Thread by @doctimcook

A thread on why a slower lockdown release makes sense for the wide and younger community (& so for all)

ICU pressures will not fall for up to 8 weeks after similar falls in deaths
@john_actuary
1/n

…-publications.onlinelibrary.wiley.com/doi/full/10.11…

The reasons can be illustrated by the median ages of patients in the 3 groups affected by COVID
-patients who died (median age 83) @ONS
-hospital admissions (age 73) @ISARIC1
-ICU admissions (age 61) @ICNARC

Impact of vaccination is much slower in the younger groups

2/n

There's been evidence vaccination is impacting deaths in the older groups for some time

John adds to the tweet below

https://twitter.com/john_actuary/status/1361689166183038982?s=20

3/n

Also evidence that cases in the above 70s are starting to fall

@IanDenton12's analysis of age of new cases by day shows the proportion of case in those aged >70 is dropping

4/n

https://twitter.com/IanDenton12/status/1362120534025240576?s=20

In hospitals there is still a lot of pressure
Today there are still as many patient in hospital as at the peak of surge 1

5/n

In ICU the numbers of ventilated are still at roughly the same as at the peak of surge 1 - despite the fact that far more patients are being managed on the wards in surge 2.

6/n

Although this is not all about ICUS ..... the ongoing pressure on ICUs is becoming widely underestimated
@ICS has produced excellent infographics to illustrate this

https://twitter.com/doctimcook/status/1359252464155910146?s=20

7/n

@ICS have a detailed document 'recovery and restitution' for ICU services

They describe an increase in occupied ICU beds by
2,251 (vs Feb 2019)
Equivalent to 141 new ICUs
An approximate 70% increase
These beds did not exist last year

8/n

ics.ac.uk/ICS/ICS/News_S…

This is the extra staffing needed every day to run those extra beds.

9/n

These staff have of course been borrowed from elsewhere or staffing ratios reduced

The reality is both are happening
To illustrate - in December -18% of anaesthetists were unavailable for normal duties, most redeployed to ICU
nationalauditprojects.org.uk/ACCC-track-Ana…
@NAPs_RCoA @emirakur

10/n

The knock on effect on routine surgery is massive
1 in 5 operating theatres closed and open ones working at 75% efficiency

Falls in all surgical activity
-non cancer 36%
-paediatrics 35%
-cancer 25%
-emergencies 10%

#ACCCTrack

11/n

It's equivalent to a 28% fall in all NHS surgery
5,500 operations not done each day
>1,000,000 NHS operations not done in a year

and January & February have been much worse

Anaesthetists are a finite resource & redeployment impacts on planned services
@RCoANews @AAGBI

12/n

Important to remember that it's still an awful disease & around half of all patients admitted to ICU are still dying.

Although the headline figures look to be lower, amongst completed episode of ICU
- 61% overall mortality
- 54% of those ventilated early

13/n

While most ICUs have roughly doubled their size regional variations have been enormous.

Some ICUs have been overwhelmed & for the greater good patients have been moved to less overburdened (though still above normal capacity) ICUs

Several thousands patients
@ICNARC

14/n

All this needs to be put back in place
-ICUs
-patients
-staff

Then we can fully resume planned surgery & other services needing anaesthetic/ICU support

But patients need to recover and so do staff

We cannot move seemlessly from this to normality

But that's another thread

END