I am a senior doctor in Critical Care in one of the UK’s largest Trusts, so unhappily I have gained expertise in COVID, and humbly I say that there is much more pressure on hospitals, especially their ICUs
ICU/Critical Care is one of those specialities which is a fulcrum on which most hospitals depend

People who need major surgery often require ICU care as do those who suffer complications of cancer treatment, heart disease, trauma, infections, etc
The UK has a baseline of around 3500 staffed ICU beds, far below countries like Germany, Italy, and the US

They barely meet our needs at the best of times…
So if ICU is full of people with COVID, we can’t treat people with cancer when complications arise, or who have had major surgery… there is no point doing operations unless you can get through the aftermath
And while ICU capacity is partly about “beds”, physical facilities, and equipment, more than anything it’s about skilled staff

And we don’t have enough
Brexit, and the war on “Freedom of movement”, has made the situation much worse because it has dramatically reduced the number of EU citizens with professional skills we need who will work in Britain… it’s just a fact
We are trying to maintain services to prevent the govt estimated 185,000 deaths that may occur due to non-COVID disease if hospitals are overwhelmed by COVID, and we are trying to prevent deaths directly due to COVID
But the reckless pronouncements of people like Tice, Trump, “COVID hoaxers”, anti-vaxers, and other cranks are doing much harm, because they are decreasing compliance with lockdown, and undermining public understanding of COVID
Definitively Tice is wrong and his opinion is worth less than nothing on COVID

So by giving people like Tice a platform on this issue, @LBC and other “news” organisations have blood on their hands…
The only thing Tice should be saying to anyone is sorry

And @LBC should stop platforming these dangerous charlatans who are all about glib opinions which are contrary to the facts
Our government for all its flaws has procured 90 million doses of vaccine which will get us out of the COVID trap

And these vaccines work, which is brilliant news
To have active treatments, and vaccines proven to be safe and effective is an achievement that surpasses the Manhattan project, and yet all these charlatans do is deny and denigrate
And let’s put this in perspective

The Black Death killed over 100 million over 320 years, and worldwide we may get away with ~2m deaths world wide from COVID over a couple of years…
For many people the lockdown is economically devastating, and it’s completely right that they are supported, but let’s reflect on how the US spent on “the war on terror” to avenge 3000 deaths?

$6.4 trillion
We will recover from COVID, and we will suppress it… but let’s not squander more lives and cause more grief than necessary before we reach this point
And as a society I hope we will learn again to value each other more, and again to value objective facts and integrity, and to stop amplifying vacuous opinions…

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More from @DrSimonAshworth

9 Oct
If you have to ask, it’s disappointing.

But the answer is none of the staff who we need to care for critically ill patients have quite mastered the art of being in two places at once…
I realise my reply may seem facetious, so I will give more details. Initially COVID was presented as a simple disease and a bit of ventilation was all that was required. In fact it isn’t.
COVID is a multisystem disease that causes pneumonia skewed towards the highest severity of illness with terrible lung disease, kidney failure, brain involvement and very abnormal blood clotting. Some patients get poor cardiac function too. Treatment is rapidly evolving.
Read 9 tweets
8 Oct
Reckless with Hydroxychloroquine, there is a better chance Trump will be right that REGN-CoV2 will be of benefit. But we don’t know for sure and RCTs are essential

Not so sure millions of doses will be available that fast though…

And there is some observational evidence in #COVID19 for convalescent plasma, the active ingredient of which is mixed antibody

And convalescent plasma appears safe - adverse events occurred in 1% of people given convalescent plasma (extracted from those recovering from COVID)

Read 9 tweets
16 Aug
Really important paper. It proves that live virus can be cultured from air 2-5m from patients, and gets suspended in the air. This doesn’t mean social distancing is valueless, but it means it is not enough.



There are major implications for businesses returning to work in September:

1. Social distancing won’t be enough
2. Cloth masks won’t be enough - these particles are <1micron in diameter
3. Keeping the windows open is a good idea

4. We will need to review standards for ventilation and air conditioning
5. Risks will depend on the prevalence of SARS-CoV2, footfall, and immunity…
6. Probably respires particles like these are the most dangerous because they get right into the alveoli of the lungs

Read 4 tweets
19 Apr
@globalhlthtwit @Johnrashton47 @AllysonPollock @profhelenward @richardhorton1 @GabrielScally @devisridhar The situation is pretty obvious.

They lacked capacity, and lacked the imagination to go to big molecular labs for help, or to take on staff for proper contact tracing. Their plan was superficial and not calibrated for a more major or lethal pandemic.
@globalhlthtwit @Johnrashton47 @AllysonPollock @profhelenward @richardhorton1 @GabrielScally @devisridhar They were put on the back foot by Johnson who 3/2/20 said he thought it was trivial. There is a penchant for pseudoscience in govt, and an instinctive distrust of experts. Groupthink was inevitable.

There was a poverty of real data because 111 took a week to test
@globalhlthtwit @Johnrashton47 @AllysonPollock @profhelenward @richardhorton1 @GabrielScally @devisridhar People don’t realise expertise is quite subtle and fragile.

You either need a lot of courage or you need to feel very safe to stick your head above the parapet and say something unpopular. And in a pandemic the decisions are huge.
Read 4 tweets
11 Apr
How should we consider #COVID19?

This is primarily a vitally induced thrombotic disease spread by droplets
Post-mortems tell us the virus causes endothelial damage and overt blood clots in both small and large vessels #COVID19
The clinical features fit with this as the primary pathology

Pulmonary arterial thrombosis causes breathlessness and high alveolar dead space #COVID19
Read 9 tweets
5 Apr
Inflexible? We have doubled ICU capacity in a month

I went into an ICU with 14 COVID mostly ventilated patients ~30 times last week, and the nursing staff probably spent 30h in there each… I am one of thousands risking our lives

The editor of the Telegraph should resign
“Pandemic” has been No 1 on the national risk log for years

All governments have failed to regard spare capacity in the NHS as a strategic asset, and the last 10y cuts have made this worse

No ideology will make Healthcare suddenly cheap and infinitely flexible
The outrageous thing is that the Telegraph has been at the forefront of those denigrating sober careful analysis of fact in favour of uninformed ideology - that is our problem today…
Read 8 tweets

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