Is the National Health Service about to be overwhelmed? This is the stark question that is keeping ministers, doctors and many other people awake at night. The latest Covid figures are, frankly, alarming. Both new cases and death toll have risen by a third in the past week and show no sign of levelling off. Hospitals are now treating 50 per cent more patients than at the peak of the first wave last April, with 3,697 Covid patients admitted on Tuesday alone. Extra critical care beds are being opened and Nightingale hospitals are being used as overflow facilities. But this extra capacity is just not enough, because the pandemic comes on top of the usual winter surge in admissions for other conditions. The need to separate Covid patients from others has forced hospitals to reorganise their wards; this means fewer beds.
Sir Simon Stevens, head of NHS England, admitted yesterday that he could not guarantee normal levels of care, as admissions were “accelerating very, very rapidly”. Those who have experience of care in hospital will testify that staff shortages are much worse than usual. Most staff have yet to be vaccinated, many are ill or isolating and stress is contributing to high levels of absenteeism, along with Covid itself. Statistical comparison with previous winter flu crises shows that the present emergency is on an entirely different scale. The NHS has never had to deal with anything like this before.
What is to be done? The bluntest but most immediately effective instrument is still lockdown. It takes weeks, though, to flatten the curve. In London, where the danger of the NHS being overwhelmed is greatest, daily hospital admissions have doubled to nearly a thousand since Tier 4 restrictions were imposed less than three weeks ago. Despite the restrictions, life in the capital appears to be continuing much more normally than during the lockdown last spring. Social distancing in public places, shops and on transport is still not strict enough to prevent the new variants of Covid from being transmitted. In the London Borough of Barking and Dagenham, more than 1,500 people per 100,000 now have Covid — the highest level in the UK. Every single day, London needs the equivalent of a major new hospital just to keep abreast of the pandemic. Lockdown works, but not fast enough.
The second major factor that is working in our favour is the vaccination programme. So far something over 1.5 million people have received their first jab. The Oxford vaccine came on tap this week; it is cheap and does not require minus 70 degree refrigeration like the Pfizer-BioNTech vaccine. Only 500,000 doses were immediately ready for use, but once bottlenecks in production and distribution are overcome it should accelerate the process. The Prime Minister has set a target of two million a week, with the aim of inoculating all 13 million vulnerable adults by mid-February. If this can be done, the R number should rapidly fall below the present level. However, the new variant has raised R by up to 0.7 to well over 1 and so transmission is still rising. Vaccination is not yet winning the race against time.
The third tool that doctors have is stepping up their treatment of Covid patients. Here there is some good news. Two well-established drugs normally used for rheumatoid arthritis have been found by British scientists to improve Covid patient outcomes by suppressing the overreacting immune system. The improvement in the case of the critically ill is of the order of 24 per cent. Tocilizumab and Sarilumab are being distributed immediately to all hospitals. Unlike Dexamethasone, a cheap steroid which was also first successfully repurposed by British scientists, these arthritis drugs are expensive. It must be hoped that the manufacturers are prepared to make them available at cost price to save lives in this emergency.
A combination of lockdown, vaccination and treatment might just be enough to get this terrifying second wave of the pandemic under control. We, the public, can help by taking the well-known precautions much more seriously. At the back of our minds, we still assume that if we fall ill, the NHS will always be there for us. But the queues of ambulances outside hospitals in London and elsewhere, with desperate patients waiting for beds, tell their own story. Moving patients around the country is a stopgap solution that is wasteful and only works as long as the coronavirus is unevenly distributed. For the next few months, the country faces an unprecedented ordeal. Deaths, now approaching 80,000, are almost certain to exceed 100,000 by the end of January. We will get through the pandemic, but it is now an NHS crisis as well as a Covid crisis. It will get worse before it gets better. Now, more than ever, the nation needs inspiring leadership. The Prime Minister needs to speak for Britain, reassuring us that everything possible is being done to keep the health service properly supplied and supported. Never before has it been so vital to follow the scientific advice. NHS staff are going far beyond the call of duty. It should not be too much for Britain to expect our politicians to do theirs.
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