Thread by @danielgoyal

Thanks for all the support raising awareness for the NHS and Covid-19 🙏🏼
I hope you will now permit me to share my academic side with you. I promise it won't be (too) boring.
It tells the story of the pandemic response from a certain perspective. It starts in April 2020..

Early Intervention
Witnessing the 'hands-off' approach being taken by the UK (and US) to patients with Covid-19, we wrote this opinion article to remind our colleagues that we don't need a 'magic bullet' to save lives. Best Supportive Care matters!

rcpjournals.org/content/clinme…

This line became quite useful:
"The battle for lives will likely be won in the community. It is the community doctors, the paramedics and the emergency department staff who will shift the balance and save most lives..."

"For most it will be, clear, sound triage systems and clear clinical guidelines that will determine the mortality rate probably much more than the total number of ventilators available."
This remains as true today, sadly.

Still in April 2020
STEROIDS
The WHO got this wrong. There should not have been a recommendation against steroids in SARS. No RCTs does not mean no evidence of benefit.
We developed this paper as it became apparent on the ground that Covid is inflammatory.
frontiersin.org/article/10.338…

Still in April 2020
The '111' Triage System
As patients were directed to '111' if concerned and this new online triage platform was preferred, we thought we should examine it.
It took the "hands-off" approach to a whole new level.
informatics.bmj.com/content/28/1/e…

While some change to the '111' algorithm occurred over the proceeding year (such as all shortness of breath being triaged in to further care), after a year the '111' online triage system remained not fit for purpose.
informatics.bmj.com/content/28/1/e…

In May 2020
Oxygen Rationing
You may be aware that in April 2020, NHS England issued a directive to reduce what level of oxygen was permissible (for all conditions).
We reviewed the evidence behind the assertion this would not cause harm.

frontiersin.org/article/10.338…

IMV, it was entirely unnecessary and likely harmful in the UK.
Proving a causal link is difficult during a pandemic, but we certainly found an association between national oxygen targets and national mortality rate.
frontiersin.org/article/10.338…

Later in 2020 we formed a cross-discipline team (GPs, Medics, ED, Resp, Public Health,) to examine the features associated with Covid-19 disease progression. BUT not in those admitted to hospital. We focused on those in the community.

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

A summary of our findings about how to detect Covid-19 pneumonia in the community.

And then, finally, (and the reason I joined Twitter, to promote this paper), our Lancet paper examining how restricted access to healthcare in the UK during the pandemic is simply causing more death and more healthcare burden.

thelancet.com/journals/lanep…

So there you have it. Hundreds of hours of research summed up in about ten tweets 🤨
▪️Early Intervention
▪️Effective Triage
▪️Optimal Treatment
▪️Healthcare Access.
Think I will remember 2020/21 as a time when stating the obvious was very much needed.

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