The #NHS response to #COVID19 - did hospitals 'close'?
(SPOILERS: No.)

Just the facts. /thread
Over the course of the pandemic there were just over 135,000 hospitalizations for COVID-19, with the highest peak over the month of April in the UK.

coronavirus.data.gov.uk/healthcare
If we look over the A&E data at the time, in April A&E ATTENDANCE dropped by 50%, but % of those actually ADMITTED ROSE from 30% in Apr 2019 to 37% in Apr 2020, suggesting those attending were sicker than average.

Also note A&E was open. I went myself.

england.nhs.uk/statistics/sta…
In February 2020 we had approx 4372 ICU beds in England, Wales and NI.
The data from ICNARC reports we received at least 10,834 ICU patients icnarc.org/Our-Audit/Audi… , mostly in April.

You can see the issue here.
By any definition the usual capacity of ICU was 'overwhelmed'.
So how did we manage?

We freed up as much capacity as we could, by stopping elective surgery (freeing up ventilators and anaesthetists) and other non-urgent ward work and clinics (freeing up doctors, like me, and nurses, to be redeployed to ICU).
We built the Nightingale hospitals when it wasn't clear that the lock-down measures would have an effect, as there is a lag between exposure and symptoms and requiring intensive care of around 14 days.

Thankfully, we didn't need them, but would've struggled to staff 4000 beds.
And hospitals absolutely were overwhelmed:
- bbc.co.uk/news/uk-englan…

At the peak ran out of beds, staff, oxygen, sedative medications. Some hospitals had ONLY COVID patients on their wards.
We were running at about 85% bed occupancy (normal level) in Dec2019-March and after cancelling much of the routine elective surgery work etc ran at 64% bed occupancy during Apr-June, a reduction of 20%.

england.nhs.uk/statistics/sta…
The illusion here is that we could've filled 35% more beds - but we couldn't then maintain infection control to prevent the most vulnerable (sick patients in hospital) suffering another COVID outbreak.

This is why hospital activity reduced. Not because of 'lockdown', but COVID.
I'm really not sure what advocates of 'anti-lockdown' really expect NHS services to do:

We can't bring sick patients to hospitals with uncontrolled COVID in them safely.

We can't do surgery if all the ICU beds are full.

We can't do clinic if all the clinic doctors are in ICU.
The other important point is we lost over 620 colleagues in healthcare and social sector.
HCWs are 2.5x more likely to contract COVID than the general pop.

Healthcare workers lives were put at risk, and many died trying to help.
elifesciences.org/articles/60675
What about in the community?
Again, GP surgeries have to restrict access and waiting lists to protect patients and staff, due to high endemic COVID we continue to have.

If we could reduce our levels (53/million) to NZ levels, (0.41/million) currently, we could open safely.
There is also a lot of talk about lockdown causing lots of deaths, specifically from suicide and cancer.

For suicide the official numbers for that period have yet to be confirmed, but there hasn't been a suggestion of higher signal: fullfact.org/online/suicide…
For cancer it is concerning that screening and some cancer appts delayed, but many urgent treatments have continued, and day beds remained open at 50% capacity throughout the lockdown.

How we tackle this huge backlog (already at record length BEFORE COVID) is a huge challenge.
The vast majority of excess death seen this year was due to COVID: ons.gov.uk/peoplepopulati…

But there was a significant rise of 12,900 deaths in non-covid 'excess death' as well.
So what caused these deaths?
The honest answer is we don't know.

We do know that the majority occurred in older age groups, 5404 of these deaths were ascribed to Dementia causes and 1567 were 'ill defined'.

On this basis the ONS theorise this may be due to undiagnosed COVID .
Due to the nature of investigations etc this may take a lot longer to come out.
But in summary: the evidence doesn't support a large rise in non-covid excess death due to delays or lack of treatment.

For cancer we will need to watch carefully over perhaps the next few years.
But the other point is these delays weren't caused by the NHS 'choosing' COVID over non-COVID. We can only prioritise the most urgent patients in front of us, and deal with the rest as safely as possible.

I'm yet to hear a coherent argument for how else this could've been done.
Lastly, I keep being told that 'flu' is killing more people than COVID. I actually don't know where this data is coming from - but surveillance of influenza reported NO positive influenza swabs in the week ending 3/9/20 and currently low levels of 'flu':
assets.publishing.service.gov.uk/government/upl…
The bottom line is the only coherent argument to keep shops, schools, pubs, businesses, GPs and hospitals running normally is to control the virus.

This takes vigilance and compliance from EVERYBODY. Lockdown is the last resort, so let's not get there. /end

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More from @juniordrblog

18 Sep
Ivor @fatemperor has helpfully resubmitted his latest video for a second review:

Unfortunately we still found significantly misleading and pseudoscientific assertions.

Full video:

Let's pick it apart (again):
thread/
0:06: Ivor opens with a statement about how he is only making inferences.

This seems apt:
"Pseudoscience consists of statements, beliefs, or practices that are claimed to be both scientific and factual but are incompatible with the scientific method"

en.wikipedia.org/wiki/Pseudosci…
1:48- he starts off claiming COVID-19 is now part of the 'respiratory season'. Again this isn't a defined term, but flu season peaks in Dec-Feb, and we have now seen spikes, in the US and Europe, for example, in July and August.

cdc.gov/flu/about/seas…
Read 52 tweets
15 Sep
This is deeply pseudoscientific and dangerous rubbish. I wouldn't normally amplify, but in this case given the public health emergency I've made an exception.

The full version is here:

Otherwise let's take it apart here: /thread
0:36 - Straight out of the gate we get a graph of deaths due to COVID in UK, Italy, Ireland and Sweden.

Ivor claims this is 'entirely in line with influenza'.
This is from the CDC showing the typical flu season: It ends in March, not begins, and very rarely extends into spring.
0:55 points to this and labels it a 'Gompertz Curve'. It isn't, but the deeper point is that implies a natural end to growth, rather than an external force.
Read 44 tweets
11 Sep
A Rapid Response Thread for modernsocietyinitiative.org (@msiuk_)

"What is going wrong with #COVIDUK test and trace?"

Sept 10th 2020

Full article: modernsocietyinitiative.org/latest-researc…

Keep reading for #thread 👇
1/ There have been increasing reports of those trying to get a COVID test in the UK being forced to travel 500 miles or more....
standard.co.uk/news/london/lo…
2/ Meanwhile govt have said that 'test and trace' remains 'world-beating' and have now announced plans to massively upscale their programme, Operation Moonshot, testing 10m people a day.

Both of these cannot be true, 𝘀𝗼 𝘄𝗵𝗮𝘁 𝗶𝘀 𝗴𝗼𝗶𝗻𝗴 𝗼𝗻?

itv.com/news/2020-09-1…
Read 23 tweets
6 Sep
Wow this is crazy ignorant from @richardm56 Let’s take it apart. /thread

express.co.uk/comment/column…
So in the opening sentence @richardm56 finds a criminal offence! Falsifying death certificate causes is illegal. I expect he reported it directly to the police so no worries.
Mmm a 'blood test' - the plot thickens. Blood tests are only for antibodies, which aren't great at acute illness. Swabs are for current illness. If COVID was on the death cert it would make sense to be the latter. Great case though - can't wait to see more details....
Read 12 tweets
1 Sep
A sustained rise in cases, while another drop in deaths (60day).

This isn’t “good news”. /thread
It seems like new cases are now increasingly distributed in younger people. /2
So what? Younger people far less likely to die and be hospitalised.
This is correct, and explains the trends we are seeing overall. /3
Read 6 tweets
11 Aug
A thread on #schoolsreopening schools and #COVID by a doctor (also a parent and a brother to a teacher) /1
Do children get coronavirus? Yes, although only very rarely get sick with it. How rarely is a difficult question to answer.
In terms of absolute figures in the UK there have been 3591 confirmed positive cases in 0-9yrs & 6880 in 10-19yrs. gov.uk/government/pub… /2
The number of children hospitalised with CV-19 aged 0-19 has been reported as 440. bbc.co.uk/news/health-52…
Including 71 children admitted to intensive care picanet.org.uk/wp-content/upl… /3
Read 26 tweets

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