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  1. Newbie

    Manx Care

    It doesn't generally work like that. The decision to refer a patient is taken in conjunction with the patient after discussing the various aspects of it, no doubt including the likely waiting time. Not all people want surgery, and are prepared to accept some pain/limitation of function, and wait to see how things go. On the other hand some people want surgery at an earlier stage for a variety of personal and lifestyle reasons. There is no one 'standard patient' and they are all individuals. For those people that do feel they would like surgery for say a hip problem, you can understand the reluctance to wait until they are desperate for it, knowing that when they are referred they will likely face a wait of around 18 months until they are pain free and mobile again
  2. Newbie

    Manx Care

    Either of those could be the case, but as far as demand is concerned, a bigger concern seems to be that people have found it much harder to access routine healthcare during the pandemic, which you would have thought would result in fewer referrals. The number of referrals should be known, so it should be easy to determine whether demand has increased. As for capacity, I guess Wrighty would now whether that is likely to be reduced as a result of precautionary Covid measures that might need to be taken, but I can't really see why it should have a significant impact. Surely, it is mainly a matter of testing people pre-admission. Once in hospital, the treatments shouldn't take any longer (unless Wrighty knows better). If you are right, since the waiting time has gone up by nearly 3 years in just over 12 months, it means that they must be getting at nearly three times the number of referrals that they are able to cope with. If that is the case, unless something changes, in another 12 months, the waiting time will have gone up to 7 years! However, as Wrighty says, maximum waiting time might not be the best measure of the hospital's ability to cope with the demand - in which case it shouldn't be the measure used to determine whether extra money is required. There needs to be a better measure of the balance between demand and capacity.
  3. Newbie

    Manx Care

    The MR report says that maximum waits are up to 5 years in some specialties. Before lockdown last year, the maximum waits were a little over 2 years in the worst specialties. It is difficult to see how waiting lists can rise by nearly 3 years in a little over 12 months. Even assuming no routine work at all had taken place since then (although it was restarted briefly last year), the wait should only have gone up by a little over 12 months. Something doesn't add up.
  4. What you said was And So maybe you can see where confusion might arise
  5. I was talking about India, not the Isle of Man, and I have not suggested that because things are clearly desperate in India we should be panicking here. But from a humane point of view, to see people pushing their relatives around on trollies for hours, begging for someone to try to help them is a pretty good representation of Covid Hell, and the headlines reflect that fact. If you don't agree, well each to their own, but i think that trying to suggest that the headlines are an over reaction, and trying to downplay the situation using dubious statistics, demonstrates a lack of empathy for the suffering of fellow human beings.
  6. I am sure that the relatives of people dying on trolleys in the carpark will be comforted by that. Do you seriously believe that figure?
  7. There are people dying on trolleys and in the back of ambulances outside hospitals in Delhi because they haven't got beds. It is almost certainly worse in areas with less resources. The headlines seem absolutely appropriate given the situation
  8. I think that the CDC is an organisation that can be taken seriously, and they do mention the limitations of the study within the discussion. The original link was to a press release highlighting the findings of the study, rather than to the study itself which was published online on the same day by the CDC in their weekly Morbidity and Mortality report. I would agree that it isn't a real world study insofar as the majority of the participants were medical personnel, although arguably, their work could put them more at risk of contracting Covid, meaning that the results are more impressive. It could also account for the relatively low incidence of asymptomatic infections. Medical personnel who know that they are taking part in a post-vaccination surveillance study are likely to have a greater awareness of symptoms than the general population, or at least be more likely to report them. One further caveat is that any study such as this can only look at the effectiveness of vaccines against the SARS-Cov-2 variants that are prevalent in that area at the time, rather than any variants that might emerge, or become more dominant, in the future. The CDC do appear to have a number of such studies ongoing and/or planned, and presumably any change in effectiveness of vaccines against new variants will be assessed in due course.
  9. Except that the person would have caught covid a week or so ago in order to be testing positive now. That would only be a week after vaccination, when the level of protection would still be very low. It takes time for immunity to develop after a vaccination - longer than a week.
  10. Largely I agree with you regarding the false negatives. I think the level of disease now is such that it isn't worth doing the tests. But the raw figures for false negatives and positives are a bit misleading. For argument sake, if the incidence in the community of Covid is say 1 per 10,000 (i.e a low level) and you test a million people you would expect to get 100 positives, but because of the false negatives you might only pick up 50 or 60 of them. You could argue that it is better to find the 50 or 60 than not find them, otherwise they will all be down the pub. Also as trmpton says (below) you may well pick them up next time they get tested a few days later. The problem is that with even a 99.5% specificity you would expect to get 5,000 false positives out of your 1 million tests, so all of those people and their families would have to isolate, at least until the PCR tests come back (if they get done). You are then looking for the 50 or 60 true positives out of over 5,000 positive lateral flow test results. Which is more of a problem, is arguable. When the incidence in the community is relatively high, the false negatives are the problem, when the incidence is very low, the false positives become more of a problem
  11. The false positives become more of a problem when the incidence of disease in the community has dropped to very low levels. Where the incidence of disease is less than 1 in 1,000 the chances are that a positive result from a Lateral Flow Test will be a false positive result. It is difficult to establish the exact numbers, but in London, where the incidence of Covid is currently very low, it has been estimated that only 25% of positive lateral flow tests are true positives (although it does depend a bit on the brand of test used, and who has taken the test). The positive results can be checked with a subsequent PCR test, but that takes time to organise and analyse, which means lots of people (including their families) have to isolate unnecessarily until the PCR test comes back. In short, as the incidence of disease falls, the false positives are more troublesome than the false negatives. There will still be false negatives as well, but not many because there will not be many people with Covid.
  12. It is exactly what Dr Ewart said about lateral flow tests, that they are of limited value when the level of disease in the community is very low (i.e. low probability of having the disease), but become more useful when there is a high level of disease in the community.
  13. Except that the organisation of the FoM starts in January/February
  14. The clue is in the statement. The vaccine works by getting the body's immune system to react and thereby develop an immunity to covid-19. If someone has a weakened immune system due to some other medical condition, their immune system may not react as well as would normally be expected, meaning that they wouldn't develop a full immunity. Under those circumstances, young people living in the same household may well feel that they would want to do all they could to help protect their family members. Transmission between family members is one of the commonest causes of covid spreading. If a healthy 16yr old is vaccinated, there would be a reduced risk of them catching covid and passing it on to a family member who hasn't developed a full immunity.
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