▪️How to tell if a Covid-19 patient is deteriorating at home?
A cross-discipline team reviews the signs and symptoms to watch for.

(1/10)
Share pls.
2/10
The majority of Covid-19 resolves without event. Typical symptoms are similar to the cold or flu and tend to start improving after two or three days.
3/10
The public should exercise the same judgement for who and when to contact if concerned as they did prior to the pandemic.
[The British Thoracic Society CAP guidelines remain unchanged.]
4/10
Certain symptoms require urgent clinical contact:
➡️Shortness of breath
➡️Confusion
➡️Persistent, unremitting fever
5/10
Other symptoms seem to have some predictive value for disease progression:
6/10
Silent Hypoxia
Covid-19 pneumonia sometimes causes low oxygen levels without the feeling of breathlessness. It requires urgent medical attention. This is much more challenging in countries with no formal Covid triage or follow-up services, like the US or UK.
7/10
Silent hypoxia may cause other symptoms, such as confusion or severe fatigue (exhaustion after minor exertion like climbing stairs).
Almost all patients feel unwell, albeit sometimes non-specifically. BUT…
8/10
...the only reliable way to check for Silent Hypoxia is by using a pulse oximeter. If in England or some parts of Scotland and have confirmed, symptomatic COVID-19 you may be eligible for oxygen monitoring at home (via primary care/111).
9/10
If not eligible, you can buy your own pulse oximeter (accredited). More information here:

england.nhs.uk/nhs-at-home/co…

For clinicians using remote monitoring, there is a BMJ practice paper:

bmj.com/content/372/bm…
10/10
Other observations (pulse, BP, RR) are useful for excluding disease mimickers (e.g. bacterial pneumonia or sepsis).
In the ISARIC cohort, despite a mortality of 30%: Obs in 60–69 years at presentation were RR: 22, HR: 91, SpO2: 95%, temp 37.3° and systolic BP: 130 mm Hg
A1
Other findings:
Chest X-rays were deemed to offer limited additional value to the community assessment.
Clinical examination was of unknown value (although, an 'eye-ball' assessment may be of use).
Blood tests are usually not required. [CRP was noted to be of some use < 75yrs]
A2
Summary Table
A3
The full review is available here.

Stay vigilant and look after each other.

Many thanks to my co-investigators: @DanLasserson @mattinadakim @stephenrthomas1 @FatmaMansab @adeebnaasan @PHcritique...

bmjopenrespres.bmj.com/content/8/1/e0…

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More from @danielgoyal

6 Nov
Why are so many willing to let the NHS go under?
I have found a lot of bad assumptions at the heart of those who want to see the NHS fail and a new system take its place. A few tweets to add to the debate..
#YourNHSNeedsYou
#SaveOurNHS
@NHSMillion
@EveryDoctorUK
Some argue that no health system has copied the NHS.
The reality is that most high-income countries have copied the NHS-model and have a very similar model. Few have however, managed to make healthcare provision the sole duty of the state...
Although in 2012, I believe this current government pushed through an amendment to make it NOT the responsibility of the Health Sec.
@JolyonMaugham
@ChrisCEOHopson
Read 11 tweets
4 Nov
More people will die this week from COVID-19 than died of FLU in the whole of 2019.
And just to be clear: if you are in hospital you will be tested for the flu. And excess deaths last week = 1400. That is, 1400 people are no longer here that would be here if we stopped behaving like spoiled children - gov and others included. Norway excess death = -6.
Ok. Just to be very very clear!!!

FLU and COVID are like Ghandi and Boris Johnson….yes, both human but one causes much more damage and destruction.

Thread explaining the ACTUAL facts!!!! Happy to answer any reasonable question
Read 4 tweets
4 Nov
#
When government policy is not evidence based and is not in the interest of the patient...we must speak out.

🧵
#YourNHSNeedsYou #FBNHS
@dgurdasani1 @trishgreenhalgh @doctor_oxford @theAliceRoberts @mikegalsworthy @YourNHS2021 @NHSMillion @docrussjackson @PeoplesNHS @NurseSayNO
As panic gripped a rudderless nation, worst-case scenarios were being projected and simulations cast doom over the healthcare service’s ability to cope, the relative unknown fatality of this new infection foraging the globe loomed over our heads.
It was March 2020, and within this culture of fear, speculation became an acceptable basis for decision-making. Fear of needing to ration became rationing itself; protecting the NHS became failing to protect the people, and government policy suddenly became 'clinical guidelines’
Read 13 tweets
4 Nov
My Pinned Tweet
I believe we should mitigate against Covid-19 - masks, vaccines, ventilation/filtration, etc.. - and increase BASIC healthcare capacity. This will help prevent death, disability, social restrictions, economy, and the secondary impact on non-Covid diseases.
Mortality is high in the UK.
1 in 400 of all UK citizens have died from Covid.
Most didn't need to.
Enough mitigation strategies to permit access to enough healthcare will allow life to function closer to normal with the least amount of suffering.

The government's strategy is based on faulty logic and/or questionable motives...

Firstly, the fact: good control of the rate of infection leads to much better economic security.

Secondly, the Herd Immunity Strategy is hugely damaging...

Read 11 tweets
3 Nov
Restricted access to the NHS during the pandemic...

...the evidence and policies that led to excessively rationed healthcare provision in the UK.

Summary thread
1/18
RT pls
#YourNHSNeedsYou
#MedTwitter
thelancet.com/journals/lanep…
This paper was developed from a collaboration between primary, secondary, and public health care specialists. Its aim was to examine and highlight the policies that have led to restricted access to healthcare in the UK.
2/18
It shows:
1. No triage for suspected or confirmed COVID-19 cases

Despite WHO recommendation to triage all patients with this novel coronavirus, patients are told to NOT contact their GP and instead use an AUTOMATED, online patient-led triage system,... BUT only if concerned... NHS England Suspected Coronavirus, patient information leafl
Read 17 tweets
31 Oct
The NHS response to the Pandemic.

The public have a right to feel ABANDONED...
...in many ways they were.

But give me a moment to convince you: it was NOT the NHS that abandoned the public...it was our Leadership who abandoned us all.

[RT pls - people need to know].
1/10
2/10
All but the most suggestible would agree: the UK have sh*t the bed with COVID-19. A series of colossal and deadly failures led to the highest mortality rate in Europe,...
3/10
..one of the worst economic declines in the world, and a devastating effect on non-COVID diseases.
Read 18 tweets

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