The dangers of misunderstanding the comparison between FLU and COVID-19.
There have been significant misinterpretations of the FLU death numbers. For some this has justified a "covid is not that bad" mentality. The dangers of group-think, once again.
Covid and flu can both cause viral pneumonia. Both can lead to secondary bacterial pneumonia.
But the direct death rate of each is:
Flu = 4/day
Bacterial Pneumonia = 55/day
Covid = 125/day (at CURRENT rates!)
ONS:
Most of us experience FLU as an unpleasant but rarely serious illness. This remains true for those of us working in acute medicine - we rarely see a flu pneumonia.
We do see a lot of bacterial pneumonia and now Covid pneumonia.
Where does the confusion or mis-information come from?
Sometimes its just that flu and (bacterial) pneumonia are lumped together: "20k deaths from flu and pneumonia".
Actually less than 10% are caused by FLU, the vast majority are caused by bacteria (like strep).
You may also have heard some stating flu kills between 4,000 to 20,000 people a year in the UK. These numbers come from modelling studies and are projections for a possible contributory role of Flu in other deaths, mainly bacterial pneumonia.
The hypothesis is that while flu causes only a small number of deaths, it can weaken the body and can increase the chance of death from other things...mainly bacterial pneumonia.
While this may be so (more evidence is needed), the deaths referred to are by bacterial pneumonia.
So, the modelling effectively TAKES deaths from the bacterial pneumonia column and puts them in the Flu column. The argument: take flu more seriously!
You can't of course use the same modelling to argue Covid is not that serious.
The issue is perception. We perceive flu to be relatively benign. So, if we say Covid is currently killing three times that of flu, it may not sound that bad - very few people know someone who has died of flu.
But these higher numbers quoted refer to bacterial pneumonia.
Comparisons with bacterial pneumonia cause no such perception problems. We know the number of deaths, we know the burden on health services it causes, and there is no need to use modelling or projections.
➡️On a population level, pneumonia is bad, but Covid is much worse.
At the current rates of Covid, it is TRIPLING the total number of deaths from community acquired pneumonia (includes flu and bacterial). It is likely TRIPLING the healthcare BURDEN from pneumonia both acutely and in the longer term.
The public health impact of COVID is massive!
My obligation is to my patients, whoever they are and wherever they live.
But I want to work in the NHS…
Selfishly speaking, I appreciate not having to say no to treatments because a patient can’t afford it..
But…
🧵 1/6
After 14 yrs of Tory rule and a cowed and complicit NHS Leadership, patients are being denied treatment due to lack of resources. It is hard to witness, day in and day out.
The very principal of the NHS - access for all - no longer exists!
2/6
So do I blame any doctor seeking work elsewhere? Absolutely not. Better to survive and help patients than to be broken by a system that makes treating patients harder and harder, in a country increasingly polarised. Staying in the NHS now can be very damaging for staff.
3/6
The top down diktats ignorant to what’s actually happening on the frontline
And the kick in the teeth: there was no need for such chaos…we had plenty of warning!
1/n
You may be asking why only testing if travel history?
There were limited tests available, even though we had months of warning
It should have been a clinical call who gets tested not a management call
And remember at the time the UK was downgrading PPE, we were an international outlier. WHO never changed the advice. Even in poorer nations, medical staff were still kitted out in FFP3. Germany, France, Spain, Norway,…never downgraded.
It’s been a brutal winter for most of us in the NHS.
Now I’ve a got a few weeks off I’m reflecting on medicine in the NHS in 2024
🧵
To be clear, as a general medicine consultant in the NHS we get an unselected patient group. We see all sorts from sepsis to heart attacks to strokes to cancer to drug overdoses to alcohol withdrawal…I will see most of them from admission in A&E through to discharge or death.
My impression
Medicine is way more advanced than it was when I qualified in 2001. For example, we used to have two or three medications to treat heart failure and most patients with heart failure died in three years.
The Covid Inquiry has been asking questions about whether Lockdown could have been avoided. Some (like Sunak/Johnson) have interpreted this as suggesting we shouldn’t have locked down. It’s the entirely wrong interpretation and not the question the Inquiry is asking…
1/14
It is true that some countries didn’t lockdown and did far better than the U.K. But it was not the presence or absence of lockdown that determined the outcome. It was the presence or absence of an effective pandemic response executed early and well that determined outcomes
Lockdowns are ultimately a failure of basic pandemic management - isolating cases, tracing contacts, infection controls, treating the sick, etc.. A last ditched, heavy handed measure when you have completely lost control of the outbreak.
After 13 years of seeing this govt attempting to spin even the most damning of self-inflicted catastrophes, Johnson’s attempt to spin the UK’s tragically incompetent pandemic response takes the biscuit. It was as arrogant as it was hopeless.
1/n
It should have come as no surprise that Johnson would treat the UK’s Covid Inquiry with the same contempt as he had shown the British people throughout the pandemic.
But, in truth, I had hoped he would have contained his overwhelming sense to serve only himself for even a moment, so as to help the British Public avoid a repeat pandemic disaster - which is, after all, the primary reason for his appearance. He didn’t.