The vaccine conversation took an unexpected turn this week with the decision to prioritise first doses for people who haven't been vaccinated over second doses for those who have. Staff who all year have worked in COVID zones are now preoccupied with their immunity status. 1/8
This has turned out to be a very emotive issue for NHS staff. The topic has split us along invisible fault lines. In some cases, our position in the vaccination queue (and that of people we care about) seems to define our views on the science. 2/8
I'm not expert in the science but listening to those who are, delaying the second dose seems a legitimate thing to debate. Technical discussion revolves around how long the 2nd dose could be delayed and how much difference this might make make, as opposed to a binary debate. 3/8
Of course this is the expert opinion of medical scientists based on their understanding of how vaccines work. It isn't scientific observation from a clinical trial. But I was still surprised when this was translated to 'The science doesn't prove delayed 2nd doses still work'. 4/8
This is the thorniest of ethical debates which could almost replace the balloon debate as the classic moral dilemma in the school classroom. We all need to realise this means there is NO one right answer. 5/8
NHS organisations will need to implement the government guidance, and as always that means a local policy for local situations. Leaders in many NHS organisations are struggling with this moral dilemma as we speak. 6/8
So my plea to NHS colleagues is please don't let this divide us. Every view is valid but decisions have to be made sooner or later. Your health still matters and the health of those you care about still matters. Policy decisions will never change that. 7/8
My context: I have had the first dose but not the second. I would happily delay my second dose for someone I have never met to have their first. But if it was a vaccine dose for one of my loved ones, that choice suddenly gets much much harder... 💙 8/8

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More from @rupert_pearse

5 Jan
Why did we need a lockdown? For many people, their lives have not (yet) been touched by COVID as an illness – only by public health measures. But we need a lockdown to protect everyone’s healthcare, even those who aren’t ill. Here's why... 1/8 Photo @jometsonscott
NHS hospitals are under extreme pressure. We now have more than 21,000 hospitalised patients with COVID-19. This number continues to rise and will carry on rising for most of January. Many of these patients will need to stay in hospital for several weeks. 2/8 https://coronavirus.data.go...
The NHS cannot and will not turn emergency patients away. We treat every patient who comes to hospital. But when hospitals fill with emergency patients, there is always an impact on elective (planned) care. This often happens in Winter but is far far worse this year. 3/8
Read 8 tweets
31 Dec 20
Media reports of pressures on the NHS are all true. The situation in London is now MUCH worse than the first wave, and still deteriorating. Sad to see long queues of ambulances outside the hospital where I work. Re-visiting reasons for hope and also words of caution…. 1/10 Photo from the Evening Standard @standardnews
1. We understand the disease: The baptism of fire in the spring taught us how COVID-19 behaves. NHS teams have reflected on what worked and what didn’t. For example, we know we will see problems like blood clots and kidney damage more often than usual. 2/10
2. Treatments are more focused: The media furore around wonder drugs was a massive distraction but @NIHRresearch and others have rapidly delivered major clinical trials which busted a few myths eg hydroxychloroquine and showed simple things can save lives eg dexamethasone. 3/10
Read 11 tweets
24 Dec 20
Situation in London continuing to deteriorate as expected. Many doctors are worried that other parts of the UK will follow. A lot of misinformation around, so some fairly blunt observations here, for which I apologise. But we all need to understand the equation. 1/10
As with the first wave, the sharp rise in people testing positive for SARS-CoV-2, will be followed by a sharp rise in hospital admissions for COVID-19, and then a similar rise in excess deaths in January.... 2/10 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan
….but like all disasters, for every death we can expect many more people to be injured and survive. And so it is with COVID-19. Most hospitalised patients will survive but they will take a long time to recover. Many will experience so-called ‘Long COVID’. 3/10
Read 10 tweets
22 Dec 20
News of the lockdown was greeted with grim relief by NHS staff on Saturday. On the one hand, it will ease the pressure on hospitals affected by COVID-19. On the other, everyone’s Christmas is affected including NHS staff, many of whom live away from their families. 1/5 Photo: @jometsonscott
NHS hospitals are under huge pressure and expect to remain so until well into January. The number of people testing positive for the virus SARS-CoV-2 has risen sharply and so have hospital admissions with the disease COVID-19. 2/5 https://coronavirus.data.gov.uk/
The south-east England and south Wales are worst affected but now some areas of the midlands are seeing high numbers of positive tests as well. With news that the new virus mutation is more infectious, we should prepare for a rebound rise across the UK. 3/5 https://coronavirus.data.gov.uk/
Read 5 tweets
19 Dec 20
On the intensive care unit today covering a colleague who is unwell, so only time for a brief update this week. You may have seen a lot of coverage that London hospitals are very badly affected by COVID-19 right now. This is all pretty accurate I’m afraid. 1/10 Photo: @jometsonscott
Hospitals in the north of England seem to be stabilising now which is a relief, but the situation in south Wales, east London and the north Kent remains very difficult. COVID patient numbers have doubled where I work in the last week. 2/10 https://coronavirus.data.gov.uk/details/interactive-map
Compared to the first wave, we are looking after a much larger number of patients with ‘usual’ illnesses. Heart attacks, strokes, trauma, cancer surgery etc. NHS staff are getting pulled in lots of directions. 3/10
Read 10 tweets
12 Dec 20
Spoke too soon. Two weeks ago I was hopeful that the second COVID tide was starting to turn. Things weren’t easy but had stabilised and national numbers were down. Now we're seeing rising numbers at national level in and several regions, including where I work in east London. 1/7
The number of people testing positive for SARS Cov-2 is definitely up in the last 7 days, while the number of patients admitted to hospital with COVID-19 is beginning to rise, and the number of deaths (which lags behind admissions) was falling but has now levelled off. 2/7 https://coronavirus.data.gov.uk/
Government data fit with the independent data from @ICNARC describing intensive care admissions. The number of patients in ICU with COVID-19 appeared to be falling 7 days ago but not any more. 3/7 https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports
Read 7 tweets

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