SARS CoV-2 coronavirus / Covid-19 (No tin foil hat silliness please)

[Wolverine]

DNR notices thought to have been given to patients with learning disabilities without consent. Shocking if true.

https://www.theguardian.com/world/2...-covid-19-patients-with-learning-difficulties

I don't believe this to be true. I'd be very surprised if it was to the extent its being reported. I'd be interested to hear findings more about it if its looked into.

"DNR notices" don't exist anymore in the UK. There used to be a red-bordered form denoting that but they've been replaced by advanced care plan (ACP) with a separate purple RESPECT form (Recommended Summary Plan for Emergency Care and Treatment) which codifies patient's wishes with regards to preferred place of care and ceiling of therapeutic intervention.

In the event patient were to lack capacity then discussion is had with family members. If somebody has lasting power of attorney for health reasons, their wish takes priority, otherwise its a designated next of kin whose input is sought out.

And that form has as a mandatory part filled in with regards to documenting what was discussed with family, where and when. And it is countersigned by a senior doctor (either registered GP or hospital consultant) with registration numbers.

Also to note that CPR is brutal. In elderly patients or those with co-morbidities, it is an undignified and cruel thing to do. The decision to do that or not do that, and also to offer ventilator or escalate to ITU is legally up to the medical team to decide. But we do take patients and families wishes on board as much as possible. Also DNACPR doesn't affect treatment or escalation of care. CPR also has a very poor survival in the context of a disease like COVID, it’s value is greatest following a heart attack, usually in a young-ish patient, but chances of surviving post-return of spontaneous circulation even in hospital setting is very low, something like 10%. And there is usually a lot of damage done due to hypoxic brain injury etc.

Learning disability in of itself in NOT a reason to say somebody shouldn't be resuscitated. Learning disability patients have hospital passports and care plans on how to ensure their hospital stay is as minimally traumatic as possible and so that they are holistically looked after in hospital and community. Separate from DNACPRs.

I've done DNACPR discussions with patients with learning disabilities but those who are really frail, elderly or with complex medical conditions and these consultations take hours, with feedback from patient, carers and families. It is an important discussion, reporting around it and understanding about importance aspects of it is pretty woeful in the UK.

There's more here
https://www.bmj.com/content/371/bmj.m4069

Sorry for sidetracking the thread, it is something pretty close to my heart for more than a few reasons.

 

[Wibble]

I don't believe this to be true. I'd be very surprised if it was to the extent its being reported. I'd be interested to hear findings more about it if its looked into.

"DNR notices" don't exist anymore in the UK. There used to be a red-bordered form denoting that but they've been replaced by advanced care plan (ACP) with a separate purple RESPECT form (Recommended Summary Plan for Emergency Care and Treatment) which codifies patient's wishes with regards to preferred place of care and ceiling of therapeutic intervention.

In the event patient were to lack capacity then discussion is had with family members. If somebody has lasting power of attorney for health reasons, their wish takes priority, otherwise its a designated next of kin whose input is sought out.

And that form has as a mandatory part filled in with regards to documenting what was discussed with family, where and when. And it is countersigned by a senior doctor (either registered GP or hospital consultant) with registration numbers.

Also to note that CPR is brutal. In elderly patients or those with co-morbidities, it is an undignified and cruel thing to do. The decision to do that or not do that, and also to offer ventilator or escalate to ITU is legally up to the medical team to decide. But we do take patients and families wishes on board as much as possible. Also DNACPR doesn't affect treatment or escalation of care. CPR also has a very poor survival in the context of a disease like COVID, it’s value is greatest following a heart attack, usually in a young-ish patient, but chances of surviving post-return of spontaneous circulation even in hospital setting is very low, something like 10%. And there is usually a lot of damage done due to hypoxic brain injury etc.

Learning disability in of itself in NOT a reason to say somebody shouldn't be resuscitated. Learning disability patients have hospital passports and care plans on how to ensure their hospital stay is as minimally traumatic as possible and so that they are holistically looked after in hospital and community. Separate from DNACPRs.

I've done DNACPR discussions with patients with learning disabilities but those who are really frail, elderly or with complex medical conditions and these consultations take hours, with feedback from patient, carers and families. It is an important discussion, reporting around it and understanding about importance aspects of it is pretty woeful in the UK.

There's more here
https://www.bmj.com/content/371/bmj.m4069

Sorry for sidetracking the thread, it is something pretty close to my heart for more than a few reasons.

Not sidetracks as it has been reported as a covid related issue. Lets hope it isn't as reported as it would be horrific if it is.

And I've had a little to do with CPR and it is indeed brutal. And as you say the chances of success are poor. In the 80's I was a dive instructor working in QLD and we had a guy walking past arrest on the beach and we started CPR almost soon as he keeled over. We even had oxygen resus gear to give us a bit of respite but despite our best efforts he died in the medical plane on the way to hospital (we were on a very remote island). The two of us were superfit but we were really struggling as we had to keep going for about 2 hours. I can still hear the broken ribs grinding together. And the other guy can't face drinking champagne any more as the guy had just had a champagne breakfast and threw it up while we were giving mouth to mouth.

Strangely the guy I worked with had a diving accident the year before and had to be resuscitated and air evacuated in the same way. Despite arresting 7 times he lived. Amazingly.

 

[Ecstatic]

Without going into any detail- the unemployment, the mental health issues and the missed cancers all will do more harm than covid will

I also believe that the cure is worst than the disease.

The short and long-term negative impact of current public policies in terms of economic, social, and individual health is an elephant in the room.

At the international level, I would also mention the various direct/indirect consequences of over-indebtedness and a lack of economic activity on communities (poor countries reliant on tourism, children will never see school again, etc.).

Lockdown is difficult. Nobody would disagree with that. But let’s not forget that the alternative is people left to die on the street after road accidents because there isn’t a spare ambulance, or hospitals turning away seriously ill patients because they don’t have the beds or staff to treat them.

Portugal has had to send critically ill patients to other countries because their hospitals completely ran out of capacity. And that’s with a lockdown.

Taking all of that into account, I think it’s badly missing the point to talk about a year or two missing out on our usual fun as the real issue here.

The real issue is that the healthcare system has been neglected and badly run for a long time for different reasons.

The real solution would have been to really strengthen the healthcare system (means, efficiency, projects, etc.) given the fact the pandemic started one year ago...

To govern is to foresee

 

[Pogue Mahone]

I also believe that the cure is worst than the disease.

The short and long-term negative impact of current public policies in terms of economic, social, and individual health is an elephant in the room.

At the international level, I would also mention the various direct/indirect consequences of over-indebtedness and a lack of economic activity on communities (poor countries reliant on tourism, children will never see school again, etc.).



The real issue is that the healthcare system has been neglected and badly run for a long time for different reasons.

The real solution would have been to really strengthen the healthcare system (means, efficiency, projects, etc.) given the fact the pandemic started one year ago...

To govern is to foresee

The healthcare system has been under-funded and under stress for decades. That’s a super tanker nobody can turn round in a single year. Even at a purely practical level surely you can see how impossible that is? Say we decide we need to double the number of intensive care physicians and ITU trained nurses. How do you magic these individuals out of thin air, in under 12 months? All at a time when the existing workforce - who would need to supervise trainees - is dealing with unprecedented stress and workload (and that’s with a lockdown)

Obviously, beefing up our services to cope with the next pandemic will have to be a priority in the years ahead. It was never going to help us avoid lockdowns with this pandemic though.

 

[Ecstatic]

The healthcare system has been under-funded and under stress for decades. That’s a super tanker nobody can turn round in a single year. Even at a purely practical level surely you can see how impossible that is? Say we decide we need to double the number of intensive care physicians and ITU trained nurses. How do you magic these individuals out of thin air, in under 12 months?

I don't disagree with you.

We are in a period of war against Covid and I don't know if all the possible emergency measures (retraining, redeployment of staff, requisitions) have been really considered to support current hospital staff in charge of Covid patients.

 

[Eire Red United]

The healthcare system has been under-funded and under stress for decades. That’s a super tanker nobody can turn round in a single year. Even at a purely practical level surely you can see how impossible that is? Say we decide we need to double the number of intensive care physicians and ITU trained nurses. How do you magic these individuals out of thin air, in under 12 months? All at a time when the existing workforce - who would need to supervise trainees - is dealing with unprecedented stress and workload (and that’s with a lockdown)

Obviously, beefing up our services to cope with the next pandemic will have to be a priority in the years ahead. It was never going to help us avoid lockdowns with this pandemic though.

All valid points- I just find it disgraceful that the government could pull billions out of nowhere for all the various covid schemes- furlough etc, but the health service is still criminally underfunded.

 

[Wolverine]

I don't disagree with you.

We are in a period of war against Covid and I don't know if all the possible emergency measures (retraining, redeployment of staff, requisitions) have been really considered to support current hospital staff in charge of Covid patients.

Its all been done and we are still buggered.
I’ve had to do nursing and healthcare assistant modules to do those duties as well as my usual role.
All specialties have stopped outpatient clinics unless its cancer or suspected cancer. We’ve all had our training cancelled, exams cancelled. Doctors and nurses come out of retirement, medical students are helping on wards too.

 

[Pogue Mahone]

All valid points- I just find it disgraceful that the government could pull billions out of nowhere for all the various covid schemes- furlough etc, but the health service is still criminally underfunded.

In our last budget there was a huge increase to the HSE funding. Too little, too late though.

You also can’t have permanently increased capacity to cope with very rare events. It’s the same when Ireland grinds to a halt in the snow, while other countries cope fine. It doesn’t make economic sense to invest in tonnes of snowploughs and gritters and hire permanent employees to drive them when we only get heavy snow once a decade. Same logic applies to ITU beds/staff.

I do agree that our health service should have been better funded to begin with. And it it was, we’d have been able to get away with a less strict lockdown. The difference would be fairly minimal though. Exponential growth means that no matter how well resourced the health service it can get overwhelmed scarily quickly if the virus is completely unchecked. Hence even health services with much better funding than ours also hit the wall.

 

[Reddevildans]

Ah yes, definitely the priority.

When do schools in France reopen?

No idea mate

 

[Ecstatic]

No idea mate

September

 

[11101]

The new Italian government is getting off to a good start.

Ski slopes were supposed to reopen tomorrow morning in low infection areas, ordinance was signed over the last week to set the rules and allow it to go ahead. Resorts stocked up and prepared for the reopening, and people bought lift passes and hotel rooms. At 7pm this evening the government changed its mind and has decided they cant open until at least March, and is now threatening another nationwide lockdown after weeks of falling case numbers.

To say people are annoyed is an understatement. Nobody is going to listen to a word they say if they keep it up.

 

[Traub]

Do you guys think the big cities will see enough people moving out to cheaper cities or the countryside to see a knock on effect to rent and house prices?

I think it depends on how long this actually lasts. A medium-term impact (i.e. 3-5 years) of constant lockdowns, WFH etc., and I think prices will drop. However, if all of this is over in the next year, most people will go back to normal.

 

[golden_blunder]

I think it depends on how long this actually lasts. A medium-term impact (i.e. 3-5 years) of constant lockdowns, WFH etc., and I think prices will drop. However, if all of this is over in the next year, most people will go back to normal.

My question I guess is loaded around the assumption that many firms will go to a wfh model where maybe you only have to go into the office once a week or so

 

[Traub]

My question I guess is loaded around the assumption that many firms will go to a wfh model where maybe you only have to go into the office once a week or so

Ya, it's a tough one. I think it's going to be an option for some, but overall I don't think it will dramatically reduce house prices - there will always be the demand to live in the fanciest places.

 

[Sandikan]

Ya, it's a tough one. I think it's going to be an option for some, but overall I don't think it will dramatically reduce house prices - there will always be the demand to live in the fanciest places.

The fanciest places yet, but not necesssarily the places that aren't fancy at all, but are 30-45mins from London for eg.

 

[Sandikan]

My question I guess is loaded around the assumption that many firms will go to a wfh model where maybe you only have to go into the office once a week or so

Probably depends on the dynamics of your team as well.

My current team are spaced over the country, whereas my job before was all in the same office.
Latter makes more sense to get back to regular office time than the former.

Probably also depends on whether your company own or lease the offices.

 

[Penna]

The new Italian government is getting off to a good start.

Ski slopes were supposed to reopen tomorrow morning in low infection areas, ordinance was signed over the last week to set the rules and allow it to go ahead. Resorts stocked up and prepared for the reopening, and people bought lift passes and hotel rooms. At 7pm this evening the government changed its mind and has decided they cant open until at least March, and is now threatening another nationwide lockdown after weeks of falling case numbers.

To say people are annoyed is an understatement. Nobody is going to listen to a word they say if they keep it up.

I've just read that new data has shown that nearly 18% of new cases of Covid in Italy are now the UK variant, and I think this may have caused a bit of a panic. I don't know why they've waited until today.

edit - I don't think our cases are falling fast enough really. We've had higher numbers than the UK for a couple of days. I think the slow roll-out of the vaccines isn't helping.

 

[Paul the Wolf]

September

They started opening on 11 May 2020. Opened fully 22 June 2020 and been open ever since except where individual schools were shut because of Covid.

Have one grandson in collège and one in lycée and they haven't missed a day since June 22 (apart from school holidays of course)

 

[Wibble]

Australia beginning to discuss reducing the already small number of Australian's allowed to return to limit the potential for the new more infectious variants from getting lose in the community until we have significant vaccination. It could be that almost all are locked out barring compassionate grounds. There is also pressure to improve quarantine procedures and all far more back. We will see I guess.

 

[11101]

I've just read that new data has shown that nearly 18% of new cases of Covid in Italy are now the UK variant, and I think this may have caused a bit of a panic. I don't know why they've waited until today.

edit - I don't think our cases are falling fast enough really. We've had higher numbers than the UK for a couple of days. I think the slow roll-out of the vaccines isn't helping.

That's the problem with it, after having approved the reopening four days ago. The governors of the Northern regions are going mad.

Personally I'm starting to find it all a bit testing. I cant ski on a mountainside, go to the gym, or play football outdoors. But I can go and sit inside in a bar with 50 other people...

 

[utdalltheway]

The new positive test numbers seem to have dropped a lot in my area, Orange County, California. The numbers are at mid November levels, before the big rise in cases due to thanksgiving, etc.
I suppose I should check other areas too, especially nearby (LA, etc) but it seems quite positive, right?

 

[Regulus Arcturus Black]

Portugal has had to send critically ill patients to other countries because their hospitals completely ran out of capacity. And that’s with a lockdown.

There’s a counter argument to that though Pogue, as in Portugal is exactly the situation the health authority here warned about and wanted to avoid at all costs.
If lockdowns are misused, they can, and have lead to champagne cork effects when lifted.

Instead of flattening the curve over the entire duration of the pandemic, Portugal misused lockdowns in the Spring and November to devastating effect.
Arruda himself blamed the November restrictions “in preparation for xmas” for causing a champagne cork clusterfeck.

 

[Ecstatic]

They started opening on 11 May 2020. Opened fully 22 June 2020 and been open ever since except where individual schools were shut because of Covid.

Have one grandson in collège and one in lycée and they haven't missed a day since June 22 (apart from school holidays of course)

Thanks

I wrote September because I would have expected normal summer holidays from June to August

 

[ThierryHenry]

We've got all staff at home at the moment, other than a few who have to be in to keep the office functioning. We're finding that people are much less keen on working from home full time during this lockdown. The novelty seems to have worn off and the fatigue is kicking in. We're being told that people are sick of being at home alone all day and are missing colleagues. A few people seem to be having a rough time of it.

I think there's a definite place for working from home for some of the working week. Perhaps some will work exclusively from home if it suits them, but I don't hold with the idea that we'll move to virtual offices generally.

I agree with all of that, matches my experience exactly.

 

[Paul the Wolf]

Thanks

I wrote September because I would have expected normal summer holidays from June to August

OK. They had two full weeks until they broke up for summer holidays on 3rd July.

 

[Grinner]

The new Italian government is getting off to a good start.

Ski slopes were supposed to reopen tomorrow morning in low infection areas, ordinance was signed over the last week to set the rules and allow it to go ahead. Resorts stocked up and prepared for the reopening, and people bought lift passes and hotel rooms. At 7pm this evening the government changed its mind and has decided they cant open until at least March, and is now threatening another nationwide lockdown after weeks of falling case numbers.

To say people are annoyed is an understatement. Nobody is going to listen to a word they say if they keep it up.

I'd say skiing is out this year. I was hopeful but didn't bring any gear with me. What's it like in Milan? Here in Florence we just went to Orange so everybody was out this weekend living it up despite the freezing temps.

 

[11101]

I'd say skiing is out this year. I was hopeful but didn't bring any gear with me. What's it like in Milan? Here in Florence we just went to Orange so everybody was out this weekend living it up despite the freezing temps.

Life is almost back to normal here. Restaurants and bars are full and the streets are busy, so I doubt it will be long before cases go up again.

I'm just going to go over to Switzerland for skiing now i think, as will a lot of people.

 

[Grinner]

Life is almost back to normal here. Restaurants and bars are full and the streets are busy, so I doubt it will be long before cases go up again.

I'm just going to go over to Switzerland for skiing now i think, as will a lot of people.

Once inter-regional travel is allowed I'd be doing that too.

 

[golden_blunder]

Are you living in Italy now @Grinner?

 

[Grinner]

Are you living in Italy now @Grinner?

Yes. I made it. Even visited Penna and Oates at their home.

 

[golden_blunder]

Yes. I made it. Even visited Penna and Oates at their home.

Great stuff. How’s the transition been?

 

[Grinner]

Great stuff. How’s the transition been?

Very enjoyable. Nice to be away from the craziness and Florence is a pretty nice place to be restricted to.

 

[golden_blunder]

Very enjoyable. Nice to be away from the craziness and Florence is a pretty nice place to be restricted to.

Awesome. You’ll have to fire up a few photos when you’re out and about again

 

[golden_blunder]

Was checking our passports last night, just popped in my head not planning any trips.

my wife’s U.K. passport has expired in September- can do it online but will take at least 8 weeks. Not easy to find a place locally to take pictures either.

my eldest sons Irish passport expires end of this month but the passport office is totally closed so no chance of getting that done anytime soon

 

[Eire Red United]

Was checking our passports last night, just popped in my head not planning any trips.

my wife’s U.K. passport has expired in September- can do it online but will take at least 8 weeks. Not easy to find a place locally to take pictures either.

my eldest sons Irish passport expires end of this month but the passport office is totally closed so no chance of getting that done anytime soon

Think you can apply online for Irish passport and take the photo at home yourself, assuming it’s the same for UK one?

 

[golden_blunder]

Think you can apply online for Irish passport and take the photo at home yourself, assuming it’s the same for UK one?

My experience of doing passport photos at home is that they get rejected. That’s why I liked using https://www.camera.ie/ because they check it passes the requirements before emailing it to you.

can’t find anything about Irish passport online applications for renewals. Maybe they do but can’t find it, could only find a message about offices being currently closed.

https://www.dfa.ie/passportonline/

Which I do get as it’s level 5 and we don’t have reason to be travelling. My wife is just worried in case anything happens to her parents in England

 

[Mr Pigeon]

More coronavirus funding for Scotland, more moaning from the SNP for increased devolution. I'm a bloody nationalist (albeit Labour voting nationalist, weird huh) and even I'm sick and tired of it now. Westminster done good. Leave it at that. There will be plenty to complain about tomorrow or something.

 

[Eire Red United]

My experience of doing passport photos at home is that they get rejected. That’s why I liked using https://www.camera.ie/ because they check it passes the requirements before emailing it to you.

can’t find anything about Irish passport online applications for renewals. Maybe they do but can’t find it, could only find a message about offices being currently closed.

https://www.dfa.ie/passportonline/

Which I do get as it’s level 5 and we don’t have reason to be travelling. My wife is just worried in case anything happens to her parents in England

I renewed mine online the last time as far as I remember. Maybe the staff need to be physically on site to process online applications. If the worst does happen, slip up to Belfast and you’ll get over to England on a driving licence.

 

[Sparky_Hughes]

Was checking our passports last night, just popped in my head not planning any trips.

my wife’s U.K. passport has expired in September- can do it online but will take at least 8 weeks. Not easy to find a place locally to take pictures either.

my eldest sons Irish passport expires end of this month but the passport office is totally closed so no chance of getting that done anytime soon

Do you have Timpsons in Ireland, if so they will take the photos to the right standard and email them to you to go on your application.

 

[F-Red]

I've had an alert on the covid app this lunchtime saying I've come into contact with someone that's tested positive. It's told me to isolate until Friday at midnight.