Yet again the government has been caught flat-footed by Covid-19, moving too slowly in the face of the impending inferno. In Australia, when there is a wildfire in the bush, they cut a firebreak many miles ahead and deep enough to prevent the fire spreading. The government’s approach to the pandemic is more akin to gentle pruning as the flames lick ever higher all around.
Instead of acting weeks ago, when impending crisis became apparent, we have had a familiar exercise in dithering and delay. Hospital staff and their patients are now paying the price. The grim, inevitable rise in cases this week will mean already overwhelmed A&E departments will soon enter uncharted territory.
As president of HCSA, a professional association and trade union representing all hospital doctors in the UK, I am aghast at the way we lurch from one crisis to the next. At every turn, policymakers drag their heels in the face of incontrovertible evidence. Days and weeks are squandered.
It is only when the inferno takes hold that essential measures are taken, and then the lessons seem forgotten until the next fire is upon us. Our members on the frontline report desperate situations which make the record case numbers all the more alarming. The national statistics tell only a part of the story.
In London and the south-east, the new variant has plunged A&E departments into chaos, with some ITUs running at 200% capacity while patients wait 24 hours, forced to stand in corridors, the infected mingling with the uninfected. Ambulances queue outside, while breathing aids are increasingly rationed.
One can only speculate on the reason for this sluggish reaction, rolling out tier 4 in the south-east only on 20 December, when it was already too late to avert disaster. It is hard to avoid the conclusion that unfulfillable promises made in haste, such as on Christmas or keeping our schools open, have placed a straitjacket on government decision-making and acted as a brake on the pace of essential steps.
Wednesday’s decision to place more areas into the highest tier is also likely to prove too late. The new variant is everywhere. The average gap between a test and hospitalisation for this new form of Covid-19 is around seven days. It does not take a mathematical genius to see where current record case numbers will take us. In a matter of days hospitals in these areas too are likely to be inundated.
Did it have to be this way? History will judge. But in any post mortem the long-term neglect of our NHS and its staff, with its perennial winter crises even before Covid-19, will be an important chapter.
I have been asked in many interviews why our health system does not appear to have the capacity to deal with this crisis when so many other countries in Europe have coped better, with lower death rates and lower infection rates. The answer is simple. Years of “efficiency savings” have resulted in a lower capacity than most other European countries. We have a bed base one-third the size of Germany’s and chronic staff shortages. We simply don’t have the flexibility to cope with a pandemic requiring large numbers of hospitalisations and ventilatory support.
In a rushed acceptance of these shortcomings, the Nightingales were thrown up. But what was undoubtedly an impressive feat of engineering and teamwork failed to take into account the number of trained staff that would be required to make them work. Ventilatory support and critical care is a highly specialised area of medical care and cannot be delivered by volunteers.
Diluting staff within our already overstretched hospitals to get the Nightingales running appears a fantasy. As hospitals deal with their own staffing crises every day, as staff self-isolate or are themselves off with Covid, their existence is little more than a totemic placebo.
In the face of a rising torrent of patients, staff are being redeployed within hospitals to assist in unfamiliar areas, adding additional stress to an already fatigued and burnt-out workforce. In London, staff are being called back from much-needed leave, and there are limits on leave in other areas which deal a further blow to their wellbeing and ability to cope. This pandemic will have a long-lasting impact on hospital staff that policymakers ignore at their peril.
Symbolically, within just a few days we are likely to surpass 26,500 Covid patients in our hospitals. This is the point at which, we were told in October on the eve of the November lockdown, all surge capacity and additional capacity freed up by the cancellation of hospital procedures would be reached.
Around 5-6% of reported community cases end up in hospital with the new Covid variant. With known cases of 50,000 a day, the writing is on the wall. London and the south-east will merely be the start of an NHS catastrophe if strong, decisive action is not taken throughout the UK now.
This virus transmits through contact. The only way to stop the transmission is to radically reduce contact and restrict movement. It is a difficult decision to halt the country yet again, but when we have a solution through vaccination for the middle and long term, radical action must be taken in the immediate.
The threat we face must be treated with the seriousness it warrants. We need a total national lockdown, now, and we need secondary schools, which act as incubators for this virus, to remain closed until we regain control. Crucially, the laissez-faire approach to enforcement has to end.
It may be hard for the public to relate to the enormity of the national crisis our NHS faces, but it has implications for everyone. Heart attacks, strokes, cancers and traumatic injuries will be more dangerous. While a young person may not suffer extreme illness from Covid, if they have a significant car accident or life-threatening injury, they too will feel the direct consequences of gridlocked hospitals. This is a national crisis that touches us all. It now requires a national response.
Dr Claudia Paoloni is president of HCSA, the hospital doctors’ union, and a consultant anaesthetist