Thread by @danielgoyal

#COVID19 UK thread:

Why has the UK mortality been so high?

Overall mortality of the pandemic can be measured as total deaths.

Deaths per 100k inhabitants:

UK - 205
Sweden - 144
Germany - 113
Ireland - 103
Norway - 16
Japan - 14
Singapore - 2 (yes, two)

1/n

So why has the UK had more deaths?

Sweden pursued a herd immunity strategy. Germany had a similar public health response to the UK. Both have done much better than the UK.

if you get Covid-19 in the UK, you have a higher chance of dying. Why?

The first FATAL flaw of the UK response was the “stay home” approach.

Instead of triaging (assessing) covid cases, the UK opted to make NO routine clinical contact with ANY covid cases. UK national policy relies on the patient to come forward if severely unwell.

NO TRIAGE

This increases mortality for several reasons:

1. Most people are not doctors or nurses. It is not easy without the tools and experience to know if someone has severe covid. For example, many people think that shortness of breath is normal for covid.

PEOPLE PRESENT LATE.

2. Late presentation of any pneumonia leads to much worse outcomes. Mortality is higher but also recovery can take much longer - months and for some even years. #LongCovid

3. But also if people present later they spend more time in hospital. This takes up a hospital bed (+\- ICU bed) for longer. More pressure on hospitals mean less space for patients and then hospitals HAVE to start only admitting the most severe patients. The spiral sets in.

This brings us to the second greatest FATAL flaw in the UK response:

Failing to increase BASIC healthcare capacity!

Common sense would dictate that if you are expecting more sick people, then you need more space to treat them. This is why one of the @WHO first recommendations was for countries to increase their “Basic healthcare capacity”.

Treating covid pneumonia is actually very simple, early on. Oxygen, rest, meds to prevent clots, and a tablet to reduce inflammation. And preventing covid from getting worse is the best way of reducing deaths from it (and length of hospital stays).

EARLY INTERVENTION

The UK government ignored this advice. And actually reduced bed capacity by 8%. Bed capacity (despite waiting lists) remains lower now than before the pandemic. MORE PATIENTS but LESS BEDS #NHS @NHSMillion

Not only did this cost lives because we simply didn’t have the space to treat them, but COVID beds took over normal beds, so we have less beds to treat everyone.

Norway, Germany, Japan, Singapore, China, India, all increased their basic capacity. Field hospitals, military hospitals, even building entirely new hospitals to increase basic bed capacity.

The UK instead tried to create ICU field hospitals. Not only was this the least effective way to save lives, it clearly disadvantaged the elderly, many of whom would not have a chance at ICU care, but would have with basic care.

It failed miserably. ICUs require very high levels of very specialised staff. Neither were available. Half a billion pounds that could have gone to expanding basic care wasted because we failed to follow the very basics of pandemic management….

TRIAGE
And
INCREASE CAPACITY

Very simple. Saves lives. Reduces the threat of the virus. And stops covid from consuming all the resources.

Have we learned the lessons? All signs suggest we have not.

#fbnhs #CovidEnquiryNow

Thanks to @DrSelvarajah for highlighting the oxygen issue.

In April 2020, NHS England issued a directive to ration oxygen nationwide. It was unnecessary.

This meant people with severe Covid could be kept at home. It did not save lives or resources.

Here is a paper with the evidence trail for above, including references to national #COVID19 policies:

thelancet.com/journals/lanep…