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Brexit

Westministenders: Peak something

990 replies

BigChocFrenzy · 16/04/2020 15:05

Westministenders: Peak something

The story so far

COVID has changed the world for the next few years, like a slowly exploding nuke:

  • killed well over 100,000 people
  • made many people afraid to leave their home
  • caused a Global Depression

Countries locked down because they needed the extra time to

Raise the Line while Flattening the Curve:

  1. Flatten the curve of the numbers needing healthcare to a level the system can manage

  2. Raise the capacity of their health services and public health systems - their testing and tracking process

Also, scientists desperately needed time to find out more about COVID:
how to avoid it, how to treat it

What happens next ?

Research teams around the world are working to produce a vaccine,
will become hopefully available within the next couple of years

In the meantime, treatment procedures are being developed to better treat COVID sufferers.

Also in the meantime, countries will need to gradually exit lockdown to rescue their economies from complete catastrophe.

Timing & measures for each country will be dependent on:

Death rate after peak,
health service capacity,
testing & tracing capacity etc

....and also what their govt and public deem an "acceptable" level of extra deaths & serious illness.

Possibly some countries will need to cycle in and out of lockdown,
whereas others will be able to accept the death toll with lesser social distancing measures.

The first few countries are already relaxing lockdown,
so the UK will watch, wait and hopefully learn what works and what doesn't

..... then copy these the correct way round

Westministenders: Peak something
OP posts:
Thread gallery
43
Barrique · 22/04/2020 09:32

@davidallengreen

This would be a good question for someone to ask

Was that "clarification" letter voluntary, or did McDonald insist on a "ministerial direction" so he would have to write it?

And, if so, which minister?

("Ministerial directions" are powerful self-protective tools for officials)

ClashCityRocker · 22/04/2020 09:33

I do wonder if effective treatment is the key to getting us out of lockdown quicker.

One of our local gp practices is trialing hydroxichloriqine (spelling?) on over fifties. Is this the one that Trump has been raving about? Signing up to the trial also seems a fast track to getting tested...

Barrique · 22/04/2020 09:36

Interesting edition of R4 More or Less just finishing. Statistician interviewed has delved into the figures to allow for reporting delays and thinks that for the UK a peak of around 800 deaths occurred on April 8th and the UK is currently on about 700 per day.

That’s on the officially available figures though.

BigChocFrenzy · 22/04/2020 09:40

Tatiana Germany treats cases from the first symptoms

Queues and rationing have never been a part of the German health care model
So far, the huge spare capacity of the system

  • and some amazingly quick reorganisation to form "Coronataxi" home visit teams -
has meant COVID patients are also treated to the maximum they need

Regular home visits with checks on temperature, blood O2, BP, heart
and administer meds

Anyone with breathing difficulties is admitted early

  • doctors here have been frequently saying in articles and on TV how vital it is to treat this v early, to head off worse problems developing

Sometimes people feel OK, but blood O2 is too low - this can lead to very sudden deterioration, so low blood O2 cases are admitted early too

Even for those with no symptoms or very minor ones, there are daily monitoring phone calls to check if symptoms are worsening

  • and also to check they have stayed home; there are heavy fines and possible jail terms for leaving after a positive test
OP posts:
BigChocFrenzy · 22/04/2020 09:46

From red's link about dodgy tests:

"Ministers boasted we were world leading in developing this test back in January"

Every time in this crisis that minister claim "world leadership" seems to mean that they decided to ignore what everyone else is doing and instead do it the British way,
their interpretation of which is to try all possible wrong ways first

OP posts:
BigChocFrenzy · 22/04/2020 09:53

Hospital treatment in Germany is usually lung Xrays, oxygen, meds for bacterial infections that have often hitched a ride

Stats are that 2% of confirmed cases went to ICU, 75% of whom on ventilators (so 1.5% of total)
but 16% of all cases were hospitalised

Likely gives lower death rate than making sick people wait at home suffering breating problems - and panicking - until they turn blue enough for treatment

OP posts:
DGRossetti · 22/04/2020 10:01

There's been a viral theory of Multiple Sclerosis for at least 25 years.

squid4 · 22/04/2020 10:19

I've been ranting about the german approach at work BCF; and have started admitting anyone even slightly borderline. we actually have beds for the first time in YEARS due to the cancellation of all the routine stuff (the surgical beds are all full of covid); I'm so used to the site manager breathing down my neck about discharging as many patients as possible; it's hard to adjust

I am trying to get some of the doctors we have moved off the frontline due to health issues to head up some sort of telephone follow up for the mild cases we don't admit (the government have talked about this, but as usual zero action yet)

I just don't feel we know enough about this virus yet to assume people will be ok

So many patients are turning up extremely sick, at the point of palliation or ventilation

squid4 · 22/04/2020 10:20

And yes, the comfortably hypoxic is DEFINITELY a thing

Twice in one shift a junior doctor came to me saying they thought the gas machine was broken because they didn't believe how low the oxygen level on a patient who didn't look that sick was

Those patients were then ventilated

squid4 · 22/04/2020 10:28

Anecdotally I know a number of people who signed up for the NHS volunteers scheme and also retired doctors who signed up for re-registration to help out

None of them have been followed up and found anything to do. The retired GP I know said he was sent an email several weeks after he put himself forward and it sent him to a broken link where he had to register more details and he simply couldnt' make it work and there was no one to contact about it.

It's all headlines isn't it. None of these promises are actualy meaningful.

However I have to say my local trust has been brilliant, miles ahead of the curve, testing staff for over a month now, cancelling surgery and redeploying staff and resources well ahead of time, and we are doing fine. We are not a hard hit area though.

Senior management have quite openly said to me the government is compiled of absolute idiots right now. Zero handle on anything.

BigChocFrenzy · 22/04/2020 10:32

Squid That's what home visits here can pick up early:
low O2, but patient feeling reasonably OK

Doctors here have long been warning it is essential to treat early,
so dangerous otherwise

System here is that
either someone has been identified via contact tracing of infected people
as possibly infected
or
they fell unwell and phone their own GP or a central hotline for assessment
(3 x as many GPs per 100k pop here, so GPs know their patients well and are normally quickly available)

In either case, people are then allocated a test, either to drive to, or via home visit if they can't
e.g. unwell, elderly, no car etc

and as I said, positive cases are not left to suffer on their own,
but are regularly monitored and fully treated according to their individual needs & condition.

OP posts:
BigChocFrenzy · 22/04/2020 10:37

Seems mad that people are suffering with breathing problems at home - as on MN "Lungs" threads -
but the headline reports are that hospitals are half-empty
and MN has threads from nurses with "apparently" nothing to do Hmm

which makes it look like the govt have managed the crisis so well

  • unlike "silly" Italy who actually tried to save all the patients, instead of the govt's reputation -

also feeds into the narrative that the crisis was blown out of proportion
and hence that lockdown needs to end now

OP posts:
squid4 · 22/04/2020 10:38

I feel almost complicit in all this!! I am only one doctor and can only treat who comes to A&E...

I am not happy.

DGRossetti · 22/04/2020 10:42

Somebody appears to be sounding out a Boris-free future Hmm

Would a useless unelected Tory leader be any less of a distraction than a useless elected one ? Who's taking odds ?

If people like history, art, drama, romance, weird misogyny and tales of incredible women, the story of Holman Hunts painting "The Scapegoat" might just be your cup of tea.

Not sure why I thought of that ....

MaxNormal · 22/04/2020 10:46

@ClashCityRocker I'd be cautious about signing up for any hydroxychloroquine trials. The most recent US study produced a slightly higher death rate for those given it.
It's also got absolutely vicious, potentially long-lasting or permanent side effects.

The trial is mentioned in the below:

www.theguardian.com/world/2020/apr/21/coronavirus-second-wave-hydroxychloroquine-trial?CMP=Share_iOSApp_Other&fbclid=IwAR0q1o8uCIwteFw-ICkUGzIWZ_GsgrSIrZidLu0Pil_OowVkjypI1ljL3YI

cloudsinspring · 22/04/2020 10:48

Maybe we need primary care to be taking real leadership on this one.

They need to be following up on all suspected cases who make contact with them and feeding back to NHS England that there is an urgent need to do that and pick up severe cases early and proactively refer people to hospital. Not let people make their own pathway through the illness.

Eg my friend's 8yo son has suspected covid, they have made contact through 111 and spoken to their gp but they are now left to their own devices and will need to make any further contact themselves.

I am actually really worried because they seem quite blasé about his wheezing but it does seem that oxygen levels can get quite low before people are in distress. It seems that it can be hard for people to know when things are serious and really there needs to be much more proactive follow up care.

DGRossetti · 22/04/2020 10:50

Seems mad that people are suffering with breathing problems at home - as on MN "Lungs" threads - but the headline reports are that hospitals are half-empty and MN has threads from nurses with "apparently" nothing to do

Anyone remember that "Porridge" episode where the prison doctor was very proud of keeping an empty ward ?

(Or the "Yes Minister" about the empty hospital ?)

DGRossetti · 22/04/2020 11:10

Meanwhile ...

Coronavirus: World risks 'biblical' famines due to pandemic - UN
www.bbc.co.uk/news/world-52373888

Coronavirus has mutated into more than 30 strains, say scientists in China
news.sky.com/story/coronavirus-has-mutated-into-more-than-30-strains-say-scientists-in-china-11976380

COVID-19 Could Help Solve Climate Riddles
www.scientificamerican.com/article/covid-19-could-help-solve-climate-riddles1/

but ...

COVID-19 May Increase Heat Extremes This Summer
truthout.org/articles/covid-19-may-increase-heat-extremes-this-summer/

(which references www.sciencedaily.com/releases/2019/10/191017131431.htm so not so fruitloopy)

The last is the most intriguing (and worrying) since the French heatwaves have already been remembered. And since we probably know more on balance about COVID than we do the climate, any sudden input to the Earths climatic system should be of concern.

DGRossetti · 22/04/2020 11:11

Maybe we need primary care to be taking real leadership on this one.

I think there is some middle ground. I've designed a badge ....

ClashCityRocker · 22/04/2020 11:18

@Maxnormal thanks, I'm not eligible anyway but yes, I thought it was the same one.

They're looking for 3,000 either over 50 with certain conditions, or over 65 with no conditions.

I do think there has been too much focus on preventing people from getting it (which is of course important with regards to managing NHS capacity, but ultimately doomed to eventual failure unless we get a vaccine magically quick) rather than treating it effectively. Just to be clear, I'm talking about government level decisions.

BigChocFrenzy · 22/04/2020 11:22

Ever since the crisis really hit,
my social circle have been hoping for a repeat of last year's long (horrendous) 40C heatwave

There is a belief / prayer that weeks of v strong sun could kill off most of the virus and also make it less transmittable
(I'm neutral on this, insufficient data)

Well, it's not something a govt can actually program ....
but maybe they can do a heatwave dance, as distinct from a rain dance

OP posts:
JeSuisPoulet · 22/04/2020 11:25

Isn't it odd they are arguing about whether it was an admin error or a political decision...heaven forfend it would be a medical decision Hmm

I am so depressed at the lack of planning. Nightingale empty due to no staff and apparently hospitals full of staff but no patients. Huge lists of ex NHS workers who could be helping out in both not being used.

Added to the textiles companies not being used for PPE
Added to the testing centres not getting swabs because no increase in testing
Added to the ventilator companies not being used in favour of giving money to donors
Added to the cost of bots to convince us NHS staff think we should come out of lockdown instead of spending on proper community testing, tracing and isolating

It's just a constant cycle of shit.

Added

BigChocFrenzy · 22/04/2020 11:30

DGR Scientists working in this field keep saying that the variations that COVID produces are not a concern wrt treatment, vaccine, or possible re-infection rates

Also that for most viruses, mutations over time are to less virulent forms

Ending COVID via Vaccination

https://www.city-journal.org/coronavirus-vaccine
The biopharmaceutical industry will be able to make a Covid-19 vaccine

  • probably a few of them -
using various existing vaccine technologies.

But many people worry that Covid-19 will mutate and evade our vaccines,
as the flu virus does each season.

Covid-19 is fundamentally different from flu viruses, though, in ways that will allow our first-generation vaccines to hold up well.

To the extent that Covid does mutate, it’s likely to do so much more slowly than the flu virus does,
buying us time to create new and improved vaccines.

Every virus has a genome composed of genetic material (either RNA or DNA) that encodes instructions for replicating the virus.

When a virus infects a cell, it accesses machinery for making copies of its genomic instructions
and follows those instructions to make viral proteins that assemble, with copies of the instructions, to form more viruses

(which then pop out of the cell to infect new cells, either in the same host or in someone new).

There is a critical difference between coronaviruses and flu.

The novel coronavirus genome is made of one long strand of genetic code.
This makes it an “unsegmented” virus—like a set of instructions that fit on a single page.

The flu virus has eight genomic segments, so its code fits on eight “pages.”

That’s not common for viruses, and it gives the flu a special ability.
Because the major parts of the flu virus are described on separate pages (segments) of its genome, when two different flu viruses infect the same cell, they can swap pages.

Imagine two people with eight-page reports fighting over a copy machine.

In the tussle, some copies might turn out to have a mix of pages from two different reports.
This page-swapping process, where viruses exchange parts of their genome, is called reassortment.

The flu can change rapidly when multiple strains pass through the same host.
But coronavirus, as a one-page report, tends to stay together,
and while coronaviruses can swap sections

  • in a process known as recombination -
it is difficult to achieve and thus rare. (Imagine two pages ripping in the same way and swapping pieces that get glued together again.)

Coronavirus does mutate.
.....
A vaccine is like a description of a wanted criminal:
it tells your immune cells whom to look out for.

So long as the suspect’s appearance doesn’t change too much, then the vaccine works.
....
But once we’ve developed a vaccine for this strain

  • and once we’ve all taken it -
we’ll have herd immunity to it.

That immunity may fade as our immune system forgets the picture that the vaccine showed it,
but we can solve that by getting booster shots of the same Covid-19 vaccine periodically.

What we don’t have to worry about is the virus rapidly mutating away from our vaccines as fast as flu can,
because owing to its simplicity, it can’t pull off the flu’s face-swapping tricks.

(Early serious mistake by WHO and govt epidemiologists is that they initially assumed that - as for flu - people without symptoms would not yet be infectious

But that isn't the case for COVID-19 !)

OP posts:
JeSuisPoulet · 22/04/2020 11:32

Wow, that 30 strains link DGR...
I suspected a while ago it had mutated but kept being told it was stable as most coronavirus are. It certainly does explain the range in symptoms, effects and severity. Looks like more variance on tests are needed. "Prof Li and her colleagues said their findings also indicated that a "higher viral load leads to a higher cell death ratio"." which is what I was saying a while back that the govt haven't acknowledged at all with NHS staff and so are much less likely to think about with regards to the general population roaming free after lockdown.

Now, which strain was it Bozo wanted us all to get again?

JeSuisPoulet · 22/04/2020 11:35

BCF isn't the concern prompted by that article more about the amount of strains around all at one time? We may get one or two less harmful strains in a row but that infection history may make the 3rd much more severe?