As Covid-19 pressure rises, UK hospitals find a pandemic paradox

They have established protocols so that elderly people carrying the virus are not sent from hospitals to residences, where last spring these movements sowed the spread of the virus that killed thousands of people. They use improved treatments for Covid-19 that keep more people alive.

Meanwhile, they have continued with elective surgeries to get people with serious conditions such as cancer to receive procedures. This also means that more hospital beds have been occupied.

The downside: hospitals are even fuller and with more pressure than last spring.

This time there is “a perverse paradox,” said Will Ricketts, a thoracic consultant at the capital’s Royal London Hospital, where it is estimated that one in 30 people is infected with the virus.

“Patients who previously did not survive beyond a few days of admission now survive for weeks,” Dr. Ricketts said. “This is obviously good news in general, but at least in part it explains why this wave has spread us so thin.”

The number of people hospitalized with coronavirus in the UK has risen to the highest levels of the pandemic and is now 49% higher than the previous April peak.

“The next few weeks will be the worst weeks of this pandemic in terms of the number of admissions to the NHS,” Chris Whitty, chief English doctor, warned on Monday.

The number of spare hospital beds in England fell from 18,397 on Christmas Day to 6,516 on 5 January.

Pressure on hospitals is particularly high in London and the south-east of England, where the rapid-spread variant of coronavirus appears to have originated in September and has since been consolidated.

The variant increases the large number of infected people. It is estimated that one in 50 people has the virus in the UK Scientists estimate that the mutated virus, first detected in the UK in December, is between 50% and 70% more transmissible than previous versions of the pathogen.

This time there are more young people suffering from the disease because it is easier to catch and many of them end up in the hospital. A quarter of all Covid-19 admissions to hospitals in England are under 55, NHS chief executive Sir Simon Stevens told lawmakers on Monday.

In mid-April last year, the NHS said it had released more than 33,000 beds, the equivalent of 50 new hospitals, partly sending home non-coronavirus patients, to prepare for a wave of cases. of virus.

Campaign hospitals that offer never-needed overload capacity in the first wave have been largely shut down. One in London is now used for vaccine delivery and is once again becoming a rehabilitation center for patients with Covid-19.

Elective procedures had been reinstated before the virus renewed the attack. Hospitals continue to try to erase accumulated accruals since a drop in elective cases began with a 73% year-on-year decline in April.

Collateral damage in terms of hospital waiting times, deaths from other illnesses, and a high number of deaths in Covid-19 in nursing homes after the first phase of the pandemic caused officials to try to keep the normal health services until 2021, even when the new variant coincides with the winter pressures of other respiratory diseases such as the flu.

Clinicians are now much better at treating coronavirus patients and also at capturing the signs that intervention is needed. While it is too early to judge mortality rates, daily reported deaths between spring and winter peaks have increased by only 8%.

“The last nine months have spawned Covid specialists,” said David Strain, a senior professor and consultant in a Covid-19 ward at the University of Exeter School of Medicine in the south-west of England.

“That also makes people live longer,” he said. Which means, he said, they stay in the hospital for longer periods.

“We’re seeing a lot more time in both intensive care and high-dependency units,” Dr. Strain said.

Elderly patients living in nursing homes are no longer discharged unless they have a negative test for the disease or have been quarantined, usually in hospital, for 14 days after a test. positive.

Daily discharges from hospitals to nursing homes during the first two weeks of last March, as the NHS prepared for the pandemic, were 5% to 9% higher than in the same period in 2019 Covid-19 tests were not required for discharge.

More than 20,000 UK-based nursing homes died of Covid-19 in 2020, according to data from the country’s National Statistics Office, a quarter of the country’s deaths from the disease last year.

Doctors have been given guidance pages on the medical discharge of patients in nursing homes and say they are now very careful when it comes to letting out of the hospital anyone who needs home care or residential care, for fear that the virus could spread through workers going from house to house.

Treatment with dexamethasone, a relatively inexpensive steroid, has also improved the survival rates of patients with Covid-19 as the pandemic has progressed, according to doctors.

NHS data show that the average patient stay confirmed with Covid-19 before discharge or death was 12 days in July, compared with seven days in April. This means that more hospital beds have been occupied for longer.

And as the most critical patients survive the virus, they need extra care during their recovery, doctors say.

“While this is a huge, positive advance, the benefit is that it increases bed pressure and the ability of hospitals to respond during this second wave, which has yet to peak,” said Tom Wingfield, consultant and a public health specialist from Liverpool, in the north-west of England.

Write to Joanna Sugden to [email protected]