In March 2020, hospitals in England started seeing greater numbers of COVID-19 patients – as a result the country entered strict national lockdown on 23 March. In April, the numbers of people on ventilators increased, as sadly did the number of COVID-19 deaths.
Over time, the NHS received sufficient supplies of the protective equipment it needed, implemented robust infection prevention control measures, and learnt more about the disease through research with patients and staff.
As knowledge of the virus grew, better treatments became available, testing capacity expanded and, following the national lockdown, COVID-19 pressures in hospitals fell dramatically by summer 2020.Senior Analysis Manager
As knowledge of the virus grew, better treatments became available, testing capacity expanded and, following the national lockdown, COVID-19 pressures in hospitals fell dramatically by summer 2020. With the experience of the first wave, as well as adaptations and innovations in service design and delivery, the NHS was in a better position to treat COVID-19 patients whilst maintaining a larger proportion of non-COVID care going into winter.
Dealing with the unknown nature of the virus was very challenging for NHS staff, and the past year has frequently been described as the most difficult time of any NHS career. But how did the latest peak in January compare to the peak of the first wave in terms of pressure on hospitals?
Comparing the April 2020 peak to the January 2021 peak
Since early 2020 the range and depth of information related to COVID-19 has expanded; it is essential for our understanding of the pandemic. Daily figures are now published across a range of key indicators including: hospital admissions; total number of COVID-19 patients in hospital; patients in mechanical ventilation beds; and deaths. Information relating to testing and vaccinations is also available.
Looking specifically at the hospital activity data for England, pressures during the latest wave in January significantly surpassed activity levels reached during the first:
- The total number of people admitted to hospital with COVID-19 on a single day was 33% higher in January (4,134 admissions) when compared to the peak of 3,099 admissions in April 2020.
- The total number of patients in mechanical ventilated beds was 30% higher in the latest wave, compared to the first wave.
- Trusts have opened large numbers of critical care beds to accommodate the growing number of patients requiring a ventilator. By the end of January 2021 there were 68% more of these beds open across the country than the same time the previous year, and almost nine in ten of these beds were occupied.
- The daily death total was 49% higher in the latest wave. On 26 January 2021, the UK passed the tragic milestone of 100,000 deaths from the virus when looking at the government daily deaths data. In January 2021 alone, England recorded almost 30,000 COVID-19 deaths, approximately one-third of the country's total to date.
But most stark is the difference in the total number of COVID-19 patients, showing the sheer scale of the impact on hospitals. At the peak of the latest wave there were 34,336 COVID-19 patients in hospitals across England; 81% more than in the first peak. In fact, across the whole of January 2021, there were an average of 30,500 COVID-19 patients in hospital every day.
While the strain on hospitals in the early stages of the pandemic was undoubtedly intense, as many new challenges were tackled for the first time, the pressure on the NHS during the second wave far exceeded this. In total, between 1 December 2020 and 31 January 2021, COVID-19 patients accounted for 1,450,000 NHS bed days, which is almost double the amount during the first wave (92% higher than the 752,000 recorded between 20 March and 20 May 2020).
Why was the January wave larger?
Winter posed a new threat as a combination of factors made conditions more conducive to the transmission of the virus, including colder weather and more time indoors with less air circulation. The emergence of a highly contagious new variant in Kent fuelled a rapid expansion of cases, with London, the South East and the East of England rising fastest, and the high numbers then spreading further north.
New variants have clearly played a part in the latest wave, with early estimates suggesting it could be as much as 50% more infectious, and the risk of death 30% higher once infected. Some commentators have noted other instances of the second wave of a pandemic having a greater impact than the first. Notably, there were far more deaths during the second wave of the Spanish flu pandemic than the first.
Lastly, there has been a slower decline from the latest peak meaning there has been a much larger proportion of COVID-19 patients in hospital over a longer time period.
By the end of March 2021, COVID-19 hospital activity was greatly reduced. In parallel to managing the latest wave and doing everything possible to maintain non-COVID services, the NHS impressively rolled out a national vaccination programme. The government has committed to vaccinating all adults by the end of July 2021, which, pending any further supply problems, looks likely – a huge achievement for the NHS.
As the country follows the steps set out by the Prime Minister in the roadmap, the government must continue to be driven by the data,not dates, nor prior commitments. The threat of new variants and the increase in cases across Europe are acute reminders that the path to ending social distancing is not simple and cannot be rushed.
Maintaining low levels of COVID-19 hospital activity is a key pillar of the strategy to fully reopen the economy. It will also provide the NHS with more capacity to restore non-COVID activity, to tackle the backlog and pent-up demand for physical and mental health care that has built up over the past year.
This blog was first published by Public Sector Focus.