U.K. hospital mortality figures

[Kitchendoctor]

From the Guardian report of the update today:

Today marks a sombre day”, Hancock says, as the death toll has topped 10,000 in the UK.

A total of 19,945 people had now been admitted to hospital, he says, which means about half of all hospital admissions have died.

What is going on with our figures? Based on data from other countries, a 50% mortality rate was expected from those patients poorly enough to require admission to ICU, but should be much lower for hospitalised patients as a whole.

Are people not being admitted until their illness is much more advanced?

What else could be going on here?

Very concerning. Wish I hadn’t read it.

Not sure if I'm correct, just surmising, but there's been a lot of people dying with covid 19 who were already in hospital. This means they're in the death figures but not in the admission figures I think.

I thought the same thing today, it does seem very high. I'm hoping someone with some medical knowledge can come and explain.

I do know anecdotally (from a paramedic) that some very elderly people are refusing to go to hospital so that would increase the death to hospitalisation ratio. As far as I understand some very old people are deciding they would rather die at home with family than alone in hospital and don't want to take up a hospital bed that could be used by someone much younger.

Hmm - I agree these figures if accurate are really worrying.

Is the reason why our intensive care units are holding up reasonably well (compared to Italy and Spain at this stage of Covid fatalities) because we are simply not admitting patients until they are dangerously ill?

We also have to bear in mind that the death rate doesn't include anyone who has died outside of hospital - so people who die at home or in a care home.

Which obviously doesn't impact the mortality rate in terms of hospital admissions but means the overall mortality rate could be a fair bit higher than most people realise. (Sorry that's more bad news)

Are people not being admitted until their illness is much more advanced?

This seems to be the case. I've read lots of stories, particularly of younger victims, who've been told they're not ill enough to go to hospital, only to then die at home. And if you've read the lungs thread on here, it's frankly horrifying the state that some people are getting to and yet still being told to manage at home. In many other countries, people are admitted to hospital as soon as signs of pneumonia are apparent, so that they can quickly get treatment as soon as they begin to deteriorate.

Is the reason why our intensive care units are holding up reasonably well (compared to Italy and Spain at this stage of Covid fatalities) because we are simply not admitting patients until they are dangerously ill?

I know anecdotally from a couple of different Mumsnetters that when they had breathing difficulties which one described as 'feeling like she was drowning in fluid' the paramedics said they wouldn't take them to hospital unless "their lips were turning blue" and a couple of other things which I can't remember but which seemed equally really worryingly late to me as a layperson.

I think the way that patients have to be isolated at home till they are really seriously ill is to blame. If they can be tested earlier and treated earlier, then the outcome will be better.

The figures will actually be much higher, as they don’t include deaths outside of hospital. My aunt died 10 days ago, having been sent home from hospital with suspected C19. She won’t be counted yet.

Cross post with Powerslide basically saying the same.

And the shame of this....

Medics in China and Italy have told us that one of the most important things is to be able to provide medical support as early as possible if they're having breathing difficulties.

It was reported in the media weeks ago. But we seem to know better again

Yes I also think people are taken to hospital late.

The threads on here from people with Covoid are saying that they are being told they are not sick enough to go to hospital until they can only string a couple of words together, this seems absurd to me. I'm glad I'm not a Nhs 111 adviser having to deliver that kind of advice to people. What is the reasoning behind this ? is it because of hospitals being swamped? Surely better to be safe than sorry and have early intervention ? I have gone back onto the emergency Covoid register ( nursing) and not even been contacted by anyone as to how I could help despite being told I would be contacted over ten days ago ?? I can't help in a frontline area due to DH being vulnerable but could surely help somewhere ??

It must be absolutely terrifying being at home , especially alone getting more and more breathless yet told you aren't sick enough for admission ?? Questions need to be answered.

Right - so sick people have to be really really sick to be treated in the UK.
It makes senses as I haven't seen any phone footage of corridors filled with patients on oxygen in UK hospitals - which the media were reporting in Italy at this stage.
I'd read that medics/virologists estimated that one in every five/six patients sick enough to require hospital treatment were likely to die? These figures suggest a lot of this group are staying in the community bumping up the CFR in hospitals.

surely as soon as blood oxygen levels drop below optimum all of the bodies organs and tissues are compromised and the climb back to recover is significantly steeper.
Surely for the best chance of survival there should be intervention before a person reaches this stage, if we all could measure blood oxygen levels at home that'd help, wouldnt it?

It also really worries me how late people are being taken into hospital. I had a severe chest infection last year and rang 111. They asked me if I was struggling to breathe while sitting down and I said "yes" and they responded "an ambulance is on its way". I had to convince them to cancel the ambulance as I was well enough to get in my partner's car. At the time they said anyone who says they have difficulty breathing without any exertion is an automatic ambulance send out. This seems a million miles away from what people are being told now.

Aren't a lot of people just staying at home though if symptoms are mild and not going to hospital ( assuming they have it ) they are not hospitalising every single case . Lots of people seem to think they may of had it when you read posts but haven't actually had to go to hospital of course until we have a reliable antibody test we won't know for sure people have had it .

twoHopes - When my dh was admitted to hospital with pneumonia he couldn't speak a full sentence and they rushed him straight in.

Even Boris was still at number 10 and his lips were slightly blue tinged and he was taking gasps between sentences, although I wonder how much of that was him not wanting to be admitted?

Keeping people at home keeps our stats looking more favourable. Both in positive tests and the daily reportable deaths.

Are people not being admitted until their illness is much more advanced?
That is pretty much the case. On the Lungs threads I read of someone who phoned 111 with breathing difficulties and they were told that if they can say half a sentence then they are not ill enough to be admitted to hospital. Another was told you have to actually be gasping for breath to be admitted.

Many on the lungs threads, in normal circumstances, would have been hospitalised. Because of the volume of infected patients, you definitely only get taken to hospital with it if you are very seriously ill.

Surely for the best chance of survival there should be intervention before a person reaches this stage, if we all could measure blood oxygen levels at home that'd help, wouldnt it?

Depends what their threshold for taking somebody into hospital is - unfortunately, it's not necessarily the point that somebody should be getting treatment Lots of Mumsnetters have had ambulances out who've checked their O2 sats and left again regardless.

That said, I do have an oximeter myself and if I'm unlucky enough to get a serious case of coronavirus, I'll use it to judge when to go to A&E and stay put there, whether they're willing to admit me or not. They can't ignore someone deteriorating right in front of them.

Although Boris was undeniably unwell when admitted, I do believe he went in before many community cases would have (and wouldn’t have had to wait hours for an ambulance). He was also moved promptly to ICU as they didn’t want an emergency admission. All of this means he spent less than 7 days in hospital when the average is 2-3 weeks. Also concerning is the published data relating to ICU outcomes, which account for only a fraction of the deaths, suggesting that most who are dying in hospital are not even getting to intensive care. This agrees with the suggestion that many are simply admitted too late to get help.

Having had symptoms myself for over 3 weeks, when I phoned 111 for advice in my second week with fever and shortness of breath at rest among other symptoms, I was told to call back if my fingers, lips or tongue went blue or if I could no longer speak in sentences. Given there was over an hour wait for 111 and 24 hours wait for a ‘within 6 hours’ doctor call back, you can see how easily this could happen.

Boris was exactly typical of those who get hospitalised, in that he managed 11 days at home before being hospitalised. By 11 days you're either better or worse.

Some people died not in hospital but in other places, hospices (they were already dying of something else) or nursing homes.

Some people were admitted to hospital for something else, and then got cv19 because of the exposure they had in hospital (this is common in pandemics).

I thought I saw an ICNARC report which suggested 3 days in ITU was exactly typical of survivors, too. I would have said 1 day hospitalised before admission to ITU, 3 days in ITU, and 3 days afterwards before being discharged was also exactly typical for UK patients. I have references somewhere...

Chinese patients had a different duration in ITU, though.

19000 hospital admissions seems awefully low

I think its impossible to say really. Are we admitting people too late, amd they are therefore dieing when they wouldnt have? Or are we keeping people out of hospital who have been okay getting better at home.

Some of the deaths may be hospital aquired cases, in patients already very ill.

This is what concerns me ablut our 'save the nhs' culture. Whilst obviously it is important to only go to hospital if necessary there are people who already avoided going to hospital, there will be sections of the population who wont go to hospital when they need to.

Hmm, I think this could be a misunderstanding of what he said by The Guardian. If you actually listen to what he says in the press conference, he says "Across Great Britain, the number of patients admitted to hospital with coronavirus is 19,445". I would take this to mean that the current number of inpatients is 19,445 and the graphs accompanying the press conference appear to confirm this. Therefore, the figure of 19,445 does not include those who have already been discharged (either because they've died or recovered). It also seems unlikely that with over 80,000 confirmed cases since the beginning that only 19,000 including 10,000 people who've since died, would have been admitted to hospital.