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Tuesday 7 April 2020

C-19 Sensemaking

Boris Johnson: What we know

Britain’s prime minister is seriously ill. We all have questions and concerns. Here are some answers

By Giles Whittell

Last night Boris Johnson was moved to an intensive care unit in St Thomas’s Hospital when his condition worsened a day after being admitted with symptoms of Covid-19. Twelve days after first announcing that he had the virus, the prime minister is in good hands; the hospital has some of the most advanced respiratory care in the country. And yet the odds are daunting. Only about half those who require intensive care for this disease survive.

How long has he been unwell?

The PM first said he had tested positive for Covid-19 on Friday 27 March. He tweeted that he was self-isolating in his flat in 10 Downing Street with “mild” symptoms including fever and a persistent cough. Last Friday his self-isolation was extended after the minimum seven days because he still had a high temperature.

There is little mystery about how he became infected. Everyone in public life is at risk, and at a 3 March press conference Johnson said he was still “shaking hands with everybody”, including people he had met recently at a hospital where he believed there were coronavirus patients. At that point he said he understood the most important public health advice was to wash hands frequently.

Why was he hospitalised?

Johnson was taken to St Thomas’s Hospital on Sunday evening after ten days with the virus because of persistent symptoms including a high fever. His spokesman called the move a precautionary step. Johnson didn’t need an ambulance but is understood to have been given oxygen in his prime ministerial car even though the hospital is a two-minute drive from Downing Street.

Studies of Covid-19 patients in Wuhan suggest most of those with severe infections are admitted to intensive care at the ten-day mark. Johnson wasn’t. He’s thought to have spent his first night in hospital in the private Howard ward on St Thomas’s top floor.

What treatment has he received?

Johnson, 55, was moved to an intensive care unit on Sunday evening, when Downing Street said his symptoms worsened. He is probably now in the hospital’s East wing. It’s not clear if the move was for immediate specific treatment or to ensure he was close to the one-on-one care and monitoring and life-support machinery that are only available in ICUs. At least in his first 36 hours in hospital, Johnson was not put on a ventilator. He is likely to have been supplied with oxygen using a CPAP (continuous positive airway pressure) system.

What is his condition now?

As of Tuesday lunchtime, Johnson is said to be in stable condition, meaning his condition did not worsen significantly overnight. Ministers say he is in “good spirits” but he would not be in an ICU if he were not seriously ill. With Covid-19 that usually means the infection has spread to the lungs, but doctors said he does not have pneumonia.

How long could this go on for?

Days… or weeks. The average length of hospital stay for patients who recovered from Covid-19 in Wuhan was 17 days. Treatments still available to Johnson’s doctors, besides the use of a ventilator, include: extracorporeal membrane oxygenation (ECMO), in which the blood is oxygenated outside the body by instruments doing the jobs of both the heart and lungs; and so-called convalescent plasma therapy, using whole blood from patients who have recovered and are assumed to be carrying antibodies.

Who is in charge of the government?

Johnson’s powers as prime minister have not been formally handed over to anyone else, but Dominic Raab chaired this morning’s cabinet meeting as first secretary of state. Raab is authorised to deputise for the PM if necessary, which is not the same thing as being acting prime minister. Broadly, it entails pursuing policies already set in train by the government, although a spokesman said Raab could in principle take the country to war. If Raab becomes incapacitated, his place will be taken by Rishi Sunak, the chancellor.

How is Johnson’s partner?

Carrie Symonds has said she is recovering after self-isolating with Covid-19 symptoms for the minimum of seven days. The 32 year-old conservationist and former head of communications at Conservative Party HQ is thought to be at her flat in Camberwell rather than in Number 10 or the prime minister’s official country residence, Chequers. She is expecting the couple’s baby this summer.

Photograph by Getty Images, shows a patient being treated for Covid-19 in an intensive care unit in Italy

 

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