Optimistic news: National data on new coronavirus infections data do now show we have passed the peak. Good news but really this is just the end of the beginning for the NHS response. 1/7
Firstly, the national data hide regional differences. New infections are still increasing in many parts of the UK. NHS hospitals in different areas will need to support each other for some time to come. 2/7
This map illustrates this much more clearly. Many areas of the country still very badly affected by new infections. This affects NHS healthcare in pretty much every part of the UK. 3/7
Hospital admissions are still rising although we hope they will peak within 7 days. BUT the second wave has already lasted much longer than the first, with far more hospital admissions. These patients will take a long time to recover and go home. We have a long way to go. 4/7
A similar pattern in intensive care. The demand for ICU beds is far greater than the first wave - something which was hard to imagine until a few weeks ago. It now seems inevitable that hospitals will still have a large COVID workload as Summer begins. 5/7
BUT vaccination roll out is impressive - 4 million people have now received their first dose. This is vital to preventing virus spread and protecting people from the disease COVID-19 (don't @ me about 2nd dose delay, I'm waiting for my 2nd while most have not had their 1st). 6/7
Take home messages: 1) Infections may have peaked but pressure on hospitals is still rising; 2) Things may still be getting worse in your area; 3) #HandsFaceSpace remains vital; 4) The NHS will still be doing a lot of COVID care beyond June; 5) Have the vaccine when offered! 7/7
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What reaching the peak means for the NHS: We're increasingly confident we have hit *a* peak and hopefully *the* peak of the second wave of coronavirus infections. Hospital admissions lag behind and will carry on rising for another week or so, but this is still a key moment… 1/10
I have talked before about how and why the healthcare the NHS provides right now is simply not as good as usual. We have protected emergency care but routine care for cancer, cardiac disease and so many other illnesses has been badly affected. Especially surgical treatments. 2/10
The surge in COVID patient admissions has a huge impact on other parts of the NHS. We see this pattern often in the winter flu season but it is far worse right now. The shortage of normal hospital beds and ICU beds makes in-patient work very difficult. 3/10
The number of new coronavirus infections may be levelling off, but patient admissions to NHS hospitals for COVID-19 will increase for another 7-10 days. The question of how we choose which patient gets an ICU bed is now a routine one in media interviews. Doctors are worried. 1/11
The burden of decision making around ICU admission traditionally falls on senior ICU doctors. Most of us are privately very worried about what will happen if we run out of resources. The false suggestion that we rationed ICU beds in the first wave has upset a lot of people. 2/11
To be clear, I am not aware of ANY patient who was not admitted to intensive care during the pandemic when the ICU consultants responsible believed that they should be. But we would be failing in our duty if we do not plan for this situation. 3/11
Recent trial results show some promise for Tocilizumab in the treatment of severe COVID-19. Welcome news at a difficult time and excellent work from @remap_cap & @NIHRresearch. But the results raise some difficult issues for doctors treating patients. 1/9
To recap, Tociluzimab is normally used to treat inflammatory arthritis and other immune disorders. The drug suppresses the systemic (whole-body) inflammation (AKA 'cytokine storm') and may reduce the harm of COVID-19 especially for critically ill patients. 2/9
Scientists from @The_MRC population health sciences unit combined data (meta-analysis) from 2107 patients in six trials including @remap_cap. The results suggest a small reduction in 28-day mortality. But most of the benefit was from REMAP-CAP. The results are not clear cut. 3/9
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
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
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
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
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
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