It is now May 2021 and time to revise this blog. Sadly we are seeing the number of worldwide infections continuing to increase due in the main to politicians failing to identify and act on the problem in October 2019, failing to isolate epidemics in January 2020 and failing to close international borders. Many foreign leaders are not effectively locking down and this is magnified by poor healthcare provision, slow vaccination and in cases corruption. The heros have been those developing vaccines and particularly Uger Sahin who personally led on the Pfizer mRNA vaccine. He gets my vote for the Nobel peace prize.
Fortunately in the western world we see incidence falling following crippling lockdowns, and the USA where vaccination is handled Federally but lockdowns vary from state to state demonstrates vaccination started to control case numbers by mid April. In the UK the NHS is starting to reopen although waiting lists will continue to grow and take a decade to bring back down. I also believe by July we should unlock because we cannot fund healthcare without a working economy.
In terms of the individual patient readers may recall I presented evidence to the Commons Select Committee on Health in 2020 that we should vaccinate patients at preassessment. I still believe that to be the case given that the ONS has since shown 24-40% of all UK covid deaths in Q1 2021 were infected by the NHS. However, I do not manage the NHS and I can only comment on my practice and Phoenix Hospital Group where I am a director
We have run the Weymouth Street Hospital as a fortress – by ensuring every patient was covid free we stopped transmission. We also uniquely measured antibodies on our staff every 4 weeks to demonstrate not one member of staff became infected since May 2020. We can say that we didn’t infect a single patient.
As vaccination increases and viral incidence falls we can revise our fortress strategy. Almost all staff are vaccinated with Pfizer and the latest data shows it not only prevents illness but also sterilises and stops transmission. No treatment is 100% but several studies involving over 100,000 individuals and a million man days shows the Pfizer and Moderna vaccines reduce the virus to a level that makes successful infection of another normal adult less than 1 in 100,000. This is an important level because it is the risk of an anaesthetic. Although a separate risk, if a risk is of this level it should be acceptable to our patients.
So much for staff – they still wear masks, have temperature checks etc but these measures are because the NHS hasn’t caught up, not due to science. What about patients? As the incidence falls so does the risk of a patient being positive by chance. We measure temperature and require a negative PCR test, but the main safety requirement is isolation – the longer the patient isolates the lower the risk. So for unvaccinated patients it remains important to isolate for 24-36 hours before the PCR test because the PCR remains negative for 24 hours after inoculation, but we can probably accept 72 hours isolation and a PCT 48 hours before admission. Ideally we should try to have patients vaccinated but the UK government wont release vaccine. And if unvaccinated it remains important to continue to isolate after any operation until inflammation has settled. I advise all my patients on the length of isolation for each operation.
The core message remains the same – you can have an operation safely, but please isolate before and after the operation unless you are vaccinated. As always these are my personal views and different hospitals understandably come out of lockdown at different rates and with different strategies so please follow more stringent rules if your hospital asks.