Is the NHS overwhelmed by incoming COVID-19 patients?

By Ludovic Noble

A woman was arrested in her home after she posted a video of herself wandering around an apparently empty Gloucestershire Royal Hospital. The video appears to conflict with the impression left by the mainstream media: that hospitals are full with COVID-19 patients and can’t cope.

It appears to conflict with the reports of doctors and nurses who are insisting that they are indeed busy and are working overwhelmingly long shifts to keep up with the added stress caused by COVID-19. So what’s going on?

The answer appears to be complicated. Here’s a summary of the situation according to the data:

• • The number of people with COVID-19 in hospitals is large but the number of people coming into hospitals with COVID-19 is about the same (a bit worse) as a bad flu season.
  • They are overwhelmed because the NHS is already overwhelmed and has reduced bed capacity and are sending people home who test positive for COVID-19.
  • Hospitals are overwhelmed but not due to an influx of COVID-19 patients.

According to the NHS official spreadsheet Beds Time-series 2010-11 onwards (XLS, 93KB) (download here), the overnight bed occupancy rate is actually lower than in previous years [1].

The reason why is more or less explained in this BBC article: beds are being removed so that the remaining beds can be spaced out to prevent infection.

The reason why staff are so busy, despite there actually being fewer patients in hospital than normal, is because of the measures being taken to prevent infection spreading. This involves sending doctors and nurses home when they test positive for COVID-19, making them go through anti-infection procedures and, as mentioned, reducing the total number of available beds so that they can be spaced out (the total number of overnight beds was reduced by about 10,000 in this period).

In addition, the NHS is already an overwhelmed health system. Dr Mark Holland, president of the Society for Acute Medicine (SAM), said in 2016:

The volume of patients and disease severity is so much that we are now functioning at the edge of what is possible.

In 2018, the Guardian reported:

four in five intensive care units (ICUs) are having to send patients to other hospitals as a result of chronic bed and staff shortages.

It is plausible, therefore, that reducing the capacity of beds and sending staff home would make the NHS even more overwhelmed than it was before. The question now is: Are incoming COVID-19 patients contributing in a significant way to the overwhelming of the NHS?

According to this NHS official spreadsheet January 2021 COVID Publication (XLSX, 12.8MB) (download here), the number of people admitted to hospital with COVID-19 daily in England was about 300 at the start of November. It reached about 1,000 in early January [2].

This number of people being admitted to hospital with COVID-19 is comparable to the number of people admitted to hospital with the flu during a bad flu year. I couldn’t find official data on historic flu admissions. However, if we use this BBC article as a reference:

around 5,000 people were admitted to hospital with flu in the first week of January [in 2018].

2018 was a bad flu year. The number of people being admitted to hospital with COVID-19 in England during this winter has reached about 1,000 people a day, so about 7,000 people a week. 2018 was a bad flu year, so we can say this year is comparable (a bit worse) to a bad flu year.

In conclusion, the NHS is overwhelmed but not because the public are being hospitalised with SARS-CoV-2 at an extraordinary rate. The NHS is overwhelmed because (1) it is already an overwhelmed system and (2) the hospitals are working at a reduced capacity.

Of course, this discussion introduces more questions, namely, would the hospitalisation rate be higher if it weren’t for the restrictions and, regardless, does the possibility of the NHS being overwhelmed justify these restrictions? It is not the aim of this article to answer these questions.

Notes & Sources

1. The occupancy rate of overnight beds is usually around 85%.
   However, it was at 50% at 2020/21 Q1 and 70% at 2020/21 Q2. In other
   words: The have been proportionally fewer people in hospital at the end
   of 2020 and start of 2021 than in previous years. [[BACK]]
2. If you use this spreadsheet Daily Admissions and Beds 21 January2021 (XLSX, 164KB) on the same page you may be led to believe that
   the number of people being admitted to hospital with COVID-19 daily in
   England has been around 4,000. However, this is the number of
   admissions and “diagnoses in hospital.” [[BACK]]