Just do it…

Primary Care Training_NHS General Practice Just do it...

What did you get for your Birthday?  

Socks, flowers, the chance to jump out of an aeroplane, a day at a spa, dinner, a bottle of something… a card.

This year, the Director General of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus, for his Birthday, March 3rd, got to make a speech about COVID-19, the scale of the problem and its likely impact.

He said;

“Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected…”

That’s all we need to know.  As I write, the World-O-Meter website is calculating the death-rate at, guess what, 3.4%.

Johns Hopkins rolling calculator gives a global death rate of 3.49%

Italy is up to nearly 5%.  Iran, right on the WHO prediction.

Different countries have different health systems, spotting milder cases is difficult and it is highly likely most cases will never get counted. 

The best guess in the UK, 2% but it depends on how well you are, how old you are, where you live and access to care.

It’s access to care that is most worrying.

Essentially, Corona gives us respiratory problems, pneumonia and pressures will come from the number of patients who will need access to oxygen and mechanical ventilation.

Italy say, 10% of people diagnosed need ITU and they are becoming overwhelmed.  

Last December the NHS had 4,048 adult critical care beds available and 3,048 occupied.  There are efforts to open more, but you can do the maths… and they must be staffed by experts.  Maximum, one nurse for two patients.

On top of that, there are complicating factors such as organ-function damage, including kidney and cardiac injury and liver dysfunction.  All of which need complex and skilled treatment.

It is likely the survival time of the non-survivors, is within 1-2 weeks after ICU admission.  Survival might take 28 days.

Bluntly, this means we will need beds with special kit, staff who are specially trained and patients will occupy beds, for no short period.

It is easy to see how the NHS could become overwhelmed and why it is important that retired, volunteers and others, with clinical expertise, are recruited, to back-fill for ‘normal’ patients, whilst regular staff work at the high-end of their registration for Coronavirus patients.

Do we have a crisis?  

Who’d argue, the worst is yet to come?  We are starting from the position; there is no headroom, we are choc-a-bloc, there are significant rota-gaps and a worrying dependancy on bank and agency staff.

It’s the old story; if you’re going to have a crisis, I wouldn’t start from here. 

The plan; to kick the Corona-can down the road, in the hope that better weather produces Coronacide.  It’s brave, hopeful and optimistic.  Fingers crossed?

National crisis… it’s worth remembering there is no such thing…  

All ‘national-crises‘ are local and personal for the people involved.  We have a national flood-plan but it still left people with ruined photographs of their Mum and lost memories.  Crises are very personal.  

The national-plan, to self-isolate is fine, if you are prepared and can use the time to paint the bedroom.  If you’re not, it’s about who’s going to walk the dog, get your med’s.

National plans only exist in the minds of national planners.  Everything is local, everything is personal.  Everything is; ‘what happens to me and mine’. 

BoJo talking of ‘beating’ and a ‘battle’ with Corona is bonkers. Evoking the sprit of war says, rationing, shortages, stockpiling and panic.  

Everything we don’t want.

He should be saying; ‘If we wash our hands, take sensible precautions and look-out for each other, we are as ready as we can be and together, we will come through this.’

Note the words; ‘we’, ‘each other’, ‘together‘ and the honesty of ‘as ready as we can be‘.  Evoking sharing, support and ‘I’ve got you’.  

Everything we do want.

Yesterday, the Corona-COBR committee delayed decisions on escalation.  Mmmm…

As the Corona-flap turns into something more sinister there is only one person, there is only one voice worth listening to.  

The one who talks like yer favourite uncle; sense, experience, truth, with warmth and believability… the CMO, Chris Whitty.  Here he is at the Health Select Committee.  Peerless.

If you could speak to him, he would tell you; never mind buying blog-rolls, Corona-salvation is in our own hands, go and wash them… just do it!

News and Comment from Roy Lilley

Contact Roy – please use this e-address roy.lilley@nhsmanagers.net

Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.