In Wave 1, we had an empty hospital to play with, it was easy. We’re going into Wave 2 with trolleys in corridors and ambulances outside.
We’re also reaping the after effects of a deconditioned group of patients who have reached the end of their reserve, people presenting later with their pathologies to avoid coming to hospital and (anecdotally) a lot more attempts at suicide than is usual for this time of year.
I really don’t envy the people having to make these decisions. There is no easy answer.... if there was an easy answer, they would have done it. Every option facing them is equally bad. Locking down causes harm. Not locking down causes harm.

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More from @WelshGasDoc

15 Oct
Remdesivir = Approx £318/dose for 5 days
Dexamethasome = Approx £5 for 10 days
I know this Tweet of mine was shooting from the hip again, and we need to see the actual paper. If it shows that Remdesivir reduces ITU admissions (which cost circa £5,000 a day [at least]), then perhaps it has a role. Don’t write it off just yet, let’s see the science.
As nihilistic as this sounds, I think the only thing that helps anybody who I meet with COVID is pure blind, dumb luck.
Read 4 tweets
1 Jul
Most weekends, we admit somebody to ITU because they’ve had too much to drink, we need to put a tube into their windpipe to stop them choking on their vomit until they sober up. They’re fairly easy to manage and usually go home the next day...
...The problem now is that these patients might be infected because they’re young and fit, and might not that be symptomatic - but still contagious. It takes about 48 hours for the swab to come back, so until then, they’re isolated from “clean” patients... any extra demand will quickly overwhelm resources quite quickly, and snarl up patient flow, or risk an nosocomial outbreak. We can usually manage this - but not when the Government are pushing the line of “go out, get pissed - don’t forget to clap”...
Read 6 tweets
24 Apr 18
Intensive Care provides organ support while a reversible process is treated. There is no benefit of intensive care in the context of an irreversible pathology.

For Intensive Care to work, you need both a reversible disease and a patient with the reserve to respond to treatment.
Intensive Care is a burdomsome treatment. It is rare for patients to come out of it unscathed (either physically or psychologically). It is not “sleeping on a breathing machine” - at a cellular level, patients are running consecutive marathons.
Without Intensive Care, some people will die. When it’s clear that either the disease process is irreversible, or the patient doesn’t have the capacity to survive, then that’s when withdrawal of life prolonging therapies is considered.
Read 8 tweets

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