Thread by @KatiaKerswell

@IndependentSage 🇬🇧 #covid #longcovid #NHS crisis

@DrGuddiSingh @DrRachelWardGP @mattinadakim @ProfEmer @Dr_D_Robertson @SusanMichie @globalhlthtwit @BinitaKane @Daltmann10 @SGriffin_Lab @sheencr @HelenRSalisbury @DeenanDpillay @martinmckee @Kit_Yates_Maths @ArisKatzourakis

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@DrGuddiSingh #covid

devastating impact on #NHS after years of underfunding & staff shortages: long waits for emergency services, operations postponed, delayed cancer treatment & difficult to secure doctor & dentist appointments.

Why & how can we help?

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@Dr_D_Robertson sparse data now; dashboard only England 🏴󠁧󠁢󠁥󠁮󠁧󠁿

First thing to watch as it impacts our future is growth of variants:

Three increase fast in 🇬🇧
each at 4-5% of sequenced samples —> watch this space to see what will happen in the weeks & months ahead…

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@ONS
— cases fall yet still 1 in 50-60 infected. Scotland 🏴󠁧󠁢󠁳󠁣󠁴󠁿 potentially rising but uncertain
—> situation where cases are falling, new variants increasing
so in a plateau period (for all age groups) waiting to see what will happen in the weeks ahead…

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#NHS National Health System

1) *Staff sickness significant*, highest in patient-facing groups, to #covid respiratory & infectious disease as protections lift regardless (note - latest data is until Jan)

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2) Hospital admissions — primarily for #covid relatively small but still significant

3) 🚑 wait times for several types of patients eg signs of stroke show significant delays

+ after admission, wait times longest in a decade:

28% wait more than 4 hours, 5% more than 12

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4) Waiting to start non-emergency treatment

- 1 in 9 waiting to start is significant & increased in March
- 38% waiting over 16 weeks greatly misses the target
- 4.8% waiting longer than a year is high after low figures pre #covid

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5) Finally, waits for diagnostic tests…

—> all pressures building up & increasing on the NHS.

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#NHS 💬

@HelenRSalisbury
- 3 guests from frontline help understand #covid impact
- huge task treating acute & #longcovid which also sickens staff —> shortages
- infection controls profoundly alters way we work
- build capacity of systems in community, hospitals, social care

@mattinadakim
- #covid disrupting prevention has hidden cost —> now see later more severe presentations coupled with the desire for elective care with a background of increasing emergency activity, a perfect storm
—> to survive next 5-10 years need sea change in integrated care

@BinitaKane perfect storm resonates. Staff really hit too —> lost a large number to death, chronic illness, burnout & stress & workload went up. For years consultants cancelled routine care to enter front line —> cumulative effect just peaks now.
- @mattinadakim better systems:

#covid swamps generalists:

@DrRachelWardGP
- for 17k patients max 500 calls daily. Now >1000 like seeing each 20 times/year instead of 2-3
- England 🏴󠁧󠁢󠁥󠁮󠁧󠁿 GPs see 46 people/day, safe level 25
—> patient safety concern in a background of a reducing workforce, losing GPs every month

—> staff exodus at all levels to stress, makes health service even more difficult

⚠️

1600 missing general doctors in the country —> Rebuild GP campaign

Negative press on lack of face contact significantly impacts morale

1 in 4 GPs knows a colleague who ended their own life

@ProfEmer #covid massive staff impact
- more deaths than the greatest previous disaster, as many staff as workers died; for every death 100 people injured
- #longcovid 3-4% workforce incl bad prognosis like strokes, a million lost working days/year
- 30-50% ill health & burnout

@ProfEmer shocking ~50% of staff not at full capacity

⚠️ must move away from government discourse only deaths/ICU overload matters —> must *prevent* covid from spreading, harming & mutating with unknown long term costs

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@DrGuddiSingh thanks guests for quite shocking testimony

- worrying statistics then first hand accounts of known & hidden costs of #covid & #longcovid responsible for a million lost days/year, history of neglect leads to doctors being swamped now; needs fundamental rethink

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(more to come below)

From audience:

- nursing perspective, unions campaign to keep NHS public & for treasury to properly fund enough staffing, sufficient pay to live in expensive cities. Get key people together —> we need some kind of leadership in terms of a workforce strategy

@DrRachelWardGP:

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- @HelenRSalisbury gov disbanded SAGE as thinks it’s all over but isn’t —> continue losing staff if we don’t act to stop #covid & #longcovid & resource the NHS

- @mattinadakim get what we pay for 🇬🇧 GDP per capita spending is lowest in developed world, affects all services

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@martinmckee put in international context:

- 🇬🇧 higher winter mortality & the most deprived areas in W Europe, labour supply issues

—> improve work practices & make investment case for health: higher economic growth, productivity, more secure & safer societies

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See report:

independentsage.org/independent-sa…

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Question: how much is current crisis used to hide further privatization of the #NHS either directly or by creating the situation where privatization will be offered as the only solution to ‘save’ it?

@globalhlthtwit worries this would increase costs, reduce access & service

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@martinmckee thinks any privatisation likely ‘by default’
—> people discouraged by long wait times approaching private care than the NHS being sold off wholesale, hospitals & all

@HelenRSalisbury @DrGuddiSingh — service really fell since 10 years ago, patients leave — shocking

Question: the root cause of many NHS problems is the collapse of social care so why is government reluctant to make a substantial intervention here?

@SusanMichie politics & values —> as citizens we should speak up about this political question, demand better service

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Question: @DeenanDpillay can integrated care systems help?

@DrRachelWardGP theory is great but practice can be too heavy & crush local initiative

@mattinadakim opportunity to improve care, smooth relations between silos — necessary to meet coming demands

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@BinitaKane
it’s really important as well to not forget other social determinants of health like where they are born, poverty, good housing, education; have an addiction.

NHS on its own can’t solve all of that, without a wider focus on prevention.

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Question: @SGriffin_Lab government proposes to shorten waiting times & get to patients more quickly by dropping #covid restrictions, separation of patients, personal protective equipment (PPE). What do you think of this as a long term solution?

@ProfEmer crazy — risks chaos

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@ProfEmer

#NHS should primarily be about stopping disease in the first place. Not mixing everyone in one huge caldron of survival of the fittest

—> If we put this virus through all this mess it will survive it & come back to bite us. And if not this one, it will be another

@ProfEmer

⚠️ engaging in a simplistic zero sum game without understanding the implications of what happens when you drop the control of the source, the pathway & the reception —> the dynamics will turn everything upside down & we could end up at square one like snakes & ladders

@mattinadakim extend to everyone —> respect means masking/isolating when ill.

Countries with respectful cultures do better against #covid

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(General Q&A to follow below)

Question: will the current pandemic make people more susceptible to other viral infections? Have our immune systems been made weaker or is reduced contact responsible for this?

@Daltmann10 @sheencr lockdown etc only marginal effects but #longcovid can alter immunity in some :

@globalhlthtwit measles can depress immunity for nine months

@Daltmann10 like HIV or Epstein Barr —> complex immunology

@sheencr can temporarily damage some tissues’ immune response too

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Question: new studies show vaccination protects less from #longcovid than expected. What implications?

Can vaccines be tweaked to make them more effective or is the only option not to catch #covid in the first place?

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@Daltmann10

#Longcovid so much more ghastly than we thought, even in the face of triple vaccination & so-called milder Omicron, gave 380k new cases.

We need the best possible future defenses against covid & long covid and they go hand in hand, we’re still in a very tough place

@SGriffin_Lab

⚠️ as we don’t know the cause of #longcovid we don’t know if vaccines can prevent it. Recent studies seem to show very little protection.

Best is to suppress #covid & use vaccine plus strategy, not vaccines alone.

Question: as mitigations are abandoned, those who deem them necessary are openly criticized. How do you navigate this?

@SusanMichie some people are averse to social norms, find it hard to mask —> be clear WHY you’re doing it helps to be a role model to protect self & others

@SGriffin_Lab shifting blame from authorities to individual choice is unlike any other public health issue: driving, smoking, environment contaminations…

⚠️ yet still #longcovid high prevalence & new variants coming…

+ unfair as excludes the vulnerable from ‘freedom day’

@BinitaKane daughters wear FFP2 in class out of choice as educated on the risks —> stood up to someone questioning why wearing despite vaccine, says as they don’t protect from #covid

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@dgurdasani1 @chrischirp @Zubhaque @ReicherStephen @trishgreenhalgh

@longcovidwork @LongCovidSOS @LCKNIreland @LCKScotland @LongCovidKids @LongCovidCH

#independentsage

To add — @dgurdasani1 warns of high hospital acquired infection already & urgency to stem this to protect patients & staff — #covid can complicate other diseases, contributing to admissions even where it’s not the primary cause.

NHS bed capacity is already under strain

Note — protections reduce other deadly diseases circulating & new ones arising faster in our warming world (incl microbe resistance):

Hospitals should be careful especially when already under strain & full of vulnerable patients & staff

Several recent studies show vaccines don’t prevent #longcovid & post acute sequelae as much as we’d hoped

— new variants ‘breakthrough’ more easily

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2/2 #Longcovid risk even if vaccinated:

@chrischirp :

@dgurdasani1 :

Several studies in this 🧵

@LongCovidCH @longcovidwork @LongCovidKids @LongCovidSOS @LongCOVIDEurope

@ShaunLintern @NHSEngland @NHSMillion @NHSuk @NHSEnglandLDN @NHSuk @NHSConfed @NHS_HealthEdEng see this IndependentSage 🧵 on challenges to the NHS

(Note — see in thread number 27 replies as it continues the discussion on the importance of continuing protections in hospitals)

Note — return to thread 33 replies to see the rest of it