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‘Covid is affecting all of acute care – so the system sludges up’ | Nick Scriven

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“Hospitals in the north of England are incredibly busy now, in particular because of Omicron. At the hospital where I work we’ve gone from 26 Covid inpatients on Boxing Day to 104 now.

Unlike previous waves of Covid, only four people are being cared for in ICU, whereas in previous waves we were maxed out at 20 people in ICU. That’s good from the patients’ point of view. But it does stress the rest of the system, including the bit of the system I work in – acute medicine.

That’s because the system sort of sludges up because of the infection control procedures we have to operate to keep patients safe, and keep Covid and non-Covid patients separated. Those are particularly necessary just now, given how easily Omicron is spread.

Covid patients need to be kept in single rooms as far as possible or isolated in areas for them, which can reduce the number of beds for other patients to go into. Do we have enough single rooms for them all? No, not at all. And if a non-Covid inpatient in a four-bedded bay tests positive for it then you can lose the other three beds, because segregation is so important.

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If there aren’t enough beds for other patients then you cannot get patients in to have an elective procedure, because urgent patients have filled up the elective beds. That means that we can’t get as many patients in for elective procedures as we would like.

The numbers of patients we are treating now – both Covid and non-Covid – is quite incredible. Our acute medicine team is staffed to look after 45 patients but this morning we had 62. Ten of those 62 have got Covid and the others have a mixture of all the medical conditions that land people in hospital – pneumonias, strokes, heart attacks, liver disease. My colleagues on the respiratory wards are the same. They’re staffed for 45 and have got 58. Covid is affecting all the acute specialties.

We’ve got more non-Covid patients than we’ve ever been looking at before in the first week of January, and we’ve got Covid on top of that. It’s not the worst year ever, but it’s on a par with that.

This is my fourth wave of Covid. Staff are mentally tired from making so many decisions all the time without a break. But this time myself and colleagues aren’t thinking ‘here we go again’. It’s more ‘we have to do this, we will look after these people, it’s something we have to do’. No one’s happy. No one’s enjoying it. But it’s sort of heads down and do our utmost for these people.

You do always feel a bit of anxiety, though, coming in every morning to see how many patients are waiting for you in A&E, who haven’t got a bed. How long have they been there?

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Omicron-driven staff sickness is not affecting my hospital too badly. We’ve had some junior doctors off, but only a few consultants, and nursing-wise we are coping. But I know that parts of other hospitals in the north have been really ravaged, decimated, because of horrendous staff shortages.

You know an NHS trust is in trouble when they’re sending out group texts saying ‘can anybody come in and do a few hours?’ Loads of NHS staff up and down the country will be getting those messages now from their workforce department. They are messages to doctors and nurses saying basically ‘please can anyone spare a few hours to come in and help?’ They’re seeking help in all the frontline departments – A&E, medical admissions, surgical admission and respiratory medicine. They’re the ones that are really busy and need extra staff.

Are people answering the call? Mostly people are now just too tired. Some answer and do come in. Maybe they’ve got a few days off and choose to come in, at whatever risk to themselves.

But I talk to people who say: ‘Yeah, I got the text, but I’m just too tired. My choice is either doing the extra hours or doing my shift tomorrow. And I’ll stick with my shift tomorrow’.”

* Dr Scriven is a former president of the Society for Acute Medicine, which represents doctors who specialise in acute medicine and look after patients who do not need surgery, including many who are Covid+

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