Thread by @DRTomlinsonEP

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief Continuing in my role as a methods freak, I’m really struggling with the concept that “the science changed”.

@medrxivpreprint preprints since Jan provided multi-nation data allowing modelling of the UK peak casualty time point occurring w/o appropriate preemptive quarantine.

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief @medrxivpreprint Plus, the groundwork is described in the DoH pandemic flu “Managing Demand and capacity” document, which blandly states:

• Health services will be rapidly overwhelmed.
• Critical Care bed numbers would need to double within 1-2 days.
• Peak likely within 50 days of UK entry

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief @medrxivpreprint The effects of cancelling elective procedures on the timing of availability of IP beds was also described:

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief @medrxivpreprint ...as was the inevitability of excess deaths despite such measures, with a description of the scoring system used to determine appropriateness of ongoing mechanical support on ITU:

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief @medrxivpreprint So that brings us to the SOFA score.
Is anyone actually using this for nCoV-2019?! @Poppyjuice

I ask because the (microbiological) population with sepsis described in this “validation” paper is very different to #COVID19:

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief @medrxivpreprint @Poppyjuice So this brings me back to the comment about the science changing:

• nCoV-2019 was known to have R>2

• By definition this would behave like prior pandemics, with modelled peak by 50 days and overwhelming even “surge” capacity.

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief @medrxivpreprint @Poppyjuice Therefore, in the absence of a new Rx obviating the need for mechanical ventilation, only a complete and immediate quarantine would have the desired effect of limiting excess deaths.

So why on earth was this not done?!

@DrTedros

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief @medrxivpreprint @Poppyjuice @DrTedros @threadreaderapp unroll please 🙂🙏🏻

@SukhNijjer @DrHusainShabeeh @NEJM @DrAsifQasim @rallamee @drandrewsharp @richardhorton1 @mmamas1973 @DhirajGuptaBHRS @DrDerekConnolly @BorisJohnson @CMO_England @PHE_uk @DHSCgovuk @drjbajwa @JonathanBehar @uksciencechief @medrxivpreprint @Poppyjuice @DrTedros 🤦🏻‍♂️ forgot to paste the SOFA score ref...sorry!
ncbi.nlm.nih.gov/pmc/articles/P…