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
When this happens we usually admit the patient even though we dont expect them to survive. It's hard to refuse. But for a few weeks in the first wave it seemed the whole country understood. We admitted anyone with a realistic chance. People accepted these difficult decisions. 4/7
I work in one of the NHS trusts worst hit by COVID. We never used fixed rules about who could or couldn't be admitted to ICU. I know many docs working in hospitals large and small who say the same. Ethical concerns raised in this article reflect the concerns of doctors too. 5/7
In March, we were terrified the first wave would keep rising until we were forced to impose blanket rules. Senior docs were dreading it. To our massive relief, patient numbers stabilised just in time. We got away with it. If there were exceptions, I never heard about them. 6/7
I sort of always understood that society's memory of the first wave would dim over time. It was a desperate time that threatened everything ICU staff stand for in patient care. This is why I recorded my own history in an audio diary for @BBCRadio4: 7/7

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More from @rupert_pearse

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
bbc.co.uk/news/health-54…
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
17 Oct
It's been a tough and rather disappointing week. On Sunday I wrote a short thread about the COVID-19 caseload during my day at work. This got picked up by someone with a very large following, triggering a tidal wave of hostile responses (many kind messages too). 1/5
.....as a result the tweet created extra work for colleagues so I deleted it and apologised. But my basic point that that we are dealing with a major problem in NHS hospitals was correct. It was disturbing to see so many people reject an objective report from the frontline. 2/5
With depressing predictability, the Number 10 briefings the next day showed things were even more serious than I had suggested, especially in hospitals in the north of England. Thoughts right now with colleagues having a tougher time than we are.
3/5
Read 5 tweets

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