http://www.24dash.com/news/Central_...ctors-warn-of-swine-flu-intensive-care-crisis
Doctors warn of swine flu intensive care crisis
Published by Hannah Wooderson for 24dash.com in Central Government , Health
Friday 24th July 2009 - 4:55pm
Doctors warn of swine flu intensive care crisis Doctors warn of swine flu intensive care crisis
The swine flu pandemic could overwhelm intensive care beds in England, especially in children's units, leading doctors warned today.
Demand for intensive care beds could outstrip supply by 130% in some regions, while the need for ventilators to help people breathe could exceed supply by 20%.
Paediatric facilities are likely to become "quickly exhausted", while hospitals could face "massive excess demand", according to the researchers.
Hospitals on the South East coast, in the South West, East of England and East Midlands are likely to be worst hit, they said.
The warning comes as a pregnant woman critically ill with swine flu was being treated in a Swedish hospital today after being transferred from Scotland.
The 26-year-old suffered a rare complication and was flown to Stockholm because no beds were available in the UK for the procedure she needed.
The woman was admitted to Crosshouse Hospital in Kilmarnock, East Ayrshire, last week where she was put on a ventilator because of an extreme reaction to the swine flu virus.
NHS Ayrshire and Arran's specialist intensive care team recommended that she received a highly-specialised procedure known as extracorporeal membrane oxygenation (ECMO).
This involves circulating the patient's blood outside the body and adding oxygen to it artificially - a relatively new technique which is used when a person's lungs are functioning very poorly even with ventilation and high levels of oxygen.
Scottish Health Secretary Nicola Sturgeon said today that the woman was getting the "best possible treatment".
But experts in intensive care and anaesthesia from the University of Cambridge, the Intensive Care Society and St George's Healthcare NHS Trust in London warned that English hospitals might be unable to cope with the amount of people affected by the pandemic.
London would fare the best and should have enough intensive care beds and ventilators.
But demand for beds could be 130% above supply in the South East Coast Strategic Health Authority (SHA) area, and 120% above supply in the South West.
In the East Midlands and East of England, demand could also be 120% above supply.
Across the whole of England, demand for beds could be 60% above the number available, all based on a hospital admission rate of 0.25%.
The experts warned that intensive care units were already running at high bed occupancy rates.
The Government has insisted that it can cancel non-emergency operations to increase the number of beds available but today's experts said even this would not meet demand.
They added: "Only 10% of critical care beds in England are in specialist paediatric units, but best estimates suggest that 30% of patients requiring critical care will be children.
"Paediatric intensive care facilities are likely to be quickly exhausted and suggest that older children should be managed in adult critical care units to allow resource optimisation."
Dr Ari Ercole, from the University of Cambridge, who worked on the study, said: "Any predictions need to be based on the most accurate information available at the time and we recognise that we are in the early stages of the pandemic.
"However, based on figures provided by the 10 regional health authorities and using the FluSurge model developed by the Centres for Disease Control and Prevention in the USA, we can see that hospitals would face massive excess demand even if the pandemic lasted an optimistic 12 weeks.
"Paediatric intensive care facilities for children under 15 would be quickly exhausted, as they make up 10% of current provision but could face 30% of the demand for pandemic related beds.
"Early experience of the present strain suggests that the attack rate is particularly high in the young and that this virus may severely compromise the immune systems of people who contract it."
The research was published in the journal Anaesthesia.
The World Health Organisation (WHO) said today that 160 countries were now affected by swine flu, and around 800 people have died worldwide.
In the UK, there have been about 30 deaths in people who have contracted the virus.
Yesterday, it emerged that most people in England with swine flu being treated in hospital are aged 16 to 64 - 435 cases - followed by the under-fives, with 169 cases.
Among the over-65s, 149 people are in hospital and there are 87 cases among youngsters aged five to 15.
The proportion of under-fives being admitted to hospital has risen slightly in the last week.
Overall, there are 840 patients in hospital with the virus in England, 63 of them in intensive care.
Yesterday, the Government announced that there were an estimated 100,000 new cases of swine flu last week - around double the 55,000 in the previous week.
Its National Pandemic Flu Service website crashed within minutes of launching at 3pm but appeared to be running normally a short time later.
However, the Government admitted it was having to increase capacity due to demand.
The website received 2,600 hits per second - or 9.3 million hits per hour - at launch.
Speaking about the pregnant woman, Ms Sturgeon told BBC Radio Scotland's Good Morning Scotland programme: "She's now getting treatment that gives her the best possible chance of survival."
The minister said the Scottish woman arrived in Sweden last night and added: "She's now in hospital in Sweden. Doctors were pleased with how she coped with the journey.
"So she's now in very good hands, getting the best possible treatment, and I'm sure we all wish her well and hope she makes a full recovery."
But Ms Sturgeon said the woman was critically ill, adding: "She had a very severe and a very rare reaction to the H1N1 virus."
The UK has a national ECMO unit in Leicester but all five beds there are currently being used.
However, a bed was found in a similar unit in Stockholm and the woman was transferred under pan-European arrangements for sharing such scarce facilities.
Ms Sturgeon said the treatment "might and hopefully will save her life".
She added: "It's a highly-specialised procedure and that's why, given a bed was found for her in Sweden, the decision was taken by her clinical team to recommend transfer there."
Before the patient was transferred, a medical team from Sweden came to Scotland to assess her.
Dr Robert Masterton, executive medical director of NHS Ayrshire and Arran, said: "Once an ECMO bed was identified in Sweden, our intensive care specialists worked closely with our Swedish colleagues to make sure the patient was stable before being transferred."
He added: "The family have been fully involved in this decision and support this referral. They have asked for privacy while they concentrate on the patient's treatment and recovery."
However, Ms Sturgeon stressed that this particular case was unusual.
She said: "It remains the case that, for the overwhelming majority of people who get this virus, the symptoms are very mild and they will make a full recovery within a matter of days without any complications whatsoever.
"It's that fact that should continue to give the public a lot of reassurance."
Dr Alan Hay, director of the London-based World Influenza Centre, estimated that the number of swine flu cases would peak within the next two weeks ahead of a return of the virus in the winter.
He told Today: "I think we will see a peak in this country in the next week or two, if not already - it will reduce, we don't know to what extent the level will drop down to a background level.
"We've seen in the US, although they peaked many weeks ago, that the level of infection in some of the states is still quite widespread.
"So it's a bit too early to predict the trough that we will see before we see the virus re-emerge in the winter."
The World Health Organisation's flu chief, Keiji Fukuda, said two billion infections over the course of the global pandemic was "a reasonable ballpark to be looking at".
The team behind today's UK research calculated an average of 4.5 critical care beds per 100,000 people in England.
In London, there are 7,5 per 100,000, 5.9 in the North East, five in the North West and 4.4 in Yorkshire and the Humber.
The lowest number of beds is on the South East coast, which has three per 100,000 people.
They said that, using numbers based on historical assumptions, "it has been shown that a flu epidemic could potentially overwhelm critical care bed and ventilator capacity in England".
They said that, while extra beds could be made available by cancelling routine operations, "this would have important implications for ongoing acute and elective service provision".
They said the total number of critical care beds in England currently stands at 2,030 adult beds and 265 for children.
An additional 1,607 adult high dependency beds are also available alongside 43 high dependency beds for children, which could be used to ventilate people.
"Nevertheless the calculations still show that even this number could be far too small to cope with demand.
"Additionally, since many intensive care units (and acute hospital beds) run at high occupancy, much of this capacity would not be available during a pandemic.
"Whilst regional variations in critical care provision exist, the data suggest that these are small and so inter-hospital transfer is unlikely to provide a solution to an overwhelming pandemic."
The authors looked at ventilator capacity around the country and found that, while some areas should cope, demand could outstrip supply by 10% in the East of England and the South West, and by 20% on the South East coast.
Dr Ercole said: "One of the main problems is that these beds already run at high occupancy rates and even delaying elective surgery to create additional ventilated beds would not meet demand."
Professor David Menon, one of the authors from the University of Cambridge, said the figures used in the research could fall on the conservative side.
He said it was possible that four times as many patients would be admitted to hospital as suggested, of whom about half would need intensive care.
He also said that between 10% and 50% of patients in intensive care with swine flu were suffering renal failure and requiring kidney support.
"If it's 10% then we should be able to cope reasonably well but if it's 50% then it would be a big ask," he said.
"We don't have the equipment to deliver that level of support."
In an accompanying editorial, Dr Jonathan Handy, a consultant intensivist and anaesthetist from the Chelsea and Westminster Hospital in London, said: "The best case estimates predict that capacity could be significantly increased from baseline, while the worst case could exceed current capacity by an order of magnitude.
"All acute trusts should have already developed local flu plans to include a 100% increase in critical care capacity.
"However, some may be more comprehensive (and optimistic) than others."
He said the predicted demand levels suggest that immediate action is needed, from stockpiling supplies to looking at how medical students could play an active role in patient care.
A spokeswoman for the Department of Health said: "We can't be certain how the current pandemic will develop, but we have to prepare for the reasonable worst case.
"All NHS organisations have pandemic preparedness plans.
"This was included as a key priority in the NHS Operating Framework for 2008/9. SHAs have recently completed an assessment of these plans.
"Exercises at national, regional and local levels have also been used to test plans.
"As part of our preparations, guidance has been issued which contains information for primary and secondary care services in the UK on managing surge capacity and the prioritisation of services and patients during an influenza widespread outbreak.
"The guidance also identifies how maintaining an essential health service will be a community effort involving self care, support for those for whom hospital admission is not deemed appropriate, and supporting early discharge of patients from hospital."
A spokeswoman for eBay said the online auction firm would not permit the re-sale of Tamiflu through its website.
She said: "eBay.co.uk does not permit the listing of any prescription-only medicine. The sale of Tamiflu on eBay.co.uk is therefore prohibited."
On the issue of critical care beds, a spokeswoman for the Department of Health said: "The issue of critical care has been considered as part of planning for a pandemic.
"Trusts have been given advice on how to increase their critical care capacity.
"Trusts have advised that, in the event of a flu widespread outbreak, they estimate that they could double their critical care capacity for ventilated patients.
"This would be done by invoking their escalation procedures, which include cancelling elective procedures and redeploying staff and providing a more basic level of care for critical care patients (i.e. less diagnostic tests etc)."
Liberal Democrat health spokesman Norman Lamb said: "Many areas of the health system will come under severe strain if the swine flu outbreak continues to spread as expected.
"We have to make sure that hospital beds are being used as effectively as possible.
"Too many of our hospitals are full of patients who could be better cared for in community and social care beds.
"If the NHS doesn't address this problem then the strain on hospitals and staff will severely challenge the system.
"The NHS is more than capable of managing this outbreak but they must be given the freedom to prioritise resources where they're needed most."
According to the Department of Health, there are currently 3,637 critical care beds in England.
Doctors warn of swine flu intensive care crisis
Published by Hannah Wooderson for 24dash.com in Central Government , Health
Friday 24th July 2009 - 4:55pm
Doctors warn of swine flu intensive care crisis Doctors warn of swine flu intensive care crisis
The swine flu pandemic could overwhelm intensive care beds in England, especially in children's units, leading doctors warned today.
Demand for intensive care beds could outstrip supply by 130% in some regions, while the need for ventilators to help people breathe could exceed supply by 20%.
Paediatric facilities are likely to become "quickly exhausted", while hospitals could face "massive excess demand", according to the researchers.
Hospitals on the South East coast, in the South West, East of England and East Midlands are likely to be worst hit, they said.
The warning comes as a pregnant woman critically ill with swine flu was being treated in a Swedish hospital today after being transferred from Scotland.
The 26-year-old suffered a rare complication and was flown to Stockholm because no beds were available in the UK for the procedure she needed.
The woman was admitted to Crosshouse Hospital in Kilmarnock, East Ayrshire, last week where she was put on a ventilator because of an extreme reaction to the swine flu virus.
NHS Ayrshire and Arran's specialist intensive care team recommended that she received a highly-specialised procedure known as extracorporeal membrane oxygenation (ECMO).
This involves circulating the patient's blood outside the body and adding oxygen to it artificially - a relatively new technique which is used when a person's lungs are functioning very poorly even with ventilation and high levels of oxygen.
Scottish Health Secretary Nicola Sturgeon said today that the woman was getting the "best possible treatment".
But experts in intensive care and anaesthesia from the University of Cambridge, the Intensive Care Society and St George's Healthcare NHS Trust in London warned that English hospitals might be unable to cope with the amount of people affected by the pandemic.
London would fare the best and should have enough intensive care beds and ventilators.
But demand for beds could be 130% above supply in the South East Coast Strategic Health Authority (SHA) area, and 120% above supply in the South West.
In the East Midlands and East of England, demand could also be 120% above supply.
Across the whole of England, demand for beds could be 60% above the number available, all based on a hospital admission rate of 0.25%.
The experts warned that intensive care units were already running at high bed occupancy rates.
The Government has insisted that it can cancel non-emergency operations to increase the number of beds available but today's experts said even this would not meet demand.
They added: "Only 10% of critical care beds in England are in specialist paediatric units, but best estimates suggest that 30% of patients requiring critical care will be children.
"Paediatric intensive care facilities are likely to be quickly exhausted and suggest that older children should be managed in adult critical care units to allow resource optimisation."
Dr Ari Ercole, from the University of Cambridge, who worked on the study, said: "Any predictions need to be based on the most accurate information available at the time and we recognise that we are in the early stages of the pandemic.
"However, based on figures provided by the 10 regional health authorities and using the FluSurge model developed by the Centres for Disease Control and Prevention in the USA, we can see that hospitals would face massive excess demand even if the pandemic lasted an optimistic 12 weeks.
"Paediatric intensive care facilities for children under 15 would be quickly exhausted, as they make up 10% of current provision but could face 30% of the demand for pandemic related beds.
"Early experience of the present strain suggests that the attack rate is particularly high in the young and that this virus may severely compromise the immune systems of people who contract it."
The research was published in the journal Anaesthesia.
The World Health Organisation (WHO) said today that 160 countries were now affected by swine flu, and around 800 people have died worldwide.
In the UK, there have been about 30 deaths in people who have contracted the virus.
Yesterday, it emerged that most people in England with swine flu being treated in hospital are aged 16 to 64 - 435 cases - followed by the under-fives, with 169 cases.
Among the over-65s, 149 people are in hospital and there are 87 cases among youngsters aged five to 15.
The proportion of under-fives being admitted to hospital has risen slightly in the last week.
Overall, there are 840 patients in hospital with the virus in England, 63 of them in intensive care.
Yesterday, the Government announced that there were an estimated 100,000 new cases of swine flu last week - around double the 55,000 in the previous week.
Its National Pandemic Flu Service website crashed within minutes of launching at 3pm but appeared to be running normally a short time later.
However, the Government admitted it was having to increase capacity due to demand.
The website received 2,600 hits per second - or 9.3 million hits per hour - at launch.
Speaking about the pregnant woman, Ms Sturgeon told BBC Radio Scotland's Good Morning Scotland programme: "She's now getting treatment that gives her the best possible chance of survival."
The minister said the Scottish woman arrived in Sweden last night and added: "She's now in hospital in Sweden. Doctors were pleased with how she coped with the journey.
"So she's now in very good hands, getting the best possible treatment, and I'm sure we all wish her well and hope she makes a full recovery."
But Ms Sturgeon said the woman was critically ill, adding: "She had a very severe and a very rare reaction to the H1N1 virus."
The UK has a national ECMO unit in Leicester but all five beds there are currently being used.
However, a bed was found in a similar unit in Stockholm and the woman was transferred under pan-European arrangements for sharing such scarce facilities.
Ms Sturgeon said the treatment "might and hopefully will save her life".
She added: "It's a highly-specialised procedure and that's why, given a bed was found for her in Sweden, the decision was taken by her clinical team to recommend transfer there."
Before the patient was transferred, a medical team from Sweden came to Scotland to assess her.
Dr Robert Masterton, executive medical director of NHS Ayrshire and Arran, said: "Once an ECMO bed was identified in Sweden, our intensive care specialists worked closely with our Swedish colleagues to make sure the patient was stable before being transferred."
He added: "The family have been fully involved in this decision and support this referral. They have asked for privacy while they concentrate on the patient's treatment and recovery."
However, Ms Sturgeon stressed that this particular case was unusual.
She said: "It remains the case that, for the overwhelming majority of people who get this virus, the symptoms are very mild and they will make a full recovery within a matter of days without any complications whatsoever.
"It's that fact that should continue to give the public a lot of reassurance."
Dr Alan Hay, director of the London-based World Influenza Centre, estimated that the number of swine flu cases would peak within the next two weeks ahead of a return of the virus in the winter.
He told Today: "I think we will see a peak in this country in the next week or two, if not already - it will reduce, we don't know to what extent the level will drop down to a background level.
"We've seen in the US, although they peaked many weeks ago, that the level of infection in some of the states is still quite widespread.
"So it's a bit too early to predict the trough that we will see before we see the virus re-emerge in the winter."
The World Health Organisation's flu chief, Keiji Fukuda, said two billion infections over the course of the global pandemic was "a reasonable ballpark to be looking at".
The team behind today's UK research calculated an average of 4.5 critical care beds per 100,000 people in England.
In London, there are 7,5 per 100,000, 5.9 in the North East, five in the North West and 4.4 in Yorkshire and the Humber.
The lowest number of beds is on the South East coast, which has three per 100,000 people.
They said that, using numbers based on historical assumptions, "it has been shown that a flu epidemic could potentially overwhelm critical care bed and ventilator capacity in England".
They said that, while extra beds could be made available by cancelling routine operations, "this would have important implications for ongoing acute and elective service provision".
They said the total number of critical care beds in England currently stands at 2,030 adult beds and 265 for children.
An additional 1,607 adult high dependency beds are also available alongside 43 high dependency beds for children, which could be used to ventilate people.
"Nevertheless the calculations still show that even this number could be far too small to cope with demand.
"Additionally, since many intensive care units (and acute hospital beds) run at high occupancy, much of this capacity would not be available during a pandemic.
"Whilst regional variations in critical care provision exist, the data suggest that these are small and so inter-hospital transfer is unlikely to provide a solution to an overwhelming pandemic."
The authors looked at ventilator capacity around the country and found that, while some areas should cope, demand could outstrip supply by 10% in the East of England and the South West, and by 20% on the South East coast.
Dr Ercole said: "One of the main problems is that these beds already run at high occupancy rates and even delaying elective surgery to create additional ventilated beds would not meet demand."
Professor David Menon, one of the authors from the University of Cambridge, said the figures used in the research could fall on the conservative side.
He said it was possible that four times as many patients would be admitted to hospital as suggested, of whom about half would need intensive care.
He also said that between 10% and 50% of patients in intensive care with swine flu were suffering renal failure and requiring kidney support.
"If it's 10% then we should be able to cope reasonably well but if it's 50% then it would be a big ask," he said.
"We don't have the equipment to deliver that level of support."
In an accompanying editorial, Dr Jonathan Handy, a consultant intensivist and anaesthetist from the Chelsea and Westminster Hospital in London, said: "The best case estimates predict that capacity could be significantly increased from baseline, while the worst case could exceed current capacity by an order of magnitude.
"All acute trusts should have already developed local flu plans to include a 100% increase in critical care capacity.
"However, some may be more comprehensive (and optimistic) than others."
He said the predicted demand levels suggest that immediate action is needed, from stockpiling supplies to looking at how medical students could play an active role in patient care.
A spokeswoman for the Department of Health said: "We can't be certain how the current pandemic will develop, but we have to prepare for the reasonable worst case.
"All NHS organisations have pandemic preparedness plans.
"This was included as a key priority in the NHS Operating Framework for 2008/9. SHAs have recently completed an assessment of these plans.
"Exercises at national, regional and local levels have also been used to test plans.
"As part of our preparations, guidance has been issued which contains information for primary and secondary care services in the UK on managing surge capacity and the prioritisation of services and patients during an influenza widespread outbreak.
"The guidance also identifies how maintaining an essential health service will be a community effort involving self care, support for those for whom hospital admission is not deemed appropriate, and supporting early discharge of patients from hospital."
A spokeswoman for eBay said the online auction firm would not permit the re-sale of Tamiflu through its website.
She said: "eBay.co.uk does not permit the listing of any prescription-only medicine. The sale of Tamiflu on eBay.co.uk is therefore prohibited."
On the issue of critical care beds, a spokeswoman for the Department of Health said: "The issue of critical care has been considered as part of planning for a pandemic.
"Trusts have been given advice on how to increase their critical care capacity.
"Trusts have advised that, in the event of a flu widespread outbreak, they estimate that they could double their critical care capacity for ventilated patients.
"This would be done by invoking their escalation procedures, which include cancelling elective procedures and redeploying staff and providing a more basic level of care for critical care patients (i.e. less diagnostic tests etc)."
Liberal Democrat health spokesman Norman Lamb said: "Many areas of the health system will come under severe strain if the swine flu outbreak continues to spread as expected.
"We have to make sure that hospital beds are being used as effectively as possible.
"Too many of our hospitals are full of patients who could be better cared for in community and social care beds.
"If the NHS doesn't address this problem then the strain on hospitals and staff will severely challenge the system.
"The NHS is more than capable of managing this outbreak but they must be given the freedom to prioritise resources where they're needed most."
According to the Department of Health, there are currently 3,637 critical care beds in England.