The hospital I work in is so quiet

[QuietHospital]

London hospital.
Half empty. Some wards have less than a handful of patients, some wards are closed. Most staff have been moved to wards so are falling over selves. While their regular work goes undone.
A&E very quiet. I’ve sent patients there who are seen immediately. The heart attacks, strokes and appendicitis cases are presenting too late. People with covid are waiting too long to present. If you get breathless then for goodness sake come in. I’m so cross at the initial advice to stay home until struggling.
Had a look through covid ward lists and vast majority patients are aged over 70. Hardly any patients under 60, those who are have underlying health problems for the most part. Lots more men than women affected.
It’s just a snapshot but echoed by colleagues in other hospitals.
I think we can / should start to move back to normal life soon for the well young people among us. I fear for the short and longer term economic hit. It’s crazy to have all these young well people furloughed or made redundant.

I reckon they will start lifting things after 7th May announcement. They have the nightingales ready to nurse Covid positive patients and can keep the hospitals ‘clean’ think they just need to make sure the North and Midlands are through the peak. But people are starting to get restless now and they will have to lift things.

My hospital (large Northern city) has almost 40% of its general beds empty, and more than 25% of its (expanded) ICU beds free. Eerily quiet.

This thread has been an eye-opener!

@farfar A&E at our local hospital turned away my 1yo niece last month. She had a high temp and cough, 111 has told her parents to take her to A&E where they were told by security on the doors that no, she couldn't come in and to take her home.

A friend in Glasgow describes ITU overflowing and I’ve heard Dundee the same, yet Scotland is said to be less hard hit than England? Must be such regional variation.

I know someone who has been hospitalised with suspected covid and the threshold seems MUCH lower than Englsnd thank goodness. They were struggling with breath a bit but certainly not left till they turned blue.

I have to agree - at least in part- with the OP. I work in a trust with relatively low numbers of covid patients, and in fact I am very concerned about the reduction in patients with other conditions presenting and the treatment of patients with serious conditions that are not covid, e.g. cancer.
We set aside many many beds that we have not used. In some ways this is good - much of the red tape and hoops we had to jump through to get things going for discharges have gone, and I am genuinely proud of the trust and hospital for which I work and its phenomenal work in getting to this point.
BUT, I worry about all the 'normal' work of the hospital (disclaimer - I have had a professional qualification I have worked hard for suspended until goodness knows when so I am a bit selfish) and how we can get back to doing it, which I think we must.

Last few weeks extremely busy, normally 8 beds, last week 25 level 3 and a couple of level 2 patients spread over 4 wards. Some with very mild comorbidities or none at all and many in their 50s/60s, several younger. Constantly proning or tubing patients, very unstable, not seen anything like this for years. We now have empty beds but this is probably because of 4 weeks lockdown.

So it could be lockdown has worked incredibly well.

@LilacTree1 essentially yes, although we only get paid at cost for the operations that take place (so not staff wages for example) and the consultants and anaesthetists are doing it as part of their NHS salary of course anyway, so no 'additional' costs if that makes sense.

@justasking111 aha. Trust me- private hospitals are not making money during this. We have lost hundreds of thousands by cancelling all operations and standing empty. Even if we were full of NHS patients we still wouldnt be making any money as its all being done at cost and audited to make sure of that fact.

We will need to go back to normal eventually but the problem with this is you can’t then socially distance. It will spread in busy waiting rooms. HCPs who are asymptomatic carriers will become “super spreaders”. There’s no such thing as ‘cold zones’ because the virus is rife in the community. Lots of people carry it without realising.

GPs aren’t closed, they have just switched to trying to manage as much as safely possible by telephone and video calls. Please if you need help, give them a call. They are still there.

Suspending routine stuff is to stop spread.

The PPE issue is complicated. The guidance about what is safe has been repeatedly downgraded. Nurses are working on covid wards with a paper surgical mask and a plastic pinny which wouldn't look out of place if you worked in Greggs. This is current guidance and there is probably enough of this to go round. The problem is it feels like the guidance has been written with stocks in mind rather than safety. A few years ago we were told that the surgical masks barely do anything and I can’t for the life of me understand what the pinny is doing to protect anyone. A few months ago this wouldn’t have been sufficient for C.diff or MRSA but it’s fine for Covid? This is really puzzling.

The WHO guidance is very different and we certainly don’t have enough of that level of PPE. HCWs in other countries are astounded that we’d see known Covid patients with just the surgical mask, pinny and gloves.

Luckily we’ve had our communities pulling together to make scrubs, gowns and visors, we have to protect ourselves and our patients even if our government won’t.

@MarshaBradyo

The 16,000 figure was for all deaths in the week up to 3 April. The proportion of hospital vs care home etc was approximately normal - so people dying in their usual places, just at a higher rate than normal.

@QuietHospital

The problem with alot of posts here is that people have no idea about exponential functions. If you have R0 much above 1 then you have exponential growth again. You get a second peak and you cause long term damage to the economy. It's a stupid suggestion and slows our overall exit strategy. It does sound like we need better advise about when to seek medical treatment though.

I just watched the same report as icequeen then I started this thread. Very interesting, yet worrying contrast.

Part of the problem is patients are now too frightened to come in for treatment.

I had a very frustrating conversation with someone today who is struggling with their asthma and refusing to seek medical assistance due to fears around covid-19.

I got absolutely pulled apart on another thread when I suggested hospitals weren't overwhelmed, a strange conflict of opinion.

CrowCat awful! What did they do?

I think that other reason that Germany looks so good is that it has several times more hospital beds than us. So at the outset of the outbreak, you can tell people to come in just in case if you think you are struggling - if you are bad, we will put you in a bed and give you O2. The Bojo treatment, if you will. Other people are lingering at home too long.

And our gps will assess patients, and we have a triage cabin just for covid or suspected covid patients, they have a thorough assessment and open access to return when necessary. They are also provided with oxygen saturation monitoring which I think is helpful, and instructions as to when to be concerned and re - present. They are also followed up by phone.

If we had lots of community testing and a way of quickly assessing whether someone has it or not then you can have ‘cold zones’ and a return to normal. The 10 minute immunoglobulin test could help with this. Unfortunately they haven’t found a reliable test. A reliable quick test would make it much easier to come out of lock down.

The decision to rock up at A&E if you have chest pain? Or symptoms of a stroke? Not attending the maternity triage unit if you haven’t felt your baby move? Not seeing the GP because you have breast lump? Rectal bleeding? Your child has fever & is non responsive?

You need medical care ...

My friend today with post covid chest pain? Walked into central London A&E and had chest x-ray & ECG within an hour.

Why are people not presenting for treatment/assessment? Is it social media? Is it the Daily Mail? Is it the crap on mumsnet? Are people being denied care in the acute phase - I could believe it if they were given everything else that has been cancelled? Does the government need to be more explicit and remind people that the NHS is there to treat I’ll people? Do people really think saving the NHS means not turning up at A&E if you are ill & not being fucking incandescent that your cancer treatment has been put on hold?

@WhyCantIThinkOfAGoodOne we have to be allowed out at some point though, keeping us in lockdown is purely delaying the inevitable isn’t it!

111 doctor and my GP told me to go to A&E nearly two weeks ago because my breathing was so bad (they both thought covid but I wasn’t tested) - A&E triage nurse said I couldn’t see a doctor because they were only seeing people who were blue round mouth. At the time I could only get a couple of words out between breaths. But wasn’t blue. Oxygen sat levels were ok but blood pressure was very high.
Weirdly that evening there were only two other people in the A&E waiting room. Weirdly also my GP has provided amazing service - much better than usual - has phoned every day since except Sundays to check on me as breathing still not great. So even when A&E empty and GPs very free, hospitals aren’t admitting people who in other European countries probably would be admitted.
France had similar number of deaths but way more patients IN hospital and Germany is admitting people for oxygen therapy much earlier.
Think UK has policy of only admitting very critically ill people with covid and think also hospitals struggling with oxygen provision?
Think more people dying at home here from heart attacks because their bodies working hard to get oxygen round and then suddenly their hearts can’t cope any more?

Newsnight have people talking about lifting restrictions. Not sure when though!

Our ITU filled quickly at the beginning and we had extra wards set up as ITU overflow .These again got patients quickly but now there are only a few,on CPAP rather than ventilated.
Our problem us that ITU and ODPs/anaesthetic nurses numbers are depleted.If you take out those off due to vunerability issues ,staff who don't fit the ffp3 masks we have and those becoming ill then this area is stretched.
But we have other hospitals around and with the 12 hour turn over those patients who would normally have a preop appointment could have that by phone and a Covid test a few days before surgery,keep the hospitals as free as is possible and do all 2 week waits at least with follow up surgery as necessary.

What I find concerning is that this quietness gives the wrong perception when it’s people are not being sent in. Log jam with ambulances.

This will get worse when lockdown is lifted.

All this plays into the whole ' lets get back to school and work' narrative.

I can understand why people are not going in.

Im shielding.
Iv had contact with a food delivery driver and two nurses.

But today i have had tight chest, SOB all day.... But my oxygen sats are fine.
No temperature etc

Really do not want to go in, i started to shield a week before the government announced the advice too and going to the hospital seems like everything i have done would of been pointless...

Obviously if it gets worse, or my sats drop, i will obviously go in....
But normal times, i would of gone to A&E today....