A roulette table does not offer bets on NHS blue but if it did, that’s the colour on which Boris Johnson has placed our chips.
By Paul Nuki, Global Health Security Editor, www.telegraph.co.uk
It’s an outside bet and, if it comes good, will provide a reasonable indication that we are over the worst of Sars-Cov-2 and the need for lockdowns, in this pandemic at least.
But the wheel is still spinning. Indeed, the ball was only really put into play eight days ago when we all got together for Christmas.
As Prof Chris Whitty, the Chief Medical Officer (and croupier) for England, put it on Saturday: “Data show one in 25 people in England had Covid last week, with even higher rates in some areas.
“The wave is rising and hospital admissions are going up. Please protect yourself and those around you.”
Whether the gamble will pay off is still unknown, but the odds have lengthened in the past few days, which is why tents are being thrown up in hospital car parks across the country.
The larger ones, known as Little Nightingales or “Boris wards”, are where improving but not fully recovered patients will be kept should hospitals start to overflow. The smaller ones are made by Nutwell Logistics and other purveyors of “soft-shell body storage solutions”.
Ahead of Christmas, there were reasons to be cheerful. South Africa’s hospitals had not been overwhelmed, case growth was slowing and doctors were reporting a milder illness.
Government scientists cautioned that Africa was not England, and that festive mixing could not be later undone, but the odds seemed pretty even when the Cabinet met on the afternoon of Dec 20 to spin the wheel.
Today, alas, things are not looking as good. The logarithmic charts of Prof Oliver Johnson, the Cambridge mathematician, show that hospital admissions are rising exponentially.
There were 2,370 admissions in England on Friday – up 69 per cent on the week – and the surge is now impacting not just London and the young but all areas of the country and all age groups. In the North East and Yorkshire NHS region, admissions have more than doubled in a week, up 117 per cent.
There is also nothing yet in the UK data yet to suggest that hospital stays are any shorter, and Covid occupancy of ICU beds has once again started to creep up. It climbed seven per cent in England on the week, with growth focused on London and the East.
But if there is a storm to come, it has yet to make itself felt. Front-line doctors to whom The Telegraph talked last week said they were seeing a “milder illness” and that, while things were busy, there was no crisis yet.
Dr Andrew Goddard, the president of the Royal College of Physicians, said staff absence was his biggest concern.
“It’s workforce, workforce, workforce,” he said. “I think omicron is hopefully going to be a relatively short sharp shock… Provided the number of hospital admissions as omicron hits the over-65s isn’t too bad, I don’t think there’s going to be as much of an impact on the services as a year ago.”
He added, however, that if the tents were needed it would signal an “emergency in extremis”.
Other doctors said bed capacity was the main problem because discharging frail patients into the community was proving difficult.
“The difference now compared to the first wave is that we haven’t emptied out the hospital in the way we did then,” said an intensive care consultant in the North. “We’re going into this potentially massive wave with 95 to 98 per cent bed occupancy, whereas the first time we only had 50 per cent of our beds occupied.”
About a third of Covid patients are in hospital “with” the virus rather than because of it, seen as a sign of hope by many. But doctors who talked to The Telegraph said “incidental infections” were making hospital capacity problems considerably worse.
“Once you have a ward that is infected with Covid you have to separate it both physically and in staffing terms from the wards that don’t have Covid,” said an intensive care consultant in the South West. “It makes it much harder to run the hospital – you’re effectively running two hospitals within one.”
Two other new findings will be worrying ministers as the roulette ball completes its final few loops of the wheel. Late on New Year’s Eve, the UK Health Security Agency (UKHSA) released a report which showed that vaccine efficacy against hospitalisation was not as good as initially hoped.
Booster jabs work well for 10 weeks before starting to wane, but two doses of vaccine were estimated to have an efficacy of just 52 per cent after six months.
“These estimates suggest that vaccine effectiveness against symptomatic disease with the omicron variant is significantly lower than compared to the delta variant and wanes rapidly,” said the report.
The UKHSA also found the virus itself may not be as mild as it was in South Africa, where night curfews and other restrictions to contain infections have now been lifted.
An updated analysis of over a million cases by the Biostatistics Unit of the University of Cambridge suggested the risk of hospital admission with omicron was approximately a third of that for delta in the UK.
All of which may explain why hospitalisations are outpacing three of the four projections produced by the London School of Hygiene and Tropical Medicine (LSHTM) in the run-up to Christmas.
Currently, the real-world hospital data fits only into the lower range of the modeller’s most “pessimistic” scenario – a scenario that could see hospitalisations spike in the next few weeks at more than double last January’s peak (see charts above).
It was this model that was so widely criticised by Conservative backbenchers in the run-up to the pivotal cabinet meeting on Dec 20, with Sir Iain Duncan Smith, the former Tory leader, suggesting the assumptions behind it were unscientific and wrong.
As a nation, we must now hope that the non-interventionist instincts of Sir Iain and his colleagues were right. We really need that roulette ball to land on NHS blue this time rather than black.