A new wave of coronavirus infections could throw into jeopardy efforts to clear a backlog of surgery in the NHS, experts have warned.
They say the relaxation of Covid restrictions is expected to cause a rise in infections, while at least some resurgence in hospital admissions and deaths is also expected at some point. However, the sharp rise in cases of a variant of concern first discovered in India, B.1.617.2, has caused consternation, with modelling suggesting that if it is as transmissible as some estimates suggest, it could fuel a serious “third wave”.
Now experts have said that a new wave of infections may cause further problems, exacerbating what has already been described as “a truly frightening backlog” of care.
“We are anticipating that as lockdown is eased that cases are going to go back up slightly, that is with or without the Indian variant,” Dr David Strain, a senior clinical lecturer at the University of Exeter medical school, told the Guardian. “The biggest concern we’ve got is that if these [Covid case] numbers do start to go up, it will put a strain on trying to get other services up and running.”
“GPs are crying out under the stress at the moment … we still have people not having their operations: we have had procedures postponed for over 12 months, and we have got longer waiting lists that ever before,” he said.
Last week it was revealed that NHS figures show almost 5 million people in England are waiting for hospital treatment, and more than 400,000 have already had their surgery delayed for at least a year.
Strain said another wave of Covid infections, however minor, could disrupt attempts to get back to normal care provision.
“For example, the peri-operative mortality is hugely increased in those with even mild Covid, so even in the vaccinated people, with greater than 95% protection against severe disease, contact with Covid could delay their operations with a huge impact on their quality of life,” he said.
Prof Ravi Mahajan, the president of the Royal College of Anaesthetists, said reducing the elective surgery backlog was the “next big challenge” for the NHS.
“Many patients have been waiting months, if not years, for treatment, while doctors and healthcare staff are just beginning to get back to a normal working pattern,” he said.
“The prospect of a surge of Covid-positive cases – even regionally – will have a significant impact on the continuing efforts to tackle the high elective surgery numbers. This will inevitably mean that patients end up waiting longer for the care they need.”
James Glasbey, from the University of Birmingham and co-lead of the CovidSurg Collaborative, an international network of researchers, also voiced concerns.
“We know already that the risks of surgery – namely severe lung complications such as pneumonia, the need for ventilation and risk of death – are far higher in patients with a recent infection, and that this risk lasts for at least six weeks after infection, gradually decreasing over time,” he said. “A further wave of [Covid] cases therefore could have a substantial impact on pandemic recovery at a time when the NHS is attempting to rapidly upscale surgical provision to meet the rising backlog of delayed elective procedures.”
While Glasbey said there were actions that could protect patients, such as providing “Covid-light” hospital pathways to reduce risk of patient exposure to Covid, routine preoperative Covid testing, delaying patients with recent infections for more than seven weeks, and prioritising surgical patients for vaccination, these could bring their own problems.
“Implementation of some of these measures is logistically challenging, and not possible for every operation,” he said.
“The vaccine will play a significant role in improving overall surgical safety and should be provided for all patients planned for surgery,” Glasbey added, noting that at present it was thought the main benefit would be in reducing that chance of patients becoming infected before surgery. “However, our understanding of the extent to which it may modify risks for vaccinated surgical patients that become infected is still evolving,” he said.
To date, about 40% of adults in the UK have received two doses of a Covid vaccine.
Tim Mitchell, a vice-president of the Royal College of Surgeons of England (RCS Eng), agreed that vaccination was important: “ If there is a marked increase in cases it could put the NHS under strain,” he said. “This is why it is so important that people go for their vaccination when they are called. It’s also vital that patients follow instructions from their hospital around their admission for surgery – including guidelines on testing and self-isolation, pre and post-surgery.”
The Patients Association voiced its unease. “A substantial new wave of Covid would be the worst possible news for non-Covid patients, who are already facing longer waits and have struggled to access services”, said Rachel Power, its chief executive.
“The NHS won’t start reducing its backlog until it can undertake activity at a greater volume than patients develop new needs. Having to dedicate large amounts of resource to people who are seriously ill with Covid – even though far fewer are likely to die in a new wave – will take the NHS even further away from that goal.”