Covid 19 Part XXVIII- 71,942 ROI(2,050 deaths) 51,824 NI (983 deaths) (28/11) Read OP

majcos · 13-11-2020 12:19AM

normanoffside wrote: »

14 More 'Hospital acquired' patients in Sligo, not necessarily all in the past 24 hours, he's counting these over days and weeks.
14 have gotten it inside Sligo hospital by comparing admissions and discharges of Covid 19 patients in Sligo

There are a total of 14 confirmed cases in Sligo Hospital at the moment. Does he think every single one of those all got it in the hospital?

Do you know where is he getting admissions and discharge figures for individual hospitals?

I am not trying to be argumentative. I would genuinely like to know the hospital acquired numbers but I don’t trust his figures.

growleaves · 13-11-2020 12:22AM

Strumms wrote: »

How does he know, and what qualifications has he earned to enable to ‘tell’ people what to think ?

Workplace negligence occurs in a community.

Ahhh...

“Financial Supply Chain Process Leader”... this is what he had on his personal Twitter, yay him.

Like all the butcher, baker and candle-stick maker statisticians on this thread.

We've had middle-managers at IT companies explain to us how Giesecke and Tegnell don't truly understand epidemiology.

normanoffside · 13-11-2020 12:25AM

majcos wrote: »

There are a total of 14 confirmed cases in Sligo Hospital at the moment. Does he think every single one of those all got it in the hospital?

Again, he doesn't say or imply that at all.
His statistics on Admissions and Discharges show that well over half of Hospital patients 'with Covid' overall acquired it inside hospitals.

The recent outbreaks in Naas and Limerick Hospitals are already very well publicised.

The point being that Hospitalised numbers shouldn't be used to keep restrictions on society when the majority of the hospital numbers got it inside the hospital having been admitted for something else.

Stheno · 13-11-2020 12:27AM

majcos wrote: »

Yes. I’m not disagreeing that there is a problem but I would like to see the figures transparently rather than based on calculations that are flawed.

160 staff is very easy to get to with just a very small number of hospital cases. Each patient encounters numerous members of staff and staff encounter numerous members of other staff. And staff often live together so even if not in contact in work are in contact at home.

It would be quite possible to get to 160 staff isolation with just two or three patients.

I would just like to see the hospital acquired numbers definitively counted before going on that tweeters potentially flawed calculations.

I'm sorry but if 2 or three patients in a hospital can result in 160 staff isolating, then something is seriously wrong

Widdensushi · 13-11-2020 12:33AM

This is why the vaccine is so important even if not available in large numbers to begin with it, if all hospital, nursing home,medical, pharmacy staff are vaccined the numbers will collapse, the majority of the seriously ill caught it from a member of staff in one of those settings.

Wolf359f · 13-11-2020 12:34AM

Stheno wrote: »

I'm sorry but if 2 or three patients in a hospital can result in 160 staff isolating, then something is seriously wrong

What do you expect, a single doctor working non-stop for 7 days and then also get them to fill in for a nurse, porter, cleaner, cook and all the other unseen staff in a hospital.

160 staff isolating, mainly due to close contacts of a confirmed case, not because they are a confirmed case.

If you want to keep it out of hospitals, you surpress the spread in the community.

Strumms · 13-11-2020 12:35AM

The end of the day, there should only be verbal contact now between a patient and a hospital staff member re: care changes / issues... or a doctor / nurse checking on them..unless a temperature check, heart rate etc...or actual treatments being administered and bathroom assistance...ie. Only when necessary.

Food orders as before covid are done in most hospitals by patients being given a menu the evening before and with them filling it in as to their preferred option or patient dictating to a staff member... too often you’d have a member of catering staff trying to get around from bed to ward before they knock off only to be stopped by some muppet trying to show them their new dressing gown, photo of their bichon frisse or whatever. Fellow opposite me rang the bell that often he had the nickname Quasimodo.

Got to be essential contact only.

normanoffside · 13-11-2020 12:37AM

Wolf359f wrote: »

What do you expect, a single doctor working non-stop for 7 days and then also get them to fill in for a nurse, porter, cleaner, cook and all the other unseen staff in a hospital.

160 staff isolating, mainly due to close contacts of a confirmed case, not because they are a confirmed case.

If you want to keep it out of hospitals, you surpress the spread in the community.

Why then is it spreading much faster in the hospitals than it is in the community?

Why did the majority of people with covid in hospitals actually catch it in the hospital?

majcos · 13-11-2020 12:43AM

Stheno wrote: »

I'm sorry but if 2 or three patients in a hospital can result in 160 staff isolating, then something is seriously wrong

It snowballs incredibly quickly in some scenarios if even just one initially unsuspected case turns out to be positive. Not every unsuspected case would generate a long list of close contacts but if that unsuspected case was a patient with a high level of dependence, it can do so.

Think about the potential patient journey in a hospital. Nurses looking after that patient perhaps in ED and then more nurses on a ward and across a few shifts. The porter who brought the patient from ED to ward, porter who brought patient for scan and helped to hoist the patient into the bed. Care attendant who changed the patient in ED, and then one or two or three more care attendants who assisted with washing at night and then the day shift care attendants over the 48 hour period prior to testing or becoming Covid symptomatic.

Add possibly the physiotherapist, occupational therapist and speech and language therapist. What about the doctor in ED who examined and admitted the patient, and then the doctor who put in the urinary catheter and drip during the night and then the doctor who saw the patient the next morning? There are probably more I’m forgetting right now.

And if one of those long list of workers contracts it from patient, then all their other co-workers have to be assessed for degree of contact.

And then that student nurse lives with five other student nurses and the intern lives with four more interns and on and on.

It’s a complete nightmare. Not all encounters would be classed as close contacts but with certain patients and scenarios, it can mushroom very rapidly.

Wolf359f · 13-11-2020 12:44AM

normanoffside wrote: »

Why then is it spreading much faster in the hospitals than it is in the community?

Why did the majority of people with covid in hospitals actually catch it in the hospital?

Well you're going off some guy on Twitter saying the majority in hospital with covid acquired it in hospital.
Last epi report where they broken-down transmission in hospital was approx 33% not a majority.

Community has no household mixing, very hard to avoid that in a hospital. As to why the outbreaks as occuring, I have no idea. But unlike the Twitter post, I wouldn't just go and assume it's Workplace negligence.

Kermit.de.frog · 13-11-2020 12:49AM

Lines for testing at Dodger Stadium, Los Angeles yesterday as cases across the United States hit record highs. Just one of many drive through test sites set up around the city.

EmlpGtlU8AAjHy3?format=jpg&name=medium

A vaccine candidate can't come soon enough as hospitalisations and deaths are increasing.

Stheno · 13-11-2020 12:52AM

majcos wrote: »

It snowballs incredibly quickly in some scenarios if even just one initially unsuspected case turns out to be positive. Not every unsuspected case would generate a long list of close contacts but if that unsuspected case was a patient with a high level of dependence, it can do so.

Think about the potential patient journey in a hospital. Nurses looking after that patient perhaps in ED and then more nurses on a ward and across a few shifts. The porter who brought the patient from ED to ward, porter who brought patient for scan and helped to hoist the patient into the bed. Care attendant who changed the patient in ED, and then one or two or three more care attendants who assisted with washing at night and then the day shift care attendants over the 48 hour period prior to testing or becoming Covid symptomatic.

Add possibly the physiotherapist, occupational therapist and speech and language therapist. What about the doctor in ED who examined and admitted the patient, and then the doctor who put in the urinary catheter and drip during the night and then the doctor who saw the patient the next morning? There are probably more I’m forgetting right now.

And if one of those long list of workers contracts it from patient, then all their other co-workers have to be assessed for degree of contact.

And then that student nurse lives with five other student nurses and the intern lives with four more interns and on and on.

It’s a complete nightmare. Not all encounters would be classed as close contacts but with certain patients and scenarios, it can mushroom very rapidly.

It still speaks to something being fundamentally wrong tbh
I'm not really looking to be argumentative though

Miike · 13-11-2020 12:55AM

Stheno wrote: »

It still speaks to something being fundamentally wrong tbh

I typed out a really long message to the this posters initial proposition and just deleted it because it was turning into a novel. This is the most succinct way of summarising what I had typed.

This is a problem within the system and given contact tracing isn't even completed with this outbreak either, I foresee this number potentially doubling over the coming week in UHL alone and I foresee a vile, dangerous amount of derogation.

I also want to address a comment Paul Reid made to the media this afternoon regarding derogation of healthcare workers in the face of COVID19 - He explicitly stated, in a public forum, that staff "close contacts" are immune to derogation. This is NOT in line with current HSE policy on the derogation of Healthcare Workers. I'm not sure if he is inept or genuinely trying to mislead the public but he made a dangerous distinction, on public record.

HCWs may not be derogated if they are a close contact of a suspected or confirmed case in
their home (household contacts) due to the higher risk of transmission. Household contacts
are defined in the ‘National Interim Guidelines for Public Health management of contacts of
cases of COVID-19’ as people ‘living or sleeping in the same home, individuals

So close contacts of positive cases in the hospital environment are not 'immune' to derogation.

KrustyUCC · 13-11-2020 12:59AM

If there is covid cases occurring in hospitals with people who didn't have it before entering hospital and now staff are also getting cases, it's going to be a stick to beat the rest of society with before 1st of December if cases increase

Stheno · 13-11-2020 01:06AM

Miike wrote: »

I typed out a really long message to the this posters initial proposition and just deleted it because it was turning into a novel. This is the most succinct way of summarising what I had typed.

This is a problem within the system and given contact tracing isn't even completed with this outbreak either, I foresee this number potentially doubling over the coming week in UHL alone and I foresee a vile, dangerous amount of derogation.

I also want to address a comment Paul Reid made to the media this afternoon regarding derogation of healthcare workers in the face of COVID19 - He explicitly stated, in a public forum, that "close contacts" are immune to derogation. This is NOT in line with current HSE policy on the derogation of Healthcare Workers. I'm not sure if he is inept or genuinely trying to mislead the public but he made a dangerous distinction, on public record.

Edit derogation means allowing those who may have been exposed to return sooner than self isolation guidelines for the public

I'm mindful of Reid comments that he/the HSE aim to get things right 70% of the time which is frankly laughable.

Seems to me one of the many things in the 30% is shambolic management which I most is a significant contributing factor in the problems in our health system

majcos · 13-11-2020 01:06AM

normanoffside wrote: »

Why then is it spreading much faster in the hospitals than it is in the community?

Why did the majority of people with covid in hospitals actually catch it in the hospital?

There have been almost 7000 confirmed cases in Ireland in last two weeks. 272 in hospital tonight. Don’t have updated data on average length of stay for Covid in hospital. Vast majority of people with Covid are at home and in nursing homes and other residential units.

A person with Covid in the community can isolate or at least minimize their contacts. A person with Covid in a hospital has numerous contacts. Of course staff will have PPE but no PPE eliminates spread 100%.

A person with Covid in a hospital is likely to be sicker with Covid and therefore likely to have a higher viral load which increases risk of spread. And/or more likely to be immunocompromised in some other way, which is suspected to prolong their infectivity.

The more cases in a hospital, obviously the more chances of spread in a hospital.

There will unfortunately always be the possibility of spread of an infectious disease within a hospital. Hospital acquired infections are a huge problem and cause of mortality in hospitals worldwide as well as having major economic implications.

Of those in hospitals with Covid, of course it is very important to know how they are contracting it. The more is known about that, the more can be done to limit hospital spread.

But with 7000 cases in the community, even completely stopping spread within the hospital won’t eliminate all the admissions to hospital.

Miike · 13-11-2020 01:10AM

Stheno wrote: »

When you say derogation Mike, do you mean the vilification of health care workers who get sick or need to iaolate? And if so, by whom?

I'm mindful of Reid comments that he/the HSE aim to get things right 70% of the time which is frankly laughable.

Seems to me one of the many things in the 30% is shambolic management which I most is a significant contributing factor in the problems in our health system

Derogation is the process by which a healthcare worker who has been identified by OH or Public Health as a close contact of a COVID19 case can be essentially forced to return to work.

DEROGATION POSSIBLE, IF DEEMED ESSENTIAL:
Asymptomatic HCWs who are Close Contacts of a Confirmed COVID 19 Case -
healthcare or community, but NOT household

Stheno · 13-11-2020 01:13AM

Miike wrote: »

Derogation is the process by which a healthcare worker who has been identified by OH or Public Health as a close contact of a COVID19 case can be essentially forced to return to work.

So these people could then become persistent sources of infection within the health environment and the vicious cycle continues?

Especially if they are asymptomatic? And given the if one is a HCW, they may feel a sense of duty to go into work if required to do so, is this not the makings of a.perfect storm?

majcos · 13-11-2020 01:14AM

Stheno wrote: »

It still speaks to something being fundamentally wrong tbh
I'm not really looking to be argumentative though

It’s definitely not good. And I’m absolutely sure there is room for improvements to help mitigate the spread within hospitals.

I think practices have lapsed since April and May which isn’t helping. Staff have inevitably become more complacent but even with the most stringent measures, unfortunately it seems capable of breaking through. And escalates very quickly initially ‘unseen’.

Miike · 13-11-2020 01:19AM

Stheno wrote: »

So these people could then become persistent sources of infection within the health environment and the vicious cycle continues?

Especially if they are asymptomatic? And given the if one is a HCW, they may feel a sense of duty to go into work if required to do so, is this not the makings of a.perfect storm?

Exactly. This derogation process is already being abused and I'll go on the record stating that. There is already demands being made by politicians for the HSE to release stats on how many people have been told to return to work under the process. The nature of 'active follow up' is harrowing if you've a close contact healthcare professional prancing around the clinical environment, you can read about active follow up in the document I linked above.

The HSE's very own summary of evidence bank for COVID19 identifies that you are infectious for approx. three days before you become symptomatic. Yet they have a process to circumvent their own evidence BUT baked into the process is identifying asymptomatic cases as they transition into symptomatic. So.. they've had up to three days on of spreading before the process of "active follow up" catches it?:pac::pac::pac:

I've a small sup from a large barrel of wine so I apologise if I'm not making sense - I'm at my wits end with this whole thing

majcos · 13-11-2020 01:20AM

Miike wrote: »

I typed out a really long message to the this posters initial proposition and just deleted it because it was turning into a novel. This is the most succinct way of summarising what I had typed.

This is a problem within the system and given contact tracing isn't even completed with this outbreak either, I foresee this number potentially doubling over the coming week in UHL alone and I foresee a vile, dangerous amount of derogation.

I also want to address a comment Paul Reid made to the media this afternoon regarding derogation of healthcare workers in the face of COVID19 - He explicitly stated, in a public forum, that staff "close contacts" are immune to derogation. This is NOT in line with current HSE policy on the derogation of Healthcare Workers. I'm not sure if he is inept or genuinely trying to mislead the public but he made a dangerous distinction, on public record.

So close contacts of positive cases in the hospital environment are not 'immune' to derogation.

I think derogation should only be taken as an absolute last resort for staffing. It could be disastrous. Jumping to it as an out when pressure is on does not seem at all wise. I think it could potentially just further deepen a staffing crisis.

normanoffside · 13-11-2020 01:22AM

majcos wrote: »

There have been almost 7000 confirmed cases in Ireland in last two weeks. 272 in hospital tonight. Don’t have updated data on average length of stay for Covid in hospital. Vast majority of people with Covid are at home and in nursing homes and other residential units.

A person with Covid in the community can isolate or at least minimize their contacts. A person with Covid in a hospital has numerous contacts. Of course staff will have PPE but no PPE eliminates spread 100%.

A person with Covid in a hospital is likely to be sicker with Covid and therefore likely to have a higher viral load which increases risk of spread. And/or more likely to be immunocompromised in some other way, which is suspected to prolong their infectivity.

The more cases in a hospital, obviously the more chances of spread in a hospital.

There will unfortunately always be the possibility of spread of an infectious disease within a hospital. Hospital acquired infections are a huge problem and cause of mortality in hospitals worldwide as well as having major economic implications.

Of those in hospitals with Covid, of course it is very important to know how they are contracting it. The more is known about that, the more can be done to limit hospital spread.

But with 7000 cases in the community, even completely stopping spread within the hospital won’t eliminate all the admissions to hospital.

All well and good but the number of cases in general have been decreasing for 3 or 4 weeks straight. The number of hospital admissions with COVID have been getting less and less and the number of patients with Covid being discharged have been more than those being admitted for a few weeks now. Despite that hospital numbers are not coming down massively and there have been reports of several hospital outbreaks.

I am not blaming doctors or nurses here but something is wrong and questions should be asked of the HSE.

AssetBacked2 · 13-11-2020 01:29AM

Strumms wrote: »

How many people by your logic died ‘with’ a bad heart, ‘with’ cancer, ‘with’ cystic fibrosis... ?

If a medical professional deems that a person died ‘from’ or ‘because’ of covid I’m happy to go with the opinion of an informed health care professional , the doctor who signs and completes the death certificate therefore registering the death... date, time, details of the deceased, certified cause of death... if that’s decided to be covid...they have died of covid, not with it.

You can die ‘with’ your family, your chihuahua, your pet parakeet, you die ‘from’ a medical condition.

Whataboutery nonsense. This is a covid thread, we are discussing it and the context of locking down society for months and severely curtailing the freedoms of individuals as a response to it. That isn't happening with CF or bad heart deaths.

AssetBacked2 · 13-11-2020 01:32AM

KrustyUCC wrote: »

If there is covid cases occurring in hospitals with people who didn't have it before entering hospital and now staff are also getting cases, it's going to be a stick to beat the rest of society with before 1st of December if cases increase

Exactly, TH will double down in his advice to continue with heavy restrictions like only moving to level 3 instead of 1 or 2. Anything to shine a light away from the health sector.

Stheno · 13-11-2020 01:33AM

Miike wrote: »

Exactly. This derogation process is already being abused and I'll go on the record stating that. There is already demands being made by politicians for the HSE to release stats on how many people have been told to return to work under the process. The nature of 'active follow up' is harrowing if you've a close contact healthcare professional prancing around the clinical environment, you can read about active follow up in the document I linked above.

The HSE's very own summary of evidence bank for COVID19 identifies that you are infectious for approx. three days before you become symptomatic. Yet they have a process to circumvent their own evidence BUT baked into the process is identifying asymptomatic cases as they transition into symptomatic. So.. they've had up to three days on of spreading before the process of "active follow up" catches it?:pac::pac::pac:

I've a small sup from a large barrel of wine so I apologise if I'm not making sense - I'm at my wits end with this whole thing

Bonkers

And I say that as someone who works in an organisation with 200000 employees including tens of thousands in China

I used think we were a slow and unwieldy organisation, but my companies response was frankly incredible,, now I wfh all the time but have to do a weekly health questionnaire and if I were to report even close contact, there are structures in place to make sure I have the support I need, to the extent that I have colleagues around the world who have had the virus, were unable to self isolate and the company paid for them to self isolate in a hotel (with the hotels full knowledge)

I must admit that given I work from home, I cannot begin to understand the level of mental strength it takes you and your colleagues to do what you do everyday, however I do fear for our health system if this is the HSE approach

I hope the wine has eased the crap even momentarily and I'm sure I reflect the thoughts of many in saying thank you for what you do and then making the effort to come on here and being so informative

Keep taking care as best you can

majcos · 13-11-2020 01:34AM

normanoffside wrote: »

All well and good but the number of cases in general have been decreasing for 3 or 4 weeks straight. The number of hospital admissions with COVID have been getting less and less and the number of patients with Covid being discharged have been more than those being admitted for a few weeks now. Despite that hospital numbers are not coming down massively and there have been reports of several hospital outbreaks.

I am not blaming doctors or nurses here but something is wrong and questions should be asked of the HSE.

Drop in hospital numbers will lag behind drop in cases in community. Cases in hospitals can even continue to go up as newly diagnosed cases go down due to lag time between diagnosis and deterioration in symptoms. Hopefully a drop in hospital numbers will follow overall drop. Agree hospital numbers are being stubborn at the moment.

And I also agree that hospital acquired infections is playing by into that. My only concern as I have said a few times is that I would like to see the official hospital acquired numbers and definitely think the HSE/HPSC should be and hopefully are recording and documenting this statistic and investigating the reasons for it. Obviously knowing the source of the problem is a major step to getting it sorted it.

Stheno · 13-11-2020 01:34AM

AssetBacked2 wrote: »

Exactly, TH will double down in his advice to continue with heavy restrictions like only moving to level 3 instead of 1 or 2. Anything to shine a light away from the health sector.

With my cynical hat on I agree

Paul Cullen or David Quinn should pick this up. Preferably Paul

Stheno · 13-11-2020 01:38AM

majcos wrote: »

Drop in hospital numbers will lag behind drop in cases in community. Cases in hospitals can even continue to go up as newly diagnosed cases go down due to lag time between diagnosis and deterioration in symptoms. Hopefully a drop in hospital numbers will follow overall drop. Agree hospital numbers are being stubborn at the moment.

And I also agree that hospital acquired infections is playing by into that. My only concern as I have said a few times is that I would like to see the official hospital acquired numbers and definitely think the HSE/HPSC should be and hopefully are recording and documenting this statistic and investigating the reasons for it. Obviously knowing the source of the problem is a major step to getting it sorted it.

Iirc the reporting has become less detailed

No reporting like we used have on median age of deaths and Tony H was clearly reluctant to answer that question today

And whens the last time we got data on the % of infections that are HCWs?

Used to be a headline item each day

Now you've to go searching for it

Something rotten there

Strumms · 13-11-2020 01:39AM

Wolf359f wrote: »

Well you're going off some guy on Twitter saying the majority in hospital with covid acquired it in hospital.
Last epi report where they broken-down transmission in hospital was approx 33% not a majority.

Community has no household mixing, very hard to avoid that in a hospital. As to why the outbreaks as occuring, I have no idea. But unlike the Twitter post, I wouldn't just go and assume it's Workplace negligence.

Problem with hospitals is, you are awake from 7am, lights out about 9.30pm or so from memory.. so about 14.5 hours awake.

It’s not bad if you are a young or tech savvy older person with a smartphone/ WhatsApp and a tablet with games, newspapers, Facebook / Netflix and other social media apps that keep you good to stave off boredom and keep you entertained and connected to loved ones... if you are 75, not been brought up with that technology and not being available it’s difficult but needs must.

I remember for those older folks a lot of them would try grab any carer, nurse, doctor whoever was passing, just to initiate conversation, could be a bit frustrating for these professionals with a job to do, getting stopped for the 10th time that week

majcos · 13-11-2020 01:39AM

Miike wrote: »

Exactly. This derogation process is already being abused and I'll go on the record stating that. There is already demands being made by politicians for the HSE to release stats on how many people have been told to return to work under the process. The nature of 'active follow up' is harrowing if you've a close contact healthcare professional prancing around the clinical environment, you can read about active follow up in the document I linked above.

The HSE's very own summary of evidence bank for COVID19 identifies that you are infectious for approx. three days before you become symptomatic. Yet they have a process to circumvent their own evidence BUT baked into the process is identifying asymptomatic cases as they transition into symptomatic. So.. they've had up to three days on of spreading before the process of "active follow up" catches it?:pac::pac::pac:

I've a small sup from a large barrel of wine so I apologise if I'm not making sense - I'm at my wits end with this whole thing

Abuse of derogation is very, very concerning. That is just going to perpetuate the problem of hospital acquired infections.

Covid 19 Part XXVIII- 71,942 ROI(2,050 deaths) 51,824 NI (983 deaths) (28/11) Read OP

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