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… Comparing the four countries.  Red means case is triaged on
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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More from @danielgoyal

22 Nov
The Johnson Legacy:
"Pursuing a mass infection policy while refusing to provide the treatment needed for those infected."
The fact this is happening is irrefutable.
But why refuse to strengthen the NHS during a pandemic?
And is there time for the PM to change this legacy?
Things are a bit hazy just now. We are all reeling from a difficult 20 months. Most are fed-up with Covid-19. And many have realised the damaging secondary impacts of the measures implemented to control it. Popular sentiment bastes in this recent trauma.
Popular sentiment will change. Indeed, for PMs in office during major historical events their legacy takes on a different quality. And I think few will argue the Covid pandemic is the most historical event since WW2. It is certainly killing more civilians.
Read 13 tweets
21 Nov
Johnson's legacy of pursuing a mass infection policy.

One fact will dismantle the Johnson Government’s entire defence at the Covid Inquiry and harm them irreparably at the General Election…

[#JohnsonOut #JohnsonTheCorruptPM #YourNHSNeedsYou]
The PM embarked on ‘freedom day’ without making provision to treat the inevitable increase in severely unwell cases. Just pause for a moment and consider that…
The UK has less inpatient capacity than before the pandemic. Freedom day has led to so much Covid Pneumonia it has TRIPLED the healthcare burden from 'normal' pneumonia - one of the highest burden diseases in the UK - and still the capacity of the NHS is less.
Read 6 tweets
20 Nov
Prompt treatment of Covid-19 Pneumonia saves lives.

Here, our cross-discipline team reviews some of the signs and symptoms that suggest Covid-19 has progressed to Covid-19 Pneumonia.

Seek help sooner rather than later!

Summary thread
1/7
Share pls.

bmjopenrespres.bmj.com/content/8/1/e0…
The public should exercise the same judgement for who and when to contact if they are concerned as they did prior to the pandemic. Waiting until severely unwell neither helps patient or health service.
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.
Read 8 tweets
18 Nov
We can now say with confidence that the government's NHS strategy is leading to more people dying (all-cause).

This report by the Royal College of Emergency Medicine is a shocking and sickening indictment of the Johnson leadership.

#JohnsonMustGo
#YourNHSNeedsYou
1/9
Under this government, the number of available hospital beds (and therefore frontline staff) has declined dramatically...
2/9
And look what happened during the pandemic...
[Bed capacity fell dramatically]
3/9
Read 9 tweets
18 Nov
What the UK can learn from South Korea’s Covid response | Devi Sridhar

Brilliant article by @devisridhar. A must read for all involved/interested in the pandemic response.

Below, I expand the point on clinical lessons from S.Korea.

1/9

theguardian.com/commentisfree/…
The first part of any pandemic response is to identify those who have the infection. It sounds obvious, I know. And I can't believe it actually has to be said. But such are the times we are in!

There are two reasons:
1. Isolate.
2. Treat.

@theAliceRoberts
Isolation prevents the spread of infection and thus death and disability.
Treatment directly prevents death and disability - the actual threat posed by the virus. It is this 'threat' we are concerned with. Fail to identify and treat cases, more people die and the threat grows.
Read 10 tweets
14 Nov
How complicit has NHS Leadership been in Johnson’s pandemic calamities? And have lessons been learned?
There is a long list of failures:
▪️Ageist policies
▪️Blanket Do Not Resuscitate orders
▪️Inadequate PPE
▪️Ethnic disparities on the frontline

#TeamNHS
#TeamGP
▪️No Triage
▪️No clinical follow-up
▪️The ‘Stay Home’ messaging
▪️Ineffectual Contact and Trace
▪️Circumventing primary care
▪️Rationing of access to healthcare via ‘111’.
▪️Oxygen rationing
▪️Shrinking the NHS during a pandemic
And these failures, while still remediable, continue to place HCWs in unsafe and traumatic working conditions, and are still leading to unsafe care provision for the British public.
Read 10 tweets

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