A lot of people are asking about @NightingaleLDN and the current response. Having spent a lot of time there during the last wave, we are proud of all the energy that went into the response. The NHS in London has adapted and changed since the first wave, with hospitals such as 1/

@NHSBartsHealth vastly increasing critical care capacity. It was always clear that care would be better delivered within the confines of an established NHS hospital although at the time this capacity was just not there. With the creation of a 170 bed critical care unit 2/
@RoyalLondonHosp the current efforts are in bringing all that new resource online to help people needing critical care, and this is progressing. One of the challenges @NightingaleLDN was around public information, and this was tricky to overcome. The other challenge in 3/
providing staff was also well documented. NHS staff, especially in the numbers needed to staff a critical care bed are not ‘spare’ when an incident hits and all hospitals, Nightingale or not, are grappling with the staffing challenge. This current wave is huge, and who knows 4/
if the resources of @NightingaleLDN will be needed, even if in a different operating model. It would be silly to say this won’t happen, as the new variant wave is shocking for us all. But the focus on firstly using the additional new capacity within @NHSEnglandLDN is the 5/
right one. Ambulances queuing is a related but slightly separate issue. The impact of the surge on emergency departments this time is very different from before (bigger, because of bigger numbers). Ambulances can’t offload because of space within the emergency department, 6/n
despite all the immense efforts to make space within hospitals. Official numbers of attendances to ED compared with ‘last year’don’t reflect the acuity of covid, and the need for cubicle use for patients. If covid patients are left in corridors then covid will spread like 7/n
wildfire within the hospital. This cannot be allowed to happen. The corridor medicine that was previously endemic in emergency departments would kill people (and staff) if allowed to reoccur. Hence the awful, terrible option of treating patients outside hospitals in 7/n
ambulances. No one wants to do this, it is a red line for all of us but we’ve now had to cross it. The impact on ambulances services is inevitably that patients will come to harm while waiting for a response. This is awful, truly awful. The only solution currently seems to be 8/n
to prevent covid from spreading. Vaccination is an answer, but won’t have any effect at all for many weeks. Hands, face, space, is the right strap line as is ‘stay at home’. Of course, the parallel impact on the economy, education, mental health are enormous. But without 9/n
controlling the spread we will not see any light in this tunnel for a painfully long time. ‘Opening the Nightingales’ is a decent idea, but is not without massive implications for everyone. However we definitely know that if some new model needs to be built, the @nhs staff 10/n
will find even more energy to make it work the best we can to help those who catch this terrible, nasty, evil virus.

More from Health

1/16
Why do B12 and folate deficiencies lead to HUGE red blood cells?

And, if the issue is DNA synthesis, why are red blood cells (which don't have DNA) the key cell line affected?

For answers, we'll have to go back a few billion years.


2/
RNA came first. Then, ~3-4 billion years ago, DNA emerged.

Among their differences:
🔹RNA contains uracil
🔹DNA contains thymine

But why does DNA contains thymine (T) instead of uracil (U)?

https://t.co/XlxT6cLLXg


3/
🔑Cytosine (C) can undergo spontaneous deamination to uracil (U).

In the RNA world, this meant that U could appear intensionally or unintentionally. This is clearly problematic. How can you repair RNA when you can't tell if something is an error?

https://t.co/bIZGviHBUc


4/
DNA's use of T instead of U means that spontaneous C → U deamination can be corrected without worry that an intentional U is being removed.

DNA requires greater stability than RNA so the transition to a thymine-based structure was beneficial.

https://t.co/bIZGviHBUc


5/
Let's return to megaloblastic anemia secondary to B12 or folate deficiency.

When either is severely deficient deoxythymidine monophosphate (dTMP*) production is hindered. With less dTMP, DNA synthesis is abnormal.

[*Note: thymine is the base in dTMP]

https://t.co/AnDUtKkbZh
I think @SamAdlerBell in his quest to be the contrarian on Fauci gets several things wrong here. 1/


First, the failure last year actually was driven by the White House, the #Trump inner circle. Watch what's happening now, the US' scientific and public health infrastructure is creaking back to life. 2/

I think Sam underestimates the decimation of many of our health agencies over the past four years and the establishment of ideological control over them during the pandemic. 3/

I also am puzzled why Tony gets the blame for not speaking up, etc. Robert Redfield, Brett Giroir, Deb Birx, Jerome Adams, Alex Azar all could have done the same. 4/

Several of these people Bob Redfield, Brett Giroir, Alex Azar were led by craven ambition, Jerome Adams by cowardice, but I do think Deb Birx and Tony tried as institutionalists, insiders to make a difference. 5/

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