Protocolo de manejo de COVID-19 en Reino Unido

[pic 1]

Materia: Calidad en Instituciones de Salud

Alumno: Miranda Hedrosa Navarrete

ID: 00322552

Trabajo: Protocolo de manejo de COVID-19 en Reino Unido

Docente: Dr. Sergio Edward Bruce Aguilar

Fecha de entrega: 26 de abril de 2021

INDEX

1. Introduction
2. United Kingdom Healthcare System
3. Demographic data
4. Guidelines and protocols for COVID-19
5. Vaccination
6. References

1. INTRODUCTION

Through this work, I will be explaining, analyzing and discussing how the United Kingdom managed and is still managing the COVID-19 pandemic. It is important to analyze how different countries managed this situation and the outcomes, because we are still learning how to do it and as  healthcare workers we need to start identifying opportunities to achieve a better quality level not only in terms of the COVID-19 pandemic, but in general for the future of all of the healthcare systems.

1. UNITED KINGDOM HEALTHCARE SYSTEM

It is key to know for a better understanding of how the United Kingdom managed the pandemic and how the actual healthcare system works, because we get a vast perspective of the decisions that they made.

The NHS that stands for National Healthcare System, is provided by the government for the citizens of the United Kingdom and funded by the taxpayers. So this means that healthcare is practically free for everyone and private medicine is rare. It is known for being a good healthcare system but as everything it has its flaws, but is constantly changing and improving for better, for example the NHS implemented the NHS Quality Board, which was created to make the healthcare system more effective, safer and that patients and healthcare workers have a positive experience in this system.

1. DEMOGRAPHIC DATA

Understanding the demographic characteristics of the UK when it comes to healthcare. The United Kingdom is a nation formed by four countries: England, Wales, Scotland and Northern Ireland and is located in Europe. The UK has a population of 67.8million approximately and the predominant ethnic group is white, but as a country that has important inmigration there is a rise in other ethnic groups such as asian and black, in fact between December 2019 and by the end of march 2020 there was an increase in inmigration.

The distribution between male and female citizens in the UK is practically even, and the most common age groups are 30-34 and 50-54, so this means that adults are a majority and there are less child births, this is because of many factors such as cultural and socioeconomic and it is also important to mention that the fertility rate is changing and declining over time, right now the TFR is 2.1. This means that the population in the UK is aging and there are some projections that say that in 2050 one in four people in the UK will be aged 65 and older.[pic 2]

A really interesting point is the life expectancy in the UK because for many years the life expectancy showed a steady improvement for example 2002 and 2011 life expectancy increased each year by 16.7 weeks and between 2012 and 2019 it only increased 6.3 weeks. Although life expectancy is not exactly going down, we can say that this may be related to quality of their healthcare system, because a healthcare system not only is focused on treating diseases but on preventing them and as a result we may see some lack of quality in the life expectancy, but let us not forget that many factor contribute to this precise indicator. Also another interesting point in this subject is that by autumn 2021 the national life tables will be published and we will see the impact of the pandemic.

Provisional data estimates that in 2020 the UK life expectancy was 78.7 years for males and 82.7 years for females.

[pic 3]

Now talking about death causes, the number one cause of death for males in the UK is Ischemic Heart Disease and for females is Dementia and Alzheimer Disease.

[pic 4][pic 5]

If we analyze these charts we can conclude that these death causes are proper of a developed country because we don´t see for example many infections but we do see neurodegenerative and chronic degenerative diseases.

So maybe we can conclude that the healthcare system lacks more quality in terms of prevention that in treatment. As a quality recommendation they should implement more programs focused on preventive medicine and analyze how their prevention programs have worked so far.

1. GUIDELINES AND PROTOCOLS FOR COVID-19

On January 31st, the UK declared their first case of COVID-19, on March 5 the first death caused by the virus in the UK and on March 11 the WHO declared it a pandemic.  By then the government had already published a detailed plan for the COVID-19 pandemic and started lockdown on March 23.

[pic 6]

As we know the SARS-CoV2 is a strain of a coronavirus first detected in Wuhan China, transmitted by respiratory droplets and can result in an asymptomatic presentation to a really critical state of infection and even death. One of the risk factors for a more severe case is being over 60 years, and as we saw before, the UK population has a predominance in the ages between 35 to 65 which resulted in many severe cases and deaths.

The NHS stated that the only prevention measures for de COVID-19 infections were:

• lockdown
• social distancing
• use of face masks
• washing hands

All patients with suspected COVID-19 infection must be tested with a RT-PCR or antigen testing, but the RT-PCR is the gold standard for diagnosis. At the moment imaging studies can tell us about infection but not so much about severity, the NHS states that a chest x ray is mandatory in all patients admitted to the hospital and a CT scan in all patients with uncomplicated and complicated pneumonia.

The Guidelines for managing COVID-19 in the UK followed the WHO disease severity definitions to categorize patients and are as following:

• mild disease:

• Patients with symptoms meeting the case definition for COVID-19 without evidence of viral pneumonia or hypoxia.

• moderate disease:

• Adolescents or adults with clinical signs of pneumonia (fever, cough, dyspnoea, fast breathing) but no signs of severe pneumonia, including SpO2 90% or more on room air.
• Children with clinical signs of non-severe pneumonia (cough or difficulty breathing plus fast breathing or chest indrawing)

• severe disease:

• Adolescents or adults with clinical signs of pneumonia (fever, cough, dyspnoea, fast breathing) plus 1 of the following: respiratory rate more than 30 breaths per minute; severe respiratory distress; or SpO2 less than 90% on room air.
• Children with clinical signs of pneumonia (cough or difficulty in breathing) plus at least 1 of the following:

• Central cyanosis or SpO2 less than 90%; severe respiratory distress (for example, fast breathing, grunting, very severe chest indrawing); general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions.
• Fast breathing (in breaths per minute): less than 2 months: 60 or more; 2 months to 11 months: 50 or more; 1 year to 5 years: 40 or more.

• critical disease:

• ARDS (acute respiratory distress syndrome)

• pneumonia with worsening respiratory symptoms and on imaging bilateral opacities caused by infiltrates

• sepsis

• life-threatening organ dysfunction

• septic shock

• life-threatening organ dysfunction with persistent and severe hypotension

A patient will be admitted to the Intensive Care Unit when the deterioration of the general health state is notable :[pic 7]

Also if SpO2 is less than 90 %.

Right now there is not any specific treatment for COVID infection, but the NHS standardized some medications and measures that apply to most patients with a favorable outcome.

[pic 8]

[pic 9]

Thromboprophylaxis in COVID-19 infection:[pic 10]

• the drug of choice is Enoxaparin which is an anticoagulant and inhibits IL-6 which is a potent inflammatory agent.
• The process to prescribe thromboprophylaxis is, as the NHS stated is:

1. coagulation screening

• PT
• APTT
• fibrinogen
• D dimer

1. thromboprophylaxis to all patients except those with contraindication

• IMPROV scale

The NHS has really clear the potential complications of the COVID-19 infection and these are:

• respiratory failure
• arterial and venous thromboembolism
• heart failure
• arrhythmias
• sepsis
• septic shock

When we know what to expect in the worst case scenario we can take proper measures in action, for example thromboprophylaxis and mechanical ventilation. With this we can have in mind that the processes of many COVID-19 cases were studied and analyzed maybe in a Deming Cycle until they came out with the solution for each of them, or at least possible solutions and are still learning, because as we saw it in class it is a continuous cycle.

...