HOSPITALS could be forced to ration oxygen in the near future as Covid inpatients reach record highs, a doctor has warned.
Almost 38,000 Covid patients are in hospitals now, 79 per cent higher than the spring, and 3,900 are on life-supporting ventilators.
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As pressure builds on the NHS, Dr David Strain said it’s “too late for solutions”, meaning doctors may have to make “tough decisions” on how to use oxygen.
It would be the first time the health service faced such a moral dilemma, which could leave doctors carrying guilt for years.
Dr Strain, a clinical lecturer at the University of Exeter and hospital doctor, told The Sun: “At some point in the not too distant future we may reach a point when it is not possible to pump enough oxygen through the hospital pipes to supply everyone who can potentially benefit from it.”
Dr Strain said: “NHS staff will then be faced with impossible choices as to who gets treatment and who does not get potentially life-saving treatment.
“The long term implications on the mental wellbeing of the NHS will become a significant factor in the safe staffing of hospitals beyond the pandemic.”
Most regions in England have not reached their “peak” of hospital admissions, which is expected in the next few days.
People with severe Covid disease suffer oxygen deprivation because their lungs struggle to transfer oxygen into the bloodstream.
It’s too late for solutions. We’re just having to deal with it
Dr David Strain
But even if there are enough hospital beds and staff to treat Covid patients, “hospitals were never designed to carry the amount of oxygen they already are” from the huge cylinders outside and onto wards, Dr Strain said.
He added: “We have never been in a position before – in all the flu pandemics and other major outbreaks – where the NHS couldn’t meet the basic requirements of the users.
“It’s too late for solutions. What is happening now is we are reaping the impact of bad decisions made before Christmas. We are just having to deal with it.”
Difficult decisions
If the NHS reaches a point in which it has to ration oxygen to patients, doctors could be forced into deciding how to best use supplies.
The Prime Minister warned on November 2, before the second lockdown, that if the NHS is overwhelmed we could face a “medical and moral disaster” where doctors and nurses could “be forced to choose which patients to treat, who would live and who would die”.
The chief medical officers have since determined there is a material risk of the NHS being overwhelmed in January, if a third lockdown was not used.
Guidelines have been produced by the British Medical Association (BMA) and NHS England on how to navigate such an unfathomable choice between one patient and another, but there is no official strategy.
“None of us were trained to make those sorts of calls”, Dr Strain said.
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“It doesn’t matter how good the guidance is, it doesn’t take away from the personal element that a doctor somewhere will have to make that choice that is effectively one person will die because we don’t have enough resources.”
Rationing of oxygen supplies can theoretically be done a number of different ways; In one scenario, patients considered most likely to survive are given the optimal level, while others don’t get offered the potentially life-saving treatment.
Another way of addressing it is to scale back how much is given to each patient, but this could potentially have damaging consequences.
“If you have prolonged periods of not enough oxygen to the brain, that could have lasting consequences”, Dr Strain said, adding: “We don’t have the answers. This type of research has never been done before.”
Last week healthcare organisations and unions called on the Government to introduce emergency legislation that would protect doctors from being sued, should they have to prioritise patients.
The letter, signed by the BMA, Doctors Association and Medical Defence Sheild, said “there is no national guidance… on when life-sustaining treatment can be lawfully withheld or withdrawn from a patient in order for it to benefit a different patient”, adding “this crisis is upon us now”.
NHS leaders have already warned of limited oxygen supplies in some areas due to rising numbers of Covid patients in their wards.
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For example, last week, a Southend Hospital, in Essex, said it had reached a “critical situation with oxygen supply”.
Mid and South Essex Hospitals Foundation Trust, who runs the hospital, told staff to lower the oxygen given to patients in order to conserve supplies, lowering target range for oxygen levels from 92 per cent to a 88 to 92 per cent.
Other hospitals are transferring patients to other hospitals which have more space as a means of coping with short supply.
Dr Tom Wingfield, a senior clinical lecturer and honorary consultant physician, Liverpool School of Tropical Medicine said hospitals “need to monitor rate of oxygen use and anticipate need”.
But he told the Sun: “With meticulous planning and rational, indicated use of oxygen, I do not think we will have shortages during this current Covid-19 wave.”
Dr Daniele Bryden, vice-dean of the Faculty of Intensive Care Medicine, said the NHS is already buckling, which is clear from patients having to be transferred between hospitals.
She told Sky News: “The fact that people perceive that intensive care units up and down the country are coping doesn’t mean that we have actually not been overwhelmed, because we have.
“NHS staff have been transferring patients across the country for critical care, we have been using other staff groups to help us deliver care and intensive care nurses have been looking after significantly more patients than they normally would do.
“So it’s an adjustment of the term ‘coping’, I think, really.”
She said the pressure would continue on hospitals “well into the spring”, while Dr Strain sees it lasting until May or June.
This is because although the vaccines are being rolled out as fast as possible to the elderly, patients in hospital are mostly middle-aged.
Record breaking inpatients
Daily admissions are falling in the South East and London. However, hospitals are more full than ever before and will take a while to recover.
Part of this is because Covid patients are typically using a bed for three weeks, on average, far higher than for patients with flu or pneumonia.
Treatment has also improved, meaning patients are spending more time on wards than in March, when the seriously ill died quickly.
Although figures show the average number of patients admitted to hospitals in London and the South East per day is declining, Dr Strain said it “isn’t easing the case load”.
He warned: “The total number of people in hospital is still growing, and the ones that were admitted about a week ago are coming up to their sickest time point when demand on services is at its highest.”
At least half of the patients in hospitals have been there since around New Years Day – around three weeks ago.
And those being admitted today will still need treatment in three weeks time, at the start of February.
Deaths are not expected to reach a pinnacle until February some time, based on the time lag between infection, hospitalisation, and death.
