Coronavirus summer wave could lead to hundreds of daily deaths within weeks, officials warn

Scientific advisers say contingency plans needed as modelling suggest another 33,000 or more people will die in a year

Shaun Lintern
Health Correspondent
Monday 12 July 2021 20:10
<p>The NHS should have contingency plans, the experts warn</p>

The NHS should have contingency plans, the experts warn

Lifting the final corornavirus restrictions will pile pressure on the NHS, England’s chief medical officer has warned, as government officials said a summer wave of Covid may lead to hundreds of daily deaths within weeks.

Speaking at Downing Street as Boris Johnson confirmed plans to lift restrictions from next Monday, Chris Whitty said the suggestion of no pressure on the NHS was “not fully realistic”.

At the same time, modelling for the government’s Scientific Advisory Group for Emergencies (Sage), shows that ending restrictions could lead to between 1,000 and 2,000 hospital admissions a day within weeks, with up to 200 deaths daily now thought to be likely.

The new modelling from experts from the University of Warwick, Imperial College London and the London School of Hygiene and Tropical Medicine predicts a summer wave of Covid infections in the coming weeks, with Warwick making a central estimate of around 33,700 deaths by June next year.

The size and scale of infections, hospitalisation and deaths will depend on how the public responds to measures being eased from next week.

The sooner people return to pre-pandemic ways of living and working, the bigger the peak in infections and deaths will be, the modelling shows, with some scenarios showing hospital admissions of more than 4,000 a day by next month, with a total of 46,000 deaths up to the end of this year.

In the Commons on Monday, health secretary Sajid Javid told MPs cases were rising now and had doubled over the past 11 days, warning: “They will get a lot worse before they better.”

But he said rates of people being admitted to hospital were lower than in previous waves, adding that he did not believe current infection rates would lead to unsustainable pressure on the NHS and that there was no “risk-free” option.

Newly released minutes from a meeting of Sage show acceptance among government scientific advisers that a sizable wave of infections, hospitalisations and deaths is under way.

Summarising the position, the papers said: “All modelled scenarios show a period of extremely high prevalence of infection lasting until at least the end of August.

“The scale of the next wave in hospital admissions is highly uncertain. While most modelled scenarios have peaks lower than in January 2021, a resurgence of this scale of hospitalisations cannot be ruled out.”

They added: “If the aim is to prevent the NHS being under pressure, the priority should be to avoid a very rapid return to pre-pandemic behaviour, which could lead to a peak in hospitalisations similar to (or possibly even higher than) previous peaks. The mechanism by which this gradual change to more mixing is achieved is much less important than the fact it is gradual.”

Sage said delaying the easing of restrictions would likely have some positive impact as more people could be fully vaccinated but it would be a small effect and would push the wave into the autumn and winter.

Even if the summer wave involved lower hospital admissions than previous peaks of the pandemic, it could still affect hospitals’ ability to cope.

Sage said: “If the average length of stay is nine days, 1,000 hospitalisations per day for a sustained period would lead to hospital occupancy due to Covid-19 of 9,000 individuals. In Warwick’s results, under the central and optimistic assumptions on vaccine effectiveness, half of the scenarios generate extended periods with more than 1,000 hospital admissions a day. Under the cautious assumptions on vaccine effectiveness, all behavioural scenarios breach 1,000 hospitalisations a day. It is highly likely that any such pressure on the NHS would vary regionally and temporally.”

They warned ministers to have plans in place should the NHS be overwhelmed: “If the aim is to avoid the NHS becoming overwhelmed, Sage advises that it is important to understand the impact of different levels of admissions on NHS function and have appropriate contingency plans in place.

“Given the time between infection and hospitalisation, at any point that cases are still increasing exponentially, admissions can be expected to at least double once more, regardless of any measures put in place at that point. Pre-defining hospital (and ICU) admission or occupancy levels which would trigger further contingency planning and interventions would be important.”

In recent days, hospitals in some parts of the country have had to cancel some operations, including for cancer patients, and open up more wards for Covid patients.

Ambulance services have reported being under extreme pressure for several weeks, with long delays at A&E departments, which are also reporting record numbers of patients.

Chris Hopson, chief executive of NHS Providers, which represents hospital trusts, told The Independent: “The impact of greater numbers of Covid-19 infections will vary by trust, given differences in infection rates and capacity. Some trusts are already reporting that they are having to slow down their care backlog recovery and that will only increase as infection rates rise.”

Whitehall officials are now resigned to large-scale infections and hospitalisation rates but no one can be certain of the exact numbers.

There are thought to be between 21,000 and 42,000 new infections every day in England, with hospital admissions hitting 563 on Sunday. With a doubling time of 10 days, that means more than 1,000 patients a day being admitted before the end of the month.

Despite the success of the vaccine programme, significant numbers of people are still susceptible to becoming seriously ill or dying.

Sage warned the four major risks are an increase in hospital admissions and deaths, more cases of long Covid, effects on workforce levels due to illness and the threat of a new emerging variant.

“The combination of high prevalence and high levels of vaccination creates the conditions in which an immune escape variant is most likely to emerge. The likelihood of this happening is unknown, but such a variant would present a significant risk both in the UK and internationally,” it said.

A paper by experts at Imperial College London estimated hospitalisation numbers would be comparable to the January wave of Covid-19 but deaths would be substantially lower.

It said in the most optimistic case, based on the vaccine effect and lower levels of contact and spread of infections, the number of deaths could be limited to 9,400 by June next year. But if the vaccines prove less effective and the public return to high levels of contact and risky behaviour, there could be 115,800 deaths by then.

Th experts’ central estimate was for 33,700 deaths.

Modelling by Warwick University said all seven scenarios it considered generated a third wave this summer. The smallest wave led to a peak of 668 hospital admissions on 11 August, while the worst-case scenario led to a peak of 2,490 people being admitted to hospital every day.

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