Boris Johnson and the precautionary ‘4 litres of oxygen’

[Lycidas]

In the NHS, the current threshold for being admitted to ICU is needing 15 litres of oxygen. Yet Boris Johnson was admitted and only given 4. Early signs from Germany are that giving oxygen and early admissions might help lower the death rate. Instead, we seem to be telling people to wait until they’re blue in the mouth, when they’ll need to risk the ventilator lottery.

Can we start discussing the Boris exception to treatment and if it’s feasible to roll out this ‘precautionary’ approach to the rest of the population?

BJ is the Prime Minister, that's his exceptional circumstance. It's quite a big one.

St Thomas's is not overrun, and generally London ICU have spaces. I am sure they are doing their best and trying to make the right decisions as best they can. Including assessing changes to best practise every day.

Unless you have clinical input to make, I think it unlikely you'll be able to help.

How do you know he only had 4?

Where are the admission guidelines/thresholds published?

All I've seen is that it's a decision to be taken by an intensivist (unless none available, in which case the most senior nearest-matching doctor) plus a whole list of factors to,cinsider. Not a hard threshold on amounts of oxygen.

But I may well have missed something important, hence question.

I agree with you. I've read a few things about the hypoxia being non typical and people with very low sats still being able to speak etc, which means by the time they can't, it's catastrophic for their body.

Also a couple of things about why ventilation may not be as appropriate perhaps for covid 19 as for other pneumonias, and why flooding the blood with oxygen may be better.

Not at all medical but would like someone medical to explain the current pathway and why it's deemed the best option.

It’s widely reported in the media that he had 4.

Yes I’m sure the NHS is doing their best so let’s sit still and not discuss or question anything ever...

Don't believe everything you read.

He's the PM presumably a perk of the job. I also suspect it was useful to protect his privacy as the patients in ITU are going to be much sicker and hopefully not so keen on trying to sneak a picture or video of Boris coughing or struggling to breathe.

We won’t really know about Johnson but I agree re Germany.

www.spectator.co.uk/article/is-germany-treating-its-coronavirus-patients-differently-

“The other question that needs to be asked is whether there is something about Germany’s treatment of coronavirus victims that has resulted in a lower death rate. That is how Dr Thomas Voshaar, a lung specialist who runs a clinic in the town of Heinsberg in North Rhine-Westphalia sees it. In an interview with the Frankfurter Allegmeine, he speaks of how he has treated 29 patients without suffering a single death so far. It isn’t testing that makes the difference, he says – he doesn’t even bother with the tests because he finds them unreliable. Instead, he gives suspected Covid-19 patients a CT scan of their lungs in order to assess the extent of damage – and then treats them occasionally.

What he doesn’t do, he says, is rush to put patients on a ventilator.“

I'd interpreted it as the media trying to downplay the seriousness of BJ's condition, rather than preferential treatment but it is an interesting point if this has been the case!

But was he given preferential treatment? Where did that 15 figure fine from?

They could tell us anything. I think there is no real way of knowing.

Did it come from his mouth that he had 4? Did he say this in his video message after hospital? Pretty sure he didn’t

If it’s just what the media has said, unless they have seen his medical notes how would they possibly know?

Also his prime minister of course he was going to be given special treatment, same for queen if she happens to get sick 🤷🏻‍♀️

It does seem, from various things I have read, that early intervention lowers the death rate. I am very worried by reports that people here are being left to struggle on alone until they have levels of oxygen low enough to be life threatening. Most people on ventilators seem to die, and a lack of oxygen can cause permanent damage to organs and the brain. Our deaths compared to Germany are truly horrifying.
I wonder whether the people who would normally be weighing up what treatments are most effective here, are stuck in a cycle of using the accepted pathway, as they are not getting any time to be adjust.
My feeling is that we need to be treating many people with oxygen far earlier.

And anti virals too, possibly.

I absolutely agree with you OP. It has been shown in Germany that early oxygen can save lives and open up beds for others. The UK Government under the command of Boris Johnson has failed its citizens.
Boris Johnson was on holiday in February when he should have been leading the country.

If they can get on top of this and bring people in earlier it could be the better way to go. If then people don’t stay on as long then that will help.

Now we are lowering cases in hospital I like it to be considered.

If the above isn’t the case fair enough but if it is then worth pursuing.

@P1nkHeartLovesCake

Would you say the same about politicians getting tested for Covid but not frontline NHS workers? That we should just suck it up because they’re running the country?

In fairness, I understand they moved him early because racing the prime minister across the hospital to ICU is a huge undertaking and not one you want to do as an emergency. So they decided to move him there in case it was needed rather than leave it until it was actually an emergency. Which makes a lot of sense to me.

However, the OPs actual question is whether doing this for as many people as possible would be of benefit, I think?

Again, not an expert, but my understanding is that many patients are being given oxygen therapy from normal wards, and that the limiting factor is not ICU beds (as they aren't required for CPAP type therapies) but the mechanism of delivering oxygen around the hospital?

But, yes, it does look like more oxygen and earlier would be of benefit in a lot of cases.

Ah, I got a bit ranty there, sorry.

Are we still on this carping rubbish? Yes, the Prime Minister was treated appropriately by NHS professionals in ICU. Next!

I think earlier intervention and oxygen will be one of the next big discussion points. I don't think it will be overly helpful to focus that on any individual cases initially, let alone Boris although I share your frustration at what people are going through.

The govt seem very reactive and responding to the latest issue to be emphasised by the public, frontline workers, media. We have had lockdown, schools, self employment, PPE, testing, care homes, masks. I think we should definitely have a focus on early intervention, and I suspect a focus on prisons might be coming if more is going on there than we know.

Also his prime minister of course he was going to be given special treatment, same for queen if she happens to get sick 🤷🏻‍♀️
I have no idea whether he was given preferential treayment. But I see no reason why he or the Queen should have preferential treatment over eg a young mother in her 20s or 30s, or a doctor working on the front line etc. Treatmnet should be based solely on medical need.

It’s a shame this will be derailed by politics from usual pp taking umbrage.

The question of early intervention is a good one.