UKC

I think it’s probably fair to say we are at the height of the pandemic and it’s as bad as it’s going to get.

Does anyone really know how it’s going in U.K. hospitals?

Obviously there aren’t a lot of media crews wandering about documenting things for the the evening news and from just the video link-ups with staff on their breaks it’s hard to comprehend just how bad it is (or isn’t). Anyone with first/second hand info? Is it as bad as the pictures we’ve seen from Italy where people weren’t getting the treatment they needed?

As I understand it staff have been told not to discuss it.  

As for being at the peak, I hope you are right but we will have to see.  

There have been the odd story in the Guardian about a couple of hospitals reaching a critical stage indicating that there is info out there. Appears to be more localised other than the whole system is overloaded. 

In our sector there are plenty of beds, no scenes even vaguely comparable with Northern Italy and A&E is the quietest I’ve seen it since I started my training in 2017. I don’t know about us having peaked yet though.

Not had any instructions to keep my gob shut either Marsbar, but then, perhaps the powers that be are simply picking their battles?

Edit: I should add, I’ve got mates working in other sectors, stretching a further 80 or so miles North of where I am. They’re all saying the same.

I’m thinking of the peak as broad Cairngorms plateau rather than a Skye pointy bit. Fingers crossed.

It’s very much dependant on where in the UK you are. Here in North Wales it’s all largely very quiet based on first hand accounts from doctors in two of the three main hospitals. 
With London being the current epicentre I imagine they are busier. I’m not sure how the pop up hospital there is doing in terms of patients.

Of course one persons busy may not be the same as another’s. 

I hope so too, that is what we need.  Annoyingly there will be people complaining we over reacted if it succeeds but what can you do.  

I read that some doctors have been told not to speak out about PPE shortages.    

It good to hear that capacity isn’t overstretched everywhere at least.

I guess it’s probably a fair comment that the numbers I’m looking at and the comparisons I’m making with other countries probably don’t account for ongoing more admissions than discharges.

If they’d had the chance, I’d imagine the people in charge of cladding Grenfell or crowd control at Hillsborough would’ve wanted their underlings to keep their gobs shut too.

Quite.  

With 10,000 dead and counting, if this is over reacting I shudder think what under reacting would have looked like...

I had a job lined up at the Nightingale and was put in the Bank for the local trust which runs that and 5 other major hospitals in London. I spoke last with them on Friday to ask about starting dates, as it's been nearly 2 weeks since they said it was an 'immediate start', and was told that so far it's actually much quieter than they were expecting and so all new starts are on hold for the time being.

Good news generally. Perhaps not so good news for you personally if you could have being doing with the work.

I’ll take that as more positive news. Good to hear.

My wife's community physio department has never been quieter - with the nonessential stuff cancelled, most of what they can do to free beds or keep beds free done, and the team poised to help directly with the SARS2 stuff.

It isn't clear whether the intensive care system is going to overflow; cautiously optimistically, it might not.

That's the good news. The bad news is that with 10,000-20,000 already dead or going to die from current infections and perhaps as little as 5% of the population having been infected so far (although this figure is very far from certain), the final death toll is not looking like the more optimistic estimates, and we still have a long haul ahead.

The official statistics only show people who have died in hospital after a positive diagnosis of Covid-19. Any idea what the numbers dying at home or in other facilities without the diagnosis looks like? 

Glad to hear that hospitals aren't overloaded elsewhere. My partner's hospital (in the southeast) has been converted into almost entirely covid wards, itu has spread across theatres and all 40 beds there are full. It has felt fairly bleak for a while, but they've had two patients recover and been discharged from itu which is fantastic news!

I don't - but it's being widely stated that there are a lot of people dying in care homes, in particular. Also, the figures are only for deaths reported (and they're a bit different in each devolved nation - Scotland is trying to include care home deaths, for example). The daily figures are being revised upwards in the following days, as more deaths are properly registered.

Add to that those who are currently infected and going to die in the next couple of weeks, and the true death toll appears to be 'up to double' the official one just now.

The area where there's huge uncertainty is what fraction of the population has already been infected - it seems to credibly be anything from 'a low single digit percentage', but the lack of testing makes the realistic upper bound very uncertain.

The two doctors I know, one in London and another in Shrewsbury, are still doing their normal 'day to day' jobs and have not been called up to deal with Covid 19 patients.

There's also a doctor living in my tenement in Glasgow and he's still working his normal job. 

My impression is that its busy but, in most places, not over-flowing.

Well like you, I’m cautiously optimistic the nhs hasn’t crashed and burned with this initial first wave.

I find it difficult to understand what shape the exit strategy will take and what it’ll cost in lives. I can only assume we’ll implement the Imperial College on/off lockdown and there hasn’t been a better plan produced since. 

Sounds like tougher conditions than further North.  

Unfortunately there are still plenty of people who think it's all a fuss over nothing, "I will take all my kids to the shop for an ice cream if I want" and get very angry if anyone dares mention that they are putting people at risk.  

I'm extremely worried that this kind of thinking will lead to measures being lifted too soon and a second wave that may be worse.  

Yes - if about 95% of the population have not yet been infected, releasing the lockdown now would be catastrophic.

Have a look at the UK 5pm briefing - they usually have a graph showing the regional distribution of C19 hospitalisation. High in london, low in other areas, middling in some.

Happily in my area (SW England) we look to be doing ok so far.

As an example, all our deaths here in Guernsey (9 in 3 weeks since the first death) have been pensioners. Not one person has been in ICU, and out of our 200 detected cases only 3-5 are in hospital at any one time so far. Small numbers I know, but it demonstrates how people are dying without going into hospital. Article on BBC today says 13 residents of a 72 bed home have died. It's going to be a high percentage, probably equal to that dying in hospital.

All our figures don't seem to include people dying at home.

They don’t but it could be argued that the figures include people who were already very poorly and about to die. For example a 96 year old who already had pneumonia was recorded as a Covid death... I’m sure there are plenty more examples. There are also many folk in care homes were a common cold would finish them off. 

Hospitals (including the one I work in) are just about coping purely due to the monumental effort of staff from every area. This is absolutely not business as usual it is orders of magnitude worse than anything within living memory.

We have quadrupled the number of ITU beds (no small feat) these are now full and patients are still coming, we have plans to expand up this number significantly as required but this is consuming a colossal amount of the hospital resources. Staff from many clinical and non-clinical areas are being deployed in new roles far outside their usual roles. In critical care and anaesthesia consultants and juniors have doubled on calls and moved to a full shift pattern.

We won't know if the peak has passed until several weeks from now but we are not seeing any suggestions that this is the case locally.

I haven't been asked not to talk in public and I don't know of any of my colleagues who have.

If there was a decent test/trace/quarantine program that might allow for less restrictions. The on/off lockdown as put forward in that IC report would be pretty brutal on society and the economy. 

The bit I'm slightly unclear about with the IC strategy is whether it's intended to let enough people get gradually infected to achieve herd immunity. There's some pretty obvious costs if that's the case but barring a vaccine it might be the only way.

Agreed. But if so far only 5pc of the population has been infected and survivors have (we hope) developed some kind of immunity what is the next realistic step? A vaccine is obviously the magic bullet but despite some optimism they could have one by the autumn it seems next year may be a more realistic estimate. Do we go for  some kind of slight easing aimed at gradually infecting more people but in manageable numbers, presumably while shielding the most vulnerable, until we achieve  'herd immunity'? That sounds like a recipe for an even more hideous death toll but we seem to be running out of options unless you believe lockdown can be extended indefinitely which I personally think is probably not sustainable for more than a couple of months before people just start ignoring it. I live in open country with miles of paths through woods and fields and I'm already sick to death of it. I dread to think what it would be like couped up in a  flat or tiny terrace with toddlers or, God forbid, teenagers. That must be absolutely hellish.

It's so hard to tell what extent Covid has played in an elderly death, and they aren't even testing.

I'm currently working in a care home. One gentleman died at the weekend. 2 weeks ago he was still getting himself up and dressed totally independently and sat up in a chair. By last week he could barely get out of bed on his own and stopped eating and drinking towards the end of last week. He wasn't tested for Covid, (the home tried to get him tested but no one would do it) and due to his age, if he had it then he may never have survived long enough to show the classic symptoms. Another gentleman was taken to hospital a couple of weeks ago and once in hospital he did test positive. However, he wasn't tested straight away when he went in so they can't tell us if he got it in the home or if he contracted it in hospital! He seems to be doing well though. He has dementia and is very mobile so I believe he is giving the staff some headaches! Lol

Apparently they are likely to suspect that Covid is a factor in care home deaths, but aren't going to test to confirm, so we will never know.

The ONS weekly report on deaths is probably the closest to the real numbers that we're going to get. But it's a couple of weeks behind due to the inherent delays in death certification.

The interesting (sic) bit in that is the graph that shows that covid deaths are still a small proportion of the total but that the number is taking off.

I'm pretty sure that in a couple of weeks (in the report) covid deaths will push the total up significantly.

Could you possibly provide a link to this report as I tried to find an ONS causes of death report but it only had suicide and unnatural deaths so I think I was in the wrong place - I couldn't find one on the general causes of death.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriage...

Hopefully that'll work, otherwise Google search on ONS and deaths and look for a "bulletins" link (I think the"top" link will take you to a stats spreadsheet).

I’m convinced dementia gives people super resilience; I think because it prevents too much dwelling in memories of better times and so loosing the will to live.  Not very scientific of me I know...!

Spoke to a friend the other day who is a staff nurse, she said its pretty much normal - a few in ICU but not many more than usual.

A nursing friend of mine who has been tested says it is not a pleasant experience. Effectively after the test you are sick in a bowl ( considering she works in theatre I was amazed she said it is not pleasant)  I suspect that alot of people in care home environment would not relish the prospect of testing.

How is the new job going, you took a big step forward from your previuous job into this one.

From my own expereince alot of care homes ( with my parents)  are good places to work with tight groups of friendly people. Hope you are in one of those and it is going Ok for you.

I work in major hospitals in Scotland for nursing agencies - ward level. It's my experience that most wards I've been to (hence most wards in hospital as I usually get sent where I'm most needed) are more quiet than usual, better staffed than usual and have more empty beds than usual. Staff are taking a well-earned break from the usual business of the wards. Even some COVID 19 wards are quiet. I had only one patient the other day on shift, compared to my usual 4-10... One thing I did note was perhaps a higher level of acuity on the covid wards?

I'm sure ITU/HDU is a different picture altogether, but at the moment I'm worried that I might soon have no work at all! (Of course I wish ill upon no one, but without sick people I'm out of work). My friends' theatre unit was turned into an ICU and her training very minimal (usually you'd get about 4-6 weeks supernumerary in an ITU before you're unleashed). The annual winter crisis is much worse than this yet the public are giving the NHS much more attention now than usual. I do hope, once this has blown over, that the public in general don't return to a passive acceptance of a collapsing health service that seems to have gripped the country.

There's also an immense amount of chocolate, pizza and cakes in some wards... and I have to say (guiltily) not having to deal with visitors can be a positive...

New job going ok....but I have been sent home this morning as I have a sore throat! Very unlikely to be the virus as it's not a classic symptom, but I am being referred for testing anyway as they can't take chances. My throat is only sore indoors though, fine when I cycled there and home, so I think I'm allergic to being indoors! Lol

It does seem to be a nice bunch of people though and you very quickly get the hang of the work, so all good. 12 hour shifts seemed really long, but they actually fly in as you are busy all the time.

Hopefully the testing will happen soon and I can get back to it!

It might depend on how demented a person is. Some of ours are really struggling emotionally with no visitors and being kept in their rooms. They have dementia, but are not so demented to be entirely in their own world and unaware of surroundings. 

Latest figures published today

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriage...

6000 more deaths in that week than the past 5 year average, and those number are preliminary.

My cycling buddy works in the big hospital in the nearby Lancashire mill town. He says they are at capacity but no more. What is worrying staff there is they they are hearing reports of Imans in the town telling their congregations it's OK to go to mosque. 

That needs reporting to the police.  I'm all for religious freedom usually but not at any price.  

Muslim council of Britain have been quite clear that it's perfectly possible to pray at home.  

https://mcb.org.uk/mcb-updates/coronavirus-guidance-for-mosques-and-madrass...

My take on it is that the IC stategy is only really about managing hospital capacity. Herd immunity may be a side effect long term. Beyond having a hospital bed available and the best possible treatment available WHEN you fall sick I think it isn't intended to protect the population as such. The vulnerable will still very much stay at risk. Given the timescale to vaccine, I've come to the thinking that the vulnerable are pretty much goners or be it spread over the next year rather than all in the next couple of months. So, as others further up the thread suggested, there a lot of death to come.

I'd only recently got around to reading this (below) which outlines the virus time line. It seems to suggest that at least some of the blame for our slowest to react was down to the science advisers. Though I still think Boris was at least a week, maybe two, slow on the lockdown. I find it hard to believe the "timing" was carefully calculated to get us into the position this thread has suggested i.e. full but coping hospitals and head start on herd immunity.

https://www.reuters.com/article/us-health-coronavirus-britain-path-speci/sp...

This moving article gives an idea of what some NHS medics are going through: https://www.theguardian.com/world/2020/apr/14/coronavirus-i-worry-about-my-... 

US wise it's bad but generally not over run yet. my wife trained in NJ so a lot of her friends are in NY hospitals. It's not totally crashed the healthcare system like in other countries, which is now leading to accusations of overreacting because we have fairly successfully flattened the curve NY seems to be easing down.

Dont forget Cummings as BJ’s go to person for interpreting scientific advise and the apparent schism in the advisory board...

The accusations of over-reacting are really annoying. If you lockdown and keep deaths low then people say 'you crashed the economy for something that killed less than flu'. If you don't take measures then you get it in the neck for letting so many people die.

I think some people never think about alternate worlds, i.e. how things would have looked if things had happened with a different response, they can only consider the situation that actually happened and don't consider what-ifs. 

When the CDC down graded their projection to just 60,000 dead I saw one comment, "I thought over 2 million were meant to die".

Yep it does my head in! The average outraged commentator has no idea of statistics, expectation values or cost-benefit etc., they just repeat some non-fact they think they read somewhere. How strong do we think the economy would be if there wasn't a lockdown and the bodies were piling up in the streets and hospital corridors? This happened in Wuhan and was shown by a lot of videos filmed in the city which were very quickly taken down. The videos were reasonably verifiable as you could see the 'Come on Wuhan!' banners in the background occasionally. 

Can you explain how this chimes with news reports like this (https://www.independent.co.uk/news/health/coronavirus-uk-cases-intensive-ca...)?

Seem to be getting very mixed messages.  From my personal experience, Addenbrookes appears to be a ghost town.

I asked my Asian neighbour why the Grand Mufti or the Muslim Council can't make it clear to all British Muslims that thy need to worship from home and he explained that there are too many sects, each of whom consider that anybody who doesn't follow their idealogy is not a real Muslim. Sounds like the Catholics, doesn't it? 

Both my neighbour and my walking buddy's Asian neighbours in Leeds are receiving visits from family groups. In Leeds last weekend there was a sizeable get-together in the back garden.  And now it's beginning to emerge that BAME minorities are heavily over-represented with 36% of CV cases while they comprise only 14% of the population. I know there are other reasons, but big gatherings with several generations present and going to mosque can't be helping. Oh and one of the family groups we've seen visiting my neighbour comprises a GP, a paediatrician and their children.

Can I explain how one London hospital is very busy but the hospitals I'm attending 200 miles away aren't? Dunno, population density and demographics?

Yes, but you can't at the same time be too strident in your claim that the government should have acted two-weeks earlier.

The govt had to do a cost-benefit analysis working in the other direction too and at a £500 billion (?) smack to the economy, those two weeks of inaction might be saving not just economic livelihoods but human lives.  

Few seem to give the govt any credit.  As much as we should accept over-estimates of potential death projections we should also accept the govt will likely have been presented low-range figures too which, weighed against the astronomical economic costs and downstream deaths of an economic shutdown, make an early lockdown a less than easy choice.

Sorry, no idea where you worked.  I was just interested in the language used as when I read the article (weeks ago) it seemed to indicate an outright emergency of dramatic proportions and gave little emphasis that this might be highly localised.  

Agreed, but I think saving lives and saving the economy is to a large extent the same thing. Consumer confidence would not be high if we thought that by going shopping we could end up killing ourselves or elderly relatives etc. The seemingly number of care-home deaths which is probably about to be released shows that we can't just lockdown the elderly while the rest of us carry on as normal.

And an earlier lockdown would probably have been cheaper. Other countries like Denmark and Austria, where they locked down much earlier in their curves, are easing restrictions now while it looks like we will be locked down for much longer. It could have been nipped in the bud to some extent. For example, what on earth were we thinking allowing Cheltenham to go ahead with over 100 k visitors in the second week of March?!

The police need to act on this, and the community leaders and Immans need to take responsibility.  

Meanwhile in America another evangelical Pastor has died after insisting on holding Sunday services.  

Interesting contrast with what friends in villages in Gilgit-Baltistan are telling me - there, all the mosques are closed and the imams are spending their time teaching hygiene and how to restrict the spread of the virus. Anyone coming from outside the village is put in enforced quarantine in one of the schools (closed) for 14 days.  Given that there is virtually zero medical care, they need to do everything they can. 

Then again, the Nurbakhshi were always one of the more sensible Islamic sects.

Maybe, and all this will be the subject of PhD thesis for years to come.  

But many people, still notionally employed, probably don't realise that their jobs have been given a death sentence, and that they may be out of work for a year or more.  The end of the lock-down doesn't mean business returns to normal and the economic reactor is cooling to the point that turning the thing back on is not so simple.  The economic impacts of the shut-down have, imho, barely begun to be felt yet and there may be a very different attack on government taking place in two month's time when the impact of a globally inactive economy, even before major changes to taxation and a further tightening on spending, hit.

There are real costs to having your savings, income and security wiped out.  Be that suicides and lost life-years now, or the benefits poorer nations (with zero social safety nets) receive through our DfID budget and the investment a healthy UK economy brings.

I don't envy any person in a position of responsibility having to make these decisions, and having to weight whether every life saved (and to put this bluntly, "saving" in many cases may only be extending life for a relatively short period until natural causes would have taken them anyway) is worth the £500,000 cost.

I agree, the lockdown is going to do massive harm to the economy which will in turn kill people. But I think that everything you say, the job losses etc, would happen anyway if we didn't lockdown due to the total chaos and huge number of deaths we would see.

Let's say that if we didn't lockdown the hospitals were over-whelmed such that the case fatality rate of the virus increased it 1 % (the WHO has it at 3.8 % already but that's likely an over-estimate due to undiagnosed mild cases). Losing around an excess 1 % of the population is a bit less than the percentage lost in WW2. Not a huge amount in percentage terms but I would guess that the chaos it would cause and the loss of consumer confidence would ruin the economy to a similar extent to the lockdown anyway. 

P.S. it's not just deaths, if you survive invasive ventillation then you won't be particulary fit afterwards. Viral pneumonia can have serious long-term consequences as well even if you don't need such drastic measures to survive it. If SARS-Cov-1 is anything to go by, many of the recovered will have serious problems. The economy would also take a big hit from so many workers being off sick. 

P.P.S. I don't believe that many of the Covid-19 deaths were about to die of underlying illnesses anyway. The big co-morbidities are things like type II diabetes, COPD, obesity etc. These can take years or decades to kill people if at all, whereas Covid-19 kills in 2 to 4 weeks, so what are the odds that all the people who died of Covid-19 with these long-term co-morbidities were just about to die?

I'm not really taking issue with a lock-down itself.  For all the reasons you mention, it is a valid angle of attack.

My concern, and my issue with the criticism of the govt, is the accusation it didn't go far enough with the lock-down.  Its quite likely that the government got it bang-on or even over-shot, and because we are comparing apples (lives) with oranges (economy) it is a very difficult (and emotive) comparison to make. 

There seems to be, in some areas of the media, a zero-sum outlook on this.  That the govt are essentially callous murderers, that mortality rates, or that empty or full hospitals are immediate evidence of right or wrong in a situation that has no straight-forward of cost-free answers.

OK I agree with you, I only disagree in that I think lockdown started a bit too late, as a later lockdown has to be longer due to there being more of a virus problem to stamp out. The decisions to allow the Liverpool - Athletico Madrid match and Cheltenham were psychopathic (I  think these decisions were made at the time because the plan was for us all to catch the virus quickly and get back to work). 

But you're right. By the way it isn't necessarily apples and oranges. The NICE guidelines are that they will only recommend a treatment if it can save lives at a cost of < £30 k per quality adjusted life-year that it saves https://www.nice.org.uk/Media/Default/guidance/LGB10-Briefing-20150126.pdf

Of course it's very hard to get an estimate for the costs of lockdown and non-lockdown per QALY. I suspect that non-lockdown would be more harmful to the economy than lockdown anyway due to the points I made earlier.

“The 16,387 deaths that were registered in England and Wales during the week ending 3 April is the highest weekly total since we started compiling weekly deaths data in 2005.”

Oh shit, here we go 😨

All my in laws are following guidelines and as far as I'm aware the majority of British mosques are shut as they should be.  Unfortunately some people always decide that the rules don't apply.  

Just a point further to much common sense from previous posts. 
I am a Nurse Practitioner in North Wales and  the lockdown looks to be flattening the peak but the problem is that it is not over after the peak. It is like a tsunami where the damage is not done from the initial hit of water but from the relentless wall of water behind it. This is the reason why many additional beds are being allocated in leisure centres and exhibition centres. For several months there will be a constant stream of admissions of very sick people using up the capacity of the nhs. The lockdown will only dampen this but not stop it.

Stay safe everyone and we will climb on the other side of this!

Disclaimer: A&E doctor here, not working intensive care, epidemiology, public health.

I don't think we're at the peak yet; London may or may not be at the peak but there are significant parts of the UK which are a good couple of weeks behind.

In A&E we're seeing 40-50% fewer patients each day. We're seeing fewer timewasters and non-accident non-emergency attendance which is great, but we're also seeing fewer elderly people having strokes, heart attacks etc. That is worrying, as these heart attacks are happening presumably as normal and people aren't wanting to attend A&E. So we are seeing some strokes well beyond the the time limit for the most effective treatments.  Clearly we are also seeing many patients with possible covid-19. A lot of these go home without being tested, but a lot come in and get tested. Many who test positive are dying in hospital or later on at home. 

We are though seeing some utter dickheads enjoying themselves at parties and large gatherings.  
 

High dependency areas are of course busy, as are intensive care units.

The worst is yet to come imho, certainly where I am in rural Scotland.

And regarding UKC, unfortunately I know of at least two UKC users who have been out climbing big lines despite lockdown. 

My wife works on a COVID ward in Pinderfields hospital, Wakefield and the ICU is running at about 50% capacity... 

That's good to hear. Still a good idea to build new makeshift hospitals so we have capacity on-hand for if things get worse. It's very early days yet.