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expert reaction to Sadiq Khan declaring major incident in London

A major incident has been declared today by Mayor of London Sadiq Khan.


Dr Marisa Miraldo of Imperial College Business School said:

“The major concerns of coronavirus infection rates in London exceeding 1,000 per 100,000 people relate to the NHS ability to meet care standards for those in need of care. Hospitals are increasingly at risk of experiencing capacity shortages, which could result in  delays in treatment for many patients, whose health will deteriorate. If the number of cases is not controlled ultimately hospitals will not be able to provide lifesaving treatment to those that need it. Also patients that see their elective care postponed might require emergency treatment in the near future creating further pressures on emergency care. 

“In the absence of further national investment in care provision beyond the efforts already made during the first wave, careful planning of whom to admit to hospital care is vital.  Blanket policies that prioritize COVID-19 patients over non-COVID-19 patients, and cancel elective procedures, might result in the deaths of younger patients, with more years of life ahead of them and would benefit most from treatment. There ought to be a more fine-tuned assessment of which patients to prioritize, and when based on their capacity to benefit from timely treatment, which could minimize loss of life caused by bed and staff shortages. In the longer term these blanket policies also mean that hospitals will need to provide costlier treatment to those patients whose treatment was postponed. This is likely to challenge hospitals financially in the near future.  

“At Imperial we have developed a prioritization tool that can help policy makers better refine how to respond to hospital capacity shortages (Report 40). The tool does this by prioritizing patients across all disease areas in order to save life years and save the NHS costs.  Our findings outline key prioritization principles that save lives that can be embedded in national policies. We show for example that when capacity shortages are severe like those we are experiencing now the NHS should prioritize patients with higher capacity to benefit from treatment, such as patients suffering from tumours and diseases of the digestive system injuries & poisoning. Also, when capacity shortages are severe, prioritizing critical care access to patients with tumours and diseases of the circulatory system (e.g. conditions affecting the heart or blood vessels). over elderly COVID-19 patients reduces years of life loss.”


Dr Katharina Hauck of Imperial College London said:

“Hospitals in London are overwhelmed, which is a dangerous situation for all patients requiring urgent care, whether they have COVID-19 or another life-threatening condition. Hospitals mobilized additional surge capacity, converted general wards into critical care wards, and staff are working overtime. But sadly, some hospitals are now forced to follow NICE guidance NG159 on emergency triage of all patients requiring critical care. Applying this guidance effectively means that patients under the age of 65 who are not frail will be prioritized over elderly and frailer patients for critical care. Frail patients would be cared for in general wards with less intensive care. This is to prioritize patients that have a greater capacity to benefit from invasive treatment and the greatest likelihood of survival (Report 40).  

“Nightingale hospitals were set up to deal with pandemic surges in demand and prevent that hospitals get into a situation where they need to apply emergency triage. Unfortunately, during the first wave, hospital managers and health service experts pointed out that staffing Nightingale hospitals is the major bottleneck. Our research showed that main constraints are critical care nurses and junior doctors. So how could we use the Nightingale hospitals most effectively when they are opened next week? Our findings suggest that patients that are triaged into critical care should stay in our main hospitals where there is the highly specialized intensive care capacity that gives them the best chance of survival. It would then make sense to transfer frailer and older patients into Nightingale hospitals where they can receive general care. This would prevent older patients that are care home residents being transferred back into care homes before they are ready to be discharged.”



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