital bed, very unwell. You might expect to see a colleague occasionally due to accident or illness, but when you know they have ended up in that bed due to doing their job, that is something else

Been redeployed to hospital discharge this week, and to be honest it has been very .. very quiet 1st week.
All but one of people on list are C.19 positive, so unable to be discharged. Already some of the bright ideas from those at the top have made from the safety of their own homes WFH have failed miserably .. I have been required to go onto C.19 wards wearing my flimsy little surgical mask and goggles.
What surprised me too was the mountain of freebies coming in for NHS staff: pizza; Indian & Chinese takeaways; cakes & biscuits, and the senior nurse told me they are expecting a load of iPads donated soon too. All great – but when compared to the care/nursing home I visited just before that still hadn’t received the recommended PPE it really emphasised the continuing lack of recognition and value of those working the front line of C.19 outside of the NHS.

I will be unable to do my job if the care agencies and care homes can’t increase their contribution in this, and asking an already undervalued workforce to take on even more will be very difficult – that will mean there will be nowhere for vulnerable people to be discharged to, so hospitals will likely be put under even more pressure.

To be honest it’s all feeling a shit storm ready to hit. And I not slightest bit confident those WFH are the best people to be making decisions on the safety of us at the front. Donkeys leading lions.

I think they are thinking about 6l on our ones – Drager Primus, although we haven’t got the point of needing to use them yet. I have grave concerns how a circle system is going to cope with minimally sedated spontaneously breathing patients when the time comes to trying to do any weaning. Fine when people are sedated and paralysed.

6l will produce less condensate than low flows but will interested to see how well that works with patients on the machines for long periods. I’m not familiar with the Primus but I know our machines don’t have the vent modes suitable for spontaneously breathing machines. I share your concerns but like you we haven’t started to use them yet.

I will be unable to do my job if the care agencies and care homes can’t increase their contribution in this, and asking an already undervalued workforce to take on even more will be very difficult – that will mean there will be nowhere for vulnerable people to be discharged to, so hospitals will likely be put under even more pressure.

We were speaking with Sandwich Jr last night, he’s a charge nurse in a care home with learning disability clients. It’s going to be an abbatoir in his place of work. He has clients that do not understand what is happening and short of restraining them can not be isolated. He has a management team that have been unable to source sufficient PPE and are recommending that he wears it between rooms in the home when tending the infected. Walking in the common areas whilst wearing contaminated equipment! He’s steaming mad about the incompetence being shown by his leaders and his support workers are on the point of walkout as a result.

If anyone has a care home nearby find out what they need and get donating. A civilised society takes care of it’s weakest and least able as well as the able. If we abandon these people we sacrifice our humanity and civilisation.

Sandwich – unfortunately speaking to my colleagues from other teams it seems what your son is describing is the norm.
Whilst I support businesses and individuals donating things to NHS hospitals, I also feel those working the front line in the community need their contribution recognised .. maybe they can be encouraged to make dance videos on Tik-Tok too? But some how I don’t think they will have as much spare time during their working day.

Mooman. He’s working 55 hour weeks currently and could work more but I suggested he hang back as he’s been ill with the virus. I expect that in around a fortnight to 3 weeks he may have to live in and possibly grab sleep when he can whilst being the last man standing.

The lack of focus from everyone except (notably) Lewis Goodall should be a source of national shame.

Soz – deleted.

Sandwich – your son is one the many unsung heroes during this crisis, and you and your family should be very proud of him, and also yourselves, for your part in making him the person he is.

Mooman – I’m prouder than I have any right to. My son has a highly developed sense of community service, somme from me some from Mrs Sandwich. We worry that he may be in danger of the secondary infection wave.

My daughter and son-in-law are running a community hub from the pub kitchen providing hot meals and supplies for those around them. It’s currently that most sad of things a pub with no beer!

They are both fantastic young people (Mrs Sandwich did most of the early heavy lifting when they were younger, I apparently blossomed as they got into teenage years according to herself).

Our next door neighbour, Dr at Addenbrookes, is obviously very relaxed about the whole thing as they’re currently having a house party (it’s her B’day apparently)…..

Part way through my shift today the powers that be decided we all had to go into ppe. I see no reason for this in my ward.

However my respect for those at the pointy end just went up another notch. It’s effing horrid to weara mask gloves and pinny continuously. Full PPE must feel utterly awful

I heard that the NHS were looking for IT workers as volunteers. Anyone know why or what for? Looking for ways to help.

At the risk of sounding trump-esque, I’ve read that China, Italy, France and the US (and others) are using that malaria drug alongside some antibiotics as an early treatment, before people get really sick and also trying some antivirals on trial. I’ve not heard anything about the UK giving treatments like this, or anything at all. is there a reason why? Are we trying anything as treatment or is it only a ventilator / o2?

China seemed to have decent death rate stats so I wonder why are we not using their protocols?

I known nothing about medicine which is probably obvious from my post

One story of am American doctor who tested positive outlined his symptoms, ct scan results and daily treatments. He prescribed himself both those drugs daily, amongst other things. Which seems to suggest something positive about them?

Because in the UK we follow evidence based medicine. there is no evidence for the antimalerials working and antibiotics are given if there is a bacterial infection

Wrong thread for this

molgrips
Subscriber
I heard that the NHS were looking for IT workers as volunteers. Anyone know why or what for? Looking for ways to help.

If you are serious about volunteering to help out during the C.19 crisis then all you have to do is phone up your local care/nursing home or care agency, and I can guarantee they will be very appreciative of your help.
That said – it wont be working from the safety of your own home – you would be expected to be one of those ones that are actually doing something during this crisis!

Update us if you decide to; some how I think you will come back with an excuse though ..

Number of deaths in retirement homes in France is really high when virus gets inside.
Where I work, all residents are in their room. Poor sods are going to be there for a long time. Visits are banned and, only staff are allowed in. Even my catering team and I are not allowed near the patients.
Some places have lost 20% of their patients due to the virus.

Uneccessarily harsh mooman – someone with specific, non-medical expertise is aware it may be needed and is enquiring why/ how he could help.
Have you approached every person you’ve met or know and accused them of cowardice for not volunteering?
It’s unprecedented and scary times and not everyone can or will volunteer to help for a myriad of reasons.
No need to be a dick – from your posts it’s obvious you are in at the deep end and it’s bloody stressful, doesn’t mean everyone else can do the same.
I’m an ex itu nurse with an itu medic wife whose working – I can’t as we have no childcare as our nursery dropped us in the shit. Taken me time to accept I can’t do more than support my wife and mind our kid, alongside supporting workers after the crisis in my current occ health role. Does that make me worthy of your bile? Let me know what criteria you have imposed so we can see where I stand.

I heard that the NHS were looking for IT workers as volunteers. Anyone know why or what for? Looking for ways to help.

My trust has a specific email/webpage for the roles they are currently trying to fill. Some are admin based, which might be of interest?

My advice would be to find your local trust, acute/community, recruitment info and get in touch.

Failing that, you could always go on the bank (temp staffing) as a HCA or similar.

Given what I have seen in Lothian I would NOT recommend anyone with no healthcare experience to join the bank right now. Induction is almost non existent and thus someone with no experience would be at risk and not be terribly helpful.

If you have some background in healthcare then its different

@molgrips I’ll have an ask around. A lot of the hospital trusts are customers of ours and I try and keep in touch – I reckon they appreciate a friendly call from a techie over a slimey one from sales or renewals.

I had a sqy on the volunteer site but it appears to be shut down while they process the first batch & our local CCG & hospital trusts have nothing posted on their sub sites.

That said – it wont be working from the safety of your own home – you would be expected to be one of those ones that are actually doing something during this crisis!

**** sake mate. Don’t be a dick. You think I’m sat at home because I’m scared? Because I’m a coward? You utter ****, seriously. Why the hell would you attack me like that?

—–

Anyway, problem is I’m still working full time, my job is quite busy. So my boss might not appreciate me sodding off for 60 hours a week but I can donate 10-15 without too much issue, more if it’s more related to the day job.

If you have some background in healthcare then its different

And I have none.

Mind you I would enjoy having molgrips as a support worker under my instruction!

Thank you to every front line worker out there! My fiancée is a radiographer xraying C19 patients and her trust sent around an email yesterday saying PPE is running low…. it’s a fearful time as we’ve seen the results of inadequate PPE

Thank you to every front line worker out there! My fiancée is a radiographer xraying C19 patients and her trust sent around an email yesterday saying PPE is running low…. it’s a fearful time as we’ve seen the results of inadequate PPE

Everything is running a bit short already, drugs are already becoming an issue – we are getting through sedatives at a rate of knots on ICU – as is every icu in the world right now – which adds up to a looming problem potentially.

Fair enough tj – just genuinely interested in the differences in approach in different countries but you’re right not the right thread.

As for mooman, I’m sure you’re having a very difficult time and everyone appreciates everything people are doing, but that doesn’t give you right to lash out like a nob at someone who’s only trying to offer some help in some way. Wind your neck in.

Wise words regarding induction and training @tjagain I’ve reluctantly turned down the offer of volunteers at the moment precisely for that reason. The offer to help is greatly appreciated but at the moment I am worried enough about keeping our guys safe who have had infection control and PPE training; we don’t have the opportunity at the moment to offer that training to new team members right now.
Apologies if this comes across as a bit snotty: it’s not meant that way – just trying to explain one of the dilemmas we are trying to figure out at the moment

Part way through my shift today the powers that be decided we all had to go into ppe. I see no reason for this in my ward

Have you got cases somewhere in the building? Unfortunately there have been cases in our Trust of the ventilation system spreading the virus.

Re Care Homes, unfortunately it’s the grim reality of deciding who gets treatment and who doesn’t. In a local care home 8 out of 30 residents died in a week.

If you also notice the daily figures do not include old people homes/care homes.