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Coronavirus: doctors warn of shortage of critical care beds

Medical workers wearing protective gear - Reuters
Medical workers wearing protective gear - Reuters

Doctors have warned that a shortage of critical care beds and staff could put pressure on an already overstretched service in the event of a large-scale coronavirus outbreak in the UK.

Data on the availability of critical care beds - those for treating the most severe cases of pneumonia - shows that the UK has one of the lowest rates of beds in Europe.

One senior doctor said that “tough decisions” would need to be made about who should be treated.

Critical care bed capacity in the UK
Critical care bed capacity in the UK

While there have only been 17 cases of the coronavirus, called Covid-19, in the UK so far it is impossible to know if and when the virus will turn into a major outbreak here.

Data released by the Chinese authorities on the first 44,000 cases shows that around five per cent of those who contract coronavirus are critical cases and need to be treated in intensive care and high dependency units.

The death rate from the disease is two to four per cent in Wuhan - the epicentre of the outbreak - and 0.7 per cent in the rest of China and beyond.

A study by Chinese and Dutch experts of deaths in Wuhan said that an overstretched health system and a lack of beds and resources could be to blame for the high death rate.

In a letter to the Lancet medical journal, they said the higher mortality rate in Wuhan was down to the "rapid escalation in the number of infections around the epicentre of the outbreak, which has resulted in an insufficiency of healthcare resources".

A survey by the UK Faculty of Intensive Care Medicine (FICM) two years ago showed that critical care units were under intense pressure, with three out of five not having a full complement of nursing staff, two out of five having to close beds on a weekly basis and a fifth having to transfer patients elsewhere at least once a week because of a lack of beds.

Dr Daniele Bryden, vice dean of the faculty, said the FICM was about to carry out another survey and she expected to find a similar if not worse picture to 2018.

“What has been consistently the case is that we have been identifying a lack of resources in critical care both in terms of beds and in terms of workforce - both nursing and medical workforce. The shortfall is still there [from the 2018 survey],” she said.

According to Department of Health “surge plans” coronavirus patients will be sent to five specialist centres in Sheffield, Liverpool, Newcastle and London which has two units.

Only if those units were full would other NHS hospitals take patients.

Dr Bryden said: “Since 2009 when we had the H1N1 swine flu there have been a lot of dedicated surge plans put in place, including a review of critical care services.

“But also since 2009 there has been an increased demand on critical care capacity and we haven’t had an increase in resources to manage that increased demand. The surge planning is very good but we do have a shortfall of critical care beds,” she said.

“The service has been under pressure for a good few years. The reason we are not seeing big stories about winter pressures any more is because it’s become normalised. The worry is if coronavirus does happen and it cannot be contained in the five named units,” she added.

The faculty estimates that since 2009 demand for critical care beds has grown by about four per cent every year.

Critical care bed capacity in England
Critical care bed capacity in England

According to data from NHS Digital critical care beds run at between 70 and 80 per cent capacity most months. However, the faculty believes these numbers do not reflect the true picture - a bed may be counted as empty when the reason it is not being used is because there are not enough nurses to staff it, for example.

Wales and Northern Ireland suffer a particular shortage of beds.

A senior doctor at a London teaching hospital, who did not want to be named, said the NHS would be able to cope with a small number of cases.

“But if we end up with a massive epidemic - in terms of numbers of ICU beds we probably won’t have enough and we will have to make some pretty tough decisions. There would have to be some rationing - who goes to the ICU and who doesn’t because we do not have the capacity to take everyone,” the doctor said.

A paper by Canadian researchers in the journal Critical Care looking at how well prepared intensive care units were for an influenza pandemic warned that in most well developed countries ICU beds are often close to capacity.

It said that during the severe acute respiratory syndrome (Sars) outbreak in 2003 there were only 251 cases in Canada but “resources were critically stretched”.

It also warned of the toll on health care staff - in Wuhan some 1,700 health workers have fallen ill.

The London doctor added: "If there's a massive flood of patients we will get into trouble. We will go into a major incident response. There are protocols and processes for that but it will be thoroughly unpleasant, particularly in ICU when your own staff may end up ill.

"You cannot just magic up intensive care nurses from nowhere as it's such a specialist role."

A survey by the British Thoracic Society, which represents respiratory experts, found an “understaffed and overstretched” service with 73 per cent of respondents saying staff shortages meant they were unable to cope with an increase in emergency respiratory hospital admissions.

Professor Jon Bennet, chair of the BTS, told the Independent: “A severe coronavirus outbreak will be very challenging. I have tried desperately not to think about it because when you do it is a very worrying situation. We would be in serious trouble.”

Helen Buckingham, senior fellow at health think tank the Nuffield Trust, said if there was a "slow and steady" spread of coronavirus the NHS would cope.

"But if there was a short, sharp surge in pressure that would be much more difficult to manage. It's not easy to stand up a critical care bed at short notice. It's partly staffing but it's also about the equipment," she said.

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