Controversial Covid post

[Ravshoutsatbeck]

And how do you interact with covid patients? Just interesting to hear from someone on the 'inside'.

Overnight I am the most senior intensive care doctor in the hospital. So I receive the referrals for any patient that has low oxygen levels despite maximum ward treatment. We then asses whether the patient would benefit from intensive treatment with either non invasive or invasive ventilation.

I also look after the patients on our intensive care units, both covid and non covid. As of this weekend one of our units has become a full covid unit because of the number of patients requiring ventilatory support in the hospital

 

[T_A_D]

I am based in a northern ICU and maybe there are other areas that are fine. This is not normal for October.

Thanks for the first hand info, not expecting you to name your hospital and position

 

[Ravshoutsatbeck]

I said earlier in this I’ve been in touch with 2 consultants one in a South Yorks hospital, one in Manchester.
The South Yorks has gone from 4 cases in Sept to around 150 as of yesterday.
Manchester is better than last year.

Yeadon does acknowldege some locations could be worse than March but, in general, a 2nd wave can’t happen (unprecedented for this kind of virus)

One thing that would help is how do you diagnose Covid in your hospital?

Covid diagnosis is based on clinical picture and PCR swab.

We also look for other possible diagnoses, including PCR for other respiratory illnesses.

 

[BoroMart]

Marty people like Yeadon and Ioannidis have 40 years in the field.

ok and to put it another way, giving equal time allows the odd rogue individual the same level of respect as the overwhelming scientific consensus.

 

[Alvez_48]

Overnight I am the most senior intensive care doctor in the hospital. So I receive the referrals for any patient that has low oxygen levels despite maximum ward treatment. We then asses whether the patient would benefit from intensive treatment with either non invasive or invasive ventilation.

I also look after the patients on our intensive care units, both covid and non covid. As of this weekend one of our units has become a full covid unit because of the number of patients requiring ventilatory support in the hospital

That's awesome, glad to have you with us! How many numbers you putting on CPAP vs vent in your hospital? What demographics are you mainly seeing? How longs the average stay? Noticed you said you use PCR tests for other illnesses, I always thought prior to covid 19 PCR tests weren't used for diagnosis?

 

[Alvez_48]

ok and to put it another way, giving equal time allows the odd rogue individual the same level of respect as the overwhelming scientific consensus.

Plenty of rogues out these days from very prestigious positions.

 

[1finny]

Covid diagnosis is based on clinical picture and PCR swab.

We also look for other possible diagnoses, including PCR for other respiratory illnesses.

Clearly a tough time for you and your team. Thanks for the info and hope you all get through this.

 

[BoroMart]

Plenty of rogues out these days from very prestigious positions.

That avoids that the people you have discussed are rogue from th scientific consensus.

 

[1finny]

That avoids that the people you have discussed are rogue from th scientific consensus.

Not sure we can conclude there is scientific consensus. There rarely is. SAGE is calling the shots.
Yeadon has basically labelled Vallance and others liars - you would think they would take issue with that and provide the evidence he is wrong.
Within a week or so we ought to know who has called this right so no big deal really

 

[BoroMart]

Not sure we can conclude there is scientific consensus. There rarely is. SAGE is calling the shots.
Yeadon has basically labelled Vallance and others liars - you would think they would take issue with that and provide the evidence he is wrong.

They're not gonna respond to every single crackpot out there. SAGE do have some issues in that they have government interference though, I'll grant you that.

 

[1finny]

They're not gonna respond to every single crackpot out there. SAGE do have some issues in that they have government interference though, I'll grant you that.

Yeadon’s credentials stack up and he quotes lots of sources.
All good for the curious.

 

[Alvez_48]

That avoids that the people you have discussed are rogue from th scientific consensus.

So why is Yeadon a rogue exactly and or Ioannidis?

 

[Ravshoutsatbeck]

That's awesome, glad to have you with us! How many numbers you putting on CPAP vs vent in your hospital? What demographics are you mainly seeing? How longs the average stay? Noticed you said you use PCR tests for other illnesses, I always thought prior to covid 19 PCR tests weren't used for diagnosis?

Mostly on CPAP, and we are trying to maintain CPAP as much as possible.

PCR is a staple of in hospital diagnosis. Most winters our ICU patients get PCR respiratory swabs (that can detect flu, paraflu, RSV, non covid coronaviruses).

Elderly with co-morbidities are still worst off with regards to covid. Had a few with minimal co-morbidities in their 50s-60s. Obesity is a big issue with covid as well.

Stay is very variable.

 

[bear66]

Mostly on CPAP, and we are trying to maintain CPAP as much as possible.

PCR is a staple of in hospital diagnosis. Most winters our ICU patients get PCR respiratory swabs (that can detect flu, paraflu, RSV, non covid coronaviruses).

Elderly with co-morbidities are still worst off with regards to covid. Had a few with minimal co-morbidities in their 50s-60s. Obesity is a big issue with covid as well.

Stay is very variable.

Is a single swab used to determine a number of possible infections?

Are you finding many flu cases yet?

 

[Ravshoutsatbeck]

Is a single swab used to determine a number of possible infections?

Are you finding many flu cases yet?

The Covid PCR is seperate to our usual respiratory PCR test. We will also take deep sputum samples on ICU if we think it is appropriate.

My hospital has not yet had any flu diagnoses leading to critical illness.

 

[bear66]

The Covid PCR is seperate to our usual respiratory PCR test. We will also take deep sputum samples on ICU if we think it is appropriate.

My hospital has not yet had any flu diagnoses leading to critical illness.

Thanks!

 

[Alvez_48]

Mostly on CPAP, and we are trying to maintain CPAP as much as possible.

PCR is a staple of in hospital diagnosis. Most winters our ICU patients get PCR respiratory swabs (that can detect flu, paraflu, RSV, non covid coronaviruses).

Elderly with co-morbidities are still worst off with regards to covid. Had a few with minimal co-morbidities in their 50s-60s. Obesity is a big issue with covid as well.

Stay is very variable.

Thanks for getting back to me..

What would you say is the best way forward?
Do numbers in hospital go up and down or just up at the moment? Have you been expecting this throughout summer given the nature of coronavirus'? How do find this cycle different to the one in March?
What do you think to Yeadons' point on the PCR tests especially in community / pillar 2 testing?
What treatment do you give patients? Do most general admissions get released same day that don't need ICU admissions?

 

[Alvez_48]

The Covid PCR is seperate to our usual respiratory PCR test. We will also take deep sputum samples on ICU if we think it is appropriate.

My hospital has not yet had any flu diagnoses leading to critical illness.

Why is the swab different? And aren't we seeing a 95% drop in flu cases according to serological testing?

 

[Ravshoutsatbeck]

Thanks for getting back to me..

What would you say is the best way forward?
Do numbers in hospital go up and down or just up at the moment? Have you been expecting this throughout summer given the nature of coronavirus'? How do find this cycle different to the one in March?
What do you think to Yeadons' point on the PCR tests especially in community / pillar 2 testing?
What treatment do you give patients? Do most general admissions get released same day that don't need ICU admissions?

We clearly had a drop off in summer and a steady rise again in the last month. I am not an infectious disease expert, but from what I had read - the current situation is not that surprising.

We are treating admissions with dexamethasone and remdesivir depending on the specific context. Most people admitted to hospital are at least in for a few days receiving oxygen.

I am not sure about the way forward - but think test, trace and isolation with strong financial support from those who are effected. I can see arguments for lockdowns to reduce infections, but I can also understand the desire to avoid further economic hardship.

My current concern is that is the numbers continue as they are it will become almost impossible for hospitals to continue other services that are required.

I think without further restrictions we are likely to have more deaths in the elderly population - both from covid and from disruption to normal elective care, but this is not clear because the specific circumstances are all unique and everyone is trying their best to predict the way forward.

As for Yeadon - I feel the test has greater false negatives than false positives. (We have had patients that have only been positive on their second or third swab despite clear covid patterns on CT scans and an appropriate history)

I am unsure if Yeadon has a specific reason to selectively choose the evidence he is presenting. He is a biochemist whose PhD was in respiratory insults that has work almost exclusively in the pharmaceutical industry. I am going to look into the company that he is CEO of.

 

[Juninho10]

I've felt a little depressed this past week with it all... and I'm normally an upbeat person

Maybe depressed isn't the right word - but totally fed up with the entire situation