Tim Cook Profile picture
10 Feb, 11 tweets, 6 min read
Round 3 of ACCC TRACK. Exploring impact of COVID on anaesthetic departments and surgical activity out now
@emirakur @jas_soar @HSRCNews @RCoANews

nationalauditprojects.org.uk/downloads/ACCC…
Only about a third of anaesthetic departments operating well in December- worse then October and before the new year surge hit Image
All but 14% of hospitals in a surge setting and half not able to meet ICU demand as normal Image
Impact on surgery at least as bad as in October
1 in 5 operating theatres closed
Open theatres working at well below normal activity ImageImage
Impact of surgical activity across the board
Non cancer down 36%
Paediatric surgery down 35%
Cancer surgery down 30%
Even emergencies down 10% ImageImageImageImage
Overall impact shown here Image
Overall we’re NOT doing more than a quarter of normal surgical activity
That’s 5500 cases a day
Well over 1 million a year Image
The reason for the downturn lies mostly in availability of staff
Almost 1 in 5 of anaesthetists not available for normal work
Oct-Dec big increase in redeployment of anaesthetists to ICU Image
Amazing response from Uk Anaesthetists to provide this - almost real-time data - on impact of ICU pressures on UK surgical capabilities

Thank you

Importantly the 3rd round capturing key data from January is now under way
Please send your data Image
Many thanks to to the @HSRCNews staff at @RCoANews for working through this so promptly and to the #NAP7 fellows who have done so much this year despite the main project being stalled
@emirakur
@adk300
@drrichstrong
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More from @doctimcook

12 Feb
Nice to see this published
Working with @john_actuary from @COVID19actuary we’ve modelled impact of vaccination on
-deaths
-hospital admissions
-ICU admissions

…-publications.onlinelibrary.wiley.com/doi/full/10.11…
Vaccinating just by age would have this impact on the three measures

The lag in the last two is because the groups differ.

Median ages
-deaths 83
-hospitalised 73
-ICU 61

So the cohort who might get to ICU have to wait for vaccination Image
If the graphs are adjusted to account for
-gp2 health/social care workers
-gp4 extremely clin vulnerable
-gp6 high risk
They look like this with lag slightly reduced (and the health service staff protected)

Vaccinating 15% of popln
-huge impact on deaths
-modest impact on ICU Image
Read 7 tweets
12 Jan
@nico111111 @rupert_pearse @JeremyFarrar An important piece by an excellent communicator laying out what it means when the NHS is 'overwhelmed'
@chrischirp

-first more difficult to provide care
-then standards of care reduce
-finally inability to provide even that care to some needing it

theguardian.com/commentisfree/…
Important to remember that pressure on NHS will last longer than high rates of mortality

As @chrischirp says if we reach the point where we cannot deliver care to some patients there need to be a plan

The @ICS has perhaps produced the best 'organisational overview'
ics.ac.uk/ICS/patient_an…
Read 4 tweets
12 Jan
An important piece by an excellent communicator laying out what it means when the NHS is 'overwhelmed'
@chrischirp

-first more difficult to provide care
-then standards of care reduce
-finally inability to provide even that care to some needing it

theguardian.com/commentisfree/…
Important to remember that pressure on NHS will last longer than high rates of mortality

As @chrischirp says if we reach the point where we cannot deliver care to some patients there need to be a plan

The @ICS has perhaps produced the best 'organisational overview'
ics.ac.uk/ICS/patient_an…
Read 5 tweets
22 Dec 20
Not sure altmetric is be-all & end-all but it looks like
the meta-analysis of ICU outcomes from COVID by
@drrichstrong @adk300 has just become @Anaes_Journal no. 1 using that metric
Quite a feat during a pandemic while doing your day jobs
Well done🎩

altmetric.com/details/849725…
1/n
The article is here - obviously free to all
…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

Thanks @Anaes_Journal for publishing it and handling it so expertly and promptly, as usual

2/n
Unlike most papers this year it had a somewhat positive message showing how in-ICU mortality has fallen over the first months of the pandemic
- from around 60% in Jan-March
- to less than to 30% in May

An awful disease but one in which we have been making improvements

3/n Image
Read 8 tweets
21 Dec 20
Coughs make aerosols

It's long been time for ward staff to upgrade to FFP3 around coughing patients and those with COVID

The urgency for this is dramatically increased by the new variant virus

No one seems interested....

@TheLancet @bmj_latest @PHE_uk
It is very clear that anaesthetists & intensivists were at lower risk of infection and harm in 1st surge

There are several plausible reasons but until it can be shown that it is not because of better PPE surely ward based PPE needs to be revisited.

…-publications.onlinelibrary.wiley.com/doi/full/10.11…
HCWs at 3-4x higher risk of infection ImageImageImageImage
Read 8 tweets
22 Oct 20
Out in all its glory the Bristol Aerosol paper

Ready for tonight's debate
This study showing precious few aerosols generated at intubation
@Anaes_Journal @drjulesbrown @TonyPi314 @_andyshrimp

…-publications.onlinelibrary.wiley.com/doi/10.1111/an…
Lots of respiratory aerosols with a voluntary cough
Almost none during intubation sequence - anaesthesia/BMV/suction/intubation

Note the log scale
Read 9 tweets

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