If the NHS isn’t overwhelmed, why aren’t our death rates better than Italy?

[CarolynMartens]

Totally prepared to be told I am stupid! We are 2 weeks behind Italy and their system was overwhelmed - but I keep reading the NHS isn’t at full capacity or overwhelmed. In 2 weeks it seems likely we’ll reach the figure they’re at now. Should it not be lower?

I know there are discrepancies between the way countries count deaths.

Italy has a death rate of441 per million Vs UK 305 per milion
Our death rates are better than Italy death rates

This is driving me mad. Figures from France have lead me to believe that there have not been enough people in hosptial or admitted to late. I think this will come out eventually as a big mistake and a scandal. The gov keep saying we have capacity.
The times and the daily mail ( sorry) seem to say that people have not been getting to hospital in time as well.

I predict a massive social care crisis in all countries affected, no one will ever want to set foot in a care home, senior living facility etc, again, in the mind of the public they have become synonymous with morgues

@B1rdbra1n nooooo! Don’t go ruining everything with the actual facts

It is very hard to judge. I would not want to rush to hospital personally given the infection rates in there, viral loads, sick staff etc etc. never mind that most people put on an ventilator die although oxygen as BJ had seems worth having if you need it. However if there is a god chance of survival if and only if you go to hospital then I suppose most of us would want to go unless we are already terminally ill or aged 96 and feel we want to die anyway.

It will be very hard to compare figures as most people are not tested anyway so comparing our normal 600,000 die a year in the UK v. how many died this year will probably pick up a lot of covid deaths (and a few people who died as they did not get someone to help them when they had a heart attack).

A similar motivation was no doubt in play when the NHS instructed paramedics in London to not admit patients to hospital even if they had serious symptoms. That was the paradigm from March 12th until the criteria was apparently changed on April 10th. One month. The Sunday Times reported that this raises questions about how many died because of this protocol?

www.telegraph.co.uk/news/2020/04/24/care-homes-ordered-take-patients-suspected-coronavirus-nhs-hospitals/

@Bool I can’t speak for Maggie but I think she is saying it could be the case that care doesn’t come early enough rather than it being inadequate. I very much believe that the people who are admitted to hospital are getting the absolute best care that they can but would they have had a better chance of survival if they are admitted earlier which is what’s reported to be happening in Germany.

I can understand why we are doing what we are doing though, we couldn’t allow what happened in some Italian hospitals. Only hindsight will show if we made the correct decision on when to admit patients.

Bool yes I never even thought about Vit D before we moved to France, despite living my whole life in the northeast US and UK. I was surprised to see how seriously people took it, all elderly people and children are supposed to get the supplements from their doctor and lots of other people take them too.

It would be great if all this spurs the NHS to push Brits to take Vit D in the winter too, loads of people have deficiencies which do affect your health generally.

The facts will emerge slowly after this has passed and all the data has been collected, we don't have the true picture yet

The NHS in London has altered its official guidance to lower the threshold at which paramedics take suspected coronavirus patients to hospital.The disclosure is likely to prompt questions over whether some Covid-19 patients became seriously unwell or died because they were not taken to hospital before the guidance changed. News2 allocates a score to vital signs including breathing rate, oxygen saturation, temperature, blood pressure, pulse rate and level of consciousness. Originally a score of five indicated a need for hourly monitoring.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

Deaths at home are included in statistics. Just not the daily ones. They are included in the weekly ones so long as the doctor signing the death certificate has written Covid, even if that is prefaced with the word possible or probable

Death rates will only be affected if people are unable to get the treatment that they need. We have been consistently under capacity so locking down earlier or harder would not make any difference to death rates.

The reason we are consistently under capacity is because until recently the gatekeepers of admission to hospital - paramedics and 111 - had been given an extremely high score, 7, I think, to work to on the 1-10 scale being used to triage patients. By the time many patients were being admitted, they were so ill that their survival was compromised in a way it would not have been had the revised score, now 3-5, been used with them. So you're right that they were unable to get the treatment they needed early enough for it to be effective and that has undoubtedly contributed to our death rate, which, however you twist it, is high.

Indeed - proving the one certainty in this - the NHS is rarely there if you need it and worshiping a God like thing called the NHS is like people forced in dictatorships to worship a leader who abuses them.

The long term affects of not going in until blue will be interesting to see as well.
How much additional damage does it do to the lungs, does it increase your risk of developing other illnesses? Does it increase the severity.

If lungs are protected earlier, does it make a difference?

Or is all that irrelevant and they are ok?

*Italy's hospitals were overwhelmed because they tried to save everyone

whereas in the UK, people are often told they have to be turning blue before they can be taken to hospital
which is basically keeping the NHS going by restricting access*

Not true , scaremongering

Probably because UK population is 10% bigger (66m v 60m) in a land area which is considerably smaller (240,000km2 v 300,000km2)

Population density matters hugely when comparing outbreaks of infectious disease

The only way to control deaths is to control the number of people that get infected. Lots of people who are elderly or particularly susceptible WILL DIE whether they get treatment or not. I think the public is under the misunderstanding that if the hospital can treat you they can save you, this sadly is not true. Which is why letting the virus rip through our communities is not a great idea. Germany are containing it therefore less deaths

It could also be that because UK is 3 weeks behind Italy, the NHS had more time to prepare than Italy by freeing up beds, limiting non Covid admissions, expanding ICU capacity etc which helped hospitals.

Two examples. One was the decision to apply a stiff broom to move elderly patients from hospital to care homes without testing them for Covid. The upshot of that is becoming explicit. Second, between March 12th to April 10th, paramedics and ambulance crews were specifically told by NHS management to apply a criteria so restrictive, patients who required medical care were denied it. The motivation behind both? To create capacity in hospitals. The question is did those decisions kill people?

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

Germany are recordingdeaths differently. So you can not compare

@WatcherintheRye

Exactly as you say the goal posts have been moved now that the panic has abated.

As far as care homes go, if your granny is paying 1k a week why the heck is the owner not putting their hand in their pocket and ordering ppe for their staff.

I do know an ex owner of three homes, they fly first class around Europe and as far as Australia, New Zealand, they have a caravan/chalet in the UK they paid £500k for.

She is an ex nurse, he worked in a car factory. There is so much money in care if you have the nouse. To be fair she would have bought all the ppe that was needed becauseshe is a caring person.

Yes helpful, i believe they are one the graphs now but the scale is so small and they are behind ( i know they count certifcates). I am waiting to see tomorrows figures and would be interested to see what they are like and hopefully the gov wont skim over them. I also noticed in last weeks 400 people died at home with covid - this seemed very high to me so will see tomorrow. I want the no.s fo be given even weekly and even if behind by the gov in the update. But this seems impossible and i am not sure why.

Figures can easily be manipulated, or made to look “shocking” or “reassuring” as needed; no wonder the government keeps throwing figures at us, instead of facts.

Even if not by moving a zero here and there, subtleties in the waffle can be very significant. For a start, there’s dying “with” and dying “of”. Countries might not be consistent in whether they’re including deaths in care homes, workplaces, hospitals etc.

@bool I said in the absence of data so clearly not factual. I am also not doubting the good work done by every individual in the NHS and wider care system. Certainly not criticising it. However on this discussion forum, I feel like the care the system is providing is inadequate.

Genuine question - was the government's objective to stop the NHS being overwhelmed or save lives? I don't think it's unreasonable to feel like it was the former not the latter based on what we're seeing. Or at least that so much focus went on the former, other measures which could have prevented the latter weren't well managed.

Italy is a Catholic country and seemed to be more aggressive about putting people on ventilators. Turns out putting older people on ventilators is ineffective - v sadly they die anyway. In the U.K., they seem to have decided to avoid this (which everyone is furious about, but know if I were v old and had Covid, I’d much rather die in a care setting that on some awful disease)