December 29 2020

With our government still insisting that secondary schools and Colleges return as usual after the Christmas break, the Labour Party are demanding to see the medical and scientific advice they have to support the plan. The Educational Unions say its unworkable, so yet again the poor army are called into help schools mass test all the children. My own view is that they will announce a U turn on New Years Eve when the decisions being made tomorrow will be made public. The tier structure is due a regular review. These reviews are comprehensive for each area, and consider the repercussions of the virus in each area including the impact on the local NHS.

We have not had Tier 4 long enough to see any benefit but the situation is considerably worse in most areas than it was 10 days ago.

I predict that they will conclude that we are seeing a general worsening of the situation especially with the NHS and that the whole country will be moved into Tier 4. This will not be sufficient on its own so large areas will move to a new tier 5 for at least 2 weeks with all teaching, including university teaching, done online at home. A ban on driving more than say 5 miles from home unless to go to work, get essential shopping or for medical appointments. We might then get the message that we have to stay apart to stop this.

I hope those who come out to celebrate New Year’s Eve will be hit with a £10,000 fine and 14 days incarceration in their own home.

Australia now has recorded a case of the South African Variant of Covid. They have threatened to deport the mainly Britains who gathered in a large group to party on the beaches with no social distancing.

If you have been reading this regularly you do not need reminding that the conditions in our hospital are dreadful. The staff all battle on in extremely difficult conditions. In many areas numbers have already passed the peak of the first wave. One of the things that has changed is that we are getting better at keeping people alive. This means they stay in hospital for longer and are less likely to go on a ventilator, so more beds are needed this time round. The Nightingale hospitals are there ready for action but we have almost run out of staff to run them. So many are either ill themselves, exhausted or self isolating. Medical students, paramedic and nursing students and recently retired staff are all helping out now.

I am becoming increasingly aware of inconsistencies in the advice being given on the 111 system and the skill and understanding of some staff. Here is a personal example. I now have the day today care of my stepson, now aged almost 40 but is vulnerable and suffers from schizophrenia. A few days before Christmas he told me he had a cold and sore throat with a cough. It seemed to clear completely in 2 days and on Christmas day he told me he was well and I collected him for lunch as planned. He seemed ok. Half way through lunch he suddenly said ‘I cannot smell or taste this’. Alarm bells rang. When I took him home I strongly advised him to ring 111 and arrange to have a test. He did this the next day, Boxing day. They said he could not have a test but must self-isolate for 10 days! To me he had clear symptoms for 6 days and should have a test. That leaves me wondering about my risks. With that background I will also continue to stay at home, but if I get symptoms at all I will request a test. If they won’t let me have one, there will be an interesting argument which I will win!

One of the reason patients are staying in hospital longer is due to the increased use of proning and the use of CPAP masks rather than intubation. This requires more oxygen than some hospital piping systems can cope with. The Queen Elizabeth hospital in Woolwich had to declare an internal major incident on Sunday when they nearly ran out of oxygen. Ambulances were diverted and some patients moved to other hospitals. Many off duty staff were called back. The crisis was resolved later that night. During the first lock down, Walford and Scunthorpe hospitals had similar problems. We have seen several disasters in ITUs abroad due to oxygen fed fires. Normal room air contains about 20% oxygen, where a lot of oxygen equipment is being used the concentration can rise to about 23%. If it goes higher there is a greatly increased risk of fire, the last thing we ever want on an ITU. Every unit now has to regularly check the ambient oxygen levels.

Sky News report that Russia has finally admitted that their death rate is 3 times greater than previously reported. The revised total is 186,000 which has risen from the previous figure of 55,265. This now puts them third in the league of world deaths led by the USA, then Brazil with Russia third and India 4th. The statistics are still badly affected by the holiday and yet again there are no hospital statistics for after Christmas. However, the number of cases testing positive was 53,125, a new all- time record, and is a rise of over 50, 000 in the 7 day average. There were 357,238 tests done yesterday so they were a lot short of the capacity of 500,000 tests per day, they could easily have tested my poor step son had they been so inclined.

There is no doubt we have a tough time ahead and hibernation seems an attractive offer. We will see leaked information tomorrow and the definitive changes on Wednesday. Be prepared for tough decisive action.

Meanwhile let me know your thoughts. Just stay at home till next year and remember the Hands, Face, Space rules, set a good example to everyone and we can stay safe. Vaccines are coming in force in only a few days now.

Keep yourselves safe.

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