NHS Hospitals Are Not ‘Scaremongering’ About a New Winter Coronavirus Wave
David Oliver makes a plea on behalf of his colleagues as they face a surge of admissions due to the spread of the omicron variant of COVID-19 this Christmas
Like so many NHS colleagues in acute care, I shall be working over this Christmas weekend. And, like many, I saw at first hand the awful toll of the first major COVID-19 wave in Spring 2020 and the even higher one in Winter 2021.
With the Omicron variant surge, we face an uncertain January – hoping for the best, fearing the worst and planning for something in between.
We know just how rapidly things escalated this time last year, with hospitals and intensive care units seeing record numbers of Coronavirus patients and with daily death numbers peaking at over 1,400. The scale of human tragedy and distress, for patients and their families and the staff coping with it daily, is not something we need to see again if we can avoid it.
We would be delighted if a third wave of demand for acute care never even arose and I pray it doesn’t. But the Coronavirus pandemic has surely taught us that the precautionary principle should be respected and that it is better to act too early and decisively than too little and too late.
Pandemic health protection measures are not all about you and your own personal risk or appetite for it, your own ‘natural immunity’ or fitness, your own liberty or freedom. They are about protecting everyone else
Labour Shadow Health Secretary Wes Streeting said in the parliamentary debate on the introduction of further COVID public health protection measures that “I don’t know why this has to be explained, again and again. We need to protect the NHS and prevent it from Toppling over”. He had a point.
If the NHS ambulance, hospital and intensive care services find themselves unable to meet the needs of all of the sickest and most vulnerable people – with or without COVID – not only will they suffer, or die avoidably, but so will others who need care. As there is no magic reserve supply of beds or staff, ‘protect’ in the short-term can only mean ‘prevent so many people becoming infected or becoming seriously ill when they do’.
Our main hope of achieving this is mass vaccination, which does reduce our chance of becoming seriously ill, hospitalised or dying, along with general health protection measures designed to reduce the risk of transmission and the speed of spread.
I am not here to make party-political points or to argue the case for particular interventions such as vaccine certificates or lockdowns. But I do want politicians, media commentators and members of the public alike to treat the threat of a third COVID wave seriously and for this to inform their decisions and views accordingly.
I have seen plenty of disconcerting comments I’ll paraphrase: Omicron is only a mild illness; it is no worse than a cold; it is less likely to hospitalise people; it is less dangerous than other variants; people are admitted or die with COVID and not because of COVID; scientists and medics are exaggerating and scaremongering; that the models were proved wrong before; that the NHS should be there to protect us, not the other way round; and if the NHS can’t cope, it isn’t fit for purpose.
The motivation for saying these things seems either to be hostility towards the NHS model or a refusal to accept that any further health protection measures are justified.
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The Reality We Face
Firstly, the NHS really is under pressure in terms of demand and capacity.
Right now, the service has just about the smallest number of general, acute and intensive care beds, doctors and nurses per capita among OECD (Organisation for Economic Co-operation and Development) nations.
Hospitals are routinely running very ‘hot’ at more than 90% bed occupancy. There are a record number of ‘stranded patients’ who are medically stable enough to leave (although by no means well and problem-free) but because of serial cuts in social care provision and insufficient capacity in community health services to support them outside hospital.
Meanwhile, the number of people attending emergency departments or calling ambulances is back at pre-pandemic levels, waiting times and overcrowding are deteriorating. The service is also now under significant pressure to catch-up on a record number of patients on waiting lists for elective care such as investigations or operations. Support grants for public health departments have also been cut by around 25% in the past five years.
Yes, during the first and second Coronavirus waves, the NHS did manage to near double intensive care capacity, change rotas and repurpose wards – but it came at a cost to planned care and patients remained at risk of contracting COVID-19 within hospital even if they were there for other reasons.
Secondly, the NHS faces a huge staffing crisis.
The NHS has more than 100,000 vacancies (as does social care). It has no more GPs than in 2015 despite consultation numbers growing year on year. Around one in 10 nursing posts are unfilled. Frontline staff working on COVID wards are several times more likely to catch COVID or be hospitalised than the rest of the workforce and more than 1,000 have died during the pandemic. Many more have Long COVID or are just burnt-out and demoralised after the past 21 months. We all know colleagues badly affected.
With Omicron increasing so rapidly and staff living in households and the community like everyone else, we are bound to see more going off sick or self-isolating.
It takes years to train healthcare professionals and, with no staff, there is no service. Trite soundbite solutions and rhetoric – sometimes designed to undermine the NHS model – won’t magic up staff and fewer are now coming here from overseas. Neither Brexit nor new immigration rules are helping the workforce gaps.
Thirdly, the Coronavirus does not care for political discourse, ideology, opinion columns, retweets or clicks.
We cannot minimise the threat with words or wish it away. Omicron is more infectious than earlier variants and the number of infected people is doubling every two or three days. We have already hit record numbers of daily positive tests and these are not, as is sometimes claimed, simply because we are testing more as major ongoing population surveillance studies from Oxford University and Imperial College show. Omicron is also more resistant to immunity from previous infection or vaccination, though boosters do seem to confer decent immunity.
The Precautionary Principle
It may be that Omicron is no more likely, even less likely, to hospitalise or kill people than the Delta variant. But, if we end up with two or three times the number of cases as we have seen in earlier waves, including cases in the unvaccinated, it would only take 1% of say 200,000 cases a day being admitted and one in 5 of them to require intensive care treatment to cause a serious problem.
It takes around seven to 10 days for someone infected with COVID-19 to get sick enough to be hospitalised and another week or more for them to get sick enough to die. So, what we see in January will reflect the patterns of transmission in late December.
Of course, models are imprecise. That is inherent – they have a range of variables and potential outcomes, although at a local level throughout the NHS they proved quite accurate in terms of predicting hospital admissions, bed days and intensive care demand. Dismissing or mocking models just because the worst-case scenarios didn’t materialise last time (after we had put in mitigating measures to prevent just that) is unwise.
But my biggest plea is this. Pandemic health protection measures are not all about you and your own personal risk or appetite for it, your own ‘natural immunity’ or fitness, your own liberty or freedom. They are about protecting everyone else.
It might be your own parent, grandparent or sibling that dies from COVID-19 or from a lack of access to overwhelmed services. It might be your neighbour or someone in another town or from another social class or ethnic group. This isn’t a game and we need to take it seriously and stop posturing and point-scoring, before, once again, we have left it too late to act.
David is an experienced NHS consultant physician who has worked on Coronavirus wards. He is a columnist for the ‘British Medical Journal’ and has held a variety of senior leadership, academic and policy roles in medicine