Bernard Jenkin MP is Chair of the Liaison Committee, and MP for Harwich and North Essex.
The spring lockdown was necessary to avoid the NHS being overwhelmed by hundreds of thousands of seriously ill people. Today, infection rates are rising again. So again, we must ask the question: what hospital capacity is required to keep pace with rates of infection?
Today, there is far more data, better understanding of the virus, and better treatments, so we no longer need to entertain the most apocalyptic predictions. Nevertheless, the figures are stark.
It is medical consensus that it takes an average of seven to ten days for someone infected with Coronavirus to develop severe symptoms which require hospitalisation. This affects a smaller proportion now, but ONS data suggests it is still significant.
In the week up to the 1st of October, 16,000 people per day were infected with coronavirus in England. Hospitalisation data for this specific this specific period is still emerging, but already, seven to ten days later, the Government’s daily Coronavirus updates suggest that between 500 and 600 new hospitalisations are taking place daily in England.
This suggests that some three to four per cent of those newly infected with coronavirus will require hospitalisation. This is lower than earlier in the year (which was up to three times higher).
However, the epidemic is currently most prevalent among young adults. They are far less likely to require hospitalisation. This is the case in my own county, Essex, but low case rates are now doubling every ten days, as the virus spreads up the age range. So rising case rates will lead to rising hospitalisations.
Intensive care units will also come under pressure. Estimates from the spring suggest that up to 17 per cent of those in hospital with cthe Coronavirus required a move to the ICU. Perhaps that will be lower too. Let’s assume it will be only 10 per cent (and that optimism makes the sums easier).
The length of hospital stays also matters. Those infected with Coronavirus can expect a length of stay in hospital of between five and 15 days, depending upon from where the data is drawn.
Here, a consensus has yet to emerge. (The paucity of studies from outside China and the pandemic’s continuation means that medics are still feeling their way.) In his presentation on Monday, Jonathan Van Tam, the Deputy Chief Medical Officer, showed a graphic with a range of nine to nineteen days: taking the middle point of that gives an average stay of 14 days. Similar evidence suggests that eight days is also the approximate length of stay for patients in ICU beds.
England has approximately 140,000 hospital beds, and 4,100 adult ICU beds. For this part of the year, we would expect around 85 per cent of beds to be full, which gives ‘spare’ capacity in England of around 20,000 hospital beds.
So what do all this statistical estimates mean, when asking how much hospital capacity will be needed if there is serious Coronavirus spread throughout the UK?
Let’s assume that we let the virus spread, so that, over the next three months, an additional quarter of the population of England becomes infected with coronavirus – an additional 14 million people. This is equivalent to just under five million infections per month, or 156,000 infections per day. 3.5 per cent of five million would become sick enough require hospitalisation. That is equivalent to 5,500 daily hospitalisations.
We have to date ignored two factors which make things seem better than they would be. First, there would not be a flat rate of infections at 156,000 per day over three months. Instead, the daily infection rate would follow the familiar (and far more disastrous) bell-curve.
Second, we are assuming that the population which falls sick is relatively young and healthy, as now, and that we can protect the vulnerable. Experience in this second wave already suggests this is most unlikely.
But let’s look again at what would be necessary to manage 5,500 daily hospitalisations. We know that hospitalisations last, on average, for 14 days. This means that we would need 77,000 extra beds on top of what we now have. So in addition to the 20,000 spare hospital beds that we currently have, we would need to find another 57,000 – equivalent to just over 16 new London-sized Nightingale hospitals.
In this (flat) scenario, these hospitals, as well as every hospital in the country, would have to be run at 100 per cent capacity, each and every single day for three months.
We have also assumed that we can perfectly match hospital capacity to the location of infection hotspots, which is not the experience. Images we have seen of packed hospital corridors in Lombardy or New York demonstrate this task is very difficult, if not impossible.
For ICU capacity, the numbers are even more stark. If one in ten of those requiring hospitalisation require being moved to the ICU, then 5,500 daily hospitalisations becomes 550 daily ICU admissions. At an average length of stay of eight days, England alone would require 4,400 ICU beds, more than the entire capacity of ICU beds in the country.
And if the epidemic spreads to older and more vulnerable people, this shortage would become yet more acute. In Essex, the NHS is not planning to stop doing anything but Coronavirus. The aim is to keep the NHS open for as much normal business as possible, but there would be no possibility of achieving that in the scenario above.
This is the maths which is driving the conversation in government around the need for new Covid restrictions. If test and trace was working better, perhaps we would have been better able to keep the number of cases down.
But absent massive test and trace capacity, the Government has no option but to consider the second round of Covid restrictions to get us through this winter.
The reality of this virus is that it is not like ‘flu; something you get once and gives you immunity. It is also very hard, perhaps impossible, to find a permanent vaccine. There never was a vaccine for AIDS or for SARS (another coronavirus).
Time and science will improve the resilience of people, society and the economy. We certainly should not plan to have varying degrees of lockdown every six or twelve months. The Government should set up a long term strategic group, away from the daily pressures of Whitehall, to draft a strategic White Paper, Living with Coronavirus, which sets out how we can best manage Covid-19 while keeping the economy open.