NHS facing Italian-style crisis if we don’t stay at home, says PM
Doctors told to prioritise patients with best chance of survival as coronavirus deaths accelerate
THE NHS could be “overwhelmed” like the Italian health system in just a fortnight, Boris Johnson has warned, as official guidance paved the way for British doctors to prioritise coronavirus patients who are most likely to survive.
In his starkest warning yet, the Prime Minister said the UK was only “two or three” weeks behind Italy, where the death toll from Covid-19 rose by 793 in 24 hours. Urging people to heed advice to “stay at home” in order to save “literally thousands of lives”, Mr Johnson said: “Unless we act together, unless we make the heroic and collective national effort to slow the spread – then it is all too likely that our own NHS will be similarly overwhelmed.”
The extraordinary plea came as the National Institute for Health and Care Excellence (Nice) instructed doctors to admit patients to intensive care units “on the basis of medical benefit, taking into account the likelihood the person will recover to an outcome that is acceptable to them”. The rules also say some cancer patients would be safer staying away from hospitals than coming in for treatment.
They were issued as:
The number of deaths from the virus rose by 56 to 233 in the UK. They included a 41-year-old, who was thought to be the youngest patient to have died from the disease in this country
The NHS wrote to 1.5million people at the highest risk of hospitalisation, urging them to stay at home for 12 weeks and to refrain from visiting shops. Military personnel are helping to coordinate plans to deliver groceries and drugs to those being “shielded”
Baroness Barran, the loneliness minister, writing in The Sunday Telegraph, urges those in isolation to “reach out” if they need support. She states that 50 members of her own family have taken to writing extended letters and emails to each other in order to stay in touch
Health service chiefs struck a major deal with private hospitals to make use of 20,000 staff and 8,000 beds. Some 1,200 ventilators will come into circulation from next week.
A French newspaper claimed last night that Emmanuel Macron privately threatened to shut his country’s borders to British nationals if Mr Johnson failed to take more draconian measures against the spread of the virus – which the Prime Minister went on to announce on Friday.
No10 said the measures, including the closure of bars and restaurants, were taken “based on scientific advice and following the government’s action plan”. Last night Mr Johnson said: “The numbers are very stark, and they are accelerating. We are only a matter of weeks – two or three – behind Italy. The Italians have a superb healthcare system. And yet their doctors and nurses have been completely overwhelmed by the demand. The Italian death toll is already in the thousands and climbing. That is why this country has taken the steps that it has, in imposing restrictions never seen before either in peace or war.”
Health Secretary Matt Hancock also announced that after a call on Friday for recently retired doctors, nurses and other medical staff 4,000 nurses and 500 doctors had signed up to return to the NHS within the first 48 hours. Writing today in The Sunday Tele
graph, Mr Johnson warned of a need to keep elderly parents in isolation, stating: “I am afraid that this Mothering Sunday the single best present that we can give – we who owe our mothers so much – is to spare them the risk of catching a very dangerous disease.”
The Nice guidance instructs doctors to review critical care regularly, considering “whether the goals of treatment are clinically realistic”. It states that critical care should be stopped when it is “no longer considered able to achieve the desired overall goals”.
In Italy – now with a higher death toll than China – potentially hundreds have died because they did not have access to a ventilator. As of Tuesday, the NHS in England had access to just 8,175 of the life-saving kits, and Mr Johnson has put manufacturers on a “war footing” to produce more.
However, clinicians are already complaining about having to deny life-saving treatment due to low capacity, and on Friday Northwick Park Hospital in London was forced to declare a critical incident after running out of intensive
care beds. Reflecting the acute surge in demand for intensive care beds, staff are now being told to delay admitting appropriate patients for a time in the hope their condition improves.
Health officials have so far refused to acknowledge explicitly that doctors will have to ration life-saving care to Covid-19 patients with the best chance of survival.
Last night Prof Donal O’Donoghue, registrar of the Royal College of Physicians, said the new Nice guidelines “fall short by not offering clarity on what happens if at any stage we have insufficient resources”.
Front-line staff say they are already being forced to take patients who are not improving off ventilators earlier than they normally would.
Dr Rahuldeb Sarkar, consultant physician in respiratory medicine and critical care in Kent, said: “In normal days, that patient would be given some more days to see which way it goes.”
Unpublished NHS figures that emerged yesterday showed that 86 of the 93 cases (92.5 per cent) last Tuesday in south London were in need of a ventilator.
Such is the escalation of Covid-19 patients coming into hospital, oncologists should consider telling cancer patients to stay away from hospital during the coronavirus outbreak, particularly those on immunosuppressant treatment, the guidance further states.
“They should also balance the risk from cancer not being treated optimally versus the risk of becoming seriously ill if they contract Covid-19 because of immunosuppression.”
Rosie Loftus, chief medical officer at Macmillan Cancer Support, said: “There must be a clear plan for continuing essential chemotherapy and radiotherapy treatment so that we don’t see people with cancer missing out on critical support and treatment, and we will continue to support the hard-working professionals who are doing all they can to ensure that this happens.”