Jon McMullan prepares to leave intensive care at the Conquest Hospital after successful treatment for Covid-19, Even before the virus struck, NHS hospital services were stretched (photo: East Sussex Healthcare NHS Trust).

Hospitals – avoid them if you can!

One of the reasons why Hastings and Rother have been moved into Tier 3 and now Tier 4 is the increasing pressure on local hospitals from Covid infected people. While hospital treatment is essential for the most serious cases, Hastings-based Brian Bostock, a registered nurse of 25 years currently managing end-of-life and complex care provision over four London boroughs, gives an insider’s view of why admission to hospital should be a last resort, whatever the illness.

I have often said this – hospitals are full of sick people. It amazes me how many rather well people fight tooth and nail to get themselves into a hospital bed, considering the real dangers to their health, just by being there.

Of course, the problem is that the really sick people have a lot of really bad illnesses, which no one really wants well people to get. Then of course there are unintended problems like adverse drug reactions, accidents and assaults – because mentally ill people need hospitals too (more so in fact). Then there are the patients who come in mobile, but after a week of lying in a bed have lost the capability to walk – this one happens a lot – and need months of rehab to recover.

All of this before we consider infections like Hospital Acquired Pneumonia, Methicillin Resistant Staphylococcus Aureus (MRSA) or phlebitis – an inflammation of the blood vessels that can be caused by repeated or problematic intravenous injection.

Brian Bostock

So it is no surprise that a lot of the time the NHS tries to keep people out of hospital, and only admits people who really, REALLY need it. In pre-Covid times, on an average day, this would keep about 95 to 98% of the beds occupied.

Now, I should at this point say I don’t know anyone that’s had Covid. I haven’t nursed anyone that’s had Covid, as far as I am aware I haven’t had Covid. I also know that wearing a mask does very little to protect me, but protects everyone else from me – it’s why surgeons wear masks in theatres so they are not breathing viruses into patients’ open surgeries. You might think I would be sceptical about novel coronavirus. This could not be further from the truth.

Massive increase

What I know is that the number of really sick people, you know, the ones that get let into hospital because they are so sick that even considering the risks there is no other option, has increased massively due to Covid. I know that in an intensive care unit (ICU) run by a friend of mine, she has had to take over the operating theatres next door to put in more beds, taking her ICU from 32 to 76 beds. That’s more than double.

I know that deaths are currently 5,000 more a week than the five-year average and I also know that whilst all of them won’t have had a positive test, there will have been many that were positive but didn’t know it, or just too scared to go to the place full of very sick people to get what they need – and some are people who have lost livelihoods, homes and businesses due to lockdowns and have had no way of coping except to take their own lives.

Yes, I know its infection to mortality rate (IMR) is ‘only’ about 1.2% – but that is still between 10 and 25 times higher than the average winter ‘flu and is based just on the known infections. It would be foolish to estimate what that figure for ‘flu would be without the modern medicine we have today, compared to, say, Spanish ‘flu over 100 years ago (IMR about 2 to 2.5%).

Insidious virus

Known infection is where it gets tricky. Because Covid is insidious. It disguises itself from the immune system so effectively that the body doesn’t react until you’re already very ill with it. It’s why you can transfer it before you have the symptoms. It’s why I wear a mask because I may not know I am sick with it until I am really sick with it. It’s why sometimes relatively well people are getting very sick with it because when the immune system wakes up to an already rampant infection it has to unleash the equivalent of a scorched earth policy in the hope of fighting back.

And it’s why we are admitting so many more patients than our usual summer/autumn maxima. Remember the terrible pictures last winter of overloaded hospitals? That was winter – but we are already there, two to three months early, having cancelled all but essential life-saving treatment, put beds where we have never put beds before, and still have seasonal ‘flu to come. This winter will certainly – even if it is mild – prove the most testing in living memory, if not in the 75+ year history if the NHS.

The NHS are not making this up. They do not admit people, at the best of times, unless they really, REALLY need it, and, well, people sick with coronavirus need it. We need lockdowns to reduce the spread of disease. We need to preserve the capacity of our hospitals

I have my reservations about the vaccine – as I have with any medical treatment that is innovative – but will I have it, even so? Yes I will, because what I also know is that without a vaccine everyone, and I do mean everyone, will get infected sooner or later – Hastings has been pretty good so far, but without preventative and restrictive measures it will hit hard, hardest  of all on the poorest, of whom we have many.

And I really don’t want to go to hospital if I can possibly help it. It’s full of sick people and I don’t want to need a hospital bed when there are none left.

Also in: Covid-19