Yes, you may have noticed we’ve got more Covid-19 cases in the UK today than yesterday. But wait… this isn’t surprising; it’s the natural history of a respiratory viral infection. I think it’s probably worth a quick “keep calm and carry on” update…
So we are now in the “slow it down phase”
We (us with our fingers on the don’t panic buttons) always knew we couldn’t contain Covid-19, and that we would enter the “slow down the spread”, whilst trying to prevent the most vulnerable people from acquiring it, phase sooner rather than later. Those that appear most vulnerable to this infection include those of older age (over 80 years), diabetics, those with chronic lung diseases (especially smokers) and the immunosuppressed.
So we are now in the “slow it down phase”
We (us with our fingers on the don’t panic buttons) always knew we couldn’t contain Covid-19, and that we would enter the “slow down the spread”, whilst trying to prevent the most vulnerable people from acquiring it, phase sooner rather than later. Those that appear most vulnerable to this infection include those of older age (over 80 years), diabetics, those with chronic lung diseases (especially smokers) and the immunosuppressed.
Why the massive spike in numbers?
Well unexcitedly the testing criteria have changed. Like most statistics, when counting or testing criteria changes all the numbers change too. The NHS is now testing all patients admitted to hospital with respiratory or flu-like symptoms, irrespective of where they have travelled or who they have been in contact with. Be it, exacerbation of COPD, cystic fibrosis, community acquired pneumonia, upper respiratory tract infections, or in fact breathlessness for any reason, that’s a lot of people!
Before it was only the limited few tested; now it “feels like” most of the hospital admissions! However this is a sensible acknowledgement of the fact that the virus is spreading within our community and therefore travel is no longer the only risk factor for exposure. This increased testing will give the NHS and Public Health England (PHE) a better idea of the scope of the problem (how many people have the virus) as well as allow healthcare services to manage patients safely and effectively. Keep calm… not all “the community” will feel ill or need hospitalisation, many will be asymptomatic or have minor symptoms and so will never be tested and therefore are unlikely to know they have had the virus, hence how it spreads easily in the community!
Testing of patients who fit epidemiological criteria including travel to certain “hot-spots”, as well as contact with confirmed Covid-19 patients, will also continue for now.
Use of isolation facilities
With the change in testing criteria comes the need to isolate all patients being tested until they have a negative test and can then be de-isolated. This means all of these patients need to be put in individual side-rooms and the staff looking after them wear personal protective equipment (PPE) until the patient is given the all clear and can be moved to another area of the hospital. As you can imagine this is quite a logistical problem for hospitals.
Hospitals are a bit like a sliding puzzle. You know the type; you have a number of tiles in a grid with one space kept empty so that you can slide the pieces around until you complete the puzzle. In hospitals you need to keep some beds empty so that you can admit new patients and move patients into the best areas to care for them. Filling your “spaces/beds” up with Covid-19 patients that cannot be “moved on” means the puzzle jams. It is therefore vital to have access to rapid tests for the virus which if negative allow you to relax the isolation precautions and move the patient onto an open ward. The current issue for local laboratories is scaling up testing for the virus; previously all tests went to PHE.
Well unexcitedly the testing criteria have changed. Like most statistics, when counting or testing criteria changes all the numbers change too. The NHS is now testing all patients admitted to hospital with respiratory or flu-like symptoms, irrespective of where they have travelled or who they have been in contact with. Be it, exacerbation of COPD, cystic fibrosis, community acquired pneumonia, upper respiratory tract infections, or in fact breathlessness for any reason, that’s a lot of people!
Before it was only the limited few tested; now it “feels like” most of the hospital admissions! However this is a sensible acknowledgement of the fact that the virus is spreading within our community and therefore travel is no longer the only risk factor for exposure. This increased testing will give the NHS and Public Health England (PHE) a better idea of the scope of the problem (how many people have the virus) as well as allow healthcare services to manage patients safely and effectively. Keep calm… not all “the community” will feel ill or need hospitalisation, many will be asymptomatic or have minor symptoms and so will never be tested and therefore are unlikely to know they have had the virus, hence how it spreads easily in the community!
Testing of patients who fit epidemiological criteria including travel to certain “hot-spots”, as well as contact with confirmed Covid-19 patients, will also continue for now.
Use of isolation facilities
With the change in testing criteria comes the need to isolate all patients being tested until they have a negative test and can then be de-isolated. This means all of these patients need to be put in individual side-rooms and the staff looking after them wear personal protective equipment (PPE) until the patient is given the all clear and can be moved to another area of the hospital. As you can imagine this is quite a logistical problem for hospitals.
Hospitals are a bit like a sliding puzzle. You know the type; you have a number of tiles in a grid with one space kept empty so that you can slide the pieces around until you complete the puzzle. In hospitals you need to keep some beds empty so that you can admit new patients and move patients into the best areas to care for them. Filling your “spaces/beds” up with Covid-19 patients that cannot be “moved on” means the puzzle jams. It is therefore vital to have access to rapid tests for the virus which if negative allow you to relax the isolation precautions and move the patient onto an open ward. The current issue for local laboratories is scaling up testing for the virus; previously all tests went to PHE.
Laboratory testing
The benefit of local laboratories being able to test patients for Covid-19 means a faster turnaround time, which in turn allows hospitals to better control their use of side-rooms and isolation facilities. The NHS is aiming to have the capacity to do in the order of 10,000 tests nationally every day. That’s impressive! Locally we have probably been sending a dozen a day to PHE…
So what’s next?
So with a change in testing criteria, and the ability to do many more tests we can expect the number of confirmed cases to increase and rapidly… and I mean exponentially! WHAT!!! But does this mean the “pandemic” is getting worse!? Well not necessarily, the more tests we do the more positive results we will find. Remember, the more we know the better we are placed to deal with the problem. I personally think the virus is already within the community, just it’s asymptomatic or mild (could my cold a few weeks ago have been Covid-19 but I wasn’t “tested” ‘cos I’d never been to China and my trusted “Lemsip” cold and flu remedy helped?). So in fact large numbers of positive well patients is not actually alarmist, rather than causing panic, it should actually provide a bit more reassurance that we are more aware of the scale of the problem, and also any deaths from the virus are in better proportion to the overall incidence of the illness.
Better knowledge of who is infected will allow us to better protect the more vulnerable people in our society so this is also a positive aspect of doing more tests.
The NHS has plans in place for how to deal with these types of pandemics (something that was learned when “swine flu” happened in 2009 based on what went well and what didn’t go so well). How will the NHS cope? Well a step-wise response will happen that involves devoting increasing amounts of the NHS capacity to dealing with Covid-19 instead of less urgent areas of medicine.
There may come a tipping point where there are more people with Covid-19 than we can successfully isolate. In this case there may have to be a decision that, rather than “isolate patients with the infection” we have to “isolate vulnerable patients without the infection”… some call this “reverse isolation” which sounds a little alarming but the correct term is “protective isolation”.
The fear is that Covid-19 is going to be with us for a few months yet, but in fact that is the aim!! We want this to be slowed down, dragged out, even if the news is constantly about coronavirus, so that there are not too many patients in one go! The problem will be high demand and a peak; the NHS is hoping it slows down and never really produces more than a bump. Eventually we will reach a point where enough people within the community have had the virus creating “herd immunity”, a bit like mass vaccination, and the virus will no longer be able to circulate, (no one new can acquire it as they will be immune). At this point the reproductive rate will drop below 1 and the outbreak will burn out. This is what appears to be happening in China, with only 20-30 cases a day in the whole country over this week.
So what are the key messages this week:
Curiously, the overall number of all respiratory viral infections (including influenza) has gone down… it’s because self-hygiene has gone up… so don’t forget to wash your hands….
P.S. No one is reporting soap shortages! :-)
The benefit of local laboratories being able to test patients for Covid-19 means a faster turnaround time, which in turn allows hospitals to better control their use of side-rooms and isolation facilities. The NHS is aiming to have the capacity to do in the order of 10,000 tests nationally every day. That’s impressive! Locally we have probably been sending a dozen a day to PHE…
So what’s next?
So with a change in testing criteria, and the ability to do many more tests we can expect the number of confirmed cases to increase and rapidly… and I mean exponentially! WHAT!!! But does this mean the “pandemic” is getting worse!? Well not necessarily, the more tests we do the more positive results we will find. Remember, the more we know the better we are placed to deal with the problem. I personally think the virus is already within the community, just it’s asymptomatic or mild (could my cold a few weeks ago have been Covid-19 but I wasn’t “tested” ‘cos I’d never been to China and my trusted “Lemsip” cold and flu remedy helped?). So in fact large numbers of positive well patients is not actually alarmist, rather than causing panic, it should actually provide a bit more reassurance that we are more aware of the scale of the problem, and also any deaths from the virus are in better proportion to the overall incidence of the illness.
Better knowledge of who is infected will allow us to better protect the more vulnerable people in our society so this is also a positive aspect of doing more tests.
The NHS has plans in place for how to deal with these types of pandemics (something that was learned when “swine flu” happened in 2009 based on what went well and what didn’t go so well). How will the NHS cope? Well a step-wise response will happen that involves devoting increasing amounts of the NHS capacity to dealing with Covid-19 instead of less urgent areas of medicine.
There may come a tipping point where there are more people with Covid-19 than we can successfully isolate. In this case there may have to be a decision that, rather than “isolate patients with the infection” we have to “isolate vulnerable patients without the infection”… some call this “reverse isolation” which sounds a little alarming but the correct term is “protective isolation”.
The fear is that Covid-19 is going to be with us for a few months yet, but in fact that is the aim!! We want this to be slowed down, dragged out, even if the news is constantly about coronavirus, so that there are not too many patients in one go! The problem will be high demand and a peak; the NHS is hoping it slows down and never really produces more than a bump. Eventually we will reach a point where enough people within the community have had the virus creating “herd immunity”, a bit like mass vaccination, and the virus will no longer be able to circulate, (no one new can acquire it as they will be immune). At this point the reproductive rate will drop below 1 and the outbreak will burn out. This is what appears to be happening in China, with only 20-30 cases a day in the whole country over this week.
So what are the key messages this week:
- Don’t panic
- Wash your hands regularly
- If you sneeze, need to blow your nose or cough, use a tissue and “catch it, bin it, kill it” and then wash your hands
- If you become unwell self-isolate as instructed and wash your hands
- Stay healthy and don’t forget to wash your hands!
Curiously, the overall number of all respiratory viral infections (including influenza) has gone down… it’s because self-hygiene has gone up… so don’t forget to wash your hands….
P.S. No one is reporting soap shortages! :-)
RSS Feed
