DAUK’s Dr Dolin Bhagawati in The Financial Times: Covid hospital patient numbers in England surpass April peak

The number of people in hospital with Covid-19 in England has surpassed the April peak, according to official data that emerged as the UK government prepared to decide whether to tighten restrictions on millions of Britons.

The high volumes are in part because of clinicians’ increasing understanding of how to treat the disease, according to NHS officials. Far more are surviving than earlier in the pandemic, but patients may require weeks on a hospital ward to recover fully, doctors noted.

But NHS leaders have warned that hospital capacity is at breaking point. “People are incredibly worried about what is to come. We’re in the eye of the storm, and the storm means something big and destructive — it’s a hugely challenging time,” said Saffron Cordery, deputy chief executive of NHS Providers, which represents leaders across the health service. 

The warning came as Boris Johnson, prime minister, chaired a meeting with senior cabinet ministers on Tuesday evening, and ahead of an update on the country’s tiered restrictions on Wednesday by Matt Hancock, health secretary.

More areas of England look likely to be placed under the highest level of curbs as government concern grows about the spread of the South African variant of Covid-19 and a second variation known as B.1.1.7. 

The prime minister’s official spokesperson on Tuesday said the government kept all measures and the latest scientific data under “constant review”, adding: “That is what we have done throughout the pandemic and that is what we will continue to do.”

The strain on hospitals was evident in official data showing that as of 8am on Tuesday, a total of 21,787 hospital beds were occupied by patients with Covid-19 — higher than the peak of 18,970 on April 12.

But the figures also showed that while total daily admissions of Covid-19 patients were 2,572 as of December 27 — the highest for about eight months — they were still roughly 500 below their peak at the start of April, when 3,100 people were being admitted each day. 

Meanwhile, the number of beds occupied by Covid-19 patients on mechanical ventilators stood at 1,728 on Tuesday morning, less than half the April peak of 4,000. 

NHS staff and executives pointed to the very different demands now being made on the health service compared with the early months of the crisis. Ms Cordery said: “People are surviving but they need to be hospitalised for longer. The profile of people with Covid is younger, but they need more treatment.”

She added that staff absences around the country were more than double the normal levels for this time of year. 

NHS leaders have spent months pressing the health service to make up lost ground by performing surgery and procedures delayed during the pandemic, with significant success.

However, Dolin Bhagawati, a London neurosurgeon who speaks for the Doctors’ Association UK, said rising Covid-19 admissions would have an inevitable impact on other services. “In London we’re at where we were in the first wave and it’s going to get much worse over the next few weeks,” he said. “A lot of places are cancelling planned care and surgeries to free up staff and beds for Covid patients.”

Independent Sage, a group of scientists who offer an alternative view to the government’s own advisory committee, said: “The pandemic in England is now at the most threatening stage of the entire year.” It forecast that with cases still rising steeply, pressures on the NHS in England would get significantly worse over the next few weeks.

One London health leader told the FT that the peak of Covid-19 admissions was not expected to be reached until the week after next in the capital.

David Strain, a geriatrician who co-chairs the British Medical Association’s medical academic staff committee, noted that the steroid dexamethasone was proving even more effective than in clinical trials and significantly reducing deaths from Covid-19. But he said that the time from admission to release could be up to 35 days, in contrast to the flu, where a patient would generally be admitted for no more than five or six days. 

A two-week illness “is actually deconditioning far more than we normally see”, he said, adding that in some cases, “we are looking at a month’s worth of rehabilitation” before people can be discharged.

Read the article here: https://www.ft.com/content/9e4ffdab-8245-44d6-a110-206c6cc94796