Chief Medical Officer, Professor Chris Whitty writes about the UK’s battle with Covid-19
We have faced several grave moments during our battle against coronavirus. But right now, the country is perhaps facing the most serious yet.
The new, more transmissible variant of this disease is spreading rapidly across the country and having tragic consequences.
On Monday the 4 UK Chief Medical Officers and the NHS Medical Director recommended raising the national alert level to the maximum of level 5 for the first time.
This means that without further action there is a material risk of our healthcare services being overwhelmed within 21 days.
Since then the situation has deteriorated further.
Hospitals are always busy in the winter but the NHS in some parts of the country is currently facing the most dangerous situation anyone can remember. If the virus continues on its current trajectory many hospitals will be in real difficulties, and very soon.
This means that the time people wait for care will continue to increase to potentially unsafe levels, hospitals won’t have room to take redirected emergency cases in regional networks, staff to patient ratios which are already stretched will become unacceptable even in places likes intensive care.
There will be avoidable deaths. NHS staff are doing their absolute best, and working remarkably; we all owe them a huge debt of gratitude, but even they have limits.
The public have made an extraordinary effort so far. Of course we are all tired of restrictions, but we need to find the collective strength to get through this critical stage and save as many lives as we can.
The advice right now is unambiguous: to drive the numbers down, we must stay home except for work, exercise and essential activities. Every unnecessary interaction you have could be the link in a chain of transmission which has a vulnerable person at the end.
These restrictions will not last forever. Science has delivered new vaccines, drugs and tests, with more on the way, in record time. People will be reunited. Vaccines and new treatments offer us hope and a clear way out. But we are not there yet, and should not act as if we are.
We still have weeks to go before vaccines will start reducing COVID deaths and, some weeks later, the number of people being hospitalised. We cannot afford to let our justified optimism for the future come at the expense of difficult action today.
That means for now staying home and avoiding all unnecessary contacts. By following the rules, we will save lives and help normal life return more swiftly.
THE Scottish Fire and Rescue Service is warning communities across Scotland to stay clear of frozen water as temperatures drop.
The national service is urging the public to be aware of the risks of going onto or allowing children and pets to go onto the ice.
According to the Royal Society for the Prevention of Accidents, more than 50 per cent of all drowning cases involving ice in the UK involved the attempted rescue of another person or a pet.
And SFRS is warning that while ice can look and feel solid, it can suddenly crack and cause a person to fall through and potentially become trapped under the ice.
DACO Alasdair Perry is SFRS’ Head of Prevention and Protection. He said: “We would ask everyone to be aware of the dangers of ice during this cold snap and strongly advise against walking or playing on any iced-up waterways and always ensure that children are kept away from any iced over ponds or rivers.
“If you are out with your pet, do not throw sticks or balls near frozen water, and if they do get into trouble on the ice, do not venture onto the ice yourself to attempt a rescue – dial 999.
“The ice may look solid, but it is not worth the risk to step out on to it.”
The low temperature of the water can also bring on cold-water shock, which can be potentially deadly.
Cold-water shock can cause breathing difficulties, blood vessels to close, the heart-rate to increase and lead to a heart attack.
Michael Avril, the Royal National Lifeboat Institution’s Regional Water Safety Lead for Scotland, said: “Walking on ice is extremely risky and unpredictable and the RNLI advise that you avoid doing this.
“If you do fall through, the freezing water temperatures can bring on cold water shock.
“If you find yourself or someone else in trouble, dial 999 and ask for the fire service immediately. Do not attempt to rescue anyone yourself.”
To protect the NHS, the UK government must abandon ‘rash’ plans for household mixing
Two leading medical journals – the British Medical Journal and the Health Service Journal – have joined forces to warn that the UK’s plan to ease Covid rules over Christmas is a “rash decision” that will “cost many lives”:
Since the UK’s first lockdown in March, the government has had one (perhaps only one) consistent message—protect the NHS.
Now, with the number of hospital patients with covid-19 again on the rise, and a third wave almost inevitable, the New Year is likely to see NHS trusts facing a stark choice: be overwhelmed or stop most elective and non-urgent work. Rather than lifting restrictions over Christmas as currently planned, the UK should follow the more cautious examples of Germany, Italy, and the Netherlands.
By and large the NHS has coped well with the additional caseload from covid-19 patients during the autumn. The second wave began to hit hospitals at the start of September. Government figures report 451 inpatients with covid-19 in England on 2 September.1 Over the ensuing 10 weeks, the numbers rose steadily and then rapidly, peaking at a reported 14 712 inpatients in England on 23 November.
If the third wave turns out to be of the same order of magnitude as the second wave, the health service should manage. But this will be the case only if the third wave starts with a broadly similar extra caseload of covid-19 inpatients as at the beginning of the second wave: around 450.
With current restrictions failing to control the virus, extrapolation suggests that the actual figure is likely to be more than 40 times higher, as we explain below. The planned relaxation of restrictions over Christmas will boost the numbers further as the NHS also struggles with the additional demands of winter.
England went into lockdown on 5 November, and the number of inpatients with covid-19 began to fall, down to 12 968 on 5 December.1 If this rate of decline had continued, the English NHS would have been on course for just under 11 000 covid-19 inpatients on 31 December.
However, in the past two weeks, despite most of the country being in tiers 2 or 3 of restrictive measures, numbers of inpatients have started to rise again. By 14 December (the latest data available) the covid bed occupancy had climbed back to 15 053.
Unless something happens to change this trajectory, hospitals in England will have just short of 19 000 patients with covid on New Year’s Eve. This figure, derived by extrapolating a straight line from 5 December to 14 December through to 31 December, would be almost exactly the same as the 18 974 peak of the first wave on 12 April.
The NHS currently has around 95 000 general acute beds. It is operating with around 10% fewer beds than a year ago as a result of infection prevention and control measures introduced to try to stop the spread of covid in hospitals.
The main effect of a further surge in covid-19 inpatients is likely to be felt most by those with other conditions. The NHS has learnt from the first and second waves and has robust plans to rapidly increase intensive care capacity, including through the Nightingale hospitals. But how are these to be staffed? A large influx of patients with covid-19, similar or greater than that seen in the autumn, can only be managed if staff and other resources are diverted from treating non-covid patients.
Having recovered much of their capacity for elective and non-urgent care during the autumn, NHS trusts in the most pressured regional health systems are already having to cancel almost all such activity because of the resurgent virus.
A substantial third wave could wipe out almost all the reductions in waiting times for elective procedures achieved in the past 20 years. Average waiting times will reach 12 months by March next year.
This will take years to recover from, at the cost of much suffering and loss of life.
The coming months are also likely to see the NHS under intense winter pressures from seasonal outbreaks of norovirus, increased admissions of frail older people, and the peak of staff absence. The NHS will also be in the middle of delivering the largest vaccination programme in its 72 year history, through already overstretched general practices and hospitals.
Even if NHS England succeeds in vaccinating all those “at risk” by Easter, this won’t be in time to prevent hospital admission and death for many during the next few months. NHS Track and Trace, which in fact has almost nothing to do with the NHS, continues to squander money on failure.
So too does the mass testing of asymptomatic people using lateral flow tests that are not fit for purpose.
London and many neighbouring counties will enter tier 3 on 16 December. However, other areas such as Kent, which has been in tier 3 since 2 December, are still seeing strong increases in hospital admissions. These measures are clearly inadequate.
Ministers are meeting on 16 December to review current restrictions for England. When they devised the current plans to allow household mixing over Christmas they had assumed the covid-19 demand on the NHS would be decreasing. But it is not; it is rising, and the emergence of a new strain of the virus has introduced further potential jeopardy.
Of particular concern is the effect on staff, many of whom have already worked through the hardest nine months of their professional lives. Levels of burnout and sickness absence are likely to exceed those already experienced.
What should be done
Members of the public can and should mitigate the effect of the third wave by being as careful as possible over the next few months. But many will see the lifting of restrictions over Christmas as permission to drop their guard. The government was too slow to introduce restrictions in the spring and again in the autumn.
It should now reverse its rash decision to allow household mixing and instead extend the tiers over the five day Christmas period. In order to bring numbers down in advance of a likely third wave, it should also review and strengthen the tier structure, which has failed to suppress rates of infection and hospital admission.
This joint editorial is only the second in the more than 100 year histories of The BMJ and the Health Service Journal. We are publishing it because we believe the government is about to blunder into another major error that will cost many lives.
If our political leaders fail to take swift and decisive action, they can no longer claim to be protecting the NHS.
We’re aware of an email scam going around which appears as if from the Government and NHS, asking for charitable donations to help fund their efforts.
Criminals will use any opportunity they can to defraud the public out of money, often impersonating professional and legitimate organisations.
Don’t allow yourself to be pressured into donating money, and never make donations by cash or gift card, or send money through transfer agents such as Western Union or Moneygram.
Be sceptical if you receive an email, text or WhatsApp in relation to #Coronavirus, and never click on any attachments or links.
Never provide personal data such as your full name, address and date of birth – scammers can use this information to steal your identity.
In the run up to bonfire season, Police Scotland, City of Edinburgh Council and Scottish Fire & Rescue are keen to keep everyone safe during the festivities. In previous years we have seen firework-related anti-social behaviour (ASB) and disorder in this area, and we are asking for your help to prevent this occurring again.Continue reading Bonfire Season: Advice to local parents
FIREFIGHTERS attended more than 500 accidental house fires during last year’s festive and New Year celebrations, latest figures show. They were alerted to a total of 517 such emergencies at homes across Scotland between 7 December and 11 January.Continue reading Firefighters issue winter safety appeal
For some, they’re the latest ‘must have’ but more than 15,000 imported self-balancing scooters – ‘hoverboards’ – have been assessed as unsafe and detained at the border in recent weeks.
The Scottish Fire and Rescue Service (SFRS) has urged people who have bought ‘hoverboards’ to heed Trading Standards’ advice after a huge number of the self-balancing scooters imported from abroad were assessed as unsafe and detained at the border.Continue reading Hoverboards: heed the warning
