We can’t ever get complacent about ICU beds filling up with coronavirus patients

Whilst 82 per cent occupancy may not be out of the ordinary for this time of year, it has the potential to reach 100 per cent very quickly

Hospitals in Greater Manchester are under increasing pressure as the number of people becoming critically ill with Covid-19 there continues to rise.

Leaked NHS documents show that, as of Friday, 82 per cent of the region’s critical care beds were occupied by patients who are seriously ill with either Covid-19 or other illnesses.

People have been very quick to jump on this headline and point out that an ICU occupancy of 82 per cent is not unusual in the NHS. And they’re not wrong. Indeed, a spokesperson for the NHS in Greater Manchester noted that “it’s not unusual for 80-85 per cent of ICU beds to be in use at this time of year”.  

But the assumption that people are overreacting is, I think, a dangerous one. To explain why, it’s worth considering some of the nuances behind this story. Communication is key in a public health crisis and the context surrounding facts is just as important as the facts themselves.

From the 1st of September to the 15th October, 1,233 patients with Covid-19 were admitted to critical care facilities in England, Wales and Northern Ireland (data for Scotland is recorded separately).

As we saw in the first wave, BAME individuals and those from more deprived backgrounds continue to be over-represented in these figures. But early evidence suggests outcomes are better this time around. This is not surprising, given that we know more about how to manage and treat Covid-19 than we did six months ago.  

Most of these second wave critical care admissions have been in the North of England and the Midlands, which have accordingly been allocated as the highest risk areas.

Covid-19 ICU admissions are rising nationally, but at a slower rate than the first wave. But there is no denying that regions like Greater Manchester are seeing a worrying trend in the number of Covid-19 patients requiring critical care. 

Indeed, the leaked documents suggest that by the middle of November, some of the region’s hospitals could have two to three times the number of patients requiring critical care than the number of beds available. So whilst 82 per cent occupancy may not be out of the ordinary for this time of year, it has the potential to reach 100 per cent very quickly. That is not normal and should be viewed with a great degree of concern.

“But what about all that extra ITU capacity and the Nightingale hospitals set up during the first wave?” you might ask.  

The problem here is that, whilst it may sound obvious, when we talk about “ICU beds”, we’re not just talking about the physical bed, but the staff as well. It takes years to train an ICU nurse and typically there’s a 1:1 nurse to patient ratio in intensive care. There’s already a shortage of nursing staff and that’s before you take into account the increased sickness absence because staff themselves are having to isolate at home.  

You also have to consider what a rising Covid-19 critical care load means for other NHS activities. ICUs are not meant to be full. Many intensive care admissions are not planned. An assumption of unpredictability is built into the system to ensure that when a patient becomes very sick elsewhere in the hospital, they do not have to wait for an ICU bed to become available before they can receive the treatment they need.  

I can assure you that there is no greater relief than knowing your unwell patient is being taken to the place they need to be without delay.

It is not uncommon for a patient undergoing complex surgery to have an ICU bed “reserved” for them, should they require critical care input following the operation. As we saw during the first wave, if you cannot guarantee that support, you cannot proceed with the operation. That’s just one of the reasons why so much elective surgery was suspended during the peak of the pandemic.  

Regardless of the contingency plans that have been put in place over the past six months, if we are unable to control coronavirus through a combination of hygiene measures, restrictions and sufficient testing and tracing, routine NHS activity will inevitably be affected.

I don’t disagree that it’s useful to compare ICU occupancy to historical levels. But it would be complacent and dangerous to assume that current occupancy should not be a cause for concern.  

Dr Tom Gardiner is a junior doctor working in London. He is a member of campaign group Keep Our NHS Public and sits on the Executive Committee of the Fabian Society