Editorial – 25 Mar 2020

On 22.03.2020, the National Institute for Health and Care Excellence (NICE) issued the first rapid COVID-19 guidelines covering the management of patients in critical care. It also includes the management of patients who are having kidney dialysis and those who are receiving systemic anticancer treatments. The guidance includes a guideline on critical care for all patients on admission to hospital with a patient frailty score to enable an assessment if needed. This will of course be discussed with the patients themselves, carers or advocates and families so that informed decisions can be made about treatment wherever possible.

We all know that there is a risk of the NHS becoming overwhelmed. But with the frailty score, we also know that we, as individuals are just that. Individual. One size does not fit all.

Let’s have a look at the categories.

1. Very fit. If you are robust, active, energetic and motivated, you commonly exercise regularly and you are among the fittest in your age category.
2. Well. If you have no active disease symptoms but are less fit than 1 above, exercise or are very active occasionally (or seasonally).
3. Managing Well. If your medical condition is well controlled but you are not regularly active beyond routine walking.
4. Vulnerable. You are not dependent on others for daily help, but your symptoms limit activities. A common complaint is being slow and/or feeling tired during the day.
5. Moderately Well. If you have no obvious problems and need help with daily activities such as finances, transport, heavy housework, medications. Mild frailty gradually impairs shopping and walking outside alone, meal prep and housework.
6. Mildly Frail. If you need help with all outside activities and keeping house. Often have problems with stairs and need help with bathing and may need a little help with getting dressed.
7. Severely Frail. If you are totally dependent on personal care from a physical or cognitive cause. If you seem stable but not at high risk of dying (time frame is over six months time).
8. Very Severely Frail. Completely dependent, coming to your end of life and you would typically not recover from a minor illness.
9. Terminally Ill. You are approaching end of life with a life expectancy of less than six months who are not otherwise frail.

I’m sure we can all figure out where we may lie on the scale above, but I bet some of you will be a kind of ‘in between’ two stages.

So, how can we do our bit to help the NHS and the staff? Aside from the fact that we should now stay at home and only take trips out for essential journeys such as food and medicine, we can try and maintain/improve our general health. If we are then unfortunate enough to catch COVID-19, we might have a better chance at dealing with the virus without the need for hospitalization.

It is a well known fact that sleep is very important. Quality of sleep rather than quantity of sleep is the over-riding factor. Put down your phone an hour before bedtime. Try not to do anything too stressful.

If you already attend a gym, maybe use a bit of creativity to keep up on your routine? And if you don’t normally do any, perhaps implement some gentle exercise. Yesterday I found an app called NHS Active 10 which tracks how much brisk walking you’ve managed to do and ways you can do more. It advocates brisk walking whether it be for one or ten minutes and sets targets. If you can’t walk outside, then certainly in the garden or, as I’ve been doing, a set amount of walking up and down my stairs.

Another thing we can do is look at what we are eating, do a few tweaks to make our food healthier or maybe cut out our usual treats? Easter is soon coming up, so I’ve set myself a challenge to NOT eat my Easter eggs early!

Sometimes it only takes a small change to feel a big difference…

On 20.03.2020, the Government put out a rallying call for retired medical professionals to return and assist with the current pandemic. 65,000 letters went out and many retired nurses and health professionals answered that call. Understandably, as retirees, many may have already had to quarantine themselves, and not able to volunteer.

I want to give thanks to all those working in social care trying to manage the risks for their residents.

Both the NHS and social care staff continue to put their own lives and families at risk to help with the pandemic. An amazing display of courage tempered with a desire to help others. Not to forget the people still working in supermarkets, in the supply chain, as binmen, or many of the other essential lines of work that we need to keep the country ticking over – thank you.

We can all do our bit, even if that simply means staying indoors.

Lin Mason
Associate

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