An update from ground level across the UK NHS. Things are very different to March. UK COVID-19 projections continue to look more like a ‘slow burn’ than a second wave. But the NHS is under very definite and increasing strain. We are going to have a long hard winter…… 1/12 Photo from @jometsonscott
COVID-19 hospital admissions continue to rise. Now 1750 new patients/day. Much less than the mid-April peak of 3100/day but we will reach that same rate in 8 weeks unless the rise slows. It takes at least four weeks for the lockdown to take effect. Perhaps it will soon? 2/12
The same pattern is reflected in @ICNARC (independent) data describing COVID-19 admissions to intensive care units: 140 new patients/day and rising with >1500 COVID patients currently in ICU… 3/12
…and in government data describing and the number of COVID-19 patients ‘in mechanical ventilation beds’ (i.e. an ICU bed): Currently 1400 patients (compared to a peak of 3250 in mid-April). NB the numbers in 3 and 4 are defined & calculated differently. 4/12
The most important graph is this one. We currently have 15,000 hospital in-patients with COVID-19 and rising compared to the April peak of 20,000 COVID-19 in-patients. But we now have a greater number of patients with other illnesses too (non-COVID pts not shown in graph). 5/12
.@ICNARC data show we are still putting fewer patients who need ICU on a ventilator than the spring (23% vs 54%). Mortality after ICU also remains lower (23% vs 40%). But REMEMBER: 45% of these patients are still in hospital. They haven’t died but they have yet to survive. 6/12
We could be getting better at treating COVID-19, or the virus may be getting less virulent (harmful). A major reason is that hospitals don't YET have the massive overload of patients we saw in April. This affects which patients go to ICU and the average severity of illness. 7/12
This week I have been chatting with friends working in NHS hospitals across the UK. They report a common experience of struggling to deliver care not only for COVID-19 patients but many more with a wide range of ‘usual’ problems including cancer, heart disease and trauma. 8/12
The north of England is still the worse affected with the majority of patient admissions to intensive care in the past 14 days. A few hospitals are shutting down some usual services. ICU admissions are also rising fast in some quieter parts of the country. 9/12
Speaking to ICU doctors around the world in an online meeting this week reveals a similar story in many countries. Things especially bad in the USA, Poland & Romania, but Australia has the virus under control coming into the southern hemisphere spring. 10/12 WHO Coronavirus Disease (COVID-19) Dashboard
The NHS heads into the winter months with many hospital beds occupied by patients with a highly infectious disease. This will definitely be my hardest NHS winter since 1999/2000 when we had a very bad flu season, and probably the hardest of my career. 11/12
NHS staff remain committed and determined to care for every patient with every illness. But we face inevitable media & political scrutiny, some of which will be misleading and negative. I will continue to share objective facts as I see them. Thanks for all your support. 12/12 Photo from @jometsonscott

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More from @rupert_pearse

19 Nov
Some interesting news here from @remap_cap that #Tocilizumab may improve patient outcomes for COVID-19. Understandable that the team are eager to announce this but given the limited detail and small sample of 303 patients, a few notes of caution are needed.... 1/7
The researchers have declared #Tocilizumab has 'efficacy' for a combination of patient outcomes which include survival and how long patients spend on organ support eg a ventilator. Efficacy means the drug can work in specific (usually well controlled) circumstances. 2/7
It looks like there is a big treatment effect (odds ratio: 1.87) in this trial. That's great but results like this are sometimes too good to be true. Treatment benefits are generally smaller in large trials which account for the real-world problems of delivering patient care. 3/7
Read 8 tweets
8 Nov
As the NHS enters what will likely be our hardest ever winter, what about the Nightingales….? is a common question, and for some a retort to news that hospitals are struggling to deliver routine patient care in the face of a rapidly rising patient admissions for COVID-19. 1/10
The speed with which the Nightingale Hospitals were established, and our need to believe in them, has left us with the impression that building a major NHS hospital within a few weeks is a thing we can easily do. It isn’t. 2/10
The old Nightingale style wards had rows of beds down each wall. A few nurses could have sight of many patients, and easily communicate with each other. If a patient has a problem (e.g. cardiac arrest) it is easy to spot and help arrives faster. Photo: Wellcome Collection. 3/10
Read 10 tweets
1 Nov
As we come to terms with a second lockdown, some reflections on the latest report on Intensive Care admissions for COVID-19 published on Friday. A big shout out to the @ICNARC team and the many ICU staff who collect the data. 1/12…
Patient admissions to Intensive Care with COVID-19 continue to rise steadily. The trajectory is slower than March but still enough to take us to those patient numbers by January. If we don’t stop this rise, even widespread use of temporary ICU facilities will not be enough. 2/12
As expected, ICU admissions currently reflect the heavy impact of COVID-19 on the north of England. Some ICUs are already in trouble. Thoughts with friends and colleagues doing their very best in tough circumstances. 3/12
Read 12 tweets
31 Oct
Routine NHS services under big pressure as COVID hospital admissions rise. We cancelled most surgery in the first wave including many cancer operations. Public, patient groups & doctors arguing strongly to keep surgery going this time. This will be a major issue within days. 1/15
Throughout the NHS, we are desperately trying to avoid another major shut down of services. If you are ill, it is important that you contact your GP or come to hospital just as you normally would. We are busy but happy to see you. 2/15
Sadly, there will be many extra deaths during the pandemic from causes other than COVID-19. Hospitals almost completely shut down in Spring for all but the most urgent cases. Many patients stayed at home when ill, either not wanting to burden the NHS or afraid to come in. 3/15
Read 15 tweets
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

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