Talk evidence covid-19 update - natural history of covid, include patients in guidelines
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Welcome back to this week's Talk Evidence that we're recording on the 6th of May. As always, we're trying to give you an update on what's happening with coronavirus, the evidence that's building all the time, even though that might be quite murky sometimes. This week we are going to be looking at the natural history of the disease and a little bit about how patients are involved. To do that, I'm joined, as always, by our two favourite EBM nerds. First of all, Helen MacDonald, who's a resting GP and UK research editor for the BMJ. Welcome back to the podcast, Helen.
Hi, Duncan.
And Carl Hennigan, who is Director for Oxford Centre for Evidence-Based Medicine. You forgot who I am already! You've got lockdown fever. I'm trying to rationalise all the things that you're doing and making it into a soundbite and it's just not happening. EBM nerd. There we go. EBM nerd. Chief EBM nerd. So, that's Carl.
Carl, in your EBM Nerdery, each week you've been talking to us a little bit about the death data. So what's going on this week? Boris Johnson says we've passed the peak. Is he right? Can we tell?
Yeah, it's pretty much more of the same this week with the Office for National Statistics data comes out. But remember, that's about going back about 10 days ago. So it comes out on Tuesday and looks back in time. But when we say we're looking at the peak, I think there's a multitude of bits of data that allow us now to say we're well past the peak. If you look at the hospital data on deaths, The peak of the death there was the 8th of April. We can also look at the admission data which we've got access to and that peaked on about the 2nd of April. All the other measures show that they're now trending down and particularly the admission data is really helpful. because we've now come down from a peak, as I said, on the 2nd of April, they've come down by about 70%, and we've been low 1,000 admissions a day.
All of that information is reassuring, and that's going to help us when we come out of lockdown.
And hopefully that's what we can talk about next week, what this means, and maybe what the fears of coming out of lockdown too early mean as well. Great. Well, thanks for that update, Carl. So each week in Talk Evidence, we try and give you something to start or to stop doing. And Helen, you've been looking this week at severity of infection amongst households.
I have. We've had a lot of drugs in our list and I wanted us to spread our wings and look at other things. There was an interesting analysis article published on the BMJ today, 6th of May, asking for simple measures to reduce the spread and severity of infection among household contacts of COVID-19. And it's written by a primary care academic, Paul Little from Southampton and colleagues. And I picked it out because I think there's growing momentum behind the idea that we have to pay close attention to what's going on in the community now, because that's where most of the infection is. So the argument, and this is a debate paper, so it's making an argument rather than giving us research. What it's saying is we basically want to try and reduce COVID.
Most people with COVID are at home, so it makes sense to focus there. And a lot of them live with other people. We've got evidence that healthcare workers have higher rates of infection. And we think that's because they have a lot of contact with people who have COVID and they take in bigger doses regularly. of infecting virus because they're close physically close to people with infection and the same therefore may well be true of people who live with people with COVID healthcare workers need PPE protection to try and reduce infection to themselves but Those kind of measures aren't practical for household contacts. So this paper is looking at what are the alternatives. We don't have a lot of good evidence to say clearly what people should do and people's circumstances in their household vary enormously.
But what they're suggesting is if we use the precautionary principle of Are there simple things that people could think of themselves to try and protect their family members?
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