Looking at COVID-19 admissions this past week, we are seeing a change. More patients are testing positive for the virus and getting sick enough to need ICU. Definitely a second wave but we don't know how big. Sad news but we have reasons to be more confident this time (thread):
1. We understand the disease: The baptism of fire in March-May taught us how COVID-19 behaves. NHS teams have reflected on what worked and what didnt. For example, we know we will see problems like blood clots and kidney damage more often than usual for ICU patients.
2. Treatments are more focused: The media furore about wonder drugs was a massive distraction for doctors. Fortunately @NIHRresearch delivered major clinical trials which busted a few myths eg hydroxychloroquine but also showed some simple things saved lives eg dexamethasone.
3. Escalation plans: The vast planning exercise before the first wave has lasting impact. All hospitals have an escalation plan for COVID, tried, tested and improved from first time round. We know how to use our real estate to the optimum making patient care more efficient.
4. Normal patient care wont stop: In the first wave, treatment of other diseases stalled almost completely. But we now have very robust procedures so we can keep treating cancer, stroke and heart attacks safely - patients should not worry about visiting hospitals if they need to.
5. Logistics are in place: Equipment supply chains were under huge strain in March. We came very close to running out of PPE, ventilators, dialysis equipment, clothing ('scrubs') and lots more. The supply chain is now much more resilient and well stocked.
6. Calm routine: In the first wave our planning was very excitable and sometimes it showed. We wasted time managing people with ill-conceived ideas which weren't going to work. This time we know what to do. Staff are well drilled in 'donning and doffing' PPE. Training is routine.
7. Second wave or slow burn? We talk about a second wave but the most likely experience will be a steady flow of patients with COVID-19 over the winter months. We think (hope) we will avoid the very high peaks of demand which put services most at risk.
There are also some reasons to be worried. NHS staff, like all key workers, were inspired by the massive community response to the crisis. This time we see push back from deniers and people putting personal freedoms ahead of others' lives. Some of this is very hard to take.
The NHS is still here - ready and waiting. We are proud to look after you but staff are tired and stressed. We have not properly decompressed from the spring. Please keep up your amazing work and #staysafe. The routine is a grind but it works. Thank you.
Thanks @jometsonscott for this and other amazing photos 🤗

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More from @rupert_pearse

25 Oct
The suggestion NHS intensive care units thoughtlessly turned away COVID patients purely because of their age is very upsetting. This article quotes ICU doctors off the record but I don't recognise these experiences. We cared for a number of patients aged 80+ on @teamaccu 1/7
A 'triage tool' was developed by @NICEComms but doctors decided not to use it. Instead we fell back on a long standing practice of discussion between experienced NHS consultants (at least three). Patient and family views were always included if possible. 2/7
Being on a ventilator in intensive care is not nice. You wouldn't do it to anyone you loved unless you thought it could help them. But few people outside ICU (doctors or public) realise this and often argue strongly to ventilate patients who have little chance of survival. 3/7
Read 7 tweets
24 Oct
A lot of new data out on treatments for COVID-19. Updating a previous thread with what we know now. Still lots of research ongoing and a few things may change. Much of this world leading research is taking place in the UK, funded and delivered by @NIHRresearch. 1/20
Dexamethasone: A simple steroid drug widely used in many diseases. Shown in @NIHRresearch RECOVERY trial to improve survival for respiratory failure due to COVID-19 (i.e. severe cases only). Probably acts by reducing lung inflammation. 2/20
Hydrocortisone: Another widely used steroid drug. May help systemic (whole body) inflammation in critical (life threatening) illness which some call 'cytokine storm'. @NIHRresearch funded @remap_cap trial suggests benefit in ICU patients but weaker signal than dexamethasone. 3/20
Read 20 tweets
23 Oct
A bit of recent history: The first SARS epidemic in 2002-4 was caused by the virus SARS-CoV which is very similar to the virus causing the current pandemic. The story of the outbreak of SARS in Hong Kong courtesy of Wikipedia: en.wikipedia.org/wiki/2002%E2%8… 1/5
On 21st February 2002, Liu Jianlun and his wife checked into a room on the ninth floor of the Metropole Hotel in Hong Kong. Liu was a doctor at a hospital in Guangdong, China where he had looked after SARS patients. 2/5
Despite feeling ill, he attended a family wedding and they travelled around Hong Kong. By 22nd February he knew was very sick so he walked to the nearby Kwong Wah Hospital. On arrival, he warned staff about his illness and that he should be put in isolation. 3/5
Read 5 tweets
19 Oct
I'm going to discuss this with you, working on the assumption that you are a good person who is either poorly informed or has misunderstood the data. Please be respectful though (not everyone is).
1. There is a second wave but as the graph nicely shows, the rate of growth is much slower this time. Believe me, we are all very relieved about that. But a few ICUs eg Liverpool are already stretched to the limit.
2. I totally give credit to lockdown measures and #HandsFaceSpace for this. Tweet 6/6 in my thread makes that very clear and also our gratitude to everyone for working so hard to make that happen.
Read 8 tweets
18 Oct
Lots of discussion about improved survival in the latest @ICNARC report on COVID-19 admissions to intensive care published on Friday. But there's an even more crucial message in this graph showing the rate of increase in ICU admissions. 1/6
We can now see that ICU admissions with COVID-19 are increasing at a much slower rate than March. So we are seeing a 'slow burn' rather than a 'second wave'. This could make the vital difference to how well @NHSuk copes through the winter. 2/6
This slower rise does NOT mean we will see fewer cases overall in the pandemic second phase. But it does mean we will see fewer cases AT ANY ONE TIME. NHS hospitals are like a flood wall: things are OK until the waters reach the top. But when they do we have a major crisis. 3/6
Read 8 tweets
17 Oct
Some optimistic commentary here from @FICMNews
Dean @AlisonPittard, suggesting we are getting better at treating COVID-19 leading to fewer deaths than the first wave. Is this over-optimistic, or are patient outcomes really getting better? 1/18
Importantly, @AlisonPittard is not just giving her opinion. Her comments are based on published data. For many years UK intensive care units have reported activity data to @ICNARC. During the pandemic, some of the most robust and objective data reports have come from them. 2/18
The latest @ICNARC report published yesterday describes outcomes for COVID-19 patients admitted to intensive care before and after 1st September. The report is available here: icnarc.org/Our-Audit/Audi… But remember this ONLY tells us about patients admitted to ICU (see later). 3/18
Read 18 tweets

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