New wave of Covid could worsen NHS surgery backlog, experts warn

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A new wave of coronavirus infections could undermine efforts to clear a backlog of NHS surgeries, experts have warned.

They say easing Covid restrictions are expected to lead to an increase in infections, while at least some resurgence in hospital admissions and deaths is also expected at some point. However, the sharp increase in cases of a worrisome variant first discovered in India, B.1.617.2, has caused dismay, with modeling suggesting that while it is as transmissible as some estimates suggest, it could fuel a Serious “third wave”. .

Today, experts said a new wave of infections could cause further problems, exacerbating what has already been described as “a truly frightening backlog” of care.

“We expect that as the lockdown is eased, cases will rise slightly, i.e. with or without the Indian variant,” said Dr David Strain, senior lecturer at the Faculty of Medicine of the University of Exeter. “The biggest concern we have is that if these [Covid case] the numbers start to increase, it will force you to try to set up other services. “

“General practitioners are crying under stress right now … we still have people who are not operated on: we have procedures postponed for more than 12 months, and we have longer waiting lists than ever before”, a- he declared.

Last week it was revealed that NHS figures show that nearly 5 million people in England are awaiting treatment in hospital and that more than 400,000 people have already suffered a delay in their surgery by at least one year.

Strain said another wave of Covid infections, however minor, could disrupt attempts to return to normal care.

“For example, perioperative mortality is dramatically increased in people with Covid, even mild ones, so that even in vaccinated people, with greater than 95% protection against serious illness, contact with Covid could delay their operations with a huge impact on their quality of life, ”he says.

Professor Ravi Mahajan, president of the Royal College of Anesthesiologists, said reducing the elective surgery backlog was the “next big challenge” for the NHS.

“Many patients wait months, if not years, for treatment, while doctors and caregivers are just starting to return to normal work,” he said.

“The prospect of a surge in positive Covid cases – even at a regional level – will have a significant impact on continued efforts to tackle the high number of elective surgeries. This will inevitably mean that patients will end up waiting longer for the care they need. “

James Glasbey, of the University of Birmingham and co-director of the CovidSurg Collaborative, an international network of researchers, also expressed his concerns.

“We already know that the risks of surgery – that is, severe pulmonary complications such as pneumonia, the need for ventilation and the risk of death – are much higher in patients with recent infection, and that this risk lasts for longer. at least six weeks after infection, gradually decreasing over time, ”he said. “A new wave of [Covid] the cases could therefore have a substantial impact on the resumption of the pandemic at a time when the NHS attempts to rapidly increase surgical supply to meet the growing backlog of delayed elective procedures.

While Glasbey said there were actions that could protect patients, such as providing ‘Covid-light’ hospital pathways to reduce the risk of patient exposure to Covid, routine preoperative Covid testing, delaying patients with recent infections over seven weeks old and prioritize surgical patients for vaccination, these could bring their own problems.

“Implementing some of these measures is a logistical challenge, and impossible for all operations,” he said.

“The vaccine will play an important role in improving overall surgical safety and should be given to all patients whose surgery is scheduled,” added Glasbey, noting that at present, the main benefit was thought to be would reduce the risk of infection of patients before surgery. . “However, our understanding of the extent to which this can alter the risks to vaccinated surgical patients who are infected is still evolving,” he said.

To date, around 40% of adults in the UK have received two doses of a Covid vaccine.

Tim Mitchell, vice-president of the Royal College of Surgeons of England (RCS Eng), agreed that vaccination was important: ‘If there is a marked increase in cases, it could put the NHS under pressure,’ he said. -he declares. “This is why it is so important that people get vaccinated when they are called. It is also essential that patients follow their hospital’s instructions regarding their admission for surgery, including guidelines for testing and self-isolation, before and after surgery. “

The Patients’ Association expressed its unease. “A substantial new wave of Covid would be the worst possible news for non-Covid patients, who already face longer waits and have struggled to access services,” said Rachel Power, its chief executive.

“The NHS will not start reducing its backlog until it can undertake activities at a higher volume as patients develop new needs. Having to devote large amounts of resources to those severely affected by Covid – although far fewer are likely to die in a new wave – will take the NHS further away from this goal. ”

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