Covid-19 Pandemic Thread

[Iris]

Worth a read...

Future Health Secretary Helen Whately and the firm that hijacked the NHS

It's the usual half-informed hatchet job.

There is a decent article to be written on the influence of private healthcare and consultancy firms on the government, the NHS and public policy, but that's not it. Because a good article would have real evidence and weigh it up.

[The Real Ravenhurst]

BBC News - 'Shamed' despite sticking to social distancing rules
https://www.bbc.co.uk/news/uk-scotland- ... e-52230081

People are clearly being driven mad by this.

'she produced a measuring tape from her pocket'

[LowlifeDes]

I think that, to do it properly, she needed a 4m long pole with a mark in the middle. In the future this unit of measure will become known as a CV19 but no one will remember why.

[Mister Paul]

BBC News - 'Shamed' despite sticking to social distancing rules
https://www.bbc.co.uk/news/uk-scotland- ... e-52230081

People are clearly being driven mad by this.

I stood in the Sainsburys "special people" queue at 7:30 on Tuesday morning. There was a nurse in front of me going out of her way to make an issue of anyone she though was flouting the rules. Tutting, shaking her head, calling people out and complaining to the staff on the door. I don't think any of her anxiety was valid.

She was also in uniform. I didn't think that was allowed?

[LowlifeDes]

Perhaps it was the nurses uniform someone got her for February 14th.

[Mister Paul]

Perhaps it was the nurses uniform someone got her for February 14th.

I did notice that she had a MKUH lanyard on. Milton Keynes is some way from North Somerset, but nurses to get around I suppose.

[JohnToo]

... the Excel White Elephant.

I'd be interested in your thinking. Should they not have built it at all? Should they have set different entry criteria to generate more patients? Should established hospitals have been lent on not to try to cope with everything themselves? Or is it only temporarily underused, and will come into its own over coming weeks?

[Regulator]

I stood in the Sainsburys "special people" queue at 7:30 on Tuesday morning. There was a nurse in front of me going out of her way to make an issue of anyone she though was flouting the rules. Tutting, shaking her head, calling people out and complaining to the staff on the door. I don't think any of her anxiety was valid.

She was also in uniform. I didn't think that was allowed?

An absolute 'no no'. Jon has to take a separate set of clothes into work with him each day, so that he changes out of the clothes he's travelled in. At the end of the day he has to change again.

[Regulator]

I'd be interested in your thinking. Should they not have built it at all? Should they have set different entry criteria to generate more patients? Should established hospitals have been lent on not to try to cope with everything themselves? Or is it only temporarily underused, and will come into its own over coming weeks?

It's a showpiece. It isn't clinically fit for purpose. It has a lack of basic facilities - and what it has are concentrated in the central core (the exhibition halls are on either side of a main concourse).

There's nowhere in the clinical areas (and we need to remember how big those are) where staff can do something as basic as wash their hands and change their PPE between patients. So they have to walk back to the central concourse, past other patients, to wash their hands and changes their PPE between patients. My IPC colleague had an absolute fit when she saw the plans.

There's also an issue with the oxygen supply. It simply wouldn't be able to cope with the number of patients envisaged (don't forget this is supposed to admit only patients who are ventilated). Hospital with small numbers of patients are experiencing oxygen issues.

I could say a bit more but I have to go onto a Zoom call...

[JohnToo]

It's a showpiece. It isn't clinically fit for purpose. It has a lack of basic facilities - and what it has are concentrated in the central core (the exhibition halls are on either side of a main concourse).

There's nowhere in the clinical areas (and we need to remember how big those are) where staff can do something as basic as wash their hands and change their PPE between patients. So they have to walk back to the central concourse, past other patients, to wash their hands and changes their PPE between patients. My IPC colleague had an absolute fit when she saw the plans.

There's also an issue with the oxygen supply. It simply wouldn't be able to cope with the number of patients envisaged (don't forget this is supposed to admit only patients who are ventilated). Hospital with small numbers of patients are experiencing oxygen issues.

I could say a bit more but I have to go onto a Zoom call...

Thanks. Is it then your understanding that there's a conscious strategy to keep patients in overloaded London hospitals rather than ship them to the underused Nightingale because the relevant people realise that the Nightingale is not fit for purpose? My understanding is that nonetheless, recruitment of staff for the Nightingale is continuing?

[Regulator]

Thanks. Is it then your understanding that there's a conscious strategy to keep patients in overloaded London hospitals rather than ship them to the underused Nightingale because the relevant people realise that the Nightingale is not fit for purpose? My understanding is that nonetheless, recruitment of staff for the Nightingale is continuing?

At the moment, NHS hospitals are on the whole coping with the numbers of patients - their main issues appear be around a lack of supplies (particularly PPE - it's fairly clear that the "co-ordinated PPE supply" isn't particularly co-ordinated...)

I think the level of demand is not currently as high as was predicted, in part because the social isolating is working and also because patients simply aren't being admitted to hospitals. I am constantly hearing reports of patients who should be/would normally be in hospital being left in the community. It's also becoming clear that Covid patients who should be admitted aren't - hence why the care homes are having such high numbers of deaths.

Our hospitals are currently, on the whole, standing empty - which is very frustrating as we have geared up to take patients - including Covid19 patients - from the NHS. You would expect that capacpity, which is designed to treat patients and has all the required facilities there, to be used before shipping people off to a hastily knocked-together field hospital.

I think that in London there may also be a professional reluctance to send people to the Nightingale at Excel, as it is seen as a palliative care facility.

Staff recruitment is continuing at Excel and the government (through NHS E) is trying to pressure hospitals into sending patients there... but I think that, unless there is a sudden upsurge in numbers over the next few weeks, Excel will remain very underutilised.

Whether there will be an upsurge will, I think, depend on decisions taken by the government over the next few weeks - particularly around the social distancing provisions. I'm not convinced that the government is being driven entirely by the science.

[JohnToo]

At the moment, NHS hospitals are on the whole coping with the numbers of patients - their main issues appear be around a lack of supplies (particularly PPE - it's fairly clear that the "co-ordinated PPE supply" isn't particularly co-ordinated...)

I think the level of demand is not currently as high as was predicted, in part because the social isolating is working and also because patients simply aren't being admitted to hospitals. I am constantly hearing reports of patients who should be/would normally be in hospital being left in the community. It's also becoming clear that Covid patients who should be admitted aren't - hence why the care homes are having such high numbers of deaths.

Our hospitals are currently, on the whole, standing empty - which is very frustrating as we have geared up to take patients - including Covid19 patients - from the NHS. You would expect that capacpity, which is designed to treat patients and has all the required facilities there, to be used before shipping people off to a hastily knocked-together field hospital.

I think that in London there may also be a professional reluctance to send people to the Nightingale at Excel, as it is seen as a palliative care facility.

Staff recruitment is continuing at Excel and the government (through NHS E) is trying to pressure hospitals into sending patients there... but I think that, unless there is a sudden upsurge in numbers over the next few weeks, Excel will remain very underutilised.

Whether there will be an upsurge will, I think, depend on decisions taken by the government over the next few weeks - particularly around the social distancing provisions. I'm not convinced that the government is being driven entirely by the science.

Thanks, again.

I agree that hospitals seem to be coping so far in terms of physical capacity - ICU beds, other beds, etc. I'm less sure they're coping in terms of the demands and pressures on staff. But my understanding is that any retired doctor (in the London area, which is all I have any knowledge of) who indicates that they are willing to return to front-line work is being directed to the Nightingale, not to any existing hospital. Does that feel like the best strategy?

[Mister Paul]

We're not seeing anything significant in care homes over here yet, apart from staff working hard with limited PPE. The one I know of thar has cases doesn't have any wanderers so it's easier for them to contain.

[Iris]

It's also becoming clear that Covid patients who should be admitted aren't - hence why the care homes are having such high numbers of deaths.

There's a pretty strong argument that the reason care homes are having such high numbers of deaths is that they're chock full of sick, old people.

Working backwards, there are over 400,000 people living in care homes, almost all over 65. About 4% of the general population has been infected, so you'd expect about 16,000 infections in care homes if everything else were equal. If you have been infected, the probability of dying of Covid-19 if you're over 85 is 15% and it's 4% if you're over 60. Which means, depending on the age profile of care homes, that all other things being equal you might expect somewhere between 600 and 2500 deaths in care homes.

All else is not equal - care homes are a great vector for disease, so it's likely that a higher proportion of the care home population has been infected, and their residents are likely to be sicker than the general population so their mortality rate is likely to be higher.

All the estimates I've seen for care home deaths are broadly in line with that back-of-the-envelope calculation.

On the other hand what the ONS stats do show is that the overall increase in mortality in the first week of the surge in infections is far bigger than either the NHS hospital death data shows or than can be explained purely by recorded deaths with a Coronavirus connection. The likeliest explanation is that people are scared to go to hospital - NHS, shiny private or Nightingale field hospital - when they really should, because they believe (rightly or wrongly) that it'll make them more likely to be invected by Coronavirus. That's backed up by anecdotal evidence from ambulance drivers, who are saying that they're attending more people who have already died at home than usual.

[JohnToo]

I can't be the only person whose first thought on seeing this picture was "Big Brother"...