Read on Twitter
@DrMCecconi introduces proceedings
Also speaking are
@charlot_summers
@rupert_pearse
@stephen_t_webb
And @avkwong
Do send in questions and comments.
Up first is Dr Stephen Webb (our new @ICS_updates president) to give an update on the current UK status..
Also speaking are
@charlot_summers
@rupert_pearse
@stephen_t_webb
And @avkwong
Do send in questions and comments.
Up first is Dr Stephen Webb (our new @ICS_updates president) to give an update on the current UK status..
Stephen reminding us all about @DrMCecconi’s timely efforts warning everyone from Lombardy https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=video&cd=&ved=2ahUKEwii-9T0jIruAhVHQMAKHZ0HD80QtwIwAHoECAUQAg&url=https%3A%2F%2Fedhub.ama-assn.org%2Fjn-learning%2Fvideo-player%2F18315311&usg=AOvVaw2KiUT819ilO6v-bUs4N9Vg
Now he iterates that the UK is in the similar position of warning everyone “this is coming”
Now he iterates that the UK is in the similar position of warning everyone “this is coming”
Despite our experience with the condition, Wave 2 seems worse than wave 1
Patients seem sicker (?due to the new variant)
Capacity is shorter
Younger patients seem more affected
The South of England is running out of intensive care beds.
Prepare yourselves everyone.
Patients seem sicker (?due to the new variant)
Capacity is shorter
Younger patients seem more affected
The South of England is running out of intensive care beds.
Prepare yourselves everyone.
Now up is @rupert_pearse from @NHSBartsHealth
“I echo everything Stephen has said. The situation is genuinely serious”
UK Wave 1 peak- 3,000 admissions a day
We are already there at this point in Wave 2 and we are nowhere near the peak...
“I echo everything Stephen has said. The situation is genuinely serious”
UK Wave 1 peak- 3,000 admissions a day
We are already there at this point in Wave 2 and we are nowhere near the peak...
40% of ICU patients were COVID in November (I believe this is up to 60% now, based on latest @HSJEditor data)
The lockdown in March 2020 worked
As those restrictions were lifted, cases started to rise again in September- a little bump
Then the massive explosion in December
The lockdown in March 2020 worked
As those restrictions were lifted, cases started to rise again in September- a little bump
Then the massive explosion in December
"In the first wave, we avoided thoughts of a triage scenario
We are considering triage now”
This is awful.
We are considering triage now”
This is awful.
A plea to those trying to turn this into a choice between the virus and the economy:
It’s a false dichotomy. They are both interlinked. Control COVID, you get the economy back.
- @rupert_pearse
It’s a false dichotomy. They are both interlinked. Control COVID, you get the economy back.
- @rupert_pearse
Powerful words from Rupert:
This is a society effort. We all need to work together to beat this.
Splintering into factions won’t help.
This is a society effort. We all need to work together to beat this.
Splintering into factions won’t help.
Now up it’s @charlot_summers - discussing the research aspects
The new strain is 40-70% more transmissible than the first strain
The UK is not the only area with concerning strains- there’s a South African one too
No evidence that it causes more severe illnsess as yet
The new strain is 40-70% more transmissible than the first strain
The UK is not the only area with concerning strains- there’s a South African one too
No evidence that it causes more severe illnsess as yet
The clinical profile has changed- it’s affecting younger, fitter patients
The strain is still detectable with the current PCR tests
And will be covered by the vaccine, based on preliminary data- hence vaccination is key.
The strain is still detectable with the current PCR tests
And will be covered by the vaccine, based on preliminary data- hence vaccination is key.
In terms of therapies:
What works- Steroids https://jamanetwork.com/journals/jama/fullarticle/2770279
What doesn’t work:
HCQ, Remdesivir, Interferon B-1 alpha https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
what we don’t know about :
Anti IL-6 (Tocilizumab)- conflicting data (new data from REMAP-CAP due today!)
What works- Steroids https://jamanetwork.com/journals/jama/fullarticle/2770279
What doesn’t work:
HCQ, Remdesivir, Interferon B-1 alpha https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
what we don’t know about :
Anti IL-6 (Tocilizumab)- conflicting data (new data from REMAP-CAP due today!)
Other things we don’t know about yet:
Convalescent plasma
Other antibody therapies (Regeneron et al)
Convalescent plasma
Other antibody therapies (Regeneron et al)
Now it’s time for a panel discussion…
@stephen_t_webb on capacity:
-UK better organised this time
-Capable of expanding into more areas, and such expansion has been done so
-however rapid patient wave is challenging this and stretching resources
-staffing is a big problem
@stephen_t_webb on capacity:
-UK better organised this time
-Capable of expanding into more areas, and such expansion has been done so
-however rapid patient wave is challenging this and stretching resources
-staffing is a big problem
-Once again, the problem is not a PHYSICAL BED SPACE.
ICU “bed state” includes the manpower to care for the patient.
Further understanding here - from @ics_updates https://www.ics.ac.uk/ICS/ICS/News_Statements/Understanding_intensive_care_staffing_occupancy_and_capacity_03012021.aspx
ICU “bed state” includes the manpower to care for the patient.
Further understanding here - from @ics_updates https://www.ics.ac.uk/ICS/ICS/News_Statements/Understanding_intensive_care_staffing_occupancy_and_capacity_03012021.aspx
ICUs are expanding into “surge” areas all round the UK- so more bed space and more kit
But with the same number of staff. And we can’t magic up fully trained staff out of nowhere.
What does that do to the staff? What does that do to quality of care?
But with the same number of staff. And we can’t magic up fully trained staff out of nowhere.
What does that do to the staff? What does that do to quality of care?
Staff to patient ratios are being diluted.
We are using medical students, consultants from other specialties, other AHPs to fill in for nursing gaps.
This isn’t ok. The effect on trained ICU nurses- the added stress on an already crazy busy job- is intense
We are using medical students, consultants from other specialties, other AHPs to fill in for nursing gaps.
This isn’t ok. The effect on trained ICU nurses- the added stress on an already crazy busy job- is intense
And of course the redeployment
To man the ICU we pull people from other services, which leads to those services shutting down (elective surgery)
Yet another horrible effect of #covid19
To man the ICU we pull people from other services, which leads to those services shutting down (elective surgery)
Yet another horrible effect of #covid19
Hospitalisations in younger people are rising
And not only that- younger people are spreading this more rapidly to the older population
Thanks to @ICNARC we can track the median age of those being admitted to ICU. This hasn’t really changed (still 60)
And not only that- younger people are spreading this more rapidly to the older population
Thanks to @ICNARC we can track the median age of those being admitted to ICU. This hasn’t really changed (still 60)
However this is all associated with increased infections and increased death
1000/day for the first time yesterday
1000/day for the first time yesterday
Superb question from @avkwong
Is there a point at which ICU care becomes diluted so much, it starts becoming harmful?
I have my thoughts on this...
Is there a point at which ICU care becomes diluted so much, it starts becoming harmful?
I have my thoughts on this...
Literally just posted on Twitter
And tally with my thoughts (and @ElieAzoulay5) https://twitter.com/schellongowski/status/1346961267718819841
And tally with my thoughts (and @ElieAzoulay5) https://twitter.com/schellongowski/status/1346961267718819841
@rupert_pearse discussing the moral injury associated with dilution of care
Society has no interest in having that discussion and will squash it (as certain “leaks” have shown); leaving healthcare practitioners to carry that burden
His recommendation: Have the discussion now.
Society has no interest in having that discussion and will squash it (as certain “leaks” have shown); leaving healthcare practitioners to carry that burden
His recommendation: Have the discussion now.
Get ahead of this as a society.
Decide what your boundaries of quality are.
See what the Israeli ICU community have done.
Moral injury like this should not be carried by a small group of people.
Decide what your boundaries of quality are.
See what the Israeli ICU community have done.
Moral injury like this should not be carried by a small group of people.
Big shout out to our respiratory and general medical colleagues, who have provided noninvasive respiratory support for swathes of patients and have supported us in ICU.
However now @charlot_summers raising some VERY CHALLENGING STATEMENTS...
However now @charlot_summers raising some VERY CHALLENGING STATEMENTS...
There is NO FIRM DATA that Noninvasive ventilation is the primary strategy of choice!
We are seeing an increasing (anecdotal) amount of barotrauma in the noninvasive population
We need more data to support our approach (and RECOVERY-RS will look at this)
We are seeing an increasing (anecdotal) amount of barotrauma in the noninvasive population
We need more data to support our approach (and RECOVERY-RS will look at this)
@rupert_pearse discussing the effects on families
Sadly there has been very restricted visiting, aside from end of life care
I have personally found this traumatic. I can only imagine how horrible it is for relatives.
Sadly there has been very restricted visiting, aside from end of life care
I have personally found this traumatic. I can only imagine how horrible it is for relatives.
Daily family updates via telephone or video chat is super helpful, and really helps both clinicians and families connect.
Now discussing controversial therapies:
Ivermectin- “Not enough data. Not outside a trial”
Ivermectin- “Not enough data. Not outside a trial”
