Daily numbers, graphs, analysis thread 5

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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.

I agree they are rethinking intubation. There are a couple of hospitals in London setting up dedicated tracheotomy wards, both for stepping down patients who they are unable to take off intubators in the normal way, and also for some patients to avoid intubation at all.

The idea is that rather than the on/off respiratory aid that is intubation, they can do a more gradual move to independent breathing (hopefully).

It's dangerous for staff though, as is C-PAP.

The biggest problem at the moment seems to be getting people off ventilators.

It was pointed out on another thread that the nurse from NZ who monitored Boris is a specialist in ECMO.

Cary2012, I'm delighted your dd's team is being tested. I would like to see testing for nurses outside of ICU as I think they are actually in more danger of infection because of the low levels of PPE they have.

ECMO nurses don't usually just nurse ecmo patients ime. They are particularly experienced in looking after critically ill respiratory patients though.

I think retroviral treatment will be on the market in the next 6 months, long before a vaccine 3-6 years away.

There is a good article in the ABC Australia about the difficulty in finding a coronavirus vaccine. It's a sobering reading.

www.abc.net.au/news/health/2020-04-17/coronavirus-vaccine-ian-frazer/12146616

I had thought Boris received Oxygen and possibly meds for additonal non-COVID infections present,
but otherwise was there to have ECMO and ventilators on hand if need be

The PM & key govt ministers, royal family etc will obviously not be treated the same as an ordianry bod, in any country

Where people suffering at home / care homes in the UK are really being failed imo is in not being admitted to receive oxygen
Many with breathing difficulties don't need - and wouldn't benefit from - very intrusive treatment like intubation etc

However, oxygen at an early stage would give more time for their bodies to fight off the infection

The early admissions in Germany certainly are not being ventilated, in most cases

• many get lung xrays, oxygen, tests & early meds / treatments for any additional infections picked up, such as bacterial pneumonia

Ah ok thanks Reallybadidea

Yes Alondra, dd has been saying all along that the answer is some type of antiviral cocktail given either prophetically or at the first sign of illness. Something along the lines of treatment for HiV. That's the dream I suppose - for countries that can afford it

BigChoc, we seem to keep coming back to early oxygen treatment. I simply don't understand why the Nightingales can't be filled with people like Boris, or even people earlier along the way.

@NewAccountForCorona
Thank you. DD I know would be the first to agree with you.

There has been a fixation on ventilators . At the start they were also saying simpler oxygen could be ramped up much more quickly, it's what Germany does and all the lousy journalists do is ask when will lockdown be over

I don't know about England, but that's what the Nightingale hospital in Scotland will be used for (ie supportive measures such as oxygen, antibiotics etc but not for ventilation)

Actually, I think I misread your comment about proning. Intubation certainly isn't a contraindication to proning.

However, oxygen at an early stage would give more time for their bodies to fight off the infection

Oxygen at early stage is giving a chance between life and death. It's also the reason why Lombardi and Madrid despite having great health systems, collapsed. Spain and Italy tried to give the best chance o over 80s until they couldn't. I still take my hat off to them.

What I won't ever accept is give up on a life because of their age and ability. Old and disabled people have a RIGHT to enjoy life. Same as everyone else. To say otherwise, it's to justify nazi's thinking.

We have had several scientists working in the field give very different predictions about how long before a vaccine

They may just be giving an estimate for their own work, or for work in the institutions / country they know
Or assuming the usual process of vaccine development, which minimises development costs but sacrifices delivery time.

Estimates range from 1 year from scientists in the UK - which I find too optimistic -

to several years - maybe from those who have to try each development line in sequence as usual, to stay within budget,
rather than working all lines in parallel, to save time and manpower, money no object

COVID is the only disease in modern times that has caused a Global Depression
and it has killed well over 100,000
So far greater pressure - and more willingness to accept more risks

Where people suffering at home / care homes in the UK are really being failed imo is in not being admitted to receive oxygen
Many with breathing difficulties don't need - and wouldn't benefit from - very intrusive treatment like intubation etc

Yes, and one sign of how much this support isn't happening where it might elsewhere is people reporting that they have called ambulance out multiple times before finally being admitted or not being admitted at all. I doubt people are calling an ambulance lightly right now, so they are probably in a state where from what you say Big Choc, they'd have been admitted in Germany.

Going from reports of people who have been admitted in Germany,
this is as soon as they report breathing difficulties,
or if the health teams - who regularly visit the sick ones - find deterioration in their monitoring of blood O2, BP, heart etc

Hospital is not only about receiving O2 though:

In hospital there are lung Xrays to confirm COVID - often more reliable than tests - and to see the state of the lungs
There are tests for non-COVID infections that they may have picked up with their immune system weakened - prompt antibiotics or antivirals can head off these getting more serious

It is about actually treating patients as early as possible, as much as they need,
heading off further deterioration
which can prevent them ever needing ICU

It's even about reassuring them that they are getting the best possible treatment, so they don't get panicky

That's the dream I suppose - for countries that can afford it

The dream is possible unless you live in Africa, Middle East or some parts of Latin America. If you unfortunately do, you'll have to wait years, and a few million dead, until pharma is disposed of their "intellectual property". It's the difference between living in the first or third world country.

The dead are the same. The suffering is the same. The pain is the same.

But the accounting is different.

I read back through thread and meant to say thanks to BigChoc for answer re how they know when to intervene

The oxygen situation is the one area I’d like to see explored more urgently here

@Reallybadidea
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

Is ecmo a treatment that requires longer time as an inpatient ?

Ecmo is a Hail Mary treatment - effectively cardio-pulmonary bypass. Your blood is oxygenated outside your body then returned to you. It isn’t something that many people survive let alone walk out of hospital afterwards!

Can anyone explain how the r0 is being calculated in the UK .?

it might be useful to talk about euthanasia as a possibility for patients on ventilators but unlikely to recover

I had this conversation with my DH just this morning.

I also think we need to consider that many in the vulnerable category are simply not going to want to isolate themselves for a prolonged period of time, they are going to prefer to take the risk. We have to treat people as adults.

Post ECMO patient aftercare doc from Guys and St Thomas’

www.guysandstthomas.nhs.uk/resources/our-services/peri-operative/critical-care/ecmo-aftercare.pdf

This study suggests the average hospital stay of someone who has received ECMO is 51 days (average time actually receiving ECMO is 9 days).

academic.oup.com/ejcts/article/37/2/339/774991

@NewAccountForCorona also not having such restrictive limits on NHS tests, I'm sure I've read on here that no more than 3 can be tested a week/fortnight.

I also think we need to consider that many in the vulnerable category are simply not going to want to isolate themselves for a prolonged period of time, they are going to prefer to take the risk. We have to treat people as adults.

Yes exactly. I have grandparents in their 90s who are pretty much housebound anyway. What benefit are they getting from not seeing anyone for months? It would be much better if they could choose for themselves whether to take the risk.