NHS hospital capacity during covid-19: overstretched staff, space, systems, and stuff

Dear Editor,

As noted by Fong et al., the threat of covid-19 has not disappeared. Intensive care professionals, including me, are emotionally drained from battling to save the lives of the immunocompromised and clinically vulnerable. We must continue to protect patients, healthcare professionals (HCPs), and the healthcare system, from capacity issues related to covid-19. Over the 2023-2024 winter period, around 2000 people in England were admitted to hospital with covid-19 every week.[1] The pandemic has exacerbated people’s underlying health issues, and many now require more complicated treatment.[1]

This is especially true for immunocompromised people who account for 22% of covid-19 hospitalisations and 28% of intensive care unit admissions, despite comprising around 4% of the general population.[2] Even now they are reliant on protective behaviours (e.g., reduced social interaction, masking) to manage their risk of SARS-CoV-2 infection.[3]

Immunocompromised people with covid-19 can spend weeks in intensive care and may require invasive mechanical ventilation after respiratory failure. Patients then endure months of recovery from weak muscles, kidney failure, neuro-psychological issues, and many other complications. Caring for severely ill patients also has an emotional impact on the caregivers and care professionals involved. Patients are with us for months and quickly become part of our lives. Many immunocompromised patients with covid-19 that I care for do not survive. When they do survive, it is seen as a victory. How can this be when the person is left battered, broken, emaciated, and a frail fraction of their former self?

A perception remains amongst primary care colleagues and peers that the immunocompromised population is limited to organ transplant recipients but immunosuppression can be due to a particular health condition (e.g., haematological malignancies, chronic lung disease, chronic kidney disease, and cardiovascular disease) or immunosuppressive treatment (e.g., immunosuppressants for organ transplant recipients, cancer chemotherapy, or B-cell depletion agents for autoimmune diseases including multiple sclerosis).[4]

In the UK, 1.8 million clinically vulnerable people including the immunocompromised, remain at high risk of becoming seriously unwell from covid-19,[5] despite high covid-19 vaccination rates and >80% of immunocompromised people having already received at least three doses.[2] Furthermore, the British Medical Association reported that HCPs are still not appropriately protected when treating patients with covid-19,[6] which can induce anxiety.

Effective prevention strategies are needed to reduce the impact of covid-19 on hospital capacity, and to help relieve the psychological burden of covid-19 on patients[7] and HCPs. If we prevent SARS-CoV-2 infection in immunocompromised people with effective preventative therapy, we can protect them from severe covid-19 outcomes, reduce hospital and intensive care admissions, reduce mortality, and ease the mental health burden of covid-19 and its psychological impact on patients and HCPs.

We must learn from the crisis and continue to ensure that immunocompromised and other clinically vulnerable people at highest risk of severe covid-19 outcomes are not left behind and can access the appropriate prevention, diagnosis, and care they need and deserve. Action today can make all the difference to minimise surges in admissions due to covid-19 and other infections, and alleviate pressure on hospital capacity by preventing infection, especially in immunocompromised people.

• Join the many HCPs already raising awareness of the diverse groups of people at highest risk of adverse covid-19 outcomes.
• Recognise that HCPs are suffering psychologically from the impact of the covid-19 pandemic on their patients, and advocate for peers who are still confronting this crisis.
• Offer easily accessible mental health support, such as online support groups and teletherapy, to address the psychological toll of isolation and constant threat of infection.
• Stay ahead of the curve! Keep HCPs informed about innovative solutions on the horizon, including vaccination strategies and preventative therapies.

References
1. The Health Foundation. What’s driving increasing length of stay in hospitals since 2019? 2023. https://www.health.org.uk/publications/long-reads/what-s-driving-increas... (Accessed 26 April 2024).
2. Evans RA, Dube S, Lu Y, et al. Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study. Lancet Reg Health Eur 2023;10.1016/j.lanepe.2023.100747:2666-7762.
3. Kidney Care UK. How does kidney disease affect my risk from Covid-19 and how do I manage my risk? 2023. https://kidneycareuk.org/kidney-disease-information/about-kidney-health/... (Accessed 26 April 2024).
4. Independent Advisory Group. Defining the highest risk clinical subgroups upon community infection with SARS-CoV-2 when considering the use of neutralising monoclonal antibodies (nMABs) and antiviral drugs (updated March 2023). 2023. https://www.gov.uk/government/publications/higher-risk-patients-eligible... (Accessed 1 May 2024).
5. National Institute for Health And Care Excellence. Tixagevimab plus cilgavimab for preventing COVID-19 [ID6136]. 2023. https://www.nice.org.uk/guidance/ta900/documents/committee-papers (Accessed 17 October 2023).
6. British Medical Association. COVID-19: How well-protected was the medical profession? 2023. https://www.bma.org.uk/advice-and-support/covid-19/what-the-bma-is-doing... (Accessed 26 April 2024).
7. Bernardi L, Daniels J, All Party Parliamentary Group for Vulnerable Groups to Pandemics. Forsaken but engaged: An inquiry into the psychological aspects of COVID-19, mental health, and political engagement of immunocompromised people. 2023. https://www.liverpool.ac.uk/media/livacuk/humanitiesampsocialsciences/do... (Accessed 1 May 2024).