Tomás Ó Flatharta

Looking at Things from the Left

“ Dialysis Machine Shortages Lay Bare Wider Threat From Covid-19” – Bombshell Story from the Financial Times, April 7 2020

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A bombshell story appears on the same day that most Mainstream Media Outlets Worldwide are Over-Blitzing readers about the British Prime Minister staying in hospital.

Leading London hospitals are running short of vital equipment in intensive care wards, including blood dialysis machines needed to treat patients suffering from coronavirus-related kidney failure, according to a leaked memo. The shortages, which go far beyond concerns about the lack of ventilators and protective equipment, emerged from a conference call of some 80 senior National Health Service doctors. They illustrate the way Covid-19 can damage much more than the lungs and respiratory system in patients who become seriously ill — affecting the kidneys, heart and occasionally even the brain. The 1,000-word memo, seen by the Financial Times, is written by Daniel Martin, head of intensive care for serious infectious diseases at the Royal Free Hospital. It paints a picture of doctors and nurses still scrambling to develop treatments for coronavirus as the shortages bite.

The Financial Times Uses Excellent Editorial Judgement – Covid-19 Can Trigger Multi-Organ Failure – Critical Shortage of Dialysis Machines in the British State – “Johnson remains in hospital” a minor story

Paul Hunter, professor in medicine at the University of East Anglia, told the FT that, although the public generally views Covid-19 in terms of respiratory failure, hospital doctors are experiencing it as a multi-organ disease. “Once you become really ill, more than your lungs will suffer,” said Prof Hunter. He did not take part in the conference call. Analysis at the weekend by the Intensive Care National Audit and Research Centre found that of 690 UK patients admitted to critical care with confirmed Covid-19, 25 per cent needed advanced cardiovascular support, 18.5 per cent required renal support and 4.5 per cent received neurological support.

The summary of the NHS hospitals call, which was written by Dr Martin, said Covid-19 is not simply a one-organ disease that attacks the lungs, but is also causing “high rates” of acute kidney failure as a result of complications in treating the disease. The summary of the call, which was designed to share information about how best to treat coronavirus patients, warned nurse-to-patient ratios are at six-to-one in intensive care wards with hospitals using everyone “from med students to dental hygienists” to absorb the overload. Dr Martin warned “overzealous” use of diuretics such as Frusemide were leading to “unnecessary” kidney complications and related blood clotting issues. He also flagged the “higher-than-predicted need” for kidney treatments, while noting that several London hospitals, including King’s College Hospital, are running short of blood-filtration machines. He wrote that King’s was “running out of” CVVHF blood-filtration machines and an unnamed centre had “run out of pumps” used to administer some drugs. The note, designed to share insights and develop best practice among colleagues, painted a picture of the pressure on the NHS as hospitals race to train sufficient doctors and staff wards that are already facing shortages. “Most centres now getting towards 1:6 nursing ratio with high level of support workers on ICU [Intensive Care Unit],” Dr Martin wrote. “Training has largely fallen by the wayside as it is too large a task. People are being trained on the job,” he added. He also chided colleagues that they need to catch up with other hospitals in seconding staff, and noted some “non-medical staff” were refusing to enter intensive care wards — a practice that needed to be tackled. “We need one support worker per patient. Other centres are using everyone they have. From med students to dental hygienists. We are behind the curve ‘++’ with this,” he wrote. “Last time I was on a night shift, theatres were full of non-medical staff refusing to help ICU — this is unacceptable,” he added. The account of the call emerged as the NHS across London braced itself for the “peak” of Covid-19 admissions, around Easter, with government models expecting this in the next seven to 10 days. Dr Martin’s note to colleagues also revealed the extent to which doctors are still learning about treatments for the virus, despite all the information being passed back from China and hotspots hit earlier in the pandemic in Europe, such as Lombardy in northern Italy. He warned, for example, to avoid ventilation too early in the intensive care process as this “may be harmful”, while noting patients were having to go back on to ventilators if taken off too early. “Not many patients have reached extubation yet in London,” he wrote, before adding “re-intubation seems to be common” and his doctors should “wait longer than usual before extubating”. “An extubation protocol is needed immediately,” he added.

Another evolving area of coronavirus care is the question of “fluid balance” among patients, and how far they should be hydrated. “All centres agreed that we are getting this wrong,” he wrote. Dr Martin concluded with a final note of uncertainty, arguing that colleagues “desperately need to look at our own data to understand whether we are getting this [treatment] right or not”. A spokesman for the Royal Free Hospital declined to comment on the communication. A request for an interview with Dr Martin was declined, citing his work commitments in managing the response to the virus.

Activists in Ireland, and elsewhere, need to find out the real position in their own medical system – this crisis of the British State Health Service, the NHS, impacts directly on the part of Ireland called “Northern Ireland”.

Some Financial Times CoronaVirus Articles are Free to Read Here :

Irresponsible Behaviour Risks Lives

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