Birmingham’s hospitals are at a”tipping point” as rising coronavirus cases threaten other services, the city has been warned.
University Hospitals Birmingham is to act ‘within days’ to protect critical services, including turning away anyone who arrives at A&E who does not need urgent hospital care.
Elective operations and outpatient services are also under review.
“We are at a tipping point. The next few weeks are going to be very challenging,” said UHB operations director Jonathan Brotherton.
More than 200 patients with coronavirus are currently in the Queen Elizabeth, Heartlands and Good Hope hospitals, with more arriving daily. That’s about a tenth of the total capacity.
Around 27 are in intensive care, with the number increasing – taking up around a quarter of all ICU beds.
Mr Brotherton had this stark message for politicians: “It is obvious what we need to do…as the rate keeps going up it seems inevitable we are going to have to lock down far more than we currently are.”
And to people flouting guidance, he issued a wake-up call: “Some people (seem to) think ‘I will be okay, it won’t be that much of a problem for me because I’m fit and healthy and won’t get too ill.’
“What they don’t realise is the onward transmission and rising R rate means other people get sick and the hospitals are already under so much pressure.
“It is putting our staff into a terrible position of working back in full PPE and dealing again with people dying without their relatives around – but it also affects all the patients who don’t have covid but need urgent attention.
“We can’t deal with all of that at once.
“People are not making the link that if there are more coronavirus cases, someone is not going to get their operation – but that is what is going to happen.”
In a first step to ease pressure, anyone arriving at the city’s three A&E departments who is not deemed in urgent need of hospital care will be turned away.
This will come into effect in the next week.
It is to ensure staff and space is free for the critically ill and allow 999 ambulance patients to get the quick access they need, freeing up paramedics to get on the road to other emergencies.
Ambulances have been routinely held up, sometimes for an hour or more, because A&E is full and there is nowhere to hand the patient over.
During a frank hour-long interview, Mr Brotherton laid out how the hospitals had been able to cope with the first wave of coronavirus because most other services came to a halt.
In March, April and May, all but the most urgent elective operations were axed, outpatient clinics were suspended, and A&E attendances plummetted as all focus was on coronavirus.
Hundreds of beds lay empty across the hospital as staff fought a desperate battle to save the scores of people arriving daily with the virus.
“At the peak of wave one, we had 700 inpatients at any one time, with about 127 patients in intensive care. ICI capacity was expanded, staff were redeployed to Covid wards and into intensive care,” said Mr Brotherton.
As cases rocketed “we had to throw the whole weight of the organisation behind Covid.”
But that contrasts with the situation today, where the hospitals are managing rising coronavirus cases alongside everything else.
“This time the cases are going up much more gradually, but they are going up every day. As a result we have stood up a lot of other services, rightly so, and been able to manage those, thanks to the incredible work of staff.”
This has included restarting outpatient clinics, elective surgery and more vital healthcare, with around 75 per cent of services now running as normal.
Solihull hospital is now solely for non-Covid care, and is not taking emergency patients.
But, he said: “It is getting harder every day – we are getting bigger queues at the front door and in A&E.
“The resilience has served us well but since mid September, when cases really began to go up, we have been in a very tricky place.
“We are now having to make difficult decisions to reduce those non critical services.”
Cases began to rise in early September, said Dr Mark Garvey, the trust’s infection control deputy director.
Initially they doubled weekly, rising quickly from about 30 cases to 60.
The rise has slowed but continued daily to increase.
There are now 206 in patients and 27 in intensive care – that’s up from 179 patients less than a week ago.
Another 150 or so other beds are daily out of action as positive covid cases are uncovered within the hospital among asymptomatic patients, leading to bay and ward closures, or to ensure social distancing.
Patients with coronavirus in intensive care are highly dependent and mostly ventilated, meaning they are on life support. They will also likely stay for around two weeks – that’s in contrast to most typical ICU patients, who tend to be admitted post surgery for two or three days.
A continued rise in the number needing intensive care will have a drastic knock on impact on the hospitals’ ability to invite people in for surgery that is likely to need ITU care, explained Mr Brotherton.
Even six more coronavirus patients in ICU could have a major impact on elective surgery, he said.
“We are working with other trusts and hospitals to manage that, where their Covid caseload is lower – but once those other hospitals get as full as we are, which will not be long, we may run out of options.”
When asked if he felt current restrictions in Birmingham were sufficient to control cases, he had this to say:
“I find it really straightforward because of what we are seeing (inside the hospitals) – it seems so obvious what we need to do.
There’s no doubt that Covid-19 has had a huge impact on all our lives.
Birmingham has seen thousands of deaths as a result of coronavirus and one hospital trust in the city has recorded higher deaths than anywhere else in the country.
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“It’s easy for me to say that because I don’t need to consider the economic impact and the mental health impact of isolation, though we are also seeing much more mental health issues, but as it keeps going up it seems inevitable to me we are going to have to lock down far more than we currently are, so how long are we going to carry on before we make those decisions?
“If we make the decision tomorrow we still have two to three weeks of seeing cases go up (because of the gap between someone becoming infected and becoming poorly enough to require hospital care.)”
He also warned that the second wave would likely ease once lockdown restrictions are imposed – but more “waves” would emerge each time society opened back up.
“In the absence of a vaccine we are now managing wave two, but in two years we could be managing wave seven or eight – it is that unknown that is a huge challenge.
“Most people back in March, when we went into lockdown, took it on the chin and thought we will get through this.
“Our staff did amazing work – they managed Covid, dealing with lots of dying patients in really difficult circumstances, wearing full PPE – now we are asking them to do it again, and almost certainly again and again.
“It is a tricky position for everyone.
“We are gearing up our whole operation around this being the cycle for the next two or three years.”