We can’t wait for hospital admissions to increase – England needs a breaker now | Christina Pagel – Nach Welt

TThe advent and rapid proliferation of the Omicron variant poses the greatest threat to the NHS since the rise of the alpha variant last December. The NHS then only did it by cutting down a lot of non-Covid work and helping to increase cases the second lockdown in January 2021 slowed down. A year later, the lack of urgency The government’s response is a threat to all of us.

NHS staff are exhausted. You have been working at full speed for almost two years. For some time they struggled with increasing numbers of seriously ill patients with Covid-19. As each wave subsided, they turned to the backlog of cases that had built up in the meantime – this huge backlog started before the pandemic and is almost numerous 6 million people. Covid patients meanwhile still make approx a quarter of the intensive care beds used.

The risks to the NHS come from three sides. First, Omicron has grown faster than any known variant – including the original spread of Covid-19 in March 2020. The UK health authority reports that cases of Omicron have occurred Doubling every two days in most regions of the UK. A certain percentage of the newly infected will require hospital treatment – even if Omicron causes a less serious illness than Delta. Let’s say the risk of hospitalization with Omicron is half that of Delta, although analysis by Imperial College London suggests it can be optimistic. In one variant, which doubles every two days, we only have two days ahead. Regardless of the final percentage of people with Omicron who will need NHS treatment, the absolute number of people needing care will also double every other day.

Since it takes seven to 14 days from infection to hospital need, the demand for it is increasing NHS Services won’t be seen right away – probably not until after Christmas – but it will happen. Modeling by the Scientific Pandemic Influenza Group on Modeling, Operational Subgroup – which reports to the Sage Committee – suggests that by the time we see these effects, it may have been four doublings. This means much higher pressure on the NHS that we cannot do anything about if we wait for hospital admissions to increase before acting.

Last Thursday, Sage valued that without further reductions in transmission (beyond Plan B) there will be at least 3,000 daily hospital admissions in England (corresponding to the first wave in 2020), and it could get even worse than it was last January. So the question is not whether it will be bad for the NHS, but whether it will just be terrible or catastrophic.

The second risk is focusing only on the number of patients and not on staff capacity. It is very likely that staff absences due to infection will also have serious effects. Fortunately, almost all will have been boosted, so unlike the early days of the pandemic, they have little risk of serious illness or death. But we know that those who have been charged are infected and need to isolate. And when a neurosurgeon isolates, his entire team cannot survive. It also adds to the stresses on those who can still work.

The NHS in London is already struggling with major staff shortages due to Omicron: The trust of Guy and St. Thomas already had to Cancel services and the London Ambulance Service currently has Hundreds of employees sick. The speed at which Omicron is growing makes it inevitable that we will lose many key employees as demand increases. The number of NHS hospital beds in England has increased more than halved in the last 30 years, with the UK among the countries with the lowest ICU capacity per inhabitant in all of Western Europe. And we already have far fewer doctors than in other parts of Europe.

The third risk arises from the way we have taken the efforts of NHS staff for granted. During the pandemic, the NHS staff have adapted remarkably to incredibly difficult situations. You have learned new skills. They have created new ways of working, such as remote consultation (with much maligned GPs seeing many more patients than before). They have repurposed facilities and converted conventional wards into intensive care units. They supported each other when it got too much. But at some point they can no longer. Many employees have left and many more have left burned out and can’t face the trauma another winter desperate for people to breathe. Many have long developed Covid with more than 3% of the health and social workforce Report persistent symptoms of Covid-19 for 28 days or longer, the highest in any occupation.

After nearly two years of crisis management, the NHS simply no longer has the resilience it had at the start of the pandemic. This means that with lower hospital admissions from Covid-19, the pressure is now higher than in previous waves. As a society, we have a duty of care to the NHS and the caregivers who have looked after us in incredibly difficult circumstances. We let them down.

We urgently need to protect our health and social workers with adequate personal protective equipment. We must provide high quality PPE (including FFP2 / 3 masks) to all employees so that they can protect themselves and their families and reduce hospital transmission that can cost lives. We need measures that can quickly reverse the rise in cases. Vaccine boosters are crucial, but they work for weeks rather than days. We missed the opportunity for less serious early action. The only thing that could work in time is a short one Circuit breaker to limit indoor social interaction (and return the rule of six outdoors while leaving outdoor hospitality, shops, and schools open) as suggested by Independent Sage and Sage. New data on severity and spread arrives every day, and if the news is good, the breaker can be quickly opened. But we have to act now.

  • Christina Pagel is the director of UCL’s Clinical Operational Research Unit, which applies advanced analytical methods to health care problems. This article was co-authored by Deepti Gurdasani and Martin McKee


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