Coronavirus

[Ex contributorParticipant @mgnbuk]

I agree that our country appeared to be woefully unprepared for a pandemic and I hope those who neglected preparations are taken to task and learn from this situation.

Any preparation (i.e. stockpiling of PPE, purchase of testing & intensive care equipment etc.) would have had to have taken place well before the current situation started in Wuhan. It appears that most (if not all) of the required consumables are not made here, and when the problems started either the items could not be obtained (China – due to lockdown) or would not be supplied (certain European counties – due to export bans).

Preparations and/or an ability to be able to cope in future would seem to me to start with an ability to produce the items we need (or may need) here, without having to rely on others to provide them to us. Perhaps this situation will cause a re-think about "globalisation" – it does not appear to be serving us well at the moment.

Maybe such investment – in stockpiled items or increased medical & testing capability – should be considered part of the Defense budget, as it is obvious that not all threats towards the Country are of a Military nature.

Nigel B.

[Neil WyattModerator @neilwyatt]

Anyone considering going shopping might want to try online.

I went on the Morrisons website before travelling, more in hope than expectation, and got a slot for 5:30 tomorrow, which saved me the journey.

Was able to replensish dog & cat food, loo roll and milk as well as some fresh food, although their stocks of fresh fruit and veg are very sparse. Onion soup anyone?

Neil

[Ex contributorParticipant @mgnbuk]

Was able to replensish dog & cat food, loo roll and milk as well as some fresh food, although their stocks of fresh fruit and veg are very sparse.

I did a shop at the local (West Yorks – not far from Morrisons head office) Morrisons for the MIL last week – fresh fruit and veg, meat & fish and in-store bakery bread products were plentiful, but no loo roll or flour. Can't find any type of flour locally.

Nigel B.

[V8EngParticipant @v8eng]

Something that seems to be getting forgotten in the criticism of lack of PPE stock is that things like face masks have an expiry date.. You cannot therefore just fill a warehouse and leave it all there for many years just in case.

[Roger ClarkParticipant @rogerclark]

Posted by V8Eng on 09/04/2020 15:57:42:

Something that seems to be getting forgotten in the criticism of lack of PPE stock is that things like face masks have an expiry date.. You cannot therefore just fill a warehouse and leave it all there for many years just in case.

You've hit the nail on the head, you can't prepare for pandemics when you don't know when or where they will happen, what products/ equipment you will need and in what quantity, the same as you don't keep and pay for an armed force to fight a world war.

What can be done and lessons to be learnt are contingency planning, ramping up production, production repurposing etc, really what is happening now but planned for and ready to be put in place when needed.

Roger

[pgk pgkParticipant @pgkpgk17461]

<<Hi Guys

Things are moving apace at our Lab. Current update on work can be found here.

**LINK**

regards Martin>>

Seriusly impressive science. Tell 'em we appreciate it.

Posted by Neil Wyatt on 09/04/2020 15:18:11:

Anyone considering going shopping might want to try online.

I went on the Morrisons website before travelling, more in hope than expectation, and got a slot for 5:30 tomorrow, which saved me the journey.

Was able to replensish dog & cat food, loo roll and milk as well as some fresh food, although their stocks of fresh fruit and veg are very sparse. Onion soup anyone?

Neil

They don't deliver here…
I drove to my nearest Lidl today and turned around when i saw the queue. Even with distancing one could imagine the cloud of virus hanging over their heads in the windless heat and a carpark unnaturally full for that store…
The last couple of trips out I've made have been on deserted roads but today the traffic was back to normal. Pre-easter shopping anyone?

pgk

[Ex contributorParticipant @mgnbuk]

You cannot therefore just fill a warehouse and leave it all there for many years just in case.

But could you not rotate new stock in to replace items supplied to the NHS, care homes etc. from a central stock during normal usage ? Though may not be feasible if items have short storage lives – though surely vinyl or latex gloves, plastic aprons, visors, face masks, coveralls etc. won't have very short storage lives ?

Nigel B.

[BazyleParticipant @bazyle]

You have just listed all the things that do have short lives! Plastic loses its plasticisers and goes brittle, clear plastic fogs over as it ages, some plastic gloves weld themselves together etc. elastic bands go solid.

[Ex contributorParticipant @mgnbuk]

You have just listed all the things that do have short lives!

Define "short" ?

Not something I have bothered to look at in the past, but we use dust masks (3M) & vinyl gloves at work, so I'll have a look for "use before" dates next week when I go back.

Nigel B.

[Mike Woods 1Participant @mikewoods1]

I have just looked at the expiry date on a box of nitrile gloves I bought about a month ago, it states 2025-01. So it looks like 5 year shelf life to me.

Originally bought to keep hands free of gloss paint while decorating, but now being used for shopping duties. Very useful as I have been unable to secure a delivery or collection slot anywhere and not all stores near me are providing a means of cleaning shopping trolley handles.

Edited: Read nitrile on box, by the time I typed it, it had morphed into vinyl in my mind. My goldfish needs a smaller bowl, methinks 

Edited By Mike Woods 1 on 09/04/2020 18:13:32

[duncan webster 1Participant @duncanwebster1]

I've got 2 boxes of disposable gloves, neither has use by date. I've had them for a couple of years and they show no sign of deterioration. Stuff like visors will degrade eventually, but I've got grinding goggles that are years old. As mgnbuk says, have a year's supply in a warehouse and manage it on a first in first out basis. Of course the accountants won't like it, too much capital tied up

[Martin KyteParticipant @martinkyte99762]

A few thoughts.

Some of the PPE in hospitals will need to be sterile.

One cannot assume that there is an unlimited supply of equipment, Neils efforts in printing masks bears witness to this. I have not seen any figures but I would expect that the manufacturers of PPE have massively uplifted output to a capacity that just was not there before the emergence of this pandemic. A single country 'clearing the selves' of for example surgical gloves would perhaps cause more deaths in other countries through cancelled operations etc and quite probably would not get such massive orders.

As was seen in the panic buying just before the lockdown many people were going without because other had more than they needed.

Planning for pandemics has been going on for many years and SAGE seem to have got going on modelling in January or early Feb. Personally just from the little I know of the massive tasks faced by all involved I'm pretty impressed, not least with the response of the general public.

Thank goodness we were not the first country to see the outbreak.

It's not a simple problem.

best regards Martin

[V8EngParticipant @v8eng]

I find it difficult to see how a massive rapid extra demand can be fitted into a more normal routine supply system.

Whilst in our workshops something like goggles visors and gloves can be reused until they are beyond the pale it is difficult to visualise the something like that being sensible when dealing with virus loaded patients.

As to the supply system holding massive stocks (even on rotation) that would soon be looked at as wasteful overstocking and the media would probably have a field day on that one.

Edited By V8Eng on 09/04/2020 21:58:11

[Raphael GolezParticipant @raphaelgolez]

We are all fully aware of the limited supply of PPE in our hospital. We have colour coded zones to deal with the inlflux of symptomatic patient that needs admission. Those that are doing a very high risk procedure (intubation, CPR, nebs, suctioning etc) in a ward full of COVID19 (including ITU and Theatres) are obliged to wear high level protection PPE and the mask we use is a 3M FFP3 provided you have been fit tested and a face shield and if this does not provide a proper seal for you then you wear a full head suit to cover all your head plus full suit. If you are in a suspected COVID19 ward awaiting test results and does not require pulmonary support then we wear a full face shield with a surgical mask and an apron. of course if we have a high index of clinical suspicion then we have to wear FFP3 especially if a coughing patient is in front of us. Full gloves also. Once we get out of the bay we have to carefully do proper doffing procedures. All PPE should be single use however if we stay inside the bay we use it all day long. If we exit the bay we are now required to wear face mask on the nurses station and inside the ward premises. If we go out of the ward into the corridor of the hospital we have to take of the surgical mask everytime we exit the ward. We are all mindful of the limited supply. We should all be provided with a single use PPE and change when needed for our own protection. I can feel the tiredness and the stress that are all impacting us but we have to carry on the fight and continue the care we provide. Our case load is still climbing up, 2 of our nurse are intubated and one had a tracheostomy. My senior house officer was admitted and he is positive although he was hypoxic he is doing ok. We have a constant update, constant communication with our fellow consultants and colleagues. I estimate that we are still on the rise. Going home today I am surprise that a young couple together with their kids are again walking outside and they are in close proximity to the hospital. I saw them yesterday. If they can only see what's going on in our ward, maybe they will think twice in stepping out of their doors. I still see a lot out and running and walking their dogs. I understand they are giving distance but then again maybe they are not worried at all. I am worried for my wife and daughter hence I am self isolating strictly in the house. I have fallen to the illness roughly 3 1/2 weeks ago. Recovered and went back to work after clearing from our head of medicine. I would not risk going out of my house unless I got to buy food. During weekends I still self isolate and stay at home. i will do this until all this crisis resolved. So far I'm almost 4 weeks since I last hugg my family. Only contact is through face time even when we are in the same house.

Edited By RAPHAEL VAL GOLEZ 1 on 09/04/2020 22:24:46

Edited By RAPHAEL VAL GOLEZ 1 on 09/04/2020 22:26:42

Edited By RAPHAEL VAL GOLEZ 1 on 09/04/2020 22:28:02

[SteviegtrParticipant @steviegtr]

Wow what a write up Raphael. Now if just everyone thought like you do we may be further ahead of this than we are. My other half is a nurse at a private clinic which closed two weeks ago. She is still waiting to hear about being sent into the NHS. Some issue with the wages I think. The best of luck to you & your family. Everyone else too. Regards.

Steve.

[Raphael GolezParticipant @raphaelgolez]

Thanks Steve. Many thanks also to your wife for stepping up and making this decision to help our NHS and people in need. Tell her thank you very much for her service to us all. Stay safe to you and your wife Steve.

Regards,

Raphael

[V8EngParticipant @v8eng]

Raphael.

You and your colleagues have my greatest respect and admiration, Thank you for the excellent explanation.

[Michael GilliganParticipant @michaelgilligan61133]

Posted by Steviegtr on 09/04/2020 22:36:44:

Wow what a write up Raphael. Now if just everyone thought like you do we may be further ahead of this than we are.

.

+1 from me Raphael

Absolutely heroic behaviour … and we know you are not alone in that.

MichaelG.

[Bill PhinnParticipant @billphinn90025]

I knew Mancunians were bad, but didn't think they were this bad:

https://www.bbc.co.uk/news/uk-england-manchester-52221688

[not done it yetParticipant @notdoneityet]

Perhaps the importance of isolation/distancing will come home to them (too late) when the death rate per capita exceeds that of New York? Idiots.

[pgk pgkParticipant @pgkpgk17461]

Raphael. I applaud your amazing work and dedication. I'm just curious since you've had the disease is the PPE still necessary due to overwhelming viral load or a precaution because there isn't an effective antibody test to determine your level of immunity and no knowledge regarding repeat infections? Or whether it's possible to create a section staffed by recovered doctors and nurses? Just too many unknowns?

pgk

[Robert Atkinson 2Participant @robertatkinson2]

It amazes me how many people can't shop on their own. Went to the village store (Tesco Extra, yes it's the only food shop in the village) to pick up the wife's medication and some essentials last night. In self chck out there was couple with a child in a stroller. Just one basket and most of that was alcohol! Utter stupidity.
I'm closely involved with this project: https://www.theengineer.co.uk/exovent-covid-19-ventilator/ Basically a modern iron lung.

Robert G8RPI

[Danny M2ZParticipant @dannym2z]

I cannot believe that every visitor arriving in the U.K. is not isolated for 14 days! .

* Danny M *

[pgk pgkParticipant @pgkpgk17461]

Posted by Danny M2Z on 10/04/2020 09:49:07:

I cannot believe that every visitor arriving in the U.K. is not isolated for 14 days! .

* Danny M *

You're working on the assumptions that one could reasonably police this and that one is looking to remove COVID-19 from the world. There is no plan for that. We are all going to have to catch this disease or stay isolated indefinately. The only plan is to limit the level of serious infection to a point that NHS can cope with and hope that sometime in the future there is a vaccine or effective treatment. Current mutterings from above imply they may plan age and location relaxations to lockdown to develop a population that got through it with mild symptoms and low death rates so they can go back to work in locations where resources aren't overburdened.

pgk

[Raphael GolezParticipant @raphaelgolez]

Thank you Gentlemen. I really appreciate all the inputs placed into this discussion here. I also thank you all for the full support you guys do to help us all recover from this situation.

 

PKG, there are to many unknowns at the moment. To answer your first question, your statement here is very true. I still use PPE to still protect myself from a possibility of re-infection, to avoid myself being a possibility of a possible carrier state and im not sure if my immunity is up to the safe level. I might have been expose to low level infection and not an overwhelming viral load in a patient who have ARDS. Lastly I have to comply with all infection control and making sure I follow the rules set by our hospital.

As far as I know NHS is rolling out testing for staff that are working in a high risk area first, however I have not yet heard of them testing for immunity as of now. I really wish they do as I will volunteer myself to be tested straight away so I know how my self is coping with the virus immunity.

In term of section staffed by recovered doctor, I think it is a brilliant idea to pool a team of medical staff recovered from this disease but too many unknowns at the moment. We don't have enough resources (medical staff) to start with in the first place. We have restructured the rota of all junior doctors to cover 24 hours / 7 days a week to help us managed this situation. So I myself is allowed to continue my service the same way I do. I lead our orthogeriatric cases and 2 of my wards take in outlier medical patient including all suspected COVID19 cases.

You are also correct to say that there are too many unknowns and I completely agree with that. We are learning as we go along. Maybe by next year we will have more or less a better understanding of our current situation. I understand you are also a doctor (retired). Are you a surgeon or a medic? And lastly thank you for all your wise input here, I really appreciate it.

Hi Robert, thank you for your involvement in this project. It is really very good to know and heart warming that in our little engineering community her we are able to discuss this and give a very good outlook and ideas on what is happening to all of us. I appreciate the inputs here especially the massive effort from an engineering stand point to help people in need.

Above all I wish everybody here to be safe and continue your help and sacrifice for our fight against this virus. We will concur this virus and learn from our mistakes.

Best wishes,

Raphael

Edited By RAPHAEL VAL GOLEZ 1 on 10/04/2020 10:36:12

Edited By RAPHAEL VAL GOLEZ 1 on 10/04/2020 10:37:40

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