“There is no disease on the planet that would mean that we would intubate and ventilate 70% of the over 80s because they do not survive – they are too fragile,” said an intensive care doctor.
Fears that the NHS would be overwhelmed were compounded by a second imperial article published on March 17 suggesting that Britain could cope with 250,000 dead without large-scale repression.
Ministers quickly moved from a collective immunity plan to the current foreclosure to avoid disaster and called for a huge increase in critical care capacity.
Yet, as the virus peaked in the second week of April, only three percent of people in intensive care were over the age of 80, it can be released, prompting charges of wasted time and in the nine hospitals of Nightingale, based in London, Birmingham, Manchester, Harrogate, Cardiff, Glasgow, Belfast and Bristol.
Since the start of the epidemic, statistics from the National Center for Research and Audit in Critical Care (ICNARC) have consistently shown that only 10% of those who died from coronavirus were admitted to critical care.
NHS England has confirmed that most patients die in emergency rooms, highly dependent units and acute care units. Many are elderly people with pre-existing conditions who are in specialized services, such as stroke units, and a few are good enough to receive intensive care.
Another doctor said that the original modeling assuming that seven out of 10 patients over the age of 80 would be intubated or ventilated was “so far from real-world practice that it’s a bit laughable”
“It appears that they do not understand one of the guiding principles of critical care, but were happy to forecast it without seeking expert advice,” he added.
“The more fragile you are, the longer it will take to recover from an ICU admission, and the more complications you will experience in the unit.” Recovery can take years and is often partial.
“Most people are much more fragile after recovering from intensive care than before. There is a tipping point where admission is not considered to be in the best interest of the patient and is not offered.
“It was a big problem at first. We didn’t watch the models because we didn’t know what they were, and we just believed that we had to prepare for this huge ramp-up capacity, which we did. “
At the height of the crisis over the Easter weekend, figures from the NHS operational dashboard showed that 40.9% of acute care beds were unoccupied about four times the normal number.
In the same week of 2019, approximately 90% of intensive care beds were occupied and since lockout, a greater proportion of over 80s have died in care homes than in hospitals.
Nightingale’s new hospitals are still largely unused and at the height of the epidemic over Easter weekend, only 19 patients were treated at the 4,000-bed hospital in east London.
In some cities – like Bristol – the number of free intensive care beds has never been higher during this multi-year period. A doctor told the Telegraph that the government should have changed course on Nightingales last month.
“It has been very clear for weeks that most of these hospitals will not see a single patient,” he added.
“Time, resources and money have been invested in it, but they are essentially field hospitals where you can ventilate people on very poor equipment in the event of a catastrophic outbreak of the virus among the population – it is whatever they are good at. “
At present, Nightingale’s hospitals will not be commissioned until hospitals reach 80% of peak capacity in the region, but specialists from all countries still take time to be inducted.
“It will only happen if we get a catastrophic second wave,” added another senior specialist.
“I think it is politically impossible for them to lock everyone out and then let them go again, let them tear the people apart.
“We have now chosen a strategy of deleting the numbers until they are so low that we can isolate the cases and find the contacts. “
An analysis from the University of Oxford also revealed that there has been no increase in deaths from viral pneumonia, suggesting that the predominant cause of death from Covid is not respiratory and therefore would not have need ventilation.
Carl Heneghan, a professor of evidence-based medicine, said, “Something went very wrong. “We would have expected to see an increase in viral pneumonia in people who died from a coronavirus, but we have not done so.
This indicates that it is a multi-system disorder affecting your heart, your circulation, but not something that requires ventilation.
“With an epidemic, you have to keep responding to new data and what’s going on in the field, without looking into a crystal ball, and if you did, you would have come to very different conclusions about the answer. “
Professor Ferguson last night defended the estimates he provided to the government.
The figures in the table referred to by the ICU doctors “reflect the worst reasonable planning scenario agreed to by Sage (Scientific Advisory Group for Emergencies) and the NHS in early March”.
“The demand for health care figures were based on extensive clinical input from the NHS and academic clinicians, including intensivists,” he added.
“The Sage subgroup involved in developing the worst reasonable scenario was aware that triage decisions are sometimes made for those over the age of 80, but felt that the planning scenarios intended to inform worst-case capacity planning cases should, by definition, be conservative.
“In a crisis, it is better to have more health care capacity than necessary than less.”
In a first email to the Sunday Telegraph, he wrote: “I reiterate that the assumptions made regarding clinical treatment for British modeling were not” our “assumptions.
“We are not clinicians. This was the “worst case worst case” planning scenario informed by the clinical input of senior NHS staff and approved by Sage (Scientific Advisory Group for Emergencies), used to inform capacity planning in the NHS.
“Across the board, capacity planning by the NHS and government more broadly has involved allowing us to face a reasonable worst-case scenario, on the basis that it is much better to have overcapacity than an under-capacity. “
Most hospitals already have up to three times more bed capacity than normal at the ITU – but doctors are increasingly concerned that non-Covid death rates will skyrocket.
The Nuffield Trust has shown that about 20% of recent excess deaths cannot be attributed to the coronavirus.
Urgent references to cancer in England fell by 62% due to chemotherapy treatments which only represent 70% of normal levels.
The Faculty of Critical Care medicine has defended government policy on Nightingale hospitals – claiming that the estimate was based on a “complex” set of factors beyond the need for elderly people in need of intensive care.
Dr. Alison Pittard, Dean of the Faculty of Critical Care Medicine, said, “I would say that it is very easy to criticize people who make decisions, which includes medical organizations, the Department of Health and the government.
“I think the first indicators suggested that we would exceed the capacity of intensive care in hospitals and we had to make sure that it was possible to treat all the patients who would benefit from it and that is what resulted in the hospitals of Nightingale.
“The fact that they were not used as intended is an indicator of success in terms of all the plans put in place in hospitals and in terms of the government’s social distancing strategy.
“The lockout means we didn’t have to include Nightingales. “
An NHS spokesperson said, “The NHS had to plan flexibly based on the regularly updated Covid demand scenarios commissioned by Sage, and in doing so, the NHS succeeded in ensuring that every coronavirus patient requiring hospitalization or intensive care is able to receive it. “