THE CORONAVIRUS pandemic has taken a back seat in the news recently.
Most public health restrictions in relation to the pandemic were lifted on 19 July, on Boris Johnson’s ‘Freedom Day’, such as the social distancing requirements, and mask wearing. All businesses could open.
Then on 16 August, the need to self-isolate after being ‘pinged’ by the Covid app was no longer necessary for people with two vaccinations, or under the age of 18, and no symptoms.
Hospitality, nightclubs, open air festivals, and football matches have been going ahead with Directors of Public health considering Covid passports and evidence of negative tests to be adequate for entry.
According to the Today Programme on BBC Radio 4 (29/8/21) the policy is to ‘face up to rising infections, rather than lockdowns’.
The Office of National Statistics on 27 August reported that in England one-in-70 people were infected with coronavirus. In Scotland, with the schools having gone back the previous week, Covid case numbers doubled.
In the week ending 27 August, coronavirus infections in the UK, were running at over 30,000 per day, (7-day average 34,361), with deaths at over 100 per day, (7-day average 112 per day),
This contrasts with the situation in the second half of January 2021 when case numbers also came down to over 30,000 per day, but resulted in deaths of over 1,000 per day.
At that time, there were almost 40,000 patients in hospital with Covid-19. Many hospitals had between a third and half their beds devoted to Covid care.
Intensive care unit (ICU) beds were ‘surged’ to double their normal number. Scores of inter-hospital ICU transfers took place.
In December 2020 and January 2021 many hospitals declared red alerts, overwhelmed with the tsunami of daily Covid admissions up to 4,000 per day nationally, with thousands of staff off sick with Covid. 27,277 patients died of Covid-19 in England and Wales in January alone, with Covid-19 the top cause of death.
The strict lockdown (4 January to 8 March 2021), followed by a phased reopening, reduced Covid cases numbers to 1,926 by 16 May, with help from vaccinations.
It is the vaccination programme in the UK which has drastically reduced the conversion rates of cases to hospitalisations, and deaths.
Eighty-eight per cent of the adult population over the age of 16 years have had one dose, and 78% of adults have had two doses. 60% of the whole population has had two jabs.
The virus is mainly circulating amongst young people, which is why the government is continuing to push a vaccination programme for 17-to-23 year olds, and is awaiting a decision of the Joint Committee on Vaccinations and Immunisations, as to whether to vaccinate children from the age of 12 years.
However, the most significant indicator of the severity of the pandemic at any point in time is the number of patients in hospital with Covid -19
At present the number of patients in hospital in the UK with Covid is slowly and steadily increasing; from 870 on 30 May, to 1,667 on 16 June, to 3,964 on 16 July, to 5,894 on 16 August, to 6,942 on the 29 August and 7,596 on 2 September, with 1,032 of these on ventilators on that date.
Despite the protective effects of the vaccinations, Covid is now circulating in the community at a level 26 times higher than it was last summer.
It is these high circulating case numbers which are now the cause of the steady rise in hospitalised patients. (BBC 20/8/21)
Prof Paul Hunter, Professor of Medicine at the University of East Anglia, said: ‘It would not matter a jot if Covid caused a million cases a month if it didn’t make anybody sick. It’s the actual illnesses which have to drive what we do next.’
The NHS, however, is in deep trouble right now in the summer, before any potential surge in cases in the autumn makes its appearance.
A surge is expected as children go back to school, students start college and university, more parents go back to work and indoor mixing increases.
The NHS is ‘running hot’ this summer, because there are ‘winter levels’ of patients presenting at A&E departments and record numbers having to be admitted.
Many more patients are getting seriously ill, because they have not been able to access NHS care, when they needed it, in the last 18 months of the pandemic.
Together with the almost 8,000 Covid patients currently in hospital beds, this puts hospitals under extreme pressure.
It has been suggested that the NHS can just about cope with 8,000 to 10,000 Covid patients in hospital for a week or two, but that if this were to continue with no let-up during September and October, there would be a much more profound hit to other hospital services. (Editor of HSJ twitter 23/7/21)
In addition, the NHS is being instructed by NHSEngland (NHSE), to catch-up with the huge backlog of five million elective procedures built up during the pandemic.
So, because hospitals are having to care for patients with Covid, and catch-up with elective cases, and deal with record emergency admissions, the hospitals are as full as they normally are in November.
England has around 94,000 general and acute beds, (remembering that capacity is reduced by the spacing requirements of infection control) and has suffered winter capacity crises for the last five years, because of constant bed cuts.
The NHS went into the pandemic with 100,000 staff vacancies. On top of this, at many times during the summer there have been 80,000 staff absent due to sickness, isolation requirements, and annual leave.
In mid-June 2021, hospitals in the North West (NW) Region, Lancashire and Greater Manchester, noted increased numbers of Covid patients coming into hospital, associated with a surge in community cases.(HSJ 16/6/21)
This surge in cases led to record numbers of 999 ambulance calls. By July, this resulted in patients in the NW having the longest waits for Category 3 ambulance call-outs in the country.
Category 3 patients, are defined as urgent, not life threatening, for example, patients with abdominal pain or diarrhoea and vomiting.
The national average wait of Category 3 patients for the ambulance to arrive is 1 hour 58 minutes, whereas in the NW it was 3 hours 28 minutes. But in 10% of cases, patients waited more than 7 hours 50 minutes! (HSJ 8/7/21)
June was also a month in which over one million people (1,436,613) attended A&E departments at acute hospitals, the highest since records began. This is 8% higher than the June level in 2019.
1,289 of these patients had to wait for more than 12 hours after the decision was made to admit them, until their placement in a hospital bed, which rose to 2,200 in August. (HSJ 8/7/21)
Nottingham University Hospitals Trust was warned by the Care Quality Commission (CQC) about unsafe overcrowding of patients on trolleys in its A&E department as a risk factor for the spread of Covid between patients. (HSJ 13/7/21)
By mid July, similar pressures appeared in the North East (NE) & Yorkshire region, concurrent with a surge in covid cases in the community, making this region the epicentre of Covid in the UK.
Hospital Covid patients in the region doubled in one week to 800, from 5-12 July.
Leeds Teaching hospitals began cancelling operations, including those for cancer. (HSJ 14/7/21)
A surge of Covid admissions also affected the huge University Hospitals of Birmingham NHS trust, in the Midlands, resulting in 30 extra Covid patients in ICU and the postponement of some elective surgery.
Sandwell and West Birmingham hospitals suddenly experienced a similar influx. Patients had to be transferred to other ICUs across the East Midlands. (HSJ 16/7/21)
The increased call demands and the blocking of ambulance downloads at A&E departments, led to a corresponding crisis in the ambulance services in the NW and NE & Yorkshire.
By 16 July, Covid cases spiked in the UK at over 50,000 cases. Many attributed this to the super spreader effects of the big Euro football matches.
After this, some hospitals in London began returning to ‘Covid surge’ mode, where they began to transform general wards and/or operating theatres back into extra ICU space. (17/7/21 Rupert Pearce on Twitter)
One week later, NHSEngland Midlands sent a warning letter to hospital trusts in that region warning them to make surge preparations for more Covid cases, admitting that this would have an impact on elective surgery. (HSJ 21/7/21)
The British Association of Critical Care Nurses, informed their members that many trusts were moving into ‘surge measures’, and would be forced to dilute the regular one-to-one ratio of trained critical care nurse to ventilated patient, in order to staff the extra areas.
Instead, one CCU nurse would be caring for two ventilated patients or four high dependency patients. Nicki Credland, chair of the association, warned that inevitably there would be a reduction in the quality of care provided. She said: ‘There are simply not enough qualified critical care nurses.’ (HSJ 22/7/21)
In the north of Ireland, at the end of July, hospital trusts in Belfast had became overrun with A&E admissions from Covid patients requiring ICU care. Cancer surgery had to be cancelled. (BBC26/7/21)
By this time also, a number of trusts in the most affected regions of the NW, NE & Yorkshire, the Midlands and some parts of London, had admitted Covid patients to the point of occupying 10% of their beds.
The 10% level represents a pivotal turning point in a hospital, as it requires a considerable reconfiguration of beds and redeployment of staff to care for the seriously ill Covid patients in separate facilities from the non-Covid patients, which leads to severe reductions of other hospital work.
The following eight trusts had 10% of their beds occupied by Covid patients; In the NE – S. Tyneside and Sunderland Foundation trust (FT), Queen Elizabeth Hospital Gateshead, N. Tees and Hartlepool FT; In S. Yorkshire – Barnsley Hospital and Rotherham FT; in the NW – hospitals belonging to Pennine Acute Hospitals trusts in Manchester, Oldham and Bury; In W. Midlands- Sandwell and W B’ham; in London, – Whittington Health Trust. (10)
But other trusts came close to 10% bed occupancy; University Hospital Birmingham, London hospitals – Royal Free London, North Middlesex Univ Hosp, Croydon Health Services, Barts Health Trust; W.Yorkshire; Bradford Teaching Hospitals and Calderfield and Huddersfield; NW – South Tees Hospital (HSJ 26/7/21)
On 11 August, the NHS Borders health board in Scotland announced that all routine operations would be suspended, because of the rise in Covid in-patients. (BBC 3/9/21)
An ambulance paramedic blurted out the truth when he wrote that the NHS is ‘already overwhelmed’. (Letter, Guardian 25/7//21)
‘People are waiting in excess of 15 minutes to have their calls answered. Can you imagine waiting so long for an operator to ask “is the patient breathing?”.
‘We don’t have the resources to allocate the most life-threatening emergencies and those we deem to be less critical are waiting for hours – and sometimes till next day – for an ambulance.’
A Welsh paramedic interviewed outside Glan Clwyd Hospital said: ‘We know there are people in the community that are screaming out for an ambulance, but as you can see, there are a lot of ambulances waiting here.
‘It never used to be like this. We used to bring poorly patients in and we were out on the road in 15 minutes.
‘We could do 10 jobs a shift, today we’ve done two. It’s so demoralising … A lot of us feel pretty broken at the moment.’ (BBC 11/8/21)