Thread by @danielgoyal

Lessons I have Learned so far

#COVID19

Experience:

+ Clinical Lead for level 1 and 2 (HDU) COVID Unit

+ Clinician for CAC (Covid Assessment centre)

+ Regional Lead for Remote COVID monitoring and follow-up service.

+ researcher orcid.org/0000-0003-0418…

1. Respect experience.

The two best preparations I undertook were to read, properly, the WHO guidelines (deep dive where necessary)
+
Spoke with the clinical lead in Singapore.

We are juniors in pandemic management and treating SARS. They are not.

IMO: when there is a new pathogen, the experts are those on the frontline treating the disease. At least until enough data is collected to analyse empirically…

2. Isolate and TREAT those infected.

An effective TRIAGE System is absolutely key:

- symptom profile must be wide enough to catch most cases and catch them early enough to treat

- thresholds for admission must be low - it’s an unknown entity

- value the “eye-ball” assessment

2. TRIAGE is dynamic and responds to resource availability LOCALLY.

You cannot undertake national or regional triage.

Triage is an opportunity to save an ICU admission, a prolonged stay, and a life.

Waiting for patients to deteriorate and then acting is bad economy.

3. Capacity.

Triage and increasing basic healthcare capacity are the two fundamentals of a clinical response to a pandemic.

It saves resources, and allows other essential work to continue. Much easier to staff, and early stages of covid pneumonia are quite clear to manage.

4. Do not allow the clinically uninitiated (eg politicians and managers) dictate clinical priority or triage criteria. Their job is to get us the resources to do ours. It is only someone who understands the disease that can direct resources efficiently.

Thankfully, our duty is not to government, policy, or management…ours is to do the best for the patient with what we have available.

5. Finally, we may be new to SARS, but basic principles still apply. Early intervention, monitoring for complications, easing symptoms, good nursing care, all matter.

I always remind myself: Ebola in the sticks carries a nearly 50% mortality. 10% with best supportive measures.

Anyway, given the #CovidReport was devoid of any contribution to the actual treatment of patients, I thought I would share mine.

Would appreciate hearing yours…

And yours:

@EmergMedDr @seahorse4000 @DrSimonHodes #TeamGP #MedTwitter @DrNeilStone @DrTedros

From feedback:

Determine your own level of Risk and what protection you need. PPE guidelines are simply that, a steer, often the minimum. A hacking cough in a closed room, you will need more than bib and looose mask. Good care can still be safe care.

Thanks @dgurdasani1

If possible triage should be undertaken by those used to determining mild from severe with little info.

Primary care physicians (GPs) are astute at picking out the mild viral illness from the progressive ones. It is a valuable skill in pandemic triage.

Thanks @DrSimonHodes