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?

France's worst day regading deaths was 605
Uk if they have hit peak ( hope so ) is 980
As of today france has 30,000 in hosptial
Uk has 17,000
Are these people not being admitted in time.

Lots of misunderstanding on ICU practice and patient management (understandably).
For one thing, the average Covid19 patient admitted to ICU who doesn't require full mechanical ventilation is discharged after 3 days. So Boris was about the same timeline I think?
None of us know the exact therapy he required and ICU admission is based on clinical signs and a prognosis, not by how many litres of O2 or what his 'sats' were. Assessment of circulating volume, heart rhythm, ability to drink, tiredness, chest xray results, blood results, urine output etc etc will have been all taken into consideration. An overall picture is what the decision is based on.

BJ is the Prime Minister, that's his exceptional circumstance. It's quite a big one. It isn't a medical one though is it. We probably all have reasons that could be considered exceptional.

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.

That assumes the patient has the chance to be in hospital to get the oxygen that way - in which case, yes, getting it with monitoring and observation is obviously better than having it without. But what about people for whom hospital isn't an option (yet)?

Hypothetically, if the delivery mechanism could be solved, would there be a category of patients who are not yet acute but in danger of becoming so, who would benefit from a low amount of oxygen at home to prevent them getting worse?

Or are the dangers of unmonitored home oxygen (however low flow) actually much worse than the breathing difficulties?

Just wondering, because "we can't give you O2 at home, but we won't bring you into hospital yet" isn't quite the same thing as saying "O2 won't help you".

Apparently the prime minister should be handed a copy of cosmopolitan and told to sit in the waiting room.

They have the highest death in the world though - so perhaps not the best example to use They count every possible death as a covid death as opposed to us who just use the confirmed cases in hospital so not a fair comparison.

Walkaround - Don't Germans pay a lot more for their health care system?

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?

Er, OP, you do realise that being in Government is about as frontline as it gets? We do actually need people to run the country in order for the NHS to function!

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I would like some facts on ambulances. I have hreard reports they are coming, seeing you can speak 6 words not only just 2 and going away. (One London mother died in that situation as by the next day she was dead at home).

A mumsnetters's 9 year old (most has covid) rang an ambulance because his mother (a teacher) could not breath and the ambulance refused to come out (I think because lips were not blue). Another report had ambulances taking 9 hours to arrive in which case surely getting your family to drive you to A&E would be a lot safer but would they then turn you away?

Lots of people cannot get through on 111 or to a GP and if you are almost dead and cannot breath you cannot hold on a line to some 111 call centre anyway.

Basically it sounds like most of us have no NHS care to count on unless we are very lucky so we should be seeing how much the NHS is not with us cradle to grave at all and all be wanting big tax cuts next year and much less NHS provision.

Trying out my new user name
I know people who have called 999 as they are struggling to breathe and haven't been taken to hospital as their lips are not blue and they can speak
One is an NHS colleague who caught the virus at work
All hospitals in my area have capacity
I'm not sure who we are saving it for
OK Boris is PM so will get preferential treatment but why are we not offering Oxygen at an earlier stage as in Germany
Other patients are suffering because many services have just been told to discharge everyone so they are not getting their usual service
Apart from acute services others are twiddling their thumbs. It's disgraceful. How many will die not of covid because services have been cancelled

I don't agree he was given preferential treatment in hospital.

But he had a doctor speaking to him and advising him prior to his admission. A doctor that told him to go to hospital.

The general public have 111 telling them not to go to hospital until its too late.

111 were misdirecting people to their deaths before this, and nothing has changed.

That in itself is preferential. Regular Joes can't speak to a GP about coronvirus. They are directed to 111 where they may wait an hour or more

All hospitals in my area have capacity I'm not sure who we are saving it for OK Boris is PM so will get preferential treatment but why are we not offering Oxygen at an earlier stage

I'm wondering this too. We're still being told we need to slow the spread but the hospitals are empty. Private doctors are complaining they're twiddling their thumbs in empty wards.

I have oxygen at home for my son. I was asked before the lock down started if they could collect my surplus equipment. I assumed so they could provide oxygen therepy to people at home. That doesn't appear to be happening and they still haven't collected the equipment.

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?

Nope I think the NHS is often working on protocol and that is happening atm.
I also think that our hospitals arent struggling yet with lack of beds (unlike Italy, Spain etc...) which points towards the fact people are not taken to hospital until the last minute. At which point, they probably need ventilators of course.... Same with the fact that older people in care home are not taken to hospital OR tested (How many of them are dying when they dont have the CV and could have been treated?).

Basicall the issue is NOT the training of the doctors. It's the whole system aorund it.

I am getting really sick of medical staff bristling with outrage at people questioning the UK's lack of treatment for the general population. I don't think anybody is saying doctors and nurses are not doing their absolute best, we are saying that people are barred from getting into hospital in the first place! I can't stop thinking of that poor 36 year old woman's husband and children either.
And, no Xenia, I don't want to pay less tax and scrap the NHS. Private medical care ends in a barbaric situation whereby insurance companies decide if people live or die, and that, to me, is even worse.
I would happily pay a separate NHS tax, as a percentage of my wages, but only if they are actually providing timely care for people who don't happen to be Prime Minister.

Naturalbornkiller - it stands to reason that if you had preferential treatment to get you into hospital in the first place, you end up having preferential treatment all round, given that deterioration of patients is known to be rapid. They had him on site, ready and waiting to get the best treatment possible at the best time. Obviously not everyone has that. And given his behaviour before he was admitted, still trying to keep going, I think without a close eye being kept on him, he may well have waited too late himself before he panicked and called 111.

There's a lot of 111 bashing on this thread.

Lots of patients are moved to ICU as a precaution - I myself have been done so on numerous occasions. It's not something that is special to BoJo. There is no limit on what oxygen you need to be admitted - I have been in without oxygen and without oxygen, intubated (previous medical condition) and with CPAP (for COVID, and then again for COVID complications / Sepsis red flags).

It's a total myth you need to be on a ventilator or needing one to be in ITU. ITU is there for if patients are at risk of sudden deterioration as well. I have been in there and then have had to be ventilated on day two. An hour before this I was walking around - thankfully the doctors were not hundred percent happy with my bloods and stats so they kept me in there. it's much easier to intubate in ICU than it is in resus or on any other wards. I don't think people realise intubation involves a shit lot of specialists and is not something any doctor can perform.

Those who have had issues with 111/999 need to raise complaints.

NHS frontline staff and families are being tested if they've had symptoms which have shown up within five days. People are getting pissed off because they are not being tested when they don't have symptoms but there simply is not enough testing to test everyone at the moment.

Agree with @Xenia
We're not getting a decent service from the NHS at all. Something needs to change.

His medical/nursing team are, quite rightly, not allowed to comment on his case. Unless he himself gives details, it's speculation. If any of them leaked details to the press, shame on them.

He is just as entitled to privacy as the rest of us when it comes to his health.

Those who have had issues with 111/999 need to raise complaints.

The above is difficult if they are too late and you die. Ok being a bit flippant but honestly we need a good system where we are not left too late.

Rogue did you call 111 (for CV19) and also do you think we could learn from Germany re earlier intervention?

Also -This is less about what happens in hospital, I think we can see the medical teams are doing excellent work as best they can. But the pathway to get there.. is it the best we can do?

American ITU Dr said that ventilators were actualy making people worse,it wasnt getting the amount of 02 required into the blood, and what people very sick with the covid actualy have is a form of altitude sickness, and they are being treated for "standard" pneumonia.

I'm no fan of Boris, but as our Prime Minister, he should get preferential medical treatment, in my view. It's about the office, not the man.