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Paul Nuki

5 Jan, 9 tweets, 4 min read

1/5: Medical triage (rationing) in a crisis is a difficult issue but it needs to be confronted directly to prevent things getting much worse. We are now at alert "Level 5", meaning there is a *material risk* of NHS services being overrun, so I looked at it for today's paper...

2/ First, the news story. In the absence of national guidelines (more on that shortly), clinicians in Bath have drafted and circulated a detailed protocol for debate among doctors. The story is free to read here: telegraph.co.uk/global-health/…

3/ A news story can never do justice to such a complex subject but can spark debate. You can read the full draft protocol and accompanying background here. Note, the authors wrote it when deaths were low to encourage calm debate ... jme.bmj.com/content/medeth…

@DrMQureshi

4/ Why is there no national policy on triage? @DrMQureshi regards it as an "abdication of responsibility" by ministers. It's brave for local clinicians to have devised a protocol but it's not optimal. There should be national guidance. I explain why here: telegraph.co.uk/global-health/…

5/ The Dept of Health's behaviour has been appalling. Exercise Cygnus in 2016 flagged the need for a national triage protocol and the report that followed ordered one be drafted. Yet the DH claims to have fulfilled the Cygnus recommendations *and* not to have a protocol (magic!)

6/ You can read more about Cygnus here. It will be at the heart of any future public inquiry into the Covid-19 pandemic in the UK telegraph.co.uk/global-health/…

@Jeremy_Hunt

7/ Note too, that when hospitals were overrun in Cygnus, the then health sec @Jeremy_Hunt was asked to turn off ventilators but refused to do so as detailed here: telegraph.co.uk/global-health/…

8/ For that story (in nice quiet October) his office gave me the quote below, which makes good sense in many ways. The trouble is where is that "rethinking" today?? We are perhaps 21 days from parts of the NHS being overwhelmed and clinicians are being told nada

9/ Last, it is important to note the NHS is not yet overwhelmed and may never be so. There are more in hospital now than in April but fewer Covid cases being admitted to ICU. There is still time for the DH to issue national guidance. The rest of us should remain indoors #COVID19

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Paul Nuki

@PaulNuki

4 Jan

1/4 What will PM say tonight? My guess is it will be a March-style national lockdown, with many schools closed. Here is some of the data driving the decision making. Note, school closures push the London/SE peak, taking pressure off a stressed NHS #COVID19

2/4 These charts show impact by region in absence of widespread vaccination. Deaths in 6mth to July worse than last year - start in London and SE and spread across country. The reason: new variant is breaching current measures and infecting many more people...

3/4 Here is how it looks with vax rollout. Still worse than 1st wave unless we can get to 2m shots a week by January 1 - 4 days ago. We are currently at about 300,000 shots a week

Read 4 tweets

Paul Nuki

@PaulNuki

4 Jan

1/4 Quick thread on vaccine rollout globally. Key message: supply is super tight and will remain so for some time yet. Global coordination urgently needed... Israel ahead in % population but it is a small nation...

2/4 In terms of doses delivered - a indication of access to supply - China and US miles ahead and neck and neck. Expect India to race up in next few weeks. Remember China has been administering vax since the summer...

3/4 Doses administered gives an indication of a country's ability to scale up. Here US and Israel stand out, though scale of countries is vastly different....

Read 4 tweets

Paul Nuki

@PaulNuki

3 Jan

https://twitter.com/clarewenham/status/1343995195667394560

1/ This thread making a distinction between point of entry controls and blunt travel bans is a good one, although I'm not sure Oz and NZ are the best examples

https://twitter.com/clarewenham/status/1343995195667394560

2/ Super important to look at the plans of places like South Korea. Post SARS, they operated on the principle of find every case, isolate and track contacts in event of outbreak. This applied as much to airports as it did bars and hospitals etc apaci.asia/images/Resourc…

3/ It seems to me that if you have a track and trace system which says, we will check everything except the ports and airports which are very busy and therefore expensive to check, you don't really have a track and trace system at all

Read 4 tweets

Paul Nuki

@PaulNuki

25 Oct 20

1/ Super interesting new info coming out on Exercise Cygnus, the 2016 dry run for a UK outbreak, since its formal publication was forced least week. Raises some important questions on current response... #COVID19

2/ First the sexy bit. Jeremy Hunt, then health minister, "stopped playing" on first day of exercise after being asked to turn off the ventilators of 4,000 people. He says it was 'morally repugnant' and prompted a rethink on triage. Not all agree... telegraph.co.uk/global-health/…

3/ “The hospitals were full and Hunt was asked to make the call as part of the exercise. But instead of doing so he basically said ‘I’m not playing anymore’. People were very cross as it mucked up the exercise”, said one source.

Read 11 tweets

Paul Nuki

@PaulNuki

4 Oct 20

@HowardMarkel

1/5 It was a real pleasure researching this piece on social distancing - thanks to @HowardMarkel Dr Martin Cetron @mlipsitch and all the others who helped... #Covid_19

telegraph.co.uk/global-health/…

2/ We should not be surprised Geroge W grasped this with both hands. He and Cheney had good reason to be worried by existential threats. The 9/11 attacks in 2001 were quickly followed by anthrax, early outbreaks of H5N1 and Sars. Here's their pandemic severity index...

@PEPFAR

3/ Bush also did more than anyone to tame the HIV epidemic by launching the game-changing @PEPFAR programme... he did a huge amount in public health, saving millions and should be credited with it...

Read 5 tweets

Paul Nuki

@PaulNuki

15 Sep 20

@BillGates

1/6 Interesting to talk to @BillGates for the launch of the #Goalkeepers report on the UN's #SDGs. His key message: development now in reverse and we need to unite to build up again. Also good on: Sweden, WHO, Vaccines, and the prospects for winter telegraph.co.uk/global-health/…

2/6 On the coming months: “I'm pessimistic about what the fall in the northern hemisphere is likely to look like. If we don't have interventions, the death rate in a number of countries including the US will go back up to the levels that we had in the spring."

3/6 On a vaccine: “By next summer, we'll be getting vaccines out to all the countries of the world... I'm optimistic that next year will be the year that we bring the numbers down very, very dramatically, and that this thing will be over by sometime in 2022.”

Read 6 tweets

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