Covid 19 Part XXII-30,360 in ROI(1,781 deaths) 8,035 in NI (568 deaths)(10/09)Read OP

Goldengirl · 08-09-2020 11:47PM

Non solum non ambulabit wrote: »

So somebody presenting with Covid symptoms for the first time into a hospital is so sick they are placed straight into ICU.

Covid ward would be the first stop surely. At least get assessed by some doctors first?

Not necessarily , could go straight from ambulance to resuscitation room and I CU then , or theatre and ICU depending on main condition . Might be some other condition complicated by Covid or just Covid .

Would be isolated in ICU until results back .
If that is not available you are getting into opening up overflow or separate ICU for Non Covid , and having to transfer those all out elsewhere .
Nightmare !

majcos · 08-09-2020 11:51PM

NegativeCreep wrote: »

My mother was in Beaumont hospital for a while up until Monday and she was tested every so often for no apparent reason so that patient might not have had any symptoms (obviously I don’t know but they might not have)

Sounds like she tested negative and is back at home now so that’s good.

Testing may have been for a reason that she was not informed of, especially as Beaumont has had an outbreak. She may have come into contact with one of the cases there or with one of the two staff members who tested positive. I’m sure the threshold for testing was/is very low at the moment in Beaumont. She doesn’t necessarily have to have been on one of the now closed wards to be considered a contact. Could have happened in ED, the radiology department, etc. Might also depend on her underlying condition or type of ward she was on.

I think it would be good idea from an infection control perspective if all patients (and staff) were periodically tested in the hospital setting but that would overwhelm labs and it’s not a very pleasant test when done properly.

Thinking about it, routine testing of staff possibly could have a negative impact on precautions taken as people become careless thinking that as they had a negative test last week, they’re fine, and forget that they could have been incubating it in the meantime.

Non solum non ambulabit · 08-09-2020 11:53PM

Goldengirl wrote: »

Not necessarily , could go straight from ambulance to resuscitation room and I CU then , or theatre and ICU depending on main condition . Might be some other condition complicated by Covid or just Covid .

I would love to know how often a previously untested Covid patient ended up in ICU in this manner. You are really clutching here.

Suspected cases in ICU are almost entirely non Covid related. Every night we have up to 10 suspected ICU cases, hundreds a month, yet ICU numbers remain static. That says enough for me.

Charles Babbage · 08-09-2020 11:54PM

DebDynamite wrote: »

Not only that, we were one of the lowest at one point! How did we mess it up so bad?

People acting the maggot.

ixoy · 08-09-2020 11:58PM

Downlinz wrote: »

The rationale is to reduce community interaction to contain the spread. We already know the restrictions worked in other counties.
Specifically no non-essential travel outside of the county and closing restaurants, bars and other indoor social gathering areas.

Do we know that it was these social indoor gatherings that spread it though? Closing them down and pointing that as the reason for the success doesn't mean the two are linked. In these places there were strong links to factories which made it easier to get a grip on.

The trouble is more getting people not to gather in unsafe numbers in homes - I believe private transmission is where you need to get people and that's much harder to target.

Indeed that's the advice coming from the HSE:
"The more extreme measures [lockdown] don't have to happen if people rally together, if they limit the number of contacts, avoid congregated settings, and break that chain of transmission from household to household."

That message is far more important to rally home than jumping straight to lockdown.

Goldengirl · 08-09-2020 11:59PM

Non solum non ambulabit wrote: »

I would love to know how often a previously untested Covid patient ended up in ICU in this manner. You are really clutching here.

Suspected cases in ICU are almost entirely non Covid related. Every night we have up to 10 suspected ICU cases yet ICU, hundreds a month, yet ICU numbers remain static. That says enough for me.

No, . this is the most common route to ICU .
Admission straight from A&E via Resus and not even xrayed , never mind negative swab returned, alhough at the moment that is the first thing asked as isolation rooms are very valuable . .

Not saying that is recent but that is how a lot of patients end up in ICU .
Some come from wards but unfortunately others present later to hospital and in acute respiratory distress .

NegativeCreep · 09-09-2020 12:01AM

majcos wrote: »

Sounds like she tested negative and is back at home now so that’s good.

Testing may have been for a reason that she was not informed of, especially as Beaumont has had an outbreak. She may have come into contact with one of the cases there or with one of the two staff members who tested positive. I’m sure the threshold for testing was/is very low at the moment in Beaumont. She doesn’t necessarily have to have been on one of the now closed wards to be considered a contact. Could have happened in ED, the radiology department, etc. Might also depend on her underlying condition or type of ward she was on.

I think it would be good idea from an infection control perspective if all patients (and staff) were periodically tested in the hospital setting but that would overwhelm labs and it’s not a very pleasant test when done properly.

Thinking about it, routine testing of staff possibly could have a negative impact on precautions taken as people become careless thinking that as they had a negative test last week, they’re fine, and forget that they could have been incubating it in the meantime.

I don’t want to get into it but she was in the hospital for 3 months and was periodically tested during that whole time. Granted she has COPD so they might’ve wanted to catch it early if she did have it

douglashyde · 09-09-2020 12:01AM

igCorcaigh wrote: »

It's the scale of deaths in the elderly that is so scary, if this gets out of control. We could lose huge numbers of our older people. I don't want to see that, knowing it can be prevented.

I 100% agree. If hospital loading (particularly ICU) & death rates are nearing a critical point then the country should respond accordingly.

Surgical intervention not blunt force policy.
We should take the highest level of precaution in high risk patients (tight restrictions in nursing homes, use of clean hospitals for high risk patients etc).

But Open society. Get on with life.

Strumms · 09-09-2020 12:02AM

Charles Babbage wrote: »

People acting the maggot.

Truth, covid doesn’t pick the locks or just come in down the chimney...

Goldengirl · 09-09-2020 12:05AM

NegativeCreep wrote: »

I don’t want to get into it but she was in the hospital for 3 months and was periodically tested during that whole time. Granted she has COPD so they might’ve wanted to catch it early if she did have it

Or ensure she didn't get it from any source, given her vulnerability. Good they looked after her well .

DevilsHaircut · 09-09-2020 12:06AM

is_that_so wrote: »

Much of what you listed. It's the constituency of Dublin West.

https://en.wikipedia.org/wiki/Dublin_West_(D%C3%A1il_constituency)

Dublin West, North-West and North Central are HSE operational areas, not constituencies.

From 24 August:

https://twitter.com/ZaraKing/status/1297968231647457280

majcos · 09-09-2020 12:06AM

Non solum non ambulabit wrote: »

So somebody presenting with Covid symptoms for the first time into a hospital is so sick they are placed straight into ICU.

Covid ward would be the first stop surely. At least get assessed by some doctors first?

Patients with Covid can deteriorate very rapidly so could come from home and be sick enough to need to go straight to ICU. Not unusual for someone to be intubated or started on other forms of oxygen support in ED and sent straight to ICU from there.

Would be seen by a doctor in ED/in resuscitation areas but that doesn’t mean Covid is confirmed/result is back before ICU admission.

Strumms · 09-09-2020 12:07AM

douglashyde wrote: »

I 100% agree. If hospital loading (particularly ICU) & death rates are nearing a critical point then the country should respond accordingly.

Surgical intervention not blunt force policy.
We should take the highest level of precaution in high risk patients (tight restrictions in nursing homes, use of clean hospitals for high risk patients etc).

But Open society. Get on with life.

Open society as normal, patients will crush the capacity of the health services, think about them...

People are STILL being diagnosed with cancer, STILL having heart attacks, STILL having strokes and the thousands of other medical conditions,,, who NEED a functioning heath services full of available and healthy doctors, nurses, carers, physiotherapists, porters, caterers, cleaners, security, psychologists....

Martina1991 · 09-09-2020 12:10AM

Non solum non ambulabit wrote:

I would love to know how often a previously untested Covid patient ended up in ICU in this manner. You are really clutching here.

If a patient presented with stroke, sepsis, acute respiratory distress or a number of other things as a result of Covid, someone could absolutely go straight to ICU without a previous test.
People can become very ill very quickly with Covid.

Non solum non ambulabit · 09-09-2020 12:11AM

Goldengirl wrote: »

No, . this is the most common route to ICU .

I find it hard to be believe that the most common route into ICU is Covid patients that never went to a GP, never looked for a test, never went to hospital with symptoms, never ended up on a Covid ward but the first medical interaction was to arrive in an ambulance almost dead. That is the most common route? Really? I am shocked at that.

Non solum non ambulabit · 09-09-2020 12:15AM

majcos wrote: »

Patients with Covid can deteriorate very rapidly so could come from home and be sick enough to need to go straight to ICU. Not unusual for someone to be intubated or started on other forms of oxygen support in ED and sent straight to ICU from there.

Would be seen by a doctor in ED/in resuscitation areas but that doesn’t mean Covid is confirmed/result is back before ICU admission.

Thanks. I wonder why suspected cases are not materialising as cases in ICU. What is going on there? 8 tonight.

Goldengirl · 09-09-2020 12:17AM

majcos wrote: »

Patients with Covid can deteriorate very rapidly so could come from home and be sick enough to need to go straight to ICU. Not unusual for someone to be intubated or started on other forms of oxygen support in ED and sent straight to ICU from there.

Would be seen by a doctor in ED/in resuscitation areas but that doesn’t mean Covid is confirmed/result is back before ICU admission.

Before this, often got patients intubated and straight to ICU and it could be some time before anyone will check that swabs have been done .
At the present time Covid status is top of the list and every patient dealt with as Covid positive until proven otherwise.

majcos · 09-09-2020 12:20AM

Non solum non ambulabit wrote: »

There are far worse killers of old people than Covid unfortunately.

Covid deaths in the elderly have been very grim. A phone call rather than a sit down conversation with multiple family members to discuss resuscitation status and/or inform a family member that the end is near. No family to hold their hand or only a very brief visit from immediate next of kin covered head to toe in plastic. No last visits from other family members. May not have seen loved one for many weeks beforehand due to visiting restrictions in nursing home and hospitals. Nursing staff and healthcare assistants doing their best but not even they are able to provide as much comfort as usual due to PPE, time restrictions, workload, etc. Limits on pastoral care for patients and families.

The dying process due to other causes during the pandemic has been affected too but there was marginally more flexibility for immediate family members and staff to provide a little bit more comfort.

Non solum non ambulabit · 09-09-2020 12:23AM

majcos wrote: »

Covid deaths in the elderly have been very grim. A phone call rather than a sit down conversation with multiple family members to discuss resuscitation status and/or inform a family member that the end is near. No family to hold their hand or only a very brief visit from immediate next of kin covered head to toe in plastic. No last visits from other family members. May not have seen loved one for many weeks beforehand due to visiting restrictions in nursing home and hospitals. Nursing staff and healthcare assistants doing their best but not even they are able to provide as much comfort as usual due to PPE, time restrictions, workload, etc. Limits on pastoral care for patients and families.

The dying process due to other causes during the pandemic has been affected too but there was marginally more flexibility for immediate family members and staff to provide a little bit more comfort.

I was referring to the disease itself.

Goldengirl · 09-09-2020 12:26AM

Non solum non ambulabit wrote: »

I find it hard to be believe that the most common route into ICU is Covid patients that never went to a GP, never looked for a test, never went to hospital with symptoms, never ended up on a Covid ward but the first medical interaction was to arrive in an ambulance almost dead. That is the most common route? Really? I am shocked at that.

Waste of time and energy .
You asked , I answered , twice .
Common route to ICU is via A& E as even those coming from GP could be in a bad way
I never said any of what you say above .
All patients whether swabbed prior or not are swabbed and tested on admission unless cast iron written result in front of admitting doctor .
Why do you think that is ?
Or do you not believe people are that sick with this virus ?
Or that it is imperative to keep it away from other sick , vulnerable patients ?

majcos · 09-09-2020 12:29AM

NegativeCreep wrote: »

I don’t want to get into it but she was in the hospital for 3 months and was periodically tested during that whole time. Granted she has COPD so they might’ve wanted to catch it early if she did have it

With COPD, periodic drops in her oxygen levels may have triggered a few tests. Likely to have existing changes on her chest x-ray too which could trigger more testing. There would have been a low threshold to retest her.

Hard she was in for so long. Enjoy having her home.

DevilsHaircut · 09-09-2020 12:31AM

https://twitter.com/AdamJKucharski/status/1303246679727116288

https://twitter.com/zorinaq/status/1283132291527503873

majcos · 09-09-2020 12:38AM

Non solum non ambulabit wrote: »

Thanks. I wonder why suspected cases are not materialising as cases in ICU. What is going on there? 8 tonight.

Not all suspected cases are truly clinically suspected cases, but include those being screened as a precaution. Those eight may all turn out negative and the doctors looking after those patients may not be expecting otherwise.

That’s why I think suspected should be left out of the public numbers. The suspected case numbers matter to bed managers who are trying to juggle isolation rooms etc but may not matter clinically.

DevilsHaircut · 09-09-2020 12:38AM

'the [current] law says gatherings of more than 30 people are illegal and £100 fines can be issued for breaches, rising to £3,200 for subsequent offenders.'

https://twitter.com/SkyNewsBreak/status/1303440309716750339

douglashyde · 09-09-2020 12:48AM

Strumms wrote: »

Open society as normal, patients will crush the capacity of the health services, think about them...

People are STILL being diagnosed with cancer, STILL having heart attacks, STILL having strokes and the thousands of other medical conditions,,, who NEED a functioning heath services full of available and healthy doctors, nurses, carers, physiotherapists, porters, caterers, cleaners, security, psychologists....

It's a fair point.

However I remember back when 'flatten the curve' was all the rage.

We've done that. Now proper precaution and common sense is what's needed (distancing, masks, hand washing, guard the at risk). And if people are afraid, so be it; you do you.

It's all about cost & benefit. Right now, for society at large its lots of cost and no benefit.

DevilsHaircut · 09-09-2020 12:59AM

douglashyde wrote: »

It's a fair point.

...

It's all about cost & benefit. Right now, for society at large its lots of cost and no benefit.

People won't magically start spending because the last few economic restrictions are lifted.

It's just wet pubs and nightclubs left.

EY's Yvonne Kiely: 'many governments “are urging consumers to get out and spend, but many consumers are deciding they’d rather not – or not yet"'.

It's the virus, not the restrictions.

https://twitter.com/IrishTimes/status/1300380469826064384

Goldengirl · 09-09-2020 01:00AM

douglashyde wrote: »

It's a fair point.

However I remember back when 'flatten the curve' was all the rage.

We've done that. Now proper precaution and common sense is what's needed (distancing, masks, hand washing, guard the at risk). And if people are afraid, so be it; you do you.

It's all about cost & benefit. Right now, for society at large its lots of cost and no benefit.

Benefit is keeping numbers down so no need for further restrictions .
Continuing restrictions are hurting everyone economically.
Countries that are suffering a second wave are seeing that it is everyone's interests, if not health and society , financially then , to not have resurgence of the virus in an uncontrolled manner .

09-09-2020 01:06AM

DevilsHaircut wrote: »

https://twitter.com/AdamJKucharski/status/1303246679727116288

https://twitter.com/zorinaq/status/1283132291527503873

Indeed this trend of spread would be logical, considering that young people tend to move around more than older people, so they would be front of queue to catch it, but it ends up inevitably spreading to the least mobile of the population.

il gatto · 09-09-2020 01:16AM

douglashyde wrote: »

It's a fair point.

However I remember back when 'flatten the curve' was all the rage.

We've done that. Now proper precaution and common sense is what's needed (distancing, masks, hand washing, guard the at risk). And if people are afraid, so be it; you do you.

It's all about cost & benefit. Right now, for society at large its lots of cost and no benefit.

We did flatten the curve. And now we’re undoing that work rapidly. We’re going to open primary, secondary and third level education and pubs all in the same month. Without waiting to see what effect each one has on case levels.
At 200-300 a day, it could spread like wildfire in the next 2 months. We pride ourselves on being one of the wealthiest countries in the world and yet apparently we cannot subsidise one industry, staffed by mainly low paid workers, to stay shut for the greater good.
There’s lots of landlords agitating for reopening. There’s not so many bar staff, glass collectors etc. because they’re going to have to come face to face with drunk customers for rock bottom pay.
Per capita, today we had more cases than the UK who already have pubs open and are bringing in new restrictions and local lock downs. We’re so busy patting ourselves on the back for our initial response that I fear we’ve taken our eye off the ball.

09-09-2020 01:28AM

I hear Dr Ronan Glynn giving out some slightly contradictory-sounding messages. On one hand he has said words to the effect that people must not lick themselves away socialise to maintain their mental health, and on the other hand, to keep socialisation to a minimum. I get what he means, ie strike a bit of a balance and maintain some face-to-face contact, but it does sometimes come across that he is speaking from two sides of his mouth as he has said these things alternately.

Covid 19 Part XXII-30,360 in ROI(1,781 deaths) 8,035 in NI (568 deaths)(10/09)Read OP

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