This is a powerful thread about how social care world is becoming an (even closer) adjunct to the NHS during #Coronavirus #COVID2019 epidemic. It raises some important and difficult questions. 1/ https://twitter.com/lewis_goodall/status/1245830505146322944

The first is about frankness with the public.

NHS doctors on Covid frontlines are clear that these patients would almost certainly not get ventilated in hospital.

Even now, before the peak, am told prioritisation is already strong. Those with best shot get to ITU /2

This is not a random process - there are guidelines and score charts and ethical committees making evidence-based decisions.

But, per doc, estimate mortality of vented patients is around 50% - and the over 70s have much worse chances. See this on deaths by age from Times.

So. To give you an idea, docs use a scaled ”Decision Tool” circulated to NHS docs which scores patients on three factors: age, frailty and comorbidities.

As a rule, you need to score less than “<8” to go to ICU. If you are over 80, you *start* at level 6. /4

The borderline is around 71-75 where you score 4 for age, add 3 for “frailty” defined on the scale as “not regularly active beyond walking” and if you have NO other issues then you are at 7 score. Borderine for ICU care. /5

This isn’t some callous/terrible thing - it’s about docs making data-based decisions on outcomes and resources but also what’s best for patients because, as one doc tells me in unvarnished style “dying alone on a ventilator is a sh*t death”. /6

This will obviously put a lot of burden on carehomes and management of those deaths - and for example begs Q of why social care workers/system are not part of NHS protective equipment (PPE) supply system, which they don’t seem to be /7

Stories of companies scrambling to get supplies and facing huge price hikes are deeply concerning.

Also need to be clear what additional provision is being made to manage these inevitable deaths in care sector. /8

As a side note, worth considering how vital the work of those carers will be - outside NHS and often not even U.K. citizens. Now isn’t time for politics of the immigration debate but when that returns we should remember this fact. /9

Lastly, we know #CoronavirusPandemic poses tough questions for frontline doctors (aided by the scientific approach outlined above) but it does for us all too.

For some elderly people going into hospital really might not be the best choice, from my discussions with docs. /11

Everyone makes their own decisions - but I’m surprised by lack of public guidance on this issue.

Understand it’s hard, but hospital leaves families separated from loved ones (already the case in a lot of carehomes it seems), unable to visit or be at bedsides /12

The #CoronavirusPandemic thrusts a world of difficult choices on everyone - not just frontline doctors. They at least have protocols and decision-trees to help them.

Wonder if us members of the general public could use the same? ENDS