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Covid-19: Government must reintroduce precautionary measures now, say health leaders

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2566 (Published 20 October 2021) Cite this as: BMJ 2021;375:n2566

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  1. Gareth Iacobucci
  1. The BMJ

Health leaders have urged the UK government to reintroduce measures such as mandatory face coverings in crowded and enclosed spaces “without delay” to stop the NHS from being overwhelmed this winter.

Last month the government set out its “plan B for England,”1 which it will implement if data show that the NHS is likely to come under unsustainable pressure this winter. This may include introducing mandatory vaccine certification in specific settings, reintroducing the legal requirement to wear face coverings in some settings, and advising people to work from home if they can.

The UK saw 49 156 new infections on 18 October, the highest daily figure since mid-July. The number of patients in the UK being admitted to hospitals with covid has reached 900 a day—approaching the 1000 a day figure that experts think should trigger plan B.

Public effort

The NHS Confederation said that hospitals had seen a 10% increase in covid cases in the past week, with deaths averaging around 120 a day but totalling 223 on 19 October. It noted that precautionary measures such as mask wearing and covid certification were already common in parts of Europe with a lower prevalence of the disease, and it called on the UK government to act now.

Matthew Taylor, chief executive of the NHS Confederation, said, “It is time for the government to enact plan B of its strategy without delay because, without pre-emptive action, we risk stumbling into a winter crisis. Also, health leaders need to understand what a ‘plan C’ would entail if these measures are insufficient.

“The government should not wait for covid infections to rocket and for NHS pressures to be sky high before the panic alarm is sounded.”

The confederation also called for a “plan B plus” that would go further than the government’s plan by calling on the public to do “whatever they can” to support services this winter. This could include:

  • Getting vaccinated, including booster shots, when invited

  • Turning up for scheduled healthcare appointments on time

  • Using frontline services responsibly, and

  • Volunteering to support the NHS and joining or returning to the workforce, if eligible.

The call came as NHS England’s chief executive, Amanda Pritchard, and its national medical director, Stephen Powis, warned that covid-19 would continue to place a major strain on the health service’s capacity this winter and would limit its ability to tackle the treatment backlog.

Giving evidence to the Health and Social Care Committee on 19 October, the leaders warned of a difficult winter ahead, emphasising the public’s role in keeping infection rates under control by coming forward for vaccination and continuing to wear masks to limit infection rates.

Powis noted that 6000 inpatient beds in England were currently occupied with covid patients who would not normally be admitted with respiratory illnesses in the autumn. On top of this the NHS was unable to use “several thousand” more beds because of infection control measures required to keep covid patients separate, and it was continuing to grapple with staff absences due to covid, he said.

“All that is putting pressure back through the system onto the ability for emergency departments to get patients onto wards, and putting pressure back onto the ambulance service,” said Powis.

Pritchard said that invitations for a booster vaccination were being sent to over 50s as soon as they became eligible, but she added, “What we are seeing—and this is absolutely the crux—[is that] while it’s great people are coming forward for boosters, they are not coming forward as quickly as the start of the vaccine programme.

“It’s now really important that we absolutely get the message out that covid is still with us, and it is serious.”

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