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UK News Coronavirus: London critical care units to turn away patients 'within days'

21:00  25 march  2020
21:00  25 march  2020 Source:   inews.co.uk

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Several hospitals in London will have to turn away coronavirus patients "within a few days" due to their critical care units being full, a senior NHS official has warned.

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Chris Hopson, the head of NHS Providers which represents hospital trusts, said: "London trust CEOs are incredibly proud of how much has been done, how quickly, to clear space and create capacity but they're concerned about how quickly this extra capacity is now filling up. Preparation and planning has been incredibly helpful but size of demand surge is off the scale.

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"It's evident a number of hospitals in London are on a trajectory where their critical care capacity will become full within a few days."

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Emergency coronavirus guidelines for doctors and nurses have been published by the National Institute for Health and Care Excellence (Nice) so staff know who to prioritise. The first three “rapid guidelines” consider patients in critical care, those having kidney dialysis and people being treated for cancer in England and Wales. They are the fastest guidelines Nice has ever produced.

Patient assessments

Doctors and nurses have spoken out about their fear of being able to cope with the inevitable influx of coronavirus patients (Photo: Christopher Furlong/Getty)

All patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”, the guidelines state. For those who test positive, doctors should decide whether they are admitted to critical care on the medical benefit, taking into account the likelihood of the person’s recovery.

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Mr Hopson said the new advice on what should be done in the face of this demand had been "helpful" but said in some places the pressure is already so great that these have to be a broad “sense of direction as opposed to minutely observed reality".

He said “ordinary” A&E emergency attendances have dropped significantly compared to the normal levels of demand the trusts would expect at this time of year.

"This is a help but only a very small one given the overall context... Every member of the public can play our part too: STAY AT HOME and follow the guidance. Can’t stress how important this is."

Trust chiefs also praised London Ambulance Service for managing demand and being able to use "real time information" on how full hospitals are and therefore deciding which ones can take emergency patients.

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'Alarming' rise

Earlier this week the president of the Intensive Care Society warned that the rate of increase in coronavirus patients who will need critical care is at the "alarming end of the spectrum". Ganesh Suntharalingam said the society may need to have a "broad discussion" on which patients should receive such care, but that the UK is not at that stage yet.

On Thursday Northwick Park Hospital in Harrow, part of the London North West University Healthcare Trust (LNWUHT), declared a critical incident after its intensive care unit was overwhelmed with coronavirus patients and could not take any more. Twenty-one of the 87 coronavirus-related deaths reported in the UK on Tuesday were at LNWUHT.

Meanwhile, the UK lockdown means the NHS should be able to cope with the coronavirus pandemic, an expert has said. Professor Neil Ferguson, who is recovering from Covid-19 himself, told the Science and Technology Committee measures taken by the Government could tip the outbreak from a growing epidemic to a declining epidemic.

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The director of MRC Centre for Global Infectious Disease Analysis, Imperial College London, also explained there was some uncertainty, but that if current measures work as expected, then intensive care demand would "peak in approximately two to three weeks and then decline thereafter".

Professor Ferguson told the committee current predictions were that the NHS would be able to cope if strict measures continued to be followed.

He said: "There will be some areas that are extremely stressed but we are reasonably confident - which is all we can be at the current time - that at the national level we will be within capacity."

Drinking from a Keep Calm and Carry On mug, he said: "There will be some resurgence of transmission but the hope is that by employing more focused policies to suppress those local outbreaks, we can maintain infection levels at low levels in the country as a whole indefinitely. It remains to be seen how we achieve this and how practical it proves to be."

What Italian medics did

If UK has to endure the same situation facing medics in Italy they are likely to prioritise patients with a greater likelihood of survival and then those who have more potential years of life.

Those are the guidelines already issued to Italian doctors by the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care.

The document begins by likening the moral choices Italian doctors face to the forms of wartime triage that are required in the field of “catastrophe medicine.”

The College warned that maintaining the criterion of “first come, first served” would “amount to a decision to exclude late-arriving patients from access to intensive care”.

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