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20 minutes ago, Dunge said:

The main thing I thought about the clapping in the first lockdown was that people were going out there and risking their lives against a disease that was still largely unknown at that point while the rest of us stayed away. I thought that deserved something to mark it on a human level.

 

I wasn’t applauding politics. I was applauding people.

You're not seeing the link between politics and people, then.

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There are so many Covid patients, younger this time. But my hospital is full

Truly, I never imagined it would be this bad.

Once again Covid has spread out along the hospital, the disease greedily taking over ward after ward. Surgical, paediatric, obstetric, orthopaedic; this virus does not discriminate between specialities. Outbreaks bloom even in our “clean” areas and the disease is even more ferociously infectious. Although our local tests do not differentiate strains, I presume this is the new variant.

The patients are younger this time around too, and there are so many of them. They are sick. We are full. There can be no debate: this is much, much worse than the first surge.

 

We start the morning with 10 new patients to be concerned about. These are just the worst of them; we cannot worry about those who, though less unwell, would have had us scared in days gone by.

They are scattered on general wards around the hospital, being given as much oxygen as possible through a standard mask. Most are lying prone on their fronts, breathing rapid, shallow breaths, too breathless to talk, blood oxygen saturations alarmingly low.

The eldest is in his 70s but most are much younger. All urgently need respiratory support. This is ideally given non-invasively using a Cpap mask or very high oxygen flows through the nose. Like most hospitals we have set up a new respiratory-led breathing support unit for this purpose, but it filled up with patients weeks ago.

 

Our intensive care unit, able to deliver these therapies as well as invasive ventilation for the very sickest, is also full despite being stretched and pushed way beyond its previous capacity. Our neighbouring hospitals are under the same pressures, or worse; even if patients were well enough to transfer out safely there is no space to receive them.

We divide and conquer. Some of us rush through the morning ward rounds on the breathing support and intensive care units, desperately hoping to find patients that have improved enough to step down on to a normal ward or could be swapped between the two units according to their needs.

Some of us go to assess the new referrals. We make sure that everything possible has been done to avoid the need for more support but our colleagues have already been thorough. They need to come to us, and soon.

We initiate difficult conversations with some patients who were frailer before catching Covid and would therefore have less chance of benefit from additional breathing therapy. We no longer have the luxury of “giving it a go”; we have to ensure that we select only those with the best chance of survival.

 

Getting it wrong may occupy a precious high dependency bed for many days, often ending in a difficult and symptomatic death while preventing other patients from receiving the correct therapy. Conversely, identifying those who will not survive will allow us to ensure better symptom control and a kinder end to life.

These conversations, often barely intelligible through our PPE, are draining, fraught, brutal. We must justify to patients and their families, and often our colleagues too, why we cannot offer these therapies to everyone.

There is a common misconception about ventilation and respiratory support. These are not treatments; they simply stop people dying while they hopefully heal. Dexamethasone, the steroid identified as effective at reducing mortality in the Recovery trial, is the single best treatment we have available for Covid.

It certainly stops many people dying, but it may not make them better, at least not quickly. This is a large part of our current problem: people who previously died within a few days now need respiratory support for weeks on end. Our mortuary is emptier than it was, but the hospital is much fuller.

We reconvene to discuss what to do with the 10, plus another two referred during the morning rounds. We feel that three have such a poor prognosis that we cannot justify offering more support, leaving nine to accommodate.

A couple of intensive care patients have died; two available beds. We step down a total of four others to normal wards, though two of these much earlier than we would like; we just have to hope they will not sicken again and need to come back.

That’s six accounted for now.

An alarm call goes out as another patient on the unit suddenly deteriorates. We peel off to assess him, gently remove the Cpap mask, transfer him to a side room, call in his family to be with him, administer medications to control terminal symptoms, help comfort the nursing staff who are in tears; they had got to know him and this has come as a huge shock. Still, it’s another bed. Seven.

 

There is no option for the last two but to further expand our breathing support unit, stretching it into yet another bay on scavenged kit with nursing levels way, way below what we used to consider safe. Problem solved, temporarily, but it has taken many hours during which the patients have not received the care they need. Our nurses are amazing but they are being stretched beyond breaking point on a daily basis now.

Meanwhile, maybe 30 new patients have been admitted through A&E, most of them requiring high levels of oxygen. We have no more beds in the hospital and barely enough staff to support the ones we do have. Our A&E fills up again and ambulances queue out the door.

There is barely time to process any of this; I go home and fall asleep. We have not even reached the peak of new cases in our area. The numbers arriving in hospital will peak some days after that and the death rate even later; it takes time for people with Covid to sicken and die. I have not heard of any credible central plans to relieve this pressure, yet already the system is about to fail. It is this that wakes me, anxious, in the small hours of the morning.

There is nowhere left to go.

  • The writer is an NHS respiratory consultant who works across a number of hospitals

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1 minute ago, Buce said:

There are so many Covid patients, younger this time. But my hospital is full

Truly, I never imagined it would be this bad.

Once again Covid has spread out along the hospital, the disease greedily taking over ward after ward. Surgical, paediatric, obstetric, orthopaedic; this virus does not discriminate between specialities. Outbreaks bloom even in our “clean” areas and the disease is even more ferociously infectious. Although our local tests do not differentiate strains, I presume this is the new variant.

The patients are younger this time around too, and there are so many of them. They are sick. We are full. There can be no debate: this is much, much worse than the first surge.

 

We start the morning with 10 new patients to be concerned about. These are just the worst of them; we cannot worry about those who, though less unwell, would have had us scared in days gone by.

They are scattered on general wards around the hospital, being given as much oxygen as possible through a standard mask. Most are lying prone on their fronts, breathing rapid, shallow breaths, too breathless to talk, blood oxygen saturations alarmingly low.

The eldest is in his 70s but most are much younger. All urgently need respiratory support. This is ideally given non-invasively using a Cpap mask or very high oxygen flows through the nose. Like most hospitals we have set up a new respiratory-led breathing support unit for this purpose, but it filled up with patients weeks ago.

 

Our intensive care unit, able to deliver these therapies as well as invasive ventilation for the very sickest, is also full despite being stretched and pushed way beyond its previous capacity. Our neighbouring hospitals are under the same pressures, or worse; even if patients were well enough to transfer out safely there is no space to receive them.

We divide and conquer. Some of us rush through the morning ward rounds on the breathing support and intensive care units, desperately hoping to find patients that have improved enough to step down on to a normal ward or could be swapped between the two units according to their needs.

Some of us go to assess the new referrals. We make sure that everything possible has been done to avoid the need for more support but our colleagues have already been thorough. They need to come to us, and soon.

We initiate difficult conversations with some patients who were frailer before catching Covid and would therefore have less chance of benefit from additional breathing therapy. We no longer have the luxury of “giving it a go”; we have to ensure that we select only those with the best chance of survival.

 

Getting it wrong may occupy a precious high dependency bed for many days, often ending in a difficult and symptomatic death while preventing other patients from receiving the correct therapy. Conversely, identifying those who will not survive will allow us to ensure better symptom control and a kinder end to life.

These conversations, often barely intelligible through our PPE, are draining, fraught, brutal. We must justify to patients and their families, and often our colleagues too, why we cannot offer these therapies to everyone.

There is a common misconception about ventilation and respiratory support. These are not treatments; they simply stop people dying while they hopefully heal. Dexamethasone, the steroid identified as effective at reducing mortality in the Recovery trial, is the single best treatment we have available for Covid.

It certainly stops many people dying, but it may not make them better, at least not quickly. This is a large part of our current problem: people who previously died within a few days now need respiratory support for weeks on end. Our mortuary is emptier than it was, but the hospital is much fuller.

We reconvene to discuss what to do with the 10, plus another two referred during the morning rounds. We feel that three have such a poor prognosis that we cannot justify offering more support, leaving nine to accommodate.

A couple of intensive care patients have died; two available beds. We step down a total of four others to normal wards, though two of these much earlier than we would like; we just have to hope they will not sicken again and need to come back.

That’s six accounted for now.

An alarm call goes out as another patient on the unit suddenly deteriorates. We peel off to assess him, gently remove the Cpap mask, transfer him to a side room, call in his family to be with him, administer medications to control terminal symptoms, help comfort the nursing staff who are in tears; they had got to know him and this has come as a huge shock. Still, it’s another bed. Seven.

 

There is no option for the last two but to further expand our breathing support unit, stretching it into yet another bay on scavenged kit with nursing levels way, way below what we used to consider safe. Problem solved, temporarily, but it has taken many hours during which the patients have not received the care they need. Our nurses are amazing but they are being stretched beyond breaking point on a daily basis now.

Meanwhile, maybe 30 new patients have been admitted through A&E, most of them requiring high levels of oxygen. We have no more beds in the hospital and barely enough staff to support the ones we do have. Our A&E fills up again and ambulances queue out the door.

There is barely time to process any of this; I go home and fall asleep. We have not even reached the peak of new cases in our area. The numbers arriving in hospital will peak some days after that and the death rate even later; it takes time for people with Covid to sicken and die. I have not heard of any credible central plans to relieve this pressure, yet already the system is about to fail. It is this that wakes me, anxious, in the small hours of the morning.

There is nowhere left to go.

  • The writer is an NHS respiratory consultant who works across a number of hospitals

It would be interesting to know how old the 'much younger' patients are.

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12 minutes ago, Nalis said:

It would be interesting to know how old the 'much younger' patients are.


More in their 40s and 50s if I was to guess. 

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29 minutes ago, Nod.E said:

You're not seeing the link between politics and people, then.

I’m suggesting you’re not recognising the difference between them.

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The clap was a nice gesture to begin with, but worn out very quickly. No need for it to return but the reaction to it has been pathetic. Forcing the person who's idea it was to distance themselves and release a  statement saying they don't work for the government because of abuse. Jesus Christ. If people want to clap let them.

 

Saw something about new treatment being quite successful, usually used for rheumatoid arthritis. Anything like that has to be positive.  EDIT - see its been mentioned above. 

Edited by RowlattsFox
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42 minutes ago, Nalis said:

It would be interesting to know how old the 'much younger' patients are.

 

29 minutes ago, Finnaldo said:


More in their 40s and 50s if I was to guess. 

 

I saw a report the other day that included an interview with a senior nurse dealing with Covid patients. She said there were a lot more this time in their "30s, 40s & 50s".

 

I assume that's partly because the elderly are taking more precautions in the knowledge that they're more at risk - and often find it easier to avoid risk (not having to work etc.).

I suppose there's also the maths of it: even if a similar, fairly low proportion of younger people with Covid end up in hospital, the nominal figure will be much higher than before as more people have been infected this time, due to new variant etc.

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10 minutes ago, Corky said:

Deaths still at appalling levels (over 1k again) but 10k fewer positive tests today.

Deaths will continue to increase. We hit the peak in recent days (we hope) of cases so we'll see the deaths from these in the next two to three weeks. 

 

Let's hope the lower case number is the beginning of these dropping.

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8 minutes ago, Stevosevic said:

Deaths will continue to increase. We hit the peak in recent days (we hope) of cases so we'll see the deaths from these in the next two to three weeks. 

 

Let's hope the lower case number is the beginning of these dropping.

I'm not certain we've hit the peak of cases yet. 

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4 hours ago, bovril said:

Working from home and there's a steady stream of cars outside my window. During the first lockdown it was eerily quiet. 

I wonder if any of the teachers on here can confirm but it seemed to me, that were more than 3-4 times the numbers of kids at the ‘key’ workers club at school.

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4 minutes ago, Facecloth said:

I won't be clapping tonight, I stopped after about 2 weeks of the first one when some dickhead was outside at about 7:55 shouting for people to come out and clap and then banging a dustbin lid with a wooden spoon. **** off.

 

Why can't we just be low-key  and respectful in this country? Why is there always so much one-upmanship? People always have to have a bigger and better poppy, or show the most grief on social media. A simple round of clapping was enough, but some twat always has to go over the top.

agree, probably creates more cases people cheering spreading all those particles in the air :ph34r: good idea

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Hopefully it's a one off as it did get a bit flat near the end.  However, people receiving recognition for the work they do shouldn't be understated in any profession or circumstance and is something that is under used in normal life.  In my own professional experience, receiving recognition for good work is moral boosting as long as it's merited.  Having seen the most recent Fergus Walsh video form an ICU, it most definitely is merited.  Knowing a few NHS workers, they were grateful for the recognition during the previous clap and hopefully this is a one off to show people are grateful for what they're doing and that it isn't taken for granted.  It's why I feel that comments about it being meaningless and we just need to give them money are pretty daft.  I agree they should get a bonus, but as others have mentioned, I can't do anything about that.

 

I won't be doing it, as making a racket outside a 6-month old baby's room isn't a great idea, but I'm supportive of people doing so as long as they mean it and it isn't just for social media d**k swinging.

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1 hour ago, RowlattsFox said:

The clap was a nice gesture to begin with, but worn out very quickly. No need for it to return but the reaction to it has been pathetic. Forcing the person who's idea it was to distance themselves and release a  statement saying they don't work for the government because of abuse. Jesus Christ. If people want to clap let them.

 

Sums up the difference between lockdown 1 and lockdown 2

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1 hour ago, Alf Bentley said:

 

 

I saw a report the other day that included an interview with a senior nurse dealing with Covid patients. She said there were a lot more this time in their "30s, 40s & 50s".

 

I assume that's partly because the elderly are taking more precautions in the knowledge that they're more at risk - and often find it easier to avoid risk (not having to work etc.).

I suppose there's also the maths of it: even if a similar, fairly low proportion of younger people with Covid end up in hospital, the nominal figure will be much higher than before as more people have been infected this time, due to new variant etc.

If you go to the uk dashboard, select health care and then select a region, there are per age breakdowns.  About 1/2 in hospital are under 65 which surprised me.

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58 minutes ago, Facecloth said:

I won't be clapping tonight, I stopped after about 2 weeks of the first one when some dickhead was outside at about 7:55 shouting for people to come out and clap and then banging a dustbin lid with a wooden spoon. **** off.

 

Why can't we just be low-key  and respectful in this country? Why is there always so much one-upmanship? People always have to have a bigger and better poppy, or show the most grief on social media. A simple round of clapping was enough, but some twat always has to go over the top.

Yeah now that you've said that, I think this is one of the main reasons I get annoyed by it.

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6 hours ago, UpTheLeagueFox said:

Can't we do both?

This time it was meant to be appreciative of all key workers and heroes  rather than just the NHS but I guess it wasn’t really going to work this time given the time of year and most people probably feel they are helping the NHS etc by sticking to the guidelines.

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