the times | Wednesday April 8 2020 2GM 5
News
Coronavirus kills people by preventing
them from breathing. This means that
to help patients survive it, you find ways
to breathe for them.
The course of treatment, which Boris
Johnson has already begun, starts with
oxygen, probably through a nasal can-
nula or mask. As the prime minister’s
condition worsened, the oxygen kept
his blood saturated, helping his lungs to
do their job.
If his condition continues to deterio-
rate intensive care doctors will find
other ways to take the load off his lungs,
and so give them space to recover.
The first step could well be a breath-
ing aid known as a continuous positive
airway pressure machine. This main-
tains air pressure to keep the lungs open
and working, effectively forcing air
through. It is only an interim step
though. The reason, we are told, that
Mr Johnson has been taken intensive
care is so he can rapidly be given the
assistance of a ventilator.
As with any patient in intensive care,
the prime minister is being treated by a
dedicated team of doctors, nurses and
support staff, led by a consultant of
critical care medicine and a consultant
anaesthetist. They are there to spot any
sign of deterioration.
Alison Pittard, dean of the Faculty of
Intensive Care Medicine, said: “The
doctors have the skills to look at the
whole patient, to look at their lungs. We
are the experts for when the patients
become critically ill.”
Mr Johnson’s vital signs, including
blood pressure, heart rate and oxygen
levels, will be monitored round the
clock and his team is on standby to act
immediately if anything changes.
If it does, he will be heavily sedated
and transferred to a ventilator, which in
a sense replaces the muscles in the
lungs. The machine exhales and
inhales for the patient, pushing air in
and sucking it out.
It is distressing, both for the patient to
be told they need it and for the family toThousands of prisoners set to be re-
leased early because of the Covid-
crisis will not be tagged and curfewed
for up to 36 hours after leaving jail.
Offenders are to be freed to their
homes or other accommodation such
as hostels but for most there will be a
delay in fitting tags to track their loca-
tion, The Times has learnt.
Ministers have announced that up to
4,000 offenders who have less than two
months of their sentence left to serve
will be eligible for early release to help
to tackle the spread of coronavirus in
jails in England and Wales.
Prison governors said yesterday that
official advice said 15,000 inmates
would have to be released to safeguard
other prisoners and staff.
The figure has apparently been put
forward by Public Health England and
Her Majesty's Prison Service, accord-
ing to a submission from the PrisonInmates released early will
not be tagged for 36 hours
Governors Association to the Com-
mons justice committee. It is almost
four times higher than the 4,000 low-
risk offenders who have not been con-
victed of violent or sexual offences who
are to be considered for release in the
next few weeks.
Announcing the plans, the govern-
ment said that released prisoners
would be electronically monitored —
including with GPS tags — but did not
disclose that it could take more than a
day for the monitoring to begin.
The Ministry of Justice confirmed
yesterday that prisoners released under
the scheme would be “tagged at their
homes” within 36 hours of being re-
leased. It said that this would allow the
tagging contractors time to visit people
at their homes or other verifiable
addresses.
The department added that anyone
who failed to comply with the terms of
their release, such as staying at a set
address, would be recalled to prison.News
through crisis, deputy insists
The support on hand to help
patients breathe more easily
have to watch. It is part of the grim
situation we are in, though, that the
latter problem is no longer a concern. In
normal circumstances families are en-
couraged to visit loved ones in intensive
care as it is beneficial to their recovery,
according to Dr Pittard. But St
Thomas’, like many hospitals across
Britain, has banned visitors in line with
social distancing rules.
“To reduce the spread of infection we
are not allowing visitors to adult
patients in our hospitals or community
sites,” the hospital said.
“This will help us to minimise the
number of people in the hospital and
reduce the risk of spreading infection to
protect our patients and staff. There
may be some exceptions to this which
we will discuss with you on an individu-
al basis.”
Dr Pittard said that “in some cases a
single family member will be allowed in
if the patient is at the end of life”.
For most patients, the best we can
then do, once they are on a ventilator, is
wait. Coronavirus has no treatment in
the sense of drugs that attack the virus
itself, which means all doctors can do is
help the body to defeat it.
If that begins to happen, Mr Johnson
will be moved back to a regular ward
where he will complete his recovery.
But if his condition goes the other way,
the prime minister is lucky that St
Thomas’, which overlooks the Houses
of Parliament, is one of only five facili-
ties in England that has a device even
more advanced than a ventilator: an
extracorporeal membrane oxygena-
tion, or Ecmo, machine.
If a ventilator helps the lungs, Ecmo
dispenses with them entirely. It takes
the patient’s blood supply and oxygen-
ates it directly, giving the most severe
cases breathing space, so to speak, to
recover. The average cost of Ecmo
treatment for one patient is £45,000.
If Mr Johnson is transferred to an
Ecmo machine then he will be lucky to
receive the very best care in the world.
It will also be a sign, however, of just
how serious his situation has become.Tom Whipple Science Editor
ALBERTO PEZZALI/AP; PETER NICHOLLS/REUTERS; JUSTIN SETTERFIELD/GETTY IMAGESgovernment offices were sprayed by a specialist team of cleaners in Westminster
Analysis
A
ccording to figures
published at the end of
last week, half of all
coronavirus patients
who have passed
through intensive care in the UK
have recovered. The other half
have died (Katie Gibbons writes).
The Intensive Care National
Audit & Research Centre
(ICNARC) recorded 2,
admissions of patients with
Covid-19 infections to intensive
care units (ICUs) up to April 3.
Most patients are still in ICUs,
but 690 have left. Of those,
344 lived.
Patients aged 50 to 69 had a
54.2 per cent chance of survival.
However, only a third of patients
who required a ventilator had
been able to leave intensive care.
Duncan Young, professor of
intensive care medicine at the
University of Oxford, said: “We
only know the outcome
[discharge or death] for a small
proportion of those admitted to
an ICU, so we can’t necessarily
generalise these findings to what
might happen to those admitted
to an ICU in future.
“The majority of the cases
reported here are still being
treated in ICUs, and the
ICNARC report contains
appropriate cautions on
interpreting outcome and
treatment data. ICNARC only
looks at patients who become
critically ill with Covid-19, not
those many others who have mild
symptoms managed at home.”
Of the Covid-19 patients in
intensive care, 73 per cent are
men and the average age is 60.
London, Thames Valley and the
southeast of England are still the
regions with the most cases.the last Thatcher biography launch,
detained the waitress for at least a
minute while he pushed down
prongfuls of cocktail sausages.
Mr Raab was more composed
than on Monday night after Mr
Johnson was taken to intensive care.
Boris? “He’s a fighter,” said Raab.
“I’m confident he’ll pull through.”
Out came the graphs and for once
they were not all bad. New cases
down, critical care beds in fair
supply and travel stats showed we
are staying at home. But then, as
ever, came the deaths chart, a daily
moment comparable to turning up
the Tarot card of a hollow-eyed
black knight on his charger.Despite more grim losses, the chief
scientific adviser, Sir Patrick
Vallance, thought infection trends
did “begin to suggest things might
be moving in the right direction”.
“Total unity, total resolve,” said
Mr Raab, when asked who would
make decisions if the cabinet was
split on policy. He hoped Mr
Johnson would “be back in very
short order”.
Questions from the media
followed. The man from Sky was
astonished that Downing Street
figures caught the virus. “How was
that allowed to happen?” he asked,
as if there should be a law against it.
Mr Raab has an unusual delivery.
He keeps stopping mid-paragraph.
Maybe it’s a foreign minister trait,
what you do to allow interpreters to
relay your remarks.
You expect a man of Mr Raab’s
chiselled jawline to speak gruffly
but his voice is soft, as light as a
decent hock. Caricatures have him
down as a hard man. So far, that is
not evident. He is deputising with
tact and a gentle grace. We could
have done an awful lot worse.seemed a particular regret this
year’s Wimbledon has been
cancelled. Even Sir Piers Morgan
OMG, that great agitator of
breakfast telly to-do, cooed
sympathy and two former Tory PMs
made video clips wishing Boris well.
Theresa May grimaced from a
sylvan bower while David Cameron
seemed to have been filmed by a
water mill, unless it was a flushing
lavatory. Sir John Major, who blew
bubbles about Boris at the last
election, did not film a tribute.
Unlike him to bear a grudge.
On the BBC News Channel its
presenter Clive Myrie sombrely
asked the political documentary
film-maker Michael Cockerell for
his “reflections” on Boris. Was that
the warble of Abide With Me on an
electric organ in the background?
These two titans agreed that the
PM was once a figure of “energy”
— “lots of juice”, said Myrie, as
though discussing a blood orange —
while Cockerell dwelt on the
Johnson waistline. “He’s a lot of
solid flesh.” This from the same
Cockerell who, when I saw him atDavid Cameron, the former prime
minister, wished Boris Johnson wellRichard Ford, Francis Ellliott