Across the country, even before Omicron admissions have started to rise, the bed occupancy in our hospitals is 94%.
“The secret consultant” www.theguardian.com
That seems a luxury to me; it is quite a while since I saw an empty bed in mine. Our bed occupancy hovers around 100% and has done so for some weeks.
There is nothing unusual in this, however. Successive decades and serial A&E closures, combined with rising healthcare demands from an elderly and growing population, have meant our bed provision is far too small for our area. Even in a normal winter, critical bed crises are a common problem, with operations cancelled and patient care often compromised as a result. The whole system has been slowly gutted to the point that there is not even enough capacity to deal with routine fluctuations in demand.
This, however, is not shaping up to be a normal winter. The Omicron variant is spreading with a speed that is terrifying to me, even after all I have seen and done over the past months.
I don’t even need to look at the figures to know this; the evidence is all around me. Friends and family, even the careful ones, have started testing positive and having to isolate. There are multiple outbreaks in schools again. Football matches are being cancelled. And there are already many colleagues unable to attend work, leaving rota gaps that we are already struggling to cover.
And the worst of it is yet to come.
Extrapolating from the current figures, it looks like within our local area we will have infections in the tens of thousands by the middle of next week. And here comes the biggest unknown.
Is this variant really, as we all hope, less virulent than its predecessors? Will our vaccines and immunity be enough to keep people out of hospital? Even with a hopelessly optimistic low rate of hospitalisations, it still looks like there will be far too many patients for us to look after.
A small proportion of a very large number is still a large number. Remembering also that there is a lag of a week or two between infection rates rising and people becoming unwell enough to present to hospital, this means the potential point of maximum pressure comes around Christmas and New Year, when many of us were hoping, finally, to take a few days off, and many more will be sick or isolating with Covid.
And we have significant other pressures working against us. GPs are scaling back the routine care they offer in favour of vaccinations. Some hospitals are also cancelling elective care so that their consultants can join in the jabbing.
Despite this, the new variant has some power to evade the vaccine, meaning that even the current heroic effort may not put the requisite protections in place in time. Vaccinated patients are unlikely to get critically ill, but even relatively well patients coming into hospital could overwhelm us.
The reduction in usual care is likely to result in more patients seeking help in hospitals, despite best efforts.
One glimmer of hope is the new treatments for Covid now available for patients who are particularly vulnerable, with the aim of stopping the disease progressing and reducing the need for hospitalisations.
The first centres for this went live this week, using staff redeployed from other vital work. The problem is, however, that these were set up and resourced based on numbers calculated from the Delta variant. Within the first 24 hours of opening it became clear that the numbers now identified for treatment already exceeded capacity fivefold and are rising exponentially.
So even this hope must be tempered with realism: how much will these really be able to hold back the tide?
I find myself grudgingly admiring the Covid-19 virus, that with all our modern medicine and incredible science, it is still managing to confound us even 20 months on. It is a fearsome opponent.
So why, yet again, do we seem to be underestimating it? Why do we not learn from our mistakes?
For a healthcare system already strained beyond capacity the potential threat that Omicron poses is obvious, even though its virulence is yet unknown.
Why not therefore take at least some sensible precautions to try to hold back the spread, to buy us time to vaccinate some more and make sure we are set up to give all the therapies at our disposal?
Plan B will make very little difference to a strain this infectious. In any case, these measures take time to work.
By the time that hospitalisations start to rise, it will be too late. Surely it would be better to make the mistake of introducing early restrictions unnecessarily than to make the mistake of not doing so and causing unnecessary deaths?
Boris Johnson “know[s] the pressures on everyone in our NHS”. But does he really? Has he got any idea of the exhaustion, burnout and low morale that I see and feel every day? The dread that my colleagues and I express as we talk about what this winter holds in store, again? How it feels to be potentially facing yet another wave?
And yet still we sit on the fence, pretending we can vaccinate our way out of this while carrying on with life as normal. Talk of shielding the NHS rings hollow in the face of this inaction.
And while we have been working on throughout to keep people safe, it seems that in Downing Street they found the time to have unmasked quizzes and after-hours gatherings. How nice.
It really is hard to put into words exactly how shameful, deceitful, and hypocritical this is.
In medicine we sign up to a “duty of candour” that we all owe to our patients, whereby if mistakes are made we admit them, apologise, do our best to make amends. It is a basic thing that even the most junior medical student knows about. Too basic, it seems, for some important people to be concerned with.
What we have achieved in the NHS over the past year is little short of amazing. And now we are being asked to make another “extraordinary effort” by leaders who show themselves to be above such things yet too cowardly to admit it.
Yet without measures to protect us, will it be enough?