Another wave hits and the ongoing trauma of the first two waves on the NHS highlighted in Inquiry

Another Covid wave

Another Covid wave has hit England, with recorded hospital admissions with Covid increasingly sharply over the last two weeks. While there has been lots written about the new subvariant XEC, it’s not nearly prevalent enough (yet) in England to be behind this wave. Instead, I think this is being driven by return to education and work combined with a cold and wet September.

This is now our fourth or fifth wave this year depending on how you count - and they are coming quickly enough that the troughs never reach the lows we saw in 2023. It’s enough to keep the risk of coming away from big events with Covid quite high (e.g current Fresher’s week or party conferences), enough to disrupt people’s jobs and lives, and enough to keep too high a number of people developing new Long Covid.

Prof Kevin Fong’s testimony at the Covid Inquiry

Prof Kevin Fong, an ICU clinician and academic, had a senior role in NHS England during the pandemic. As part of his role, he went on several visits to hospitals all across the country during the first 18 months of the pandemic, covering the devastating first two waves. Today, he testifed as a witness at the Covid Inquiry’s hearings.

Frequently on the verge of tears, his testimony was incredibly powerful. As he said “there is more to know than you can count”. There are lives and experiences behind every point on the above chart.

Prof Fong explained how traumatising the waves and deaths were for ICU staff, trying to care for dying patients separated from their family.

He explained how totally beyond any normal experience the sheer scale of deaths was, how it left staff traumatised with no time to recover and feeling that they could not give patients a dignified death. He later explained how smaller hospitals suffered in particular: as they filled up, more stable ICU patients were transferred to bigger hospitals (they had to be more stable to survive an ambulance trip), leaving the very sickest patients behind. Some hospitals experience more than 7 out of 10 ICU patients dying during the height of the pandemic. An unimaginable experience for staff.

Despite the line trotted out last November at the Inquiry by some such as Hancock saying the NHS coped, the NHS was dangerously overwhelmed. Prof Fong described visiting hospitals as close to collapse as he had ever seen, of the waves leaving staff broken by the summer of 2021, angry at how they ran out of everything during the peaks.

Watching his testimony reminded me yet again of how much we owe to NHS staff and other front line workers and how much we let them down.

The consequences of the NHS struggle of the first two waves

As the report from Module 1 of the Inquiry found, the UK went into the pandemic unprepared - we had much lower ICU capacity than most peer countries, and our stocks of PPE had been allowed to run far too low. We had never planned to prevent or mitigate the pandemic and so we were far too slow to reduce transmission - eventually resorting to the extreme of lockdown very late.

In a dangerous case of the tail wagging the dog, it seems as if lack of PPE contributed to the infamous “infection prevention cell” (IPC) refusing to adapt to Covid being airborne and downgrading required protective equipment for staff to the flappy blue surgical face masks (FSRMs). This piece by David Osborn digging into the decisions of the IPC and the consequences is a sobering must read. Hospital staff and patients were left far more exposed to infection than they should have been.

Overwhelmed hospitals contributed directly to the disastrous decision to discharge elderly patients into care homes without testing, where PPE was also lacking in the first wave. By the second wave, Boris Johnson was so obsessed with the feel good vibes of “saving Christmas” that he, and his government, ignored all the obvious and scary data about the surge of the new Alpha variant in December and didn’t lock down till early January. This delay, given all the learning from the first wave and the fact that we had literally just started vaccinating people, was and remains unforgiveable and criminal. Thousands died who could have lived had we been able to delay the spread of alpha until at least the most vulnerable had received a first vaccine dose.

The embrace of ‘freedom day’ in the summer of 2021, despite the rise of Delta, meant that an exhausted NHS had to cope with a high Covid burden for the rest of the year - and then into 2022 with the arrival of Omicron. NHS staff were depleted by Long Covid and burned out, with thousands leaving the NHS entirely . This directly contributed to the huge NHS waiting lists continuing to this day - the NHS never had the respite to cope with the backlog. It directly contributed to the collapse of NHS emergency services in the winter of 2022/23, as a triple wave of Covid, RSV and Flu broke the fragile system.

Refusal to learn

We seem stuck in a phase of denial about Covid - we don’t want to remember. We don’t want to think about it. People justify this deliberate forgetting by minimising what happened, what Covid is now (still here!), and what could happen in the future with new diseases.

Despite all the evidence on clean indoor air, there has been no push to improve the air quality of our buildings, private or public. This is particularly egregious in settings where clinically vulnerable people have no choice but to be: hospitals, pharmacies and care homes. We know that good quality masks work (when worn!), and we should be normalising their wearing within hospitals and health care settings.

Despite knowing that forcing people to go to work when sick is bad for their health and risks the health of others, there has been no push to improve statutory sick pay in the UK or encourage people (including children) to stay home when sick. The consequences of this shortsightedness will become even clearer when the next airborne pandemic hits us.

Finally…

The autumn vaccine booster campaign has started, and the NHS is using the latest version of the vaccine tuned to the JN.1 variant. Please do get a booster if you are eligible! If you are not eligible for an NHS booster, and are in a position to afford it (it’s up to £100 depending on provider), you could also consider getting a booster privately (there are many places that offer it, including Boots). Vaccines work - please avail yourself of them!

And - really encouragingly - the new generation of nasal spray vaccines are performing really well in trials and might provide us all with much longer lasting immunity within a few years.