The scale of #COVID19 in China is unimaginable

An estimated 37 million people/day are contracting COVID, and 9000/day are dying, expected to rise to 25,000/day

Hospitals are overwhelmed. Why is this?

1/🧵

economist.com/china/2023/01/… China has relied upon inactivated virus vaccines CoronaVac and Sinopharm, which have lower efficacy than mRNA vaccines and are subject to waning

nature.com/articles/d4158…
2/

The thing we all have to appreciate is that disruption of emergency admissions doesn’t only have an impact on early deaths it has an impact all the way through…

Delayed care extends length of stay, increases complications and rehab requirements, and causes death Everyone looks tired working in hospitals at the moment from the CEO down…

A fatigued workforce make more errors, and are likely to be more short tempered and less well motivated - these are facts of human nature

Add low morale due to govt neglect and what will happen?

I am an Intensive Care Consultant and Clinical Director of one of the largest Critical Care Directorates in the UK

I, my family, and almost every consultant in my Trust are all fully vaccinated and if eligible, boosted…

#GetVaccinated
#GetBoosted
#MandateVaccines 👍🏻 The science clearly shows that vaccination is very safe and reduces infection, transmission, hospitalisation, severe illnesses, and saves lives.

#GetVaccinated
#GetBoosted
#MandateVaccines 👍🏻

Masks work Vaccines work

Hard to say how sick I am of people like Fysh drawing false equivalence between Nazi Germany: Gestapo, Auschwitz, Buchenwald, Blitz, genocide

and
Vaccine passports, lockdowns, masks in a pandemic, or the EU, etc

It’s profoundly offensive and divisive

Just stop.
1/ Public health measures intended to prevent harm save lives and nudge people towards sensible and socially responsible actions are NOT Nazism

Indeed they are its antithesis

Motives matter
Outcomes matter
Lives matter
2/

@LoyalStingray @kprather88 @ChrisCarrollMD @First10EM Respiratory viruses are transmitted by particles along a spectrum of sizes. The starting assumption was that the main mode of transition was large particles deposited on surfaces (fomites) which we touched and put in our mouths…
1/ @LoyalStingray @kprather88 @ChrisCarrollMD @First10EM This partly arose because it was assumed that SARS1 was triggered by people pressing the button in a hotel lift and then going off around the world…

2/

Dear @DesmondSwayne I have seen your statement that “ICUs are operating at below normal capacity”

I am the Director of intensive care at a London Trust. I have worked in ICU since 1995.

We have opened 5 makeshift ICUs over the past year (one we closed and haven’t reused) We now have close to 3x as many people on ventilators as we were established for this day 12 months ago…

We opened an 18 bed ICU at Hammersmith Hospital about 10 days ago - does anyone have any idea what a big deal that is?

It’s now full of patients with #COVID19
A testament to the professionalism of our staff

We have opened 5 ICUs in the past year…

@ImperialNHS It’s a scary thing to do... but colleagues have identified problems and fixed them…

But it is hard to put into words how big the challenge is for staff, and how hard they are working… nobody should take them for granted.

It’s the people who make an ICU

Had a phone call today to go and receive the Biontech/Pfizer vaccine at a GP Hub which had run out of patients to inoculate

We turned up at 30min notice were screened, ID checked, and vaccinated in 10min

THANK YOU to all those who contributed to this!
1/ It made me reflect on what a vindication COVID has been for science

The scientific method of observation, generating a hypothesis, testing the hypothesis and adapting has worked brilliantly, even if we are all pretty gloomy
2/

70% rise in transmissibility of #SARS_COV2 is really worrying

Sounds like enhanced Christmas restrictions are more than justified Clear evidence of exponential spread in London and New Tier 4 areas

#SARSCoV2

I am a senior doctor in Critical Care in one of the UK’s largest Trusts, so unhappily I have gained expertise in COVID, and humbly I say that there is much more pressure on hospitals, especially their ICUs

https://twitter.com/Ferretgrove/status/1330484232880320513

ICU/Critical Care is one of those specialities which is a fulcrum on which most hospitals depend

People who need major surgery often require ICU care as do those who suffer complications of cancer treatment, heart disease, trauma, infections, etc

If you have to ask, it’s disappointing.

But the answer is none of the staff who we need to care for critically ill patients have quite mastered the art of being in two places at once…

https://twitter.com/johnredwood/status/1314268776066617344

I realise my reply may seem facetious, so I will give more details. Initially COVID was presented as a simple disease and a bit of ventilation was all that was required. In fact it isn’t.

Reckless with Hydroxychloroquine, there is a better chance Trump will be right that REGN-CoV2 will be of benefit. But we don’t know for sure and RCTs are essential

Not so sure millions of doses will be available that fast though…

And there is some observational evidence in #COVID19 for convalescent plasma, the active ingredient of which is mixed antibody

ncbi.nlm.nih.gov/pmc/articles/P…

Really important paper. It proves that live virus can be cultured from air 2-5m from patients, and gets suspended in the air. This doesn’t mean social distancing is valueless, but it means it is not enough.

#COVID19

1/

medrxiv.org/content/10.110… There are major implications for businesses returning to work in September:

1. Social distancing won’t be enough
2. Cloth masks won’t be enough - these particles are <1micron in diameter
3. Keeping the windows open is a good idea

2/

@globalhlthtwit @Johnrashton47 @AllysonPollock @profhelenward @richardhorton1 @GabrielScally @devisridhar The situation is pretty obvious.

They lacked capacity, and lacked the imagination to go to big molecular labs for help, or to take on staff for proper contact tracing. Their plan was superficial and not calibrated for a more major or lethal pandemic. @globalhlthtwit @Johnrashton47 @AllysonPollock @profhelenward @richardhorton1 @GabrielScally @devisridhar They were put on the back foot by Johnson who 3/2/20 said he thought it was trivial. There is a penchant for pseudoscience in govt, and an instinctive distrust of experts. Groupthink was inevitable.

There was a poverty of real data because 111 took a week to test

How should we consider #COVID19?

This is primarily a vitally induced thrombotic disease spread by droplets Post-mortems tell us the virus causes endothelial damage and overt blood clots in both small and large vessels #COVID19

Inflexible? We have doubled ICU capacity in a month

I went into an ICU with 14 COVID mostly ventilated patients ~30 times last week, and the nursing staff probably spent 30h in there each… I am one of thousands risking our lives

The editor of the Telegraph should resign

https://twitter.com/RichardBentall/status/1246372352092442624

“Pandemic” has been No 1 on the national risk log for years

All governments have failed to regard spare capacity in the NHS as a strategic asset, and the last 10y cuts have made this worse

No ideology will make Healthcare suddenly cheap and infinitely flexible

Where the fuck is the opposition?

Johnson all set to give away £9bn to the wealthy, sell off the NHS and impoverish generations, and what is @UKLabour doing?

Nothing… Why am I angry?

We live with the hopes and fears of our patients and their loved ones

It outrages me that Brexit will require Drs to break the bad news that a people will die, avoidably but for the predictable economic harm Brexit will do

It’s not a game