Coronavirus - worldwide spread and control

[Daisybell]

She lives in the UK. From talking with her, the restrictions are having a significant impact on people being able to access healthcare - from the GP up.

So a quick look for some figures leads me to this for the UK:
The peak Covid day was 12 April, with 17,152 inpatients. The next day, the Health Service Journal broke the story of unused NHS capacity.

“Figures from the national NHS operational dashboard, seen by HSJ, show that 40.9 per cent of NHS general acute beds were unoccupied as of the weekend — 37,500 of the total 91,600 relevant beds recorded in the data. That is 4,500 more than the 33,000 the NHS said had been freed up on 27 March, and nearly four times the normal amount of free acute beds at this time of year.”

At the same time, people were actively avoiding going to hospital - partly because they were told to stay at home to save lives, and partly because they were too frightened of catching Covid.

Thousands of people will die earlier than they would otherwise because of not going to hospital, or being told they could not have an appointment with a specialist. I fear that this will be the scandal that we end up regretting.....

Here in NZ, I had a phone consult with my rheumatologist during the first lockdown. Her husband is a cardiologist. She wasn’t talking to him because she was so angry that the cardiology department were cancelling all the planned appointments, and sending great swathes of people on the waiting list back to the care of the GP. I don’t know how many people we had in our local hospital with Covid - perhaps a handful at the most. But everyone else I have spoken with has had their healthcare suffer. And the hospital is now changing how it runs things - so any outpatient work that can be done out of the hospital setting will be... Already I have picked up patients for my group that I run for people with aphasia because the hospital group is now terminated with no view to reinstate it.

There has to be a better balance than the one we have currently.

 

[Woolie]

@Daisybell, I'm sorry to hear your mum is in the UK. Maybe someone form there can comment?

Here in NZ: I do some work with the neurosurgery department here Wellington, and they had a huge backlog of cases because of lockdown in April that they've only recently got through.

Having said that, I was totally in favour of the strict lockdown in April, and was totally in favour of protecting our medical staff during that period by cancelling all but emergencies. But we've been below Level 2 for months now (at least outside of Auckland), so it seems to me the problem now is not restrictions, its managing the fallout. We need a better way to manage healthcare in the new circumstances. And a bigger healthcare budget.

 

[Jonathan Edwards]

She lives in the UK. From talking with her, the restrictions are having a significant impact on people being able to access healthcare - from the GP up.

I think there is a confusion here. The idea that restricting are causing deaths from other conditions is misinformation being spread by people who don't like the restrictions.

The restrictions - pub closing, travel limits, rule of six, shops closing - have NOTHING WHATEVER to do with the inability of the health service to cope. The inability of the health service to cope is PURELY DUE to the failure to put the restrictions in place in time. People are not being denied cancer care because of 'the restrictions'. They are being denied it because it is impossible to safely deliver care because there weren't any restrictions when there should have been. The inability to deliver care is very real so yes people are not getting care, but nobody is stopping them. My relatives who work in A and E have empty departments not because people are not allowed to come but because people are rightly frightened to go. They are rightly frightened because my relatives themselves have developed Covid while at work. It is the virus that is stopping care, not rules.

I think this misinformation has been spread by some of the more right wing newspapers - maybe Telegraph or Express. But you see all sorts of people falling for it - even people writing in the Guardian.

 

[Daisybell]

I’m sorry but I don’t agree with this @Jonathan Edwards - my mother’s care has not stopped because she doesn’t want it - it has stopped because the doctors won’t see her. They think that the risk of her being exposed to Covid is too great for her to attend for chemotherapy. Which is basically saying they won’t put her at an immediately increased risk, but are prepared to increase the risk of her cancer returning in the longer-term. The health service is denying her care. And having done so for six months, she doesn’t think they will restart her treatment. I’m sure she won’t be unusual in this regard.

 

[Andy]

They think that the risk of her being exposed to Covid is too great for her to attend for chemotherapy. Which is basically saying they won’t put her at an immediately increased risk, but are prepared to increase the risk of her cancer returning in the longer-term. The health service is denying her care.

Personally, in the circumstance you describe, if it was my mother, then I would be happier for her treatment to be paused so that she could avoid the immediate increased risk of catching covid (and potentially spreading it to others as well) as opposed to a possible risk of a cancer returning at some point in the future.

And obviously the wider point is that if the UK had dealt in a much better way with coronavirus than we have then the wait that she will have for her treatment would be far shorter - we have the proof of a number of asian countries, Australian states and NZ to show us how it should have been done.

 

[Trish]

I am sorry to hear about your mother's lack of treatment, @Daisybell. I think in the UK the problem has been compounded by lack of medical staff and lack of rapid testing.

This has meant it has been impossible to keep Covid patients completely isolated from non Covid patients, so a lot of non Covid patients haven't been treated. This included some cancer patients. I think doctors will have weighed up the dangers of some chemo reducing the patient's ability to fight infection, and concluded the danger to life in some cases would be greater from the high probability of catching covid while in hospital than from the cancer. I don't envy the doctors having to make those daily life or death decisions. Compounded, in the early stages by inadequate PPE.

The UK set up the Nightingale hospitals which I understood were to be used for mass treatment of Covid patients away from other hospitals so they could get on with their normal work. What they didn't take into account was treating those Covid patients required expert staff, who would then not be available in the regular hospitals. The NHS was already underfunded and understaffed when Covid hit, and the old reliance on immigrant staff dried up. And lots of medical staff themselves got sick, got long Covid or died. We simply dont have enough doctors, nurses and carers to treat everybody safely. And the more Covid is allowed to spread freely, the less the NHS will be able to cope. That will be bad for everyone with any illness.

Over the summer, after the first wave had been suppressed by lockdown some of the general hospital work caught up, but not all, and now with the second wave in full swing and ineffective partial lockdown, covid cases and deaths are rocketing up again.

If we dont have another lockdown, hospitals will be overwhelmed with covid and winter flu cases again, and people with other conditions will be even less able to get treatment.

I really wish the UK government had been better prepared for a pandemic in advance, and had done as New Zealand and Australia have done and imposed a harsh lockdown from early on. And I wish they had used the time to get a really comprehensive local test, track and isolate system established. Then case numbers would by now be manageable, and the NHS could focus on it's normal work, including cancer care.

 

[spinoza577]

The restrictions - pub closing, travel limits, rule of six, shops closing - have NOTHING WHATEVER to do with the inability of the health service to cope.

I don´t know if I should be astonished or not be astonished that people claim such nonsense you describe here.

The inability of the health service to cope is PURELY DUE to the failure to put the restrictions in place in time. People are not being denied cancer care because of 'the restrictions'.

This looks like an indirect effect, so "purely" shouldn´t apply here. Here in Germany hospitals have been empty and nurses stayed at home while people havn´t got their medical care. Right, this is a problem of organisation in an unclear situation, but as you can see, Germany had react timely, as Sweden had not strongly react timely, and both are not in agreement with your statement.

Personally, in the circumstance you describe, if it was my mother, then I would be happier for her treatment to be paused so that she could avoid the immediate increased risk of catching covid (and potentially spreading it to others as well) as opposed to a possible risk of a cancer returning at some point in the future, well the latter with paying something, of course.

But this is somehow an open question, and not to the advantage of your opinion. Most of the affected covid patients had more than one critical disease, and to my knowledge this hasn´t change since spring. We will see the impact of measures in the future.

 

[spinoza577]

Here a video on the situation we are with special regard to herd immunity from a physicist.
Hossenfelder cites, we are in a situation where we have only bad options.

Spoiler

In the comments Guy Mercier writes

Love real intelligent high quality scientific information... bravo all is said : )

 

[Adrian]

There has to be a better balance than the one we have currently.

I think there could be a much better balance than what is happening in the UK. I get the impression that the current UK strategy is to try to keep figures at a 'lowish' managable level and when, like now, they have got high then to clamp down a bit to reduce them.

It feels like a result of very short term thinking and a false dicotomy that it is lockdown vs the economy (and treating other health conditions). When really it seems to me that the issue is acting too slowly ends up with a continual need for restrictive actions which continue the damage to the economy and the treatment of other health conditions.

Had we locked down earlier then the spread would have been much less and we could have targetted an eradication (rather than a management strategy). This may have ment more severe restrictions but could have lead back to more normal life quicker (as I think is the case in NZ). Equally as there has been a push to get people back to normal too early then this has had bad consquences (as well as a non-functional test and trace system (and little in terms of isolate and support!)). So when things like the universities reopened (they rely on rents from student accomidation!) it was a short term measure to help institutions but probably helped spread Covid across the UK which coinsided with the current rises in the number of infections.

So I tend to think we have the balance wrong as the UK approach its one of dithering and action too late rather than action early with an aim to eradicate, quickly manage new infections through test, trace and limits on who comes into the country.

 

[Sly Saint]

What has happened to England's seven Nightingale hospitals?

Most of the hastily constructed Covid centres have never had a patient, with some repurposed

Despite the Nightingales being hailed by government ministers, who emphasised the role of army field planners in helping to build the flagship facility in east London from scratch over nine days, they have not been without problems. Dozens of patients with Covid-19 were turned away in London because the Nightingale hospital had too few nurses to treat them.

https://www.theguardian.com/society...pened-to-englands-seven-nightingale-hospitals

the nightingale hospitals imo should have been '1 stop shops' for Covid-19 not just loads of ICU beds; ie testing, tracing, treating/quarantining.

 

[Jonathan Edwards]

I’m sorry but I don’t agree with this @Jonathan Edwards - my mother’s care has not stopped because she doesn’t want it - it has stopped because the doctors won’t see her.

Yes, I may not have been very clear - they will not see her because they judge it too dangerous for all concerned. The A and E situation is different - that may have confused. Emergency care is not restricted but elective care has got pushed out because the system cannot cope.

I was trying to focus on the mistake of muddling up restricting non-essential activities in general and the need to restrict access to medical care once the failure to restrict general activities has made it unsafe to go to clinical facilities.

You might say why is medical care being restricted - why isn't it continuing. The answer is that there are no safe facilities left where distancing and PPE etc can be put in place. Facilities and staff normally looking after other illnesses had to move over to Covid care just to keep people alive. By June the situation was improving but now we are back to square one or worse because the restriction on general activities were relaxed.

I was upset that on the BBC a newsreader said that we had learnt that the NHS was not overwhelmed in the first phase after all. This is absurd because the NHS had been overwhelmed even before Covid came along and was even moire overwhelmed - to the extent of there being about 20,000 unnecessary deaths - when it did.

 

[chrisb]

Facilities and staff normally looking after other illnesses had to move over to Covid care just to keep people alive

That seems to be the crux of the problem. There is a perception that the decision to keep "people alive" does not address the problem that that is a choice involving the deaths of others.

 

[Mij]

I think there is a confusion here. The idea that restricting are causing deaths from other conditions is misinformation being spread by people who don't like the restrictions.

But the backlogs to clear surgeries that were postponed in some Canadian provinces are up to 84 weeks. In Ontario between March and June hospitals accrued a backlog of 148,364 procedures. Surely there will be deaths as a result when all the data is collected?

 

[Jonathan Edwards]

But the backlogs to clear surgeries that were postponed in some Canadian provinces are up to 84 weeks. In Ontario between March and June hospitals accrued a backlog of 148,364 procedures. Surely there will be deaths as a result when all the data is collected?

Yes, I am sure there will be deaths.
The simple point is that if restrictions to air travel and social events had been put in place sooner none of these delays would have been necessary. Although if Canada is like the UK significant backlogs for surgeries had been around for twenty or more years already.

I guess what I am saying is that the government lockdown restrictions that limit opening of business premises, socialising and travel have nothing to do with the quite separate decision by hospitals, not to shut like shops, but to ration elective care because they had no choice on safety grounds. If 'Nightingale' hospitals had been in place - what used to be called fever hospitals and previously were scattered all over the country - then there might not have been a problem, although I suspect the biggest issue was number of trained staff available.

What I constantly hear on the television is people saying that the social lockdown restrictions are causing deaths from cancer and that is complete nonsense.

 

[Daisybell]

Personally, in the circumstance you describe, if it was my mother, then I would be happier for her treatment to be paused so that she could avoid the immediate increased risk of catching covid (and potentially spreading it to others as well) as opposed to a possible risk of a cancer returning at some point in the future.

And obviously the wider point is that if the UK had dealt in a much better way with coronavirus than we have then the wait that she will have for her treatment would be far shorter - we have the proof of a number of asian countries, Australian states and NZ to show us how it should have been done.

With respect, I think that unless you have actually been in this situation, then it is impossible to know how you would feel under those circumstances. What we are talking about here is not that treatment has been paused temporarily, its that her treatment is stopped. She doesn’t think that it will be resumed, but that they will wait for the cancer to recur before talking about any more treatment. (She was told many years ago that the cancer would never be cured). And this is a specialist cancer centre, not a department in a hospital building.

It just seems that non-Covid medical treatment has been seen as not as important as treating Covid. Of course, Covid has caused huge problems, and continues to do so, but if NZ is anything to go by, the health system over-reacted to the risk and this has resulted in unnecessary harm to sick people. Governments on the whole seem to have under-reacted, and now we have a complete mess.

 

[lunarainbows]

@Daisybell

From my experience, it is not that non covid patients are being seen as less important than covid. There are two reasons they were cancelled.

1. Because they assumed a lot of beds and staff would be occupied by COVID, and/or they actually were occupied by COVID. In London this was definitely the case. Hospitals even shut to emergency patients as they reached capacity. I’ve found out in my region the cases have risen sharply in the last week and 92% of HDU and ITU beds are in use.

2. It could be very unsafe to have treatment if covid is in high circulation in the community. Especially for those who have just undergone surgery, or had treatment that knocks out antibodies.

neither of these would be happening if covid was handled properly and stamped out with hard measures. So it’s not a question of looking after COVID or non COVID. The ONLY way to start looking after non COVID patients is (if the govt were) to take COVID seriously and eliminate it, then we can resume treatment safely.

Edit: I’m in the U.K.

 

[Daisybell]

@lunarainbows - absolutely, i appreciate the difficulties of trying to protect vulnerable people from catching Covid. But from reading the figures, it seems that hospitals haven’t been full. Certainly that seems to have been true in non-intensive care wards. And perhaps that is the right thing to do because you cant mix Covid and non-Covid. But - then you have to accept that you increase the mortality of the non-Covid sick people. And when the number of people dying from non-Covid problems exceeds the number of people dying from Covid - surely you have to re-look at what the health system is actually doing?

Lots of cancelled surgeries, lots of postponed treatment = increased deaths. And I bet those deaths will outnumber the Covid deaths.

 

[Trish]

@Daisybell, I agree we can't know how we would feel if it were our family member or ourselves affected. It seems wrong to me too if a treatment has been cancelled altogether. I hope your mother can get back into treatment once it's safe to do so and there are doctors available.

We have no way of knowing whether other deaths will outnumber covid ones until after it's over. From figures I've seem so far, excess deaths have been higher for covid than other conditions so far, but who knows what will happen over the coming months and years.

The problem, as I see it, is that the resources of the NHS have been stretched to breaking point, and lots of people with and without covid will suffer.

 

[spinoza577]

neither of these would be happening if covid was handled properly and stamped out with hard measures. So it’s not a question of looking after COVID or non COVID. The ONLY way to start looking after non COVID patients is (if the govt were) to take COVID seriously and eliminate it, then we can resume treatment safely.

Edit: I’m in the U.K.

Germany was praised for its handling, at least it reacted timely, though not hard (and had only about five times lesser covid deaths than Sweden, which also had very low mortality in the year before), but now the problem you describe is clearly on the cards.

You might say of course, that Germany isn´t the best example, and might refer to NZ, Taiwan or others which I don´t know.

I still can´t share any optimism to eradicate this virus (to say it again).

Lots of cancelled surgeries, lots of postponed treatment = increased deaths. And I bet those deaths will outnumber the Covid deaths.

I would like to completely agree. Of course, the data are not available.

One must also ask who dies from covid, and if you had mostly already severly ill people, then it would be clearly antirational to safe people who are going to die anyway. But this may well not be the complete truth with the virus, as it would be also difficult to distinguish people who are about to die anyway from these who are not, in a concrete situation, which will occur of course. And caring for covid patients takes long (probably the biggest problem).

So I don´t want to say that we wouldn´t have a problem. But with a mortality rate for a new virus which may be two or three times higher than flu, and most of the people dying have more than one critical illness and are old enough that one can expect that they can die, I can´t agree that the measures are clearly justified. I expect that it will show up as bad effect in the next years.

 

[lunarainbows]

@lunarainbows - absolutely, i appreciate the difficulties of trying to protect vulnerable people from catching Covid. But from reading the figures, it seems that hospitals haven’t been full. Certainly that seems to have been true in non-intensive care wards. And perhaps that is the right thing to do because you cant mix Covid and non-Covid. But - then you have to accept that you increase the mortality of the non-Covid sick people. And when the number of people dying from non-Covid problems exceeds the number of people dying from Covid - surely you have to re-look at what the health system is actually doing?

Lots of cancelled surgeries, lots of postponed treatment = increased deaths. And I bet those deaths will outnumber the Covid deaths.

I agree, it’s terrible that so many vital treatments and surgeries were cancelled. You’re right in many regions there were non intensive care beds empty and perhaps even there might have been available staff in some regions. But I don’t think this was the case everywhere, and I also think they are/were making this decision also because covid is in high circulation and hospitals weren’t safe. I think at its peak 20% of those in London were affected with overall national rates somewhere around 7% during the first wave? That’s quite a lot. People who were going into hospital with something else, were coming out with covid. Now there are really strict protocols in place, which I’ve seen, weren’t there before, but it’s still not enough, because last I heard, a whole team in one department at my local NHS hospital are self isolating (!).

It is one of the reasons why my first surgery was cancelled, and I still haven’t had my surgery done. Summer would have been the perfect time but I wasn’t able to do it then. I think as long as covid is in high circulation, this is going to happen, which is why I don’t understand why we are still not in lockdown or attempting to suppress the virus properly - what do they think is going to happen by prolonging this and allowing it to spread? It’s awful. I lay the blame squarely at the govts door.