Mutating Corona Virus

BazzaS · May 11, 2020

It has always been the case that sometimes (where admission to hospital is felt not likely to help) that a decision not to admit someone from a care home can be made. The rationale isn’t so much “keep a hospital bed free” as “if they are going to die, do you want them to die in a hospital they aren’t used to, or in their usual home environment”. The “saving a hospital bed” does feature in the thought process, but not as the main driver.

I’m not aware of anyone suggesting that that has shifted to a policy of “ we don’t want them in the hospitals”. If there is felt a chance hospital care might help, and it is in the patients interest, I can’t see a GP / care home not sending them in -(which they can do by dialling 999, so it isn’t like the hospital can refuse) if the GP / care home insist.

ITU? ITU has always had to make difficult decisions as a resource when demand can always exceed supply*. These have become more prevalent as demand has increased due to Covid, and more so for ECMO (*2), which needs a specialist centre, as opposed to “just ventilation”, which any ITU can do.

* ITU : what percentage of non-planned admissions should die? If all of them die, they are taking patients who are too sick, and who can’t be saved even with ITU, so not a good use of a limited resource.

if all of them live, then they are probably turning away some sicker patients who might have been saved, and taking some patients who would have survived even without ITU.

A tricky decision even despite scoring schemes looking at illness severity and pre-illness baselines, or assessments like APACHE2 (Acute Physiology and Chronic Health Evaluation, 2nd Version), these are still statistically based (which is the viewpoint I’ve been asked to comment on in the past), so the stats apply to the population, not an individual. I’m glad I’m not the ITU Consultant who has to take those stats and then decide who gets an ITU bed and who doesn’t. This has always been the case, just Covid19 has brought it to the fore.

*2 ECMO : ExtraCorporeal Membrane Oxygenation. Used as an “artificial lung, outside the body” when the lungs aren’t working well enough, to sustain the patient while their lungs are given time to recover.

tobyjugg2 · May 11, 2020

4 hours ago, cjcregg said:

When you say 'left to die', by whom?

Don't you have quite a number of unanswered questions queued up on yourself that require response before you press others .. and expect a response ?

Now the example I gave would seem to be an example of someone being 'left to die'

It may be that the NHS was simply overwhelmed at the time, it could have been other reasons, but he apparently slowly, horribly, choked to death in his own home while his son tried to get help.

Still awaiting your responses to questions raised.

.. well other than you choose what you reply to ...

In which case, unto others ....

Edited May 11, 2020 by tobyjugg2

BazzaS · May 11, 2020

1 hour ago, honeybee13 said:

I assume it's health professionals following the guidelines that they must have about who they admit to hospital/intensive care.

It is pretty broad, but the initial “sieve” used is from NICE.

Once that “sieve” is used, a case by case decision needs to be made. Again, I’m glad I’m not the person being asked to decide who gets that ITU / Critical Care bed.

critical-care-admission-algorithm-pdf-87

honeybee13 · May 11, 2020

Thank you for the information, Bazza. I agree, doctors have some difficult decisions to make.

cjcregg · May 11, 2020

1 hour ago, honeybee13 said:

I assume it's health professionals following the guidelines that they must have about who they admit to hospital/intensive care.

I'm not aware of any guidelines that allow the NHS the freedom to refuse patients who need hospital care. In fact I believe they have a legal obligation to provide it.

tobyjugg2 · May 11, 2020

anyway, for those who are still confused about Johnson 'update'

Here it is summarised in 18 seconds

and in more detail, but you will end up more confused

a

Edited May 11, 2020 by tobyjugg2

honeybee13 · May 11, 2020

I saw that earlier, it's very good.

tobyjugg2 · May 11, 2020

This is a scorcher

https://www.youtube.com/watch?v=ha2vyuQprnQ

So according to a Tory MP - as long as you meet people and chat at 2 meters while shopping .....

... like he does

Edited May 11, 2020 by tobyjugg2

tobyjugg2 · May 11, 2020

For those who haven't seen this but there are all sorts of links with this that and the other that will need further investigation.

Having said that I am seeing some truly disturbing reports of what is coming out of autopsies of those who have sadly died.

This thing really does seem to generate a widespread and devastating attack the body, and especially the organs refereed in the link.

https://uk.reuters.com/article/uk-health-coronavirus-ace2-men/men-have-high-levels-of-enzyme-key-to-covid-19-infection-study-finds-idUKKBN22M0UC

tobyjugg2 · May 11, 2020

Well after Trump pointing the finger at the Chinese claiming it was generated in a Chinese lab ...

Looks like the Yanks are going to try to claim intellectual property rights on it ..

"the Federal Bureau of Investigation and Department of Homeland Security, is expected to accuse Beijing of working to steal from American institutions intellectual property and health information related to coronavirus vaccines and treatment through hacking and other illicit means and may come within days"

(Wall Street Journal)

Edited May 11, 2020 by tobyjugg2

**brassnecked** · May 12, 2020

For a breather in all the confusion, have a read of this, Johnson#s 60 pages are full of garbage. They still seem to be clinging to their original Pandemic Flu Plan that is useless for SARS. As to Labour, you couldn't expect much difference or less Muppetry all parties bought into the Plan.

http://www.eureferendum.com/blogview.aspx?blogno=87605#disqus_thread

Here is the Government Guidance as pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/884171/FINAL_6.6637_CO_HMG_C19_Recovery_FINAL_110520_v2_WEB__1_.pdf

hightail · May 12, 2020

22 hours ago, unclebulgaria67 said:

I have been working in an office throughout this crisis and from about the middle of March, staff that needed to be working from home for health reasons, have been home and will remain there for at least 3 months.

I don't understand why the media is shouting that people can 'now' return to work. The advice is and has always been that those who can work from home should while those who can't should continue to go to work. Nothing has changed. I can only guess that the government has realised there are many have been furloughed who could be working. Those sectors which cannot trade need continued support so hopefully they're looking to target it better.

honeybee13 · May 12, 2020

You seem to be one of the 30% who think the message is clear, hightail. I struggled with it, myself.

There's a view that the purpose of this is to make it the public's personal choices, whilst staying 'alert' and that if it goes wrong and ends up in a second wave, it'll be the public's fault.

One thing I don't get is why it's OK to travel from France to the UK but not from the rest of the EU, apart from Ireland. Boris was unable to answer what happens if somone travels over the border into France and then on to the UK.

tobyjugg2 · May 12, 2020

1 hour ago, hightail said:

I don't understand why the media is shouting that people can 'now' return to work. The advice is and has always been that those who can work from home should while those who can't should continue to go to work. Nothing has changed.

??

The lockdown and 'stay at home' was and still should be to prevent the spread of the virus by maintaining that 2 meter distance.

Many factories and workplaces simply weren't, aren't and economically possibly cant be set up to 'work' with that social distancing maintained

Look at the cost issues with running planes and public transport while maintaining even a one meter distance.

Look at the health and safty/cost issues of travelling to work over a distance in a work van alone, rather than travelling 100 miles as a team and staying in lodgings ... etc

If your workplace could maintain that distancing, or implemented other measures ??? to maintain the employees safety and minimise the opportunities for the Virus to spread,

then yes, like key workers who continued working despite NOT meeting those criteria (and NOT being tested) - the message was - continue to work.

Some of course are doing well from it ...

At least if you have a Tory MP lobbying for the emergency powers to be used to get you a contract without competition

https://www.theguardian.com/world/2020/may/11/healthcare-firm-advised-by-owen-paterson-won-133m-coronavirus-testing-contract-unopposed

hightail · May 12, 2020

46 minutes ago, honeybee13 said:

You seem to be one of the 30% who think the message is clear, hightail. I struggled with it, myself.

Only on work because I have family and friends who never stopped. Many businesses put the right measures in place and carried on. The only ones ‘required’ to close were the obvious - retail, hospitality, entertainment etc. Those where people would gather.

As for the rest of it - who knows. Apparently I can drive for miles and have a picnic in a crowded park but can’t visit my son and speak to him from two metres away across his garden gate.

honeybee13 · May 12, 2020

Indeed. There are some contradictions.

hightail · May 12, 2020

2 minutes ago, tobyjugg2 said:

Some of course are doing well from it ...

My brother is. He has a family business which supplies things which are in demand with parents while they’re home schooling. He and the rest of his household are working very long days getting stuff out. He hasn’t raised prices and he’s absorbing increased delivery costs. Not everyone is profiteering.

honeybee13 · May 12, 2020

I never thought I'd sing Piers Morgan's praises, but he's doing really well on challenging ministers at the moment. On Good Morning Britain, he made Andrew Bridgen MP look very silly over meeting both his sons together in the park. Piers pointed out it was against the rules as per the PM.

Today he tied Edwina Currie up in knots about being able to have a cleaner but not see his sons. She ended up saying his younger son could be his cleaner and Piers said that was against the published rules too.

tobyjugg2 · May 12, 2020

10 minutes ago, hightail said:

My brother is. He has a family business which supplies things which are in demand with parents while they’re home schooling. He and the rest of his household are working very long days getting stuff out. He hasn’t raised prices and he’s absorbing increased delivery costs. Not everyone is profiteering.

I know that - there are some heroes who are other than the oft stated ones, and some real heros who get little mention.

Oh - and my OH and daughter in law are both NHS staff.

My daughter has continued working throughout from home while looking after her 5 year old.

One son in law has managed to get another driving job after eventually being 'furloughed or laid off'

.. he got the other job in the first week while he was waiting to see what a major company would decide to do..

Other son in law started back last week on smaller jobs, where teams weren't required and preparing jobs for larger teams while other company members remain furloughed.

NONE have been tested.