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16-03-2020, 20:43   #1
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Now ye're talking - to a consultant in the HSE [ANSWERS thread]

Answers from our AMA guest to questions asked in the Questions thread.

Please only post your questions in the dedicated thread here.
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17-03-2020, 00:07   #2
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Hi, I'm the HSE Consultant who is doing the AMA. I'm NOT representing the HSE, just trying to help out by providing some answers to questions people ask... I'm going to start by reserving a few posts which I intend to use to post some particularly pertinent information.

Then I'll start replying. I went asleep as soon as I got home and only just woke up so I'll be up for a while yet answering questions listening to my youtube playlist.

P.s. Please keep comments or questions in the questions thread. The main reason I agreed to do the AMA is that I want my answers to be available in one place for people to read without being buried in a swathe of comments, jokes etc. I'm trying to do this as a public service during this difficult time.

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17-03-2020, 00:14   #3
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I'm going to use this post to link to webpages/sites which I believe could be useful for those with medical questions/specific risk factors. I am willing to give some general opinions and repeat information which appears factual and has been published by reputable sources but specialist bodies and your own GPs and Specialists are definitely the place to go for individualised advice which will always be more useful to you as individuals than any general broad advice online. I am NOT offering anyone specific, individualised medical advice and wish to be clear on that. If you want that phone your GP or Specialist.

1. WHO myth busting page... VERY useful at this time. Some of the advice and rumours online are just so dangerous.

2. WHO Coronavirus page. Lots of useful, detailed, evidence based advice there.

3. HSE's Coronavirus page.

4. Royal College of Obs & Gobs UK advice re: Pregnancy & Coronavirus.

5. UK Asthma Society Coronavirus Advice

6. Irish Asthma Society Coronavirus Advice




Errata:
1. Phylogenetics of SARS-CoV2

2. COVID-19 Infected/Recovered etc Updates

3. A really good site for getting a breakdown by country, by date and multiple useful categories. Very succinct and easy to comprehend.

I'll add to this as

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17-03-2020, 00:19   #4
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I posted this previously in the mega thread but I think it is useful to repost it here for those who wish to learn how best to use masks, gloves, handwash etc. There's the normal way you do these things - which is effective - and then there's a medical way - which is likely to be MUCH more effective. If you've gone through the time and effort to do these things then you might as well get the greatest benefit possible from them.

Social Isolation:

Lets be very clear the best way to avoid catching SARS-CoV2 and avoid passing it on to other is Social Isolation. Social Isolation is far superior to any other strategy but it isn’t always feasible, especially if you’ve got a job which involves public interaction. With that said the safest thing you can do is socially isolate yourself as much as possible.

What does this mean? If you’re retired or otherwise not working at this time then stay at home. Don’t go out unless it is a matter of life and death – you must get food or you will starve or you must get medicines. Even in these cases I would ask why you have to go out? Have it delivered by the shop or pharmacy or have a relative who has to be out and about for work pick it up for you and drop it at your door without coming inside.


Social Distancing:

If you absolutely must go out to the shop then don’t touch others, don’t stand within 1 metre ( preferably two metres ) of them and don’t dally. Don’t lean against counters, don’t use cash, go contactless or if you absolutely must pay in cash let them keep the change or put it in the charity box. Don’t touch staff’s hands to get a few pence back and then put potentially infected money in your pocket contaminating your hands, clothes etc. Get in, do what needs doing and get out. SARS-CoV2 is very infections even with limited contact.

If you are working in a job where you cannot work from home then socially isolate as much as possible from other employees and members of the public. All of the above advice applies.

If you decide to go out for something non-essential then simply don’t. By doing that you risk catching and spreading SARS-CoV2. If you catch it and pass it to two people and they pass it to two others and the doubling rate is 4 days then after 28 days you will be responsible for 128 people having it. Of those 128 people 2 to 3 will die. Was that worth the price? I would argue that almost nothing except a matter of your own life and death or essential work warrants putting others at that risk.


Face Masks:
A lot of conflicting things have been said about face masks. The bottom line is that most of the face masks people are purchasing aren’t of any use and even if they were members of the public don’t know how to use them appropriately in order to gain effective protection.

For this reason I would say that buying face masks is ineffective UNLESS you have been advised on which ones to purchase and how to put them on, fit them and take them off. There is going to be a huge shortage of face masks for medical staff in Ireland soon. In Italy many hospitals have run out of face masks and the doctors and nurses have been treating patients without wearing facemasks themselves. This pretty much guarantees they will get infected and is why we’ve seen a rise in the number of doctors and nurses dying in Italy in recent days.

The only face masks which are worth getting are surgical masks or ones rated as either N95/FFP2 or N99/FFP3. Simply put these two ratings mean they stop 95 or 99% of particles above a certain size IF put on properly but almost certainly the vast majority of you with these masks aren’t getting any protection from them.

So, now that I’ve told you that in all the panic you’ve probably bought masks which won’t screen out viruses AND even if they did you don’t know how to wear them properly so as to protect yourself AND even if you get that bit right the way you put them on and off will spread infection do I offer any solutions? Sure, if you’ve already bought them you’re hardly going to return them to hospitals so the people who really need them ( front line healthcare workers ) can benefit from them so you might as well learn how to get some benefit from them.

Here are three good videos I have found and can recommend to show how to put on, fit and remove both surgical masks and more general oval N95 face masks.

How to properly put on, fit and remove Surgical Masks:
https://youtu.be/OABvzu9e-hw
https://www.youtube.com/watch?v=2xLjCfmx0iE

N95 Oval Type Mask:
https://www.youtube.com/watch?v=zoxpvDVo_NI

Once removed the face masks should be placed in a bin which is in a relatively well-ventilated area and which you don’t use often. I use a bin on a balcony which has no risk of being spread to others and also doesn’t act as a source of infection in the living area and has no risk of spreading to my neighbours.



Gloves:

Buying pairs of disposable gloves is a reasonable precaution. I, personally, have purchased several hundred pairs of vinyl, transparent powder-free gloves as they don’t irritate my skin as much as powdered or latex gloves. Why transparent? Well, they don’t attract as much attention when out in public. I’d also consider whitish ones. If you can’t source them then any colour will do. This isn’t after all, about fashion.

Again, gloves are almost useless if you don’t know how to use them properly. There is a set procedure for how to put them on and remove them and, yes, you guessed it there’s a video for that.

How to put on and take off surgical gloves without contaminating oneself.


Once removed the disposable gloves should be placed in a bin which is in a relatively well-ventilated area and which you don’t use often. I use a bin on a balcony which has no risk of being spread to others and also doesn’t act as a source of infection in the living area.

Do NOT re-use them. If you do that you might as well just go around shaking hands with everyone you meet and then smearing your hands all over your face repeatedly every few minutes.

The gloves won’t help much if you keep touching your face. The outside of the glove will transmit COVID-19 droplets to your face readily. So is there anything you can do to prevent yourself subconsciously touching your face out of habit? Yes, read the next paragraph.

Doctors and nurses need to get used to not contaminating sterile gloves by touching our faces or other non-sterile things. I’ve always found it useful to purposely interlace my fingers so that to touch my face I’d have to consciously uninterlace them. Since this isn’t always practical and with COVID-19 we are less worried about maintaining a perfectly sterile environment I’ve taken to carrying a tissue in one hand and a biro in the other. I find that carrying something in each hand prevents the vast majority of habitual face touching because I don’t want to poke my eye out with the biro and/or I have to move the tissue in order to free that hand up. By the time I’ve thought of doing that I realise what I’m about to do and can prevent myself from touching my own face. You might find different things that work for you, this is just something that works for me.


Handwashing:

Handwashing is a good idea but, obviously, social isolation is the best followed by social distancing and protective gear ( masks and gloves ). After all of those though it is still well worth washing one’s hands…. Yeah you’ve guess it…. So long as you do it properly. The sort of handwashing most people do verges on useless. On the positive side there are, as ever, videos to show you how. Here is one I found useful and have recommended to non-clinical staff/friends and family.

How to wash your hands the medical way.

As ever, I'm simply providing some basic advice and links to videos by reputable sources. If you don't like it, do it your way and take your chances with your own style of doing things. I'm just telling you how generations of doctors and nurses have been trained to do these sorts of things. If you think you know better then you do you.

Last edited by Pseudonym121; 17-03-2020 at 16:07.
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17-03-2020, 00:26   #5
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17-03-2020, 00:30   #6
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17-03-2020, 00:52   #7
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Quote:
Originally Posted by celt262 View Post
What medicine should be taken if symptoms start to develop?
Thanks for the question. Honestly that would depend on what your underlying conditions are, the severity of symptoms you exhibit and your likely progression as well as what allergies you have so it is impossible to give a one size fits all answer here.

With that said the best advice is that IF you start having symptoms you should contact your GP and be assessed by them ( almost certainly over the phone ) and follow their advice. At this point in the pandemic in Ireland most people who think they have COVID-19 don’t, they have other more common viral or bacterial infections or even just psychosomatic issues. So long as you aren’t allergic I think you can’t go wrong with some paracetamol, rest and ensuring you are hydrated though.

As re: NSAIDs the best thing I can do is link to the HSE's advice. Might this change as we know more? Certainly but this is the advice as it stands at the moment. You'll have to make up your mind whose advice to follow. I have no reason, at this time, to doubt the HSE's advice on this issue.


Quote:
Originally Posted by dartboardio View Post
Hi,
Do you find yourself turning away lots of patients who don't have any real symptoms of the virus and are just taking up waiting rooms out of worry?
Are all your staff/colleagues full of panic/worry ? Is this the busiest you have ever been?
Thanks for the questions. I’ve certainly heard of a lot of people thinking that because they have a cough or whatever that they might have COVID-19 and I’ve heard a lot of frustration from people who want to be tested but don’t meet the criteria for testing.

It should be noted that Ireland had very few testing kits although that number is ramping up massively and will continue to ramp up. As availability increases the criteria for testing will be widened until we reach a point where we can test everyone we should be testing.

A lot of GPs are really struggling with the numbers of people phoning them seeking advice and testing and that isn’t helping. Thankfully most of those people have the sense not to come in in person and:
A) Clog up waiting rooms and
B) Risk spreading it to others if they do have COVID-19

I don’t think patients are being turned away but there are a lot of worried well who would do best to just self-isolate, phone their GP and then follow the GP’s advice. On a population level you don’t need to do anything amazing, just follow governmental advice and your doctors’ advices.

My medical colleagues and I ( Consultants and NCHDs) are worried but not really about ourselves so much, although we do know that if this gets really bad then we ourselves and our friends and colleagues stand to have higher rates of infection and mortality per capita (age adjusted) than the rest of the population. This was seen in both swine flu and SARS and I expect it will be seen with SARS-CoV2/COVID-19 also. What I see and hear much more than that is a grim determination to do our duties and pay whatever price needs to be paid. I’ve been saying for a while now that we need to gear up as though Ireland is about to fight a medium-sized war, with all of the sacrifice and difficulty and loss that that entails. I’m starting to hear colleagues use the same language … I heard it said a few times today.

This is going to be a war, there are going to be losses but I think the vast majority of doctors are determined not to let Ireland down, no matter the cost. Sure we REALLY don’t want to die ourselves but we’ll do our bit, roll the die and know it’ll happen to some of us.
I, personally, am more worried about my parents than I am about myself and I think anyone with parents feels the same way. You have to remember we’re just like you in terms of families and being more concerned about those we love than we are about ourselves right now.
I’m not a spring chicken anymore and I have two underlying health conditions which increase my risk of dying if I catch COVID-19. I estimate I have a 15 to 20% chance of dying if I catch it but I’m going in because that is what is needed to try and save as many people as possible. I don’t think my place is directly on a COVID-19 ward because I’ll absolutely catch it for sure then and I won’t do anyone any good becoming another patient and using up resources which could be used to treat others but I have a role to play and I’ll play it. I think everyone else feels the same.

My nursing colleagues have the same attitudes really. I know nurses who have been doing non-front line duties for years and who have worried wives, husbands and children and have simply accepted that they’re going to be deployed wherever they can do most good. They know the risk this puts them at --- nurses also die at higher rates per capita ( age adjusted ) during pandemics --- but they’re not going to let you, the public, our patients down. Some, with health issues etc, will be deployed in places where they are less likely to catch it so that they can contribute care as opposed to consuming it but everyone’s grimly determined to do their absolute best.

As for allied health professionals… Well, the secretaries and admin staff are still showing up, doing their best as are the OTs, Physios, Dieticians, Radiographers etc… And let’s not forget the security staff, porters, kitchen staff and cleaning staff. A few weeks from now it will be a definite act of courage for a kitchen staff or cleaning staff to come into work because they’ll be exposing themselves to high risks of infection with COVID-19. Some will falter but I expect the vast majority to continue showing up and doing their bit. We need them ALL to do their bits because doctors and nurses on their own can’t make a hospital or GPs surgery run. It is a team effort.

I do think that some the allied health professionals who haven’t done nursing or medical duties on wards don’t quite “get” just how serious this is yet. I’ve definitely had push-back from some line managers about instructions I’ve given my team because I wasn’t following HSE protocol etc but this isn’t because they’re bad people or managers it is just because it is a big ask to go from peacetime HSE footing where there’s a protocol for everything and a change in work practices is a big deal to a mindset of, this is war and in war we do WHATEVER is necessary. When the whistle sounds, we all charge, we won’t all make it but we all charge. That is one hell of a mindset change and it takes time to make it… but even today people who hadn’t made the adjustment yesterday were contacting me to let me know they’d made the adjustment and were now of the “do whatever it takes mindset”.

A lot of (insert expletive of your choice here) ;-) is spoken about the HSE and, to be fair, some of it is even justified but, right now, while I’m a bit scared for myself and my family and I’m sad that some people I’ve known and worked with aren’t going to survive this it really makes me proud of Ireland and the HSE and socialised healthcare in general to see people knuckle down and prepare to go to war and fight this. We aren’t all coming back but we won’t let you down. We will, to quote the Marvel Universe, make the Big Play.

One thing I would just say on a slightly self-serving note is that when this is all over and a year or two from now doctor and nurses etc are advocating for funding and better working conditions please do remember who ran towards the fire at this time while everyone else was avoiding it as much as possible. Support us as much as we will support you in the months to come.

I’m sure this applies to the Army and Fire Brigade and Gardai and many others as well. I just don’t have as much contact with them so can’t address their attitudes directly.


Is this the busiest we’ve ever been?

No, a lot of the people who used to clog A&E with stuff that they should never have come in with seem to be staying at home. I don’t know if this is out of civic duty or fear of catching COVID-19 but myself and a lot of colleagues are ticking over doing the day jobs but aren’t as swamped as we usually are with the worried well etc.

We’re all still busy though as we’re preparing for what is to come.

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17-03-2020, 01:19   #8
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Quote:
Originally Posted by expectationlost View Post
is it possible to protect yourself from the covid19 and treat patients, how are health workers still getting sick?, are not wearing some level protection now?
Thanks for the question. Well, you wear protective gear - goggles, masks, gloves, possibly even full coveralls over the other protective gear, taped up to prevent air flowing in or out. They're hellish to work in and exhaust you very quickly. This is one of the reasons you heard about Chinese healthcare workers dying of exhaustion and/or dehydration when they were battling this.

Why will health care workers still get sick? Cause viruses are tiny, we'll all be working long hours in exhausting stressful conditions and it only takes the tiniest mistake to get infected... especially when you're working in a ward or room in which the virus saturates everything because it is full of people with COVID-19 just spewing it into the air and on all of the surfaces as they breathe/move etc.

As to protective gear being worn now. Sure, in some areas, but we don't have limitless stocks of it and if we use it all now we won't have it when we really need it. If you listen to the reports from Lombardy in Italy doctors there are talking about running out of face masks and having to go into COVID-19 without facemasks ensuring they will catch it. Doctors and nurses and paramedics etc are dying there as we speak. Healthcare workers in Ireland will be dying in a few weeks time, alongside the members of the public they've been treating. There's no avoiding that now. We just need to knuckle down, do our best to protect ourselves and yourselves and pay whatever price we need to pay to try and save as many as we can.


Quote:
Originally Posted by TheValeyard View Post
Are there still the usual cough, colds, flu going around that could also be affecting people. If my toddler has a runny nose and slight cough, it's not immediately Covid19 but still the usual suspects?
Good question. Yeah, I right now have a runny nose and a dry cough but I've had that for a few weeks. I've had a tangential exposure to a COVID-19 patient last week and so I'm being careful about my contact with family etc just in case BUT even in my case since the cough etc predated the exposure this is almost certainly just the normal stuff that goes around this time of year rather than COVID-19.

The same applies to your and yours, except even more strongly. Right now if you have those symptoms you are far more likely to have something other than COVID-19. If the public doesn't play its part with social isolation and distancing, hand-washing etc then that may not be the case a couple of weeks from now.

With that said while children do seem to be able to be infected they do not seem to be at high risk of becoming severely unwell. So you can allay your concerns there somewhat. If in doubt though do keep your toddler away from elderly relatives. Just because the toddler won't become severely ill doesn't mean that whoever they pass it to won't die.


Quote:
Originally Posted by JP Liz V1 View Post
I have so many questions, where to start as an asthma sufferer ( and nothing on line ) how do you differentiate between an asthma attack or Covid19?
Well, an acute asthma attack is acute and should be relieved by whatever inhalers your GP or respiratory specialist has prescribed while COVID-19 will come on, last over time and often be associated by symptoms other than shortness of breath.

That's just very general advice though.... If in doubt contact your GP and allow them to assess you and follow their individualised advice.



Quote:
Originally Posted by banie01 View Post
Do you think that our effort to shift the curve and flatten growth will be successful?
Thanks for the question. I don't know, it ALL depends on what members of the public do. The scenes with people going out to pubs over the weekend made my heart and the hearts of my colleagues sink. Some of the people in those pubs will almost certainly have been infected and will have passed it on to other.

Superspreaders are a real thing with this virus and Patient 31 in South Korea appears to have infected over 1,000 people, roughly 1 in 8 of ALL cases in the country. The last thing we need in Ireland is someone like that. If they infect 1,000 people you can expect 20 or more to die.... and yet people were draped all over eachother in pubs. If Irish people continue to do this it will cause more infections, more people to become seriously ill and run a greater risk of overwhelming the health service and increasing the death rate from roughly 2% ( if we have enough ventilators ) to up to 10% ( if we run out of ventilators and capacity in the health service ). You are seeing this happen in italy where the % mortality rate is creeping ever upwards towards 10% as their health service becomes more and more overwhelmed.

We need to make that sort of behaviour as taboo as incest and child abuse for the duration. Otherwise it will condemn other Irish people to death over coming weeks and months.



Quote:
Originally Posted by banie01 View Post
Or that we took our measures a week or 2 too late for maximum efficacy?
Well, the best time to plant an oak tree was 25 years ago. The second best time is today. I'm definitely of the opinion that we need to have the strictest possible measures today but, you have to bear in mind that this is an unprecedented situation for most governments and governments don't turn on a dime, they take a long time to change course. Given the realistic exingencies of governing a country I think the government is doing OK actually.

I think we've completely missed our chance to be Singapore but they had experience with SARS and learned a lot of lessons. One of those lessons was to go in hard and early if this ever happened again. They went too easy initially with SARS. I think European governments are going to have that same experience now but I don't think this makes them negligent or anything like that, it just means that it is really hard to change your mindset and get your head around how bad this could be and what measures are really needed.

For example, when I started posting about this a fortnight or more ago because I felt people weren't taking this seriously enough I was called a scaremongerer and a lunatic and was abused for posting. Now, much of what I said then appears really mild compared to what is actually happening and going to happen over the coming week and into the future.

So, yeah it would have been better to be stricter sooner but it takes people time to get their heads around this. At least the Irish government isn't taking the callous approach of the British government. We're still putting people first as much as possible
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17-03-2020, 02:16   #9
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Quote:
Originally Posted by CtevenSrowder View Post
How long do you think the lockdowns will be required to last?
I don't think anyone knows precisely but any lockdown will need to last long enough to significantly impact on the chain of infection. To do that you MUST exceed at least one incubation period. Anything less than that is utterly useless. So that gives us a lower bound of 14 days. The more multiples of one incubation period you lock down for and the more completely the lockdown and social isolation is observed the better.

So, 8 weeks is better than 6 which is better than 4 which is better than 2.

I assume that what the government will do, and I have no behind the scenes insight into this and if I did I wouldn't be answering this question, is lock down for 2 to 4 weeks initially ( 1 to 2 incubation periods ) and then re-assess the situation. Then they'll decide whether they need another 2 to 4 weeks at the same intensity or whether we can ease it up a gradually.

How can you help at this time? Observe social isolation, handwashing, social distancing etc. The more strictly the public observes these measures the quicker the less transmission we will have, the fewer people will get sick and die and the quicker the lockdown will be over.

It is very true that while healthcare workers can save many of those who get sick it is you, the public, who can beat this. If you all go out and stand next to eachother in queues, don't wah your hands etc etc then the healthcare system WILL be overwhelmed and we will be traumatised as a nation like we were with the famine. If you follow all the advice about social isolation, distancing and handwashing and stay in as much as possible then this will hurt but we'll get through it fairly ok.



Quote:
Originally Posted by CtevenSrowder View Post
Why is it presumed that warm weather will reduce the number of cases?
Well, that's because a lot of respiratory viruses have a seasonal component and people are assuming that SARS-CoV2 will also. This seems to be a reasonable assumption but we don't know if it is correct. We could be surprised.

I think most people are using the Spanish Flu model where it hit in three waves, early 1918, October to December 1918 and then again in Spring 1919 before being pretty much burnt out by the end of 1919. Is that the right model to use? Well, it seems reasonable but we don't know for sure.


Quote:
Originally Posted by sgthighway View Post
What is your speciality?
A reasonable question but not one I will not answer for the following reasons:
1. when I posted here initially a few weeks ago I got abuse for posting. People online can be horrendous to eachother and I don't care to expose myself and my family to that abuse online or in the real world. If my identity became known I fear that could happen.

2. The HSE can be very vindictive and were I to identify myself I don't trust them not to go after me if I survive this.

I'm being careful not to present myself as an HSE representative. I'm just a doctor answering questions using my experience and knowledge to provide the best quality answers I can at this time of national emergency. I'm trying to be responsible in my answers and be open about the fact that I don't know everything and thus can't answer every question. Plus I'm fallible and make mistakes.

With that said when a Consultant came out a few years ago to talk about the trolley crisis the HSE went after him by querying whether or not he broke patient confidentiality in doing so. he clearly didn't but they just wanted to punish him and warn the rest of us to shut up. We're pulling together now but I'm very aware that if I survive the HSE management will likely return to their previous form and seek to punish doctors who say things they dislike - even if those things are true.

If I said what specialty I work in I would hugely narrow down the field for them to search to find me. I'm already concerned enough about Boards knowing my identity and technical means being used but:
a) I think this is my ethical obligation as a doctor and my moral obligation as a human
b) I think there's about a 15-20% chance I won't be alive in 6 months to be gone after and I'd hate to die thinking I hadn't done what I felt was right and
c) If I'm lucky enough to survive and they do decide to come after me then I'll just have to emigrate to Australia or Canada and get paid a lot more money for doing the same job. There are worse fates ;-)

So, I hope people will respect me desire to remain anonymous so as to avoid reprisals.


Quote:
Originally Posted by History Queen View Post
Have ye received any further guidance regarding coronavirus and pregnancy? Specifically the case in the UK where the newborn tested positive for the virus, has that changed anything regarding the treatment/guidance for dealing with pregnancy?
Thanks for the question. I think that the number of pregnant women who have been confirmed to have been infected is so low that it is difficult to draw any definitive conclusions. With that said I have been directing patients and staff ( there are lots of pregnant nurses and doctors who are worried about this on a personal level ) who are concerned about this to the Royal College of Obstetricians and Gynaecologists website which has a really good page on this:

https://www.rcog.org.uk/en/guideline...and-pregnancy/

I think that explains it really well. I think the bottom line is that we must all assume pregnant women are more prone to infection and therefore they and their families need to be really strict about social isolation and distancing and hand washing measures.


Quote:
Originally Posted by coastwatch View Post
No question yet, but just to say a sincere Thank You to all HSE staff, frontline and support for the huge effort that has gone into the preparations for the spread of this virus, and for the ongoing effort that will be required to deal with it over the coming months.
Thanks. There has been a real sense of people beginning to understand the severity of this since the Taoiseach's statement last Thursday - which almost seems like weeks ago at this stage. Before Thursday some of patients and family members were complaining about delays in being seen or not being seen in person etc but today they seemed to understand that this was an emergency situation and previous norms no longer applied. Sure, not all of them but most of them ;-).

This is really helpful because over coming months a lot of assumptions about what the HSE should and shouldn't be doing are going to be thrown out the window. As a country but particularly in the HSE we're at war and we'll do our best for you but you need to understand that what you consider urgent and severe and what we consider urgent and severe is going to be very different over the next few months to a year. We're not trying to be unsympathetic but we're at war and we have a much better idea of what will keep most people alive at this instant. You'd better believe that's what we're going to focus on --- while doing our best to provide a service to everyone in the country who isn't infected with COVID-19.

For example: People will still get pregnant, get cancer, get asthma attacks, get heart attacks, develop depression, anxiety, OCD, have car crashes, fall and break bones etc. We are going to be dealing with ALL of the above PLUS COVID-19 and no-one suddenly found clones of us to flesh out the service. All we have to make up the numbers are redeployment of staff from non-essential services, retirees called back to the colours and early-graduation medical students and nursing students. With that said we will work harder than we've ever worked before (and we weren't slackers previously no matter what you might have heard or read) and will , inevitably, die in some numbers over the coming months but what we WON'T do is let you down. That simply isn't an option. We WILL be there for as many of you as possible for as long as you need us and as long as we can still stand.

I'm sorry if that comes across as wishy washy or emotional but, you know, I'm really inspired by my colleagues in the health service right now. Anyways, massive emotional outburst over for now ;-). My team would be surprised to think I wrote the above, this is another reason I can't be identified. I've got a reputation as a bit of a tough SOB to maintain and if I'm ever linked to this post my street cred with the cool kids will be totally shot ;-)

What you can do to help us is pretty simple but really powerful. You need to socially isolate, socially distance, hand wash and convince any of your friends and family who still think this is overblown that no, this is war and if they are selfish and think of themselves first and foremost they are going to condemn a lot of good people to death over the coming weeks and months.
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17-03-2020, 03:37   #10
Pseudonym121
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Quote:
Originally Posted by humberklog View Post
Whenever my mate is asked what he does for a living he says "Doctor". He's an Ed. D (Dr. of Education) and does indeed work in this field (Adult education). Does it get your goat when you hear people claiming to be a doctor when their field is non med/psych?
LOL! That made me laugh. My dad has a PhD and always tells me he's a doctor too. I remind him that he's the useless type of doctor ;-) The greatest joy of my medical career is using the qualifications to harrass him ;-). Hey, I never said I was a good son, just his son ;-).

In all seriousness though, what your friend does for a living is work in education. And he worked really hard and needs to be commended for getting a Doctorate. That's quite an achievement and is to be respected but when one says one's a doctor I do think most people assume that means medical doctor so it does seem that he might be compensating for something --- hmm, I'm rubbish with the tech on Boards but this would, I believe, be the appropriate time to put in a winky emoji beside an eggplant emoji.

I'm happening and with it despite my age but the rest of you old foggies can have the coolest kid you know explain what I'm alluding to. ;-)


Quote:
Originally Posted by Damien360 View Post
Serious question. What would be your honest opinion of the current trolley watch numbers ? Why have they collapsed ? People didn't suddenly not require A&E or are the vast majority of A&E overblown ? Figures before Covid-19 over 300. Last year same time 180. This week reported as zero.
And thank you for putting yourselves in the way of harm to deal with this. It cannot be easy for your families.
Great question. When I worked A&E as part of my NCHD ( Non Consultant Hospital Doctor ) training scheme we used to get so many people presenting who didn't need to be there. It was cheaper or easier than seeing the GP. Or they were just drunk or high on drugs... I remember one guy who had been macheted 3 times by a drug dealer whose girlfriend he'd chatted up who kept physically assaulting us when we tried to help him. Eventually I gave the instructions to leave him be till he passed out from a combination of the drugs, drink and blood loss and then when he was unconscious we rushed him and were able to treat his injuries. A LOT of what presents to A&E should never have gone there and would be best dealt with by the GP etc. Every week I come across situations where someone has had an issue for 3 months or 6 months and done nothing about it but has now decided, at 2am on a Saturday morning that they need immediate review in A&E. It is ridiculous.

I think a lot of those kinds of presentations are down and I think that a lot of work has been done on the discharge/capacity side also. To be fair to the government the purse strings have been loosened and to be fair to management and the various Medical Colleges the rules and regulations which would hamper a response have also been set aside. Everyone has been freed up to focus on fighting the war instead of doing the paperwork.

As to families: Yeah, I think there's a lot of worry there alright... but we have to do what we have to do. It'll be far worse for everyone if we don't and by doing our jobs we don't just protect strangers, by doing our jobs and protecting those strangers we protect our loved ones also. I know that's in the minds of healthcare workers also. We are ALL in this together in a very real and impactful way.


Quote:
Originally Posted by Darwin View Post
First off, sincere thanks and respect to you and all your colleagues for working at the coal face in these unprecedented times.
My brother is to be tested for covid19 shortly, I wouldn’t expect him to be in the severe risk category. I’ve read of non acute cases that develop ‘mild’ pneumonia. Can this category of patient recover at home without intervention?
Great question. I'm sorry to hear your brother will need testing. My thoughts are with him. The good news for him is that the majority of people who test positive for COVID-19 don't seem to require hospitalisation ( up to 80% of all confirmed cases ).

Of the other 20% it seems 10% need hospitalisation but don't need ventilation/high dependency care while 10% need ventilation/high dependency care. Deaths are overwhelmingly clustered in this latter group.

Obviously these are rough figures and they'll vary from country to country but the bottom line is that:
a) lots of people will catch it and have such mild symptoms they aren't even tested.
b) of those who are tested and are confirmed 80% won't need hospital.

I hope that helps allay some of your concerns for your brother.


Quote:
Originally Posted by Boulevardier View Post
A friend is having a small dinner party (4 in total) at her home tomorrow night. Is this contrary to current HSE advice?
BTW I don't understand where the answers are. I will try again.
Hi, here is a link to the answer thread:
https://www.boards.ie/vbulletin/show...#post112858492

I asked Boards to preserve the answers thread for just answers as I wanted to have it be a concentrated source of reasonable, rational information. My hope is that people could direct family members and friends to it to have their questions answered. This is one way in which I hope to do my bit for the country at this time.

No it isn't contrary to current HSE advice and four people isn't a big high risk gathering. Still these sorts of "small" gatherings still increase the risk of passing it on above and beyond staying at home and self-isolating whenever possible.

My personal view is that when this is all over you can have all the dinner parties you want but right now I wouldn't be hosting or going to them. For however long this lasts the ONLY person entering my place is going to be the Tesco Delivery driver. I won't be having face to face contact with my parents, my siblings or my friends (outside of running into them at work). This isn't medical advice, simply me outlining where I'm drawing the social isolation line. The stricter we all are the fewer people will get sick and die and the sooner we'll be over the worst of this.


Quote:
Originally Posted by ironwalk View Post
Much respect and gratitude to all the doctors, nurses, ambulance personnel, in-hospital cleaners, admin staff, radiographers, porters, med lab scientists, etc etc.
All putting yourselves in the firing line, mentally and physically.
The vast majority of the public understands this....but you are more likely to hear from the terrified few who will shout at you.
Have you heard from your colleagues in Italy? and did the HSE start to ramp up capacity in line with the warnings that were coming from there last week?
Thanks for the kind words. As to the question... I haven't heard personally from colleagues in Italy but I'm well aware that in Lombardy they are reporting having run out of protective gear, treating patients without protection and growing numbers of doctors and nurses and others are getting sick and beginning to die. It is pretty grim but if they stick with the lockdown in about a month's time they should really see significant improvements and their situation could become more manageable. The death toll there is going to keep rising though. last week I calculated it was likely to exceed 1,000 a day before it starts to improve. Tough, tough days ahead for them.

I have a lot of friends in the US and they are beginning to get really terrified in medical circles. I think America is going to make Italy look like a walk in the park over the next year. Their federal government response is utterly incompetent and their healthcare system isn't set up for socialised care at all and in a pandemic like this having 10% of your population without any medical insurance or the infrastructure that a socialised healthcare system has is going to doom a lot of people. I think the states etc are beginning to realise this and take some action which will mitigate things but I'm really glad I don't live in America right now.

This evening one of my friends texted me that 20% of the doctors in their hospital are currently in self-isolation after exposure and they have ramped up the number of in-patients the interns can look after. They are supposed to limit it to 12 as a maximum. They are going to have to change that rule and god bless them but those interns and their patients aren't going to have good outcomes once they become overwhelmed.


Quote:
Originally Posted by ironwalk View Post
and did the HSE start to ramp up capacity in line with the warnings that were coming from there last week?
Well, I won't comment on specifics as I want to hold the line of giving advice but not divulging privileged information but I think it is fair to say that after the government was briefed last Monday a lot of people throughout the public services seem to have made preparing for this their number one priority. I don't know what was in the briefing to the government although I can guess because I ran the numbers for myself about 3 weeks ago and that's when I got scared and began contacting my family to inform them of what was coming and the need to prepare.... and then later decided I needed to try to raise the alert here because it didn't seem most people understood what was about to happen.

Anyways, I don't know what was in the briefing but I think it scared them sh**less and afterwards the government realised it needed to prepare for war.... and to the credit of the state all of the arms of the state involved in responding to emergencies ( Gardai, Army, HSE, Fire Brigade etc ) do seem to have taken this to heart and began preparing to go to war.

Massive efforts are underway to free up hospital beds and create extempore hospital beds throughout the state. I expect that those measures will be announced over coming days - I had thought they might start being announced Monday but I was wrong.


Quote:
Originally Posted by Boulevardier View Post
Not sure what is going on here. I have been several times now on the "answers thread" and there is nothing there.
Mea culpa, Mea Maxima Culpa ;-)... I was up till 3am working last night and so went straight to bed when I got home. I woke at half eleven and then began replying here. I think my hours going forward are going to be best described as "erratic". I'll reply as and when I can and do my best to address every question but, I hope you'll all understand that when this really gets going I may have to priotise things other than an internet forum.

With that said I personally think this could be a very valuable service and so I intend to continue replying here. If and when I get COVID-19 I also intend to post here with my obs ( temperature, pulse oximeter readings ) and other observations for as long as I'm physically able to because I think that might prove valulable. Don't know how but there's a long tradition of doctors documenting their illnesses which has proven useful later so I might as well do that in between bingeing Netflix ;-) I definitely need to crack out the Babylon 5 boxset again...


Quote:
Originally Posted by begbysback View Post
Is vitamin D really any good as a prevention of the virus, niacin in particular.
Niacin is Vitamin B3 not Vitamin D. I am not aware of any evidence that Vitamin B or B3 in particular is useful. By FAR the most useful thing anyone can do is to socially isolate, socially distance and hand wash. All the vitamins and other medicines in the world won't be as effective as simply not getting infected in the first place. I know that is really obvious but it does bear stating again and again and again.

I've heard of people saying that Vitamin D3 ( which is what I think you may have been thinking of ) may be beneficial in preventing cytokine storms etc and that Vitamin C boosts the immune system etc but I think we need to be really clear that the BEST thing anyone can do is socially isolate, socially distance and hand wash. If you sit in a room with an infected person who coughs and splutters and then touch surfaces they have touched and don't handwash then all of the Vitamins in the world won't help you.

With that said as I've gotten older I decided a couple of years ago to start taking some Vitamins which I felt had an evidence base for general health. I take a daily multivitamin containing cod liver oil and I take daily Vitamin C. Over the past two winters I have definitely had fewer chest infections than previously. I think part of that is that I also wasn't overworking myself as much and was trying to be a little bit more conscious of my stress levels but some part was probably the vitamins so I keep buying them and taking them daily.

Do I believe that Multivitamin and Vitamin C will protect me from SARS-CoV2? Absolutely not. Social isolation, social withdrawal, gloves and handwashing will protect me. Multivitamins and Vitamin C won't protect me if I don't observe the above precautions.

To put it another way multivitamins are great but if I were to smoke 40 cigarettes a day for 30 years I'd expect to get COAD and lung cancer no matter what vitamins I took. I hope that helps. Vitamins may be helpful in general but they are not the panacea some make them out to be.
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17-03-2020, 03:54   #11
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Originally Posted by little bess View Post
The Uk are asking over 70’s to self isolate, would you recommend the same thing to that age group here?
Yes, absolutely. My parents are in that age group and they've been self-isolating for almost two weeks now on my advice. They told me they went out to the pharmacy for medicines and I almost lost it with them... but they'd have been upset if I said that so I bit my tongue... They should have let me go to the pharmacy instead and take that risk instead of them.

So, I would advise anyone over 70 to really strictly self-isolate and have food and medicines delivered to them. Show them how to use kindle and netflix and let them spend the time reading, doing netflix and chill and skyping with everyone in the family. I've spoken with my family on the phone more in the last two weeks than I did all last year.



Quote:
Originally Posted by little bess View Post
I’ve heard diabetes, hypertension, copd are all extra risk factors, should these people take more care with social distancing?
Many Thanks
Yes, absolutely. It is unclear precisely how much these increase the risk of mortality but it is clear that they increase it. Most figures I've seen say each of these factors increases the risk of mortality by roughly 5% and having more than 1 of these risk factors would likely increase your risk of mortality more then 10% ( risk factors don't cause risk to go up additively they compound ).


Quote:
Originally Posted by Gloomtastic! View Post
What’s the difference between a bad dose of the flu and Covid-19?
Wow!!! I'm going to rephrase this question slightly so we are comparing apples to apples. What's the difference between a bad dose of the fly and a bad dose of COVID-19... Well the difference for people over 70 is the difference between having a 1 in a thousand chance of dying and a roughly 10% chance of dying. Those are rough figures but the general gist is that if you are over 70 you are 100 times more likely to die if infected with COVID-19 than the flu.

That SHOULD terrify anyone who has a loved one in that age group and why we all need to encourage them to socially isolate, get their messages, medicines etc and practice social isolation, social distancing and hand washing ourselves.

And lastly two pictures showing fatality rate by age and risk factor in China. It isn't the most up to date but I think they make the point graphically and eloquently.



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17-03-2020, 04:47   #12
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Originally Posted by patsy_mccabe View Post
If someone gets the virus, get sick and get well again, at what point can they be confident that they have stopped shedding the virus?
This is actually a really interesting and important question, thanks for asking it. As with a lot of medical questions it has multiple answers depending on the level of certainty and detail of the explanation required.

E.g I can be asked the same question by seven groups of people generally speaking:
a) patients
b) non-nurses, non-doctors but working within the HSE
c) nurses
d) NCHDs
e) Consultant Colleagues not in my specialty
f) Consultant Colleagues in my specialty
g) family and non-medical friends

Each of them will require a different answer pitched at a different level because they come to the answer with different levels of knowledge, different anxieties and agendas and my role with each of them is different.

With a patient I might answer a question about risk factors for COVID-19 by saying:
"Well, here's two graphs which show you that the older you get the more at risk of dying you are and the more chronic illnesses you have the more at risk of dying you are. Now, in your specific case you are x years old and have y so that means your risk could be about z%. My advice on how best to deal with this is a, b, c etc."

With a junior doctor on my team this is a teachable moment and I would present that data, I would seek to personalise it for them ( which aids their learning and memory ) by relating it to patients they have recently seen in clinical - ideally patients I know they have formed an attachment with so that I can link an emotional response to the information and hopefully aid its remembrance I'd also talk about how this related to other illnesses they are more familiar with so as to help them contextualise this knowledge and then I'd invite questions and allow for discussion. I'd also be aware that this sort of question might be their way of asking about their own family members' risks and I would probably reference my own risk factors and estimated mortality if/when I am infected and then link that to someone in their family they'd mentioned previously and what risk factors they might have ( a pregnant sibling or spouse, parent etc). By doing this I'd hope to subtly give them permission to raise their concerns and ask what was on their mind.

I've done that with a few NCHDs in the last couple of weeks.


With Consultant colleagues the discussion might be as simple as:
"Oh you know, elderly and crocs."
With all the shared experience and argot and the ruthless training in efficient effective professional communication which is such a large part of our training we can communicate an awful lot with very little.

And yeah I do accept that doctors can be woeful when communicating with the public. ;-). I'm talking about efficient effective professional communication with eachother.


Anyways this is my way of explaining why I can't give you a nice simple answer. It seems that you can still shed the virus in faeces for quite some time even after you've gotten "better" but the real question we're interested in is not duration of viral shedding it is duration of infectivity.

You can still be shedding via faeces but this doesn't seem to have be a significant source of infecting others even though viable virus has been found in faeces.

In terms of sputum and droplets after getting "better". We don't know precisely. We are still learning. I think our current best guess is that if you're coughing you're definitely infective but once your symptoms have disappeared your risk of infecting others should be low. How low? We don't know yet.

Welcome to real world medicine. It isn't like on TV, in the real world there are lots of unknowns and maybes and "we think that"s. Plus people do really weird stuff writers would never even imagine putting in their shows.


Quote:
Originally Posted by KKV View Post
To re-word it, how are you managing to get time to do a Q+A on here? Has your actual working day/week changed with the virus? Or are ye folks still working the same hours, albeit arguably with more to do during those hours? Or has the trolley crisis suddenly getting solved actually meant that your working day is easier than it was before the virus became so known?
Good question. I've rambled on about it below... ;-)


Quote:
Originally Posted by KKV View Post
Has your actual working day/week changed with the virus? Or are ye folks still working the same hours, albeit arguably with more to do during those hours?
Same hours or more. I think we're just prepping for this to really hit and every extra day of preparation you all can buy us through social isolation, distancing and handwashing will help reduce mortality. Please buy us those days. Not for our sakes, but for yours and those you love in the risk groups.


Quote:
Originally Posted by KKV View Post
Or has the trolley crisis suddenly getting solved actually meant that your working day is easier than it was before the virus became so known?
Oh Jesus, I'd trade the trolley crisis for this any day of the week. Any doctor I know would be down on their knees giving thanks to go back to the bad old days of a trolley crisis without COVID-19 on our radars. Give me a thousand letters of complaint about waiting lists or how my NCHD said something in a way which made someone feel they insinuated x or y instead of this.... and I HATE those letters. I could be seeing patients cutting down waiting lists instead of writing replies to them.

What are healthcare staff doing with all of our free time these days? Girding our loins and preparing to go to war.

I'll tell you some of my preparations to give you a sense of it...
I ordered food delivers, disposable gloves, masks and various other protective supplies about two weeks ago. Enough to see me through about a month of food and 3 months of personal protection.

I got my family up to speed and got them to make the same preparations. I made sure my parents got 3 months of their medicines in so they wouldn't have to go out if/when this got bad.

I figured out what my mortality rate was and wrote a will for the first time. That was a surreal experience.

I made sure my finances are in order so that if I become ill, incapacitated and die they can be dealt with by my family.

I live alone so set up a plan of daily phone checks if/when I become infected so that should I rapidly deteriorate and become incapacitated or die an ambulance can be called to bring me to hospital or the morgue.

I don't expect there to be much point to my being brought to hospital though if things get really bad because with two underlying health conditions I wouldn't be intubated in Italy today so if it gets really bad here I wouldn't expect to be intubated. That's pity for me personally but terms the breaks. With that said I'm hoping for a good outcome here. 20% mortality means 80% chance of living so the world had better get ready for Party Consultant if I get out the other side of this ;-).

I've written letters to those I care for to open if I die.

I've packed certain things into boxes and labelled them with the names of whom I wish them to go to if I die and put them in the spare room along with written instructions.

I've packed non-essentials away so that:
a) I will have less clutter to deal with and
b) it'll make it easier to manage things for my family if I pass.


I had a think about what I would do once this was spreading in the community. I decided that I wouldn't go out except for work and food/medicines. I feel, as do my colleagues, that I/we have an obligation to the public to protect ourselves so we are available to treat them if/when they become ill. That means being a hermit for the next few months.

Then I had to decide what I would do with my time. There are a couple of shows I'd really like to finish to see how they end and Westworld Season 3 is starting so, you know, a reason to live ;-).

I then decided that with the rest of my time I'd like to be of use and try to help out. Posting to Boards.ie seemed like a pretty good way of doing that without having to go out #introversionforthewin ;-)

Professionally I've changed the entire way my team works, I've been trying to help management prepare any way I can, I've been talking to other colleagues trying to find any way I can to help them - and they've done the same for me - and I've reached out to other services and hospitals to see if there's anything I can do to support them.

Tomorrow I'll be splitting my time between dropping some stuff over to my parents, answering on boards and researching online, reading some HSE and NHS protocols, reading some relevant research and writing some proposals/procedures etc which might help another service. I'll also prepare food, clothes etc so I won't have to do anything but go to work and sleep for Wednesday to Friday.

It is all about prioritisation and time management. You don't become a Consultant without being able to ruthlessly prioritise and time manage. So, that's what I'm doing in order to prioritise the stuff I think I can be most helpful doing... and as you can see I've also thought a lot about my own mortality and the fact that I may not be here 3 or 6 months from now.

And, you know, nerding out watching Picard when it comes out... Mostly though I need to survive in order to see Season 2 of The Mandalorian #lifegoals ;-)

Last edited by Pseudonym121; 17-03-2020 at 06:03.
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17-03-2020, 05:11   #13
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Originally Posted by dharma200 View Post
All my Chinese students families have been wearing masks at home at all times. They take the masks off for bed. The children ( my students) do not wear masks. They have emphatically told me over and over again to wear a mask, at all times. That this is the success against the virus. I have been seeing my parents with masks on now for five weeks. At home.
I am wondering why the advice here is not to wear masks. is it that it is a false sense of security?
My chinese families do not understand why everyone here in the west is not being told to wear a mask.
Thanks,
Great question. To be honest I think masks for the public are worse than useless for one simple reason: People don't know how to put the masks on properly, fit them properly and take them off properly and therefore they are useless for most people.

Also, it is FAR safer to stay at home socially isolated than be out and about wearing a mask so I think the government has hit on one simple message and are focusing on that - socially isolate/distance and handwash. I think they are probably right to do so.

Almost every picture I've seen online of people wearing masks shows them not being worn properly and being useless.


Even with this simple message they are having to fight idiots who just make up lies and rumours which will kill people. If they went for more nuanced messaging it would be difficult to get a consistent message through to people.


With that said it is different for healthcare workers and people who know how to use the masks and MUST be out and about. E.g. I plan to wear masks on my way into work and home starting Wednesday. But I know how to put them on, fit them and take them off so they'll be effective for me, hopefully.


In the picture below from the BBC this mask isn't being worn properly and thus provides almost no protection. All this woman is doing is preventing a healthcare worker from using this mask properly and being protected at work.

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17-03-2020, 05:30   #14
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1. Do a proportion of people who recover have permanent lung damage?
1. Well, interstitial lung disease often results in long-term chronic lung issues with decreased long-term survival. We don't know what the long-term effects of COVID-19 infection will be but it is a reasonable assumption that a portion of those who have severe or moderate illness and survive will have long-term sequelae which will both limit their ability to function as freely as they'd wish and their long-term survival.

2. SARS-CoV2 hasn't been around long enough to say this for certain but I suspect we'll have to see a significant investment in respiratory clinics etc going forward.



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2. Is the Irish strategy to get 60% of people infected and recovered, but at a steady rate so a not to overwhelm the HSE, or is there some other strategy?
No, absolutely not. The Irish strategy is to save as many lives as possible no matter what the cost. This is war and while this means people will die and Consultants are going to have to make horrifying decisions which will stain their souls and minds forever we are NOT going to write anyone off at this stage.

WE want to save EVERYONE we can so do your part and help us, socially isolate yourselves, socially distance and handwash. That's what you can do to save lives so please for the love of all that's holy do that and correct any muppet you see not doing it.



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3. Roughly, how long does each phase of the illness last?
I'm not sure I understand what you mean by this. Could you clarify please, sorry if I'm being dense.



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4. What is the current ICU capacity, and is this being massively ramped up?
Well, as a matter of public record we have about 250 ventilators in ICUs/high dependency beds. We also have additional ventilators as spares for when one goes down, ventilators in Operating Rooms etc. They are ALL being repurposed to front-line use.

Operating rooms (ORs) will become extempore isolation rooms - they're pretty good for this purpose actually but it will mean routine operations being cancelled. That's just a price we'll have to bear.

Private hospitals have more ventilators, probably mostly in their ORs and they'll all be requisitioned going forward. If you assume that someone who is amongst the 10% with COVID-19 who is most severely ill will need ventilation for 2 weeks to recover sufficiently to move onto supplementary oxygen every ventilator we find could save 24 lives over the next year.

So, holding a ventilator back will be tantamount to mass murder. We'll still need a few for emergency surgery etc obviously but every one not reserved for that purpose will need to be used to ventilate COVID-19 patients.

To give you a sense of what I mean by decisions staining souls lets do some mental maths here.

You're a surgeon in a hospital and you have to figure out how many ORs you can convert to COVID-19 patients. Lets say you have 8 ORs. If you convert 7 you can maybe save 168 ventilated patients a year... but if you have more than 1 emergency needing surgery at a time during that year the 2nd emergency might die before you can operate on them.

So you only convert 6 rooms... At the end of the year you find you only needed that 2nd OR 12 times... Sure, you saved those 12 lives at the cost of 24 others.

You did your maths in good faith but because you miscalculated more people died than needed to. You know this but tomorrow you have to go in and do it all again because your patients need you and if you break even more will die.

This sort of thing is what my Consultant colleagues are looking at right now. If we guess wrong now more will die than need to and we will carry that with us, always.

That's why I think we're going to have a lot of doctors quit medicine, develop addictions or commit suicide after this is over. I'm sure this will happen to other healthcare professionals also but when push comes to shove the Consultants and the NCHDs are the ones making these calls and the group I'm most familiar with obviously. Fortunately Consultants are tough... I think it is going to hit the junior doctors really hard. I'm worried about them, and the younger nurses too.

Anyways this is why I think we'll need to provide ring-fenced mental health care for healthcare workers after this. I think we owe it to them, especially the younger ones who haven't had time to develop the defences us old foggies have ;-).



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Thank you for taking the time to do this AMA, and also for all of your efforts in tackling this horror.
Thanks. Others are doing far more but I hope this thread increases my contribution a bit. I wish I could do more.
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17-03-2020, 05:33   #15
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And that's me done for the evening/morning. I wanted to answer the first two pages. I'm going to bed now, catch you all later today. I hope you found some useful information here and you got an insight into how Consultants' minds work. We're... different.
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