An NHS Consultant Surgeon Writes…Thu 11:00 am Europe/London, 31 Dec 2020
A consultant surgeon at an NHS trust in the North East has got in touch to say he agrees with yesterday’s analysis by Lockdown Sceptics‘s resident Doctor that this winter is little different to last winter, at least in his hospital.
ITU at the moment is full (10 Covid, six non-Covid). That said, this is not necessarily unusual for this time of the year. ITU was full last year and in previous years.
Daily Covid admissions and discharge rates are pretty much on par (between 10 to 15 in both directions), but Covid inpatients are rising and now occupy 50% of the acute beds.
Of 194 Covid patients, 10 are in ICU and ventilated, 10 on high pressure masks (non-invasive ventilation), and 20 to 30 on oxygen on the wards. The rest are ambulant and don’t require particular care. They either cannot be discharged back to nursing homes as they still test positive, don’t want to go back home for fear of infecting someone else, have social reasons for wanting to stay in hospital, or have been given an in-hospital diagnosis of Covid and don’t want to leave in case they develop respiratory problems, i.e. they came in for something else but have subsequently tested positive while in hospital. Essentially, the bulk of in-hospital beds occupied by “Covid” patients are not there out of medical necessity or a requirement for acute care. They are in hospital due to other factors.
Now this is not necessarily something novel. It happens all the time. Not all patients who are admitted to hospital need to be admitted or need to stay for the length of time they are inpatients for. This is a routine problem, particularly in winter. But the staff are gradually being ground down, both psychologically due to the heightened perception of crisis and physically as more and more staff are self-isolating, catching Covid, etc. In addition, this year a letter was sent to 140ish staff as they were deemed high risk and told to self-isolate. This has exacerbated the staffing problem.
Some of the factors mentioned – such as social care aspects preventing discharge and the lack of care home beds – are chronic issues and unrelated to Covid (we get this every year and it is worse during the winter months). But Covid has added another layer of complexity, leading to “bed blocking”. As your doctor rightly points out, ICU and non-invasive ventilation or oxygen requirements are par for the course and no worse than at the real peak in April.
During the initial spike in April/May, “bed blocking” did not happen as patients were sent back to nursing homes without tests, patients were encouraged to go home and self-isolate, hospitals were generally emptied and much activity had stopped. We also had a lot less nosocomial (hospital acquired) Covid.
I don’t have an explanation as to why hospital acquired infections have increased a lot, as in up to 30% of Covid inpatients at the time of writing. (Thirty per cent of those are said to be “asymptomatic”, but that is another story). But when half the beds are presumably filled with patients who have Covid, this must increase the viral load in the building. That is however an assumption for which I have no proof.
Stop Press: James Melville has produced a great Twitter thread comparing our current NHS crisis with previous years. Turns out, a winter NHS “crisis” is an annual event.