We can’t wait for hospital admissions to rise – England needs a circuit breaker now | Christina Bagel

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The emergence and rapid spread of the Omicron variant is the biggest threat to the NHS since the rise of the Alpha variant last December. The NHS has only managed this by reducing a lot of non-Covid work and by curbing the increase in cases with the second lockdown in January 2021. A year on, the lack of urgency in the government’s response is a danger to all of us.

NHS staff are overwhelmed. They have been working hard for about two years. For some of that time, they have had to struggle with increasing numbers of seriously ill patients with Covid-19. When each wave subsided, they turned to the backlog of cases in the meantime – this massive backlog started before the pandemic and numbers nearly 6 million people. Meanwhile, Covid patients still make up about a quarter of occupied critical care beds.

The risks to the NHS come from three directions. First, Omicron has grown faster than any variant seen so far – including the original spread of Covid-19 in March 2020. The UK’s Health Security Agency has reported that Omicron cases are doubling every two days in most areas of the UK. A certain percentage of newly infected people will need hospital treatment — even if Omicron causes less serious disease than Delta. Let’s say the risk of hospitalization with Omicron is half that of Delta, although analysis from Imperial College London suggests this may be optimistic. With a variable that doubles every two days that only gives us a two day advantage. Whatever the final percentage of people with Omicron who will need NHS care, the absolute number seeking care will also double every two days.

Since it takes seven to 14 days from infection to need hospital, this rapid increase in demand for NHS services will not be noticed immediately – perhaps not until after Christmas – but it will. Modeling by the Scientific Pandemic Influenza Group on Modeling, Operational Subgroup—which reports to the Sage Committee—suggests that by the time we see this effect, it may have gone through four doublings. This means much higher stress levels on the NHS which we can do nothing about if we wait for hospital admissions to rise before we act.

Last Thursday, Sage estimated that without reducing transmission (in addition to Plan B), there would be at least 3,000 daily hospitalizations in England (equivalent to a first wave in 2020), and it could be much worse even than in January the past . So the question is not whether it will be bad for the NHS, but whether it will be horrific or catastrophic.

The second danger comes from focusing only on the number of patients and not on the capacity of the staff. It is very likely that staff absences due to infection will have a severe impact as well. Fortunately, almost everyone will get boosters, so they are at little risk of becoming seriously ill or dying, unlike in the early days of the pandemic. But we know that those who have been boosted are infected and must be isolated. And when the neurosurgeon performs isolation, their entire team may not be able to survive. It also exacerbates the pressure on those who are still able to work.

The NHS in London is already experiencing a significant staff shortage due to Omicron: Guy’s and St Thomas’ trust have already had to cancel services and the London Ambulance Service currently has hundreds of sick staff. The speed with which Omicron is rising makes it inevitable that we will completely lose many critical employees as demand increases. The number of NHS hospital beds in England has more than halved over the past 30 years, with the UK among the countries with the lowest ICU capacity per population in all of Western Europe. And we actually have far fewer doctors than in other parts of Europe.

The third danger comes from the way we have taken the efforts of NHS staff for granted. Throughout the pandemic, NHS staff have adapted remarkably to incredibly challenging situations. They have learned new skills. They have devised new ways of working, such as teleconsultation (many GPs are seeing much more patients than before). Their facilities have been reused, transforming traditional wards into intensive care units. They gave each other support when things seemed to be getting too much. But at some point they can’t do more. Many employees have left and many are exhausted and cannot cope with the shock of another winter that is so helping people breathe. Many have developed Covid for a prolonged period with more than 3% of health and social care staff reporting persistent symptoms of Covid-19 for 28 days or more, the highest percentage of all occupations.

After nearly two years of dealing with crisis after crisis, the NHS has not had the flexibility it had at the start of the pandemic. This means that pressures are now higher at lower levels of Covid-19 hospitalizations than in previous waves. As a community, we have a duty to care for the NHS, as well as the nursing home staff, who have looked after us during very difficult circumstances. We let them down.

We urgently need to protect our health and social care staff with adequate personal protective equipment. We need to provide all staff with high-quality PPE (including FFP2/3 masks), so they can protect themselves and their families, and reduce in-hospital transmission that can cost lives. We need measures that can quickly reverse the rise in cases. Vaccine boosters are critical, but they take effect over weeks rather than days. We missed the opportunity to take early, less dangerous action. The only thing that can work in time is a short circuit breaker to limit indoor social interaction (and return the rule of six when you’re outside, keeping outdoor hospitality and shops and schools open), as suggested by Independent Sage and Sage. New data on the severity and prevalence is arriving day by day, and if the news is good, the circuit breaker can be lifted quickly. But we have to act now.

Christina Bagel is director of the Clinical Operational Research Unit at UCL, which applies advanced analytical methods to health care problems. This article was co-authored by Deepti Gordasani and Martin McKee

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