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    Covid-19: Critical care beds shortage prompts calls for review

    The NHS's "insufficient" critical care capacity has been laid bare by the pandemic, with the UK having one of the lowest number of beds per head in Europe, NHS Providers has said.

    The group, which represents trusts in England, is calling for a review of the health service's capacity.

    The UK has 7.3 critical care beds per 100,000 people, compared to Germany's 33.8 and the US's 34.3, analysis found.

    The government said it was investing £72bn in the next two years in the NHS.

    The east of England, South West and South East are areas of key concern.

    "The UK is towards the bottom of the European League table for critical care beds per head of population," NHS Providers said.

    The group added that the UK had comparatively fewer critical care beds than France, Italy, Australia and Spain.

    "It's neither safe nor sensible to rely on NHS hospital trusts being able to double or triple their capacity at the drop of a hat as they've had to over the last two months, with all the disruption to other care and impossible burdens on staff that involves."

    Seeking a review into critical care capacity in England, the organisation said it wanted the government to commit to providing additional finances in areas where it was needed.

    "There have been too many reviews of NHS capacity in the past where huge amounts of time have been wasted because the government has not been willing to fund the results of what's been found," the group said.

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    Analysis box by Hugh Pym, health editor

    When reviews and a public inquiry at some stage look at lessons to be learned from the handling of the pandemic in the UK, the question of the readiness of the NHS is sure to be considered.

    NHS Providers has highlighted one key part of this - the relative lack of critical care beds in hospitals, reflecting in part insufficient investment going back many years.

    The UK has fewer hospital beds for seriously ill patients relative to the population than leading European economies such as France, Germany, Italy and Spain.

    So going into the pandemic the health service was in some ways not as well resourced as it might have been.

    The NHS coped astonishingly well last April and in the most recent surge, and hospitals were not overwhelmed.

    But sufficient critical care beds were created for Covid patients only by using wards which could not therefore be used by others - much routine and non urgent care had to be postponed.

    The argument now being made is that there needs to be a review of what is needed as a safety net for future crises - and funding to go with it.

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    A Department of Health and Social Care spokesperson said: "The government is determined to back the NHS in every possible way in its fight against this virus, investing £52bn this year and £20bn next.

    "This is on top of £9.4bn capital funding to build and upgrade 40 new hospitals and £3bn earmarked for supporting recovery and reducing the NHS waiting list."

    They added that the government was on track to deliver 50,000 more nurses by the end of this parliament.

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    Hospital waiting list 'may double to 10m by April'

    Waiting lists for hospital treatment could more than double by April and hit 10 million in England, the Reform think tank is warning.

    A worst-case scenario could see delays continue as a new wave of referrals are made, Reform said.

    Treatment referrals by GPs were six million lower in 2020 than the year before, suggesting a mounting backlog.

    Chris Hopson, chief executive of NHS Providers, said "trumpeting worst-case scenarios" was "not helpful".

    He said while there was a "significant problem" which would take time and investment to overcome, a similar methodology had suggested waiting lists would hit 10 million by December last year, but they were currently at 4.4 million.

    He also warned the NHS is likely to be "at full stretch" for at least another six weeks and England was still "some way away" from being able to start lifting restrictions.

    Mr Hopson, whose organisation represents NHS trusts in England, has written to Prime Minister Boris Johnson to say case numbers are "still far too high" to end virus curbs.

    He told BBC Radio 4's Today programme the end of April, once the top nine priority groups had been vaccinated would be the "logical point at which we can start considering easing restrictions".

    Setting out the conditions they believe are needed to allow current restrictions to relax, trust leaders outlined four tests that could be applied.

    Among the tests are: a "significant" drop in case numbers; a return to normal NHS capacity; solid progress with vaccinations; and a "robust and effective" strategy to identify new virus variants.

    Mr Johnson is due to outline a roadmap for easing the current national lockdown in England on Monday.

    Meanwhile, the head of the UK's vaccine taskforce, Clive Dix, told Sky News all adults could be fully vaccinated by August "or maybe sooner if we need to".

    'Mammoth task'

    Reform - a centre-right think tank that focuses on public services - praised the work of frontline NHS staff, but said more now needed to be done to tackle the growing backlog in care.

    Community diagnostic centres for cancer, cardiac and other conditions should be set up to restart screening programmes halted by the pandemic, coupled with a renewed focus on prioritising those most urgently in need of care currently on waiting lists, it said. And for routine treatments, it said more use should be made of the private sector.

    Reform's Eleonora Harwich said: "We must never have the equivalent of a 'National Covid Service' again.

    "This is a system problem and in no way detracts from the heroic effort of NHS staff battling Covid-19.

    "However, the cessation of so much non-Covid care means patients are facing more serious health conditions or disabilities, and some will die prematurely."

    Layla McCay, director of policy at the NHS Confederation, which represents hospital bosses, accepted the NHS faced a "mammoth task" to tackle the backlog - although she questioned the waiting list prediction of 10 million people by April.

    She said the real problem was that the NHS was under-funded and had been operating "at the top of its capacity for far too long".

    Responding to accusations that the NHS has become a Covid-only service, Ms McCay pointed out cancer services were now operating at pre-pandemic levels.

    Mr Hopson also said that Reform's suggestion that the NHS had been a "Covid-only service" was not helpful as staff had worked hard to keep other services going.

    Prof Neil Mortensen, of the Royal College of Surgeons of England, said tackling the backlog would require both the use of the private sector, and extra investment in the NHS.

    A further 10,625 new coronavirus cases were reported on Tuesday, alongside another 799 deaths within 28 days of a positive test.

    Over 16 million people have now received at least one dose of a coronavirus vaccine across the UK.


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    Covid vaccine update: When will others be ready?


    Two Covid vaccines are now being rolled out in the UK, with a third having been approved for use.

    But how do the three vaccines compare and what about others on the horizon?

    Why do we need a vaccine?

    The vast majority of people are still vulnerable to coronavirus. It's only the current restrictions that are preventing more people from dying.

    Vaccines teach our bodies to fight the infection by stopping us from catching coronavirus, or at least making Covid less deadly.

    Having a vaccine, alongside better treatments, is "the" exit strategy.

    Oxford University-AstraZeneca vaccine

    The data also showed a strong immune response in older people.

    • There is also intriguing data that suggests perfecting the dose could increase protection up to 90%
    • The UK has ordered 100 million doses
    • It is given in two doses

    This may be one of the easiest vaccines to distribute, because it does not need to be stored at very cold temperatures.

    It is made from a weakened version of a common cold virus from chimpanzees, that has been modified to not grow in humans.

    Pfizer-BioNtech vaccine

    The big breakthrough came when Pfizer-BioNTech published its first results in November.

    • They showed the vaccine is up to 95% effective
    • The UK is due to get 40 million doses
    • It is given in two doses, three weeks apart

    The vaccine must be stored at a temperature of around -70C. It will be transported in a special box, packed in dry ice and installed with GPS trackers.

    On 2 December, the UK became the first country in the world to approve the Pfizer/BioNTech coronavirus vaccine for widespread use.

    Six days later 90-year-old Margaret Keenan became the first patient to receive the vaccine at University Hospital in Coventry. Since then, more than a million people in the UK have been vaccinated.

    Moderna vaccine

    The Moderna vaccine is a new type called an RNA vaccine, and uses a tiny fragment of the virus's genetic code.

    This starts making part of the virus inside the body, which the immune system recognises as foreign and starts to attack.

    • It protects 94.5% of people, the company says
    • The UK has pre-ordered 17 million doses which it should start to receive in the spring
    • It is given in two doses, four weeks apart
    • 30,000 have been involved in the trials, with half getting the vaccine and half dummy injections

    The Moderna vaccine uses the same approach as the Pfizer vaccine but it is easier to store, because it stays stable at -20C for up to six months.

    Vaccine graphic

    What other vaccines are being developed?

    Other trial results are also expected in the coming weeks.

    • Data on the Russian Sputnik V vaccine, which works like the Oxford one, suggests it is 92% efficient
    • Janssen's trial is recruiting 6,000 people across the UK, in a total of 30,000 volunteers worldwide, to see if two jabs give stronger and longer-lasting immunity than one
    • Wuhan Institute of Biological Products and Sinopharm in China, and Russia's Gamaleya Research Institute are all in final testing

    Understanding which method produces the best results will be vital. Challenge trials, where people are deliberately infected, could help.

    Who will get the vaccine first?

    This depends on where Covid is spreading when the vaccine becomes available and in which groups each is most effective.

    Older care home residents and staff top the UK's preliminary priority list, followed by health workers like hospital staff, and the over-80s.

    Age is, by far, Covid's biggest risk factor.

    What still needs to be done?

    • Huge-scale development must happen for the billions of potential doses
    • Researchers still need to find out how long any protection may last

    It was thought that 60-70% of the global population must be immune to stop the virus spreading easily (herd immunity) - billions of people, even if the vaccine works perfectly.

    However, those figures will rise considerable if the new, more transmissible, variants spread widely.

    Would a vaccine protect everyone?

    People respond differently to immunisation.

    History suggests any vaccine could be less successful in old people because an aged immune system does not respond as well, as happens with the annual flu jab. But data so far suggests this may not be a problem with some of Covid vaccines

    Multiple doses may overcome any problems, as could giving it alongside a chemical (called an adjuvant) that boosts the immune system.

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    COVID-19: 'People in their 30s are dying' - exhausted ITU staff reveal brutal truth of coronavirus frontline

    Health workers have said "it's a marathon, not a sprint" as new coronavirus patients "come every two minutes".

    Hope and agony on the COVID wards.

    It's around 4 o'clock when seven ambulances arrive all at once.

    COVID-19 hospital admissions may have dipped slightly this week, but glimpse into Barnet Hospital's emergency department for a reality check.

    You will see we are still in the thick of a crisis.

    Domestic cleaner Larisa Atanasova, renowned in the hospital for her machine-like efficiency, can barely wipe down the bays quickly enough.

    "They come every two minutes," she explains, before adding: "What can you do? The next patient is coming."

    She's right, two minutes after she's disappeared into another room Davian Hunt arrives.

    He is 52, in good physical shape, but he can barely walk.

    "Just total lack of energy," he says, lying on the bed. "I just want to sleep all the time."

    Across the department behind a glass wall a man, struggling to breathe, is about to be given CPAP - a mouthpiece that rapidly blasts in oxygenated air.

    The 63-year-old postal worker, Felix Ramat, lost his wife four days earlier to COVID-19 - now he is dangerously ill.

    What's more, his 40-year-old son-in-law is already upstairs in the hospital on a ventilator.

    This virus rips through families and it has also spread through the A&E department.

    The two nurses treating Mr Ramat have themselves just recovered from the illness and now they are back in the fray.

    Nurse Aoibheann McCarthy says: "It's been intense. I'm personally just back from having COVD-19. So, it's been a hard struggle. I'm weak. I'm tired. But I'm back here. We're busy. We're full every day. We're struggling, but we're getting through it. We have good support here. About seven of us went off at the same week."

    Upstairs in the COVID-19 intensive care wards recovery is uncertain, but all the same, unconscious patients are being prepared for it.

    Respiratory physiotherapist Clare Bendall is doing what's called ranging - pushing limbs back and forth, making sure the patient's joints don't stiffen up so movement will come back more easily.

    She talks the patient through each movement as they lie unresponsive on the bed.

    "We're now going to lift this left arm up. We're going to touch your chin. And straight. Lovely," she tells the man attached to a ventilator.

    She says: "Sometimes you hear from our previous survivors... they say they remember like hearing accents rather than actual words." She looks at her patient and adds: "But you know, I just think he's a person, and I'm going to tell him what I'm doing."

    She then says to the man: "Now, going to give this knee a bit of a stretch. Going to pull this knee to your tummy. So, we're going to bend that up. Lovely. Can't let these knees and hips get stiff."

    It's sometimes easy to forget that the people doing this kind of work are day-in-day-out absorbing the horror of what's happening in the room.

    "I think this sounds silly but the worst thing is when we do our ward books in the morning," says Clare. "It's when the amount of RIPs outnumber the ones that have made it down to the wards. And I think that's when it really kicks in."

    The emotion starts to rise up behind her visored eyes.

    "And they're a lot younger - in the first wave, sorry, I remember thinking that could be mum. That could be my aunt. And now I'm thinking that could be me. That could be my brother, my boyfriend.

    "We've lost people in their 30s, in their 40s. It's heart-breaking."

    Having told me this, she barely pauses before collecting herself and getting straight back to work.

    No wonder a study last month by King's College London found nearly half intensive care staff surveyed over the summer reported symptoms of post-traumatic stress disorder, depression or anxiety.

    Universally, medics say that specialist intensive care nurses are under the most pressure, people like Harriet Goudie working at an adapted outpatients' ward on the second floor of Barnet's sister hospital, the Royal Free in north London.

    Harriet says: "Honestly, it's been really, really bad for the ITU nurses. I think, this wave especially, it was really bad. The first wave, it was so stressful. And I think the amount of pressure that the ITU nurses are under now is incredible."

    Harriet has been tending to four patients when normally she would offer one-to-one care.

    She said: "These are really sick patients. So there is multiple organ support and for the ITU nurses that's just extremely difficult to try to manage.

    "This is an outpatient ward that we've had to turn into an ITU ward. So it's really difficult, as you can see in these bed spaces, to try and fit all the IT equipment in. We're trying to cram it into small spaces. We're just running out of things like plugs, for example. We don't physically have enough plug sockets in some areas to be able to charge all of our equipment."

    As we are on the ward together, a family is speaking on a video call to a barely conscious patient, telling him they love him, telling him he can get better.

    They have his glasses for him just as soon as he can sit up and read, and they miss him and can't wait for him to get better and come home.

    "He can hear us," one of them says. "His eyes are opening."

    This is the first time it's happened.

    Out of sight from their video screen he is also trying to raise a hand, but it slumps back.

    He lies still. But he is listening.

    And as they talk the curtains are drawn and porters arrive.

    A man in his early 60s in the bed opposite has died, he is being taken to the mortuary.

    A body in a white bag is placed into a blue bag on a trolley and wheeled out.

    It is a scene made more brutal by the tender voices and the sheer strength from the family, chatting to an unresponsive man, in the booth next door.

    But they are right to have hope because patients do come back.

    Upstairs in another intensive care unit 53-year-old Dima Hooper is sitting up in her chair.

    She's an NHS caterer for patients on wards.

    The week before, I'd seen her in a similar state to the man listening to the video call.

    Now, though, she has a tube in her neck and is smiling.

    She gives me and my cameraman the thumbs up and indicates that in two days' time she expects to be able to talk.

    Just down the corridor Nicolae Ursachi, who spent 40 days on a ventilator, is standing up with the assistance of a walking machine and three members of staff.

    He is breathless within four steps and has to sit down. He is also fiercely determined, and after some rest he wants more.

    Therapy assistant Chloe Davis says: "It's like a marathon, that you have to train for. That's what we explain it to the patients as. It's a marathon, not a sprint."

    The same could be said for the work being done by medics - like Nicolae their progress is slow and exhausting but driven by hope.

    Over three nights, Sky News will host a series of special programmes examining the UK's response to the pandemic.

    Watch COVID Crisis: Learning the Lessons at 8pm on 9, 10 and 11 February.

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    COVID-19: Chief medical officer Chris Whitty warns coronavirus vaccine shortages will last months

    The UK's chief medical officers have backed a change in guidance which says booster jabs should be given up to 12 weeks later.

    Vaccine shortages are likely to cause problems for "several months", England's chief medical officer has warned, amid fears that emergency healthcare staff at COVID "battle stations" are at risk of burnout.

    Professor Chris Whitty said the UK needs to urgently maximise the number of people who are vaccinated, as he defended a shift to prioritise first doses for as many at-risk people as possible.

    But he said a lack of global supplies will likely hamper efforts to protect the nation in the first part of 2021.

    A letter signed by Professor Whitty and the chief medical officers for Scotland, Wales and Northern Ireland, said: "We have to ensure that we maximise the number of eligible people who receive the vaccine.

    "Currently the main barrier to this is vaccine availability, a global issue, and this will remain the case for several months and, importantly, through the critical winter period.

    "Vaccine shortage is a reality that cannot be wished away."

    The makers of the Pfizer/ BioNTech vaccine said they are working flat out to boost production of their COVID-19 vaccine, but they warned there will be gaps in supply until other vaccines are rolled out.

    "At the moment it doesn't look good - a hole is appearing because there's a lack of other approved vaccines and we have to fill the gap with our own vaccine," BioNTech CEO Ugur Sahin told news weekly Spiegel.

    Last week Jonathan Van-Tam, deputy chief medical officer, said a shortage of "fill and finish" materials needed to produce and package vaccines could also slow down the national rollout.

    At a Downing Street news conference Professor Van-Tam said: "Many of you know already that it's not just about vaccine manufacture. It's about fill and finish, which is a critically short resource across the globe."

    The warnings came as the UK faces a rising number of COVID patients in hospitals across the nation.

    Adrian Boyle, vice president of the Royal College of Emergency Medicine, said many medical staff feel "tired, frustrated and fed-up".

    Speaking to BBC Breakfast, he voiced concerns over a possible burnout: "What is it going to be like over the next couple of months? I don't know, I am worried."

    "We are very much at battle stations.

    "There will be short-term surges of morale but people are tired, frustrated and fed-up, as everybody is, whether they work in hospital or not."

    His comments came as the Royal College of Nursing's England director, Mike Adams, said that staff leave was being cancelled to deal with the surge in demand.

    Meanwhile, Nightingale hospitals across England are being readied for use to take the pressure off hospitals.

    But Mr Adams told Sky News the expectation of a mass rollout of staff for the Nightingale hospitals was "misplaced".

    He added: "If we are having to cancel leave to staff these areas, the obvious question is where will the staff come from to open the Nightingales?

    "I have real concerns that the expectation that this mass rollout in capacity can happen is misplaced because there aren't the staff to do it."

    On Thursday, the UK's chief medical officers backed a change in guidance which says booster jabs should be given up to 12 weeks after an initial dose to maximise the number of people being vaccinated.

    But the announcement on Wednesday prompted Pfizer to issue a warning over what it called "alternative dosing".

    A spokesperson said: "There are no data to demonstrate that protection after the first dose is sustained after 21 days."

    However, the UK's chief medical officers said: "In terms of protecting priority groups, a model where we can vaccinate twice the number of people in the next 2-3 months is obviously much more preferable in public health terms than one where we vaccinate half the number but with only slightly greater protection."

    Pressure is mounting on the government to control the spread of the COVID-19, which has continued to reach new heights.

    The UK recorded a record high of 55,892 coronavirus cases in 24 hours on Thursday, as well as a further 964 deaths within 28 days of a positive test.

    Meanwhile, just under half of major hospitals in England currently have more COVID-19 patients than during the peak of the first wave last year.

    But GPs have said changes to the way vaccinations are given are "grossly unfair" for elderly patients with imminent appointments for a vaccine booster.

    Dr Richard Vautrey, chairman of the BMA GP committee, said: "This group of very elderly patients is at the highest risk of death if they contract COVID-19, which is why GPs are so concerned for them.

    "It is grossly and patently unfair to tens of thousands of our most at-risk patients to now try to reschedule their appointments.

    "Local leaders are telling us that is unprofessional and impractical to amend the appointments for thousands of frail elderly patients, particularly those booked and who have already made arrangements to have their second vaccination in the next two weeks."

    The Health Secretary Matt Hancock said one million people have been given the first dose of the coronavirus vaccine in the UK.

    The Oxford/AstraZeneca vaccine will be rolled out alongside the Pfizer jab from Monday. The UK has 100 million doses on order.

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