Coronavirus outbreak

[tom73]

We've got the numbers of hospitalisations from early on in the outbreak, and various people have been trying to make educated guesses as to what the true number of daily infections really were at that time. The multiple between true and tested positive infections is going to be much smaller now with widespread testing than it was six months ago. The potential for future cases is constantly declining anyway, due to previous infections. If, say, 25% of the population has already had the virus then the worst case scenario is only 75% of what it was at the beginning of the epidemic and that potential number is falling by whatever the real daily infection rate is.

Where do you get the extra capacity without removing day to day operational capacity ? Capacity go's way past just a bed how do intend to get the extra hospitalisations to hospital in the first place ? Have fully man front-line ambulances sat waiting ? Or use the small number we have to do that and everything else at the same time ? Or have volunteers like me manning them 24/7 ? All you'd need is a local critical incident and it all come's failing down. We don't have mass numbers of NHS staff sat waiting for stuff to happen or whole hospitals sat waiting to go. Even the nightingales hospitals turned out to mostly empty with staff and equipment down to local hospitals to find.
So tell me how do you run the day to day health service as normal with covid all around and still provide full covid care on top?
Just how is primary care going to work dealing with large numbers of covid cases that at any point may become critical ?
Just how is primary care going to do the day to day stuff without limiting it's capacity ?
Do with set up nightingale health centres ?

 

[SpokeyDokey]

Well the Guardian will probably tell you the NHS will be overwhelmed by teatime. In reality the worst hit area, the North, has a Covid occupancy of 3-4%, this in hopitals that have been preparing for months and currently have huge vacant/dormant/prepared capacity. A panic stricken NHS coped at the virus peak, with huge amounts of staff covid-absent, why shouldn't it cope this winter? We are in another hysterical fear mongering mood, just like spring, it gets to me and I have to get comfort from the scientits who called it right since March. Are we to make the same mistakes again?

More or less the rate over England as a whole with c3000 beds occupied by Covid patients out of a total capacity of NHS beds of c100000.

AFAIK the Nightingales could still be used (can someone please correct me if this is wrong) - although, in view of the minimal use they had back earlier in the year my hunch is that the NHS will cope just fine with this wave.

Re fear-mongering. The press love it (bad news) as 'If it bleeds it leads' to use the popular US press editorial maxim. Ditto Social media. There's a world of difference between sensible well thought out risk advice and needless panic inducing dialogue - with much of the latter being politically motivated whether the source is the Fourth Estate or Social Media.

 

[SpokeyDokey]

Where do you get the extra capacity without removing day to day operational capacity ? Capacity go's way past just a bed how do intend to get the extra hospitalisations to hospital in the first place ? Have fully man front-line ambulances sat waiting ? Or use the small number we have to do that and everything else at the same time ? Or have volunteers like me manning them 24/7 ? All you'd need is a local critical incident and it all come's failing down. We don't have mass numbers of NHS staff sat waiting for stuff to happen or whole hospitals sat waiting to go. Even the nightingales hospitals turned out to mostly empty with staff and equipment down to local hospitals to find.
So tell me how do you run the day to day health service as normal with covid all around and still provide full covid care on top?
Just how is primary care going to work dealing with large numbers of covid cases that at any point may become critical ?
Just how is primary care going to do the day to day stuff without limiting it's capacity ?
Do with set up nightingale health centres ?

I think that's a fair point (bolded) but not the primary point in this discussion.

As you are more aware than most, care priorities shift over time and here we are talking about the Covid response. The NHS coped with the caseload back in March/April/May etc and will almost certainly cope again imo should case numbers rise to similar levels - although I'm not currently convinced they will.

Primary care re 'normal' demand is unfortunately suffering but right now what can we realistically do about that?

 

[pawl]

Question!
I realise it's only what I've seen, but the same person has tested positive twice. Isolation for the second time.

Their job required a negative result before returning.

How can they be positive again, if herd immunity/catching it once means you can't catch it a second time?

perhaps he should set himself up as test case.

Infect him see if he recovers should he survive.
Leave him the herd
Check for reinfection
Check for long COVID which appears to becoming more prevalent
Death

I will not put myself in a situation where I consider myself at risk.I look at the number of deaths 40000 plus that equates to a football stadium full of people.

He will then perhaps have the answers he feels so confident he proposes.

 

[classic33]

I think that's a fair point (bolded) but not the primary point in this discussion.

As you are more aware than most, care priorities shift over time and here we are talking about the Covid response. The NHS coped with the caseload back in March/April/May etc and will almost certainly cope again imo should case numbers rise to similar levels - although I'm not currently convinced they will.

Primary care re 'normal' demand is unfortunately suffering but right now what can we realistically do about that?

Speaking as one who has been "left to their own devices" since March, on three conditions, because of this. Routine appointments stopped and placed under control of my GP(Last seen on the 17th March). And they're not seeing patients for the foreseeable future. What do I do?

The system coped last time because cuts were made elsewhere. Can they manage it again, without affecting/impacting upon routine treatment for longterm health issues. With the best will in the world, I doubt they'll manage.

 

[SkipdiverJohn]

Where do you get the extra capacity without removing day to day operational capacity ? Capacity go's way past just a bed how do intend to get the extra hospitalisations to hospital in the first place ? Have fully man front-line ambulances sat waiting ? Or use the small number we have to do that and everything else at the same time ?

The virus has increased the NHS workload, and until it's no longer around in significant amounts that is going to be the situation. Capacity is finite, so the simple answer is you stop doing the nice to have stuff and concentrate on the serious conditions that might potentially kill someone.
The health system just about managed to deal with the hospitalisation situation back in April, even if it was a close call. Having had six months of practical experience of the virus and the time to organise things better, they should cope with anything it can throw at the system now.
The workload is also going to depend on who is getting infected. A uni full of students is going to make a negligible difference, and this is where the effort should be focussed. Let the healthy population go around just as normal and catch the virus unimpeded. Try to keep the highest risk people away from it as much as possible. People who know they are high risk are now generally wary of excessive social mixing anyway, so to an extent the self-behaviour of high risk persons will help limit how bad it could get.
If you look at deaths vs infections for pretty much any country, you will see that confirmed infections are not translating pro-rata into hospital cases or fatalities in the same way they were at the start.

 

[Joey Shabadoo]

What virus?

View: https://twitter.com/NicosBarGlasgow/status/1314479777533833219


Meanwhile, this lot can't see a connection either -


View: https://twitter.com/kevinnjackson/status/1314631118319243265

 

[glasgowcyclist]

Does immunity from the effects of Covid also confer immunity from being a vector of transmission?

 

[SpokeyDokey]

Speaking as one who has been "left to their own devices" since March, on three conditions, because of this. Routine appointments stopped and placed under control of my GP(Last seen on the 17th March). And they're not seeing patients for the foreseeable future. What do I do?

The system coped last time because cuts were made elsewhere. Can they manage it again, without affecting/impacting upon routine treatment for longterm health issues. With the best will in the world, I doubt they'll manage.

I sympathise with you but the NHS is not infinitely elastic and as I said priorities are fluid and at some level the decision(s) are made based on the greater need across the nation on a broad brush stroke basis.

Maybe, during this upturn in cases, the experiences of the initial onset may well leave the NHS better equipped to deal with non-Covid ailments?

 

[Rusty Nails]

I think that's a fair point (bolded) but not the primary point in this discussion.

As you are more aware than most, care priorities shift over time and here we are talking about the Covid response. The NHS coped with the caseload back in March/April/May etc and will almost certainly cope again imo should case numbers rise to similar levels - although I'm not currently convinced they will.

Primary care re 'normal' demand is unfortunately suffering but right now what can we realistically do about that?

If the NHS can only 'cope' with the virus by significantly reducing work on its other priorities, including a lot of very serious health issues such as cancer, then it is clearly not coping.

Priorities are not necessarily fluid but the response to them is, and often based on political opinions.

The problem I have with this thread is the opinions and ideas are usually based on a very little knowledge and some swatting up on Google, mine included along with everyone else.

 

[tom73]

I think that's a fair point (bolded) but not the primary point in this discussion.

As you are more aware than most, care priorities shift over time and here we are talking about the Covid response. The NHS coped with the caseload back in March/April/May etc and will almost certainly cope again imo should case numbers rise to similar levels - although I'm not currently convinced they will.

Primary care re 'normal' demand is unfortunately suffering but right now what can we realistically do about that?

They coped because they diverted much of the day to capacity and staff to do it. Also the controls in place held case numbers down the virus was not left to get with it. They also managed due to staff working flat out and quickly setting up and adapting to new way of delivering services. What many are looking to be allowed to happen is let the virus run and some how keep everything else going at the same time. Which simply won't work primary care is the primary point if we let things run more cases will have to be managed in the community to prevent them become hospital cases. Or from being critical hospital admissions add in the extra long covid cases which they will expected to manage on top. It's impossible to build the capacity to allow anything near normal service to run. The need for ever changing PPE each time and cleaning down alone takes a large part of the working day out of the system. Add in staff sickness and on and off staff isolations and you have even less of the working system.

As to what to do about it realistically the only way is drive down covid numbers and drive them down hard. Until other interventions are available. But without a clear government plan that's not going to simple. It won't be fix by one thing over another but a mix of measures.
What we can't do is open everything up and pay lip service to measures and make a wish that it all work out.
I think you see the point that normal levels of health care and covid response together is not possible. Equally understanding health care is complex.

I'm pointing it out to some who believe the simple way out of this is let run and keep all the at risk out the way. At the same time believing that health service can just carry on as if nothing is happening. Because hospitals won't be full of critically ill covid cases.

 

[tom73]

The virus has increased the NHS workload, and until it's no longer around in significant amounts that is going to be the situation. Capacity is finite, so the simple answer is you stop doing the nice to have stuff and concentrate on the serious conditions that might potentially kill someone.
The health system just about managed to deal with the hospitalisation situation back in April, even if it was a close call. Having had six months of practical experience of the virus and the time to organise things better, they should cope with anything it can throw at the system now.
The workload is also going to depend on who is getting infected. A uni full of students is going to make a negligible difference, and this is where the effort should be focussed. Let the healthy population go around just as normal and catch the virus unimpeded. Try to keep the highest risk people away from it as much as possible. People who know they are high risk are now generally wary of excessive social mixing anyway, so to an extent the self-behaviour of high risk persons will help limit how bad it could get.
If you look at deaths vs infections for pretty much any country, you will see that confirmed infections are not translating pro-rata into hospital cases or fatalities in the same way they were at the start.

What's the nice to have stuff and how do you know what will turn into serious conditions? I've treated many who are fine one minute then blue lighted to A and E the next. The only way to do things the way you see it is make mass wide clinical calls quickly deciding who can live and who can die purely based on worth to society. Allowing people to die who normally would survive. It's

 

[PK99]

The problem I have with this thread is the opinions and ideas are usually based on a very little knowledge and some swatting up on Google, mine included along with everyone else.

Welcome to the Interweb!

 

[roubaixtuesday]

I'm not denying anything

Yes you are, you're denying how many people would die a a result of your proposals.

If you're proposing something which will kill a quarter of a million people, then justify it, don't deny it.

The reason you don't, is that you can't.

 

[roubaixtuesday]

We need to keep the R held Steady for herd immunity, without over running hospitals. Or play cat and mouse with it for 10 years or more.

Please explain through what alchemy you will achieve this miraculous level of control.

And, given that the peak of deaths last time around was 1000 a day, and your "policy" would require that to go on for *5 years* you might wish to ponder the practicalities a little more seriously.

[Corrigendum: give years should be ten months. Mea culpa]