Discussion: UK Coronavirus Pandemic / Epidemic Plans

[JJackson]

Thanks, good article. From the links
"RESULTS:

We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1% of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively."

and from the JAMA paper
"In the ICU, 4 patients (11.1%) received high-flow oxygen and 15 (44.4%) received noninvasive ventilation. Invasive mechanical ventilation was required in 17 patients (47.2%), 4 of whom received extracorporeal membrane oxygenation as rescue therapy. A total of 13 patients received vasopressors, and 2 patients received kidney replacement therapy."

"Compared with non-ICU patients, patients who received ICU care had numerous laboratory abnormalities. These abnormalities suggest that 2019-nCoV infection may be associated with cellular immune deficiency, coagulation activation, myocardia injury, hepatic injury, and kidney injury. These laboratory abnormalities are similar to those previously observed in patients with MERS-CoV and SARS-CoV infection."

"Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation)."

N.B anorexia (24 [66.7%] vs 31 [30.4%] in light of the question relating to obesity as a risk factor.

 

[Vibrant62]

Oh dear oh dear. Whilst I completely understand that we need to keep international borders open and flights going, the reception by the UK at the other end (making sure people self isolate when arriving from a hot spot) is still woefully inadequate. The words are great, the actions less so. This does not feel much like 'Containment' to me - nor delay for that matter.

Passengers Arriving to UK from Italy and Milan Face Zero Healthchecks on Arrival
https://www.independent.co.uk/travel...-a9387072.html

One would hope that PHE has all the information of people incoming on flights from hotspot areas like this and Iran, and at least follows up with a phone call 7 and 14 days after arrival... or something? Surely? Especially important if there is a particularly nasty substrain currently in Italy that we would not want to take hold here? This is pure supposition at this point. At the very least an information hand out, temperature screening so people can be tested if symptomatic?

This feels more and more like they are just going to let this run... and that they plan on managing with 3m volunteers. Not getting a good feeling about
this...

 

[ming]

"This feels more and more like they are just going to let this run... and that they plan on managing with 3m volunteers. Not getting a good feeling about this..."
Right. That seems to be the strategy so far - say we are doing all we can but then sit back and do nothing. Feels quite unsettling doesn't it? You'd like to feel that your leaders were actually leading..

 

[Vibrant62]

Just listening to the press conference. Key points:-

1. screening to be widened to all people with respiratory disease in hospitals
2. Shortly to ask people with even minor cold symptoms to stay at home for 7 days, but UK still remains in the contain phase - probably add this measure in the next 10 days or so.
3.UK reactions to be different to the rest of the world
4. Actions to be taken to reduce strain on NHS
5. New advice pending for vulnerable groups. Some suggestion that advice to vulnerable will be to self isolate rather than immediate contacts of cases. Not quite clear on this as yet.
6. Boris Johnson says decisions to be taken based on data and scientific advice.
7. Feeling that if you go too early people get fatigued, so timing is everything
8. No indication that they have any plans to cancel large or small meetings, sports events or similar.
9. Measures to help businesses to be put in place in budget.

Comments: if a minor cold is indeed COVID 19, then 7 days of symptomatic isolation unlikely to be enough based on current data and papers I have been reading, as it is suggested that viral shedding continues for some days after symptoms resolve. A 7 day period of self isolation will however be more financially manageable for the low wage earners and self employed. Will slow spread somewhat but not contain it. They do not seem to be using experience from elsewhere in the world, and want to rely on their own data. Maintaining the economy seems to be a primary driver rather than stopping spread altogether or limiting it to the maximum extent cf S. Korea.

 

[Vibrant62]

Coronavirus: UK changes course amid death toll fears
https://www.bbc.co.uk/news/health-51915302

This is good news and likely in response to the outcry from the medical profession.

My NHS colleagues and I won’t stand by while the government gambles with our lives. We must change our coronavirus strategy
https://www.independent.co.uk/voices...-a9404836.html

and the situation in the UK i am afraid is beyond dire

Britain must change course – and resume Covid-19 testing to protect frontline NHS staff
https://www.theguardian.com/commenti...line-nhs-staff

Coronavirus: NHS doctor warns 'a colleague is looking after several patients under 40'
https://news.sky.com/story/coronavir...point-11958542


In addition - direct feedback I am getting is that a) not even enough n95 / FFP3 masks for frontline ED staff (not to mention GPs etc), and instead of seeking to solve this problem the guidance is being changed. Medics feel like they are simply cannon fodder b) No testing offered to medics so great concerns over what they should do re: self isolation and impacts on staffing levels etc and their fear that they could still transmit virus to vulnerable patients if infected (as per article above really) c) Oxygen supply lines are worrying d) supply levels of disposables are very worrying.

 

[Vibrant62]

There has been a call for e.g. car manufacturers to switch production to ventilators with the statement of 'if you can make them we will buy them.'

How realistically possible this is in the available timescale is another issue.

Coronavirus: Plan to ramp up ventilator production 'unrealistic'
https://www.bbc.co.uk/news/business-51914490