I think I owe you an apology Peter. I skimmed through your post and thought ’that’s a bit alarmist’ but on closer reading I agree.
I think most people on the NHS will just get some oxygen, a cannula and nursing care. But that’s no small thing. Hopefully that will be enough for most.
I think many things will influence mortality for ventilators. One will be learning how to use them optimally in COVID. Another will be availability (the greater the availability, the less the barrier to putting people on them who are unlikely to survive). But also culturally, some places are probably much more likely to put people on ventilators even if treatment is going to be futile, and others might even be more likely to put people on ventilators if treatment is unnecessary. Though I am now hearing mutterings that people do better if ventilated early.
I had a friend at university who went home to China and got hospitalised and put on a drip for diarrhoea. I was horrified to hear of this happening to a twenty-something year old – how ill had she been? I quizzed her and the answer was about ill enough that my mother would have bought a bottle of Lucozade. I find myself hoping that a tendency to overtreatment might be part of the reason China put so many people on ventilators, and also part of the reason their patients seemed to do so well. But I find the idea that the outbreak was much bigger than admitted all too plausible.
Can we also have a clap for poor Scottish farmers? We are “key workers” after all.
And while we’re clapping, what about our feed merchants, vets, agricultural engineers, fuel merchants, welly suppliers, baler twine makers, gun and cartridge makers, slaughtermen and knackermen, quality assurance chaps and chapesses, ear tag and chip reader makers, fencing contractors, accountants, seed merchants, tractor factories, haulage contractors, fertilizer and chemical companies, silage wrap makers… and all their respective supply chains without which we farmers would just be an unproductive waste of taxpayers money?
As a doctor I think the best way to make hospitals efficient would be by positioning snipers on every hospital rooftop with strict orders to shoot anyone who gets closer than 1000 yards and has any kind of business/management kind of degree and intends to have any say in how the hospital is run.
Before lots of “healthcare reforms” starting in the 90s, hospitals were basically run by doctors and focused on treating patients, not on making money. Hospitals should not make money, in the same way as the police or fire services should not. If everyone in the “industry” (another terrible term for our sector) got rid of all the documentation duties that are important for the health insurance only, we’d all have a lot more time on our hands to actually treat our patients…
I agree with you about rubbish collectors Fuji. I doubt they are at quite the same risk as hospital staff, but many people do necessary jobs and I feel very embarrassed at being clapped when we have hardly had any cases yet. It’s nice to be appreciated but the people I really feel for are the self-employed and soon-to-be-made redundant. We are getting deliveries of gifts and food, which they need far more than we do.
That said, yesterday I got coughed all over by someone whose whole family are ill with a dry cough. I went to get a mask and got shouted down by one of the nurses – the patient tested -ve for COVID 5 days previously so a mask was officially unnecessary and I was wasting scarce resources. I pointed out that our test is only meant to be 80% sensitive so it is quite possible that the patient had the virus despite a negative test.
I believe I’m correct in saying that stockpiling of masks, gowns and visors isn’t an NHS function but a public health one – the funding is separate. But Jeremy Hunt personally took many of the decisions on what to order so I do hold people currently in power to account. I don’t think this is a public v. private healthcare debate. Stockpiling medical supplies is a job for governments, not private businesses. I doubt any private companies were stockpiling equipment ready for a pandemic (other than perhaps with a view to price gouging). But personally I believe that we should have opted for ensuring excess manufacturing capacity rather than holding large stockpiles: nobody could have stockpiled enough equipment for a global pandemic of this magnitude, and some of it degrades over time anyway so it would have been wasteful.
At risk of stating the obvious, it wasn’t NHS and key workers ideas to be clapped. I think most people in the NHS are a little tired and cynical of the “saving angel” stereotypes. That said, it would be churlish to shrug it off, and there’s a lot to be said for gestures that unite us at times like this.
A few posts from the doctor’s forum:
“I don’t want a round of applause, I want some proper PPE, basic hygiene measures in the hospital and not being treated like canon fodder by halfwit managerial armchair generals eyeing the next CEA or fancy job title.”
“Most of the people who turn out and clap can’t do anything about your lack of PPE or all the other crap going on right now. They do appreciate what frontine staff do. They want to show it. It may not be any use to you but it makes people feel better at a time when a lot of them are scared and isolated. If it works for them, let them get on with it.”
“I think clapping is adorable, when it’s done by ordinary people who appreciate the NHS.
I think it’s narcissistic psychopathy when millionaire/billionaire royals and politicians do it. They can and should do better and more. Luxuriating in their palaces and clapping. FFS."
“Keyworker: (noun) A person whose work is overlooked and unappreciated before the shit hits the fan”
As a doctor I think the best way to make hospitals efficient would be by positioning snipers on every hospital rooftop with strict orders to shoot anyone who gets closer than 1000 yards and has any kind of business/management kind of degree and intends to have any say in how the hospital is run.
Now where’s the “like” button?!
And if our health service was still run by medics, I wonder whether they would have allowed the results of Exercise Cygnus to be covered up by Messrs May, Hammond and Hunt?
I have a slightly different view, which is that I’ve worked in well managed hospitals and poorly managed hospitals and you can certainly tell the difference. Good managers are worth their weight in gold and deserve to be appreciated. Most doctors are not good managers, but they are more likely to have the patients’ needs at heart.
I completely agree about the bureaucracy, though in the UK ours is more about medicolegal documentation.
kwlf wrote:
At risk of stating the obvious, it wasn’t NHS and key workers ideas to be clapped. I think most people in the NHS are a little tired and cynical of the “saving angel” stereotypes. That said, it would be churlish to shrug it off, and there’s a lot to be said for gestures that unite us at times like this.
This is my concern about the clapping. I think people in the NHS are doing a great job and should be thanked. But in our village there is a sort of shaming going on if you don’t clap – ignoring whether you might have something else going on that prevents you doing it, or might just prefer not to do it. Significant virtue signalling going on,
The clapping thing… One of the more bizarre phenomena of this crisis. Like a nurse said, we need money and proper equipment, not applause.
The ideal scenario is to live far enough away from the next house that nobody can tell if you clap or not 
However the real issue remains: the medical staff don’t have anywhere near proper equipment, for a virus which will kill quite a number of them, especially as they end up getting large doses of it so it will kill even the young and healthy ones. I don’t think there is an easy solution to this. So they really are extraordinarily brave.
Re manager selection, I think – in the UK, and probably most other places – anyone with an MBA should be automatically barred unless they have masses of relevant experience post-MBA. Most of the courses are run by 2nd or 3rd tier “colleges” and people get the diploma purely for career enhancement. And, quite a few of the diplomas have been available for purchase 
It works quite well in big institutions (NHS, CAA, etc).
I have known several people who did them and all said they were full of useless crap. Much of the job is “people management” and one gets more out of specialised people-management courses.
stockpiling of masks, gowns and visors isn’t an NHS function but a public health one – the funding is separate
The funding may be nominally separate but in the UK there is only one “NHS” so isn’t it the same thing really?
