Calls to step up the production of ventilators for coronavirus patients are ‘pointless’ without the additional staff and extra equipment needed, medics warn as engineers admit it could take MONTHS to meet demand
- PM issued an appeal to manufacturers for more ventilators over the weekend
- But experts warned not enough qualified intensive care staff to operate them
- And it could take months to ensure equipment manufactured to high standard
- Coronavirus symptoms: what are they and should you see a doctor?
Boris Johnson’s call to ramp up the production of ventilators for coronavirus patients is ‘pointless’ without more staff and extra equipment, leading medics have warned.
The Prime Minister issued an appeal to manufacturers over the weekend to switch their production lines and help manufacture the life-saving breathing machines.
But experts warned there were not enough fully qualified intensive care staff to operate the ventilators, which also require a host of supplementary pieces of kit to function.
And they said that it could take weeks, if not months, to ensure the equipment is manufactured to a professional standard and safe to roll out across the country.
The NHS currently has around 5,000 adult ventilators and 900 for children in critical care facilities.
It could need an additional 20,000 in a worst-case scenario, according to the Department of Health.
The coronavirus outbreak has claimed the lives of 56 people and infected more than 1,950 – a jump of 407 in a single day – in the UK.
Boris Johnson’s call to ramp up the production of ventilators for coronavirus patients is ‘pointless’ without more staff and extra equipment, medics warn
The NHS only has 5,000 of the machines and the Health Secretary Matt Hancock said on Sunday it will need ‘many times more than that’ in the weeks and months ahead.
The coronavirus outbreak has claimed the lives of 56 people and infected more than 1,500 in the UK
Nicki Credland, chair of the British Association of Critical Care Nurses, told Nursing Times: ‘That’s an absolute guarantee – we simply do not have them. We will need to look at diluting our workforce to be able to manage the situation.
‘If you’re an intensive care patient who requires ventilation, you require a lot of other things as well as ventilation.
A machine that helps people breathe.
It puts oxygen directly into patients’ lungs and removes carbon dioxide from them.
Ventilators are used to help a person breathe if they have lung disease or another condition that makes breathing difficult.
They can also be used during and post-surgery.
A breathing tube connects the ventilator machine to your body.
One end of the tube is placed into the lung’s airways through your mouth or nose.
In some serious cases, the tube is connected directly to the windpipe through a small cut in the throat.
Surgery is needed to make the hole in the neck. This is called a tracheostomy.
‘There appears not to be plans about where we’re going to get all of that extra kit or expertise from either.’
Dr Rinesh Parmar, chair of the Doctor’s Association UK, added: ‘Whilst NHS hospitals make emergency plans to create ITU [intensive treatment unit] beds and the government purchases more ventilators, the elephant in the room is the lack of highly trained intensive care nurses and doctors.
‘It is pointless acquiring new ventilators without enough highly trained staff to operate them.’
Dr Parmar added that securing more capacity in private hospitals could free up more space to treat coronavirus patients needing breathing assistance. But he warned there were still too few intensive care beds within these hospitals.
He added: ‘The systematic under-resourcing of the NHS and exodus of staff that the government has presided over has ultimately left the country with a severe lack of specialist intensive care nurses and doctors.’
Helen Meese, vice chair of biomedical engineering at the Institution of Mechanical Engineers, said there were several problems with using vehicle manufacturing firms to make the ventilators.
Healthy Britons below the age of 70 have been urged to work from home if they can, to avoid socialising or going out and to stop all non-essential travel
Data from the Imperial College team shows that nothing can stop the coronavirus overwhelming NHS intensive care units. Even the most strict quarantine measures would not prevent there being far more cases than there are beds to handle
London Waterloo was bereft of commuters this morning after official advice told people to work from home if they could
Bristol Temple Meads train station was eerily quiet this morning at a time when it would usually be heaving in rush hour
Rush hour traffic was missing from the M60 near Oldham, Greater Manchester, this morning
UK citizens are told to avoid non-essential travel GLOBALLY for 30 days in coronavirus lockdown
UK citizens were told to avoid all non-essential travel anywhere in the world today as the Government tried to battle the coronaviris pandemic.
Foreign Secretary Dominic Raab said Britons should avoid travel ‘globally’ under new travel advice from the Foreign Office.
The new rules will initially be in place for 30 days but will be ‘subject to ongoing revision’ he told the House of Commons.
‘Based on the fast-changing international circumstances today I am announcing changes to FCO (Foreign and Commonwealth Office) travel advice,’ he told MPs.
‘UK travellers abroad now face widespread international border restrictions and lockdowns in various countries.
‘The FCO will always consider the safety and the security of British nationals so with immediate effect I’ve taken the decision to advise British nationals against non-essential travel globally for an initial period of 30 days and of course subject to ongoing review.’
He said that the government was speaking to tour operators, insurance operators and airlines over a move that is likely to grind holiday and business travel to a virtual standstill, threatening jobs and business viability.
The shift comes after EU commission president Ursula von der Leyen announced outlined plans for a 30-day ban on all non-essential inflows to the bloc.
Dr Meese told the Health Service Journal: ‘Ventilation equipment, like all medical devices, is very strictly regulated to ensure patient safety.
‘We must be clear, that while many engineering companies and individuals have come forward to support this initiative, it will take several weeks, if not months, to ensure the right processes are in place to increase production of these precision parts.’
The NHS only has 5,000 of the machines and the Health Secretary Matt Hancock said on Sunday it will need ‘many times more than that’ in the weeks and months ahead, possibly 20,000 in a worst-case scenario.
Mr Johnson wants non-health care companies to step up and help build the artificial respirators and last night he hosted a call with more than 60 company chiefs to urge them to convert production lines.
Participants with knowledge of the call said the government wants to have the ventilator push ‘on stream’ within the next fortnight.
It was claimed by one person who reportedly participated in the call that Mr Johnson had ‘joked’ the coordinated effort to build the machines could be known as ‘Operation Last Gasp’.
Mr Johnson’s attempt to mobilise the UK’s manufacturing sector has drawn comparisons with a scrap metal scheme to build Spitfires during the Second World War.
Leading companies such as JCB and Dyson have been asked to divert resources to building more ventilators as the spread of the disease worsens.
A Downing Street spokesman said after yesterday’s call that manufacturers had been asked to ‘rise to this immediate challenge by offering skills and expertise as well as manufacturing the components themselves’.
‘Businesses can get involved in any part of the process: design, procurement, assembly, testing, and shipping,’ the spokesman said.
Mr Hancock said before the call that there had already been an ‘enthusiastic response’ from businesses.
However, there have been warnings that components might be hard to source amid further concerns about how much time it will take for companies to change their production process.
Experts have also cautioned that an increase in artificial respirators will be no use unless there are enough health service staff capable of operating them.
One executive told the Financial Times that industry will be ‘very supportive’ of the push but warned it ‘has to be be driven by Downing Street’.
Another executive said if there were companies already making the machines and they want to switch to 24/7 production other businesses would be willing to ‘lend them people to run the factories’.
A woman is pictured wearing a face mask in London Waterloo. People should avoid all ‘non-essential’ travel and contact with other people, the Government has warned
A man is pictured wearing a face mask in London Waterloo station this morning. The UK is now on red alert for coronavirus and train services could soon be reduced or stopped as people work from home
OFFICIAL STATISTICS SHOW THE TIP OF THE ICEBERG OF UK’S CORONAVIRUS CRISIS
The Government’s Department of Health releases updated statistics every day at around 2pm, showing the number of people confirmed to have coronavirus and the number of test results that have been received in the past 24 hours.
But because of a change in the way officials are tracking the outbreak, these numbers only represent a small proportion of the real epidemic spreading across the UK.
Only people who are seriously ill and need hospital care, or who are already in hospital when they show signs of the coronavirus, are now being tested.
People who become ill after travelling, or think they have the coronavirus because they have the symptoms, will not be tested unless they need hospital care. Most patients will just self-isolate at home until they are no longer ill.
An announcement by the Government last week sheds some light on the true scale of Britain’s epidemic.
On Thursday, March 12, when the official number of cases was just 596, chief scientific adviser Sir Patrick Vallance said the true figure was probably between 5,000 and 10,000.
The upper estimate suggests each confirmed case is worth 16.8 undiagnosed patients.
The official number of patients is now 1,543 – multiply that by 16.8 and the potential real case toll is 25,889.
Stephen Phipson, head of the Make UK industry body, said there are only a couple of small firms that manufacture ventilators in the UK, but there was a ‘whole sector’ that does ‘contract’ manufacturing.
‘You take one person’s product then you build it to their design, then you sell it,’ he told Sky News.
Mr Hancock said on Sunday that ventilators will be key in the fight against coronavirus.
He said: ‘It’s about ventilation, because it’s a respiratory disease. So we will be stopping some other activity and asking doctors who normally do other things to retrain, to be able to, for instance, use the ventilator.’
It comes after a second coronavirus patient has died in Scotland, taking the UK’s death toll to 56.
The person was elderly, had other health problems and was being treated by the NHS board for Glasgow, the Scottish Government said in its announcement.
Wales has diagnosed a further 12 cases of the coronavirus today, bringing the UK’s total number of confirmed patients to 1,555.
Public Health Wales confirmed the country now has now had a total of 136 infected patients, which adds to 1,196 in England, 171 in Scotland and 52 in Northern Ireland.
It comes after scientists warned that dramatic lockdown measures, which have started coming into force across the UK today, could last for 18 months or more.
Prime Minister Boris Johnson last night announced the UK’s epidemic was entering the ‘fast growth’ phase and people should stop socialising, stop going out, work from home and avoid contact with elderly or unwell relatives and friends.
Over-70s and those with long-term health conditions like asthma, high blood pressure, heart disease or kidney disease should stay at home for the next three months from this weekend, he added.
The UK’s spiralling epidemic is expected to kill thousands of people and rumble on through the summer and potentially into next year, experts say. There may already be 55,000 people infected in the UK, according to the UK’s chief scientific adviser.
Ambulance workers are pictured wearing protective gear as they handle potentially hazardous samples at St Thomas’ Hospital in London – the capital is the hardest-hit area in the country
Shoppers queue to enter the Costco wholesale supermarket in north London as panic-buying grips the nation amid the outbreak
Drastic coronavirus restrictions could last TWO YEARS, Germany warns
Germany’s public health agency has warned that the coronavirus crisis could last up to two years.
The Robert Koch Institute, the German federal government agency responsible for disease control and prevention, made the claim on Tuesday as it strengthened the threat risk for Germany from ‘moderate’ to ‘high’.
It comes after German Chancellor Angela Merkel yesterday announced gatherings in churches, mosques and synagogues would be banned and said playgrounds and non-essential shops would close as the country reaches 7,000 confirmed cases, and 14 deaths.
The Robert Koch Institute said the pandemic could stretch on for another 24 months as pandemics usually run their course in waves.
According to RKI President Lothar Wieler, the length of time depends on how many people develop immunity to COVID-19 after contracting the virus, how many more people test positive for the illness and how long it takes to develop a vaccine.
Dr Wieler did not rule out the potential for some of the emergency measures established by countries to have to stay in place for that duration.
Meanwhile German Foreign Minister Heiko Maas said the government has come up with some 50 million euros (£45 million) to bring home German citizens stuck abroad.
He announced a drive to bring home thousands of tourists stranded in popular winter vacation spots across the globe – particularly people on package holidays in Morocco, the Dominican Republic, the Philippines, the Maldives and Egypt.
Maas said the government is spending up to 50 million euros on the effort to bring Germans home over the coming days in co-operation with airlines including Lufthansa.
London, which is said to be ‘weeks ahead’ of the rest of the country, is the worst-hit area of the UK and has confirmed at least 480 cases, with Kensington and Chelsea the most infected borough (43 cases).
And a report by leading scientists who are advising the Government said people may need to keep up the drastic lifestyle changes announced yesterday well into 2021.
The Imperial College COVID-19 Response Team predicted that 260,000 people could have died if the Government hadn’t changed tack yesterday and tightened its rules.
Now it could limit the fatalities to fewer than 20,000 by keeping people away from each other and slowing down the spread of the virus.
One of the lead authors, Professor Neil Ferguson said the science was continually shifting as more data became available, but what had been envisaged as the worst-case scenario had become ‘the most likely scenario’.
British officials only realised the danger ‘in the last few days’, the report said, after receiving new information about how the situation in Italy has spiralled out of control and overwhelmed hospitals. Around 2,200 people have now died there and there have been 28,000 confirmed infections, although the true toll is likely considerably higher.
Italy’s crisis has inspired a dramatic ramp-up of UK policy and Mr Johnson announced a move to war-footing to try and stop the outbreak.
The switch-up was an admission that officials’ original plans to control and slow the outbreak – to ‘flatten the curve’ – had been too optimistic and the scientists’ paper showed the Government was on course for a disaster.
Officials are urging manufacturers to help out by building intensive care ventilators if they can to plug an NHS shortfall in critical beds.
But data in the Imperial College report suggests that hospitals will be overwhelmed regardless of what measures the Government takes, and a dramatic spike in coronavirus cases is unavoidable
Meanwhile, the government is preparing a massive package of aid designed to avoid the crisis effectively sending the country bankrupt.
Scrapping utility bills and cancelling council tax are among the extraordinary ‘wartime’ measures being mooted for the response, which will be unveiled by Chancellor Rishi Sunak later.
Some experts have suggested the government will have to pump an unprecedented £450billion into the economy to avoid mass destruction of businesses and workers being sent into poverty.
Imperial College’s bombshell report was produced by a crack team of virus, disease and public health experts at the prestigious London university.
Professor Ferguson said he and his colleagues had been working ‘seven days a week for the past two months’ to advise the Government and put information about the coronavirus into the public domain. They have concluded the virus can’t be stopped.
A woman wears a face mask whilst riding a circle line train on the London Underground
Elderly people – the most at risk from coronavirus – have struggled to get essentials due to panic buyers raiding shelves. A woman buys toilet roll at a Tesco in Chester
Prof Ferguson said his team had been ‘refining’ predictions for the course of the epidemic since their ‘worst case’ estimate of 250,000 deaths.
‘No country in the world this far has seen an epidemic that large [250,000 deaths], this is an early extrapolation of an early epidemic that was suppressed in China,’ he said.
‘But we have no reason to believe that’s not what would happen if we frankly did nothing, and even if we did all we could to slow, not reverse, the spread, we’d still be looking at a very large number of deaths and the health system being overwhelmed.’
He added: ‘Initially when we came up with these kid of estimates they were viewed as what’s called the reasonable worst case.
‘But as information has been gathered in recent weeks, from particularly Italy but other countries, it has become increasingly clear that actually this is not the reasonable worst case – it is the most likely scenario.
‘The second piece of information which I think was critical is NHS planners going away and seeing how much could they surge health system capacity, particularly in critical care. Whilst they are planning a major expansion of that – cancelling elective surgery, building new beds, getting new ventilators – it just isn’t enough to fill the gap.
‘So we are left with no option but to adopt this more draconian strategy.’
If no action at all had been taken against the coronavirus it would have claimed 510,000 lives, the team’s report said.
Had the Government stuck with their strategy of trying to ‘mitigate’ the spread – allowing it to continue but attempting to slow it down – with limited measures such as home isolation for those with symptoms this number would be roughly halved to 260,000.
If the strictest possible measures are introduced – including school closures and mandatory home quarantine – the number of deaths over a two-year period will fall below 20,000, the scientists said.
‘Instead of talking about hundreds of thousands of deaths, there still will be a significant health impact that we’ll be talking about,’ Professor Ferguson said.
‘Hopefully, tens of thousands… maybe, depending on how early we are, just a few thousands.’
Government sources said the policy change had not been the result of a sudden warning from the scientists, but that new information had emerged in recent days.
A source at the Department of Health said: ‘We’ve been listening to Imperial all along. It’s based on an evolving picture, and they’ve started to get a load more information about what is happening in Italy, which is what has informed this. We’ve been guided by the science and by the evidence from the very start.’
The Imperial scientists emphasised there will be no end in sight to the measures until a vaccine is created.
WHAT DO WE KNOW ABOUT THE CORONAVIRUS?
What is the coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.
Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.
The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Where does the virus come from?
According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.
However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
What does the virus do to you? What are the symptoms?
Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.
However, an investigation into government surveillance in China said it had found no reason to believe this was true.
Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.
Can the virus be cured?
The COVID-19 virus cannot be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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