UK Govt Coronavirus Response: Sceptics Thread

[sancho panza]

On 15/10/2020 at 13:41, janch said:

Seems China had cases fro some time before they told us:

https://www.zerohedge.com/political/china-had-covid-patients-months-official-timeline

Maybe the illness I had around Christmas last year really was Covid as it wasn't your normal flu....

word is that covid pnemonia type scarring was seen on lung X Rays in November.From a relaible source...some Dr going back through some cases.

[sancho panza]

https://lockdownsceptics.org/

[sancho panza]

The truth is starting to filter out.Turns out that a lot of people may well have been denied treatment.As the Times puts it

'protecting the NHS from the elderly'.

NHS Refused to Treat Elderly Patients During Lockdown

A Sunday Times Insight investigation has revealed the extent to which the elderly were neglected by the NHS during the full lockdown.

As part of a three-month investigation into the Government’s handling of the crisis during the lockdown weeks, we have spoken to more than 50 witnesses, including doctors, paramedics, bereaved families, charities, care home workers, politicians and advisers to the government. Our inquiries have unearthed new documents and previously unpublished hospital data. Together, they show what happened while most of the country stayed at home.

There were 59,000 extra deaths in England and Wales compared with previous years during the first six months of the pandemic. This consisted of 26,000 excess fatalities in care homes and another 25,000 in people’s own homes.

Surprisingly, only 8,000 of those excess deaths were in hospital, even though 30,000 people died from the virus on the wards. This shows that many deaths that would normally have taken place in hospital had been displaced to people’s homes and the care homes.

This huge increase of deaths outside hospitals was a mixture of coronavirus cases – many of whom were never tested – and people who were not given treatment for other conditions that they would have had access to in normal times. Ambulance and admission teams were told to be more selective about who should be taken into hospital, with specific instructions to exclude many elderly people. GPs were asked to identify frail patients who were to be left at home even if they were seriously ill with the virus.

In some regions, care home residents dying of COVID-19 were denied access to hospitals even though their families believed their lives could have been saved.

The sheer scale of the resulting body count that piled up in the nation’s homes meant special body retrieval teams had to be formed by police and fire brigade to transfer corpses from houses to mortuaries. Some are said to have run out of body bags.

NHS data obtained by Insight shows that access to potentially life-saving intensive care was not made available to the vast majority of people who died with the virus. Only one in six COVID-19 patients who lost their lives in hospital during the first wave had been given intensive care. This suggests that of the 47,000 people who died of the virus inside and outside hospitals, just an estimated 5,000 – one in nine – received the highest critical care, despite the government claiming that intensive care capacity was never breached.

The Sunday Times points the finger at Chris Whitty, England’s Chief Medical Officer, as the architect of this policy.

The chief medical officer, Chris Whitty, commissioned an age-based frailty score system that was circulated for consultation in the health service as a potential “triage tool” at the beginning of the crisis. It was never formally published.

It gave instructions that in the event of the NHS being overwhelmed, patients over the age of 80 should be denied access to intensive care and in effect excluded many people over the age of 60 from life-saving treatment. Testimony by doctors has confirmed that the tool was used by medics to prevent elderly patients blocking up intensive care beds.

Indeed, new data from the NHS shows that the proportion of over-60s with the coronavirus who received intensive care halved between the middle of March and the end of April as the pressure weighed heavily on hospitals during the height of the pandemic. The proportion of the elderly being admitted then increased again when the pressure was lifted off the NHS as COVID-19 cases fell in the summer months.

Is this the Government’s version of “Focused Protection”? Instead of using our national health service to shield the elderly, it shielded the NHS from the elderly.

Worth reading in full.

[sancho panza]

via LS

John Lee ,clean win by metaphorical KO.Hilarious.

 

[janch]

This may have been posted elsewhere on the forum but also belongs here I think.  Some leading doctors have been making the case for the ineffectiveness of lockdowns.  It's worth signing the petition:

https://gbdeclaration.org/view-signatures/

[janch]

An NHS whistleblower who has resigned has exposed how few cases of Covid there are in reality in Cornwall:

https://www.dailymail.co.uk/femail/article-8916871/Whistleblower-NHS-worker-reveals-whats-REALLY-going-NHS-hospitals.html

[sancho panza]

[sancho panza]

the excelent Dr Clare Craig

Superb on so many levels.

'Boris Johnson and Chris Whitty have to start questioning whether they are wrong.'

'Boris Johnson and Chris Whitty have to start questioning whether they are wrong.'

 

[sancho panza]

 

[sancho panza]

 

https://www.bbc.co.uk/news/education-55304974

Having to isolate because of Covid-19 is having a detrimental effect on children's education and well-being, particularly the most vulnerable, warns England's chief inspector of schools.

Amanda Spielman says periods of repeated isolation have "chipped away" at progress since September's return.

She also warns that those arriving at secure children's homes have in effect been put in "solitary confinement".

Ministers say it a "national priority" to keep schools and colleges open.

In a set of reports looking at the effects of the Covid-19 pandemic on children, the Ofsted boss said: "Remote education is better than nothing, but it's no substitute for the classroom.

 

[sancho panza]

[stop_the_craziness]

1 hour ago, sancho panza said:

Ministers say it a "national priority" to keep schools and colleges open.

In a set of reports looking at the effects of the Covid-19 pandemic on children, the Ofsted boss said: "Remote education is better than nothing, but it's no substitute for the classroom.

 

Compulsory testing in schools & colleges

Masks in schools & colleges

Just fucking announce it and get it over with, we all know where this welfare report nonsense is leading.

[dnb24]

Our hospital has been rolling the vaccine out for staff- side effects have been significant to the extent that we’ve been told to ensure we don’t get the vaccine as a team- because we’ve had whole teams go off sick post vaccine in the past 2 weeks.

[janch]

I thought Gloucester was supposed to have a lot of CV-19 cases:

https://www.zerohedge.com/political/uk-woman-arrested-filming-inside-empty-hospital

The hospital appears to be completely empty.

[Harley]

On 31/12/2020 at 14:10, janch said:

.....

The hospital appears to be completely empty.

Maybe the best thing given the apparent number of people contracting cv in hospitals!

Edited January 1, 2021 by Harley

[Castlevania]

On 31/12/2020 at 15:10, janch said:

I thought Gloucester was supposed to have a lot of CV-19 cases:

https://www.zerohedge.com/political/uk-woman-arrested-filming-inside-empty-hospital

The hospital appears to be completely empty.

I thought in places with several hospitals (or at least relatively near each other) they were segregated between hospitals for Covid and hospitals for everything else, so as to minimise the risk of someone catching Covid after going in for something else.

[Loki]

On 31/12/2020 at 12:15, dnb24 said:

Our hospital has been rolling the vaccine out for staff- side effects have been significant to the extent that we’ve been told to ensure we don’t get the vaccine as a team- because we’ve had whole teams go off sick post vaccine in the past 2 weeks.

Thanks for this.  How severe were the symptoms? 

[dnb24]

10 hours ago, Loki said:

Thanks for this.  How severe were the symptoms? 

Severe enough for 20 year olds to have 2-5 days off, though this is the NHS so the bar for taking sickness is low.

[sancho panza]

[sancho panza]

Such a great read from one of the Sceptics finest.So balanced and complete capturing the nuances of the debate.How Beth Rigby could argue with this I don't know but I'm sure she would.

@dnb24

https://drmalcolmkendrick.org/2020/12/30/what-is-left-to-say/

What is left to say?

641 Replies

30th December 2020

I have not written much about COVID19 recently. What can be said? In my opinion the world has simply gone bonkers. The best description can be found in Dante’s Inferno, written many hundreds of years ago.

In it, Dante describes the outcasts, who took no side in the rebellion of angels. They live in the vestibule. Not in heaven, not in hell, forever unclassified. They reside on the shores of the Acheron. Naked and futile, they race around through a hellish mist in eternal pursuit of an elusive, wavering banner, symbolic of their pursuit of ever-shifting self-interest.

I find this description of the desperate pursuit of an elusive wavering banner rings rather true. This, it seems, is pretty much the place we have arrived at. Which banner have you decided to follow?

The ‘COVID19 s the most terrible infection ever, and we must do everything in our power to stop it, whatever the cost’ banner.

Or the ‘What on earth are we doing? This is no worse than a bad flu, and we are destroying the world economy, stripping away basic human rights and killing more people than we are saving’ banner.

There may be others.

Between these two, main, completely incompatible positions, lies the truth. It is in pretty poor shape. It has been crushed, and bent out of shape, smashed, and left as a broken heap in the corner. I search where I can, to find the fragments, in an attempt to bring together a picture that makes some kind of sense.

But what to believe? Who to believe?

I feel somewhat like Rene Descartes. In order to find the ineluctable truth he scraped everything away until he was left with ‘Cogito, ergo sum’. ‘I think, therefore I am.’

I have stripped away at the accuracy of PCR COVID19 testing. I found myself left with nothing I could make any sense of. I hacked down to establish the way that COVID19 deaths are recorded. All I found were assumptions and difficulties.

Did someone die with COVID19, of COVID19 – or did it have absolutely nothing whatsoever to do with COVID19? Who knows? I certainly don’t, and I wrote some of the death certificates myself.

Have we overestimated deaths, or underestimated deaths? I do not know … and so it goes on.

So, what do I know? I know that COVID19 exists – or I am as certain of this as I can be. Was it a natural mutation from a bat, or was it created in a laboratory? Well, I suppose it doesn’t really matter. It’s here, and there is no chance that any Government, anywhere, would ever admit responsibility for creating the damned thing. So, we will never know. If you asked me to bet, I would say it was created in a lab, then escaped by accident.

Is it deadlier than influenza? Well, it is certainly deadlier than some strains of influenza. Indeed, most strains. However, Spanish flu was estimated to have killed fifty million, when the world’s population was about a fifth of what it is now. So, COVID19 is definitely less deadly than that one. About as deadly as the influenzas of 1957 and 1967. Probably.

Will it mutate into something worse? Who knows.

Will the current vaccines work on mutated strains? Who knows.

Can it be transmitted by asymptomatic carriers? Who knows.

How effective are the current vaccines going to be? Who knows.

What are we left with?

At the beginning, I kept relatively quiet on how deadly COVID19 would prove to be. Because I didn’t know. The figures raged up and down. The infection fatality rate become a battle scene, with warriors lined up on either side to defend their positions.

I even got attacked by factcheckers, the self-appointed know-it-alls who are, it seems, capable of judging on all matters of scientific dispute. Truly, the Gods have descended to live amongst us. Those who can determine what is true, and what is not. No need for any further clinical trials, or any more scientific studies of any sort, ever. We just need to ask the Fact Checkers for the answer, to any given question.

Anyway, it appeared that tens of thousands died in some countries, almost none in others. What I was waiting to see, was the impact on the one outcome that you cannot alter, or fudge. The outcome that is overall mortality i.e. the chances of dying, of anything.

I did this because, when it comes to recording deaths from a specific illness, things can go in and out of fashion. A couple of years ago I looked at deaths from sepsis. At one time this was a condition of far lower priority. Doctors didn’t routinely search for it, or routinely record it, on death certificates.

Sepsis is an infection that gets into the blood, toxins are released, and people die. Everyone knew it happened. Or at least I hope they did.

Then, all of a sudden, there was a gigantic push to look for it more diligently, diagnose it more, treat it better. I think this was generally a good thing. Sepsis is eminently treatable, if you think to look for it, and lives can be saved. We now have initiatives like ‘Sepsis six’ and warnings that pop up on computers. ‘Have you considered sepsis,’ and suchlike. I love it … not. Because I do not love being told how to think, and do my job, by a computer algorithm programmed with ‘zero risk’ as their touchstone. But, hey ho.

In 2013, in the UK, a report was published by the health ombudsman ‘Time to Act – severe sepsis, rapid diagnosis and treatment saves lives.’ As the report stated.

‘Sepsis is a more common reason for hospital admission than heart attack – and has a higher mortality.’ The UK Sepsis Trust ¹

That last statement is somewhat disingenuous, as many people with sepsis are very elderly, often with multiple morbidities, and suchlike. They were probably going to die, shortly, from something else.

Anyway. With all this activity, with all this increased sepsis recognition and treatment, you would expect the rate of deaths from sepsis to fall. It did not. The rate has gone up, by around 30% since 2013. Does this mean there is far more sepsis going about? Or, that it is just more often written on death certificates? I suggest the latter. I use this example, simply to make it clear that even the cause of death written on a death certificate is far from rock solid evidence.

With COVID19, this is a massive problem. In the UK, and several other countries if you have had a COVID19 positive test (which may, or may not, be accurate) and you die within twenty-eight days of that positive test, you will be recorded as a COVID19 death. I do not know much for sure about COVID19, but I do know that is just complete nonsense.

There are so many cases where – even if the COVID19 test was accurate – COVID19 would have had nothing whatsoever to do with the death. Another thing known, or at least we probably know, is that the vast majority of people who die had many other things wrong with them.

In the US, the Centre of Disease Control (CDC) found that ninety-four per cent of people who died of COVID19 ‘related deaths’ had other significant diseases (co-morbidities) ².  This ninety-four per-cent figures would only be the co-morbidities that were known about – who knows what lurked beneath? Especially as people stopped doing post-mortems (i.e., autopsies in the US).

So yes, they had COVID19 (or at least they had a positive test – which may not be the same thing), but they were often very old, and already severely ill. Using an extreme example, someone with terminal cancer who is a week from death, catches COVID19 in hospital, and dies. What killed them? The statistics say COVID19. I say, bollocks.

When I started in medicine, ‘bronchopneumonia’ (a bad chest infection) used to be known as the ‘old man’s friend.’ For those who were very old, and frail, often demented, lying in care homes, often incontinent, a chest infection represented a reasonably painless way to die.

Very often we would not actively treat it, instead we allowed for a peaceful death. Indeed, this still happens. Less so now, as someone, somewhere, often a relative from a country far, far, away – who has not visited for years – is far more likely to sue you.

Did they really die of bronchopneumonia? You could argue yes, you could argue no. Yes, it was the thing that finally pushed them over the edge. No, they were already slowly dying as their body gave out. In the end, what does anyone actually die of? My Scottish grannie, who lived to one hundred and two, used to say ‘they die frae want of breath.’ Entirely accurate, but, alas, also completely useless.

So, what you need to do, is look beyond what is written on death certificates. You need to look at what is happening to the overall mortality. Whilst you can argue endlessly, pointlessly, about specific causes of death. What you cannot argue about is whether or not someone is alive, or dead. Even I usually get this one right. No pulse, no breathing, no reaction of the pupils to light, no response to pain… and suchlike. Yup, dead. Now… what they die of? Um… let me think.

Thus, I have tended to look to EuroMOMO. The European Mortality Monitoring project. As they say, of themselves:

‘The overall objective of the original European Mortality Monitoring Project was to design a routine public health mortality monitoring system aimed at detecting and measuring, on a real-time basis, excess number of deaths related to influenza and other possible public health threats across participating European Countries.

Mortality is a basic indicator of health. Therefore, understanding its epidemiology is fundamental for effective public health planning and action.

Mortality monitoring becomes pivotal during influenza or other pandemics for several reasons. In a severe pandemic, mortality monitoring can be a robust way to monitor the pandemics progression and its public health impact when other systems are failing, due to an overburdened health care sector. Decision makers will require data on the pandemics impact and on deaths by age and geographical area in various stages of the pandemic. Mortality monitoring can provide such estimates, which will be important to guide and prioritize health service response and decision-making, i.e. use of antivirals and vaccines.’ ³  

Here are the data that you can therefore, pretty much, fully rely on. It is where I go to see what is really happening across Europe. Not all of Europe, as some countries do not participate. However, there are more than enough, to get a good picture. It encompasses key countries such as Spain, Italy, the UK (split into four separate countries), Sweden and suchlike.

Here is the graph of overall mortality for all ages, in all countries. The graph starts at the beginning of 2017 and carries on to almost the end of 2020.

As you can see, in each winter there is an increase in deaths. In 2020, nothing much happened at the start of the year, then we had – what must have been – the COVID19 spike. The tall pointy bit around week 15.

It started in late March and was pretty much finished by mid-May. Now, we are in winter, and the usual winter spike appears. It seems to be around the same size as winter 2017/18. It also seems to have passed the peak and is now falling. But it could jump up again. [The figures in the most recent weeks can always be a bit inaccurate, as it can take some time for all the data to arrive]

Two things stand out. First, there was an obvious ‘COVID19 spike’. Second, what we are seeing at present does not differ greatly from previous years. The normal winter spike in deaths.

If we split this down into individual countries, this reasonably clear pattern falls apart.

Here are the figures from England

Unlike the first graph, the scale on the left is not absolute numbers. It is a thing called the Z-score. Which means standard deviation from the mean. Sorry, maths. If the Z-score goes above five, this means something significant is happening. The red, upper, dotted line is Z > 5. As you can see, despite the howls of anguish from England about COVID19 overwhelming the country, we are really not seeing much at all.

What of Sweden, that pariah country? They did not fully lock-down, the irresponsible fools (all they did was follow WHO guidance – by the way), and we are now told they are suffering terribly, they should have enforced far more rigid lockdown, their ‘experiment’ failed etc. etc. COVID19 shall have its vengeance. Or to quote Arnie – I’ll be back.

As you can see, nothing much happening in Sweden either.

Then, if you look further, there are anomalies all over the place. Northern Ireland, which is part of the UK, and did exactly the same things as the rest of the UK with regard to lockdown, masks etc. At least it did in the earlier part of the year. However, it shows a completely different pattern to England. Or, to be fully accurate, it shows no pattern at all. No waves, and nobody drowning.

What of Slovenia?

As you can see absolutely nothing happened earlier in the year in Slovenia. Now, it has the biggest spike of all – apart from, maybe, Switzerland. Earlier in the year it was held up as a great example of how brilliantly effective masks were. Now… you don’t hear so much about masks. Maybe masks only work in months beginning with M. [Maybe, whisper it, they don’t work at all].

So, what have I learned from euroMOMO? First that it appears to have made absolutely no difference if a country locked down hard, and early, or did not. Everyone points at Norway and Finland as examples of great and early government action, and how wonderful everything would have been if we had done the same.

Well, look up at Northern Ireland. Then look at Finland

Spot the difference. There is none.

Of course, much of the most heated debate surrounded what happened during the so-called first wave. Who dealt with it well, or badly. Now, everyone in Europe is doing much the same things. Lockdown, restrictions on travel, restrictions on meeting other people, everyone wearing masks, etc. etc. Yet some countries are having a new wave, and others are not.

There is a special prize for anyone who can match up the severity of restrictions in various countries, to the Z-score. I say this, because no correlation exists.

So, again, what have I learned about COVID19? I learned that all Governments are floundering about, all claiming to have exerted some sort of control over this disease and ignoring all evidence to the contrary. In truth, they have achieved nothing. As restrictions and lockdowns have become more severe, in many cases the number of infections has simply risen and risen, completely unaffected by anything that has been done.

The official solution is, of course, more restrictions. ‘We just haven’t restricted people enough!’ Sigh. When something doesn’t work, the answer is not to keep doing it with even greater fervour. The real answer is to stop doing it and try something else instead.

I have also learned that, in most countries, COVID19 appears to be seasonal. It went away – everywhere – in the summer. It came back in the autumn/winter, as various viruses do.

On its return is has been, generally, far less deadly. Much you would expect. The most vulnerable died on first exposure, and far fewer people had any resistance to it, at all. Now, a number of people do have some immunity, and may of the vulnerable are already dead.

Which means that, in this so-called second wave COVID19 is of no greater an issue than a moderately bad flu season.

If I were to recommend actions. I would recommend that we stop testing – unless someone is admitted to hospital and is seriously ill. Mass testing is simply causing mass panic and achieves absolutely nothing. At great cost. We should also just get on with our lives as before. We should just vaccinate those at greatest risk of dying, the elderly and vulnerable, and put this rather embarrassing episode of mad banner waving behind us.

Hopefully, in time, we will learn something. Which is that we should not, ever, run about panicking, following the madly waved banners… ever again. However, I suspect that we will. This pandemic is going to be a model for all mass panicking stupidity in the future. Because to do otherwise, would be to admit that we made a pig’s ear of it this time. Far too many powerful reputations at stake to allow that.

Edited January 3, 2021 by sancho panza

[sancho panza]

Interesting analysis as ever,particualrly ref sickness rates being 12% as opposed to 4%.Staffing appears to be the problem rather than bed count.

Also nice description of the differnetiating symptoms of covid

'Doctors have noticed that unlike in previous years, their patients have low white blood cell and platelet counts, sudden hypoxias and bilateral atypical pneumonias. These features can be seen in other pneumonias but are characteristic of Covid and are being seen in large numbers currently.'

https://lockdownsceptics.org/what-does-endemic-covid-look-like/

What Does Endemic Covid Look Like?

7 January 2021

by Dr Clare Craig FRCPath, Jonathan Engler MBChB LLB and Joel Smalley MBA

Viruses do not disappear. When a novel virus is introduced to a naive population there will be an epidemic. Spread will be exponential, some susceptible people will die but eventually we will reach a point where there is sufficient population immunity that spread is slowed and the virus stops spreading in an epidemic fashion. Thereafter, localised outbreaks can still occur and susceptible people can still die but there is no longer a risk of epidemic spread because every outbreak is contained by population immunity.

Coronaviruses are seasonal, so it is only now that we have had some winter weather that we can assess what endemic Covid will be like.

Figure 1 shows the sharp spike in excess deaths seen with epidemic Covid in spring. These deaths were in excess of the usual winter hump. Compared with previous years, this year’s winter excess deaths started earlier but the shape of the curve is consistent with previous years. However, we have now reached the bizarre situation where so many deaths are being labelled as caused by Covid that, for the first time ever, this winter there are fewer non-Covid deaths in winter weeks than there were in summer.

Figure 1 Total deaths by date of occurrence shown in green line. Summer minimum (dotted black line) used to calculate winter excess deaths shown beneath in blue. Covid labelled deaths are coloured red.

Doctors have noticed that unlike in previous years, their patients have low white blood cell and platelet counts, sudden hypoxias and bilateral atypical pneumonias. These features can be seen in other pneumonias but are characteristic of Covid and are being seen in large numbers currently.

However, the numbers of patients presenting through Accident and Emergency with an acute respiratory infection (which includes those categorised as Covid-like) is well below normal levels. Also, the total number of patients in hospital remains the same or even lower than in previous years despite a third of patients being diagnosed with Covid in some areas.

Figure 2: Attendances at Accident and Emergency for an acute respiratory infection (which includes those categorised as Covid-like). Attendance levels at the end of December 2020 are lower than for 2019 (left of graph) for every age group.

How can all of the above be true?

1. Changing biology

The nasopharynx can be home to a number of viruses and bacteria which are either innocent bystanders or the source of illness. However, in the same way as an ecosystem can only sustain a certain number of predators, there is competition between these microorganisms.

Much has been made of the lack of influenza diagnoses this year and the reasons for that remain a puzzle. One possibility is that SARS-CoV-2 has out-competed influenza.

What is little understood is how often respiratory infections can be identified in hospitalised patients. This study, from Spain, showed that testing of the recently deceased elderly identified a respiratory virus in 47% of them and 7% of them had a positive coronavirus test. However, only 7% of these patients had been diagnosed as having a respiratory infection before death.

There are three ways that this could be interpreted:

1. Respiratory viruses precipitated other problems e.g. myocardial infarctions that then led to death (and has previously been a massively underdiagnosed contributor to death that we have managed to live with)
2. Patients who are very ill and dying are highly susceptible to respiratory infection
3. Respiratory viruses are innocent bystanders present at death i.e. not contributing to the underlying cause of death

Because we have never routinely tested for respiratory viral infections in such volumes previously, we do not know what we would have found previously had we done so.

The significance of finding a respiratory virus in the dying is therefore uncertain and given the lack of excess deaths we should conclude that one or more of the three scenarios above must also apply to Covid.

If Covid has become the dominant respiratory virus this year, then identifying it in a significant number of deaths from other causes should not be a surprise to us. If it has no impact on excess mortality, with people dying this year who would otherwise have died, then placing the finger of blame on Covid is of little importance in terms of NHS and broader societal impact.

2. Misdiagnosis

There are two ways in which Covid cases and deaths have come to dominate this winter. As described above, a number of cases and deaths, which previously may have been associated with other viruses that were undiagnosed, are now being correctly diagnosed as associated with Covid. The second way is that our diagnosis of Covid has become dependent on faulty testing, and misdiagnosis is taking place. Evidence for the latter is clearest in the deaths data.

Figure 3 Spring excess Covid deaths were accompanied by excess non-Covid deaths as we restricted access to healthcare. However, every increase in autumn excess Covid deaths has been mirrored by a fall in non-Covid deaths.

The fact that the rise in Covid labelled deaths has been mirrored by a fall in non-Covid labelled deaths (figure 3) means that Covid appears to be behaving in a similar way to the viruses in the Spanish study, and if we were not testing for it, then deaths would have been attributed in the usual way.

3. Bed Management Crisis

Hospitals are in crisis at the moment. That is undeniable. However, the cause may not be what it seems. Total hospital occupancy is normal or even low for the time of year. However, the NHS undoubtedly faces crises every winter and the reduction in beds available for a growing and ageing population is the core underlying problem (figure 4) from 240,000 in 2000 to under 165,000 in 2019. The figure fell by a further 10,000 beds this year after a reduction in beds to allow for social distancing between patients in hospital.

Figure 4 Hospital beds total per 1,000 inhabitants 1999-2019. Data from OECD.

The capacity has not been exceeded even in regions where 30% of patients have a Covid label. Where have all the non-Covid patients gone? There has either been misdiagnosis or mass hospital-acquired infection.

Normally, hospitals work very close to or at capacity in winter. The only way this can be sustained is by a carefully choreographed flow of patients from admission to the wards and then back out. This flow has broken:

1. Bed managers, who organise the flow, used to only be concerned with whether a patient was male or female or needed a side room to avoid spread of other infectious diseases. They now have to try and keep patients with a Covid diagnosis separate from those with a suspicion of Covid and those without. This is no small feat in a full hospital.
2. In some hospitals patients are not being discharged until their Covid test returns as negative. Clearly returning patients to care homes during the window of infectivity would be a bad idea. Beyond that this policy is not justifiable. Some patients continue to test PCR positive for 90 days after infection.
3. PCR testing has led to a staffing crisis as even asymptomatic staff are made to self-isolate for two weeks, with 12% of staff absent when it would normally be 4%
4. Staff are having to work in PPE and change it between patients, adding a significant additional burden to an already heavy workload.

If patients are no longer moving smoothly from the Emergency Department to the wards, then the former will quickly fill up giving the impression that the hospital has been overwhelmed. It is easy to see how this could cause a backlog of ambulances unable to drop off their patients.

Conclusion

The NHS is facing a winter crisis which has more to do with bed management and broader policy decisions than Covid itself, although the latter will be contributing as well, because it is winter and we must now regard Covid as an endemic disease (like flu), hopefully to be mitigated to an extent by vaccination.

We may find that the mix of the predominant winter respiratory viruses has changed to have a different character and whether this is permanent remains to be seen. However, the overall impact on healthcare and on the number of lives lost is not, and will not be, that different.

Why then are we reacting in the way we are?

Edited January 8, 2021 by sancho panza

[sancho panza]

London is under severe pressure according to Senior Dr writing for LS

Interesting to see the effect on beds of waiting for a negative covid test before discharge.Would lead to queires over amplitifcation cycles being used.

 

https://lockdownsceptics.org/2021/01/08/latest-news-248/#london-hospitals-really-are-in-crisis

London Hospitals Really Are in Crisis

What follows is the regular weekly update by our in-house senior doctor, based on the just-released NHS data. It makes for grim reading this week.

Toby has kindly asked me to have a look at the weekly data packet from the NHS hospital statistics website and draw some observations from what we can see in this information and from other data sources. Clearly it has been a busy week on the Covid front, with the closing of schools and a parliamentary vote on a further National lockdown. The media coverage of the issue becomes ever more shrill and disappointingly antagonistic. The usual caveats apply to the data – we can only see what the Government release and we take what is presented at face value.

The first thing I wish to look at is Covid inpatients in the English regions (Graph 1).

The steep rise of cases within London (the orange line) over the last two weeks is obvious, with increases in the South East, East of England and the Midlands. At the risk of sounding metro-centric, I am going to focus on the figures from the capital because I think London is going to be at a very critical point in the coming days. Since December 15th, cases have been rising remorselessly in London hospitals. Prior to mid-December, the numbers of patients did not look out of the normal range for the time of year, but they are well in excess of normal now. I commented last week that London hospitals were in for an extremely uncomfortable time over the next two to three weeks – that now looks like an understatement.

It is not entirely clear what has triggered the rise in cases, but applying Occam’s razor it is probable that the new more transmissible strain is responsible for the rapid increase. There is certainly something radically different between the beginning of December and the end of the month. In one major London hospital, the new variant accounted for 15% of cases admitted at the beginning of December. This week it accounted for 90% of cases. Graph 2 shows the Covid inpatients in London hospitals (orange bars) compared to the spring (blue bars). London hospitals now have substantially more Covid patients than at the spring peak and the trend is still upwards. (I’ve updated the figures below to Jan 5th, but wasn’t able to change the legend.)

Graph 3 shows the number of Covid patients in ICU in the English regions complete to January 7th. Again, the rise in cases in London is much faster than in the other regions and, with 961 cases as of January 7th, this is fast approaching the ICU spring peak with no sign of levelling off. This is an important graph because these are the sickest patients and use up a large number of resources. Further, ICU patients require the attention of the resource that is in critically short supply – intensive care trained nurses. I will return to this point later. Interestingly, the ICNARC data (intensive care audit) to December 31st shows that patients admitted since September 1st still have a survival advantage compared to the cohort to August 31st, but that this advantage has narrowed compared to earlier in 2020. There are multiple possible reasons for this – one of which is that as the volume of patients increases, the level of care may drop, particularly if nursing:patient ratios rise. The normal nursing ratio in ICU is one nurse per patient. This is now stretched to one to two in most hospitals and to as many as one to four in some places, which is really hard to sustain for long periods.

Graph 4 shows the comparison in London between the ICU occupancy in spring (blue) and in winter (orange) showing numbers in ICU approaching the spring peak and again the trend is still rising. (I’ve updated the figures below to Jan 5th, but wasn’t able to change the legend.)

Graph 5 shows the number of Covid positive patients admitted from the community every day. There is just a suggestion that the London admissions may be starting to level off, but there is still a significant upward trend which is higher than all the other regions.

So far the numbers look worrying. Is there any good news this week?

Possibly, from the ZOE app. For those that don’t know, this is a symptom tracker app run by Professor Tim Spector from King’s College Hospital. The data is uploaded by members of the public who have either tested positive for Covid or who have symptoms. Some people think it is a more reliable measure of the level of community infections than the officially released PCR test numbers – it has certainly proved useful so far in the pandemic. Graph 6 shows the data for London to December 31st. A rapid rise from mid-December followed by a slight tailing off, but the numbers remain much higher than in the earlier part of December, suggesting that there are substantial numbers of patients in the community who will present to London hospitals with symptoms in the coming days.

Analysing numbers can only get one so far. Talking to people on the ground is also necessary to get a better idea of what is going on. I have referred to the differences between the winter and the spring in previous posts – the critical problem now is staff absence due to illness or positive contacts. This can make interpretation of bed occupancy levels in comparison to previous years a bit misleading. For example, there has been a massive expansion of ICU beds in all hospitals and especially in London since the spring, but if there are not enough nurses to service those beds, they are of limited use. So even if bed occupancy on at 85%, a hospital may be at capacity because it can only staff 85% of the available beds. A few weeks ago, when we had sufficient nurses to staff the beds, bed occupancy rates were comparable with previous years. Now the nursing resource is so stretched, I’m not sure how much comfort we can take from those comparisons.

In previous posts I have noted the reduction in ward beds due to increased spacing requirements and the organisational friction caused by patient cohorting and constant use of fatiguing PPE. What is less measurable but more important is staff morale. Morale is difficult to quantify. It’s a bit like an elephant – hard to describe, but you know it when you see it. Low morale leads to increased absence with illness and stress. At a time of crisis, medical and nursing staff are often required to go the extra mile and encouraging a demoralised and tired workforce to do that is phenomenally difficult and subject to the law of diminishing returns. You get a harder ‘squeeze for juice’ ratio, until eventually there is no juice left. In that sense, the situation is worse than the spring when morale was very high. The responsibility for this rests squarely with senior NHS management for failing to prepare, train and rest critical workers for an anticipated winter surge which was a predictable and indeed predicted risk.

Further signs of stress in the system have become evident this week. Most London hospitals have now ceased all routine activity and several have ceased urgent work as well, particularly in the SE and NE sectors which are the most stressed. Graph 7 shows paired data for selected London trusts. This graphic can be a bit tricky to read, but one can see that Barts and Guys and St Thomas’s have had rapid rises in ICU patients to spring levels in the last week because they are increasing their bed numbers to offload peripheral hospitals. Their feeder hospitals of Lewisham and Barking are at capacity, the same as in the spring. There is still some spare capacity in the West of London at Imperial and St George’s, but numbers are rising there too.

Problems have arisen with oxygen supply at some hospitals – this is not due to lack of oxygen per se, but an engineering problem with the pipe pressure. Non-invasive ventilation with CPAP which most patients require needs a lot of oxygen and the requirement is more than the pipework can supply in some places. Some hospitals are unable to operate on surgical patients because all the operating theatres have been converted into temporary ICUs. Paediatric ICUs now have adult patients in them. Some outpatient facilities are being converted into temporary acute wards. Staff are being re-allocated from normal duties to support critical care and acute Covid wards. All these observations are as useful an indication of the stress in the system as the raw numbers.

So, what does all this mean?

Earlier this week, NHS England issued an Alert Level 5 – the definition of which is that there is a material risk of the NHS being overwhelmed and unable to cope with demand in several areas in the following 21 days.

Since September, NHSE has regularly been issuing exaggerated and hyperbolic statements about the risk of the service being overwhelmed that were not supported by the published data or the ‘ground truth’ – this has diminished trust and confidence with the public.

Unfortunately, they are not exaggerating now. The situation in London is the most serious I have seen in over 30 years as a doctor and it will probably get worse before it gets better. The deterioration in the last week has been incredibly fast and has taken people by surprise. The service is incredibly resilient but it is a finite resource and can be exceeded by demand in extreme circumstances.

The final question of course is will lockdown make any difference? I’m not convinced of the efficacy of lockdowns from experiences in 2020. It’s likely that community cases were already falling before the spring lockdown started. The multiple harms of lockdown have been well documented and many of these such as delayed treatment for cancer or heart disease will not become apparent for many months or years. On the other hand, faced with the current situation, there is literally no other intervention available. The current lockdown on this occasion fits the WHO definition of an intervention of last resort, which was not the case in the autumn. If the Prime Minister did not act, he would be subject to serious criticism should the London NHS be unable to cope in the coming weeks. Of course, that might happen anyway, but the Government have to be seen to act – so I don’t think there was any choice politically. Whether lockdown makes any practical difference to the number of cases presenting to hospital will not be known for several weeks and probably be the subject of intense debate.

The observation that the new variant was spreading rapidly even during the severe restrictions in December is worrying and suggests that there may be an ‘illusion of control’. One must hope that the ZOE app proves to be correct again and that cases have actually been falling in the community since the end of December. But even if that is true, hospital admissions will continue to rise at least for the next few days.

Eventually, we will get to the other side of this problem, but it will be a bumpy ride for the next few weeks with many difficult decisions to be taken.

Edited January 8, 2021 by sancho panza

[sancho panza]

Worth remembering that the people hiding Anne Frank were breaking the law.....hattip someone on twitter

 

[Bobthebuilder]

I am a bit shocked by that, don't know what to say.

[Loki]

On 08/01/2021 at 15:03, sancho panza said:

Unfortunately, they are not exaggerating now

Fool me once, shame on you.  Fool me twice...you can't fool me again

I'll get my NHS London mate to see what things are like in the hospitals he knows

Edited January 10, 2021 by Loki