Is the NHS leaving treatment far too late?

[Lumene]

A good few threads on here have been saying the NHS won’t admit people for suspect COVID-19 until their lips are turning blue. Is this true?

If so, this quote on who to test as priority in Germany is particularly concerning:

“The other target should be patients in the first week of symptoms, especially elderly patients who tend to come to hospital too late at the moment – when their lips are already blue and they need intubation.”

Sorry, source of quote:

amp.theguardian.com/world/2020/apr/26/virologist-christian-drosten-germany-coronavirus-expert-interview?CMP=Share_iOSApp_Other&__twitter_impression=true

I'm not sure there is a proven course of treatment yet that could be given prior to getting to the stage of blue lips and struggling to breathe, is there?

I don’t know Vim, but the person quoted as saying blue lips is too late is a leading Coronavirus expert in Germany, so there must be something?

Oxygen can certainly be given before that stage, and patients can go downhill very quickly.

That quote is about testing, not treatment.

But he’s talking about testing there not treatment - saying that we should be doing early testing of people not waiting until they turn up needing to be ventilated.

“ Q: Should all countries be testing everybody?

A: I’m not sure. Even in Germany, with our huge testing capacity, and most of it directed to people reporting symptoms, we have not had a positivity rate above 8%. So I think targeted testing might be best, for people who are really vulnerable – staff in hospitals and care homes, for example. This is not fully in place even in Germany, though we’re moving towards it. The other target should be patients in the first week of symptoms, especially elderly patients who tend to come to hospital too late at the moment – when their lips are already blue and they need intubation. And we need some kind of sentinel surveillance system, to sample the population regularly and follow the development of the reproduction number.”

Yes it is leaving treatment far too late.I have seen a few articles where the oxygen levels have dropped to low levels with Covid but the patient themselves does not feel too out of breath.
Sadly when they do get bad enough to need to go to hospital they will be in a bad way.
Earlier intervention via oxygen and not placing on a ventilator would have saved I believe many lives.

Yes, I think they are leaving it too late and not learning lessons from other countries.

Agree leaving too late.
The NHS terrifies me.

Yes I agree, it certainly sounds like they are in some areas. Madness if they have the facilities and staff.

I've seen that cpap is recommended as an early treatment if oxygen levels are low.
I'd possible to request this as treatment?

Yes its true. This is why I have an oximeter. Should I contract the virus and my oxygen levels drop and they refuse to take me, I will go to the hospital myself and demand it. I live 2 miles from the hospital

Worsening shortness of breath and you need to speak to a clinician.
Shortness of breath at rest needs an urgent face to face review.
Here is the BMJ info for remote consultations which lists the ‘red flags’ ie symptoms that should they develop require urgent review.
www.bmj.com/content/bmj/368/bmj.m1182/F1.large.jpg?width=800&height=600
Important to note other symptoms such as increased drowsyness or confusion (v important in older people) or minimal/no urine output.

Any symptoms of central or peripheral cyanosis (blue lips, tongue, fingers, toes) and you need to be seen immediately.

Your GP should be available to talk to (+ face to face consult if required) during the week, Out of hours via 111 in the evening or weekends. If you are concerned about deteriorating or persistent symptoms then call them.
Any of the red flags then 999.

I read somewhere in the bbc a few days ago that sometime during March the criteria for sending people to hospital was a severe as you state, but that has been changed

This is from the Sunday Times. The relevant points are A) guidelines issued by the NHS to paramedics meant seriously ill patients were not admitted to hospital. B) those guidelines have been subsequently made less stringent. Apparently. C) waiting until a patient is in advanced stages of Covid prior to hospital admission may reduce their survival chances. Two thirds of patients who required a ventilator died.

From March 12 paramedics in the capital were told that suspected Covid-19 patients scoring as high as six might not need to be hospitalised. The guidance was then changed on April 10 to advise that people scoring between three and five should be taken in for assessment.LAS declined to say whether the change had been influenced by concerns that patients might have become seriously ill or died. It stressed that its previous guidance had been only one of several clinical assessments used by medics on the scene...The revelation will add to fears that some patients have only reached hospital when they are already critically ill. Yesterday a study by the Intensive Care National Audit & Research Centre revealed that two-thirds of Covid-19 patients who had needed a ventilator died. Of 4,078 NHS intensive care patients where an outcome was known, 2,067 died and 2,011 were discharged. That equates to a mortality rate of 50.7%. Some experts are concerned that many people are not receiving care quickly enough

www.thetimes.co.uk/past-six-days/2020-04-26/news/take-more-coronavirus-patients-to-hospital-paramedics-told-jks756c63

The ideal treatment is what our PM recieved. Early monitoring of oxygen levels and early intervention with oxygen before the condition worsened. Unfortunately for the rest of us the policy is to stay at home (as long as possible) and protect the nhs by dying quietly at home.

See nyt article for why early treatment is key
www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html

namechange
See this from Times' article:

Some experts are concerned that many people are not receiving care quickly enough. Richard Levitan, a US doctor, said last week that the number of patients who needed a ventilator could be reduced if people with symptoms such as fever and cough monitored themselves.Pulse oximeters clip on a finger and measure the oxygen in the body. The simple devices, which cost about £25, had helped to save the lives of two of his friends, Levitan said

I had breathing difficulties at rest and have severe asthma and was refused a face to face assessment even though my peak flow was at 50%. I was losing consciousness coughing and developed a secondary infection. The dr prescribed antibiotics over the phone and said they couldn't see me until I was 'seriously hypoxic'. The only criteria for that, seeing as I didnt have an oximeter, was if I started turning blue and couldn't say a couple of words together (I already couldn't manage long sentences). I know that in normal times I would have been admitted for oxygen, IVs and chest xray as I have been many times before.
I am so glad to hear they have changed the criteria.

Unfortunately for the rest of us the policy is to stay at home (as long as possible) and protect the nhs by dying quietly at home

crazydiamond
I had read myriad posts by people describing contacting 101 to obtain medical care for a relative who was struggling to breathe. And receiving none. The report in the Sunday Times confirms that was policy. It is quite incredible.

I think we all know (though I doubt the Government or NHS bosses will ever admit it) that the criteria for a face to face appointment and / or hospital admission for Covid was too strict to begin with. I think it stemmed from this constant early message that Covid was really just a bit of a cold or mild flu. And also gate keeping to stop the hospitals getting overwhelmed. I think lives will have been lost due to delayed intervention.
I’m praying that they’ve actually learnt from their mistakes.

I think we all know (though I doubt the Government or NHS bosses will ever admit it) that the criteria for a face to face appointment and / or hospital admission for Covid was too strict to begin

Both the government and the NHS management must be held accountable for the decisions they have made. If the consequences of those decisions were lethal? That needs to be forensically examined.

But he’s talking about testing there not treatment - saying that we should be doing early testing of people not waiting until they turn up needing to be ventilated.

Absolutely - but he is talking about the importance of testing early so treatment can be given early - as by the time lips are blue it’s too late.

Whereas at the moment in the U.K. there is no testing capacity or apparent plan to do this, and people appear to only be admitted at a late stage.

NHS capacity is driving our govt strategy, and it will be very different numbers of admissions - and deaths - if people are only allowed in when it may be too late for successful treatment.

Interesting thread:

www.mumsnet.com/Talk/coronavirus/3892192-warrington-hospital-s-high-survival-rate-are-other-hospitals-doing-this

Yes sadly I think this is too often the case

At work (mh unit) we are well aware that people won’t be admitted unless they are very ill. As number of admissions drop hopefully this shall change. This means we are looking after them when they are seriously struggling with covid symptoms and we are not physical care professionals.

What is considered mild symptoms I’m quite sure would allow many in normal circumstances to be admitted to hospital where they could get oxygen and constant medical professional observation (I am not able to tell if someone has a secondary infection and is in need of antibiotics it’s guess work).

And then there are the cases I have heard first hand how there is a very sudden deterioration from so called mild symptoms to needing to being in ICU