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  • Discussion: UK Coronavirus Pandemic / Epidemic Plans

    The UK may be facing a uniquely difficult situation in that there is currently a critical shortage of nurses, doctors and NHS beds. In England alone the shortage of medics is @45,000 nurses and over 10,000 doctors with the net result that current levels of NHS services are severely stretched, and existing medics are suffering from burn out and exhaustion as a consequence of extraordinary levels of sustained pressures that have been ongoing for the last few years. This will place them at significant risk of severe infections, before any battle against the coronavirus starts, and the UK cannot afford to lose any medical staff to widespread illness. A severe flu season has already stretched services to the maximum, both in terms of personnel and resources on top of an already bad situation.

    This thread is designed to allow us to discuss the issues facing the UK, post relevant news stories on how the UK plans to manage this epidemic and brainstorm ideas as to how the UK could manage the issues that a major coronavirus outbreak would bring. There are insufficient resources to employ the tactics used by China. Police numbers have been cut to the bone over years of austerity, as have the numbers of armed forces, before any consideration of societal issues.

    What are the sort of things we could discuss?

    As an example, the current focus would appear to be self isolation for entire families if there is a suspected case; however, like the US there is a preponderance of zero hour contracts, with many low paid workers; a large proportion of households literally live paycheck to paycheck. Without measures to keep people fed, it is difficult to see how self isolation at home can work (people will not be able to afford to comply) and this will apply to a large sector of the population, especially those living in cities. Working from home will not be an option for those working in the restaurant or retail sectors, who are major employers. School closures will also directly affect low income households who rely on the childcare to enable them to work. What are the current UK plans to assist and help families to manage in these circumstances? What happens when people get really sick and there are no hospital beds? I cannot see people complying with a 'stay at home' order in these circumstances.

    Again, for example: Hospitals are completely full with almost zero spare bed capacity. Current options available to discuss could be e.g.
    1. Cancel all elective surgery nationally NOW to allow us to start clearing beds. What are the issues that would result from doing this?
    2. Bed blocking is a significant factor in the UK. Much of the problem relates to who pays for a nursing home bed, and arranging this with local authorities. Should government temporarily agree to fund this directly (whilst we are in emergency mode) to clear beds where possible?
    3. Are there any factories capable of manufacturing PPE equipment domestically or are we entirely reliant on imports? How resilient are our supply chains? What stocks are currently held within hospitals? If we do not have domestic manufacturing capacity are there companies that could be requested to start manufacture?

    Hopefully this is enough to get going with and stimulate discussion.


  • #2
    One of the biggest problems overseas has been infected people coming in contact with unprepared medical workers. It brings to mind the lady wandering through almost every department in the hospital looking for the isolation pod she was meant to go to. This morning I have spoken with ill people (on the phone) who have the "soldier on" mentality. There is a Dailymail article stating "Thousands of Britons face mass coronavirus testing at GPs - as 'worst-case' Government report warns 500,000 may die in UK amid 'explosion' of infections across Europe". Hopefully people will take this more seriously.

    The Government have taken a very "softly softly" approach to disseminating information and it may well backfire.

    I have spoken with many people from a wide span of society and they are all concerned but unsure about how to prepare. It would be good to have some guidance on personal preparedness given out by the "authorities". Everything that individuals can do to prepare will help to take a strain off of the Government.

    Also infrastructure - water supplies, power and water treatment (sewerage), fuel, food. Not sure what has been done to stockpile chemicals etc. I know there are "wipe" manufacturers in the UK but not sure about other PPE. I also know that some chemicals are already in short supply.

    Good idea to have a discussion about this. Thank you Vibrant62.
    "The only security we have is our ability to adapt."

    Comment


    • kiwibird
      kiwibird commented
      Editing a comment
      "The UK may be facing a uniquely difficult situation in that there is currently a critical shortage of nurses, doctors and NHS beds. In England alone the shortage of medics is @45,000 nurses and over 10,000 doctors with the net result that current levels of NHS services are severely stretched, and existing medics are suffering from burn out and exhaustion as a consequence of extraordinary levels of sustained pressures that have been ongoing for the last few years. This will place them at significant risk of severe infections, before any battle against the coronavirus starts, and the UK cannot afford to lose any medical staff to widespread illness. A severe flu season has already stretched services to the maximum, both in terms of personnel and resources on top of an already bad situation."

      As they are so few - they are doubly precious - and should all be protected properly!

  • #3
    https://www.rcgp.org.uk/-/media/WeeklyReport_Winter_wk07_2020.ashx?la=en (graph page 4 - graph page 7 - looks like the north is trending up with pleurisy and pneumonia) and https://assets.publishing.service.go...eek_8_2020.pdf
    (graph bottom of page 2)

    for discussion.
    Last edited by kiwibird; February 26, 2020, 07:01 AM. Reason: pg 7
    "The only security we have is our ability to adapt."

    Comment


    • kiwibird
      kiwibird commented
      Editing a comment
      Pity this data is two weeks or more behind the current date

  • #4
    Originally posted by Vibrant62 View Post


    As an example, the current focus would appear to be self isolation for entire families if there is a suspected case; however, like the US there is a preponderance of zero hour contracts, with many low paid workers; a large proportion of households literally live paycheck to paycheck. Without measures to keep people fed, it is difficult to see how self isolation at home can work (people will not be able to afford to comply) and this will apply to a large sector of the population, especially those living in cities. Working from home will not be an option for those working in the restaurant or retail sectors, who are major employers. School closures will also directly affect low income households who rely on the childcare to enable them to work. What are the current UK plans to assist and help families to manage in these circumstances? What happens when people get really sick and there are no hospital beds? I cannot see people complying with a 'stay at home' order in these circumstances.

    The UK has announced today that companies will be directed to award sick pay in the event that someone self isolates, which is welcome news. See https://www.dailymail.co.uk/health/article-8047825/Health-Secretary-confirms-self-isolates-coronavirus-sick-pay.html . This clarification is certainly a good start.

    However people on zero hours contracts (and a few other situations) do not qualify for holiday or sick pay under the normal terms of their contracts, and the self employed also do not have access to these sorts of payments. What is the UK Govt going to do about these individuals to keep them home when they should be self isolating??

    Comment


    • Vibrant62
      Vibrant62 commented
      Editing a comment
      This case sums up the problems with regards to self isolation amongst low paid workers. Many of JD Weatherspoons part time employees wont even qualify for SSP.

      Headline: Coronavirus: Sick pay rules apply, says JD Wetherspoon pub chain.
      Under statutory sick pay rules, an employee is not paid for the first three days of absence.


      So - how will these individuals be persuaded to stay at home if they get the early signs of COVID 19 when it could just as easily be a seasonal cold? Adults are estimated to get 2 - 4 colds a year on average (https://en.wikipedia.org/wiki/Common_cold. So that is the potential for 4 to 8 weeks off work in self isolation. If economies are to be kept going an 'instant' test that is available to all is going to be needed very rapidly. Does anyone know what progress is being made in this direction?

  • #5
    Yes - when does the next data set get released? The only marked signal I can see is that the Midlands and East have a surge in whooping cough and to a lesser extent, tonsillitis. Possible detection of early mild symptoms? If the next weeks data set has more pneumonia and associated respiratory problems in the same area it could be cause for concern?

    Comment


    • #6
      A good article from The Independent sums up the major problems for the UK. Worth reading in full, but key excerpts below.
      Coronavirus: Patients could be denied lifesaving care if virus overwhelms NHS hospitals

      Snippet

      The medics spoke out amid frustration over what one said was the government’s “dishonest spin” that the health service was well prepared for a major pandemic outbreak.

      The doctors, from hospitals across England, said the health service’s existing critical care capacity was already overstretched and “would crumble” under the demands of a pandemic surge in patients who may all need ventilation to help them breathe.

      Those denied intensive care beds could be those suffering with coronavirus or other seriously ill patients, with priority given to those most likely to survive and recover.

      https://www.independent.co.uk/news/h...-a9361916.html

      Comment


      • #7
        A little distraught to read the following article in Today's Guardian.

        Headline: 'They have no idea': government failing on coronavirus, say GPs.
        Doctors say NHS 111 giving wrong advice and not enough patients being tested for virus




        Almost identical issues to the ones highlighted in this article were raised by GPs almost a month ago in relation to the Brighton super-spreader event, and it shows that fundamental issues have not yet been addressed at NHS 111. If the UK is to stay on top of COVID-19 containment, then they really do need to get on top of this problem, especially as NHS 111 is going to be such a core part of response strategy.

        Comment


        • Vibrant62
          Vibrant62 commented
          Editing a comment
          Another news report from today illustrating the issue. "Suspected coronavirus patient 'told to sit in Walsall Manor Hospital's packed waiting room"
          https://www.birminghammail.co.uk/bla...d-sit-17825081 so this is not an isolated problem.

          A full review of training materials and the NHS 111 algorithms are clearly urgently needed, along with personnel training so that even if the system gets it wrong, individuals know how to address the issue of a suspected case and can override it. Additionally, there needs to be some sort of alert system that flags up affected areas as this is a constantly evolving situation. The issue of online booking systems for GPs also needs to be tackled very urgently. We have to protect our medics because sooner or later these will be real cases, and we need every possible doctor and nurse. It wont be any use if they all end up having to go into isolation, not to mention the need to protect them from catching COVID 19 itself.

        • Vibrant62
          Vibrant62 commented
          Editing a comment
          Sentinel testing now going ahead at over 100 centers nationally, and hopefully testing is now being authorised when / where testing is requested also. So these are steps in the right direction.

      • #8
        Originally posted by kiwibird View Post

        The Government have taken a very "softly softly" approach to disseminating information and it may well backfire.

        I have spoken with many people from a wide span of society and they are all concerned but unsure about how to prepare. It would be good to have some guidance on personal preparedness given out by the "authorities". Everything that individuals can do to prepare will help to take a strain off of the Government.

        .
        I have also been speaking to a variety of medics and non-medics alike. Many medics are so busy running to stand still that they have not had the time we have to keep up to date with developments, and rely wholly on official guidance. IMHO this is not being updated rapidly enough.

        Amongst non-medics, it is also a very peculiar mix of reactions... on the one hand extreme fear (in the very very small minority) and at the other end of the scale (and the vast majority) is a complete disregard "its all hype, just another scare story, what is all the fuss about", and almost nothing in the middle of these two extremes. The latter are educated and intelligent people - but if you look at the comments sections of articles in The Sun and The Mail, these views are also in the very vast majority there (not trying to cast aspersions on anyone's intelligence, just that these titles reach more people across the full spectrum of society and are the best indicator I have to go on without hitting the streets and questioning people directly).

        The initial messaging of 'no worse than flu' seems to have been a very bad call, as that is now set very firmly in many people's thinking, and I am sad to say, that most wouldn't think twice about going about their normal business except for the days when they literally cannot get out or bed. I am deeply concerned that the 77k analysis study which broadly showed a CFR of almost 5% in Wuhan vs just under 1% outside of Hubei was determined wholly by the level to which healthcare provision was over-run. I am not seeing anything that gives me any confidence that the UK will not be in a similar position to Wuhan in an extensive outbreak, i.e. that the CFR here could be very much higher than 2% unless people really get on-board with the self-isolation measures to contain and reduce R0. This is not the time for 'don't worry, be happy' messaging; it is a time to educate so that we can find the happiest of balances between keeping the economy going and keeping people as safe as possible.

        PHE and the DH need to start getting their ducks in a row on messaging. We still have a 'teachable moment' but if this is to be taken seriously, they need to stop sugar coating things. People generally are disregarding news headlines (just more scare stories to sell papers) so this needs to come from the top and center. Again, just IMHO.

        Comment


        • #9
          I live very rural in the hills in Scotland. I think NHS Scotland is in far better shape than down south, and we have a population of only 5 milion. I'd like (very much!) to think we are better placed up here to cope. But I just don't know. I agree 100% with Vibrant's summing-up at the top of the page. The UK is not well organised and the govt are not informed or efficient. I am worried about this outbreak and have very low confidence in official guidance. Thank god for this forum!

          Comment


          • #10
            Article just now published in the Guardian in the UK which I am puzzling over... For some years now, army medics have been working in the NHS when not required for duties in the military to bolster NHS doctor numbers, especially within hospitals - e.g. at Frimley Park near Aldershot. Now perhaps that changed and I am behind the times? Anybody have clarification?

            Certainly welcome news that the British Red Cross and St Johns Ambulance will also be formally involved.

            Military to help NHS cope with major coronavirus outbreak

            https://www.theguardian.com/world/20...virus-outbreak

            Comment


            • Shiloh
              Shiloh commented
              Editing a comment
              Well, in China military doctors were called in to assist health care pros in Wuhan, so it may be that is what will occur in the UK and elsewhere.

            • Vibrant62
              Vibrant62 commented
              Editing a comment
              Hi Shiloh - My point was that these medics are ALREADY in use by the NHS, so if they draft them elsewhere it will leave a hole where they are already working... As far as I am aware, any not on military deployment are working in NHS hospitals... in other words, I dont think there are many/ any 'extra's' to draft in.

          • #11
            Reading this article prompts several thoughts that I hope are being considered by PHE and planners. It may be that these sorts of actions are going to be left at a local level, and some FT members are currently medics in the NHS so I think the ideas are worth considering here.

            Coronavirus: Top doctor says NHS may not cope with large-scale outbreak.
            Dr Parmar says even without a large outbreak, many hospitals are already at capacity and lots of operations are being cancelled.

            https://news.sky.com/story/coronavir...break-11945687

            As far as I can see, if it is accepted that a widespread outbreak is coming, the NHS needs to be cancelling all elective surgery as of now. Give our medics a breather and a chance to rest up a little to prepare for what is coming. All medics will need refresher training on PPE and other procedures as currently individuals with appropriate expertise is very likely limited to those working in specialist emergency care and respiratory medicine; as in China, medics of all specialities will be needed in care of critical and severe COVID patients in a full blown outbreak. That means that hospitals will need to draft in e.g. the urologists, the opthalmologists etc all of whom wont have carried out certain procedures since they were at med school or on SHO / F1 / F2 rotations. We (as in the NHS) also need to be appealing to the hordes of retired GPs and ex-nurses - many of whom left the NHS in recent years due to burn out, rather than reaching retirement age. I don't know how many will come back on a temporary basis, but some might. They may need releasing however from current jobs on a temporary basis though - many moved to the Financial / biotech / pharmaceutical sector.

            Many of the critical care beds currently in use are for post operative follow up from complex or emergency surgery, and emergency procedures would still have to go ahead.... but cancelling elective surgery would however free up some of these beds, especially where post op care requires a critical care bed ... but again, all patients would need transferring to non COVID centers if we are to create dedicated COVID beds / hospitals to reduce the risks of cross contamination.

            Designated COVID hospitals need to be clearing beds now to other hospitals IMHO - to do so in the face of a major outbreak would be almost impossible, and we have already seen how rapidly the situation can escalate (S. Korea and Italy as prime examples).

            Other possibilities to discuss. Could the 8,000 odd beds in the private sector be deputised? Either to allow normal NHS care to carry on there but away from the major NHS hospitals that are to become COVID centers? Yes costs will be involved and private healthcare members may be angry, but this is an emergency. Thoughts anyone?

            Comment


            • Vibrant62
              Vibrant62 commented
              Editing a comment
              Govt will need to legislate for retirees to waive indemnity and the need to revalidate. Should have said that above when suggesting retirees being asked to come back and help. Another valid argument is that retirees will be at greater risk from COVID 19, so perhaps any medics willing to come back should be looking after non-COVID patients, to free up existing medics to focus efforts there?

          • #12
            Good ideas Vibrant and very clear thinking. Just how to force the NHS to move fast and actually do it is another thing though. This definitely feels like a war and we need wartime innovative decisive thinking.

            Comment


            • #13
              I think that Govt are already on top of the idea of seconding hotels as isolation/ quarantine locations. Fine.

              But we need to clear the bed blockers from hospitals, and fast. That would free up a lot of beds. How can this be done? Are there enough places in care homes (if we assume the funding issue is removed from the equation, at least for the short term)?.

              I think that the idea of clearing the care homes to act as hospitals was discounted back in the early 2000's when we were looking at the prospect of an H5N1 pandemic, and nothing has really changed since then, so that is likely a no-go still. The appeal here was that care home beds had facilities for oxygen etc so could be used for severe cases or those needing oxygen. On balance it would probably still be preferable and more feasible to just clear the hospital beds of the bed blocking elderly, and use those hospital beds for COVID cases.

              That will need a policy directive from central government. Its a crying shame for these people to be stuck in a hospital bed long term anyway (many have been there for months when not needing hospital care), so could be a win-win policy, however expensive it may be.

              Comment


              • JJackson
                JJackson commented
                Editing a comment
                Move the bed blockers into hotels now, so they are away from hospitals, with some medical staff to care for them. They are a high risk group that need isolation.

            • #14
              They sold off a lot of the old cottage hospitals to developers and there's now a shortage of care homes up here. There are people in my local hosp who should have been home 2 years ago. It's like the perfect storm isn't it Vibrant? All our mistakes coming to haunt us just when we can't afford mistakes.

              Comment


            • #15


              What can I say?
              "The only security we have is our ability to adapt."

              Comment

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