United Kingdom

BEN SPENCER asks why won't they tell us the truth about coronavirus beds?

Hospital bed occupancy has become a propaganda tool in the bad-tempered row over Covid restrictions in Manchester.

Downing Street has used terrifying statistics in an attempt to gain public support for forcing local leaders into accepting strict tier-three measures.

They claim the city’s hospitals will become ‘overwhelmed’ within a few weeks, and even the surge capacity will be used up.

But Manchester mayor Andy Burnham and other local leaders have challenged the Government’s use of data, accusing ministers of ‘cherry picking’ figures to exaggerate the scale of the problem in the North West.

They claim that, even though cases are increasing, current occupancy in critical-care units is not far above the norm for this time of year.

Even Professor Jane Eddleston, who leads the Government’s coronavirus response in Greater Manchester, has insisted that although the numbers are ‘stark’ the ‘system can cope’.

But what is the truth of the matter? How bad is the situation facing Greater Manchester’s hospitals as Covid-19 cases escalate?

The fact is that we simply do not have the data to form an accurate picture. Intensive care occupancy figures are not regularly collected and the Government’s projections are murky at best.

And health officials in Manchester have refused to provide the relevant data, insisting they will not provide a ‘running commentary’ on bed occupancy.

A spokesman for the Greater Manchester Health and Social Care Partnership said last night: ‘We really appreciate the desire from the media and the public to understand what the current intensive care unit (ICU) and hospital situation is in terms of Covid-19 in Greater Manchester.

‘It is important to take the time to explain this correctly and consistently so please bear with us.’

Given the pandemic has been going on for eight months, this dearth of accurate real-time data is inexcusable. But putting that aside, what information do we have?

Hospital admissions are certainly going up. Every day over the last seven days there have been an average of 600 Covid patients in beds in Greater Manchester. That is up from fewer than 100 a day at the beginning of September.

But it is fewer than half the 1,200 patients a day in hospital at the peak in April. And the rate of increase is far slower – mainly because existing regulations are slowing the spread of the virus.

And because younger people now form the bulk of new cases, there is also a longer time lag between infection and hospital admission. This means we are less likely to see the sudden spike in very sick patients that we saw back in the spring, which put hospitals under such strain.

Nationwide, for example, it took a month – from March 1 to April 1 – for hospital admissions to rise from zero to 3,500 a day. Between September 1 and October 1, in comparison, the number went from 100 to 500.

Journalists were told at a Downing Street briefing on Monday that intensive care occupancy in Manchester was around 40 per cent of that seen at the peak of the first wave. No raw figures were provided. 

But the Prime Minister’s spokesman said assuming a 14-day doubling time – which he said was the ‘best case’ scenario – Covid patients would take up the entire current intensive care capacity of Greater Manchester by November 8 and the entire surge capacity by November 12.

The number of newly-infected patients requiring NHS care nearly tripled in the 10 days between March 23 and April 1 but in the most recent 10 days they have risen by only 42 per cent

Five weeks into the first wave of coronavirus, intensive care admissions in hospitals were up to 10 times higher than they were after the same period into the second wave. Treatments are known to have improved and significantly fewer patients are being put onto ventilators

The figures on which this projection were based were not provided and local leaders have questioned the use of data.

It is not clear what the truth is because numbers of patients in intensive care are not routinely published. Even the estimates provided have been wildly different.

Figures leaked at the weekend suggested 82 per cent of intensive care beds in Greater Manchester were occupied. Yet local MPs have been told that ventilator beds in the area are at 29 per cent capacity – albeit with some hospitals in a much worse position.

The Health Service Journal has reported that the area has around 200 patients in critical care compared with 300 at the height of the first peak.

Figures for the wider North West region do exist, and the latest suggest there were 167 Covid-19 patients in mechanical ventilation beds and 1,817 in hospitals across the wider North West region on Monday. 

This is compared with 528 mechanically-ventilated Covid-19 patients and 5,402 in hospital across England.

But even this data provides only a partial picture.

Firstly, not all Covid patients in intensive care are put on mechanical ventilation, so there may well be other Covid patients occupying ICU beds.

Secondly, it is unclear how many critical-care beds are currently available in the area, with estimates ranging from 257 upwards.

Thirdly, there is no currently available data about non-Covid occupancy of critical-care beds. If only a third are taken up by Covid patients, for example, and the other two thirds by other severely ill patients, hospitals will have a real problem.

Fourthly, no comparison has been provided to normal patterns. An 82 per cent occupancy sounds bad, but in fact it is close to what a majority of hospitals experience much of the time. Most hit close to 100 per cent critical care capacity at some point every winter.

They cope by taking advantage of flexible ‘surge’ capacity, often by taking over surgical recovery wards. Hospitals are keen not to use surge wards this winter, because doing so means other activity, usually elective operations, must be halted.

They do, however, have access to the Nightingale hospitals which were set up across the country as emergency Covid centres in the spring.

Those facilities, which remain on standby, doubled the national critical care capacity from 4,000 to 8,000. The Nightingale hospital in Manchester, set up at a conference centre in the heart of the city, is already being readied for patients, with 700 beds for ‘step-down’ care, to take those who are well enough to be discharged from intensive care at other hospitals.

So though it is hard to be exactly sure of the picture in Manchester, the trajectory is unlikely to be as bad as the Government says.

Professor Eddleston, who as well as leading the coronavirus response in the area works as an intensive care consultant at Manchester Royal Infirmary, insists the city will not be overwhelmed.

‘The system can cope,’ she said. ‘We have got very detailed escalation plans. We would bring more beds into play.’

The people of Manchester – and indeed of the whole country – deserve to know the real picture within the NHS.

Until then, the politicians should put aside their scare tactics.

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