The game is changing now. When I last wrote, Omicron had just been identified and was becoming the dominant variant. Cases were shooting up and I and my colleagues were preparing for another Covid wave like those we had seen with Alpha, then Delta. Why would we not?
The data at the time showed Omicron was fiercely infectious and case numbers were rocketing. It seemed only logical, based on my experience of the past two years, that this was going to be followed by rising hospital admissions, critical illness, death. It felt like a foolish roll of the dice not to be taking it more seriously. And – whatever may be said – those in charge did not know differently in early December.
Decisions were made day by day, trying to second-guess from our admissions one day whether hospitalisations would rise the next. If they had, it would have been too late for new measures to stem the tide.
But we got lucky. Omicron is not the same disease as Delta and Alpha. While it is unbelievably infectious – just look at how many of your family and friends will have had it recently – it is not as dangerous now. That is not to say it can be trivialised, however.
If you have not been vaccinated, you will still be at risk; severe Covid pneumonia in healthy people remains primarily a disease of the unvaccinated. But the majority of patients coming into hospital with Covid these days are admitted for other reasons and just happen to test positive, reflecting the enormous community prevalence. Not to mention the significant number who catch it while on our wards; this has been a big problem from the beginning but with Omicron it is ever harder to avoid.
The last two months have been tough, though. The winter pressures have felt harder than normal, our hospital more full, the critical incidents being declared more often than usual as we ran out of beds. Infection control has been a nightmare as we have fought to contain outbreaks on our wards, shutting and flipping wards between Covid and non-Covid on a near hourly basis.
Omicron has been just severe enough to push our already overloaded system over the edge more and more often. And yet the numbers in hospital are at last going down. We are down to just one or two Covid wards in our hospital now as we slowly win back territory. Just recently I did the first shift in a long while where during 12 hours on call I admitted nobody who had Covid.
Numbers in intensive care with Covid are small and population immunity is high. Due largely to a combination of high vaccination rates and widespread exposure through near disastrous pandemic management, Covid is not the killer it once was.
Still, there is no time to relax. We have a shiny, new, ambitious elective recovery plan to get on with. We will be showered with billions of pounds – though not as much as was wasted on unusable PPE, I note – to support us as we try to pretend the pandemic never happened.
So far as I can tell, this means targets and paperwork. It will take months for any new cash to come through. We have been mandated to come up with local plans to explain how – with no new resources, the same fragmented and knackered workforce, constraints due to infection control, among a host of other issues – we are going to reduce our backlog even as ever more referrals come in due to pandemic-delayed care. And money is no use without staff.
As things stand, we cannot fill our vacant posts and we do not even have secure funding to keep people in post for the long Covid provision we have managed to set up. It is an uphill, exhausting struggle.
And this is the time that our PM, out of the blue, has chosen to announce the early removal of all restrictions. Everyone I have spoken to has been taken aback by this. Are we still “following the science”? And, in practice, what will this mean?
Do we stop regularly testing ourselves and come to work to cough and splutter over our vulnerable patients? And also, now that the plan to mandate vaccinations for healthcare workers has been quietly shelved, raise the risk of infecting potentially unvaccinated colleagues? Although hospitalisations with Covid are manageable right now, there were more than 66,000 new cases on Thursday, even with continued mask wearing, lateral flow testing and self-isolation.
Cases will certainly rise as a result. Whether hospitalisations also will, even only a little, remains to be seen. But a little is all that it would take to destabilise the system.
And this is the crux of the problem for me. I love the NHS. The colleagues I work with and the kindness, expertise and quality we have are genuinely second to none; it beats the private sector hands down. I am incredibly privileged to do the work I do. But overall the NHS is a failing system at present, unable to offer good enough healthcare to our population.
The current waiting times for non-urgent care; the pressure placed on under-resourced staff to achieve results that are not remotely realistic; the difficulties that patients have accessing the care they need; these are all utterly unacceptable. It makes me furious.
But it is not Covid that has brought us to this point. Decades of underfunding, hospital closures, poor workforce planning and societal health inequalities have left us sailing so close to the wind that dealing with the pandemic has resulted in the continuing collapse of planned care even two years on.
We need to recognise how valuable and precious and fragile our NHS is. Yet the framing of the recovery plan to me suggests that we are aiming simply to get back to where we were in 2019. And even this is being gambled on – again – by rushing to remove restrictions ahead of a planned timescale.
We need strong, careful leadership, as we will do for many years to come. I don’t want to be over-cautious, but it is not appropriate for those in charge to risk our health by doing what suits them politically at any given moment. We all deserve better than that.
The writer is an NHS respiratory consultant who works across a number of hospitals.
