Covid-19 mainly a nosocomial disease?

[Mumlove5]

Do you think it’s possible? This article from the guardian suggests that up to 20% of hospital patients Covid-19 caught it at hospital. NHS England figures reveal some infections were passed on by hospital staff unaware they had virus.

www.theguardian.com/world/2020/may/17/hospital-patients-england-coronavirus-covid-19


My guess is that it could even be more? Also, half of covid-19th deaths are from Care homes, according to the WHO.

www.euronews.com/2020/04/17/coronavirus-care-homes-could-be-where-over-half-of-europe-s-covid-19-deaths-occur-says-new

If you read, meeting 18, items 6 and 7. Basically, it admits that they knew, by March 20th, that the majority of new ICU cases were coming from within the hospitals themselves, from in-patients being infected by medical staff and other patients. They were not coming from outside.

www.gov.uk/government/groups/scientific-advisory-group-for-emergencies-sage-coronavirus-covid-19-response

A copied post, but he does have a good point:

But my particular hobby horse is nailed in minutes of meeting 18, items 6 and 7. Basically, it admits that they knew, by March 20th, that the majority of new ICU cases were coming from within the hospitals themselves, from in-patients being infected by medical staff and other patients. They were not coming from outside.

This is almost entirely a nosocomial disease. Nearly all the deaths have arisen from infections passed around in hospitals and care homes; almost none in the general community. All they had to do was protect hospital in-patients and care home inmates and we wouldn’t have had an epidemic. Probably why there are virtually no deaths in Africa and definitely the reason for so few deaths in Japan – they protect their elderly.

Bluntly, this is an almighty fuck-up by PHE and NHS: they allowed the virus to get into hospitals early doors and then panicked and made the situation even worse by sending a whole load of infected patients into care homes. 80-90% of deaths are going to turn out to be people who were already in a hospital or care home, but it is being covered up because NHS/PHE don’t want to admit that they actually caused the problem. They have killed a lot of people.

This is the answer; it explains everything. It explains the different death tolls between countries; it explains why countries with high death tolls have so many who had pre-existing conditions; it explains why there is so little correlation between lock-downs and death tolls; it explains differing fatality rates; it explains Sweden and Germany; it explains why the outbreaks die out relatively quickly regardless. In the general community, like MRSA, it is pretty harmless, but if you get it into hospitals and medical facilities it runs riot and kills people. Did we learn nothing from Florence Nightingale?

What do you do with a disease that only kills really old and ill people? Keep it out of hospitals and care homes…

• “I’ve had a brief look myself and the minutes he’s referring to aren’t quite the smoking gun he imagines. Items six and seven in the minutes of meeting 18 read as follows:
  

The current doubling time may higher than expected in the longer term, if there is appreciable nosocomial transmission resulting in high prevalence in health care workers and a greater risk of transmission to vulnerable patients.

If the current ICU demand is being driven largely by nosocomial transmission and increased transmission to vulnerable patients and this process is separate from transmission in the general population then it will not be influenced in the short-term by current measures.
It sounds like the boffins on SAGE were discussing the possibility that COVID-19 is “driven largely be nosocomial transmission” rather than stating it as a bald fact. Nonetheless, if that does become the settled consensus about how the virus is passed on – and everything we’re discovering about transmission is trending in that direction – my banker friend is right about the authorities’ response being “an almighty fuck up”. And questions will need to be asked about why this possibility was considered, and apparently rejected, by SAGE.”

[ChipotleBlessing]

Have you just copied and pasted a conversation from elsewhere?

[TheAdventuresoftheWishingChair]

Can you explain more what a nosocomial disease is for the benefit of non-medical people. It's something that is spread in one location, is that right?

[ChristmasCarcass]

20% isn’t “most”....

My experience in ICU is that the patients there are generally fairly young and fit (which is how they got into ICU), and were admitted with Covid. My average patient is a 50yr old black bus driver with a bit of hypertension, who came in with covid and either went straight to ICU (because they stayed at home until they were really sick), or they went there after deteriorating on the ward. Obviously not every single patient fits that stereotype, but most do.

The patients who caught it in hospital are mainly older and frailer, and tended to be palliated.

Obviously that is just one hospital, but the idea that this is all spread by doctors and nurses in hospital and there is no community disease is nonsense.

[WorriedNHSer]

Surely it’s obvious that with the lockdown in place the main places the virus is circulating is those where social distancing can’t take place- in hospitals and care homes. Of course it’s much more likely to spread between people in hospital than in the supermarket or on the street because of the closer more prolonged contact.

If the lockdown is really working you would expect only key workers and their families and inpatients and care home residents to be catching the virus.

[PineappleUpsideDownCake]

I dont really understand but it sounds interesting. Basically patients already ill are being infected if its mainly spread in hospital and care homes?

Theres an awful lot of people with it from skiing in italy and other places that aren't in hospital thoigh isnt therem

[Mumlove5]

@ChipotleBlessing

Yes, I copied and pasted the main discussion.

[Mumlove5]

@TheAdventuresoftheWishingChair

Yes, it is a disease caught and spread inside a hospital.

[Mumlove5]

@ChristmasCarcass

I wouldn’t say most but 20% is a little high and I wouldn’t be surprised if it’s even higher given what was going on in other countries.

Majority of patients have co-morbidities. Some patients do need oxygen, very few need ventilators. However, ventilators caused more harm then good according to a few doctors and nurses I know. Also from what I read in a couple articles.

[Keepdistance]

Similar to nursung homes its not surprising that many many parptients who went into hospital for any reason since feb came out with covid. (Or stayed there with it)
We just dont have infection control.
The ppe for all hcp should have been the n95 masks at least. It's not just to protect them but having it asymptomatically obviously spreads it round hospital.
Other countries i watched video of woman maybe japan or china etc she was recovering in a sealed room and her stuff destroyed after etc. Having open wards and greeting suspected covid with a surgeons mask isnt very sensible. They were having to put suspected ones somewhere but they may not have had covid.
Which is why testing people when they start feeling ill helps - straight to covid wards.

There was an article where the guy had cancee went for the meeting about it but was expected to survice just before lockdown caught cv at hospital and was dead within 10d.
Hopefully they will start to find most of hcp have had it. As that makes it a bit safer if elderly do need any appts. And obviously hcp would be less likely to infect each other. On the positive side i think they are giving some of them the trial vax.

[Mumlove5]

@PineappleUpsideDownCake

Right. Obviously the people traveling, going to restaurants, skiing etc transmitted the virus and we know it is easily transmissible.

But were these people being rushed to the hospital? They mainly had mild symptoms or were asymptomatic.

[Northernsoullover]

I understand that there is very low community spread now. Everyone who I know who has it now or very recently is either frontline NHS or a careworker. However I know people who had it in the beginning who don't know where they picked it up 🤷‍♂️. A weekend event is the likely source for a few of them and for another a party.

[Keepdistance]

Some countries have covid hospitals i think.
We didnt use the nightingales when that might have helped.

[MyNameWas]

This is interesting

[AnnaMagnani]

According to DH who is a computer modeller, the pandemic models don't account for spread in care homes, hospitals, social care any different from in a normal workplace or bar.

While my experience working in community health was 2 weeks of every patient with co-morbidities who had either been to hospital, was in a care home or had carers visiting their home having COVID left right and centre.

So that was a huge gap in the beginning - these settings didn't have PPE at all to start as it was all about hospitals.

[Mumlove5]

So we know Covid-19 is mild for the majority of people and severe for people in care homes, the elderly and those with co-morbidities.

The article below is saying Colorado is now looking into the cause of deaths in their state... 25% covid-19 inflated. Interesting how they recorded these deaths!

“Deborah Birx, the physician advising the White House’s coronavirus task force, gave voice to a real concern earlier this month. She told officials from the Centers for Disease Control that some of its numbers on mortality and case count could be inflated by up to 25 percent.”

www.nationalreview.com/2020/05/coronavirus-crisis-counting-covid-19-death-toll/

[Mumlove5]

@AnnaMagnani

Thank you. Did your husband ever look into Ferguson’s model? Imperial College released a “modified” version of his code but I heard it was still a mess.

Could you show your DH this? Wondering what he would think.

lockdownsceptics.org/code-review-of-fergusons-model/

[DamnYankee]

Interesting. However, I spent about 10 minutes trying to pronounce "nosocomial*. I kept saying "nosocomical."

The article below is saying Colorado is now looking into the cause of deaths in their state... 25% covid-19 inflated. Interesting how they recorded these deaths!

Yep. Even when the cause of death clearly superceded any damage from corona. Not impressed with my state and local government. Will be interested to see if this story vanishes. Poof!

[AnnaMagnani]

DH is in an academic modelling group. I get called on occasionally as a voice of healthcare working on the ground.

His list of criticisms is long and growing, but he says this would prob apply to any model - the idea is to have lots of different models by different groups, they'll all have problems but different ones so it evens out and you find some sort of consensus between them.

He has heard that Ferguson's model doesn't run well and is very buggy - bearing in mind I have no idea what this means or what he does and he mainly does this for fun courtesy of bank of AnnaMagnani - his words to me were 'That is not good'.

[Mumlove5]

@DamnYankee

I couldn’t pronounce it either!

You might like this article. It’s written again, so hopefully people would look into this sooner than later. The media has a lot to answer for.

medium.com/@oksensei66/the-new-york-times-and-the-hysteria-sweepstakes-a8168d65ce6f

Dr. Deborah Birx, White House Task Force response administrator, may already have let the proverbial cat out of the “alarmist” bag when she said an antiquated model being used by the CDC to track coronavirus deaths could be inflating the number by as much as 25%! She says and I quote, “There is nothing from the CDC that I can trust.” A tale for another time.

[DianaT1969]

There's a slight sense of writing off patients who have co-morbidities in the OP. Let's say a 56 year old woman who was working in the kitchen of a care home (originally from the Philippines) caught it and died. She possibly had undiagnosed pre-diabetes. Overweight for her build. (True person I know of). She would be written off in this study as having a co-morbidity. But if she hadn't caught Covid-19 she might have lived another 20 years. Is that right? The same for people with asthma.

[Mumlove5]

@AnnaMagnani

Thank you! Ferguson’s model is the main one the UK government has been following, as I’m sure you know. Even the US!

This is so so bad.

[PigletJohn]

@Mumlove5

If you copy and paste content, you ought, really, to say where it comes from and provide a link. Maybe it comes from a respected source of expertise; maybe it comes from a tinfoil-hatter with an assault rifle.

Give us a clue.

[frumpety]

Nosocomial infections are common place in hospitals, be they Endogenous (something you brought with you ) or Exogenous ( something someone or something else brought to you ). Big warm box full of people. You can try to reduce the risk , but can never fully eliminate it in that sort of environment unfortunately. Especially if you are in a bay of six people. Patient one gets up to go to the toilet , feels a bit unsteady and grabs the end of patient two's bed and has a bit of a cough, less than two metres from patient two's face, carries on to the toilet. Patient three drops their glasses on the floor, patient two helpfully picks them up for them, after moving the blankets on their bed patient one has just coughed all over. See where I am going with this ?
The distance between beds in a normal six bed bay is two cabinets or two chairs , so just over a metre or a metre and a half if you are being generous. Your barrier between you and the other person is a cotton curtain which doesn't reach the ceiling or the floor. A barrier which you and staff touch on a regular basis.
Even if every staff member is absolutely rigorous about handwashing, as they should be, you are in an environment where another 29 people you are sharing that nice warm box with, might not be. Add to that mix anything that is airborne and you can see why certain pathogens go through a ward so quickly.

[Inkpaperstars]

I agree with a PP that if lockdown measures have reduced transmission in the community, and if transmission is a serious problem in places where social distancing can't be effectively implemented...that is not an argument that lockdown/distancing don't work.

Also it stands to reason that many patients and staff will bring the infection into the hospital with them, no matter where they acquired it, and if it is then spreading in a place where close contact is inevitable and many are already sick then of course things will be very bad very fast. Especially since many patients coming in for non covid reasons have been testing positive without symptoms. The links between community and hospital can't be severed.

Also agree with another PP who says their experience is of younger fitter people in ICU. They may be a smaller proportion of those who die, but they are certainly getting very sick. Doctor friends have told me ICU has been full of 30 and 40 year olds.

They have also said that PPE, discharge into care homes etc has been a disaster, and lockdown was begun too late. So I agree with you that the hospital and care home side of things has been fraught with problems and is one of the major reasons so many in the UK have died, but I don't think we can jump from that to the rest of your conclusions at this point.

As for Dr Birx, it is a shame but I am afraid her credibility is badly wounded. She appeared on Meet the Press underplaying and excusing Trumps disinfectant and heat comments, not because she believes it but because she is caught between a rock and a hard place in this. Shortly afterwards several senior medical experts who knew and said they respect Dr Birx had to admit, despite the awkwardness of it, that her credibility is badly damaged. If there is evidence for something then probably better to find a different source or messenger at this point.

In answer to your question yes, I know an Italy holidayer rushed to hospital. Obviously cannot give details, in any case I am sure they were no exception.

Re most patients having comorbidities, these patients will be in the community too, participating in society at all ages and in huge numbers. On the exact numbers you saw, was it the latest icnarc figures, and what were the percentages of ICU patients and fatalities with severe comorbidities? Don't worry if you saw other figures, I will try and hunt it out. If community transmission is becoming less of issue after weeks of social distancing measures...would we expect to see a higher proportion of patients with severe comorbidities in ICU by this point, or not?

[Inkpaperstars]

Characteristics of patients critically ill with Covid 19 from icnarc stats covering up to 4pm 14/05/20, link for further details below. Am I reading this right?

Dependency prior to admission to acute hospital..91.3 % able to live without assistance in daily activities. Less than 10 % required any prior assistance in daily life, only 0.3% requiring total assistance.
Mean age 58.
8.4% with very severe comorbidities.

www.icnarc.org/DataServices/Attachments/Download/cbcb6217-f698-ea11-9125-00505601089b

I am not equipped to interpret it but it doesn't immediately sound like a cohort of the chronically hospitalised and care home residents.