By now, most people have accepted – even the government has accepted – that coronavirus is going to put considerable pressure on our NHS. Yet as an NHS doctor currently caring for coronavirus patients, let me tell you: you have no idea how bad it’s going to get.
Without wanting to sound alarmist, the numbers are inescapable.
One week ago, we had 40 confirmed cases in the UK. We took no specific general measures other than to contain and trace the contact patients had had with others. Yesterday, we had over ten times that number of cases, and still apart from screening intensive care patients, our testing criteria have barely changed. We still aren’t testing community cases that clinically look like coronavirus if they haven’t travelled or had contact with confirmed cases. Hospital cases are only beginning to be tested this week, and only at the discretion of clinicians.
Until now, a suspected case was not allowed to be tested unless they had an obvious link to certain countries or infected patients. I’ve seen at least three people with severe disease who weren’t allowed to be tested, and heard of dozens more. This long-overdue policy change will soon be reflected – possibly as soon as the next 24-48 hours – in a big spike in case numbers.
For an idea of how quickly case numbers can explode, look to Italy. One week after it hit 320 cases, the country reported 2,036; a week later, nearly 10,000; next week that number will likely rise to 50,000 or more. There’s nothing I have seen that tells me the exact same thing isn’t coming for us in the UK. We only have around 4,000 intensive care unit (ICU) beds in England, 80% of which are already full. If we follow the same trajectory as Italy, with 10% of coronavirus patients needing ICU treatment, we will need 200 beds next week, 1,000 the week after. That’s already the entire ICU capacity. Every two days after that, we will need twice the number of beds again.
Then there is the collateral damage coronavirus will create. For while we are obsessively tracking deaths from Covid-19, it’s really the non-virus mortality we should be worried about. For every coronavirus patient in an ICU bed, one non-viral patient – possibly older, possibly with more complex healthcare needs – may be turned away. If you need intensive care and you don’t get it, it’s unlikely you will survive.
Of course, the crisis will not end when the virus does. We have already begun shutting down some outpatient hospital clinics, and I suspect will close all of them to all this week. There is already a huge backlog of non-urgent surgery and cancer care, much of which will be cancelled entirely to cope with coronavirus. The knock-on effect will be felt for years to come.
Unabated, we could see a million coronavirus cases or more in a month’s time. What happens after that, I don’t know. One thing I do know, however, is that the Italian mortality rate seems much higher than China’s (around 7%, versus 4%), a fact mostly explained by how Italian local healthcare has been pushed to breaking point. Reading the accounts of Italian doctors dealing with their outbreak reads like a warzone. Hospitals diverting all clinical staff to the care of ventilated patients. This is not healthcare but “catastrophe medicine”, of the kind one usually encounters on the battlefield; save who can be saved, leave the rest.
China had the capacity to build 2,000-bed hospitals, lock down 750 million people, and fly in thousands of medical staff. Italy, despite having a well-resourced healthcare sector, has been overwhelmed. With 100,000 missing staff, 10,000 missing doctors, 40,000 missing nurses and around £3bn missing from our budget, we have neither Italy’s well-resourced healthcare system nor China’s capacity.
I come from a medical family and in my house, it feels like we are preparing for war. My husband and I have talked about wills; hundreds of healthcare workers have died so far on the frontline of this crisis. However I am young, fit and therefore low-risk – but that isn’t true of all my colleagues, all of whom will be out there, putting their lives on the line for their patients.
There have been plans mooted to recall recently-retired doctors to help shore up frontline services, or to train up final-year medical students. The government proposed both with some fanfare weeks ago – and yet nothing concrete has materialised on either front. The plans surrounding revalidation, supervision, and basic role expectations have simply not been laid out. I asked a medical student about coronavirus preparation today, he had looked at me blankly.
If we are going to be throwing everybody we have at this in two weeks, why aren’t we training them now? We should be throwing every single resource we have at this, immediately. Rishi Sunak promised “unlimited money” to fight the pandemic – and yet we haven’t seen anything. We should be recalling every medic we can find, rapidly training up existing staff and resourcing central hospitals with every scrap of PPE and ventilation equipment we can lay our hands on. Hospital managers should be told to do whatever they have to, and don’t worry about budget constraints or fiscal penalties. The government should be providing the public directly what we need to contain the epidemic: handwashing areas at transit hubs, supplies at foodbanks, mass disinfection of public transport. We are far behind where we need to be, and every second lost will cost lives.
It is not exaggerated – in fact, it is proportionate – to think of this as a war, a national crisis with a huge potential loss of life. Our army is poorly provisioned after years of neglect, our leaders are woefully underprepared. Now is the time the government must step up and truly deliver us the resources we need. No more delay – right now. Countless lives are on the line.
The author is a doctor working in the NHS.
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