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Tue 31 March 2020
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Doctors outside London describe the “calm before the storm” as the capital deals with a Coronavirus “tsunami”.

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Some NHS hospitals will need to operate at more than four times their capacity to cope with the surge in COVID-19 patients expected when the virus peaks, stark advice to staff reveals.

Byline Times has seen internal NHS correspondence which reveals that many hospitals should be able to operate at double capacity from next week, due to emergency planning procedures already put in place – including extra beds across critical care facilities.

But the correspondence, from multiple NHS trusts, also reveals that the expected surge in Coronavirus cases will place unprecedented demands on some hospitals. The documents were sent to staff shortly before the UK announced a further 103 deaths from the virus on 26 March – the largest single-day increase in deaths since the outbreak began. A total of 578 people have now died from the virus in the UK, while a further 11,568 have tested positive.

“We have been advised to plan up to four times capacity and some [are] suggesting more,” one note to staff reveals.

The senior doctor’s note adds that, to operate significantly above current capacity, hospitals – specifically intensive care units (ICUs) – require many more ventilators, monitors and pumps.

Ministers have said that around 8,000 ventilators are currently available to the NHS and a deal was recently secured to obtain a further 1,200 from private hospitals. But NHS staff are warning that they need many thousands more to manage the epidemic. New supplies have been ordered – including 10,000 from the British firm Dyson – but it is not clear how long they will take to arrive.

Senior doctors, managers and nurses also remain deeply concerned that not enough personal protection equipment (PPE) – such as masks and visors – have reached the frontline. The time lag between Government decisions to procure extra equipment and the receipt of the stock is now becoming a significant issue across UK hospitals.

London remains the UK’s biggest concern as the entire NHS confronts the upsurge in Coronavirus cases. Most hospitals in the capital have above-average bed capacity, especially in ICUs, but are already struggling under the weight of demand for beds, ventilation and other life-saving equipment.

Chris Hopson, chief executive of NHS Providers, today said that London’s hospitals were facing a “tsunami” of COVID-19 cases. A third of all cases diagnosed in the UK are in the capital. He also warned of significant staff absences caused by doctors and nurses falling ill or being forced to self-isolate.

“We are now seeing 30%, 40% and indeed in some places, 50% sickness rates as staff catch the virus or are in vulnerable groups or have to self-isolate,” he warned.

Outside of London, some areas are now expecting similar levels of demand for hospital treatments. Senior staff across the UK are quickly trying to learn any lessons emerging from the capital, with coordinated information-sharing being vital.

The cancellation of NHS operations and the removal of many other patients from hospital wards could free up as many as 30,000 of the 100,000 hospital beds in England, it is thought.

But patient capacity is merely one issue. Doctors and nursing staff have already been warned that ventilation equipment is likely to be severely rationed during the peak, with doctors warned that they might have to withdraw ventilation for some patients after 24 to 48 hours due to extraordinary demand.

Hospitals have also made significant adjustments to their standard medical-nursing staff ratios, having been warned that they are now “clearly not applicable”.

One note to ICU staff reveals that experienced doctors and nurses will be more likely to perform a “supervisory role” – looking after a team of non-ICU nurses and carers, rather than an individual patient. The correspondence states that, while such changes will “undoubtedly” be difficult, “there is no other reasonable option”.

One senior doctor in northern England told Byline Times that hospitals are very concerned about staff numbers at the peak of the virus. “We’re working on the drugs, ventilators and floor space,” the source said. “But staffing is going to be very, very hard.”

Generally, however, medics feel that the NHS is expanding to cope with the surge in Coronavirus patients – but will only be able to do so if the population continues to lockdown, uphold social distancing practices, self-isolate where necessary and shield the most vulnerable.

A doctor in Wales said: “I can’t speak for our colleagues in London, who are already tackling a big increase in virus cases, but for some of us, this is the calm before the storm. We are using the time to prepare as best we possibly can. I have huge faith in NHS staff, but this is going to be extremely tough.”


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