Retired consultant rheumatologist
BAME people are at higher risk of developing cytokine storm syndrome, which is the cause of the severe respiratory and other organ failures with Covid-19. This has been noted before and is most likely due to genetic differences. I too have argued that their increased susceptibility should mean that they are kept out of front-line care.
Hindsight is pretty well infallible. At the outset there was no evidence that this thing would be this dangerous so everyone (and remember the government has been guided by scientists and medics) was walking into the unknown. If Covid-19 did not kill people would anyone be bothered? If I was to suggest the serious complications could be managed without deaths would we be less bothered? In fact they probably can be. Look up clinical manifestations of cytokine storm syndrome on Google. Not only will you learn what probably happens but also work out what to do. You don't faff around trying to find a virus killer, you treat the storm. Also you will learn why some ethnic groups are more susceptible.
I am not entirely stupid but if it's taken me 2 months to work it out it's not entirely surprising that no-one else has, not least because they have concentrated on testing and vaccines and have left the ICU bit in the middle unattended, at least until they realised that ventilation was a bad idea. Read about CSS and you will understand why.
If people get very sick, but will have a high chance of recovery, we can wind down.
I have spent years bewailing the problems of the NHS, but have to say that I think it, and the government, have managed this issue extraordinarily well so far. Yes, there have been glitches in for example the provision of PPE. Yes, we should be well advanced in doing antibody tests so we know who's had it and is therefore safe both for themselves and the public. But to gear up for what was a completely unknown thing in such a short time is remarkable.
My wife and I are both well retired, and like Coppers do not much care for mawkish stuff, but we were at our window clapping for the NHS staff. Not that many heard us; the Mermaid Inn is shut and most of the houses near us are holiday home or lets; our pretty town is deserted. But we already have a local volunteer network and our small traders are delivering.
At least, dear boy, it was a clap you got and not the. And well-deserved.
I think the key is the antibody test; anyone who is positive with that is almost certainly safe to go back to work. Curiously I think it may show some very odd things, not least because if I had Covid-19 before Christmas (and the described symptoms fit that better than flu, RSV etc) then it's been around for a lot longer than people might have thought. We live in Rye; you might wonder how a small relatively isolated rural seaside town might harbour it, but we get masses of tourists, including many from China... at least, we got masses of tourists, now the streets are eerily empty.
The risk of catching Covid-19 seems to be fairly high, but the risk of death from it may not be. If you look at the figures in today's "The Times" there is a huge disparity in death rates, ranging from 12% in Ukraine to 0.23% in Germany. Of course in the former case the numbers are small, but even between those countries where there are large numbers of identified cases the death rate varies substantially. Unless there is more than one strain, each with different mortality, the only explanation is that there are lots of unidentified cases. Without screening for past infection on a population basis the death rates shown appear to be meaningless, as the true denominator is unknown. All one can say is that it is highly likely the death rate will turn out to be lower than the current average of about 3%.
I had a dry and persistent cough with flu-like symptoms before Christmas. Could it have been Covid-19? Certainly that's the best fit diagnosis clinically - and if I did turn out to be positive it would put a different spin on the whole picture of transmission. So I would like to be tested. Furthermore, if we tested everyone then those who had had it can go back to work...
More detail needed. NSAIDs can provoke asthma, but this does not happen in everyone. Is that the risk, or is it some other effect we are not aware of? In my rheumatology experience we were relaxed about ibuprofen; many of my asthmatic patients took it without a problem.
When I was a schoolboy in the 1960s I ran the admin for my mother's smallpox vaccination clinics in her GP surgery. As a med student I also did some vaccinations myself. Plus ca change, plus c'est la meme chose. Remember when there were student locums for PRHOs? It filled gaps and was jolly good experience.
I was spared a large damages bill when sued by a patient, largely thanks to paper notes with an entry that would never have been put on an electronic record. These days some sort of back up is essential; having a cloud backup alone is not enough - practices need a local system as well. IT is wonderful until it fails, as any bank knows...
This is not a new problem. The year before I retired from the NHS my hospital was downgraded, lost its A&E and had all its acute physicians relocated to other places. So when a patient collapsed in my clinic there was no-one to decide whether he had had an MI or not. There wasn't even an ECG machine in outpatients. So I dialled 999. The ambulance took over an hour to arrive and ship him off to a "real" hospital. The reason for the delay? He was already in a hospital!
This was in 2010. A decade has passed and plus ca change, plus c'est la meme chose...
Missed this post. Enlightenment herewith. If a protocol comes up with a stupid answer something is wrong with its basis. Mankind has existed without statins for millennia. Most of the risk studies cannot disentangle other factors such as smoking and obesity but the bottom lines are (1) the quoted risk reduction from statins is relative; the absolute reduction is not statistically significant and (2) blood cholesterol is not a consequence of too much dietary fat because it's synthesised from carbohydrate in the liver and (3) cholesterol in plaques does not seep through from the bloodstream but is deposited as part of an incomplete repair process following inflammation, which is quite independent of the level of blood lipid. It follows therefore that the whole basis of the algorithm is based on a false premise, and I am only sad that the influencers, many of whom are paid handsomely by the statin industry, See unable to understand basic science. Self-justification papers continue to mislead. For the latest Lancet example it's worth reading the elegant dissection by Zoe Harcombe in her blog.
I have long bemoaned the general lack of institutional memory both within and without the NHS, but it must be remembered that the reason for austerity over the last 9 years was that the Labour Party had bankrupted the country. The Chief Secretary to the Treasury, Liam Byrne, even left a note for his successor to that effect. If any individual had splurged on their credit card to that extent they would have been seen as irresponsible. You cannot spend what you do not have. But now the dust has settled let's hope that sensible spending decisions can be made in the NHS. I believe that these must include serious discussions on what we don't do, as well as what we do do. Just because we can does not mean we should.
At least it's being paid for...
I don't suppose that the risk was de-aggregated into the three mentioned components, was it? BP and diabetes are definite risk factors; LDL is probably not!
As always people make decisions without thoroughly examining the consequences. One of my rules for assessing anything new is to ask "What could possibly go wrong?" Financially, pensions are the last of a long list; failed and expensive reorganisations, PFI... see my book "Mad Medicine" (https://www.amazon.co.uk/Mad-Medicine-maxims-National-Service/dp/1688011897/ref=sr_1_2?qid=1571912397&refinements=p_27%3AAndrew+Bamji&s=books&sr=1-2) out of which I suspect many GPs and others will say "Been there, done that."
Philosophical question: is the NHS working at all, let alone for whom? I don't think so. Doctors are trying to do too much (because orders are orders) with too little, and it has been ever thus. Otherwise how come NHS reorganisations never fix the system and never have?
Let's knock all the bricks out of the wall, and start again, not least by considering what doctors will not do. See my book "Mad Medicine" (www.amazon.com/author/andrewbamji) to understand my concept of futility medicine...
I have had a different lightbulb moment. Why offer appointment times at all? All it does is tie you to inflexibility. If you let them all sit and wait, first come, first served, any doctor will do, then the heartsinks will be balanced by the quickies. That's how it was back in the 1950s and 60s when my mother was a GP. Those who didn't really need to be there soon realised that turning up too often was simply wasting their time.
Only joking. Or am I?
I remember my father at the time of Powell's speech saying he thought the language was rather inflammatory but he had much sympathy with the sentiment. As an immigrant from India (and and ex-communist to boot) he was no fascist, indeed the last person one might expect to hold such views; they were perhaps coloured by the fact that he was stabbed during a race riot in Mumbai - by a Muslim as it happened, and this was in the 1930s. His view (and mine) is that the way to undermine prejudice, racism and all the other evils of the world is to engage in debate.
Furthermore if you look in the wider world you see reality; what about the plight of white farmers in Zimbabwe who have been threatened, dispossessed and even murdered? And while I cannot disagree that black rule is right (I was a fervent anti-apartheid supporter in my youth) one has to concede that there were rivers of blood there. Then there's Protestants against Catholics, Muslims against Christians, everyone against Jews, Muslims against Hindus... we'll end up with nothing to debate. As for Brexit...
Maybe global warming will reduce snowflake formation. Listen and rebut (or possibly change your views if you discover you are wrong. You need open ears and open minds. BTW in response to the suggestion, ironic I trust, that Clare Marx be de-platformed, she didn't join the GMC until after the Bawa-Garba case so cannot be blamed for the sins of her predecessors.
Many years ago I pointed out that the proposed development of an Independent Treatment Centre for musculoskeletal work in the north-west would threaten the existence not only of existing cold orthopaedics and rheumatology departments but also, as a consequence, emergency trauma care. The plan was dropped. If you have a finite budget, then to pay Peter you must rob Paul. You don't need to be a financial wizard to see this. I would seriously suggest that the CCG resigns en masse after declaring itself bankrupt. There is a good precedent; the Fracking Czar has fallen on her sword on the basis that government policy has made her job impossible.
No correction was made for alcohol consumption or smoking so the study is worthless.