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?

@CendrillonSings

Dominic Cummings is that you?

Or maybe not derailed but hopefully a more sensible discussion will happen if they’ve no interest.

I can see why the prime minster and Prince Charles for that matter were tested Yes.

Why do you assume because I can see why they would be tested and treated differently to jo public that I think nhs workers should go without tests?

No member of staff is going to have leaked accurate information. Its far more likely someone has said to be on oxygen overnight, he lis likely to have used about 4 litres, and then thats become a journalists fact, and while people carry on clicking any report mentioning it, so it stays.

"to assess the damage to the lungs - then he treats them occasionally"

Or, perhaps, accordingly?!

Thanks for the info - and the laugh, OP

We should all be able to access the same level of treatment. It's not a dig at the NHS. My friend lost a friend last week. He rang 111 and was told he wasn't ill enough to require an ambulance. His son found him dead the next morning.

I have moderate to severe asthma. The thought of getting it, not being able to breathe and not receiving medical assistance terrifies me.

Don't believe everything you read.

I agree early oxygen even at home.
Spo2 monitors
Coronataxis.
More input from gps.
Advice on signs its moved onto bacterial infection.

He might have been on CPAP.

I don't think The PM or PC or anyone else of the elite gives a shit how many of us die, just as long as they immediate treatment, just in case.

I think the question of type and timing of treatment for people in general is a good one.

For non Covid reasons I follow a few doctors and twitter and recently (within the last two weeks) saw chat about how turning ventilated patients onto their fronts seemed to be helping, should they be trying more of this?

I'd already seen pictures of ICUs in Italy about five/six weeks ago where they were doing exactly this.

I'm not medical and not debating the rights or wrongs of it but there seems to be a big failing in taking whatever knowledge is out there globally in terms of perceived best practice and using it here.

I would be entirely unsurprised to hear that Boris Johnson received preferential, early treatment - he got out of intensive care far more quickly than is the norm for a start, so must have been in better shape from the start than most people before they get as far as ICU. It would also be somewhat unusual if he had not received preferential treatment: nobody wants to take responsibility for letting the Prime Minister die, even if they do think he has some responsibility for the lack of resources. Besides, a grateful Prime Minister who now has a better understanding of the value of ensuring oxygen supplies and PPE is much better than a dead one. We really do need a healthy Prime Minister at this time.

Strangely, there was an interesting article in the Daily Mail (read on-line) about some doctors preferring to give oxygen rather than ventilating. It was very interesting, but I am not a medical person and would not presume to say whether it was correct or not.
Normally the DM is very hysterical, but this appeared to be an informed article.
The media were informed that Boris was given oxygen but not placed on a ventilator. I am not sure where the 4 litres comes from, and if this was an acredited source.
The problem with ventilating someone is that the ventilator does the breathing for you (presumably with a high oxygen mix), so the person has to be sedated, else they would naturally fight it. Being on a ventilator for weeks is very dangerous, and the success rate for full recovery, is quite low.

Even tents outside hospitals in car parks for providing oxygen.
How many hours of it do people need anyway?

If we were to log at cases (presumed) we could keep an eye on people on the danger days 10??

So if it is that a fever after 7 days is an issue that is monitored.
Even people updating an app to say their sats temp etc.

There is an awful lot of utter bullshit being spouted on SM and the mainstream media about intensive care, oxygen requirements, ventilation modes etc etc, written by people who barely seem to have a science GCSE between them, never mind any understanding of medicine or intensive care. That bloody awful article in the DM yesterday written by someone who wouldn't recognise a ventilator if it was dancing in her face is a particularly dangerous example.

There is not, and has never been, a set number of litres of oxygen that buys you a ticket to ICU. There has been a ridiculous amount of speculation about how sick BJ was or wasn't, based on very little actual information - which, as he is entitled to medical confidentiality like everyone else, is as it should be. Maybe he was admitted earlier than other patients might have been, maybe not. What good does it do for people who have literally no clue about any of it to be guessing?

I fint it hard to believe that is "the criteria" for ICU admission... People go to icu for lots of reasons, sometimes just because the ward they probably would have gone to doesn't have the time/resource to get the care right. Of course there would naturally have been increased focus on his care, I'm sure the extra attention he would have got wouldn't have been to the detriment of anyone else though. I expect its hard to treat the PM just like anyone else, when the whole world is watching.

He probably was on cpap. Early on in this outbreak, doctors were ventilating people sooner but now they try to avoid ventilating for as long as possible and try to avoid it at all costs because once you go on a ventilator you only have a 20 percent chance of survival. Problem is cpap is very inefficient so lots more oxygen gets used and supply might become an issue.

@Lycidas, you have an interesting question.

Atm the death rate for epoeple in ICU is 50% in the UK.
Some studies seem to show that this is linked with the use of a protocol that puts everyone on a ventilator. However, there are stages in the CV-19 and people who are put on a ventilator befor the cytokine storm starts (so the lungs are filled with fluids) are doing badly with being put on a ventilator as it dmages the lungs.
There are also studies that shows that peope do much much better if they are put on oxygen instead. I think that's what they do in Blegium and why they dont have issues with the number of ventilators.

Im not going to ask why BJ has had a different txt. I think its quite obvious. The question we need to ask ourselves is why other peope dont get that two stage approach.

I'm with you, OP. From various reports it sounds like we are admitting people relatively late - lots of MN posters have apparently been told by 111 that feeling breathless isn't enough. I don't think it's a coincidence that the admission criteria seem to be set higher than in other countries where they weren't expecting the same shortage of beds as we were (e.g. Germany). Now that bed availability is apparently much better than expected I wonder if we would have capacity to try earlier admission and oxygen focused treatment as apparently favoured elsewhere.

Neither here nor there whether the PM received favourable treatment - I think some PPs have missed the message of your post.

Btw some articles in newspapers are crap and clesrly the journlist who worte them doesnt know a lot about biology/science.

However it doesnt mean that the rough idea they are defending isnt right. I dont see the point of arguing about the leve; of oxygn needed to go in ICU if the really important information is that people do much better on a different protocol, involving being on oxygen first before ventilors.

Prime minister in "gets preferential treatment" shocker

I dont think anything reported was accurate and I dont think we was tweeting on the monday. I just can't see that he would be in ICU on 4l- he would be on a ward and the crash team.could be called if needed. They were keen to specify that he wasn't on invasive ventilation so suspect some mask ventilation may have been in place. I don't think we will ever be told and at the end of the day he is entitled to confidentiality with regards to his health just as much as you or I.

People are admitted on what they are projected to need, not what they actually end up using. They may need less or more. You cannot draw assumptions about people being deprived of the level of care he received. He was treated on an NHS ward where everyone is given the best treatment possible based on their clinical prognosis.

That said, I think it is possible that if he had been admitted to hospital a day later, he would have been even worse and could have required ventilation. This would have reduced his prognosis. On this basis, I am of the view that anyone still getting worse on day 7 or 8 should be admitted and put on oxygen, in the hope it prevents them from needing a ventilator. A GP friend of mine disagrees. Her husband was very unwell with cover-19 and she nursed him at home for as long as possible. He received better care than Boris Johnson during that time (BJ was receiving no care at all). She ensured her husband had antibiotics for a secondary infection, steroids for inflammation, that he rested on his front so he could best use his lungs. She was worried that, because there is evidence that repeated exposure to covid-19 makes symptoms worse, going in earlier than necessary might be a mistake. Her view is that you stay at home for as long as you can - if you have access to the care that she provided.

I can't stand Boris Johnson but to be honest I'm not surprised that they were more cautious with the PM than they would be with a random person off the street. Yes everyone should get the best care but we haven't funded our healthcare system sufficiently to do that.

Of course Boris received preferential treatment and rightly so. He is our elected leader - we (or at least most of us) voted for him to be Prime Minister - that in itself confers more 'importance' than an ordinary member of the public.