Thursday, January 22, 2009

Scarey stuff

Pandemic flu planning.

I'm in charge for my practice. I was quite relaxed until I started reading the official planning docs. Don't mean to worry you but thought you might be interested in some official figures. These are being used as a basis for planning and for once planning is on the basis of a worst-case scenario. But that shouldn't reassure you. That ranges are actually not that broad.

When it comes (as it inevitably will, we just don't know when) 50% of population is likely to get it (either in one or more than one waves, each wave lasting 8-15 weeks, with first wave peaking 50 days after the virus arrives in the UK, which in turn will be about 4 weeks after it erupts wherever). That's 30 million people.

25% will get complications. 7.5 million people.

4-5% will need hospitalising. 1.2 million people if its 4%. The UK has about 390 beds per 100k population, so about 234k beds.

1-1.5% will need intensive care. 300k. There are only 3500 ITU or high dependency beds in the UK including the specialist beds in cardiothoracic centres, trauma beds and the like. There a re a small number of paediatric ITU beds in addition to that.

2.5% potential mortality. That is three quarters of a million people.

Staff absence at any time (including health workers) expected to run at 25% (closer to 35% for smaller businesses) so fewer nurses/medics, tanker drivers, electricity engineers etc. Schools will be closed reducing the number of people able to work further. Of course, some people will not go to work to try and avoid exposing their families, which will make matters even worse.

Lets hope it doesn't come till the next century.

On a happier note, Panama by Van Halen is currently playing on Planet Rock...

Tuesday, January 06, 2009

National guidance and evidence base

I've been reading this:

Just out of interest really, as there seems to be a belief amongst certain noctors in secondary-care-land that GPs are filthy creatures who are responsible for a fair few MRSA infections.

Two main thoughts came to mind on reading the document.

Firstly, that most community acquired MRSA seems to be in people who've had recent contact with secondary care in some manner. Which is odd, as we seem to have a pelthora of posters up at the moment advising us to wash our hands at every available oppotunity so we don't kill people. I'm not aware of any evidence to suggest that GP surgeries are foci of infection, which this guidance would seem to support.

Secondly that the evidence base for this guidance is so poor. The vast majority of the recommendations throughout the document are graded as D (in other words, they are based on the opinions of the great and good rather than sound scientific data).

I can't help wondering whether HMG should be spending money on acquisition of reliable evidence for things like this rather than wasting it on white elephants (by which I mean NHS Direct, rating GPs on NHS Choices, Darzi centres and the like).