Daily numbers, graphs, analysis thread 5

[Barracker]

Welcome to thread 5 of the daily updates.

Resource links:
Worldometer UK page
Financial Times Daily updates and graphs
HSJ Coronavirus updates
Johns Hopkins Coronavirus Resource Centre
NHS England stats, including breakdown by Hospital Trust
Covidly.com to filter graphs using selected data filters
ONS statistics for CV related deaths outside hospitals, released weekly each Tuesday
Google mobility stats

Thank you to all contributors for their factual, data driven, and civil discussions.

Quentin, I agree.

I would like to see the rates of survival/death for patients who have been on ventilators for weeks rather than days.

It's worth looking at the "ICNARC report on COVID-19 in critical care" - someone helpfully put a link earlier, but I can't find it and I can't link, but if you google it it's a download.

Tables 5 and 6 are particularly interesting. Fewer than half the cases being followed have been concluded, which means that more than half are still in ICU. Of those who have left, more than half died , and of the group receiving "advanced respiratory support" more than 2/3 died. This compares to a roughly 1 in 5 death rate for patients with non-Covid viral pneumonia.

I can only presume that the survival prospects for those who have been on intubators for longer times will be even lower.

Closed systems - ships

How resistant are most people, to catching the virus

• and what % have innate whole or partial immunity, as has been documented for some other viruses ?

We don't know, but the results of "closed systems", such as military or cruise ships, show we need more research.

Maybe paid volunteer lab rats living in a dorm for several weeks

• since this crisis looks like continuing for a couple of years at least.

Cruise ship Diamond Princess:

. Elderly passengers
. 3700 on ship
. 700 (19%) cases
. 13 deaths

US aircraft carrier Theodore Roosevelt (94% of crew tested so far):

. fit, healthy, mostly young
. very close quarters together for several weeks
. 4800 on ship
. 600 (12.5%) cases
. 480 (60%) of cases with NO symptoms so far
. 1 death

https://www.reuters.com/article/us-health-coronavirus-usa-military-sympt/coronavirus-clue-most-cases-aboard-u-s-aircraft-carrier-are-symptom-free-idUSKCN21Y2GB

Anyone able to locate a list of NHS (England) acute trusts with their catchment sizes? The catchment sizes should add up to the population of England, I think!?

Re impact on children (not just clinical outcomes but social)

Born in Bradford are starting research in their birth cohort study and the local authority they are getting us to collect data on our open cases in CSC.

We have to input for each of the children in our families theoe CV-19 status:
Self isolating
Social Distancing
Shielding

Symptomatic but not tested
Tested positive
Not symptomatic

I imagine the DHSC, DofE and DWP will have their fingers firmly in these data pies too

I'm reading more and more that doctors are now trying to avoid intubation at all costs for respiratory distress in COVID-19, when with 'usual' pneumonia they would have intubated. The outcomes for intubation in this disease are worse than for usual intubation in pneumonia.

As an aside, and pure speculation, does anyone believe Boris Johnson received ECMO treatment instead of a ventilator (Extra Corporeal Membrane Oxygenation)? It does for lungs what a kidney dialysis machine does for kidneys. It was confirmed Johnson wasn't ventilated, but he was treated in ICU in St Thomas's, one of the few hospitals that have an ECMO machine. There are only 5 adult ECMO centres in the country.
The two named staff he thanked for keeping vigil by his bedside included one who was on the St. Thomas's ECMO team.
I ask not because I want to probe the man's medical record inappropriately, but because this treatment is practically impossible to access for most other patients.

These are the five adult ECMO centres:

• Glenfield Hospital: Leicester
• Papworth Hospital: Cambridge
• Wythenshawe Hospital: Manchester
• Guy’s & St Thomas’ Hospital: London
• Royal Brompton & Harefield Hospital: London

I don't think Boris had ECMO treatment but I think he was in St Thomas's incase he needed it.

I can guarantee you 100% that if Boris wasn't ventilated and was in and out of hospital within a few days that he didn't have ecmo. Tommy's is the closest hospital to Downing Street.

And the treatment is not practically impossible for other patients. What makes you think that?!

Not sure the relevance of it being hard to access is.

It's not appropriate for the vast majority of patients. Any patient in the UK who meets the criteria for ECMO should be considered for it.

the treatment is not practically impossible for other patients. What makes you think that?!

There are only 5 places in the whole country that do ECMO, and two of them are in London. Very difficult for anyone who doesn't live near an ECMO centre to get the treatment - they can be transported to a centre but not easy to do for a critically ill patient

They are testing all ICU staff at my DD's hospital, whether symptomatic or not. Her team tested negative. This will be repeated regularly.

Those respiratory ecmo centres are all retrieval centres. They go out, put the patient on ECMO in the hospital they're in and take them back with them. Plus hospitals other than those 5 have been gearing up to put covid patients on vv ecmo if necessary.

ReallyBadIdea it's really reassuring to hear that even in the midst of the crisis patients are still being evaluated for ECMO in hospitals that can't provide it. Are they then transported across the country to a hospital that has the facility, if needed? My comment about being hard to access related to the fact that most hospitals don't have the facility. I had perhaps wrongly assumed that critical patients were currently not being shuttled significant distances to other hospitals to receive it.

I'm trying to gauge whether this is a treatment that will prove more important in the crisis than previously thought, given what we are discovering about the ventilation outcomes.

I'm trying to gain an understanding.

Crossed posts, thanks ReallyBadIdea

Shoots
This is the best I can find so far
www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualsmallareapopulationestimates/mid2018

It has a section on Clinical Commissioning Groups

Can confirm that they are being shuttled 100 miles to receive it. DD treating patients outside 'local' care. HTH

Is one issue with intubation that they're not then prone on their front? That's being pushed as a key treatment.

I would like to see the rates of survival/death for patients who have been on ventilators for weeks rather than days.

I believe we will start to see these on the next couple of ICNARC reports (published every Friday).

Are they then transported across the country to a hospital that has the facility, if needed?

Each retrieval centre has a geographical area that they cover and generally the patient will go back to the hospital that the retrieval team came from. If that centre is full then they may take the patient to a different retrieval centre that does have capacity. So yes, it can mean travelling significant distances.

I'm trying to gauge whether this is a treatment that will prove more important in the crisis than previously thought, given what we are discovering about the ventilation outcomes.

I think that although vv ecmo may improve outcomes for those patients for whom it is suitable (the evidence is not unequivocal even for non-covid ARDS patients, which would be the majority of vv ecmo patients pre-covid) that it will not make a massive difference to the overall death rate. It isn't a magic cure by any stretch of the imagination, it is labour and equipment intensive and requires extremely specialist skills. You have to pick your patients really carefully to make sure that it's the ones most likely to benefit from it. But anyone who does meet these criteria should be considered for it, regardless of where they live.

Hope that clarifies a bit.

Thanks Cary2012. I'm really happy to hear this.

And ReallyBadIdea

I saw that Chaz, however deaths are (mostly) published by Foundation Trusts, not CCGs, which as I understand it relate to GPs not hospitals.

The problem I have found is that for example, Chelsea & Westminster Hospital NHS Foundation Trust claims to serve 1.5 million people, however this seems not to relate ICU beds but to some wider range of specialist services such as HIV, as it consists of essentially two hospitals serving Hounslow (pop 250k or so), and Kensington &Chelsea (pop 150k or so).

In practice it seems that the core A&E-type services likely related to around 500k people.

That's being pushed as a key treatment.

It's been pushed as a key strategy for ARDS for years. It's frustrating that many hospitals have been slow to pick up on it, although to be fair it seems counterintuitive, and needs extra staff to perform the manoeuvre safely.

Above comment refers to proning.