The UK National Health Service survives the first wave of coronavirus


When Boris Johnson made a home stay order to the British last month, he had one overarching goal: to protect the British-funded NHS from coronavirus cases.

On Monday, outside Downing Street, coming out of his own battle against the disease, Johnson said, “We are on the verge of this first clear mission. “

The number of coronavirus deaths in UK hospitals is 21,092, according to figures released Monday by the Department of Health. But as Prime Minister wonders whether to loosen UK lock-in restrictions, health officials are increasingly convinced that the service has passed the greatest test since its inception nearly a decade ago. 72 years old.

Boris Johnson praised NHS successes outside Downing Street on Monday © AFP via Getty Images

With the number of new “globally flat” cases, according to government chief physician Chris Whitty, and deaths at the flattening Covid-19 hospital, the NHS still has hundreds of empty intensive care beds and no wasn’t forced to turn away from patients, he could have helped.

A major operation to reuse parts of hospitals, transform them into emergency intensive care units, and deploy other medical and nursing staff, such as anesthesiologists, to provide specialized care has paid off. Thus, also has an operation to free more than 30,000 beds in NHS hospitals by stopping non-emergency operations and releasing all those deemed medically fit.

Fears about capacity for intensive care

Ian Higginson, an emergency medicine consultant, recalled initial fears that the UK would run out of beds, as has northern Italy and parts of Spain and China.

“We were concerned that the first phase would be much worse than it was. . . The intensive care units were not exceeded, although some of them were close to each other and in some parts of London they had to move patients [to other hospitals]”Said Dr. Higginson, vice president of the Royal College of Emergency Medicine.

The numbers tell the story of the NHS’s success. Confusing initial fears that intensive care beds will be submerged, about 2,500 remain unfilled in English hospitals. This is partly the result of careful preparation, but also reflects the course of the disease, with fewer patients than expected needing ventilation or an extended stay in an intensive care unit.

Carl Waldmann, an intensive care consultant and former director of the Faculty of Critical Care Medicine, said, “Respirators were important, but what we didn’t know was that many of these patients not only needed ventilation but often needed other types of organ support. . “

Line graph of ambulance response rates by NHS Ambulance Trust showing dramatic increase in London emergency response times due to coronavirus, Covid-19

But at no time did Dr. Waldmann’s hospital refuse patients due to a lack of resources, determining the best course of action for clinical reasons only. As the epidemic began to take hold, “every two hours two more patients had arrived and may have to come to the ITU. [intensive treatment unit], and it was quite disturbing because suddenly you were filling up. But luckily, we managed to climb. We had a climbing plan, “said Dr. Waldmann.

Signs of tension persist; ambulances take longer to reach emergency calls, for example. Some hospitals have also been hit much harder than others, particularly in the capital.

But only one hospital, Northwick Park in London, was forced to report a “critical incident” because it no longer had intensive care capacity (a second hospital, Watford General, also reported an incident due to a problem technique affecting oxygen supplies).

Managing the consequences

The attention of health leaders is turning to how to manage the aftermath of the first wave. In its most direct form, this will involve looking after the physical and mental health of patients who have survived a spell in intensive care.

Consequences may include muscle weakness as well as neurological and psychological problems, said Dr. Waldmann, wondering if the NHS would be able to cope with “the increased workload for rehabilitation”.

But the second key dimension is how to restore normalcy to a health service that has delayed treatment for millions of people and sent thousands of patients back to the community, some of whom still have significant health needs.

Two people familiar with senior NHS thinking said serious consideration was being given to a limited lifting of the non-emergency operations embargo.

Health Secretary Matt Hancock announced on Monday that, starting Tuesday, the NHS “will begin restoring other NHS services – starting with the most urgent, such as cancer care and health support mental “.

Even before the non-emergency surgery was stopped, the backlog was worrying: at the end of February, 4.4 million people were waiting for treatment to start; more than 80% waited until 18 weeks and about 1,600 waited more than a year.

Along with these predictable consequences of the NHS’s aggressive approach to preserving beds for coronavirus patients, there is an unwanted and unintended development for health officials: the dramatic reduction in the number of people seeking help for conditions unrelated to Covid-19.

In A&E alone, visits in March fell by about 30% and emergency admissions by 23%.

Do it differently

In addition to tackling this backlog, the NHS faces the prospect of a second wave of viruses – perhaps in winter when service is fighting even in normal times to cope with seasonal pressures.

There are signs that NHS working methods may have been permanently changed by the experience of the coronavirus, with doctors stressing the speed at which patients were discharged into the community, without the usual bureaucracy and arguments over funding. .

Nowhere is the change more apparent than in A&E, the long-standing pressure points in the English system, where people often wait for hours in crowded conditions.

“For the first time in a long time, our services are much less overcrowded than before. And that means we can actually treat patients as we would like, ”said Dr. Higginson.

He believes that there is a moral and practical imperative to ensure that the old conditions do not come back, recognizing that this will inevitably raise difficult questions about future funding.

The root causes of A&E overcrowding were “an underfunded health care system, an underfunded social care sector and not enough doctors and nurses working in obsolete services,” said Dr. Higginson. “We know that many of these problems will not have been magically corrected overnight. “

This article has been modified to add the number of coronavirus related deaths in UK hospitals.

Statistical research by Federica Cocco


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