Coronavirus (Non-Politics)

[OldBlueLady]

I'm not an expert on NHS procurement and the PPE issue but here's a few things I know.

- There is a central responsibility to respond to a pandemic, given the national (and global) threat they carry. The government has committed to this over the years. If there was a terrorist threat to the UK from abroad you wouldn't blame the local police services for a limited response.

- Pandemic planning work and strategies required the national government to maintain a stockpile of PPE and other equipment. This didn't happen, or didn't happen effectively

- Every NHS trust has a pandemic plan, that covers top line management of the pandemic and services in they provide. These trusts will also have a plan to ensure access and management of their own PPE supplies.

- Most NHS trusts are bankrupt. Their funding has been cut in real terms, they don't have the ability to maintain months and months of stockpiles of PPE in the off-chance of a pandemic. PPE perishes over time so the stockpile has to be continually refreshed, and storage costs money. Remember that one of the first things that was done by the government was to wipe off the "debts" of the Trusts and CCGs. These debts are the accumulation of underfunding our NHS. Preparing for a pandemic costs a lot of money, which Trusts clearly don't have.

- given we were a bit behind other countries in terms of cases, and also a by most accounts slow to react, we were back in the queue for PPE that was becoming harder to get across the globe. There have been lots of issues in terms of sourcing and actually getting PPE - flights diverted, shipments going missing etc. A lot of PPE is made in China, and the disruption to trade and materials has made supply of PPE very difficult

- local NHS trusts only have so much ability to negotiate procurement of PPE - if there isn't any in the country, how are they supposed to track more down?

Thank you for a clear response.

I still believe that privately owned care homes should have been better equipped - staff should be using quite a lot of PPE on a daily basis anyway, and the residents pay absolute fortunes. Owners should have dipped into their deep pockets sooner imho.

As for hospital Trusts, the whole system needs an overhaul - far too many chiefs and not enough at the coal front, as it were. Maybe then there might have been better provision arrangements.

 

[Member]

I was interested to see what Pubey was saying to Mk regarding the flu jab.
I know with covid it's a different beast but I always thought(probably wrongly now) that if you had normal flu you couldn't get it the following year as you had the antibodies.
I know tests are going on regarding covid antibodies but if no vaccine is found is the current situation something we need to get used to?

Just simplifying things here (and I'm not an expert by any means) but the reason we get a flu jab each year is because the strain(s) of flu mutate and change, and because it's seasonal we have a year to work out what the flu is likely to be for the coming winter and then develop and launch that years vaccine in an attempt to develop antibodies and protect people from the flu.

Some years our vaccines are more effective than others, because you're trying to plan for what the flu will be in the coming winter

My understanding is that the antibodies you develop from the flu jab do provide good long term protection.

With COVID, there doesn't seem be as much of a concern about it mutating, which is a relief. The concern though is that it's believed that antibodies (from either the infection or the vaccine) may not provide long term immunity. Therefore it may well be the case that we need repeated boosters of the vaccine to provide that long term protection that we need.

Yes we could potentially use antibody testing in a system to enable people to go about day-to-day activities, but there are a number of ethical issues and challenges with that.

The main thing we don't yet know is how long the antibodies provide immunity for - that's why the vaccine development takes a long time, we have to do tests and trials over time to observe this. Even if there wasn't a vaccine yet, we'd still want to do long term follow up of people recovered from COVID to see what their immunity is like over time, but even then the response might be slightly different to that seen in a vaccine.

I do think that only once a vaccine is widely available will we go back to a sort of normal with large events/global holidays/unrestricted travel etc. I don't think the antibody testing will be available much sooner, or in a way that will benefit day-to-day life for regular people.

 

[teabee1]

Thank you for a clear response.

I still believe that privately owned care homes should have been better equipped - staff should be using quite a lot of PPE on a daily basis anyway, and the residents pay absolute fortunes. Owners should have dipped into their deep pockets sooner imho.

As for hospital Trusts, the whole system needs an overhaul - far too many chiefs and not enough at the coal front, as it were. Maybe then there might have been better provision arrangements.

I totally agree - I feel extremely sorry for anyone in a care home, they and the staff have been let down badly by their profit making employers. It's very easy to critisize the goverment for not supplying PPE to 1000's of private care homes but the duty of care initially lies with the people that run those businesses.

Obviously in hindsight things would have been done differently and no doubt better, but in a once in a lifetime occurrence hindsight is a wonderful thing..

 

[Member]

Thank you for a clear response.

I still believe that privately owned care homes should have been better equipped - staff should be using quite a lot of PPE on a daily basis anyway, and the residents pay absolute fortunes. Owners should have dipped into their deep pockets sooner imho.

As for hospital Trusts, the whole system needs an overhaul - far too many chiefs and not enough at the coal front, as it were. Maybe then there might have been better provision arrangements.

How do nurses and doctors at the 'coal front' help provide more PPE? I want nurses and doctors to provide effective nursing and clinical care - this is what they trained to do and what they (hopefully) want to do. I want procurement managers and accountants and analysts ensuring that the complex processes are in place to ensure that there is appropriate PPE and equipment for the nurses and doctors to safely do their jobs. People criticise the NHS for having lots of managers and 'non-clinical' staff but I generally think people don't really understand what it's actually like inside the NHS and how complex it is to provide staffing and equipment and effective care when things are so uncertain.

Not sure about the care homes situation, Tinks might be able to offer an opinion.

 

[Shrimping In The House]

I work in the public sector but not in the NHS but a number of former colleagues have got jobs in the NHS not least because the NHS pays more for same job than other parts of the public sector. They feed back some horror stories about the waste and bureaucracy in the NHS

 

[Massimo Giovanni]

I work in the public sector but not in the NHS but a number of former colleagues have got jobs in the NHS not least because the NHS pays more for same job than other parts of the public sector. They feed back some horror stories about the waste and bureaucracy in the NHS

Yes , there are legion of such things. I know, very well, someone who was a manager of many wards at a large hospital. That person identified that persons were called in for ops that were not going to happen and then bed filled for days as the hospital was under performing in hitting the data for admissions on time (operation date wasn't a factor!) This was a ridiculous waste of patient time, staff time, cost etc etc, so she stopped it. Next she was hauled over the coals for under performing on that stat etc despite consent and knowledge of staff and patients. It ended up as a tribunal and hospital then paid out large sum for severance of employment etc. This is an abridged narrative but I doubt it is a "one off".
Targets can work, but targets ought not to be the major factor in managing, be it in the NHS, Police, Courts or elsewhere.

 

[MK Shrimper]

I always thought with normal flu the best way to not get it is to get it if you know what I mean.
If covid was the same it would buy people who've had it time while those that haven't could be vaccinated?
So if You had flu last year you will be fine the following year(with covid who knows?).

Flu mutates. Last year's vaccine won't work on this year's flu. hence why you have a jab every year.

 

[RHB]

Anecdotal evidence says that a flu vaccine will work for around 60% of those vacinated. Each year scientists decide which strain of flu is likely to be most viralent and the vaccine is prepared on that basis. I'm one of that sad bunch that get the jab earlier than most as I'm considered more at risk. My anecdotal stuff came from my daughter's partner (NHS front line), and my practice nurse that sticks the stuff into me. I always grateful that I've only got a 40% chance of copping flu.

 

[NZamba Legend]

I totally agree - I feel extremely sorry for anyone in a care home, they and the staff have been let down badly by their profit making employers. It's very easy to critisize the goverment for not supplying PPE to 1000's of private care homes but the duty of care initially lies with the people that run those businesses.

Obviously in hindsight things would have been done differently and no doubt better, but in a once in a lifetime occurrence hindsight is a wonderful thing..

Correct on both accounts: (1) privatisation is rubbish; and (2) it's very easy to criticise the government

 

[GBJ]

Had to pop to Costco earlier. First time out of the house for a few weeks (other than taking the dogs for their walk, or dropping supplies off to vulnerable oldies)

Firstly, the roads were noticeably busier. It’s not quite rush-hour levels, but it’s a significant increase on what it was a week or two ago.

Secondly, Costco was a bit of a ‘mare. I got the sense that the social distancing mantra has already been forgotten by some.

For large portions of the shop, people were going around as if nothing had changed. Passing by each other almost shoulder-to-shoulder & leaning across other shoppers to pick something off of the shelves or out of the meat chillers.

Not having a dig at Costco though. Personally I think they’ve handled this situation far better than any of the supermarkets close to me.

 

[Shrimping In The House]

Correct on both accounts: (1) privatisation is rubbish; and (2) it's very easy to criticise the government

Ooh, bit of politics, as Ben Elton used to say.

 

[Ricey]

Mondays are always low - there is a lag over the weekend

And that is proven with 693 deaths today which now makes us the highest death toll in Europe. ?

 

[Billy Bests boot laces]

And that is proven with 693 deaths today which now makes us the highest death toll in Europe. ?

Around 4-5 weeks ago, an Scientific Institute somewhere on the West coast of California, predicted on the evidence at the time, the UK would exceed 37,500 deaths by early Aug.
At that time we'd had a couple of thousand fatalities.
I thought they were 'nuts' predicting that by Aug. Dear me, odds on we're pass that figure this month?.

 

[Massimo Giovanni]

With the heightened risks that certain groups have will there be some changes in peoples life styles?
There is nothing to be done about ethnicity or aging; we are as born and aside from the very few who change sex (males are slightly more susceptible) those should be constants.
However there is a low level publicity regards obesity being a big factor (compared to age) and it being a respiratory virus then the fags are a short cut to afterlife.
I have seen more people out jogging and cycling; will that be a continuing (good health) habit?
Is home cooking and restricted shopping going to impact on obesity?
Will smokers cut down or out?
Air quality, certainly near me, close to The Hall, does seem to have improved.

 

[Tinks]

From speaking with a few of the homes this week all the homes I have spoken to all have enough PPE and PHE have been quite active in monitoring.
All the care homes within Southend are now privately owned and hence are money making businesses.

From a virus point of view most of the homes have experienced the virus and off the top of my head I can only think of two homes not to have been effected. Testing is now occurring in the homes and we are gradually getting round to them however, these people in the homes are an extremely high risk group as most of them have general frailty and co-morbities.
What also is worth mentioning is the fact most of these homes have been quite short staffed with regular staff going off for being symptomatic and the homes have had no alternative other than to use agency staff who go from care home to care home.

 

[Blue Yonder]

With the heightened risks that certain groups have will there be some changes in peoples life styles?
There is nothing to be done about ethnicity or aging; we are as born and aside from the very few who change sex (males are slightly more susceptible) those should be constants.
However there is a low level publicity regards obesity being a big factor (compared to age) and it being a respiratory virus then the fags are a short cut to afterlife.
I have seen more people out jogging and cycling; will that be a continuing (good health) habit?
Is home cooking and restricted shopping going to impact on obesity?
Will smokers cut down or out?
Air quality, certainly near me, close to The Hall, does seem to have improved.

Oddly there are reports of smokers fairing better than non smokers with covid 19. France had a run on nicotine products I think. Obesity seems to be an issue. Some very odd stuff going on with this virus. Ethnicity, age playing a part too.

 

[Holy Joe]

Lowest number of deaths for a while today - obviously it’s still dreadful but it does appear the restrictions have had an effect

Mondays are always low - there is a lag over the weekend

From speaking with a few of the homes this week all the homes I have spoken to all have enough PPE and PHE have been quite active in monitoring.
All the care homes within Southend are now privately owned and hence are money making businesses.

From a virus point of view most of the homes have experienced the virus and off the top of my head I can only think of two homes not to have been effected. Testing is now occurring in the homes and we are gradually getting round to them however, these people in the homes are an extremely high risk group as most of them have general frailty and co-morbities.
What also is worth mentioning is the fact most of these homes have been quite short staffed with regular staff going off for being symptomatic and the homes have had no alternative other than to use agency staff who go from care home to care home.

Would care homes normally be equipped to handle a highly contagious virus? How much truth is there that some elderly patients were moved out of hospitals and into care homes to free up beds, potentially transmitting the virus from hospitals to care homes? And why aren't care home residents with the virus moved to hospital?

I suspect care homes are being asked to do far more in this crisis than they're geared up to cope with.

 

[Shrimpers are Magic]

Oddly there are reports of smokers fairing better than non smokers with covid 19. France had a run on nicotine products I think. Obesity seems to be an issue. Some very odd stuff going on with this virus. Ethnicity, age playing a part too.

Like we had a run on bog roll. Wouldn't have thought puffing away is a good idea with a killer respiratory disease at large.

 

[Holy Joe]

And that is proven with 693 deaths today which now makes us the highest death toll in Europe. ?

Deaths are a lagging indicator in trying to assess where we are.

Positive tests numbers are also distorted by the amount of testing you carrry out - the more tests you do the more positives you should find.

For me I think hospital admissions is probably the best indicator of where we are now (or a few days ago as testing and release of data takes a little while), for England these are available here...

COVID-19: Admissions to Hospital - Update - The Centre for Evidence-Based Medicine

Overview of data on hospital admissions with COVID-19 in the UK and care home cases of COVID-19 in England.

www.cebm.net

Whilst we are clearly off of the peak, the rate of improvement has significantly slowed - bear in mind also that it probably takes a week or 3 between becoming infected and admitted to hospital - so the current numbers are reflective of infections occuring at the height of lockdown.

What's also interesting though is that the peak was reached just a week after the formal lockdown was announced - seems rather soon to me - as others have said this virus seems to behave strangely (to a layman like myself) as to who it infects

 

[please delete my account]

Things are a struggle for a lot of people at the moment. For example, I'm eating more than I should be, drinking FAR more than I should be and I've not bathed myself or changed my underpants in over 2 weeks.
In fact, I don't think I could remove them without tearing them or removing a chunk of skin from my toilet parts.
On top of all that, I've just heard there's a terrible virus doing the rounds.

Grim times indeed.