UK monitoring and treatment of COVID

[Orangeblossom78]

I have been reading this article about how people with the virus have been urged to stay at home and only seek help if they get very ill

Compared to other countries where they had more monitoring at home.

I wondered what thoughts are on this approach and has it changed any, as it seems survival rates are greatly improved more recently in the UK.
(article is from start of April)

www.theguardian.com/world/2020/apr/06/fears-britons-self-isolating-covid-19-seek-help-too-late

Also I think Germany (mentioned as a comparison) had a much better mortality rate from the virus than here and people credited the visits at home with this.

It seems this was updated in early June to involve more home monitoring of oxygen.

www.england.nhs.uk/coronavirus/publication/pulse-oximetry-to-detect-early-deterioration-of-patients-with-covid-19-in-primary-and-community-care-settings/

I read one of the reasons the death rates were so high here, was that people weren’t admitted to hospital soon enough.

Germany were much faster at admitting much less severe cases than Uk

Well hopefully these changes and also the lower numbers overall might mean things are different now. Along with new treatments as well

Would be interested in hearing from anyone who had experienced home monitoring or treatment recently. But I guess there are so few cases now

My husband had home monitoring but only because we had an at home oximeter and called the GP who used his stats to determine treatment

There were threads on here urging people to buy pulse oximeters back in April, after a NYT piece on silent hypoxia in covid patients.

UK admitted far too late and did not offer as much monitoring as somewhere like Germany. ‘Stay at home unless you’ve severely deteriorated’ was the mantra.

The mediocre 111 played its part in this too.

I remember that and in the press about getting an oximeter- the prices rose online for them too. It seems the NHS was pretty unprepared and 111 not great- it should have been possible to do this earlier seeing as Germany managed it. They are not expensive either. Maybe should have spent money on these rather than focusing so much on ventilators.

www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0445-remote-monitoring-in-primary-care.pdf

At least this new guidance says when to call 999, and more info on monitoring etc

Assessment and monitoring of patients who meet the criteria for management in a primary care setting
Patients should be managed by primary care in accordance with the policies set out in the general practice standard operating procedure.4
Following assessment using the total triage model, plan an assessment using pulse oximetry.
• Ambulatory patients: assess triaged patients on site, in accordance with local protocols adopted to separate patients with and without symptoms of COVID-19 (this could be done using a hot site, hot zone or in an appropriate out-of-hours setting, according to local service set up).
• Housebound or shielding patients: deliver pulse oximeters to patients. As permitted by local supplies, this can achieved by:
– asking a friend or family member to pick up the oximeter in person, and asking the patient to take the test at home
– using a volunteer (referrals for support can be made via the NHS Volunteer Responders portal5) if immediately available.
Contact the patient to get their oxygen saturation readings (at rest or, where appropriate, on exertion) or arrange for these to be phoned through. Written instructions for how to use a pulse oximeter and record oxygen saturations are included in the example diary in Annex 2 (published separately). A video consultation may be appropriate to teach the patient how to use the oximeter. Where patients are reliant on carers to help take measurements, it may be appropriate to support carers to put in place infection prevention and control procedures.

Good idea getting NHS volunteers to deliver oximeters to the vulnerable living alone- if they are co-ordianted enough for this and live locally.

I heard it was a bit of a mess and lots were left with nothing to do.

I've read the same as you that early administration of oxygen can make all the difference. The UK's early policy of very stringent triaging almost certainly must have increased the death rate. I don't know if the decision-making came from the government or NHS chiefs but I wouldn't be surprised if there was a great reluctance politically to have pictures of over-crowded hospitals filling out screens as happened in Spain and Italy so we got round that by not admitting people to hospital.

Hopefully lessons have been learned and earlier oxygen treatment will now be the norm.

"people with the virus have been urged to stay at home and only seek help if they get very ill"

I never heard this message, or thought that was what we were supposed to do. Many MNers often say it but they must be getting information from different sources from me. I sort of thought we were supposed to ring 111 if we thought we had it. And they would advise what to do. But I would have gone to hospital if I felt awful, regardless.

Now we have much improved access to testing too- at home if needed, whereas then maybe 111 was swamped with virus cases and also the worried well- must have been difficult to sort out the most ill from the others.

Things have changed hopefully for the best.

www.theguardian.com/world/2020/jun/22/why-doctors-say-uk-better-prepared-for-second-wave-coronavirus

sounds positive

That's a very interesting article, thanks OP. It's amazing how much has learnt over the last few months.

Yes i have also read that the mortality rate from the virus has come down lots with time too, another positive.

www.cebm.net/covid-19/declining-death-rate-from-covid-19-in-hospitals-in-england/

www.dailymail.co.uk/news/article-8462623/Are-doctors-better-treating-Covid-19-Uks-death-rate-FALLEN-quarter-peak-level.html

(sorry DM but study was by Oxford University)

and the first link mentions

"could be a reflection of either the disease becoming less severe or hospitals that are now less concerned with being unable to manage peak infections being more willing to admit patients with lower disease severity than they would admit in early April."

my GP still has a message on their answerphone when you call saying stay away if there is any change you have CV (fine but it's the next part that isn't) and only call 111 if you absolutely have to if you have a high temp and persistent cough that you really cannot manage at home. Shocking that that msg has not been updated since April and people who don't want to make a fuss will still be at risk of dying if they hear that.

I tested positive on Friday and have had 3 phone calls since then to check I'm ok.

That's good to hear Candy. Hope you're recovering well.

I think at first they were so afraid of the NHS being overwhelmed that people were kept at home when they should have gone to hospital.
A friend had an ambulance called by 111 in March as he had all the symptoms and couldn't breathe properly but the ambulance then refused to go to him as he could say 4 words in a row. Apparently they would only go if he could only say 2 words 🤷‍♀️ Luckily he was fine, but it seemed crazy that they didn't even go to check he was ok.

I had CV at the beginning of march. I was really unwell, v breathless, my pulse was really high and my oxygen low (i had a oximeter as I have asthma) I was unable to get out of bed. The message was stay at home basically, the care was awful, it was terrifying, I felt like I had to stay at home until I collapsed. It seems very different now but I think in the couple of weeks around lockdown there was real fear the nhs would be overwhelmed.

That's awful tangledyarn hope you are doing ok now

@Orangeblossom78 Thanks :) I'm ok! It's been a real struggle trying to get better and still have some lung issues but It seems to be improving now. I hate to moan as I love the NHS and i know it was just an awful time all round.

@lljkk

"people with the virus have been urged to stay at home and only seek help if they get very ill"

I never heard this message, or thought that was what we were supposed to do. Many MNers often say it but they must be getting information from different sources from me. I sort of thought we were supposed to ring 111 if we thought we had it. And they would advise what to do. But I would have gone to hospital if I felt awful, regardless.

I read it on official NHS advice and in the media when people died.

The issue, as ever, is health cuts and especially in public health.

We had no system to respond. Germany did. They recruited trainee doctors to phone people at home and ask about breathing. We did fuck all.

Perhaps if Boris could have been arsed in the early stages, or there had been a proper PM when he was ill, COBRA could have taken proper charge.

Happy hypoxia was a real issue.

I said to my DH that if we feel we are struggling to breathe a bit we call for an ambulance and go to A&E if refused, after a particular case where a young mum died at home after an ambulance wouldn't come. That we would have to make a fuss.

England's response has been disgusting and it is because there was no leadership.