Stuart McDonald – @Actuarybyday
Stuart McDonald is lucid, generous and understands how to use social media. He has kept his powder dry over the safer months of summer, but now the winter chill is upon us, he is back turning data into the insights we need to make sense of what is happening around us, especially our hospitals.
They’re back! The intensive care national audit & research centre (@ICNARC to its friends) has resumed weekly reporting in response to rapidly rising ICU admissions.
A short thread follows in which I’ll draw out key content and add some comments. 1/n https://t.co/jwsl81ZKsS
— stuart mcdonald (@ActuaryByDay) September 26, 2020
Déjà vu? Newer followers might be unaware that I used this data six months ago to challenge the myth that COVID-19 is only a risk to those who were already “at death’s door”. That thread went a bit viral, with all manner of interesting consequences! 2/n https://t.co/jEWiBISNMM
— stuart mcdonald (@ActuaryByDay) September 26, 2020
One positive outcome was an improved relationship between actuaries and the intensive care community. A tangible example is the commitment to @ICS_updates from @COVID19actuary that we would continue to highlight the impact the COVID-19 on intensive care units. 3/14
— stuart mcdonald (@ActuaryByDay) September 26, 2020
So far, numbers are small, with 291 patients included in the new cohort. Of these, 104 have outcomes reported and 187 are still receiving critical care.
The majority of recent admissions are in the North of England and the Midlands. Contrast to first wave shown below. 5/14 pic.twitter.com/DHAmxQZHD2
— stuart mcdonald (@ActuaryByDay) September 26, 2020
These charts show the daily and cumulative admissions numbers since 1 Sept. The rapid rise is clear, noting that admissions logged against the last couple of days in particular remain incomplete. 6/14 pic.twitter.com/A56xXRPbyp
— stuart mcdonald (@ActuaryByDay) September 26, 2020
Table 1 shows us the patient characteristics, and how these compare with the first wave (previous reports used a cohort of viral pneumonia patients from previous years as the comparator).
As before, seven out of ten ICU admissions are males, and they are age 60 on average. 7/14 pic.twitter.com/DbYkHpye81
— stuart mcdonald (@ActuaryByDay) September 26, 2020
There has always been a socioeconomic gradient to ICU admissions, but that is even more stark here than was seen in the first wave. Four out of ten admissions in September are from the most deprived fifth of the country. 9/14
— stuart mcdonald (@ActuaryByDay) September 26, 2020
Some positive news in the outcomes table! Of those no longer receiving critical care, four out of five have been discharged, and only one out of five has died. That is much better survival than the first wave, when two out of five died in ICU. It’s early days though. 13/14 pic.twitter.com/dKuJQt49W3
— stuart mcdonald (@ActuaryByDay) September 26, 2020
I hope you found this useful. Of course it’s a shame that we’re back where we are, but the clarity and transparency of these reports is helpful, so it’s good to have them back now we need them.
Please take a moment to read this short, hopeful letter from an ICU consultant. /end https://t.co/ZDESpT6xfV
— stuart mcdonald (@ActuaryByDay) September 26, 2020
CONTINUED…
The report has been updated overnight so charts now show admissions from 1 Sep – so a few further comments.
I said the age/sex chart looked familiar. Maybe too familiar as that WAS the older data. Main difference now is more admissions are people under 50. 15/18 pic.twitter.com/G8N9jIOdSJ
— stuart mcdonald (@ActuaryByDay) September 27, 2020
The ethnicity chart brings out very clearly the extent to which the over-representation of ethnic minorities goes beyond what can be explained by local demographics. Whites are significantly underrepresented. Asian, Black and Other ethnicities significantly over. 16/18 pic.twitter.com/2OazxWeuS9
— stuart mcdonald (@ActuaryByDay) September 27, 2020
This chart brings out the socioeconomic gradient very clearly. The most deprived groups are four times as likely to have needed ICU admission for COVID-19 than the two least deprived groups. 17/18 pic.twitter.com/26LwTTwUgl
— stuart mcdonald (@ActuaryByDay) September 27, 2020
And finally… this chart of BMI shows us that there are fewer COVID-19 ICU admissions that we’d expect among people of “healthy weight” (18-25) or who are overweight but not obese (25-30).
Obese people are more likely to need ICU admission, especially those with BMI>40. 18/18 pic.twitter.com/uvNau5CQjY
— stuart mcdonald (@ActuaryByDay) September 27, 2020