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.

The daily hospital deaths...do they appear to be plateuing? We haven't seen a big spike following the bank holiday lag.

We need to get away from thinking that the most dramatic measures like ventilators or ECMO are the gold standard

but also don't think that justifies refusing hospital admission to sick people with breathing problems etc

There is a big range of people who need much less intensive hospital treatment, sometimes just oxygen,
sometimes just regular home visits to check they are not deteriorating

.... but they do actually need that treatment to improve their chances

There are senior hospital consultants on German TV and in newspapers explaining why they want to treat sick patients as early as possible,
when they can do the most to stop symptoms getting much more serious.

I completely agree BigChoc - we need better (any) basic care for the majority not heroic measures for a tiny minority.

I couldn't find any clear numbers so had to fiddle with numbers I found on Google a bit.

I updated my spreadsheet and added more graphs (cumulative deaths, per million, etc.) and filters by Trust and Region and what not.

The per million numbers are a bit iffy in that there doesn't seem to be clear numbers - e.g., Isle of Wight NHS Trust fairly obviously covers the population of the Isle of Wight, but for instance Nottingham University Hospitals NHS Trust was claiming to cover 2.5 million people, which clearly it doesn't except for some specific services.. So I fudged the numbers down a bit.

As expected, the Isle of Wight is relatively low in deaths.

Places like Northampton are as bad as London

He was on CPAP

However, those taken off should be moved to another bed and given oxygen etc, not left to die and certainly not euthanised.

I'm really uncomfortable with terminally ill people suffering unnecessarily, which is why I commented about euthanasia. It's a tricky one but personally I would not want to be subject to a painful or prolonged death when that's inevitable. Anyway, probs not a discussion for this thread.

I would want to be asked before someone kills me

About the method of dying too

Spreadsheet link

gofile.io/?c=aq8FMZ

We can see that for London the peak was in fact 4 April

The Midlands does a shit job reporting and only 8 (!) deaths were announced yesterday.

The NE & Yorkshire region otoh is consistently efficient, announcing many deaths the same day.

As far as the last days' deaths go, they are high. Those announced yesterday were particularly high for several regions, and with only 8 announced in the Midlands, it's likely that a lot will be added tomorrow.

It's still not clear if reporting efficiency is improving, in that the 151 deaths announced yesterday for the 15th were added to 'only' 320 today, which isn't that bad, though not exactly good. It takes 3 to 4 days to have a really good idea what was going on a given day.

You can get really quite attached to these kinds of long stay patients and their families and then never find out what happened to them.

One of my daughter’s nurses once admitted she’d occasionally look up the records of her past patients, just to see how they were doing once their care was stepped down and they’d been transferred to other wards ❤️

Honestly, cannot express how wonderful I think critical care nurses are (intensivists too, but I always felt that the doctors gave the nurses a destination and a map but the nurses did ALL the driving). When my DD was intubated, the anaesthetist was quite new to paediatrics, and the nurse in charge was watching him like a hawk. It was actually lovely to witness how much respect the doctors all had for the CC nurses.

Thank you so much for all you do

Long-time lurker on these threads. They are so helpful and informative.

I think it was here that I read about the swab tests being less effective at detecting CV19, the longer someone has had symptoms. Can anyone remember that study? I have a pregnant friend who has had symptoms for 2 weeks and now the hospital wants to get her tested before she has her c-section but I'm concerned about false negatives after this long.

Thanks shoots.

NE hospitals are supposed to be pretty damned efficient generally. I know a fair few of of the hpcs working there at the mo. And a statistician working on the local stats!

We are expecting our peak to be mid May, or were a few weeks ago afaik.

I am in favour of allowing euthanesia only when patients are able to consent, possibly in advance of any illness
but not under sudden social / duty pressure because of the COVID threat.

I agree with your whole post (this is just one extract). Euthanasia should only be patient led, and should be decided way ahead of time with plenty of chances to change mind and an assessment that ensures sound mind and no external pressure. Clearly that can’t happen in an emergency situation.

Withdrawal of care based on clinical indicators and data only consent is a separate topic, and one we should all discuss with our loved ones as part of normal life.

Which means it's likely that the plateau may continue across the country for at least another month, as some areas are still creeping towards their peak? Though lockdown will have an effect.

now the hospital wants to get her tested before she has her c-section but I'm concerned about false negatives after this long.

This will be a nursing management process, they’ll do CV indicated obs too. It won’t interfere with her quality of maternity care, it will just indicate the level of PPE used by staff and where she will be assigned for care.

Try not to worry. The NHS appears to be handling things really well with those actually admitted to hospital (the problems we’re seeing seem to be more to do with the guidelines for admission that the government have put in place via 111 and the lack of expansion to the ambulance service).

Your friend will be in good hands and they’ll discharge her as soon as it’s safe for her and baby.

One of my daughter’s nurses once admitted she’d occasionally look up the records of her past patients, just to see how they were doing once their care was stepped down and they’d been transferred to other wards

That's illegal though

ShootsFruitAndLeaves, that looks as though London may be over the worst hospital death wise. I really hope they now relax the admission criteria and consider taking more people in who aren't quite as ill.

My parents are late 80s, both are fit and well, still driving, still exercising, but by NHS criteria both have underlying conditions and so wouldn't count for any treatment at all. While I wouldn't want either of them intubated, I feel very strongly that they, and others like them, should be offered oxygen support and aggressive meds (antibiotics if appropriate etc), which can only be done in hospital. In Ireland, they would be admitted but not intubated - many people of that age surviving and being discharged here - in London they wouldn't. That doesn't seem right.

My dad would tear up a DNR if he was offered one. He expects to live forever. My mum (if dad wasn't there) would sign whatever she was offered. That's not a good way to select patients for treatment

I thought they said during the briefing about 2 days ago that regions were expected to peak more or less at the same time as the same lockdown rules were imposed on all of us at the same time

I'm wincing a bit at the term Euthanasia, when I think people mean do not attempt cardiopulmonary resuscitation. It's an important distinction folks!

But I agree with the sentiment. "What matters to me" conversations about peoples preferences for their care at the end of their lives are best when they happen ahead of time, allowing people to discuss their choices and preferences with their friends and family.

Unfortunately, most of those choices, particularly with regard to place of death and people present, cannot be fulfilled at the current time and as I have posted previously on these threads, I am grateful that I was allowed to say goodbye to my own DM.

it is legal for a medical practitioner to determine that it would be medically futile to attempt to resuscitate someone who would be unlikely to recover or would have an extremely poor quality of life if they did survive resuscitation, although this should always be discussed with the patient and family when possible. I have been disturbed by what appears to be a wholesale DNACPR approach to some care home residents though. Even in the saddest, most difficult circumstances, it should always be a decision about an individual.

NE hospitals are supposed to be pretty damned efficient generally. I know a fair few of of the hpcs working there at the mo. And a statistician working on the local stats!

We are expecting our peak to be mid May, or were a few weeks ago afaik.

neuro a NE hospital trust/ccg I'm involved with said earlier this week their modelling was now predicting peak this weekend....

I suspect a slight regional variation, I think Londoners started semi voluntary lockdown a little ahead of official lockdown ( living in the south with family up north )

The traffic stats pictures may indicate that?

I really hope that we are hitting a peak but am very aware that it’ll take weeks for the infection rates and death rates to reduce to a level where relaxation of isolation can be safely considered. If we go too soon it’ll flare back up again.

I’m quite worried that longer term many older people with health conditions will be effectively barred from normal life, the effect on mental health will be huge.

almost 5600 new infections. Anyone any idea - they seem to be going up again rather than down. Shouldn't they be coming down by now?

I don't think the infection rate means anything in this country because we were hardly testing anyone and now we are testing.more, so number of new infections is bound to go up. The only data we can go by is deaths really

One of my daughter’s nurses once admitted she’d occasionally look up the records of her past patients, just to see how they were doing once their care was stepped down and they’d been transferred to other wards^

This is clearly against Clinical Governance rules and if she is caught she will be at best reprimanded and reported to her governing body and at worst sacked