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Rupert Pearse

5 Dec, 9 tweets, 5 min read

Themes of the week: vaccine roll-out, the COVID tide turning, and the lockdown ending. This is where I think we’re at, having talked again with friends across the UK and compared this all with the national data. 1/9

Friends in many (not all) badly hit hospitals tell me the second COVID tide is beginning to turn. BUT the NHS is still really busy keeping surgery services going, as well as winter pressures of acute medical admissions, and then COVID on top of all that. 2/9

News from ground level fits with the national data which show a consistent decrease in numbers of people testing positive for SARS CoV-2, a decrease in patients being admitted to hospital with COVID-19, and in subsequent deaths. 3/9

SARS CoV-2 test positive rates are now falling across almost all of the UK. Not everywhere though. The map on the left shows the 7-day average on 14th November, and on the right from 28th November. Still a few hospitals badly affected in the hot spots though. 4/9

The main problem for the NHS everywhere is staffing. Lots of staff are shielding, in self-isolation or affected by COVID-19 itself. Mental health is also a big issue for staff run ragged in a very difficult year. Extra pressure from media, public & politicians isn't helping. 5/9

The Pfizer vaccine release is big news this week. Lots of chat about who will get vaccinated first, how and when. Young and healthy may have to wait until spring but we still need volunteers for clinical trials of the new vaccines coming through (which may work even better). 6/9

@bbchealth

It's fine to ask questions about vaccination but be very careful of deliberate mis-information on social media. Please make sure you get your information from a trusted source. Here is the NHS webpage. Also @bbchealth has some good content. #DocsForVax 7/9 nhs.uk/conditions/cor…

@MHRAgovuk

I'm happy to have any @MHRAgovuk approved vaccine. Understandable that some worry about the pace of vaccine development this year but MHRA approval means rigorous evaluation. Risks of vaccination are far less than risks of COVID-19. Please speak up for vaccines. #DocsForVax 8/9

Finally, great news that the full lockdown has ended in most areas (not all). The numbers show you are making the difference. NHS staff are proud to be here for you but the virus is still out there. There may yet be a third wave so don’t give up on #HandsFaceSpace – it works! 9/9

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Rupert Pearse

@rupert_pearse

2 Dec

Fantastic news that the first COVID-19 vaccine has been approved for routine use so quickly. Here is why I am happy to be vaccinated and why I want my family and friends to have a vaccine too... 1/10 #InjectionforProtection #DocsforVax
bbc.co.uk/news/health-55…

Widespread vaccination was always our best and only route out of the pandemic. The fewer people who carry the virus, the slower it can spread. By being vaccinated, we protect not only ourselves but our family, friends, work colleagues and so on, even strangers on the bus.... 2/10

@MHRAgovuk

The UK has one of the best and strictest drug regulatory processes in the world. Testing new drugs is a thing we are really good at. Anyone who has worked on a clinical trial will vouch for the rigour and safety of @MHRAgovuk and @HRA_Latest processes. 3/10

Read 10 tweets

Rupert Pearse

@rupert_pearse

21 Nov

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

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

@ICNARC

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

Read 12 tweets

Rupert Pearse

@rupert_pearse

19 Nov

@remap_cap

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

https://twitter.com/remap_cap/status/1329391734174826496

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

Rupert Pearse

@rupert_pearse

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

Rupert Pearse

@rupert_pearse

1 Nov

@ICNARC

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
icnarc.org/Our-Audit/Audi…

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

Rupert Pearse

@rupert_pearse

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

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