Thread by @danielgoyal

Summary thread (for me too).

Clinical care for COVID-19 in the UK: shortcomings and lessons to be learned.

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My view on what next...

Here, I summarise the threads I have written over the last couple of months.

It will tell part of the story of the UK's national response from a clinical perspective.

I have attached the previous threads only for those who wish more detail.

There are several critical failures in the clinical pandemic response, including:
1. The Herd Immunity Strategy
2. Reducing basic healthcare capacity
3. Bypassing primary care triage for non-clinical Covid triage
4. No Covid follow-up service

The Herd Immunity Strategy (HIS)
= attempting to achieve an immune population through natural infection as quickly as possible.

Based partly on the belief SARS-CoV-2 is similar in impact and disease to the FLU.

It is not:

https://twitter.com/danielgoyal/status/1446955691651043329?s=20

Sweden employed a similar HIS approach but for three crucial differences:

1. Transparency.

2. Strengthened the health system first.

3. Continued mitigation strategies - masks, isolation and local outbreak containment - reducing the infection rate to allow healthcare to cope.

Sweden has not done well. Their mortality is amongst the highest in Europe.

And now that vaccines bring hope of reaching an endemic (stable) state without so much death, disability and economic disruption, it seems the HIS strategy has no upside.

The UK did worse.
It seems our government were quite fixed on a herd immunity strategy from the start.
Had they developed the COVID Care pathways better - triage, bed capacity, follow-up -, then mortality may have been closer to Sweden's (sadly, a big improvement for the UK).

Here is the initial thread.
We also discuss the impact on non-COVID conditions when allowing infection to spread freely while simultaneously shrinking healthcare provision.

https://twitter.com/danielgoyal/status/1450785022886219782?s=20

As Prof Gower (@wtgowers) wrote, March 2020...

1. "There is evidence that some people can be reinfected."

2. "We do not know that people who get coronavirus have lasting immunity."

3. "We do not have the resources to implement the policy in a non-disastrous way."

CAPACITY!

So, IMO, one of the most critical errors was pursuing a herd immunity strategy, compounded by a failure to invest in the NHS for the inevitable healthcare burden.

Healthcare capacity.

But even if not pursuing a herd immunity strategy, a pandemic means there will be more patients than before.

The UK was one of the only countries in THE WORLD that did not expand basic healthcare capacity.

We still have less beds than before the pandemic

Here is the initial thread regarding healthcare capacity.

Perhaps the most crucial point is that hospitals prioritise care as the hospital fills. Once over 85% full, the quality of care diminishes and outcomes worsen. @NHSProviders

https://twitter.com/danielgoyal/status/1450785022886219782?s=20

TRIAGE
Identifying and treating those who have the disease is the backbone of a pandemic.

Do it well and the virus is contained and the threat to life diminishes.

EARLY INTERVENTION SAVES LIVES...

and reduces disability.

Our first paper:

rcpjournals.org/content/clinme…

To this day we have no TRIAGE or Follow-up service for patients with COVID-19, not even the older or vulnerable patients.

This is hugely disappointing @CMO_England @DrGregorSmith

https://twitter.com/danielgoyal/status/1451380203176046615?s=20

We summarise the problems with healthcare access in the UK in this paper. It's a long, but for some perhaps a worthwhile read.

thelancet.com/journals/lanep…

SOLUTIONS:

For us all:
1. Note, in a vaccinated person, the vast majority of infections are similar to a cold and will clear without event. Stay engaged with life.
2. Reduce the spread - mask, ventilation, avoid crowded indoor gatherings, follow: @dgurdasani1 @trishgreenhalgh

3. The government have now removed the restrictions on accessing your primary care team. If you are unwell, seek help either from your GP, or Telephone 111. It is OK to call back if you get worse. [more detailed post to follow]

4. Also be aware of the services available to you...including pulse oximeters and home monitoring.

https://twitter.com/danielgoyal/status/1452168731652657156?s=20

For Local Leadership:

1. Increase Basic Healthcare capacity - we must get below 85% before going into the height of winter.

2. Redeploy to frontline services - GP and urgent secondary care services

https://twitter.com/danielgoyal/status/1447523719153393668?s=20

3. Revert back to an early intervention model of care...triage and follow-up...

Vastly reduces mortality, ICU usage, and length of hospital stay

https://twitter.com/mattinadakim/status/1400367512655704066?s=20

4. Clinical (not political) Prioritisation is vital to maximise the resources available. We should be on a war-footing NOT a business as usual posture.

Clinical lessons I have learned thread:

https://twitter.com/danielgoyal/status/1447523719153393668?s=20

For the central UK government:

1. Either contribute or get out the way..

#COVID19
#SaveOurNHS
#EnoughIsEnough

Apologies, some duplicated threads...here is what I meant to share

Capacity:

https://twitter.com/danielgoyal/status/1445855098408734725?s=20

Lessons learned:

https://twitter.com/danielgoyal/status/1448703669692739592?s=20