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?

Why the fuck do people think that doctors just rush to put people on a ventilator rather than "trying oxygen first?" Do you really think our training is that fucking rudimental that we would be intubating people without trying a wee bit of O2 via one means or another?

I would hope that no one was breaching patient confidentiality by disclosing details of Boris's treatment, he is entitled to confidentiality like everyone else
if the 4 litre figure is true the only way we know this for a fact is either Boris has said that this is the specific treatment he got at that flow rate or that someone has told someone else confidential medical information, so if neither of the above are the case then the 4 litre figure has been plucked out of the air or is at very best an educated estimate

And by projected to need, I am not talking litres of oxygen - I am talking overall clinical prognosis.

Why the fuck do people think that doctors just rush to put people on a ventilator rather than "trying oxygen first?" Do you really think our training is that fucking rudimental that we would be intubating people without trying a wee bit of O2 via one means or another?

Sockqueen apart from getting worked up. Do you think the current system gets people in early enough - Do you see there could be learnings from German approach?

@SockQueen

Hold your horses Queenie. I’m talking about early admissions. You can’t very well try a ‘wee bit of O2’ on a patient if 111 has told the breathless patient in question to stay at home, can you?

Chris Hopson CEO of NHS Providers said something interesting just now "We should be proud we haven't seen the sort of scenes we've had in Italy or the overwhelming of Hospitals in Japan" went on to give an example and thanked the staff.

Well, i guess if you keep people away from accessing the best care, we aren't going to overwhelm the NHS are we?

Because given our death rate and where we started on staff and beds etc its a bit odd this hasn't happened.

Aside, there is absolutely no reason on this planet that Johnson should receive better care than anyone else, my DD would grieve for me just as much as BJ's children would for him, probably more.

Why the fuck do people think that doctors just rush to put people on a ventilator rather than "trying oxygen first?" Do you really think our training is that fucking rudimental that we would be intubating people without trying a wee bit of O2 via one means or another?

I think what people are concerned about is that the system (i.e. 111 algorithms, not doctors) might be trying to keep people at home for so long (to conserve resources) that the window for trying oxygen is nearly closed by the time some people get to hospital, thus reducing options for oxygen vs ventilation.

I don't know how justified this fear is, but I can understand it given that there really does seem to be quite a high bar in terms of distress that you have to reach to qualify for admission at the moment.

Exactly, OP, Marsha, jasjas and eeeyore.

Yes I think it's entirely correct that certain people get preferential treatment. The PM and the Queen amongst them. Not based on money or privilege but on the enormous impact on the country, economy, etc if they were to die.

But it does seem that the UK is only admitting patients to hospital when they are in a dire position, when the figures over hospital capacity do not support such extreme limitations. I don't understand that approach at all.

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

They have the highest death in the world though - so perhaps not the best example to use !

Well, i guess if you keep people away from accessing the best care, we aren't going to overwhelm the NHS are we?
Yes, that. And everything else you said actually.
I can't believe people think that BJ was more important than all the people who have been refused hospital admission and then bloody died! His life is not worth more than anyone elses!
I have been thinking about this today too, the fact that you have to be actually dying before they will admit you and by then it's too late. Our death rate is a disgrace and we should be learning from Germany.

I can't fucking stand Boris Johnson but I really don't think the country's morale would cope with him dying. We would have gone collectively mad, especially the simpletons who think he's a great bloke (an unfortunately high proportion of the population). I think throwing medical care at him even if the rest of us don't get it is a good thing. Think of the generalised sopping misery lady Di's death caused and then add weeks of isolation, economic downturn, anxiety about our own and relatives' health on top of that and be glad we avoided it.

It’s not so much about BJ but are we following best practise, the best pathway?

I don’t know, if a medic or someone in the know on here says yes we are I’d find it reassuring but atm if we look to Germany and what they do there is a discrepancy. They are doing better atm.

I have been looking at france and atm the have 30,000 in hosptial whereas the uk has 17,000. Something does not seem right to me regarding these statistics. Why? There are beds.

@MarshaBradyo yes, probably. The idea of leaving admissions up to 111 operators with fairly basic criteria concerns me. I know that colleagues in primary care have altered protocols for admission/face-to-face assessment several times in the last few weeks as the initial assessment tools weren't found to be great, so hopefully things are improving on that front. I am very concerned that our death rates are so high, and fully support research into why that might be.

Home oxygen isn't a practical option for people with Covid, unfortunately. It's only suitable for people with long-term oxygen requirements who are fairly stable. Trying to manage acutely unwell Covid patients with minimal monitoring/observation, never mind the logistics of supplying, storing and removing sufficient cylinders safely, just isn't feasible.

BUT there are so many people writing utter shite with no qualifications (particularly the DM article I mentioned earlier) that makes me angry that they're just spreading fear and mistrust with minimal, poorly applied, knowledge. I'm not working in ICU at the moment but I know just how hard my colleagues have been pushing themselves and their patients in the last few weeks and it makes me sick that some DM journo thinks that they could fix everything with a bit of oxygen and "proning" them "on their side" (one of that articles gems - proning is on the front, and is already being widely used both in ICU and outside).

Being the PM (rightly or wrongly) will mean a certain amount of extra care. For a start - he leads the country and is needed. Also would you want to be the nhs hospital who allowed the PM to die in your care without trying everything?

I feel most sorry for the 2 nurses who cared for him. What a bloody huge responsibility. I suspect the effect on their MH from that will be huge.

But having said all of the above it's the same fo wall nurses and hospitals. And every life should be valued equally.

The extremely sad and frustrating realism of the situation is as mentioned above. We seem to be playing some kind of Russian roulette with leaving people home for too long. I suspect out of gear we wouldn't have enough beds if we didn't. Instead they can say "well they didn't need to stay home as we have capacity".

And anti virals too, possibly.

There have been small scale studies with anti-virals that are already on the market (for other viral diseases like Flu, Ebola and HIV) to determine proof of principle but larger scale trials will take bit longer. I'm sure we'll get treatments using anti-virals long before developing a vaccine though.

We should be looking at why Germany is doing so well in comparison to the rest of Europe (they are the exception, not us), is it just their large scale testing or a population difference or a treatment difference?

Thanks Sockqueen I appreciate your answer

Just wondering. Any doctors here - if you were to buy something like - clear 02 ( small 15 litre oxygen can ) would be worth getting in case you get Covid 19 and get the bad breathing problems
I know a friend of mine has it for asthma and she swears by it but was just thinking Is it something worth having - like toilet rolls and pasta 😂

I have no doubt whatsoever that Germany is doing a better job not just of knowing who actually has covid 19, but also of keeping track of those that do have it and what their symptoms are, so that they can receive more timely treatment. It all goes hand in hand.

I can't fucking stand Boris Johnson but I really don't think the country's morale would cope with him dying

IF early Oxygen treatment is best practice, then the aim should be EVERYONE gets it, now i understand that may not always be possible, due to the exceptional nature of CV but once we start running an NHS where policy is to treat some people better than others then we no longer have an NHS.

I've said before if I was the PMs doctor I'd rather be justifying why I let him into ICU a bit early than why I let him die.

I think Boris Johnson and what his medical treatment may or may not have been is a red herring.

The point is it's fucking disgrace leaving people until they're blue and floppy before admitting them for treatment. It must be costing so many lives.

If, on the other hand, you don’t know what you are going to be hit with next or how bad it will be, because nobody kept track of the situation and you are now fighting to get it back under control, your reaction will be panicky-defensive, not proactive...

We need to ascertain what Germany are doing right versus what we are doing wrong (along with Italy, Spain and France).

I think early intervention may be key to this. I do think our admission criteria to hospital is too strict and we know with this virus people can go downhill very quickly on day 7 onwards. We need to learn from Germany on best practice and change what we are doing. Especially as we have capacity now.