Thread by @pmdfoster

LOTS of #Coronavirus noise out there, so have been talking to senior NHS doctors about what is REALLY going on.

Some good stuff, some bad....this is NOT meant to be alarming, but it MIGHT make people think about need to take 'social distancing' advice seriosly 1/Thread

First, what's happening as NHS prepares, per frontline sources.

1. Docs with ITC experience are all being asked to self-declare

2. Ongoing (re) training of consultants and docs on intubation/ventilation

3. Assumption staff will need to work 12hr on/off shifts /2

Now we get to the tougher stuff.

- discussions ongoing about WHAT constitutes non-urgent/elective care. There will be a gradual fading out, depending on need.

But, per source, may mean stopping "two week cancer" referrals - the ones GPs do for people needing urgent tests /3

Now on building more capacity.

Some NHS Trusts - per two separate sources, one London, one Provincial - with multiple sites are reorganising 'acute' sites in order to boost capacity.

Taking ventitators from surgical theatres etc could 'double' capacity, per doc /4

/4

BUT as we know (from Imperial Resarch) that's still going to like be below capacity when this 'storm' makes landfall. These charts do NOT make for happy reading.

BUT there is some novel thinking going on...for EG.../5

imperial.ac.uk/news/196234/co…

It is POSSIBLE that a mass-shooting in Las Vegas may hold the KEY to some innovative use of ventilators - it might be possible to run FOUR patients off ONE ventilator. See this paper here:

ncbi.nlm.nih.gov/pubmed/16885402 /6

You can also WATCH this video which was shared by a doctor and is doing the rounds...

Worth a watch, but basically you use a 'splitter' to use one ventilator to serve up to four patients.

Tho there are some caveats... /7

- the machines are officially 'rated' for this
- the patients need to be similar size and have similar 'resistance' in lungs, since they're sharing.
- but it HAS been done before, in extremis, even if it's not been officially reviewed/tested.

But in extremis? Maybe /8

Which brings us back to another CAPACITY constraint - whether older NHS trusts can pump sufficient oxygen through their networks to cope with the extra load. Not clear. But that capacity is also being scaled up /9

As reported elsewhere, both testing AND access to sufficient protecive gear "PPE" remain issues.

- Per source, still "issues" with "FFP3" masks (these are the higher-rated ones) AND with insufficient in-house tests. These take 48 hours. Outisde 4-5 days. /10

This is IMPORTANT because it increases the likely level of NHS staff infection from known Covid-19 patients.

However BOTH consultants I know say authorites are promising this WILL be sorted. At this point, tho, it's still promises. /11

I understand, for example, that one large London teaching hospital temporarily ran out of masks at the weekend. There is still some time, perhaps, to fix these supply issues, but looking at London numbers, not much time. /12

On LAB TESTING, which was a problem (see above) there are moves to increase on-site capacity, turning research labs into clinical testing labs. Understand one issue was that regular labs not so keen to handle #CONVID19. /13

In better news, one hospital source says a backlog of 'community tests' is being cleared now to speed up in-patient and healthworker testing, though this clearly only one view in one hospital network. Outside London, harder to say. /14

As source puts it: "This is what happens when you run NHS laboratory services so lean - there is no slack and the virology teams are already working round the clock."

This is true for the WHOLE of the NHS. The engine is running at 95% all the time. That's bad for the engine/15

It may be true that Germany has huge redundancy in its Federal healthcare system - some 25,000 ventilated beds, although probably not enough docs to staff them - BUT the NHS is at opposite end of system /16

And the ISSUE is that that actually causes worse outcomes than running at 75% - because, for example, you can't close wards properly for cleaning, so get more secondary infections, per source in health management /17

The political reckoning will come later, I suspect, but for now it's all about ramping up: capacity, capacity, capacity in the hope that when the #Coronavirus dam breaks, the deluge does not sweep us away. /18

But very tough choices are ahead. Docs are developing the 'three wise men' protocols, to decide when/if an older/less viable patient is taken off a ventilator to give a younger/more viable patient a shot. TOUGH DECISIONS that no person must carry alone. /19

Let's hope we don't get there - one says 'only' 20,000 extra deaths would be a 'miracle'. That's why people need to LISTEN and ACT on social distancing.

This is not just about YOU.

It's disrupting the transmission NETWORK to save OTHERS.

THINK ON. Lives are at stake

ENDS