Clinical Response to COVID-19
How are other countries providing care to COVID-19 patients?
Here we compare UK versus Singapore.
[Evidence at end of thread]
1/n
How are other countries providing care to COVID-19 patients?
Here we compare UK versus Singapore.
[Evidence at end of thread]
1/n
SINGAPORE
TRIAGE:
Any cold/flu symptoms are triaged as ?#COVID19
ALL suspected or confirmed Covid cases are clinically triaged at public health clinics (run by primary care).
All cases have vitals taken, are swabbed and are clinically assessed.
TRIAGE:
Any cold/flu symptoms are triaged as ?#COVID19
ALL suspected or confirmed Covid cases are clinically triaged at public health clinics (run by primary care).
All cases have vitals taken, are swabbed and are clinically assessed.
FOLLOW-UP:
ALL cases are followed-up 3-5 days later, with an open-return policy
If confirmed positive (clinically or PCR) or develops signs of LRTI..
..patients transferred by dedicated ambulance to secondary care assessment.
Mean time to admission - 2.6 days (over 1yr)
ALL cases are followed-up 3-5 days later, with an open-return policy
If confirmed positive (clinically or PCR) or develops signs of LRTI..
..patients transferred by dedicated ambulance to secondary care assessment.
Mean time to admission - 2.6 days (over 1yr)
CAPACITY
Vastly increased basic capacity with 'field' hospitals.
Private sector commissioned to continue 'routine' clinical activities during surges.
Patients can be admitted to a 'field hospital' for Level 0/1 care, or admitted to a dedicated infectious disease hospital.
Vastly increased basic capacity with 'field' hospitals.
Private sector commissioned to continue 'routine' clinical activities during surges.
Patients can be admitted to a 'field hospital' for Level 0/1 care, or admitted to a dedicated infectious disease hospital.
Singapore has an older population, less doctors, and a denser population than the UK.
They have had less than 5 deaths/100k
Total Case Fatality Rate: 0.16%
They have had less than 5 deaths/100k
Total Case Fatality Rate: 0.16%
UK
TRIAGE
No triage.
Patients who fit the symptom profile can receive a test. No vitals taken. No healthcare contact.
Patients are advised to contact 111 - online or by phone - if they are concerned.
TRIAGE
No triage.
Patients who fit the symptom profile can receive a test. No vitals taken. No healthcare contact.
Patients are advised to contact 111 - online or by phone - if they are concerned.
FOLLOW-UP
No follow-up.
Patients who test positive are contacted by non-clinical staff to trace their contacts.
Patients are again advised to contact 111 (not GP) if concerned.
No COVID-19 confirmed patient - even vulnerable - receive any triage or follow-up.
No follow-up.
Patients who test positive are contacted by non-clinical staff to trace their contacts.
Patients are again advised to contact 111 (not GP) if concerned.
No COVID-19 confirmed patient - even vulnerable - receive any triage or follow-up.
CAPACITY
The UK REDUCED total basic care capacity prior to the pandemic by 8%.
The attempt to develop ICU field hospitals failed due to lack of staff.
The UK remains with less beds than before the pandemic.
The UK REDUCED total basic care capacity prior to the pandemic by 8%.
The attempt to develop ICU field hospitals failed due to lack of staff.
The UK remains with less beds than before the pandemic.
The UK population is probably less healthy, and testing has probably been more aggressive.
Time to admission: 5 to 7 days (over 1yr)
We have had over 200 deaths/100k
Total CFR: 1.6% (10 times higher than Singapore)
Time to admission: 5 to 7 days (over 1yr)
We have had over 200 deaths/100k
Total CFR: 1.6% (10 times higher than Singapore)
Summary,
The importance of effective triage, follow-up, and having space to treat patients - I know it may be obvious but clearly not to those making the decisions -, is to detect those who are deteriorating early enough to..
The importance of effective triage, follow-up, and having space to treat patients - I know it may be obvious but clearly not to those making the decisions -, is to detect those who are deteriorating early enough to..
1) stand the best chance of surviving
2) reduce long-term disability (#LongCovid) and
3) to reduce the need for high-level care (eg HDU/ICU) and the length of hospital stay - REDUCES HEALTHCARE BURDEN.
2) reduce long-term disability (#LongCovid) and
3) to reduce the need for high-level care (eg HDU/ICU) and the length of hospital stay - REDUCES HEALTHCARE BURDEN.
Effective triage reduces healthcare burden.
TRIAGE PROTECTS PATIENT AND NHS!
Waiting for patients to deteriorate and then treat them is neither effective nor efficient. More so for COVID-19, with a wide symptom profile and 'silent hypoxia'.
In the UK we have NO triage
TRIAGE PROTECTS PATIENT AND NHS!
Waiting for patients to deteriorate and then treat them is neither effective nor efficient. More so for COVID-19, with a wide symptom profile and 'silent hypoxia'.
In the UK we have NO triage
The reason for this is in the attached thread, but, in short, @borisjohnson seems to think we don't need to use the primary care team for test, trace, and triage, and non-clinical providers will do.
https://twitter.com/danielgoyal/status/1448971087581224985?s=20
But the fact is we have NONE.
In a pandemic we don't triage and we have less beds...
Now you know: what it could be like with engaged leadership, and what it is like with our current leadership. I am not political...but we need to call a spade a spade.
In a pandemic we don't triage and we have less beds...
Now you know: what it could be like with engaged leadership, and what it is like with our current leadership. I am not political...but we need to call a spade a spade.
Here is a study we published yesterday on the reliability of the automated, 111 Covid triage service that replaced primary care triage in the UK.
Please share widely. It was public/media pressure that got changes last time.
#NHS #TeamGP
Please share widely. It was public/media pressure that got changes last time.
#NHS #TeamGP
https://twitter.com/danielgoyal/status/1450265770894757894
• • •
Missing some Tweet in this thread? You can try to
force a refresh
