Hospitals in England will run short of critical care beds for Covid-19 patients within the next two weeks if the numbers becoming severely ill escalate on the scale experienced in Italy, say doctors.
A paper by a team at the University of Cambridge says that five of the seven NHS commissioning regions will have more patients needing critical care than the number of beds normally available in hospital intensive care units (ICUs) within a fortnight.
Boris Johnson’s announcement of a partial lockdown on Monday night, telling everyone to stay at home, is intended to prevent a disastrous scenario in the NHS, in which the health service is inundated with coronavirus patients and cannot cope. It is a situation the Cambridge researchers say is fast approaching.
Last week NHS England said it would increase the number of critical care beds by 40,000: 15,000 by stopping all non-emergency operations, 15,000 by more efficiently moving older people who have recovered out into social care and 10,000 bought in from the private sector.
Dr Ari Ercole from the division of anaesthesia at the University of Cambridge, who is an intensive care doctor, and his colleagues say they are concerned that it will take time to make those beds available, get sufficient ventilators for the patients and train the extra staff needed.
“If mechanical ventilation cannot be provided to patients who need it, they will die,” said Ercole. “ICU capacity is a crucial concern as additional capacity takes time to create both in terms of staffing and equipment.”
The government has acted on advice from the modellers at Imperial College London, who have used data from the Chinese epidemic to calculate the impact on the NHS. Ercole and colleagues, however, are using data from the Intensive Care National Audit and Research Centre on cases coming in to ICUs at the moment.
The Imperial model does not tell anyone about the current situation, he said. “It is aimed at trying to do something else. It is a good model, although scary.” The Imperial modellers calculated that 200 ICU beds would be needed per 100,000 people in the population, said Ercole. At the moment, there are six per 100,000.
It is time to pull out all the stops, he said. “We should be pressing ‘go’ now. We don’t know why northern Italy got so bad so quickly, but it seemed to come out of nowhere.” He thinks the chances are that the UK epidemic could similarly explode.
There have been 225 patients with Covid-19 admitted to critical care units in England, Wales and Northern Ireland as of 19 March. Last Thursday night, Northwick Park hospital in London sounded the alarm, declaring that its critical care beds were full and contacting nearby hospitals to take Covid-19 patients.
Ercole is sceptical that buying capacity in the private sector will solve the problem. Those beds would need to be specially equipped, because private hospitals have little in the way of intensive care. Their doctors are the same ones who work in the NHS.
The Cambridge researchers’ findings have not been peer-reviewed but are being made available early, as many other studies are, to help inform the NHS response to the pandemic.
“The bottom line is that this is a massive operational challenge to actually implement and the beds are going to be needed imminently,” said Ercole. The UK’s intensive care units operate at 80% capacity or more. One possibility is to move patients out of intensive care into general wards more quickly but he estimated that would probably not free up more than about 20% capacity.
There are about 4,000 critical care beds in England, so scaling up to 40,000 is a massive increase. “Moving ventilators from theatres and procuring equipment for new areas as well as training non-specialist staff inevitably takes time with the best of intentions.
“There is lots of work happening, but the point is that we are currently in the exponential phase which overwhelmed Italy very rapidly – representing an additional number of patients equivalent to 60% of normal total capacity within about a week. So the point is that all efforts need to be focused on this and operationalised immediately,” he said.
An NHS spokesperson said: “NHS staff are working around the clock to deal with this unprecedented global health threat, including rapidly ramping up treatment capacity within hospitals, and striking a landmark deal with private care providers which has put 20,000 staff, 8,000 beds and 1,200 ventilators at our disposal.
“But it remains absolutely vital that this huge mobilisation by the NHS is matched by action from the public which means following medical advice to the letter – please stay at home to save lives.”