@thevfmaddict
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Very true but there were also several reports from China along the way which were often disregarded. The only state which appears to have had a faultless track record in respect of anything like a volume of testing is South Korea. So as for ‘re-infection’ or ‘residual dormant virus’, for me the jury is still out. But I’m keeping an eye on it because it is the one thing that does cause the proverbial bricks to exude; after all one cannot self-isolate forever.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
If that is the case then the negative after the first bout must have been a false negative. I hope it was. I will be looking closely to see if this is likely because further incidences of apparent reinfection do not become common.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Ed, in the twentieth century a state’s pandemic control was about protecting lives. In the twenty-first century it is about protecting markets; something which has for some time been very clear.
Anyone looking at what China was doing should have recognised instantly that this was far, far worse than even the nastiest flu. But then again I feel I am preaching to the converted saying that to you because it is clear that you were reaching the same conclusions in parallel to me. Others, and perhaps pressure on their time prevented them from doing so, never looked closely at all the data out there and/or forgot the power of the state. Because it is surely clear that states have exerted a degree of pressure on the MSM possibly merely by telling the media it would crash the markets/economies if they delivered the true facts to their populations. Personally, I think the impact due to this initial deceit once the truth dawns will do far greater damage to the markets. Most businesses have due to the deceit not planned for what is coming when they should have been cross-training as fast as they could so that healthy staff could fill in for the unwell and of which there will be many a considerable number never to return.
I am very concerned that Japan has identified what appears to be a patient who suffered the virus; recovered; was cleared but then subsequently became unwell and tested positive. Was this a case of – (a) the virus being in the main beaten but remaining as some viruses do, in immunologically privileged sites within the body only to flare again in similar fashion to that which occurs with Herpes Simplex – or – (b) is the immunity one develops after beating the first infection short lived, which also occurs with some types of infection. If it is (a) then continuing an anti-viral or Chloroquine for some time even after a negative result may solve it and assist in the absolute clearance of the infection. If it is (b) the problem is more difficult to address until a 100% effective vaccine is available. Until then mankind would be certain to lose the war of attrition with the virus coming back again and again until its gets the job finished/you finished, so to speak. I will be looking very closely to see if more instances like that in Japan occur? For the record I changed my personal plan yesterday afternoon and sourced 2 further packs of Avloclor and will increase my holding further still today. If it seems to have helped I will continue with the normal prophylactic dose for malaria for at least three months after my apparent recovery. No problem with that because the prophylactic dose can be used pretty much indefinitely without significant risk. Just about any rational evaluation of the likely spectrum of incidence and impact on the NHS once this breaks will overwhelm the NHS which is already breaking under the weight of the current flu season. So I am truly of the belief that we will be either left or effectively left to our own devices; with little if any chance that the NHS will every be the relief column which comes riding over the hill, bugles blaring to save us if we suffer a severe infection. This country currently has just over 1,200 NHS hospitals; less than 170K beds and only 6,000 ICU beds. Until the NHS acquired a potent stone (a 100% effective vaccine or anti-viral) to hurl at this Goliath then it is David without his sling.
For those who think the above is alarmist or scaremongering – I say only that this virus is sound cause for very serious alarm. Frankly unless folks are truly scared they will take precautions no greater than they do with normal flu; which is typically diddly squat, isn’t it? That’s why so many catch the flu each year. But if folks consider this to be quite often deadly then just watch how careful they will be and that alone may delay its spread sufficiently to buy enough time for an effective vaccine or antiviral to be developed. The bottom line is I make no apologies for warning folks because the evidence is that they need to be thoroughly STERNLY WARNED immediately. But then again I am fairly certain that you concur, Ed. It will only dawn on the majority too late for them to prepare for their own defence and by doing fail to add their own barricade to onward transmission.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Correction to the above post – There is no outcome yet is 588 cases and not 605 cases as I wrote. That is to say 650 cases minus 62 (i.e. 45 recovered and 17 dead).
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Of the 650 Italian cases to date, the only sizeable European cohort so far:
284 are in home isolation and 45 patients have recovered from the disease. Therefore Italy is clearly not putting everyone in hospital as a precaution.
248 are though hospitalised with symptoms; that’s 38% of the 650. Worse still 56 (yes, 56) are in Intensive Care. That’s 8.9% of the 650 and almost three times higher than the 3% we were led to believe would need Intensive Care at worst.
Not mentioned in the Italian Press release is that 17 have already died; that’s 2.6%. No outcome has yet been reached for 605 of the 650 (i.e. neither death nor recovery has occurred). Sure as hell a fair chunk of the 56 in intensive care will not make it through because 35 are already critical. So its looking like the CFR (case fatality rate) could far exceed 3% and could even exceed 4%.
Facts. That’s what those figures are. Make of them what you will. But compared to the flu, which kills just 0.1% even in a bad year the figures cannot simply be disregarded except foolishly.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Data re Chinese Smoking Gender Divide
As of 2014, two thirds of Chinese men smoked. Women smoked much less. In 2010, smoking caused nearly 1 million (840 000 male, 130 000 female) deaths in China. That gender divide is massive.
Compare to the UK. The UK smoking rate had fallen to 14.4% in 2018. 25 – 34 year olds still have the highest smoking rate, with approximately 1 in 5 people within this age range smoking equating to around 1.4 million smokers in the UK. This could impact the age CFR.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
I would not rely on the WHO data because as yet it is effectively just what occurred in the Chinese population. A far high percentage of Chinese males have smoked and still do than is the norm in Western Europe and hence are more likely to suffer cardiac problems combined with respiratory problems. In other words the death rate among the previously cardiac compromised will inevitably be higher because they will in the main also be already compromised as regards respiratory function. It all makes interpreting the data in any meaningful way close to impossible. Yes, the top three categories (cardiac, diabetes and respiratory) will equally be the main risk factors in the UK just as they are with normal flu. But as regards percentages they cannot be even loosely relied upon.
I live near a large Chinese Restaurant which until lately had six, seven or eight coach loads of Chinese Tourists dine there each day. The owner seemed to have a deal with many tour operators. Truly, hundreds of exclusively Chinese tourists every single day. Almost every male would be outside smoking after the meal. As an aside not a single one was ever seen by me vaping. Looking at them obesity seemed rare. Therefore one would expect a lot of overlap between cardiac problems and the inevitable respiratory problems that derive of smoking. But in isolation Diabetes could be the biggest risk factor. It is just that more of those with cardiac problems died because they also had respiratory problems; both caused in the main by smoking.
I think therefore that we need to see some western data. However, clearly as with all ‘flu’ type conditions those suffering any of the top three morbidities will be at greater risk and far, far more so it they suffer more than one of the top three. Finally, the sex differences are actually nowhere near as great as I would expect given the huge difference in the levels of smoking between the sexes in China. Indeed my gut reaction is that we may well find that the gender differential will actually be the reverse in western states.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Ed, I’d buy your final paragraph but for the fact that such a cull would be of predominantly Tory voters. Because the over 65’s vote Tory far more often than Labour or Liberal. I am not therefore not 100% sure such is to the Tories advantage and hence that such could be Cummings’s plan.
Re Age v Risk – the WHO data you linked showed that the virus even in younger age groups is twice as lethal as flu in a bad year.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Richard, I hope your view of what’s coming is right. But too many experts appear to be towing HMG’s line. Heard a Professor today from the London School of Tropical Medicine saying the warmer weather when it comes will stop this spreading as it does the flu. What a total plank. No-one has ever it seems told him that when a theory and reality are in absolute conflict it is always the theory that is wrong. It is 28 and 21 degrees in Singapore and Kuwait respectively at present and the virus seems to be happily chugging along in its sunglasses. Moreover 9 out of 19 individuals that attended a BBQ with an infected individual in Singapore were subsequently found positive. So the perhaps the virus had its shorts and suntan oil on also.
BTW you are grammatically incorrect that my position could be called panic. Panic is an ‘overwhelming’ feeling of fear and anxiety. Yes, I have fear of and an anxious about what is coming. But I am not ‘overwhelmed’ to the point of not being unable to face the facts and take positive action to mitigate its impact; quite the reverse, which should be obvious.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
…………. It is absurd to propose bankrupting each other by suggesting the purchase of equipment that could never be delivered in time and for which no trained staff or space would be available in a 60% event.
I presume that in that last paragraph, Richard, you were talking of the NHS ‘buying-in’. True, some of what WILL be needed might not be delivered in time. But I fail to see the logic in not buying in that which IS rapidly available and could be delivered in time.
Space is less of a problem than one may think. Many hospitals have closed/inactive wards that can be reactivated. Anyone can be trained inside half and hour to set up and manage non-invasive ventilation (i.e. CPAP or BiPAP ventilation which provides breathing support without intubation). Highly trained staff are not required as such; this level of ventilation is sufficient for many. BiPAP is already in the case of those with dangerous sleep apnoea often self-administered today by patients at home after training. No medical degree required. So even nursing assistants could be trained to deliver such vital care once the patient’s need is signed off by a doctor. The NHS could then save its highly trained staff for where intubation is needed.
What I have said in this thread may alarm some but hard facts can often alarm. But it is not ‘alarmist’ to merely state fact. You possibly consider it alarmist because the facts are uncomfortable to face. It took me a while looking closely at the FACTS to face up to them so I do have some empathy. I know facing such isn’t easy. But it must be done if you and those you care for are to have any chance of taking the best possible action to mitigate the impact of the dangerous viral punch coming in our direction. This virus has already killed more than SARS, Ebola and MERS put together and in far, far faster order. No, it doesn’t have the case fatality rate of any of those viruses but, due to its virulence (infectiousness) and because it can infect others effectively covertly, it will wage a horrific war of attrition on the human race simply of its very nature.
Irrespective of whether you do take positive action or simply leave everything merely to chance I wish you well, Richard; and hope that you, as I do with all Forumites, are still with us when we eventually reach the other side of this coming nightmare.
As for me, well if this little bugger of a virus takes me then it won’t have done so without me having put up the best fight possible; and I’d rather go into that fight well equipped rather than empty handed. YMMV.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Dave –
The fatality rate of this is 2.3% while the fatality rate with normal flu is 0.1% in a very bad year and a tenth of that in a good year. For the record the fatality rate with Swine Flu was 0.4% that is to say it was/is four times more dangerous than normal flu but only approx. 1/6th as dangerous as this virus.
18% of those who are infected with this virus suffer a severe infection requiring hospital care which is astronomical compared to how many people with normal flu require such. Do almost one in five suffers with normal flu require a hospital bed? Nowhere near that number do yet such alone nearly breaks the NHS each year.
3% of those infected with this virus go critical and require an ICU bed typically needing time on a ventilator. Two out of those 3 still die. The ones that recover on average take 3 weeks to do so before hospital discharge; consuming a hospital bed all that time.
You can’t easily avoid being infected without PPE because those infected are infectious even before they have symptoms. So not only do you not know they have it typically they themselves do not yet know.
Do you think for one moment China would have effectively shut down its economy for so long due to normal flu?
There is a truth – Any action one takes before or in preparation for a serious pandemic is typically accused of being alarmist. But wait until after it strikes and any action you take is almost invariably vastly inadequate.
Imperial College London say approx. 60% of the UK population are likely to become infected. That’s 60% of 67 million = over 40 million. 18% of those will require hospital care = 7.2 million. 3% will require an ICU bed. That’s 1.3 million ICU beds.
Forget what I’m saying just go look at the facts yourself. Considering this to be just bad flu or even like Swine Flu and ignoring, responding to or preparing for it only as being such will significantly reduce your chances or getting through what is definitely coming.
The UK government has sought to play this down for numerous reasons and you appear to have bought Boris’s and Matt’s spin, hook, line and sinker. I have been looking at the facts (so has Ed); the published clinical papers; what the world’s leading centres on contagious diseases are saying, etc.
I have here merely tried here to ensure that Forumites are as fully informed as possible of what we are facing and as far as possible can take steps to mitigate its impact. It is up to each Forumite, yourself included, to make his/her own decisions. I genuinely hope the decisions you reach are based on the sound evidence rather than the spin of HMG. The NHS simply cannot be prepared to deal with this one. It is too big and even a tiny fraction of 1% of it will overwhelm the NHS. Therefore we must do all we can ourselves. I very much hope and pray that you and all Forumites are still around by the end of this. But our typical age and co-morbidities incline to the conclusion that this is most unlikely especially if one adopts an Ostrich Strategy and fails to prepare. I genuinely pray to God that you today reject such a strategy and instead very rapidly prepare.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
For the first time since this all began the UK is waking up to pretty much universal front page coverage of Covid-19 in the main stream press. I believe today will probably be the day that the majority of the UK at last take this seriously and begin to prepare. Panic buying will certainly begin to some degree today and only accelerate day on day. With it the ability to prepare in fully considered fashion and at one’s leisure will begin to end and the window within which to do so close increasingly (indeed exponentially) rapidly. Panic buying will certainly be in full swing this weekend and major shortages on shop shelves starting to become the norm. Masks and hand santizer gels have over the last couple of weeks become increasingly hard to find and heaven knows where one will be able to find them after this weekend.
Anyone desiring to increase their chances of getting through what’s coming – and – who desires to ensure they can endure long periods of lock down without major hardship must act with genuine urgency – Pretty Damn Quick.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
The USA trial design you linked is relatively sound but I always baulk at randomised placebo controlled trials in potentially life or death situations; despite them being the gold standard for providing robust clinical evidence.
To me there is a void of impeccable ethics in – “Ah yes more patients in the placebo group died while more in the active treatment survived. We have our proof”. The folks who were randomised into the placebo group also have the proof but they’ll never known that !!! Of course trials are often cut short early if a statistically significant pattern appears to be developing to the effect that the active treatment delivers clear benefits; stopped on the basis that it is then unethical to continue to withhold a known effective treatment from the placebo group. But the way I have always seen it is one has already jeopardised those in the placebo group by that point. I’ve argued that one more times than I care to remember over dinner with medics. To be fair most medics do agree with me regarding the abstract ethics. Alas acquiring proof of ethicacy is perhaps the one situation where no-one can come up with an alternative and therefore the core medic’s obligation to make the care of one’s patient one’s first concern has to be sacrificed for the greater good.
Returning specifically to this study – I note that the protocol re eligibility criteria is, in brief, there must be robust evidence of or highly suggestive of, lung involvement. The piece you sited does not state whether microbiological investigation must also have established that such proven or perceived respiratory degradation is not due to or is unlikely to be due to, a primary or secondary bacterial pneumonia. I suspect this is within the full eligibility criteria however because failing to exclude such in the protocol could undermine the study’s findings totally.
Note though that the study is a study of the fire-fighting potency of the anti-viral because it clearly requires that there is already believed to be significant evidence of lung involvement rather than merely the subjective evidence of the patient reporting that they are experiencing breathlessness. Indeed, I see nothing in the protocol that suggests that low or falling blood oxygen saturation (assessed by pulsoximeter) is even considered to be sufficient for eligibility. Basically the eligibility criteria requires evidence that the virus has already established a significant beachhead in the lungs. I personally prefer to subscribe to the old maxim that prevention is better than cure. Surely far better to intervene before the virus has established a significant respiratory beachhead.
Chloroquine, an inexpensive compound that we already have significant experience and knowledge of, including safety and tolerable doses, might just be the ideal universal early intervention. It is as you know used in malaria not merely as a treatment but also a prophylactic and its safety is such that it does not even need prescription. Perhaps if used universally upon confirmation of the presence of the virus plus lower than average pulsoximeter sats and/or reports by the patient of perceived breathlessness, then fewer patients would ever progress to marked lung involvement. In respect of bacterial chest infections no doctor waits for microbiological verification or for significant verified lung involvement before initiating antibiotics. They initiate an antibiotic right away to seek to prevent the bacteria from proliferating. Surely it makes sense to do similarly with this virus? If the patient has tested positive for the virus and has low sats (an instant assessment by pulsoximeter) them immediately attempt to seek to assist the patient’s immune system to cope with the virus by initiating Choloroquine to reduce the chances that it will ever develops to the point of major lung involvement.
My own personal trigger plan for initiating Avloclor is quite simple and follows the above rationale. Monitor my oxygen sats with our pulsoximeter; this I have already started. If I at any point from here on in I suffer a fever and my sats are to even the slightest degree beginning to noticeably and progressively fall then the trigger is pulled. Why not? It is no different from taking Chloroquine in readiness for an overseas trip. The objective here being to impede the virus to such an extent as to increase my own immune system’s ability to cope with it. I’d rather not wait until the virus has established itself fully in my lungs before initiating and then having to fire fight a fully established blaze.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Ed, having read my post concerning £1.50p zinc above now walk with me a ways.
The human body cannot store zinc hence we need regular intake of it right before and at time of infection and before it develops a stronghold. Changes in intestinal tract absorbability and permeability due, to viral, protozoal or bacteria pathogens can make both poor and additionally may also encourage fecal loss of zinc; all resulting in zinc deficiency. Errrmmm…….. This virus specifically attacks the gut as well as the lungs doesn’t it? Could it be that the reason that some younger apparently healthy individuals die of Covid-19 be that the virus depletes their zinc due to its attack on the gut and then that zinc deficiency allows the inflammation in the lungs (and elsewhere) to run away with itself because the attenuation of it which relies on zinc is no longer occurring adequately.
I’m firing this rationale off to several Chest Consultants, one a Professor, who I knew and they know me from my days in pharmaceuticals. Checking the zinc levels of Covid-19 sufferers who are approaching critical would rapidly prove or disprove this hypothesis. If they are indeed zinc deficient then IV Zinc may significantly, perhaps even dramatically, improve outcomes.
I’ve never before spoken Zinc in depth with medics. But if my experience of talking Magnesium with them is anything to go by then other than the body’s main electrolytes most medics have sod all knowledge of the importance of most cations and almost never consider them when facing problems that might in part be caused by their deficiency.
It is all out of the box thinking but it is underpinned by good science and it might be the case that such has as yet never even been considered.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Posting this picture out of enormous respect. The following picture is of Chinese medics who have died of Covid-19 while fighting it. These to me are true heros. They knew and saw first hand what this virus does to people. Yet they remained engulfed by what must have been and they knew were clouds of this virus. No different from running forward in the face of concentrated fire during a battle. They have my total respect. Sadly I have no doubts many medics in the UK will join their ranks this year.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
£1.50p that might save your life this year – Don’t fail to spend it.
If you suffer Covid-19 severely the primary threat to life is inflammation of the lower respiratory tract which results in severe respiratory distress such that your lungs become incapable of supplying oxygen to your blood. Inflammation of other organs can also occur causing sepsis.
Inflammation is one of our body’s key defense mechanisms against infection. It seeks to contain an infection to stop spread and it also aids the flood of immune systems cells into the site to fight the infection. However, quite often in matters respiratory it does more harm than good. The ‘brown’ preventer inhalers, used in asthma and conditions such as COPD contain a steroid specifically to limit inflammation. Because quite literally if it gets out of hand you drown in your own defence, so to speak.
Zinc plays a vital role in our immune systems. It is vital to the activation of our immune cells to fight infections but – and this is important here – it also plays a vital role in ensuring that the body’s inflammation is not overly disproportionate to the threat such that it does far more harm than good. This BBC piece explains this all and since its publication numerous studies, such as this, have repeatedly confirmed the rationale.
One cannot know if one is Zinc deficient without blood tests and GPs rarely test for it. If one is zinc deficient it will be more likely that your body will either act insufficiently against this virus or overreact to it doing far more harm than good. It is impossible to dangerously overdose with zinc at normal supplement doses. Therefore taking a supplement from now on during this pandemic can do no harm and could significantly increase you chances of survival if you are to any degree zinc deficient. Supplementation of 10mg to 20mg a day is optimal. Sainsbury’s sell 15mg tablets at £1.50p for 60, enough for two months at one a day, and I’ve not found it cheaper anywhere else.
I consider Zinc supplementation a truly vital component of one’s preparation for getting through this. It can do no harm but might be critical to your survival. For the record – There is far more sound scientific evidence of the value of Zinc to ensuring an optimal immune system response than there is for Vitamin C. Although I would still recommend Vitamin C supplements for other reasons during a period when fresh fruit may very well be unavailable.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
You can always trust an Aussie to tell it like it is.
Aus plus the trigger on its pandemic plan. It is also being totally upfront with its population. If only ours were also.
This is an absolute MUST READ. But be warned it is not for the feint hearted.
Extract –
Considering the mortality rate of COVID-19 is 2 to 3 per cent, “if 50 per cent of Australians became infected, that is 492,000 to 738,000 people dying, over 3 million people needing a hospital bed and over 1 million people needing an ICU bed,” Professor MacIntyre said.
Yep, that’s what I call straight talking.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
The Middle East spread continues. Italy appears not to have gained control. More EU states post first cases and Switzerland’s neutrality in this war appears not to be respected by this virus. See here for live stats. What a lovely day not. Mankind is losing this one and being battered by this ninja virus that infects others even before running up the flag of its presence by causing symptoms. Nothing to worry about though because the WHO haven’t declared it a pandemic❗
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
How long is the fuse on infection time bombs? The fact that 82% plus do not suffer a serious infection surely means it is far longer than we imagine. Infected ‘A’ infects a number of ‘Bs’. The time bomb fuse therefore seems to be one incubation period. However, it is quite possible that none of the few that A infected ever had the condition severely enough for it to be detected/confirmed. Nonetheless those Bs infect others. The time bomb fuse is now two incubation periods before the bomb noticeably explodes. If the Bs only infected a couple of folk each it becomes still quite possible that none of those they infected were in the 18% that suffer a severe infection. Hence the bomb continues undetected. The time bomb fuse is now 3 incubation periods before the bomb explodes.
I think it will be several months before we can be really confident that any confirmed case did not commence an as yet invisible chain. Especially when A might have infected B or B infected C not in person but instead by leaving presents around and which can in certain circumstances remain potent for 9 days meaning they might not have been delivered for that period; adding still further to the duration of the fuse.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Richard, you are of course correct; closer proximity and longer duration of exposure to an infected individual will result in far higher likelihood of becoming infected. As I understand it how much of a “shedder” the infected person is also comes into play. Because it seems some people shed more of the virus than do others. I presume therefore that 5 minutes around a very heavy shedder is probably as bad as 15 around a low volume shedder. All in all there are too many variables to really know what contact causes the most risk. I would rather move the odds as far as possible in my direction. Limit contact with others to only that which is totally unavoidable and even then wear all possible PPE short of a full hazmat suit. YMMV. Its an individual call we must all make personally.
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Ed, I agree that HMG will need to issue guidelines of when to call 111; and when to present to a medical establishment if 111 lines are overloaded, etc. However, generally and especially in situations such as this, many (possibly the majority) won’t follow them and of human nature will desire at the very least some spoken reassurance and guidance from a human being. I am absolutely certain therefore that 111 will be the first NHS sub-system to be totally overwhelmed.
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Breaking Points
I’ve been playing with some maths to try to determine the likely burden at which the NHS would be overwhelmed. The NHS has just south of 168K beds spread across approx. 1,250 hospitals. The average period of necessary hospitalisation for Covid-19 patients when hospitalisation is required is 21 days. This means that at any point during the UK epidemic, beds will be required not merely for patients who present on any given day but also beds will still be required for patients that presented during the previous 20 days. Those figures are very frightening when fully considered.
They mean that hospitals on average currently have 135 beds capacity for all needs. Even were every single bed suddenly allocated solely to Covid-19 patients then a new patient rate of just 7 Covid-19 patients presenting per hospital a day for 21 days would fill 147 beds (i.e. 7 x21) in each hospital. But of course they only have 135 beds. The breakpoint is therefore, just 7 new Covid-19 patients per hospital per day for 21 days, even if every single hospital bed the NHS currently has could be allocated to Covid-19. Of course the breakpoint will be far, far sooner because the NHS could not allocate even half of its bed stock to Covid-19; and that assumes only 7 new Covid-19 patients a day.
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The Impact of Human Nature on Death Rates
It is true that more older folks with co-morbidities have died in China. But we have no idea as to the standard of care they were receiving up to and at point of death. If there was a shortage of medications and ventilators, which there must have been in China, who would medics have allocated those limited resources to? If you were a medic with three patients before you all requiring a ventilator but only one was available who would you allocate it to? Old pharts A & B who, Covid-19 aside, have in any event only a few years ahead of them due to their other conditions, or young mother C who, Covid-19 aside, would have many decades ahead of her?
The point I seek to make is that once resources are critically limited a degree of god-like selection has to be made by medics as to who is given the best chance of surviving. The degree to which this selection may have reduced or inflated death rates in certain sub-groups is often impossible to dissect from the total figures. In raw terms I find myself wondering if more old men died, yes, because they had co-existing morbidities but not directly due to such but indirectly because medics quite rationally allocated to them less of the very limited life saving resources that were available.
What would you do? Only one ventilator available; two old pharts one with cancer the other in the early stages of terminal heart failure plus a younger individual who is healthy but for Covid-19. The call is obvious, isn’t it? Bottom line – What really killed the two old pharts? Was it sub-optimal care or truly intractable Covid-19?
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
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