MOST FRAIL MAY NOT GET CRITICAL CARE

DOCTORS’ CORONA ADMISSION

HOSPITALS could stop treating the most severely ill coronavirus victims if the outbreak escalates. Patients with a poor prognosis may even be taken off ventilators in favour of those with better survival chances.

Intensive care experts are drafting new triage guidelines ahead of an expected surge in urgent cases. Hospitals are rapidly increasing their intensive care capacity and doctors say wards already look like ‘war zones’ as they fill up with patients.

GPs have been ordered to hold all appointments by phone or video unless a physical examination is absolutely necessary.

As the NHS asked retired doctors and trainee nurses to ‘join the fight’ against the virus:

■ Boris Johnson is set to ban all mass gatherings and sports events from next weekend;

■ UK cases reached 798 – up 208 in a day;

■ The Queen cancelled her engagements;

■ Local elections, scheduled for May, were postponed until 2021;

■ The boss of British Airways warned of job

cuts amid a ‘crisis of global proportions like no other’;

■ The World Health Organisation declared Europe the epicentre of the coronavirus outbreak;

■ University exams, lectures and seminars are being cancelled.

Dr Shondipon Laha of the Intensive Care Society said professional bodies have been asked to write guidelines to triage patients if the number of cases rises much faster. This could even mean restricting treatment to those patients most likely to survive, as is already happening in Italy.

‘Should it come to deciding any kind of triaging system, it will be patientbased and survival-based,’ he said.

‘Intensive care can be very invasive and severe before you get better, some people can’t tolerate this. Frail people especially struggle to tolerate being on a ventilator for two weeks.’

He said the guidelines, which will apply nationally, are being prepared by the Faculty of Intensive Care Medicine and the Intensive Care Society. They must be endorsed by the General Medical Council.

‘The basis of this is currently being discussed by the legal and ethical parts of both organisations,’ he added.

In another move, hundreds of thousands of routine operations are likely to be cancelled to free up wards.

And official guidance means patients in England will not be able to see their GP face to face without first being triaged over the phone or online.

Professor Stephen Powis, NHS medical director, called on everyone to take responsibility and help the health service cope by washing their hands and staying at home if they have a cold.

He said: ‘There is no doubt that the scale of this virus means that the NHS is going to come under pressure. We all have a role to play in helping frontline staff help those people who need it most. We are already ramping up our response across the country, with preparations well underway, and we need the whole NHS family – from retired doctors to trainee nurses – to be ready to join the fight against this virus.

‘Coronavirus is now the single biggest challenge facing all European health services, and the NHS will be no exception. So we need the public to ask what they can do for the NHS, not just what the NHS will do for them.’ The health service has among the lowest number of intensive care beds in Europe per head of population, and makeshift units are being created to accommodate an extra 5,000 patients. Four in five of the 4,123 adult critical care beds in England were occupied before the coronavirus even arrived in the UK, NHS England figures show.

Italy has around 12.5 critical beds per 100,000 people, while the UK has just 6.6. Dr Laha, a consultant at Lancashire Teaching Hospitals, said: ‘We have already seen a surge in demand, the situation has not been this bad since the 20092010 swine flu epidemic. The units have been full.

‘It is already feeling like a war zone. There is that war mentality of everyone will do their best. Everyone is on a mission.’ He said that wearing protective equipment made treating patients ‘significantly more difficult’, adding: ‘Your vision can be obscured, it is hotter, more claustrophobic, sweatier.

‘Every hospital is planning how they’re going to escalate beds. We’re looking at stopping routine operations. Nationally cancellations are likely to start over the next few weeks.’

The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care this week published guidance to doctors saying priority must be given to ‘the highest hope of life and survival’.

‘In a context of grave shortage of medical resources, the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care,’ it said.

Intensive care units are used to treat patients whose lives are at risk or whose organs have failed. Severe effects of coronavirus can lead to lung failure, as well as kidney and heart failure – all of which are soon fatal without intensive care treatment. Treatments require a ventilator to take over the patient’s breathing while they are put in a coma.

Yesterday guidance by four professional bodies recommended that anaesthetists join intensive care units to help combat staff shortages.

The staff union for the NHS, the GMB, has called for the requisition of all private hospital beds if needed. The virus has claimed 11 lives in Britain.

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