Abstract
High numbers of patients with covid-19 in wards have a serious impact on health services, even if it they are in hospital for a different reason, reports Clare Wilson
THE UK is currently experiencing a surge in covid-19 cases caused by the omicron variant, in common with many countries. Inevitably, the number of people in UK hospitals with the illness is also rising, and reached 2509 people admitted on 28 March – just over half the daily admissions seen at the highest peak of the pandemic in the UK in January 2021, when it reached more than 4500 per day.
Cases of ‘incidental covid’ are now about half the total number of people in hospital with the virus
In the current wave, covid-19 is causing less severe illness than in previous waves, thanks to the lower intrinsic severity of the omicron variant and higher levels of population immunity. The number of people who need ventilation in intensive care is currently less than a tenth of the numbers seen in January 2021, the deadliest phase of the pandemic in the UK.
14,268 People in English hospitals with covid-19 on 29 March
As a result, some people say that just tracking the total number of people with covid-19 in hospital overstates the effect of the pandemic on health services. People can go to hospital for a different reason, such as a broken leg, for example, and be found to have covid-19 only after routine testing. According to figures from NHS England, such cases of “incidental covid” are now about half the total number of people in hospital with the virus.
6252 People in English hospitals on 29 March being treated primarily for covid-19
But dismissing all those with incidental covid underestimates the virus's impact on health services. Firstly, even if covid-19 isn't the main reason someone is admitted to hospital, it will still worsen most people's prognosis.
The coronavirus has always taken a greater toll on those who are older or medically vulnerable – and most hospital patients are likely to fit one of these categories. About two-thirds of people in hospital in the UK are over 65 and most of those who are younger are medically vulnerable just by virtue of their needing to be in hospital. Even a relatively minor operation, like a hernia repair, will leave people at higher risk from the infection.
In addition, covid-19 can manifest with less common symptoms in people who have been vaccinated, such as stomach upset or confusion in older people. So it might be someone's primary reason for admission, even it isn't recorded as such. “It's a slightly artificial distinction,” says David Oliver, a physician based in Reading, UK.
Another impact is that hospitals segregate patients who test positive for covid-19, keeping them in so-called hot wards, to help reduce the spread of the virus within the hospital. People with incidental covid therefore get less attention from the doctors and nurses who are experts in their primary illness. “You get less specialist care,” says Daniel Goyal, a doctor at NHS Highland.
11.3% of people with covid-19 in UK hospitals in February-July 2020 became infected after admission
Despite efforts at segregation, many people still catch covid-19 while in hospital. About one in 10 people in UK hospitals with the illness between February and July 2020 caught the virus during their stay.
Services stretched
It causes disruption when someone on a cold ward tests positive: everyone else has to be tested, those who are positive are moved to hot wards, and there needs to be deep cleaning. In the meantime, new people cannot be admitted to that ward, and care home residents who are positive cannot be discharged, meaning a loss of available beds.
Services are already overstretched – not least because staff absences due to covid-19 are up too. Some of those staff will have caught the virus from patients, regardless of whether they were admitted with the virus or because of it. “We know outcomes are worse if staffing is poor,” says Matt Butler at Cambridge University Hospitals.
Butler hopes that in time the coronavirus will come to be seen similarly to the antibiotic-resistant bacteria MRSA or diarrhoea-causing Clostridium difficile. These are rarely problems for healthy people outside of hospitals and care homes, but inside such places, staff go to great lengths to stop them spreading.
With MRSA and C. difficile, hospital spread has been tackled by bringing in strict policies on hand washing and cleaning. For covid-19, we will also need methods of preventing airborne spread, says Butler, such as better ventilation and the use of HEPA air filters.