AIUI several things
However, I suspect a post mortem on this whole thing will find that the source of most of the planning panic – ventilator capacity – was over-rated, and it’s far more important to get people into hospital at the first sign of hypoxia, which has no symptoms at that stage (in the absence of exertion i.e. for most people) and is detectable only with one of our blood o2 gadgets and only after getting somebody to walk around a bit. Then they tend to recover under just oxygen via a mask.
It could be that Germany had a different threshold for hospital admission to say the UK, which limited people to being breathless, by which time it is too late for many. Maybe Germans here will confirm. Again, having more beds would enable such a policy.
Some really dreadful news in the UK about UK PPE manufacturers being unable to get onto the NHS supplier list and thus shipping their product abroad. This has been going on all the way through. I hope that these dicks in the NHS procurement get terminated, but they are probably very well protected because they’ve been doing that job for years. 30 years ago I would have said the obvious explanation is corruption (backhanders were the normal process then) but this is IME very rare nowadays with industry… although it did carry on for many years in State industries like (what was) National Grid.
That RAF plane which went to Turkey brought back almost nothing; well that was obvious, with just one A400. It was just a symbolic thing.
I think our relative success with this pandemic is also partly down to luck (most of the early infections were otherwise healthy business travelers and skiers) and partly because our healthcare system, while heavily under fire for years, is still a notch above what most of the world has (of course I would say that, as a German doctor…).
Also federalism had an advantage in this case. We have over 400 local district health offices who are given broad, almost sweeping powers under our preexisting infection diseases protection law, and they did use these powers effectively.
Contact tracing was initiated from the outset and additional staff was recruited quickly to perform it. Hundreds of local laboratories, both private or attached to hospitals, were able to test for SARS2-CoV from an early stage.
At no stage was Germany anywhere near an ICU bed shortage, depending on how you count we have about 14000 empty beds right now, which is more than most European countries have in total capacity.
A family member in Germany spends a lot of money on mandatory health insurance and this drives the provision of a lot of “kit” there.
In the UK we have a “free national service” (done in post-WW2 austerity in 1947 by a newly elected left wing govt) and most people demand the services while demanding they pay nothing. So while it runs ok and does a great job once you get admitted, it is an obvious political football for any day the journalists can’t find a better target and runs with its head only just above the water. Consequently everybody with more than 2p to rub together goes “private”, getting usually the same stuff done but getting it much faster.
Peter wrote:
A family member in Germany spends a lot of money on mandatory health insurance and this drives the provision of a lot of “kit” there.In the UK we have a “free national service”
Well, there is no free lunch anywhere, and the mandatory health insurance in Germany is basically some form of a tax, in the sense that the premiums are not a fixed amount but rather a percentage of your monthly income (with a cap at a certain level). They are deducted from your monthly paycheck before you ever see the money on you bank account. Additionally the premiums are split between employer and employee (each pay 50% of it), which is of course some kind of social folklore, as in the end 100% of the premium is money which is not ending up in the employee’s pocket.
The main reallocation mechanism is that your spouse and your kids are insured for free as long as they do not have an income of their own, so the system is a significant subsidiary for families.
Once your income exceeds a certain predetermined level you are free to opt out of this system and go for private health insurance. For a single, this might save you some money and, depending on your contract, also entitle you to somewhat better care or faster access to it, but for familes this is usually not attractive, as you need seperate insurance for everyone in this case. Also, once you have opted out it is very difficult to return under the umbrella of the public system at a later time.
Graham wrote:
wonder if any of the medics on here could give us an indication of how patients aged 80+ (and 60+) in severe respiratory distress tend to fare when admitted to hospital during more normal times?
Depending on your definition of ‘severe’, very well – if it is due to a bacterial infection. What tends to happen is that people gradually get frailer and visit hospital more often and stay for longer each time. But assuming they get to hospital, most survive on most occasions. Antibiotics are remarkable.
In ordinary times it is pretty unusual for anyone in their 60s to die of a chest infection, unless they are in very bad shape to start off with e.g. very unfortunate in terms of comorbidities, or living on the streets. 70s… Pretty unfortunate but less surprising. 80s… Not particularly remarkable but we would still expect most to pull through.
Although we were not badly affected locally we have had a number of younger COVID patients (40s, 50s) who would plainly not have survived without fairly intensive hospital treatment, so the idea that the disease only kills older people is a reflection on modern medicine. If the hospitals became overwhelmed, people in their 30s to 50s would die in appreciable numbers.
FWIW, the funding of state health care works the same in Poland, except for the opt-out part. But most companies also provide additional “private health care” for employees, which for the most part is limited to outpatient things and sometimes dental.
Graham wrote:
Do German hospitals do something fundamentally different with patients in respiratory distress?
I don’t think we do. Peter may have had a point above though, when he mentioned that you simply don’t get a bed in a UK hospital unless you are already quite ill, whereas in Germany you often get admitted before anyone’s really sure you even need to be. This actually has more to do with legal reasons and the way our hospitals are funded. If you turn up at a German A&E with some kind of symptom, no matter how minor, you often get examined by junior doctors first, who do not have the power to send you home without repercussions. So they admit you to a ward and the final decision on wheter you need to even stay in hospital is often delayed until next day, when the consultant/ specialist arrives and gets to hear your story.
While this leads to lots of inefficiencies, it might be beneficial for Covid-19 patients if they get admitted to hospital before the fall seriously I’ll.
Peter wrote:
Some really dreadful news in the UK about UK PPE manufacturers being unable to get onto the NHS supplier list and thus shipping their product abroad. This has been going on all the way through. I hope that these dicks in the NHS procurement get terminated, but they are probably very well protected because they’ve been doing that job for years.
I completely agree with you here. Excess regulation always hurts smaller business and companies and favours large ones who can pay a department to jump through the hoops, (or lobby for the regulation they want.. )
Sadly I don’t think anything will happen to them, mid staffs, etc I think shows more what happens. In the present environment it I suspect one would be considered a heretic to suggest anyone within the NHS could do wrong…
MedEwok wrote:
Peter may have had a point above though, when he mentioned that you simply don’t get a bed in a UK hospital unless you are already quite ill, whereas in Germany you often get admitted before anyone’s really sure you even need to be.
While there may well be differences in criteria for admission during more normal times, I don’t think we are short of ordinary beds or ICU beds in this crisis. The large new facility opened in London in double-quick time is largely empty, I understand. I am yet to hear the UK media (who are pretty quick to pick up on anything shock-worthy) report that any patient has died in the UK for want of medical care, i.e. because a bed or a doctor was not available. This was not the case in Italy I understand.
I usually have very few interactions with the NHS, but I did spend a day in hospital last summer with a particularly aggressive GI infection that came with a very high fever and hallucinations, etc. The place was not busy and they got me straight into a bed which they were rather reluctant to let me leave. After a day lounging around taking saline and doing undignified things with a commode, I was in the process of discharging myself (dog needed letting out for a pee) when the consultant turned up to try and stop me, suggesting I ought to stay overnight. We bargained that I would take one more bag of saline and then go, and of course after being connected I raised the bag as far up the stand as would not attract attention :-) The junior doc said that was quick and discharged me, and the Uber driver who took me home never knew how close his lovely leather seats came to disaster!
I had always heard stories of how quickly they want you out, but my experience was different.
