Intensive care beds: UK close to capacity

In a UK press conference, alongside prime minister Boris Johnson and Deputy Chief Medical Officer Jenny Harries, the Secretary of State for Housing, Communities, and Local Government, Robert Jenrick, had the following message...

Robert Jenrick - Well, thank you, Prime Minister and good afternoon. As a nation we're confronted with the need to make big changes, and enormous sacrifices to our daily lives, and this is especially true today, on Mother's Day when many of us would want nothing more than to be at home with our loved ones in person. And so today we have to go further, and shield the most clinically vulnerable people to help save their lives. Following the chief medical officer's guidance, the NHS has identified up to one and a half million people in England, who face the highest risk of being hospitalised by the virus. The NHS will be contacting these people in the coming days, urging them to stay at home for a period of at least 12 weeks.

Ari Ercole, a consultant in intensive care at Addenbrookes hospital, recently published a report that predicted the UK's capacity in intensive care as the coronavirus spreads. He explained the secretary's comments to Chris Smith...

Ari - I think it's very important to realise that the coronavirus in most people, causes quite a mild disease, and it's still important because these people are infectious, hence the plans for social distancing, but most people are expected to get better from this disease without any ill effects. However, some people do go on to develop a viral pneumonia, that's an inflammation of the lungs, and when it's really severe that can prevent the patients from getting oxygen from the outside world, into their bloodstream. And in really serious cases that might mean that they need to go to the intensive care unit to be mechanically ventilated on a life support machine. And unfortunately, a lot of these people end up not surviving at the end of this process. Now as it turns out from the data that we're getting from China and from Italy, the virus seems to be effecting, particularly the older patients, and patients with comorbidities. These are the patients that disproportionately are having the severe disease and ending up on intensive care and not surviving.

Chris - What is it you've been modeling?

Ari - So one of the things that's important to realise about intensive care, is that it's not easy just to create intensive care beds. Our intensive care units, they're very specialist areas, and in the UK they run at typically 80%, often 90 or a hundred percent bed occupancy. So there isn't a lot of room to admit new patients, more patients, such as patients with coronavirus. So if we're going to deal with this pandemic, we're going to have to think about creating new intensive care beds. And unfortunately that's not something that's easy to do. It can be done, but it takes time. So for example, if you want to take ventilators from operating theatres, you need to move them, you need to train the staff, you need to make sure all the consumables are available. It's not an instant thing at all. So really, what we need, is an early warning of exactly when it is that the pandemic is likely to take hold in intensive care, and that's what we tried to do with some of the early data.

Chris - What exactly are you doing with that data and what does it reveal?

Ari - So we've taken cases as they appear, actually, in real time every day, and try to model what that means for the numbers of patients going into intensive care. And thinking about how long they will stay there, we can get an idea of how many patients at any one time are likely to be in intensive care.

Chris - Because it's not as simple as just saying: Oh, we're going to expect this number of patients on Tuesday, therefore we'll have that number of beds ready, because they don't just leave on Tuesday. They come in and they stay awhile.

Ari - Exactly. And some of them say a distribution of time. So often about seven days, but maybe up to 14 days, maybe less. It depends on the patient.

Chris - Does that mean then that those first, I don't want to call them lucky people, but will get potentially a bed, but then anyone who comes afterwards may not get one because you've got these people, I don't want to use the phrase bed blocking either, but you've got people who are occupying those high intensity beds, and they're not going anywhere.

Ari - No, exactly and that's the one situation we don't want to end up in, where we run out of ventilators, so it's absolutely, crucially important that we have enough capacity to deal with the surge in cases when it arrives.

Chris - And how much capacity do we have, and what do we anticipate the reality's going to be in terms of numbers of cases.

Ari - At the moment in the UK we have something like 4,000 intensive care beds. We're on the lower end of what's available in countries in Europe. Now, if I say that most of these, about 80% of these are occupied at any one time, at least, then maybe we can create about another 20% capacity. But once we're hitting about 20% of the number of beds, of patients with coronavirus, we're going to be in trouble with the number of beds that we normally have.

Chris - Yes. Because if 80% of 4,000, that means you've got 20% capacity leftover. That means you've got, you know, hundreds, as in about 800 beds in the entire country then, and we're anticipating how many cases?

Ari - Well it's difficult to know, but we are certainly going to have to multiply that total number of intensive care beds that we have available at by several times.

Chris - Therefore it doesn't seem that unlikely that we're going to exceed easily, the capacity that we can deliver.

Ari - Absolutely. And in fact our models suggest that we will probably reach that pinch point of 20% within a week or two. So really, really early, and after that things are likely to grow exponentially for a period of time. So actually things are going to get really bad, quite quickly if the assumptions behind our model are right.

Chris - And let's assume you are right. What preparations have you got in place to try to mitigate some of that impact?

Ari - So I think the good news is that an awful lot of NHS staff have been working really, really hard, actually for some time now to try and come up with ways and strategies of creating more capacity. But I think the really crucial thing is that we keep the efforts up, and because actually, if our model is correct, the peak might really be very close to hand.

Chris - Do you also assume then that people who are working in ITU continue to work in ITU? Have you taken into account the fact that doctors like you, are probably amongst the most exposed clinicians here, and may well therefore be lost to the service?

Ari - Absolutely. In fact that was the experience in Italy, that's been particularly hard hit. One of the things we're trying to do is find more staff, because of course one of the problems is it's not a matter of just creating a bed with a ventilator, you need the staff to actually look after the people. And of course you do have to factor in that some people are going to get ill.

Chris - Have you got them?

Ari - Certainly a huge amount of work has been done on that, and these beds are becoming available, but it's urgent now.