The original covid thread has been moved to the politics forum. I will be deleting any comment this is overtly political or which I judge to be too near the knuckle, without explanation or consultation.
WHAT DISCUSSION IS PERMITTED?
Medical
Scientific
Broad policy *
* this might be comparing with other countries, or considering the impact of policy changes, but there must NOT be reference to government or opposition deficiencies or performance, and zero discussion of any politician or advisor.
I won't be contributing further to this thread, not being possessed of a relevant expertise, but as a farewell I will point out that the decision whether to impose lockdown or not is just as much a political decision as a medical one.
My apology for my poor English. Reanimation departments in France stands areas for patients who need intubation or at least some significant oxygen breathing assistance (intubation is less and less used as it is not well supported by old people). So, probably critical care department.
The importance of my question is illustrated by the French government claim that, although most deaths are very old people, half of the people needing breathing help/intubation are below 65 years old.
This may be the reason why Macron claimed that without confinement, France may end up with 400000 deaths which may include a significant proportion of younger people.
I don't think it a comment on your English, it is certainly a more poetic description and one I'll be sharing with my colleagues.
To answer your question if there is no critical care capacity available then the likely outcome is the patient would die unfortunately. Local shortages of critical care capacity are relatively common in the UK even out of pandemic situations. For this reason the ICUs of a region work as a network and if one experiences a surge then patients can be transferred to different units. If the lack of capacity is only for a few hours then a patient can be kept on portable ventilator in a non ICU area until capacity is available, although there is evidence that this can worsen outcomes for the patient. Obviously this only works if there are local rather than national surges in requirement, as in a global pandemic.
The concept of ICU capacity is also multifaceted but potentially quite boring so I'll spoiler it
Critical care differs from 'normal ward' care in two main ways, the equipment and treatments available and the ratio of staff to patient. In the UK it is split into level 2 or High Dependency care (HDU) where there are 2 patients for each nurse, and level 3 (ICU) where in normal circumstances there is 1 to 1 care. Staffing ratios of medics is less clear cut but roughly one specialised doctor to between 8-12 patients is the norm.
A lot has been talked bout ICU capacity over the last year, with a particular emphasis on ventilators. Whilst equipment and physical bed space can be the limiting factor, it is usually staffing that limits capacity. In normal times it is not uncommon for an ICU to be at capacity but have empty beds and ventilators sat idle.
With a global pandemic the capacity requirement was great enough that physical space became scarce requiring us to surge into different clinical areas, usually operating theatres as they have the required medical gas pipelines and anaesthetic machines which can ventilate patients. However it is still the staff which is the main restricting factor. To deal with this most places have been dropping to 1 to 2 nursing in ICU patients, and at time as low as 1 to 4. They have other non ICU trained staff helping them out but it is a very specialised area of nursing. The medical staffing has been less of an issue. With the reduction in operating there are plenty of anaesthetists available, all of whom have significant ICU training.
This surge explains why elective work reduces the busier we get, as extra staff who are seconded to ICU all come from the theatre staff. This means that even though in this second wave we have put in place measures which mean we dot have to use the physical operating space, operations will still be cancelled. Hopefully though nowhere near as much as the first time as we have a better idea of the capacity we might need. As an idea of scale the hospital I work in was advised to prepare to require up to 200 ICU bed compared to the normal roughly 50 available. We aren't expecting to need any where near as much as that (remind me of this in the depths of January).
(A reply I'd typed out for the last thread and lucky copied when I got permission errors)
I don't think it a comment on your English, it is certainly a more poetic description and one I'll be sharing with my colleagues.
To answer your question if there is no critical care capacity available then the likely outcome is the patient would die unfortunately. Local shortages of critical care capacity are relatively common in the UK even out of pandemic situations. For this reason the ICUs of a region work as a network and if one experiences a surge then patients can be transferred to different units. If the lack of capacity is only for a few hours then a patient can be kept on portable ventilator in a non ICU area until capacity is available, although there is evidence that this can worsen outcomes for the patient. Obviously this only works if there are local rather than national surges in requirement, as in a global pandemic.
The concept of ICU capacity is also multifaceted but potentially quite boring so I'll spoiler it
Critical care differs from 'normal ward' care in two main ways, the equipment and treatments available and the ratio of staff to patient. In the UK it is split into level 2 or High Dependency care (HDU) where there are 2 patients for each nurse, and level 3 (ICU) where in normal circumstances there is 1 to 1 care. Staffing ratios of medics is less clear cut but roughly one specialised doctor to between 8-12 patients is the norm.
A lot has been talked bout ICU capacity over the last year, with a particular emphasis on ventilators. Whilst equipment and physical bed space can be the limiting factor, it is usually staffing that limits capacity. In normal times it is not uncommon for an ICU to be at capacity but have empty beds and ventilators sat idle.
With a global pandemic the capacity requirement was great enough that physical space became scarce requiring us to surge into different clinical areas, usually operating theatres as they have the required medical gas pipelines and anaesthetic machines which can ventilate patients. However it is still the staff which is the main restricting factor. To deal with this most places have been dropping to 1 to 2 nursing in ICU patients, and at time as low as 1 to 4. They have other non ICU trained staff helping them out but it is a very specialised area of nursing. The medical staffing has been less of an issue. With the reduction in operating there are plenty of anaesthetists available, all of whom have significant ICU training.
This surge explains why elective work reduces the busier we get, as extra staff who are seconded to ICU all come from the theatre staff. This means that even though in this second wave we have put in place measures which mean we dot have to use the physical operating space, operations will still be cancelled. Hopefully though nowhere near as much as the first time as we have a better idea of the capacity we might need. As an idea of scale the hospital I work in was advised to prepare to require up to 200 ICU bed compared to the normal roughly 50 available. We aren't expecting to need any where near as much as that (remind me of this in the depths of January).
(A reply I'd typed out for the last thread and lucky copied when I got permission errors)
Just to say that anyone who applies will be granted permission, but I will not confirm individually if there a lot of applications - just check back after a few hours to see if I have got round to it.
Just to say that anyone who applies will be granted permission, but I will not confirm individually if there a lot of applications - just check back after a few hours to see if I have got round to it.
Well I’ve been enjoying a glass of 2017 Soave la rocca from pieropan whilst watching Scotland beat wales and wondering if they’d finish in time for the big announcement. Clearly someone else wanted to see the finish too so put it back by an hour.
I wonder what else five o’clock will bring. My son is hoping for school closures, my daughter the reverse. It will make no difference to me work wise whatever comes up but I know I’m incredibly lucky in that.
Time for another glass with the first 15 mins of the england match
Well, we've had some good news this week, 2 weeks into Norn Iron being in a circuit breaker lockdown, we've got the R rate down below 1 again. Schools go back next week, so people becoming nervous. I tended to feel that the rise came with pubs opening and universities going back. Indeed in my son's school 13 out of the 15 cases were 6th formers. The youth of today have just got to stop enjoying themselves... for the moment! I'll just duck below the parapet now.
Just to say that anyone who applies will be granted permission, but I will not confirm individually if there a lot of applications - just check back after a few hours to see if I have got round to it.
Well I’ve been enjoying a glass of 2017 Soave la rocca from pieropan whilst watching Scotland vs wales and wondering if they’d finish in time for the big announcement. Clearly someone else wanted to see the finish too so put it back by an hour.
It was one for the purists Sean, sorry. Meantime it looks like boris wants to watch the first half, or maybe the whole Italy game.
does anyone know the rationale behind the rumoured introduction of this on Thursday? It seems to me that this will precipitate 4 days of the asinine panic buying of bog roll etc.
It was one for the purists Sean, sorry. Meantime it looks like boris wants to watch the first half, or maybe the whole Italy game.
does anyone know the rationale behind the rumoured introduction of this on Thursday? It seems to me that this will precipitate 4 days of the asinine panic buying of bog roll etc.
Plan was to announce it on Monday, debate in parliament on Tuesday, law voted in on Wednesday and start on Thursday. Announcement brought forward because of leaks
does anyone know the rationale behind the rumoured introduction of this on Thursday? It seems to me that this will precipitate 4 days of the asinine panic buying of bog roll etc.
My French friend complained bitterly about too short notice for their lockdown; he said he understands the decision but people need some time to arrange things.
But as Tom said, I guess it‘s for legal reason rather than anything.
