Covid-19

[dsr]

Thought some of you might find this interesting...



https://www.bmj.com/content/369/bmj.m1375

That could be tested when they get the antibody test. Go to every house in a suitably sized town and a London borough, and test everyone who will answer the door.

[Inchy]

As an ICU nurse I will add my thoughts on the nightingale


I don’t think the sickest patients will be sent there. A lot of the patients we are seeing are young and fit. Unless you stood there and counted their resp rate and did an ABG you wouldn’t realise they are profoundly hypoxia. These patients are often only needing a day or 2 on non-invasive CPAP (tight mask) to sort them out. This is usually delivered by a complex ventilator in HDU however can be given by a more basic Nippy ventilator for some patients. Nippy vents are used to manage obstructive sleep apnea and most hospitals have access to a large volume of them. I can imagine you can treat these patients with Nippy vents at the nightingale.


Staffing will be an issue but I feel nursing and medicine will become very task orientated. Paperwork will be minimal, pressure sores may be an acceptable risk, holistic care may be put on the back burner. A ward nurse doesn’t have the knowledge or experience to walk into ICU and look after level 3 patients. However a ward nurse can make up and attach all the IV meds for 40 ICU patients if that’s their only job. An Operational Department Practitioner (ODP) can look after a ventilator with some training. It’s relatively simple to ventilate a type 1 resp failure compared to type 2.
You can utilise the army in these settings. Fetching and carrying equipment. Rolling and proning patients. Even washing patients. Military personal are very task orientated and will just crack on with complaint.

The sickest will remain in proper hospitals obviously but the nightingale will have its place


Just to add not having an X-ray department isn’t an issue. Most sick patients don’t go to the X-ray department, they have a portable X-ray

[Claret-On-A-T-Rex]

Agreed it’s a monumental logistical achievement which the army are well placed to organise. However we should be very careful in exaggerating the capabilities of this centre. It is certainly not a fully functioning hospital. There are several major concerns about how this will function.

1. Stripping of staff from existing NHS hospitals which are already stretched to the max

2. Major relaxation of appropriate staffing levels. 1 ICU nurse to 6 patients (with non-qualified staff as back up)
1 ICU consultant to 42 patients
When you add in the shift patterns that’s an unbelievable number of staff removed from their normal hospitals.

3. Utilisation of medical students and newly qualified nurses. Really? Hardly an appropriate environment to start learning intensive care medicine.

4. Strict criteria on admissions. The plan is to only take the youngest and fittest patients. Single organ failure only. Patients that deteriorate further will need transferring back to the NHS requiring huge resources to facilitate.

5. Transfer of patients from admitting NHS hospitals to Excel after initial stabilisation - again very resource heavy procedure.

6. What equipment are they using? One thing that has barely been mentioned is what types of ventilators will be used. This will make a massive difference both in terms of management and also staff familiarity.

While we need extra capacity and I applaud that initiative I remain to be convinced this is the answer.

Careful now, the revisionists don't want to hear the truth, from "beds in a shed" to "Boris' built an entire hospital."

[martin_p]

I worry that there have been a lot of question marks about China data, even though I have defended it at times.

China is not coming out of this well at all and could suffer a backlash from Europe and the US.

When the whole world is in recession except for China, I am not sure what the reaction is going to be.

But we’ve discovered over the last day or two that out early data wasn’t that reliable either, the first death being a lot earlier than reported and the number of deaths being higher as well. Maybe we’re discovering that accurate data isn’t that easy.

[AndrewJB]

Released yesterday-

https://yougov.co.uk/topics/politics/ar ... s-its-gove

For the first time in nearly a decade, Britain approves of its government

More dramatically still, the latest YouGov data shows, that as a result of the coronavirus crisis, the government now has net positive approval ratings for the first time in almost a decade.

The results show that 52% of Britons approve of the government’s record, compared to just half that number (26%) who disapprove.

A lot of this shift has come from Labour voters, with over a fifth (22%) now saying they approve of the government’s performance, despite not voting for it just four months ago.

This current net approval figure of +26 is the highest that YouGov has ever recorded in the 1,400 times we have asked the question since 2003.

Shouldn’t we be waiting to see how things pan out so we can get the objectivity of how people think once this crisis is over? It’s normal for people to rally around a government in a time of existential crisis - even Churchill became popular for a time - so let’s see what the public think once they’re feeling more objective.

[Lowbankclaret]

Sorry don’t want to sound pedantic but the term critical care bed usually means an ICU bed. A HDU (high dependency unit) or level 2 (HDU, level 3 ICU) is the term used for the level of care just below ICU

Glad your still ok Inchy.

There are moments each day I stop and think, Is he ok.

[thatdberight]

Glad I didn’t post that link, would have had dogs abuse all night.

Even I don’t think it will be that bad.

There's nothing "bad" about it.

You do know what "asymptomatic" means don't you?

[thatdberight]

Actually it's not a bad thing because if as suggested yesterday the R0 number might be less than one then the rate of infection will slow far quicker than anticipated.

Sorry. I understood that. I meant this had better not turn out to have been much much less of a threat than we've reacted to. If we end up locked down for months and (say) the consensus coming out of it is that we'll have a five year recession to have saved the lives of 50,000 people - the vast majority of whom would have died inside a couple of years - do you fancy trying to do the same by consent next time a similar threat is perceived?

[RingoMcCartney]

The point is that physical hospital space isn't the issue at the minute. It's equipment and the trained staff capable of managing that equipment. Both of those are diluted by moving patients to a separate site.

I'll let Inchy , hope he doesn't mind.

As an ICU nurse I will add my thoughts on the nightingale

The sickest will remain in proper hospitals obviously but the nightingale will have its place

If that place is somewhere that saves a single life, then the building of a new hospital will have been worth it.

Jesus Christ. I never ever thought I'd have to justify celebrating the creating of a functioning hospital put of thin air in 9 days, at the time of a unprecedented global pandemic! Never.

[Inchy]

Glad your still ok Inchy.

There are moments each day I stop and think, Is he ok.

I worked last night and I am back on tonight.

Things continue to ramp up, more and more referrals to critical care. We admitted 3 times the amount we would normally admit in a 24 hour period.

We are coping and we still have capacity as critical care has taken over the main theatre and recover area which is next to ICU.

We are still seeing a lot of young fit people being admitted but it appears early CPAP is working and they are being discharged. No patient who has been intubated has managed to be extubated. There is a significant number of intubated patients where I work and across the country.

I read the other day that ordinarily the average intubation to outcome (extubation or death) is 4-5 days. With covid it’s 20 days. That’s going to have a massive impact in capacity.

Mentally people are fighting on but we are all aware of the greater risk for critical care workers. Today the country lost two Critical Care nurses to this virus. It’s very upsetting.




I am seeing families with unrealistic expectations of what ICU can provide. ICU isn’t a cure, it simply buys time.
Some relatives are also getting mad at the medical team if the medical team feels a person should not be for resuscitation. A lot of this is just lack of education on the matter. If someone isn’t for resuscitation it doesn’t mean we stop caring, it doesn’t me we won’t take the person to ICU. All it means is if the heart stops we won’t try to restart it. Most patients that have a cardiac arrest from covid will be in a non-shockable rhythm. The chance of survival is minimal, and even if the person does survive they are likely to be severely disabled for life, which is likely to be short. As we have to don PPE before doing chest compressions the chance of survival is even less and if someone does survive it is almost certain they will have a severe hypoxia brain injury.


Having doctors and nurses strip you and jump up and down on your chest is a very undignified way to die.


If you are knocking on and have co-morbidities have these discussions with your family. Let them know your wishes because often these discussions are had with families when patients are very sick and they are not ready. The resuscitation council website offer excellent guidance on this

[RingoMcCartney]

You really are pathetic
Comparing them to builders on a building site is about social distancing not their occupation. That building site could very easily be a site where they are building a new hospital. Why should one set of workers be treated any different from another if they are all classified as carrying out essential work ?

They are putting other peoples lives at risk if they were not adhering to social distancing guidelines - if that is what they were doing as this is the 3rd time I have said I have not seen the video.

It’s not my fault you do not understand social distancing or the purpose of it.

I have also already said that this is a positive and needed thing....but you are as you always try and do twist things. Would you say the same thing if a video emerged of frontline doctors not socially distancing ? Would it not be wrong “stupid” of them to be breaking guidelines just because the rest of their work and what they do is heroic ?

In one breath you day "they have put others lives at risk" . Then admit to you not seeing the video but still make a blind judgement that "if they have not been adhering to social distancing guidelines that is not heroic - it’s stupid."

Now you want go down some made up video route of whether doctors were behaving "stupid"

In an emergency, people take calculated risks. In the heat of the moment protocol goes out of the window and peoples natural humanitarian instincts take over. The urge to save another human being's life I'd all that matters. Its situations like this that genuine heroes are found.

I for one do not see the actions of the people who rallied to the cause of building a hospital in 9 days, while potentially putting themselves in harm's way, as "stupid" as you do. They're all selfless heroes.

Again, I simply cannot believe I'm having to argue the toss , as to whether those , whom we can all thank for their efforts. Were either "stupid" or heroic, by potentially risking their life. I really can't. Unbelievable.

I'm ending this discussion with you now. But I'll leave you with this thought.

God forbid, that either you , or any of your family had found themselves having had to use one of these Nightingale hospitals and, thankfully, had come out of it the other side unscathed. I doubt you'd be describing those that built it with little regard for their own lives as "stupid" would you.

Me neither TVC15. National Heroes the lot of 'em

[Grumps]

I worked last night and I am back on tonight.

Things continue to ramp up, more and more referrals to critical care. We admitted 3 times the amount we would normally admit in a 24 hour period.

We are coping and we still have capacity as critical care has taken over the main theatre and recover area which is next to ICU.

We are still seeing a lot of young fit people being admitted but it appears early CPAP is working and they are being discharged. No patient who has been intubated has managed to be extubated. There is a significant number of intubated patients where I work and across the country.

I read the other day that ordinarily the average intubation to outcome (extubation or death) is 4-5 days. With covid it’s 20 days. That’s going to have a massive impact in capacity.

Mentally people are fighting on but we are all aware of the greater risk for critical care workers. Today the country lost two Critical Care nurses to this virus. It’s very upsetting.




I am seeing families with unrealistic expectations of what ICU can provide. ICU isn’t a cure, it simply buys time.
Some relatives are also getting mad at the medical team if the medical team feels a person should not be for resuscitation. A lot of this is just lack of education on the matter. If someone isn’t for resuscitation it doesn’t mean we stop caring, it doesn’t me we won’t take the person to ICU. All it means is if the heart stops we won’t try to restart it. Most patients that have a cardiac arrest from covid will be in a non-shockable rhythm. The chance of survival is minimal, and even if the person does survive they are likely to be severely disabled for life, which is likely to be short. As we have to don PPE before doing chest compressions the chance of survival is even less and if someone does survive it is almost certain they will have a severe hypoxia brain injury.


Having doctors and nurses strip you and jump up and down on your chest is a very undignified way to die.


If you are knocking on and have co-morbidities have these discussions with your family. Let them know your wishes because often these discussions are had with families when patients are very sick and they are not ready. The resuscitation council website offer excellent guidance on this

Out of interest how many of the older patients being admitted already have a DNR?

[Inchy]

I don’t know exactly but I suspect the normal amount.

Covid is creating single organ failure which is manageable in many patients including those with DNRs. Obviously if he DNR has been put in place due to severe frailty then ICU is probably not appropriate but that’s the same as always

[KateR]

Inchy,
thanks for the update and stay safe, silly to say I know but...……….

A few points you made clarified a couple of things I was thinking about/wondering.

You, and all like you on the frontline are greatly appreciated.

[TVC15]

God forbid, that either you , or any of your family had found themselves having had to use one of these Nightingale hospitals and, thankfully, had come out of it the other side unscathed. I doubt you'd be describing those that built it with little regard for their own lives as "stupid" would you.

You are sick in the head.
You are one twisted f-uck Wrongo.

Lies and twisting what I said which was specifically on the issue of social distancing and then posting pathetic comments like this.
You need help....seriously you do.

[Lowbankclaret]

I worked last night and I am back on tonight.

Things continue to ramp up, more and more referrals to critical care. We admitted 3 times the amount we would normally admit in a 24 hour period.

We are coping and we still have capacity as critical care has taken over the main theatre and recover area which is next to ICU.

We are still seeing a lot of young fit people being admitted but it appears early CPAP is working and they are being discharged. No patient who has been intubated has managed to be extubated. There is a significant number of intubated patients where I work and across the country.

I read the other day that ordinarily the average intubation to outcome (extubation or death) is 4-5 days. With covid it’s 20 days. That’s going to have a massive impact in capacity.

Mentally people are fighting on but we are all aware of the greater risk for critical care workers. Today the country lost two Critical Care nurses to this virus. It’s very upsetting.




I am seeing families with unrealistic expectations of what ICU can provide. ICU isn’t a cure, it simply buys time.
Some relatives are also getting mad at the medical team if the medical team feels a person should not be for resuscitation. A lot of this is just lack of education on the matter. If someone isn’t for resuscitation it doesn’t mean we stop caring, it doesn’t me we won’t take the person to ICU. All it means is if the heart stops we won’t try to restart it. Most patients that have a cardiac arrest from covid will be in a non-shockable rhythm. The chance of survival is minimal, and even if the person does survive they are likely to be severely disabled for life, which is likely to be short. As we have to don PPE before doing chest compressions the chance of survival is even less and if someone does survive it is almost certain they will have a severe hypoxia brain injury.


Having doctors and nurses strip you and jump up and down on your chest is a very undignified way to die.


If you are knocking on and have co-morbidities have these discussions with your family. Let them know your wishes because often these discussions are had with families when patients are very sick and they are not ready. The resuscitation council website offer excellent guidance on this

Andrew Cuomo who is the Gov of New York has also pointed out that Covid patients take up a ventilator for around 20 days instead of a normal 4-5 day outcome. That’s why ventilators are becoming the most required piece of kit around the world. That the same as you are seeing. CPAP kit like you say appears to help some and relieves pressure on ventilators.

A group of us at work have set about making face shields at the request of Airedale hospital. We have just had feedback it past the fitting check by infection control. It’s now going to be subject to a chlorine clean to see if it can be reused.
The beauty of 3D printing is it can be done anywhere. Modifications can be done quickly and if sizes are needed you just ask for a 105% or 90% print and you get different sizes. Hope it works and we can be in production next week. Perhaps Leeds might want some. Let me know.

[RingoMcCartney]

Shouldn’t we be waiting to see how things pan out so we can get the objectivity of how people think once this crisis is over? It’s normal for people to rally around a government in a time of existential crisis - even Churchill became popular for a time - so let’s see what the public think once they’re feeling more objective.

Yes!

I've just posted opinion polls to show how, away from the heat and noise of this messageboard, the public at large see things. It's a simple snap shot , a moment in time.

You're right people do tend to.rally round the government in a crisis and its popularity may fall away as time passes.

We are in a crisis, there's no doubt. I give the British people credit for being able to look at the bigger picture. They're realistic and accept the fallibility of our leaders. They dont expect a perfect response. They know a perfect response does not exist. The vast majority feel no need what so ever to look for opportunities to offer "constructive criticism" /sniping.

The British People are far more considered than many of the more frantic give them credit for. They're prepared to allow the passage of time to allow objectivity to help judgement. They're more than happy to let the agitators and those that feel the need to monitor the government's handling on an almost hourly basis do just that. Knowing that those to quick to criticise can fall flat on their, all too eager, faces. Robert Peston.......

[Lowbankclaret]

You are sick in the head.
You are one twisted f-uck Wrongo.

Lies and twisting what I said which was specifically on the issue of social distancing and then posting pathetic comments like this.
You need help....seriously you do.

Click on his name and put him on your foe list.

You don’t have to read his bile output then.

It’s works fantastically.

[Spijed]

Sorry. I understood that. I meant this had better not turn out to have been much much less of a threat than we've reacted to. If we end up locked down for months and (say) the consensus coming out of it is that we'll have a five year recession to have saved the lives of 50,000 people - the vast majority of whom would have died inside a couple of years - do you fancy trying to do the same by consent next time a similar threat is perceived?

I suppose it's better to be safe than sorry and hopefully next time we'll all be far better prepared.

[Lowbankclaret]

I worked last night and I am back on tonight.

Things continue to ramp up, more and more referrals to critical care. We admitted 3 times the amount we would normally admit in a 24 hour period.

We are coping and we still have capacity as critical care has taken over the main theatre and recover area which is next to ICU.

We are still seeing a lot of young fit people being admitted but it appears early CPAP is working and they are being discharged. No patient who has been intubated has managed to be extubated. There is a significant number of intubated patients where I work and across the country.

I read the other day that ordinarily the average intubation to outcome (extubation or death) is 4-5 days. With covid it’s 20 days. That’s going to have a massive impact in capacity.

Mentally people are fighting on but we are all aware of the greater risk for critical care workers. Today the country lost two Critical Care nurses to this virus. It’s very upsetting.




I am seeing families with unrealistic expectations of what ICU can provide. ICU isn’t a cure, it simply buys time.
Some relatives are also getting mad at the medical team if the medical team feels a person should not be for resuscitation. A lot of this is just lack of education on the matter. If someone isn’t for resuscitation it doesn’t mean we stop caring, it doesn’t me we won’t take the person to ICU. All it means is if the heart stops we won’t try to restart it. Most patients that have a cardiac arrest from covid will be in a non-shockable rhythm. The chance of survival is minimal, and even if the person does survive they are likely to be severely disabled for life, which is likely to be short. As we have to don PPE before doing chest compressions the chance of survival is even less and if someone does survive it is almost certain they will have a severe hypoxia brain injury.


Having doctors and nurses strip you and jump up and down on your chest is a very undignified way to die.


If you are knocking on and have co-morbidities have these discussions with your family. Let them know your wishes because often these discussions are had with families when patients are very sick and they are not ready. The resuscitation council website offer excellent guidance on this

Just to say, my company is covering all costs.
If the need is big enough, I know they will set up a manufacturing cell. So if Leeds need some let me know.

I am doing the project plan.
Plus making the elastic straps as I had the product required as I use it for fishing.

[TVC15]

Click on his name and put him on your foe list.

You don’t have to read his bile output then.

It’s works fantastically.

Yep I know - you are right.

[Lowbankclaret]

Sorry. I understood that. I meant this had better not turn out to have been much much less of a threat than we've reacted to. If we end up locked down for months and (say) the consensus coming out of it is that we'll have a five year recession to have saved the lives of 50,000 people - the vast majority of whom would have died inside a couple of years - do you fancy trying to do the same by consent next time a similar threat is perceived?

It is really a difficult one this.

Don’t all shoot at me for posting this.

There are different strategies you could use.

Lockdown everyone over 65 let’s say.
At work we have pass through measures. Someone opens a door puts an item in and shuts the door. Someone else opens a door on the other side and removes it. It could be disinfected in the pass through protecting people on the other side. I could see how that could work for care homes. create much better virus controls to protect people.

Or take the oh well we cannot cope and need to select who gets care and who doesn’t. Take that a step further, at the next outbreak just do a risk assessment on those who might die and put them to sleep and just carry on as normal. Thats kinda what
I think people are skirting around but dare not say. I DISAGREE WITH THIS APPROACH ABSOLUTELY.

At a best guess in 5 weeks 2-3 million people in the UK will have had this.

How do we come out of lockdown

[DavidEyresLeftFoot]

I'll let Inchy , hope he doesn't mind.

I'll let Inchy what?

For context I'm a consultant anaesthetist and I'm giving my insight from the front line, having actually read the admission guidelines for the Excel.
Yes capacity is needed, but staffing is what we're desperately lacking despite everything else that's been put in place. In unprecedented times we've increased our number of ICU beds four fold. That is increasing the bed spaces with staff stretched more thinly to facilitate that. I'm struggling to see how taking highly trained staff away from every hospital makes that better.

[CombatClaret]

Sorry don’t want to sound pedantic but the term critical care bed usually means an ICU bed. A HDU (high dependency unit) or level 2 (HDU, level 3 ICU) is the term used for the level of care just below ICU

Always happy to be corrected by an expert.
I think my assertion was right if my terminology was wrong, the lesser serious cases will be sent there while the most serious will be kept in mainstream hospital ICUs.
Thank you and good luck!

[CombatClaret]

In one breath you day "they have put others lives at risk" . Then admit to you not seeing the video but still make a blind judgement that "if they have not been adhering to social distancing guidelines that is not heroic - it’s stupid."

SD.jpg (513.17 KiB) Viewed 3044 times

I posted this already but you both ignored it. It's a frame from a time lapse video of the fitting of the Excell Center. There plenty more like it of the construction workers not following social distancing rule. I wouldn't really have cared tbh, the benefits outweigh the risks, but you went full THE SUN on trumpeting the event.

The logistics of creating a working hospital out of thin air, in normal times, would have been challenging. But to do it under social distancing rules and everything else associated with this current unprecedented situation is nothing short of a miracle.

-It's not a working hospital it's a large ward with one purpose in mind that will be deconstructed afterward.
-It wasn't out of thin air, the building and all utilities were already in place and it's specifically designed for large get ins/get outs.
-Workers did not do it under social distancing rules.

But apart from that... And you wonder why they call you Wrongo

[Inchy]

Always happy to be corrected by an expert.
I think my assertion was right if my terminology was wrong, the lesser serious cases will be sent there while the most serious will be kept in mainstream hospital ICUs.
Thank you and good luck!

I assume that’s the case but I could be wrong.

[KateR]

DavidEyresLeftFoot
You are right, it doesn't make it better. For me and reading various posts we have had for a while the following issues (main and by no means all):
Bed shortages; I think that is what many posts were aimed at, I personally never believed this would be a real issue and was relatively easy to overcome. I think it is but will need continuous monitoring, such that it never becomes an issue and one less serious threat to manage.
Ventilators; Obviously a big issue and still is, people are trying to work around this in numerous ways in numerous countries, time for use by patient plus amount of patients needing the clearly makes the matter much worse than previous.
Staff; Another of the major problems being looked at, staff ill & getting them back to work paramount. Bringing in retired staff has to help, as would say using student nurses & doctors, volunteers. However if patients continue to grow faster than staff and by this I mean those trained to then clearly big issues arise that another hospital can not solve, yet if you could segregate and put people not affected by C-19 into wards/hospitals/beds where ventilators and less highly trained staff can cope then it would help, wouldn't it?

I have no knowledge of what is happening around healthcare, I am looking at posts here from Inchy, yourself, articles, news outlets, and trying to make sense of it as best I can and only offering some thoughts, not attacking or defending anyone and would greatly appreciate your response. Also please note, in no way shape or form am I trying to belittle anything anyone is doing nor am I looking at it lightly what so ever.

[tim_noone]

If beds were an issue I'm sure silent night would be churning them out. They closed the factories last week...so maybe stockpiled plenty. If they're called to work them lads and lasses are true grafters 4 sure.

[Jakubclaret]

If beds were an issue I'm sure silent night would be churning them out. They closed the factories last week...so maybe stockpiled plenty. If they're called to work them lads and lasses are true grafters 4 sure.

Doubt the hospital beds would be pocket spring I know there do cheaper mattresses there, not sure where the NHS source that kind of thing. Doubt silentnight though could be wrong.

[tim_noone]

Doubt the hospital beds would be pocket spring I know there do cheaper mattresses there, not sure where the NHS source that kind of thing. Doubt silentnight though could be wrong.

In times of crisis the government will be doing the sourcing I would imagine. But its ventilators as I understand it that are needed.

[TVC15]

Doubt the hospital beds would be pocket spring I know there do cheaper mattresses there, not sure where the NHS source that kind of thing. Doubt silentnight though could be wrong.

You are correct - there are specialist hospital bed manufacturers in the UK and across Europe. They are not cheap.
But I am not aware of any shortage of the actual beds that can be manufactured / delivered as evidenced by how quickly they have got them for the new field hospitals not just here but across the world.

The shortage they refer to in hospitals is in relation to capacity and resources more than anything. It’s one of the reason that for the last few years that patients have been left on corridors for several hours.

[mdd2]

Staff; Another of the major problems being looked at, staff ill & getting them back to work paramount. Bringing in retired staff has to help, as would say using student nurses & doctors, volunteers. However if patients continue to grow faster than staff and by this I mean those trained to then clearly big issues arise that another hospital can not solve, yet if you could segregate and put people not affected by C-19 into wards/hospitals/beds where ventilators and less highly trained staff can cope then it would help, wouldn't it?

This is the main issue you can knock together a hospital of a kind in about 10 days and you can have a surplus of ventilators in a little longer but it takes much longer to train ITU staff and as I know you could have a shed load of trained ITU staff in the sidelines having been trained theoretically since the excercise in 2016 but unless those staff continue to use their skills, they get rusty. I have done it myself and seen others do it-oh I have done this many times (but not for 3 or 4 years) and wallop you do not make as good a job as you did 4 years ago.
As Inchy points out there are patients needing ventilation for weeks and my understanding is that the death rate can be of the order of 50% for those ventilated. We oldies do far less well and so there maybe a logic to not ventilating those with a poor performance status as has always been the case in folk with end stage COPD. For sure many survivors of this thing will have a lower performance afterwards and may never get back to what they were like before contracting Covid-19

[taio]

You are correct - there are specialist hospital bed manufacturers in the UK and across Europe. They are not cheap.
But I am not aware of any shortage of the actual beds that can be manufactured / delivered as evidenced by how quickly they have got them for the new field hospitals not just here but across the world.

The shortage they refer to in hospitals is in relation to capacity and resources more than anything. It’s one of the reason that for the last few years that patients have been left on corridors for several hours.

There have been some supply problems for people who need a hospital profiling bed and pressure relieving mattres. Minor issues certainly when compared to the major difficulties around PPE.

[TVC15]

There have been some supply problems for people who need a hospital profiling bed and pressure relieving mattres. Minor issues certainly when compared to the major difficulties around PPE.

Ok.
I just know that someone who was involved in manufacturing them a few years ago and he said it had become a very competitive industry with lots of new suppliers entering the market.
Obviously the unprecedented times cause pressure points everywhere.

[DavidEyresLeftFoot]

Ventilators seems to be the buzz word for this week. But there’s issues with this sudden drive for Dyson to make them. A ventilator isn’t just a ventilator. As always the devil is in the detail. Part of the increased capacity for ventilation is utilising theatres and recovery areas. Some of these patients will be ventilated using theatre anaesthetic machines, which are perfectly functional. Unfortunately ICU nurses are less familiar with these machines and there are technical difficulties with using them for days on end. I won’t go into details but they’re designed for ventilating patients for hours not days. Traditional ICU ventilators have more modes, are more complex designs and work better as the patient starts to recover some respiratory function. I suspect that companies like dyson and mclaren would probably be producing more simplistic ventilators which, while helpful, isn’t actually what we need. Our surge capacity is for 50 ventilated beds. We could probably find the equipment for 75. However we’re going to run out of staff before ventilators. Germany are being held up as an example due to their testing. However their baseline ICU capacity ie ventilators AND trained staff is where they hold an even greater advantage over us.

[mdd2]

So, according to the latest update by Hancoxk today the bottleneck in testing is the PHE. The PHE's response to fighting the virus has been wholly lacking. They do not seem to have tried to coordinate a national response to fight the virus. Instead, they seem to have kept efforts in-house and have been pursuing the testing protocols themselves - seem their motive is plain vanity rather than helping the health of the population. This is apparent form Hancock praise - one of 1'st in world to decode the virus DNA and come up with a test. That is nonsense. There are many other companies who had tests available at the beginning of February with 99.9% specificity and these companies have been consistently overlooked in supplying the NHS with test kits and analytical platforms. There are many companies worldwide working on developing antigen and antibody tests besides PHE's own Porton Down facility. Why can't the PHE consider tests from these other establishments for evaluation? Is it a case of - not developed by the PHE so not worth consideration?

The public appointment today ( probably a few weeks late) of Prof Newton to coordinate efforts of the PHE is an acknowledgement of the failure of PHE and their insular response thus far. Lets hope we see some substantial progress now that PHE are "allowing" commercial entities, university labs and industry to be involved.

Atlanta it is a RNA virus but that is a small point. On testing whilst you may be correct about specificity ie if RTCPCR picks it up you have it. What you have is likely to be the SARS2 virus but the test amplifies and identifies bits of the virus and there are several different tests for different bits. Equally you could have picked up dead defunct virus-less likely but I would question the 99.9% specificity if you are talking about "if it is positive you have live virus."
The sensitivity of RTPCR is poor and the sensitivity of the test is important for screening not so sick people like health care workers. In China an initial swab was positive in about 60% of those infected. I am reliably informed that our test is 75% sensitive which means one in four health care workers with the sniffles and the virus will test negative for the virus even though they have it.
My fear is that this epidemic is being taken over by the media and joe public demanding what is not presently possible quoting what the Germans are doing etc. What they are doing elsewhere, none of whom have a foolproof means of detecting this in everyone is what we are doing but more screening of contacts still. In reality for the people Inchy is dealing with if shove comes to push you do not really need the test. In China the radiologists became better at diagnosing severe Covid-19 than the virologists using RTPCR on initial swabbing.
So to get the stats down to a reasonable risk where less than 1% of health care workers are Covid free would need an awful lot of re-testing of those who test negative which would not be done by the 7 days isolation recommended as if my maths is correct they would need to be tested 4 times
And that assumes the specificity of a single test is 75%, many feel it is less than that.
A reliable antibody test is what is needed assuming that the antibody present confers a degree of immunity.
I know we are now expanding testing which may be good provided the Labs are reliable. They all use kits, I have seen some great pieces made up from IKEA but you wouldn't get me doing self assembly as I am naff. Some labs are naff too and their results maybe less reliable than others.
Meanwhile self isolation and social distancing is better than any present test for a future from this illness

[HieronymousBoschHobs]

This had better not be how this pans out.

It’s received a bit of pushback. Here is a link to some responses to this article from other researchers: https://www.bmj.com/content/369/bmj.m13 ... -responses

[HieronymousBoschHobs]

If they are correct about the disease being more widespread/able to circulate more easily undetected than previously thought, that may actually be good news. It might mean more of the population may have had it already, and so may not be susceptible. In turn, that would mean there are less people who might at some point need to be admitted to hospital. Last night I saw a BBC reporter doing a finger prick antibody test and he was surprised to find it indicated he had had the disease. Like the researchers I link to above though, my initial thought was that the authors are making a questionable inference when they say evidence like this gives reason to question the utility of lockdown measures.

[mdd2]

And of course it may be an irrelevant result as these antibody tests need detailed assessments before being passed as fit for purpose and despite all the angst and earache PHE is getting, ensuring we use appropriate and reliable testing is vital. Before he went off ill the CMO said no testing is better than bad testing.How true that is

[RingoMcCartney]

I'll let Inchy what?

For context I'm a consultant anaesthetist and I'm giving my insight from the front line, having actually read the admission guidelines for the Excel.
Yes capacity is needed, but staffing is what we're desperately lacking despite everything else that's been put in place. In unprecedented times we've increased our number of ICU beds four fold. That is increasing the bed spaces with staff stretched more thinly to facilitate that. I'm struggling to see how taking highly trained staff away from every hospital makes that better.

Apologies, it should have said, "I'll let Inchy, hope he doesn't mind, speak on my behalf, when he says"

"the nightingale will have its place"

I've no doubt about the sincerity of your concerns about staffing levels being overstretched. None whatsoever.
But as a layman, I have to hope that the medical advisers that the government relies on for guidance. Have weighed up the pros and cons of pursuing such a radical policy of creating a functioning hospital in 9 days. Time may prove that it was, indeed, as perhaps you suspect, the wrong decision. I hope , for everyones sake that it proves to be beneficial and, as I've said repeatedly, if it saves one life, (now following your comments, without it costing some one else's) it will have been worth it.

Goes without saying I appreciate , as do all of us on here, the work you and all your colleagues do. Particularly at, I assume, what must be unprecedented testing times.

[tiger76]

If they are correct about the disease being more widespread/able to circulate more easily undetected than previously thought, that may actually be good news. It might mean more of the population may have had it already, and so may not be susceptible. In turn, that would mean there are less people who might at some point need to be admitted to hospital. Last night I saw a BBC reporter doing a finger prick antibody test and he was surprised to find it indicated he had had the disease. Like the researchers I link to above though, my initial thought was that the authors are making a questionable inference when they say evidence like this gives reason to question the utility of lockdown measures.

The hope,and it's only a hope just now,is that lots of people have already had this virus,and they were asymptomatic,if that's the case then that's great news,however the antibody tests are far from accurate,and therefore there must still be marks for any results they throw up,and until these issues can be resolved,any thought of relaxing the lockdown measures is out of the

I assume the reporter in was Adam Fleming,and your right he was genuinely at his findings,however even he was sceptical regarding the test,and he was adamant he wouldn't change his behaviour,probably sensible it's better to be safe than sorry.

[CombatClaret]

Key takeaways:

• US & UK both likely to pass Spain for peak daily deaths
• Daily death tolls in the thousands to become the norm in US
• UK now clearly steeper than Italy
• US at >20k new confirmed cases per day. Destined to end up the worst-affected country in the world.
• France possibly joining Italy and Spain in seeing new cases plateau and begin to dip

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[Lowbankclaret]

Suddenly orders have come in for ones we are making.
Too many for us to supply.
Gunna need a project plan .

[AndrewJB]

Yes!

I've just posted opinion polls to show how, away from the heat and noise of this messageboard, the public at large see things. It's a simple snap shot , a moment in time.

You're right people do tend to.rally round the government in a crisis and its popularity may fall away as time passes.

We are in a crisis, there's no doubt. I give the British people credit for being able to look at the bigger picture. They're realistic and accept the fallibility of our leaders. They dont expect a perfect response. They know a perfect response does not exist. The vast majority feel no need what so ever to look for opportunities to offer "constructive criticism" /sniping.

The British People are far more considered than many of the more frantic give them credit for. They're prepared to allow the passage of time to allow objectivity to help judgement. They're more than happy to let the agitators and those that feel the need to monitor the government's handling on an almost hourly basis do just that. Knowing that those to quick to criticise can fall flat on their, all too eager, faces. Robert Peston.......

So the polls are quite meaningless in real terms, because they’re only measuring the British public rallying around a government - regardless of how poorly they might be performing - in the midst of a crisis? Okay, I’ll agree with that.

[Heathclaret]

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Is this Ringo?

[Bordeauxclaret]

Right show, wrong character.

[RingoMcCartney]

So the polls are quite meaningless in real terms, because they’re only measuring the British public rallying around a government - regardless of how poorly they might be performing - in the midst of a crisis? Okay, I’ll agree with that.

Opinion polls offer a snap shot, a moment in time.

If you consider that meaningless fine. Fair enough.

So I guess the only polls that really matter are general elections and the odd referendum.

Any joy recently? (If a decade counts as recent)

[RingoMcCartney]

63E796CB-CEF2-49CB-BE18-6AC06D592DD2.jpeg


Is this Ringo?

Better looking than me.

[Elizabeth]

The Office for National Statistics are trying to proportion the number of deaths cause specifically by the virus. I think this will be helpful.

At the moment anyone who dies with the virus in the body are added to the figure shown in the death graphs. This is even when they were in the process of dying anyway or the virus was not the major contributory factor in the death.

The resident experts will already know this of course but for some of us this type of understanding may be of use.

This is not to undermine the extreme seriousness of this awful virus.

[AndrewJB]

Opinion polls offer a snap shot, a moment in time.

If you consider that meaningless fine. Fair enough.

So I guess the only polls that really matter are general elections and the odd referendum.

Any joy recently? (If a decade counts as recent)

If you consider the governments failure to deal with this pandemic properly meaningless, and the same governments decade long defunding of our society’s ability to deal with the crisis as meaningless, then what are you?