Friday 17 April 2020

Ventilator Blues

Following my rant a couple of days ago about dumb questions by journalists (A Duty Of Care? 15 April) the journalists haven't upped their game yet. At yesterday's briefing they plugged away trying to get the First Secretary to speculate about how restrictions might be eased when the government has evidently decided not to play that game. "It's all over the papers, why don't you join in?" was the gist of what one of them said. Raab stuck to his boring brief when perhaps he should have gone off piste and said yes, we read the papers and you can speculate. But if we start listing possible ways of easing then some folk will be disappointed if and when we take different decisions, so we're just not going to do it. This would have the enormous benefit that, on future days, he can refer back to this answer, cut the journalist off, not allow an undeserved supplementary and move on.

They are also still hung up on whether the total number of deaths announced daily is right, rather than what really matters, the trend. So I got nerdy and looked up yesterday's official stats. If you go to the NHS England website* you can see all sorts of detail on the daily deaths announced and on the totals to date, the latter broken down by health trust. The daily total for England logged between 5pm on 14 April and 5pm on 15 April was announced on 16 April as 740. These deaths are then attributed to the date of death: 151 on 15 April, 314 on 14th, 122 on 13th, 49 on 12th and then reducing numbers stretching all the way back to 9 March. (The ones so far back are presumably due to corrected dates or reattributed reason for death).

So with this noise on the line you can see why the precise daily total can't be taken at face value. And as these are deaths in hospitals, which are much easier to count, you can also see why looking at the daily total for all deaths, not just in hospitals, could be misleading. The numbers will still be catching up with delayed reporting over the long Easter weekend so the decline from daily numbers of over 900, while encouraging, is not yet a firm trend. I still think a rolling 3 day or even weekly total would be a better indicator.

Meanwhile the print journos aren't getting better either. The Daily Mail Health Editor started her report yesterday by saying:
"Fears have been raised that care home residents who are seriously ill with coronavirus are being kept away from hospital after national guidelines suggested they should only be admitted if 'appropriate'."
Is she suggesting that such patients should be admitted to hospital if it's inappropriate? I guess the incipient mental health issues in the community that people have been warning about are becoming apparent....

One wonders what the Chief Medical Officer would say if he were to be asked what, in his judgement, would be the proportion of residents in care homes for whom hospital treatment might be appropriate in the event they contracted coronavirus and became ill enough for hospitalisation to be considered. Actually one doesn't, he would of course avoid the question. But if you could get him to speculate... Well Chris Whitty here's my guess given my experience of visiting care homes over a 7 year period. Very few of the residents I saw in that time would be strong enough to survive pneumonia and coronavirus is much worse for the elderly with multiple pre-existing health conditions. So I would guess that the percentage for whom such a trip would make sense must be very low, possibly of the order of 10%. OK, that's a guesstimate but I'm adamant that, in the phrase the medics use, for the rest hospitalisation would not be in the best interests of the patient.

Mrs H and I have seen first hand what the medics can do for such very frail and often highly mentally incapacitated patients when they deploy all possible means and end up extending an already extremely poor quality of life in an even more limited capacity. In the words of a doctor who appeared at the bedside of a relative who nobody expected to survive the previous night "there's been too much intervention". Spotting me and Mrs H he quickly started talking to the nurses in a more coded way, though I should have interjected "absolutely right, mate". Such experiences have at least prompted me to make a "living will" type document with the health and welfare power of attorney lodged at the solicitors for if and when the day comes, so I'm never "saved" in any such circumstances.

I'm left contrasting the apparent desire of some to want to try to save all life, however degraded and at whatever cost, with the  debate on assisted dying. I guess folk just have very contrasting values and see the world in very different ways.

Which leaves me singing along today with the Rolling Stones Ventilator Blues. I know, it's actually about gangsters or something but it's kind of relevant especially since it's from Exile on Main Street -  shouldn't that be exiled from main street at the moment?

Don't matter where you are, everybody, everybody gonna
Need some kind of ventilator, some kind of ventilator
Come down and get it
What you gonna do about it, what you gonna do?
What you gonna do about it, what you gonna do?
Gonna fight it, gonna fight it
Gonna fight it, gonna fight it

So that's journalists and people who want to send their dear old demented and very ill mum or dad with coronavirus to hospital randomly berated. Tomorrow's target? Plod probably even though that's admittedly an even softer target.....

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/

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