Why didn't UK run out of ventilators?

[YeOldeTrout]

Like Italy did in their first wave? (didn't they? is that correct?)

My best guess is that in Italy, people who had no chance of benefiting were put on ventilators, but in UK, the realistic prospects were better assessed which meant 'the right thing to do was not to prolong suffering' by trying to put people on ventilators who couldn't benefit from mechanical ventilation.

It's just that if Italy & UK are about the same population size, but UK has had more actual deaths, and Italy had many more intensive care beds & ventilators, then it seems like UK should have run out of ventilators too. What am I missing? *

*I may be misinformed, glad to be corrected, if so!

That our hospitals massively increased their number of ventilators between January and March. The one I know increased the number by a factor of five. And the drop in other cases reduced the normal demand by more than half.

From what I can gather it's now being discovered that ventilators are pretty useless if it's got that far. They are being used less than previously. We are learning from Italy's mistakes

I think one issue in Italy was that the patients were massively concentrated in one area (Lombardy) whereas UK cases seem more distributed geographically.

From snippets of conversations I've had with doctor/nurse friends it does also seem as though the UK is being a bit more pragmatic (not sure if that's the right word?) about who they put on ventilators.

I think you're quite correct. I have also read that Italy was unable to utilise any private hospital beds, so in fact it was appropriate beds/wards they were running out of. Mafia has a lot to answer for.

We are learning from Italy’s mistakes
There’s probably been a bit of this for each subsequent country suffering the onslaught of the virus as it has moved around world. I thought there was a conclusion that in a lot of cases CPAP oxygen was a better choice for a number of patients.

They try to avoid ventilators at all costs now, as once you're on one you have a 20 percent chance of survival.

Early on, people were put on ventilators quicker because doctors thought it would give better outcomes.

I think it’s because of number of reasons-

1. lots of people in care homes not being sent to hospital and left in the care homes to die - in Italy lots of elderly relatives live with family rather than care homes, and likely ventilated initially as they didn’t know what was going to hit them. We were able to see what was on the way.
2. People being contacted to fill out DNRs
3. 111 not sending people to hospital until late stages - then some are too far gone to be ventilated, or don’t last long on the ventilators. Lots of reports of people dying after being refused admission after 111 calls. Others dying at home after not wanting to bother 111.
4. Due to the poor health of many who end up on ventilators they aren’t lasting on them and ‘clogging them up’ they are just dying, so they are available. My cousin said they have spare ventilators in her hospital basically because the patients are just dying. If you look at the number of deaths we have, spare ventilators aren’t a measure of how well we are doing at all.
5. The geography is different - more hospitals and ventilators spread out over the country rather than concentrated areas being overwhelmed.

These are just my ideas though, happy to be proven wrong!

I think some units found that the use of CPAP masks/ 'black box' technology could be adapted with some success if the stage was caught earlier than at the ventilator requirement (read this in a couple of diaries posted by front line ICU workers). Once a person is on a ventilator, I understand that it is not likely to be something you can just take off again all that fast for someone else, maybe the patient needing 3 weeks or more on one machine - that may have filled up available equipment quite early on.
Yes also to the geographic concentration in Italy, though I heard that they had equipped special trains in order to try to move people needing treatment to places with more capacity. Not sure whether that would have been quite a risk in other ways though.

IItalian medics tried to save everybody. The NHS had more information by the time it got bad here about the effectiveness of ventilator treatment and hospitals pretty much didn't admit anyone in a category that they thought wouldn't be effectively treated by ventilator. There was a more stringent triaging system.

111 not sending people to hospital until late stages - then some are too far gone to be ventilated, or don’t last long on the ventilators. Lots of reports of people dying after being refused admission after 111 calls. Others dying at home after not wanting to bother 111 This.

Brilliant programme on Radio4 last night that answered the question in thread title. Highly recommended.

Didn't run out because ventilators aren't actually that useful for covid19 patients, is the short answer. They really are a last resort and can make the patient's outcomes much worse. But it took a while to figure that out -- hence used a lot in Italy but not by the time UK was peaking.

Uk medics probably learnt a lot from doctors in NYC as well. I believe it was there that ventilation as the most effective measure was first questioned.
Lots of reports of people dying after being refused admission after 111 calls
Do you have any figures for that? I can only remember one incident in the news, not 'lots'.