England just lately emerged from a four-week lockdown right into a sequence of tiered restrictions, and there may be excellent news in regards to the authorisation of the primary vaccine for COVID-19, which is beginning to be deployed. However with restrictions loosened, an infection charges nonetheless excessive and vaccine deployment gradual, is there a danger of a 3rd lockdown in early 2021?
The second English coronavirus lockdown has been devastating for companies in retail and hospitality. But we are able to see the lockdown has “labored”, bringing case numbers down virtually by half from their peak. Charges of latest admissions to hospital have additionally fallen, however stress on England’s Nationwide Well being Service (NHS) has not eased considerably.
The variety of sufferers in hospital for COVID-19 has little greater than flattened throughout November, offering hardly any further capability to handle the mixed affect of loosening restrictions and regular winter pressures on the NHS.
A key distinction between this second wave of COVID-19 in England and the primary wave in March and April is that the NHS is making an attempt to proceed regular companies – similar to life-saving most cancers and coronary heart surgical procedure – as a lot as potential. So what does life within the NHS throughout winter normally appear to be, and what capability is there to handle greater than 10,000 COVID-19 sufferers in hospital at one time alongside regular care?
Finish of winter wrestle
The winter months are a high-pressure interval for the NHS at the most effective of instances. Decrease temperatures are related to a better fee of hospital admission from emergency departments, and sufferers usually want to remain in hospital longer, each of which enhance mattress occupancy charges. Older sufferers with respiratory situations and different underlying situations are most affected by a constant low temperature, even when winter is much less extreme.
Elevated stress is mirrored in a decline in efficiency for key patient-flow targets, such because the proportion of sufferers admitted, transferred or discharged from the emergency division inside 4 hours. This seasonal spike in stress will be anticipated on high of longer-term demographic developments resulting in extra emergency division attendances of sufferers with extra complicated well being wants.
Intensive care models (ICUs) in England additionally function at a excessive stage of occupancy throughout winter months. Between December 2019 and February 2020, occupancy in grownup ICU averaged 82% of the three,730 ICU beds, leaving solely about 670 spare at any time. The present variety of COVID-19 sufferers in ICU in England (as of late November) is greater than 1,500. Whereas the Nightingale hospitals have given the NHS elevated capability to deal with COVID-19 sufferers, and regular winter pressures brought on by influenza may be mitigated by social distancing, the image remains to be removed from comforting.
In previous years, hospitals have responded to winter pressures by delaying elective procedures to release capability. This strategy comes on high of each a common latest pattern for sufferers to attend longer for elective procedures and most cancers therapy. It additionally suggests there may be much less flexibility to reply to a rise in COVID-19 circumstances in the identical approach than there was through the summer season months.
Impact of vaccines will take time
Whereas it’s nice information that vaccines are being administered for the primary time this week, a number of elements work in opposition to vaccines relieving stress on the NHS any time quickly. First, the UK solely has entry to very restricted portions of vaccines to start with and will likely be utilizing them slowly over the ultimate weeks of December and into January. Second, these vaccines take between two to 4 weeks to construct immunity in these immunised.
Lastly, and most significantly, vaccines are being prioritised to these at most danger of demise – initially the over-80s, fairly than those that make up the very best variety of sufferers in ICU with COVID-19 – individuals of their 50s, 60s and 70s. Half of the sufferers in ICU with COVID-19 are below 62 years of age. It might take many months earlier than a lot of these “middle-aged” individuals have been efficiently immunised, relieving stress on ICUs.
Pressures might begin to present by finish of January
The tier system that changed the lockdown in England is harder than the pre-lockdown (October) model. For instance, tier 2 (excessive danger) within the new system broadly equal to the earlier tier 3. Nevertheless, there stays a excessive diploma of uncertainty about how efficient the tiers are at decreasing or controlling case numbers.
The federal government has additionally determined to calm down restrictions over the Christmas interval to permit extra family mixing, which appears more likely to result in a rise in infections in early January. By mid to late January, the elevated infections from the Christmas interval can have had an affect on new hospital admissions and steadily began to extend the variety of sufferers in hospital with COVID-19.
With the present winter pressures and the excessive variety of COVID-19 sufferers in hospitals and ICUs, each deliberate surgical procedure and even emergency care could also be threatened by sources diverted to COVID-19 sufferers. The federal government might don’t have any alternative however to reply with one other lockdown throughout England.
James Gaughan receives funding from the Nationwide Institute for Well being Analysis (NIHR).
Peter Sivey doesn’t work for, seek the advice of, personal shares in or obtain funding from any firm or organisation that may profit from this text, and has disclosed no related affiliations past their educational appointment.