- Re: I feel the same RG Archived Message
Posted by dan
on April 23, 2020, 8:14 am, in reply to "I feel the same RG"
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They say in Sweden that a lockdown is not necessary because people trust the government to tell the truth and support them and so are prepared to self isolate. Not sure if that is true but I am sure that one of the reasons we are where we are is because the UK government and media cannot be trusted to tell the truth on anything and clearly have no interest in our well being. Under those circumstances, the people who habitually expose lies are perhaps more likely to be biased towards thinking that this is more of the same. A call to authority is a rhetorical tool so I'll not make a claim to be right based on my own expertise. Nevertheless I do have a grey beard and an opinion based on experience. You can take or leave it. I think the underground is the corona equivalent of a chickenpox party so the london data may not be representative of the dynamic of this disease in the rest of country. Low estimates suggest 6% of people have had it in UK overall but 15% in test capital Germany - I'm hoping 20-30% in London. I pray it's higher still. In the team I work in 10 of 15 of us developed symptoms - likely before we had patients - and the 5 without have proved consistently asymptomatic though they must have been exposed. This tallies with estimates that 33% of people from Vo (Italian cluster) and on the Diamond Princess had asymptomatic infection. It's possible to derive expected deaths using these figues and an assumption that 5% of symptomatic people have symtoms severe enough to require a hospital visit and then a test. There will always be someone with someone using an alternative set of assumptions citing experts with a much lower so until we have more testing that doesn't develop my thinking. We know from the excess mortality it's going to be a big number. At the end of this peak in May multiply by 2 to get a very conservative estimate of deaths. You can count all those dying of heart attacks or missed cancers in the community too because they are the consequence of an overwhelmed system. I work in an ICU with one of the highest predicted mortalities in the country because of the specialist case mix of patients in the hospital. In a good month over 40% of the patients die. We are very prepared for death and have a palliative care team, psychologist and multi faith chaplaincy embedded in our team. The psychologists run regular debriefing sessions for staff to help them bear the strain. I spend my days helping people, mainly families, come to terms with death in surreal space age alienating environment. I'm not a robot but I would not say panic was a major part of my mind set. There is very little high quality large trial data on how to manage patients in ICU because there is such heterogeneity in the patient population - every cases of sepsis is different and trials are hard. By contrast, most heart attacks are caused by a blocked artery and are treated with a single intervention - trials are easy. It is a speciality where it's necessary to listen to the wisdom of elders and hear and critique their thinking to arrive at your own path. I am immersed in the evaluation of abstract data used to predict mortality and my specialist interest is lung failure. There is no doubt in my mind that corona virus is an exception or that hospitals in London are overwhelmed. There are two reasons we have coped 1. The UK is much less likely to take older people to hospital or ICU than in other countries with better health care systems - we are institutionally ageist. 2. All other functions of the NHS have been shut down. We have built 4 ICUs in normal wards and cancelled all non emergency surgery and procedures. There will undoubtably be harms arising from this. There are any numbers of ways I could describe the stress the system is under but will describe the major limit at the moment. We have 1 hemofilter ("kidney machine") for every 5 ICU beds and we are running out of these and the bags of fluid they use, rather than ventilators. We are building 3 dialysis ICUs in my part of London - an entirely new concept in my experience. Dialysis machines can be plugged into the mains water supply rather than using specialist saline. This is being done on the fly in ten days - an equivalent project might take two years to plan and implement under usual circumstances, and longer to fund. London is coping in the meantime by reverting to peritoneal dialysis - pouring litres of fluids into the abdominal cavity - leaving them to absorb the toxins and then pouring them out again after a number of hours. If you don't understand from that, that this is a crisis that has overwhelmed the system I can't offer anything more. Of course the government are evil f#cks but the this is no worse than flu was part of the same mindset that led to no tests and no preparation. Deaths from starvation and poverty is a political choice and we could come out of lockdown within 3 weeks of there being a widespread community testing program. The fact that there is no such program in preparation should tell you all you need to know. Herd immunity is still the only game in town. |