Covid Booster. Yes/No? *** The Covid Thread ***

[Psamathe]

It has been well publicised that the NHS is under great strain and many workers are burnt out or close to it, with increasing shortages of staff in some sectors, and that there is a huge backlog of treatments. What I have not seen is any attempt to quantify the impact of the diversion of NHS resources to Covid away from other treatments, especially those which require an ICU bed, on the mortality of those with other conditions, e.g. cancer. There was the odd human interest article in the media over the past two years in which some cancer patients described how treatment was stopped/delayed, which suggested to me that the reduction in levels of care would result in a significant number of deaths, i.e. statistically measurable.
....

There have been several reports (all links I had to hand are from last year so not useful). But I suspect it's a very complex picture e.g. behavioural changes amongst public in response to reports about NHS e.g. are people being more reserved or delaying calling an ambulance when they might face hours in the back of that ambulance outside A&E or might they delay and "see if it passes". How many people are not getting their treatment within the 19 weeks (I'm at 21 months and still don't even have a diagnosis and admin/consultant f****-ups mean I have not even had a consultant for the last 7 months and 10 of that 21 months has been waiting for procedures that medics "forgot to request" after confirming they were being requested in writing).

Somebody e.g. finding a lump, 1st see GP (my GP Practice has been on "emergency only" for weeks and today I found my own GP is down to working 2 days a week), next wait for seeing consultant, next wait for tests, next wait for consultant to analyse those tests, etc. and perhaps for some the "maybe it's nothing" will be a stronger feeling than in more normal times. Add in that some might still consider attending a hospital as a higher risk of catching Covid (my uninformed opinion is it's probably safer than e.g. a supermarket). How do you quantify all those factors beyond drop in referral numbers (and how much of that is caused by NHS issues e.g. GP appointments and how much patient hesitancy)?

Ian

[Jdsk]

It has been well publicised that the NHS is under great strain and many workers are burnt out or close to it, with increasing shortages of staff in some sectors, and that there is a huge backlog of treatments. What I have not seen is any attempt to quantify the impact of the diversion of NHS resources to Covid away from other treatments, especially those which require an ICU bed, on the mortality of those with other conditions, e.g. cancer. There was the odd human interest article in the media over the past two years in which some cancer patients described how treatment was stopped/delayed, which suggested to me that the reduction in levels of care would result in a significant number of deaths, i.e. statistically measurable.

"Evidence of the impact of COVID-19 across the cancer pathway: Key Stats":
https://www.cancerresearchuk.org/sites/ ... r_2021.pdf

Jonathan

[slowster]

"Evidence of the impact of COVID-19 across the cancer pathway: Key Stats":
https://www.cancerresearchuk.org/sites/ ... r_2021.pdf

Thank you for that. I did try to find data on this before my post, but I did not know where to search and the articles I found were all published in 2020, rather than giving an up to date picture.

Based on those slides, much of cancer care does not seem to have been too badly affected, but that is only my superficial layman's reading of them. I imagine that the long tail nature of cancer diagnosis, treatment and outcome may mean that the impact in terms of mortality and patient outcomes of even small percentage reductions in the number of referrals, of delays in diagnosis and commencing treatment might not be properly quantifiable for many more months, which is potentially too late.

On the issue of the choice whether to have been vaccinated or not should be taken into account in allocation of resources... most ethical codes in healthcare say that it shouldn't... you try to do the best for the patient in front of you (as with smoking). But of course that means that accidents of logistics and perceived urgency rather than cost-effectiveness may end up determining who gets the resources.

Are those ethical codes adequately able to take into account the asymmetry of acute vs chronic conditions which are equally serious and needing the same limited resources? I think it's only human to tend to prioritise patients with acute conditions. I think that the decisions about allocation of resources for treatment for such very different conditions as Covid vs. cancer have historically been taken at a much higher level in the NHS decision making chain than the frontline medical practitioners, i.e. by senior management and doctors in the NHS, Dept. of Health and politicians, because they control the purse strings. I think a good example of that is the long term severe underfunding of mental health care, something which is politically far less sensitive than A&E wait times (which is not simply to blame politicians, because ultimately it reflects the fact that society, i.e. collectively all of us, does not regard mental health care with the importance that it warrants).

[slowster]

I suspect it's a very complex picture e.g. behavioural changes amongst public in response to reports about NHS e.g. are people being more reserved or delaying calling an ambulance when they might face hours in the back of that ambulance outside A&E or might they delay and "see if it passes". How many people are not getting their treatment within the 19 weeks (I'm at 21 months and still don't even have a diagnosis and admin/consultant f****-ups mean I have not even had a consultant for the last 7 months and 10 of that 21 months has been waiting for procedures that medics "forgot to request" after confirming they were being requested in writing).

Absolutely. My focus on the number of ICU beds is obviously just one aspect of this, albeit a major one.

The picture should be much clearer now than it was in 2020, and become increasingly clearer as we move closer towards the end of the pandemic and Covid becoming an endemic annual virus, like flu (which is what many scientists have said will happen).

Sorry to hear of your own problems with getting treatment. Your experience does suggest to me that you, and others in the same situation, are not being properly prioritised because the NHS is still in its pandemic operational model, and parts of the NHS may now need to move faster to exit that model.

[thirdcrank]

One way to make apparent savings in many fields is to move from "belts-and-braces" to "just-in-time." It's really a gamble and when it happens in the market those who get it wrong go bust. But that's unacceptable when vital public services are involved, so the taxpayer foots the bill. We've seen this during the pandemic with the provision of PPE.

Some parts of the public sector are pretty good at making apparent economies by shonking their own costs into other parts of the system. Centralisation is an example. In healthcare, that's meant bigger but fewer hospitals - pretty much the opposite of anything described with the overworked "community" label. Reports of the ambulance service being stretched seem to be a symptom of this: it's suggested that large parts of the ambulance service are in use as an extension of hospital reception areas. Instead of reports of patients waiting in corridors etc., they are outside in ambulances (which serves the dual function of rationing the flow of people to A&E.)

[Psamathe]

Re: Boosters at Walk-In Centres
Qu: Has anybody been to a walk-in centre for a booster vaccination without an invite letter?

In my searching out route for getting my booster, I saw one NHS web page saying for booster to take your invite letter or a letter from your GP to the centre (it was ambiguous on whether that related to everybody getting a booster or just those with medical conditions rather than on age criteria - but how would the walk-in centre know). I've had a text invite but no letter (and text has no personal ID details where I assume a letter does). I did get a letter invite for the 1st dose.

I'm looking at getting one of those transport arrangements for those who can't get there under their own steam and I do't want to turn-up and be turned away and thus wasted a community transport time (there are bound to be others wanting their services as well). I've e-mailed the CCG but no answer (yet).

Thanks
Ian

[Jdsk]

Ian: I'm not clear from that whether you're going to a booked appointment or an unbooked walk-in...

Jonathan

[Psamathe]

Ian: I'm not clear from that whether you're going to a booked appointment or an unbooked walk-in...

Jonathan

Intending an unbooked walk-in. My impression from the NHS page was that booked don't say "bring your invite letter with you".

If you have a condition that means you're at higher risk from COVID-19, you’ll be sent a letter reminding you to have your booster dose at least 6 months (182 days) after your 2nd dose.

You can take this letter, or a letter from your GP or consultant about your health condition, to any walk-in vaccination site from 6 months (182 days) after the day you have your 2nd dose.

If you do not receive a letter but you think you’re eligible, please contact your GP surgery.

I don't have a "condition" beyond being old - but how does the walk-in centre know when somebody turns-up if they are there because of a condition or because of age. If it were just me under my own steam I'd just go but if using limited community resource then I want to make sure first (likely somebody will have to drive Norwich to me, take me into Norwich, wait, return me home, then return to Norwich so it'll be most of a morning spent on just me - not to be wasted).

Ian

[geocycle]

Just booked mine, first available date Christmas Eve! I’m hoping a walk in opportunity emerges before then.

[sizbut]

Walk-in centre means literally that - just turn up. The risk is you may have to wait whilst those with specific bookings go ahead of you.

The only people who need an invite are those in special categories who are invited for a 3rd dose. For the rest of us, you just need enough proof of ID for them to match your NHS number, at which point they'll know whether its 1st/2nd or booster.

1st dose: Are you over 12?

2nd dose: Has it been 8 weeks since your 1st dose?

Booster: Has it been 6 months since your 2nd dose and are you over 50?

All doses: Has it been at least 4 weeks since any positive test?

All very clearly detailed here: https://www.nhs.uk/conditions/coronavir ... tion-site/

[sizbut]

...though I suppose the irony is that it was a 'walk in' for me as I had booked, whereas those who had just walked-in on spec had to sit for a while after having gone through the initial reception process. I didn't get to sit until at the table where the injection was done.

[Psamathe]

...though I suppose the irony is that it was a 'walk in' for me as I had booked, whereas those who had just walked-in on spec had to sit for a while after having gone through the initial reception process. I didn't get to sit until at the table where the injection was done.

My worry about booking with a community transport driver waiting is that for my 2nd dose booked I still had to queue for 3 hrs (outdoors in the rain). And that is really too long to keep a community transport driver waiting.

Ian

[gbnz]

Booster: Has it been 6 months since your 2nd dose and are you over 50?

Well I'm <50, but had a "special" invite. Had my booster last Friday

Rather glad, as 7.5% of the town are now testing positive every week. It's actually at the stage where it'd seem sensible to give the shops, buses and fag smokers a miss. But at what stage does one start ignoring all this COVID nonsense?

[Jdsk]

But at what stage does one start ignoring all this COVID nonsense?

Which bits do you think are nonsense, please?

Thanks

Jonathan

[Jdsk]

Rather glad, as 7.5% of the town are now testing positive every week.

Is that 7.5% of the tests that are done being positive rather than 7.5% of the population of the town testing positive?

Thanks

Jonathan