UK might not be over the worst, scientists warn, as Covid case numbers stay high
Inoculation programme must be stepped up before the onset of winter
www.theguardian.com
UK might not be over the worst, scientists warn, as Covid case numbers stay high
Inoculation programme must be stepped up before the onset of winterwww.theguardian.com
Yup ^ someone at PHE told me the same.Since Woolhouse often got on my nerve much earlier in the pandemic for saying things I considered to be unwise that didnt reflect the magnitude of the situation, it is worth noting when even he has concerns about the future.
These diminishing returns may be one reason the authorities dont seem to be as bothered about maintaining vaccination momentum these days. I am bound to say that we need to focus on other ways to reduce the number of infections.
Long (not cheerful) thread this on UK mortality rates. The poster is well respected so not alarmist.
It is based on Europe, sorry should have said.He's been very selected on the comparisons, there are counties that have done worst than the UK, including the US, Italy, Belgium, Mexico and at least 20 other countries.
It is based on Europe, sorry should have said.
OoopsJapan & Singapore are in Europe now?
Not that I am defending the fuck-ups by our government, just pointing out some have actually managed to fuck-up even more.
He's been very selected on the comparisons, there are counties that have done worst than the UK, including the US, Italy, Belgium, Mexico and at least 20 other countries.
And he tells us that the UK has a very different triage approach but no detail to back this up.
So it just seems like someone on twitter with their personal hunches about why the UK did so badly.
Did you really pay so little attention to this aspect that you can seriously question this?
People didnt question me when I went on about the 'die at home' aspect of the UK approach. Because it was bloody obvious it was happening, and there was no system to check on the health of people who caught it. It was a deadly form of hospital demand destruction, and it was blatant at the time.
Well certainly we first need to unpick a conflation of two different questions in his first two tweets in that thread:I expect the reasons some countries did worse than others will be incredibly complex and it might never be possible to come to a lot of definitive conclusions. He is making some plausible suggestions about things that, if the UK had a different approach, it might have seen a better outcome, but without giving us comparisons I don't see how we can judge how major these factors were in the context of the bigger picture.
He asks "why has the UK mortality been so high?" and then concludes the thread with two factors (hospital capacity and triage approach). That implies that these were the most significant of all the factors involved. Maybe they were but I don't see that such a conclusion is backed by clear evidence. I am not saying that I think they weren't factors.
Part of the poor clinical response to COVID-19 in the UK can be traced back to national policies restricting access to healthcare. Early on in the crisis the national response defaulted to a passive clinical approach despite international recommendations to the contrary. UK-wide, patients were advised to stay at home, book a SARS-CoV-2 test, and if concerned consult either an automated online symptom checker or non-clinical telephone triage system. Notably, thresholds for onward referral using these new and unproven triage systems were high.Equally concerning, the subsequent automated safety-net advice given to the patient included ‘how to manage breathlessness at home’ – a practice that would have been inconceivable in 2019. This, what became the national COVID-19 clinical pathway, replaced the more typical GP-led community assessment of the infected, breathless patient.
As well as clinical contact, oxygen was also rationed. At a national level, regardless of local disease prevalence and even for patients without COVID-19, target oxygen levels were reduced. This departure from our usual standards of care was imposed nationwide without any new evidence or revision to our established pneumonia guidelines. This meant patients with severe COVID-19 could be left at home, or sent home, hypoxic and without any treatment or follow-up. [Some localities did identify this gap in the national response and implemented their own follow-up service for high-risk patients who did not meet the new, higher thresholds for admission.
The rationale for such a passive, restricted national clinical response to the disease is not entirely clear. It may have been a preemptive rationing of healthcare; an attempt to concentrate limited clinical resources to those in most clinical need. But acute medical problems generally follow a different logic. Any offsetting of the healthcare burden achieved by restricting access to clinical contact early on in the disease is lost when patients - albeit fewer in number - present more severely unwell further on in the course of the disease. A ten minute clinical assessment can quite easily become many hours of clinical time if the opportunity to intervene early is missed. And, a short, uncomplicated hospital stay can quite easily become a complicated and protracted one, if treatment is delayed.
International guidelines do not support the UK's passive clinical approach to SARS-CoV-2. The WHO issued guidelines in March 2020 recommending a clinical assessment be offered to all patients with suspected or confirmed COVID-19. The UK has yet to meet those standards. The WHO also produced similar guidelines directed at ‘resource-restricted’ countries. All four UK nations have failed to meet those standards too. Even now, in the UK, patients with COVID-19 – suspected or confirmed – are still not offered an initial clinical assessment or follow-up, be it remote or otherwise. The public can still order a diagnostic test without clinical supervision, are still triaged through an automated or non-clinical pathway, and astonishingly, are still offered advice (and now a video) on how to manage breathlessness at home without ever having seen or spoken to a doctor or nurse. Of critical concern, at the time of writing, older adults and vulnerable patients are held to the same pathway, despite our awareness of ‘silent hypoxia’ and the mortality rate of the vulnerable and older COVID-19 patients. These standards are substantially below those expected in the UK and internationally, and need to be addressed.
Improving the tolerance of society to back- ground levels of SARS-CoV-2 will require an improved clinical response.
Yes I noted that conflation when I reread the thread.Well certainly we first need to unpick a conflation of two different questions in his first two tweets in that thread:
There is overall level of covid mortality across the entire population.
There is the chance of dying if you caught it.
The former will be affected by every pandemic failing, late and inadequate lockdowns etc etc. The latter, which is what he is actually focussing on, eliminates some of those areas and allows us to zoom into what sort of care people who caught it received. It is entirely reasonable to expect that the things he focusses on are a great match for the latter question.
Yes and they will add naunce and detail. But many of their conclusions will be stuff we could have come up with in less forensic fashion from the start. Most of what I've gone nuts about in the pandemic really isnt that hard to grasp and see the basic truth of, even when precise measurements elude us.I think there will be PhD’s for decades trying to understand the pandemic and how countries performed.