The Independent - 04.03.2020

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been told all patients in intensive care who have signs of a lung infection should now be tested for
coronavirus, amid fears the virus could already be in hospitals and could spread between patients.


NHS chiefs have been told to work up plans to segregate wards such as A&E departments, critical care and
diagnostic areas in the event of a “significant escalation” in cases of coronavirus.


Trusts will also discharge patients earlier and have been told to consider plans to treat patients remotely and
where possible, see some patients in the community.


The letter, sent by Professor Keith Willett, NHS England’s strategic incident director, instructs hospitals to
“review your critical care and high dependency capacity and consider how you could increase capacity and
the impact of doing so”.


There have been fears the NHS could be overwhelmed in a large-scale outbreak with doctors forced to
ration access to critical care.


The letter says: “To date Covid-19 has been managed as a high consequence infectious disease through our
specialist centres so we could learn as much as possible about the virus and of course the illness. It is now
appropriate to begin to manage some patients within wider infectious disease units and, in due course if the
number of cases continues to grow, we will need to use all acute units, for example through the cohorting of
patients.”


In light of the virus spreading around the world the letter said the NHS was now demanding all trusts
establish 24 hour, seven-day a week incident teams which will be overseen by regional and national teams
to coordinate the NHS response to any surge in cases.


Explaining the rationale for intensive care patients to be tested the letter said: “In recent days, new
Covid-19 infections have been diagnosed in intensive care units in a number of European countries, without
any epidemiological links to high-risk areas. Nosocomial [hospital] transmission has occurred in these units
affecting other patients and staff. It is essential that we detect cases admitted to intensive care at the earliest
opportunity.”


Trusts have been told to ensure staff have been trained and fitted for specialist equipment and it said any
member of staff who has to self-isolate as a result of fears they may be infected with the virus should get full-
pay. This includes temporary staff and sub-contractors.


The letter said hospitals needed to “consider the impact that a possible surge in medical patients might have
on services and stocks” but added there was no need for stockpiling by organisations which could make
shortages worse. It added: “Where possible, consider implementing alternative models such as remote
consultations for those patients who can be supported at home and review arrangements to support
vulnerable individuals in alternative settings, including in the community.”


It also said hospitals needed to begin discussions with local care providers such as care homes and social
care companies to ensure they will be able to cope with patients discharged earlier.


Prime minister Boris Johnson outlined the government’s national plan yesterday and it is understood
ministers are working on a new bill to give them emergency powers which will include giving border force
staff the power to detain individuals and require them to take a coronavirus test.


Helen Buckingham, Nuffield Trust director of strategy, said: “The plans set out by NHS England today are
a sensible response to the unfolding picture regarding coronavirus. With confirmed cases of the disease
likely to grow over the coming weeks, it is absolutely right to ensure that hospitals and community
providers are making plans to free up hospital beds and specialist staff for people who need them most. This
means looking at where patients can be treated remotely, ensuring that hospitals are set up to isolate and
treat patients, and ensuring that the most critically ill have access to the specialist help they may need.

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