The Prime Minister is admitted to intensive care

Dermot Murnaghan paraphrased, from 0:00

The presenter asked what happens to COVID-19 patients who develop severe symptoms, as the Prime Minister clearly had: how they are treated, short of ventilation, when they end up in intensive care.

Dr Kishan Rees from the recording, 0:25

So I think it’s really important to get some messages across to your viewers: this is a serious disease, and to be quite honest I don’t know how much more has to happen. The vast majority of people are taking this very, very seriously, but there’s still a few that remain to be convinced. If the Prime Minister is on an intensive care unit, albeit not ventilated, which is obviously reassuring, I think it’s really important that members of the public take this incredibly seriously, which we’re starting to see now. In answer to your question, what sort of things will they do: judging by your reporting, and Beth Rigby’s piece where she was talking about how he gave the instruction to Dominic Raab, it does sound like he hasn’t been intubated. And you’ll have to bear with me, because I’ve just been phoned ten minutes ago by your producer. So it sounds like he hasn’t been intubated, which is obviously a good thing and we wish him well. But I think he will be on an intensive care unit, because that allows for a far higher degree of monitoring in terms of the body’s physiology, and there’s also one to one nursing: a very close eye from a medical point of view, so they can really monitor his observations, his temperature, his blood pressure, his heart rate, his oxygen saturation.

Dermot Murnaghan paraphrased, from 1:44

It was terrifying, the presenter said: this was the most high-profile warning the nation could get of how dangerous the virus is. The PM had sent a message from self-isolation saying he still had a high temperature, no shortness of breath or coughing, and he had had it for about seven days. It was striking how quickly it could turn nasty.

Dr Kishan Rees from the recording, 2:09

Absolutely, and the really scary thing with this is there’s a balancing act, in terms of we don’t want to scare members of the public and we don’t want them to panic, because there is the balance between physical health and mental health. But as you rightly said, this disease affects people in very different ways. Some people can be completely asymptomatic, have no symptoms whatsoever, don’t even know that they’ve got it, but can still be very contagious, and that’s why it’s a bit of a problem. But then the disease seems to follow two courses: some people have this mild flu-like illness for five to seven days and then they get completely better; however other people, the at-risk category, patients that have diabetes, chronic kidney disease, various other complex medical problems, which as far as I’m aware the Prime Minister doesn’t fall into. But this should serve as even more of a warning shot for your viewers, in the sense that the second stage of this disease, in some people that get it, can involve a really severe autoimmune reaction, something called cytokine storm, where the body’s natural defences are overwhelmed and the body shuts down with multi-organ failure. So I want to reassure your viewers that from the news coming out at the moment, as far as we can tell, that is certainly not the case for the Prime Minister, but it is a powerful warning of how seriously members of the public really must take this. And I think there’s an element of distrust in some elements of the media, this era of fake news, and nobody really wants to believe this. I’ve been tracking this since it started in December in Wuhan, and I’ve spoken to colleagues around the world, and this trail of destruction and sadly death has swept round the globe. So members of the public really, really need to stay at home, protect the NHS and ultimately save lives. And if the Prime Minister on an intensive care unit, albeit for monitoring at the moment, isn’t that powerful warning shot to your viewers, then honestly, I’m lost for words.

Dermot Murnaghan paraphrased, from 4:26

Turning to treatment, not the Prime Minister specifically but a patient suffering severely from COVID-19: given the cytokine storm, was this where powerful antibiotics come into play?

Dr Kishan Rees from the recording, 4:43

Well interestingly it depends on what happens. So we know that coronavirus causes COVID-19: coronavirus is the virus and COVID-19 is the disease. Now ultimately you can get superadded bacterial infections or bacterial pneumonias, and superadded means on top of, which means an antibiotic would help. However in the vast majority of cases antibiotics are of no use at all. So a really important public health message to your viewers is, you shouldn’t go to your GP anyway in the current situation, but don’t be in a situation where you’re demanding antibiotics, because antibiotics won’t actually help you. Prevention is obviously better than cure, as with all disease, and that is why the hand-washing is incredibly important. Not that I’m criticising, but my concern with the public health messaging that has been put out is that the severity and the gravity of this situation seems to have been lost among some, and that’s why it is spreading around the UK population, and that’s why we’re seeing businesses around the country taking major measures to keep not only their staff safe but the shoppers going to get essential supplies. So going back to your question: antibiotics, no, not going to help, unless there’s a superadded bacterial infection. To be honest the treatment is very much supportive, which means fluids, maybe paracetamol to control fever, but also if a patient’s case deteriorates to the point where they’re no longer able to maintain their blood pressure, then they could end up on an intensive care unit and they would be getting inotropic support. And I’m really grateful to Sky News for giving time to this, because I think it’s really important that members of the public understand these discussions that may be happening if they or a loved one end up in hospital. So inotropes is when your body cannot maintain a blood pressure anymore, because your body is getting to the point where it’s failing. Inotropic support is basically a powerful vasoconstrictor, which means all the blood vessels constrict, adrenaline is an example, noradrenaline is another, and by all the blood vessels in your body constricting, what it does is it diverts blood to the vital organs, ie your brain, your heart and your kidneys, which are the vital organs that we absolutely have to protect. So there is no treatment: that’s another reason why this disease is incredibly scary and needs to be taken incredibly seriously. And if you end up on ITU, then your body’s physiology is not in a position where it can compensate, which it does in the vast majority of healthy people.

Dermot Murnaghan paraphrased, from 7:37

The presenter thanked me for hammering the message home, and asked about me: where had I been working during the pandemic?

Dr Kishan Rees from the recording, 7:52

I’m speaking on Sky in my personal capacity as an urgent care doctor, and through my interest in WatMed Media, which is a social media broadcaster. One of the reasons I’m not on the frontline is that I actually have an autoimmune condition which would place me in a high-risk group, and ultimately I’m not willing to chance it, going on the frontline without appropriate PPE. I saw the great segment you ran on the Sunday shedding light on that vital issue: yes, there have been supply issues with PPE, but we’re also getting doctors on the frontline getting in touch with the Doctors’ Association, and getting in touch with WatMed Media, with proper reports from the frontline that there is not the PPE. So at the moment I work in a private urgent care centre in London, and they took the decision to close on the 15th of March. If I’m being completely honest with you there was a little relief in me, in the sense that once I’d committed to the shifts I was always going to do them, because to me being a doctor is sticking to your word, but with my own health condition, the autoimmune disease, I am at high risk of developing that cytokine storm that we talked about. So not on the frontline currently, but working in the pharmaceutical industry, tracking this disease from December, coming out of Wuhan, I’ve certainly read up on the literature about it. But perhaps more importantly, I’m really trying hard to communicate that science to patients in a way that they can understand, and that’s not trying to be condescending, but I see some of the science being communicated in a really shoddy way, to be honest.