How do you feel? (Part 1)

General Chat
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The approach is clinically sound, but that’s the easy bit. The resources and resilience of existing services which are already stretched, to ramp up to meet the unprecedented demand which is expected, is just not credible - the basic scale and scope numbers do not add up.

The government has starved the NHS of any investment for about 10 years now and as a result more or less every provider and commissioner is in debt arrears that are impossible to slash or transform their way out of. This has led to most providers holding vacancies right across medical, nursing and clinical support functions in community and hospital services.

The idea that the existing health (and police/ fire etc) system could cope with c 20% of the population being affected and a mortality rate of 1% (dubious) meaning 600,000 deaths, is just massively flawed.

But don’t worry Hancock and Whitty’s plan is that all the GPs and nurses who retired early or left the profession because of the government’s shit handling of health in this country will be gagging to come back to the same thing they left which has continued to crumble even further.

When the wave of this virus hits its going to be a very tough couple of months.

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Matt Hancock

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The whole 111 thing is a bit of a red herring - it’s a virus, 99.9% of the time it’s a low risk virus - so in almost all cases calling 111 serves no purpose beyond helping the health service track the spread of the disease.

The only effective treatments for the 99.9% are going to be bed rest, copious fluids, mild analgesia, and more bed rest.

Pragmatically, the 0.1% will die anyway, whether or not they ever reach the "help"line…

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How much space will stopping non urgent ops such as those for hips & knees free up?

I had the interesting experience of spending a day in A&E about 3 weeks ago. It was full, not to bursting, but full. There certainly didn’t seem to be any slack there.

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Yes - Louise has been off with similar. No temp though

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There was some plan to farm the bulk of these ‘routine’ jobs out to private sector hospitals since they’re generally straightforward and so a nice little (actually big) earner for Tory party sponsors. The NHS loses the payments that would have gone with them and is therefore left with the more challenging orthopaedic stuff (e.g. stabilising some pensioner’s crumbling spinal column) with less money than they had before.

I guess the bone-sawers won’t be able to help much with respiratory intensive care.

VB

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Doesn’t that worry you?

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About 30-40% of the bed base is dedicated to elective (all specialties not just T&O) surgery recovery. Probably 15-20% of those procedures would still need to go ahead based on higher clinical risk etc.

March was traditionally when ‘winter pressures’ began to subside but because of the reduction in service capacity all across the board (esp social care) this has now morphed into teetering on the edge all year round. So I suspect most hospitals are still coping with 95-105% bed occupancy and have all their escalation capacity beds still open.

This dramatically slows throughput and time to be seen and assessed at the front door (this is bad!!! The highest risk patients are always the ones that you haven’t assessed yet and delays are proven to drive mortality rates).

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There weren’t beds as such. Everyone was on movable trolleys That aspect actually seemed quite sensible & probably allowed them to fit more in than would’ve been possible on a traditional ward with beds.

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That’s part of what I mean by escalation bed capacity.

Lots of problems with this -

  • Dilutes the largely fixed number of clinical resource input per bed

  • Often sited in places which mean that patients on trollies receive less attention

  • This then massively increases clinical risk, whilst reducing patient comfort and dignity

The last time I had the role of Urgent Care Director for a local health system I used to go into the hospital at 7pm every night and walk every ward and corridor looking for over 70s on trollies sited in corridors or hidden/ hard to observe locations, and then hassle the fuck out of everyone to a. make sure they were relocated where they were going to be better looked after, and b. drive the kinds of actions the next day to try to reduce the numbers the following evening.

Then I’d drag the senior Execs and clinical directors in the room and ask them why the fuck they hadn’t done that!

I had one elderly lady in her 80s die in a corridor alone on my watch and I made sure that it never happened again, it still really bothers me.

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Burn out is becoming increasingly common among staff. Their personal standards are being eroded by available resources, the increasing blame game politics and ludicrous paperwork reducing patient care time. The horror scenario that is all too frequent of people, especially elderly people, being cared for in sub human environments unfortunately is all too frequent. I salute the staff of the NHS working in such difficult circumstances, not one of them joined the profession to harm people and yet are being forced due to resources to deliver care in an environment that potentially will.

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I salute the staff of the NHS working in such difficult circumstances, not one of them joined the profession to harm people and yet are being forced due to resources to deliver care in an environment that potentially will.

This. So much very this

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At home today doing some business continuity planning for when all our offices are closed, staff can’t use public transport, suppliers can’t supply business critical stuff etc.

Just realised that the following groups are ‘on the list’

  1. Over 60
  2. Heart issues
  3. Chest problems
  4. Diabetic

Three out of the four apply to me!

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As fine an example of gallows humour as you are likely to see in a while…

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My take on it so far;

82,000 People are sick with Coronavirus at the moment, of which 77,000 are in China. With a population of over 1.1 billion.
This means that if you are not in or haven’t recently visited China, this should eliminate 94% of your concern.

If you do contract Coronavirus, this still is not a cause for panic because:
81% of the Cases are MILD
14% of the Cases are MODERATE
Only 5% of the Cases are CRITICAL

Which means that even if you do get the virus, you are most likely to recover from it.

Some have said, “but this is worse than SARS!”. SARS had a fatality rate of 10% while COVID-19 has a fatality rate of 2%

Moreover, looking at the ages of those who are dying of this virus, the death rate for the people UNDER 50 years of age is only 0.2%

This means that:
if you are under 50 years of age and don’t live in China - you are more likely to win the lottery.

Now, let’s take one of the worst days so far, the 10th of February, when 108 people in CHINA died of Coronavirus.

On the same day:
26,283 people died of Cancer
24,641 people died of Heart Disease
4,300 people died of Diabetes
Suicide took 28 times more lives than the virus did.

Mosquitoes kill 2,740 people every day, HUMANS kill 1,300 fellow humans every day, and Snakes kill 137 people every day. (Sharks kill 2 people a year)

PS… Buying all the toilet roll in every shop is NOT going to save you.

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Copy pasta?

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Yes.

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That’ll be part of the Missionaria Protectiva then :+1:

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Think the numbers are something like 0.000013 of the population of this planet currently affected.

(~100,000 cases likely to date / ~7,800,000,000 population)