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Discussion: UK Coronavirus Pandemic / Epidemic Plans

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.
 
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?
 
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.
 
The link did not work for me but this did https://www.google.com/url?sa=t&rct...s_the_UK.pdf&usg=AOvVaw1t7FXBvWgIlvEryUoEMp5K

It is of little help it is rich on what they plan to do but has nothing on what they have done, in practical term, or what resources they have. If they want to reassure me they need to let me know how many additional phone lines, and trained staff, they have to cope with demand - what are normal and current wait times. What they have in terms of PPE stockpiled how many additional HCW have been PPE trained (normally only a small number of patients require PPE), how many ventilators, and trained staff, and of those how many are not already in use? Ditto for contact tracers.
I have not seen any of these numbers (there are none in the plan).
 
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JJackson - completely agree. A lot of flannel in here and nothing about what plans they have if this escalates rapidly i.e they dont get their delay to summertime. Nothing very concrete in any direction. I hope there are more solid plans and the sort of data you have outlined available somewhere. I cannot say any of this fills me with any kind of confidence that there is any sort of handle on this, just a lot of wishful thinking. I need to go through it carefully again.
 
https://www.leicestershospitals.nhs.uk/aboutus/departments-services/heart-services/ecmo/

Also;
We are the busiest of the 4 ECMO centres in the UK, and the largest ECMO centre in Europe, with in excess of 150 cases annually - http://www.eastmidlandscongenitalheart.nhs.uk/what-we-do/our-services/ecmo/

If the other seven hospitals supporting ECMO were operating at this level that would equal 150 x 8 5950 patients per annum. Probably less because very ill people need support for weeks, not days.
 
Re. ECMO
I am not sure ECMO is going to be a lot of use for COVID. I have read (somewhere - UN fact finding I think) that the Chinese experience is that mechanical ventilation works but ECMO not so much. No reason was given but I did think about it at the time and suspect it is due to the ACE2 receptor distribution in humans and the Furin cleavage site being available to common proteases. In LP seasonal flu the cleavage site is limited to some very specific proteases (found in the lung but not common elsewhere) HP versions have additional basic amino acid residues at the site allowing a much larger range of proteases to cleave it which in turn allows for greater tissue tropism. My guess is in late stage COVID the patient has rampant viral replication in other organs (multi organ failure is common in fatal cases) and solving the blood oxygenation problem, sadly, is not enough to rescue the patient. In flu ECMO is more useful as most of the action is still in the lung in very sever cases.
 
JJackson - it does prompt a question from me. Given that serious patients are occupying beds and ICU beds for several weeks before resolution (from the China data) can we work out how many beds would be needed per 1000 patients? If 19% overall - 6% critical and 13 - 14% are serious, and for sake of argument each needed 14 days in a Critical Care or ICU bed, based on current bed availability, how many patients could the UK treat? Let us assume a sliding scale of 25% Covid beds, 50% and so on. So the answer we would get to is what number of infections is the maximum number of new serious or critical patients per day the NHS could cope with on current bed numbers at any one time? I will have a go and see if we arrive at the same answers? What factors would we need to consider in the calculations?
https://www.gov.uk/government/statistics/bed-availability-and-occupancy-data-for-q2-201920
 
If you base on 15% needing CC plus 5% in ICU (keep the math simple) then 150 CC and 50 ICU per 1000. Then, as you say, these beds are not just vacant waiting for patients so we need the actual number of each type the NHS has per 1000 population and a current occupancy rate. I do not know these numbers if you know where to get them then it is simple enough to finish the calculation - take the number of unused beds and compare it to the requirements I calculated above.

I asked about these numbers in another thread and Kiwibird said the busiest ECMO centre handled 150 patients p.a. the UK has 3 pediatric centres and 2 adult plus one that does both. COVID, for reasons I do not understand, does not seem very interested in children so the 3 adult centres might cover 350 patients in a year which is not going to go very far. Dr. Aylward said he asked at one of the hospitals he visited in China how many ventilators they had and if they had ECMO, the answer was 5 ECMO and 30 (I think) Ventilators. What was not clear is if this was the hospitals normal complement or if they had arrived from other hospitals for this emergency.

Emily I followed your link but the top link said 'not available in your region' and the second did not seem to address tissue tropism.
 
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Monthly Critical Care beds sitrep for NHS England found here https://www.england.nhs.uk/statistic...-2019-20-data/

From this it gives (in December 2019) 4048 Adult critical care beds - 75.3% occupancy

and

309 paediatric critical care beds (in December 2019) 79.6% occupancy (neonatal beds not included in this)

East of England has 337 adult beds open; 13 paediatric beds open
London has 1027 adult beds open; 127 paediatric beds open
Midlands 680 adult beds open; 51 paediatric open
NE and Yorskshire 643 adult beds open, 54 paediatric open
NW has 543 adult beds and 38 paediatric beds open
SE has 523 adult beds and 31 paediatric beds open
SW has 303 adult beds and 18 paediatric beds open

Given that it has been a severe flu season it should be a reasonable guess that these were the maximum available beds, due to constraints of any one or combination of the following - Money, equipment, beds, specialist staff. It would also be reasonable to assume that only critical care / ICU beds have ventilators as I dont have specific figures for these.

If we assume EVERY bed was available for COVID 19 then we are still looking at a tiny number of severe patients being able to be treated; for reference, the severe patients needed ventilators and oxygen, the critical ones needed full ICU (please do correct me if I am wrong on this). Lets just say for sake of argument that all beds (paediatric and adult) were occupied for COVID 19, then all the beds would be filled after 21,785 became infected, assuming the 20% severe or critical rate holds. Alternatively if there is a 70% baseline occupancy from other health issues, and only 30% of these beds are available we are looking at a total of 6,500 cases being generated anywhere in England (roughly) generating 1300 critical or severe cases i.e this is the number of cases that would take all the available ventilator beds by severe or critical COVID cases. This will be further complicated though as you cannot mix COVid patients with non-COVID patients. If case numbers here enter an exponential phase, it is entirely feasible that we could reach these sort of numbers in 2-3 weeks. If every case needs one of these beds for up to 3 weeks, then we will be looking at a tiny handful of cases that can be treated per week thereafter. Lets assume homogeneity in new case numbers, and we are looking at needing to constrain new cases to a maximum of 1600 new case per week, of which 320 will be severe or need ICU; Severe (240) or full ICU (80). I hope this makes sense.

Then what? If there are extra ventilators, how many are there, and who is going to run them? Are they going to start training other nurses in critical care, at least as far as ventilation goes? If not that, then what? Retired medics willing to come back would probably be best used in 'normal' patients?

In conclusion, I think we cannot afford to be as reactive as current plans seem to suggest. We will need to be proactive to keep numbers manageable, and even then...
 
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There is a lot of very good information in this paper (you need to hit translation button and view through Google Chrome) which should help to inform patient care strategy, especially post discharge. It covers the issue of patient relapse. It also presents a lot of issues. 1) How long do patients need to be hospitalised for and 2) can patients be discharged safely home immediately after apparent recovery?

http://rs.yiigle.com/yufabiao/1183297.htm
 
Much as I expected - sadly.
"In conclusion, I think we cannot afford to be as reactive as current plans seem to suggest. We will need to be proactive to keep numbers manageable, and even then... "
I know you read my long work shop post (written last year) and this is exactly the problem I was addressing (re. surge capacity and containment), specialist care equipment on which an epidemic disease is unusually demanding will rapidly become a limiting factor. If the disease has a significant CFR (and this definitely qualifies) then the CFR will jump post saturation. Assuming capacity can not be rapidly increased (CT, ECMO, vents, hospital diagnostics etc) then spreading the load (AKA containment measures) should become the priority.
 
Not great news on the retired medics recall, if the attitudes expressed in this article are widespread, and I suspect they are. Consultants are feeling particularly shafted at the moment, and goodwill towards the NHS and government seems all but gone at every level. That may change as things unfold, but I am not so sure at the moment.

https://www.theguardian.com/world/20...ovid-19-crisis

Speaking to several current medics who are friends... Many I have spoken to feel that they won't be called on to tackle COVID 19 as they are not in the correct speciality (e.g. gastroenterology, dermatology etc); some feel they have not been on the clinical side of things (emergency care, respiratory care) for too many years to be of much use in caring for serious patients.

Given the extreme problems we already have with staffing levels (significant rota gaps), I suspect this will not be the case and anyone qualified will be on the frontline, and so there needs to be some internal emergency training and internal PR carried out rather urgently. Correct PPE use for every medic being top of the list.

Most medics do not seem to understand (yet) the seriousness of what we are about to face. As one friend said to me..'We are working in a state of permanent crisis all the time; this is just another one'.

Concerned.
 
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