Sitrep: situation report. This is what we call our daily briefings right now. Here’s mine. We are now fairly confident we have reached the high water-mark for the second wave of COVID-19 NHS hospital admissions across the UK. Good news but.... 1/10
....we still have nearly 40,000 patients in hospitals with COVID-19. Despite huge increases in staffing, we are very short-handed. In many hospitals, admissions have stabilised but not all. Some differences across the UK. Things still getting worse in the Midlands and North. 2/10
4000 of these patients (10%) need intensive care. This is huge: in January 2020 the UK had only 4100 adult ‘critical care’ beds including both ‘intensive care’ ventilated beds for the sickest patients and 'high dependency' beds for less sick patients. 3/10
kingsfund.org.uk/publications/c…
This is important because sceptics have spread deliberate misinformation about ICU ‘occupancy’ to obscure massive increases in ICU capacity. Ensuring we have a bed for every patient means we must have empty beds ready to admit them to ICU urgently. 100% occupancy isn't good. 4/10
Our usual strict rule of one trained nurse for each intensive care bed has been stretched to 1:3 and in many hospitals, to 1:4. We are still filling these gaps with nurses from other departments, retired nurses, medical students, and hospital consultants (senior doctors). 5/10
So while the situation is becoming less serious we cannot relax. The quality of patient care is not the same as usual and many other routine NHS services have given up staff to care for COVID patients. The care of patients with less urgent illnesses is still badly affected. 6/10
But mostly we can stop planning for further increases in patient numbers and focus on consolidating our response. We can think much more about the quality of patient care and how we can improve it. We are starting to look at longer term planning for COVID. 7/10
Sadly, COVID is here to stay. We will still have lots of COVID patients in hospitals in June. We must plan for winter COVID crises just as we did for winter flu epidemics. COVID will become endemic (present at low levels) and gradually take its place in the NHS routine. 8/10
On the plus side, we now understand this disease really well. We will know how to prevent and control future COVID epidemics and how to anticipate the need for NHS capacity. We will get better and better at keeping usual NHS care going while we respond to smaller outbreaks. 9/10
Meanwhile, following public health guidance remains vital to protect everyone’s healthcare. Please keep up your amazing work with #HandsFaceSpace. Politely call out those who question the need, especially public figures with big audiences. This will help save lives. 10/10 💙 Photo: @jometsonscott

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Rupert Pearse

Rupert Pearse Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @rupert_pearse

23 Jan
Oxygen supply in hospitals is getting a lot of media coverage. Some hospitals are using five times more oxygen than usual triggering low pressure alarms. Media reporting oxygen supplies ‘running out’ and ‘not enough to go round’. The problem is not quite what it sounds… 1/12
We don't usually think about oxygen supply. It isn't something we notice until the oxygen pressure alarms go off. That used to be rare. The unfamiliar and emotive problem can seem frightening for NHS staff and public alike. This from @ChrisCEOHopson 2/12

Oxygen supplies don’t run out like an electricity power cut. Instead the pressure drops like it can with the hot water system in your home. Your shower doesn’t run dry but the water pressure is not what you need. You may need to turn some other taps off to solve this. 3/12
Read 12 tweets
20 Jan
A bit of controversy at the moment about medical students redeploying in Healthcare Assistant (HCA) roles. Some unfortunate language which I’m sure is regretted. I’m very involved in the @QMULBartsTheLon @QMUL med student redeployment and would like to point a few things out. 1/8
In the first wave (March), med student studies were suspended. Ours had just finished final exams and *volunteered* to join us to support patient care. They did not expect to get paid. They were incredibly professional and made me very proud to be a @QMUL prof. 2/8
In the second wave (January) our students’ studies have NOT been suspended. We (@QMULBartsTheLon) have *sent* them to help. While many would choose this, not all would. Our final years have major exams looming and must also complete educational log books, attend teaching etc. 3/8
Read 8 tweets
19 Jan
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 https://coronavirus.data.gov.uk/
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 https://coronavirus.data.gov.uk/
Read 7 tweets
17 Jan
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 Photo @jometsonscott
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
Read 10 tweets
14 Jan
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
Read 11 tweets
13 Jan
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
Read 9 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!