Covid: How busy are hospitals when the second wave arrives?

The second wave is taking an ever-increasing toll on UK hospitals. There are more than 1,000 Covid admissions a day, 10 times the rate at the end of the summer.

Hospitals have started to cancel routine treatments, as happened during the first peak,

with Leeds hospitals this week following others in announcing that some treatments will have to stop.

But how busy is the NHS? And how much Covid can it take?

Admissions have risen, but are still not close to the numbers seen in the spring. At one point, more than 3,000 patients were admitted a day.

Instead, we’ve seen a gradual increase: the numbers are doubling roughly every two weeks, compared to every four days in a first wave stage.

But consider what happens in more normal times. Winter typically sees more than 1,000 people a day admitted to hospital for respiratory problems.

However, this time, what we don’t know is how much other viruses, particularly the flu, will add to the workload. An encouraging sign from the southern hemisphere earlier this year was that the flu season was very mild.

Despite the growing number of admissions, only one in 20 UK hospital beds is occupied by a Covid patient. This national image masks what is happening at a more local level. Hospitals in critical areas are much more crowded.

Observe the distribution of cases in the English regions.

Hospitals in the North West currently care for a third of England’s Covid patients. In fact, in some hospitals in the region, one in four beds is being used by someone fighting the virus.

The number of Covid patients in Liverpool hospitals has already exceeded that observed during the peak, says Dianne Brown, head nurse at Liverpool University Hospitals. This, he says, has been “mentally, physically and emotionally draining” for the staff.

A crucial difference between then and now is that more non-Covid work is being done. The number of routine operations, emergency room care and cancer treatments dropped significantly during the first wave, but has started to rise since then.

This, of course, is a difficult balancing act. And for some trusts, local health care groups, it is proving a step too far. In the last week alone, the heads of hospitals in Nottingham, Birmingham and Bradford have announced that some of the routine work they are doing will have to be cut before Leeds’ announcement on Tuesday.

Nottingham University Hospitals Executive Director Tracy Taylor says she had to act after a “dramatic spike” in cases meant she was losing an additional ward each day due to new Covid admissions.

What we cannot say, because the NHS chiefs do not release updated figures, is exactly how complete the hospitals are. In recent years, hospitals tend to have about 90% of their beds occupied at the same time.

By the summer when the last audit was conducted, this had dropped below 70% – there were few Covid cases and non-Covid work levels were still below normal. Even taking into account the spike in Covid admissions, it likely left hospitals with thousands of more beds than normal at this time last year.

But Chris Hopson of NHS Providers, who represents health managers, says this distorts the “very difficult” job hospitals have in managing social distancing, PPE requirements and the need to segregate Covid patients. and not Covid.

“Hospitals actually have 10-30% less capacity than they normally would. You can’t expect all beds to be full.”

One of the problems, he says, is that the NHS has very little leeway and has less space, equipment and beds than hospitals in other Western European countries.

The goal of protecting the NHS was one of the main reasons for the national shutdown in the spring. As always, there is a great focus on intensive care capacity. The UK has about 5,000 intensive care beds, but it increased by three-quarters in the first wave by converting operating rooms and recovery rooms into temporary facilities.

The NHS was never close to needing them all.

Intensive care capacity has been reduced to normal levels and, even in the worst affected regions, “augmentation capacity” has not plunged on any scale. The field hospital network, known as Nightingales, has also not been used, although the Manchester one will soon start receiving non-Covid patients.

But Nicki Credland, who chairs the British Association of Critical Care Nurses, says it would be a mistake to assume this means the NHS is free from trouble.

More and more patients are receiving oxygen therapy treatment in the wards, he says, rather than relying on mechanical ventilators as was done in the first wave.

“This can be done … for most patients, but you still need highly trained staff.”

And that, he says, is the heart of the problem.

“We can have the beds, we have the equipment and we can have all the space at the Nightingales, but we have a limited amount of staff. It won’t take long this winter for things to come to a head.”

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