Already, there are signs that things may not look so dire as originally predicted.
The results of five studies published last week – three of which were British – point in the same direction: Omicron may be less deadly than previous variants.
Of course, the concern here is what happens in the next few weeks at hospitals. Even if a small percentage of the 120,000 plus daily Covid cases become sick enough to need intensive treatment, that’s still a very large number – perhaps large enough to overwhelm the NHS.
Some are still forecasting a ‘tidal wave’ of hospital cases which, according to reports, have already begun to swamp some NHS wards.
Health chiefs are yet to rule out Government scientists’ bleak predictions of 10,000 Covid-19 hospitalisations a day by the end of January, and 6,000 daily deaths.
Yet speaking to The Mail on Sunday, some of the UK’s leading hospital medics remain optimistic – and insist predictions of January 2020 levels of disaster are unlikely to come to fruition.
It is clear that no matter how dire the hospital situation gets, there is little chance of it ever being anything like what happened in January 2020 and February 2021. Why?
Speaking to The Mail on Sunday, some of the UK’s leading hospital medics remain optimistic – and insist predictions of January 2020 levels of disaster are unlikely to come to fruition
It’s all thanks to a quiet revolution that has been taking place in hospitals across the country, with top medics joining forces to uncover groundbreaking treatments which have rescued thousands of the sickest Covid-19 patients.
Clinical studies like the RECOVERY trial which recruited over 45,000 NHS patients from around the globe since the outbreak of the pandemic have shown that some drugs can save thousands of lives, and significantly reduce hospital stay times.
Dr David Strain, Covid lead at the Royal Devon and Exeter NHS Foundation Trust, told The Mail on Sunday: ‘We’ve got an army of brilliant treatments now, which means not only are fewer people dying of this disease but patients are also being discharged earlier.’
It’s not just medicines: doctors and nurses say they understand Covid better than ever before. Since 18 months, many have been caring for virus patients daily and are now intimately familiar with how it affects them.
Is Omicron more ‘catchy’ but ‘less severe’ than other variants?
Researchers at Imperial College London discovered that Omicron infected patients were 45% less likely than people infected from the Delta virus. University of Edinburgh researchers also found that Omicron could reduce the likelihood of needing hospital care by up to 68%.
Research published Thursday by the UK Health Security Agency showed that the reduction in risk was closer to 70%.
Hospital clinicians spoke to the newspaper and also tentatively agreed with the positive picture depicted in the studies.
Experts believe that drugs such as those in the RECOVERY trial have saved thousands of lives. They also significantly reduced hospital stays.
Dr Ben Killingley, an acute medicine and infectious diseases consultant at University College London Hospital added: ‘It is nothing like where we were last Christmas.
‘There is no doubt that lots and lots of people are being infected, but so far that’s not translating into the number of admissions we’d expect. And we haven’t yet seen much of an increase of people being admitted to intensive care.’
One doctor at Barts Health NHS Trust in London says: ‘We have several cases of Omicron, including a cancer patient, but none of them are in intensive care or require ventilation.’
In London, Covid-19 patients are the highest in the city, there has been a decline in the number of intensive care patients over the last week.
Hospitalisations in the capital are rising – by roughly 30 per cent a week – but data published showed patients admitted to hospital with Omicron were 60 per cent less likely than those with the Delta variant to be kept in for more than a day.
Dr Killingley, who also sits on the Government’s virus advisory group NERVTAG, says: ‘The big difference now is that more people are vaccinated. This, along with data suggesting Omicron is milder, means it’s likely we’ll avoid the trauma of having to switch off services such as cancer to focus on Covid. I don’t think we will be in a position where intensive care wards are overflowing, either.’
It is possible that the situation may shift. UK Health Security Agency research found that the effectiveness of boosters diminishes after 10 weeks. For some it may only be 35% effective.
We have outlined why Covid may be a concern if you are already very sick.
Diabetes drugs and statins are successful
British hospitals are reporting that a variety of Covid therapies have already reduced deaths by half.
But experts are most excited about what is in store for 2022 – yet more groundbreaking medicines that are arriving imminently.
Wendy was saved by an arthritis drug trial, even though she had to face the terror of having to use a ventilator.
Wendy Coleman (63), from Derbyshire, was one of the first people to be treated with the immune suppressing drug tocilizumab for severe Covid-19.
In April 2020, the virus was contracted by the financial executive while he was being treated at a hospital for a fractured leg.
A week after testing positive, Wendy’s oxygen levels fell sharply.
Wendy Coleman, 63, of Derbyshire is pictured here with Clare her daughter
‘They were giving me oxygen through a mask but it wasn’t helping,’ says the mother-of-two.
‘I was worried that if they put me under to go on the ventilator, I wouldn’t wake up again.’
The Recovery Trial Team visited Wendy to test new treatments.
‘They asked if I wanted to go on to a trial, but warned that they didn’t know if it would work.’
Over a 24-hour period, Wendy received two intravenous infusions of the arthritis drug tocilizumab – which dampens the body’s immune response to Covid and she soon began to stabilise.
Nearly 18 months on, and with tocilizumab now given to thousands of NHS patients every month, Wendy is ‘95 per cent recovered.’ ‘I’ve got plenty of energy back now,’ she says
Some of the UK’s experts in acute medicine have told The Mail on Sunday of medicines showing promise which could be offered to thousands of hospital patients within a matter of months.
Professor Anthony Gordon of Imperial College London, who is chief investigator in a major international trial that evaluated Covid treatments within 300 hospitals, stated one such medication is the common-heart drug statins.
The daily pill, which is already prescribed to millions of Britons to help lower cholesterol, reduces inflammation in blood vessels and blood clotting – which are two of the most common, severe complications from Covid infection.
These serious outcomes were less likely in a University of California San Diego School of Medicine study of 10,000 patients, published July. It was found that statins reduced the in-hospital mortality rate from Covid by 31%.
Professor Gordon says that statins will be available to Covid patients in hospital right away as part of a medical study. Results are expected to follow within a year.
This treatment may be possible if the trial is successful. ‘Statins are cheap and easy to access, so they benefit a large group of patients if they’re found to be effective against Covid,’ says Prof Gordon.
Some other treatments may be available even quicker, such as within weeks. The University of Oxford doctors have experimented with increasing the doses of a steroid that is commonly prescribed to Covid patients who are in urgent need of more oxygen. This steroid, dexamethasone, has been widely used by Covid patients.
The drug works by dampening down the body’s immune system, reducing the inflammation in the lungs that restricts oxygen intake.
Doctors believe that current doses reduce death by about a third. However, higher doses could lead to more fatalities.
South African Omicron-related patients are using high doses of Omicron on a trial basis. Experts expect positive outcomes.
Professor Martin Landray from the University of Oxford, who leads the UK’s Recovery trial, says: ‘When you study a drug, the first thing you want to know is whether it works or not.
‘We have had great results with dexamethasone, so it’s possible we may see even better outcomes if we push up the dose a bit.’
It is expected that the Recovery trial will also publish data this year regarding the effectiveness of a diabetic drug against Covid.
Empagliflozin – a routine treatment for type 2 diabetes – reduces the amount of glucose absorbed by the body, which is then excreted into the urine instead.
This process, according to scientists, can reduce inflammation in your lungs and improve blood vessel function. It also increases blood oxygen levels.
NHS trials started in July. A similar drug, dapagliflozin was also tested in separate trials. It has been shown to lower the risks of death and organ failure in Covid patients.
All hospitals offer treatment
While pharmaceutical companies are investing millions in developing new drugs, doctors feel that two of this year’s most promising treatments were available already at many hospitals throughout the country.
Sarilumab and Tocilizumab are common treatments for arthritis. However, studies show that they may be able to significantly increase survival rates in those who have been severely ill by Covid.
Both medications reduce the spread of cytokine-cells in the body. These are inflammatory cells released by your immune system when you feel threatened.
Covid may trigger what’s known as a Cytokine Storm, when the immune system reacts too strongly and releases too many cytokine cells, which could lead to organ failure.
According to NHS recent studies, sarilumab or tocilizumab could be used in conjunction with other immune-suppressing therapies such as steroids to reduce the deaths of patients who received oxygen. However, they were able to decrease mortality by almost a third for patients receiving oxygen and nearly 50% for those who required mechanical ventilation.
According to NHS recent studies, sarilumab or tocilizumab could be used in conjunction with other immune-suppressing therapies such as steroids to reduce the deaths of patients who received oxygen. However, they were able to decrease mortality by almost a third for patients receiving standard treatments like steroids.
These treatments have been widely utilized across the NHS since then.
‘We use these drugs regularly and they have a significant benefit,’ says Dr Ron Daniels, an intensive care consultant at University Hospitals Birmingham.
‘The figures are clear: more and more people who go on to ventilators with Covid-19 are surviving.’
Best of all, Prof Landray says there is ‘no reason at all’ to believe tocilizumab and sarilumab would be less effective against the Omicron variant.
He adds: ‘The challenge in the face of big wave of admissions however, would be a huge surge of demand for these drugs. It’s still not clear whether our supply will hold up.’
Helping hands when the jabs don’t work
Most doctors worry about the health of patients with health problems that could make vaccines less effective.
It is estimated that more than half a million Britons won’t mount a strong immune response after three or even four jabs – most of whom are suffering from conditions such as blood cancer and organ failure.
These patients are the most susceptible to become seriously ill at hospital, according to doctors.
Doctors had only one drug that was effective for treating these patients. Ronapreve can be administered intravenously as an intravenous drip. It works by searching for Covid cells, and then destroying them. Pictured: Nurse working on critical patient at King’s College Hospital in London
Doctors had only one drug that was effective for treating these patients. Ronapreve can be administered intravenously as an intravenous drug. It works by searching for Covid cells, and then destroying them.
After data showing it could cut deaths by up to 70%, it was made available for NHS patients in September. However, studies over the last few weeks have revealed it’s far less effective against Omicron.
However, there are some positive developments. The NHS had announced two weeks ago that it would grant access to new drugs for immunosuppressed patients. This drug is both effective against Omicron and the Delta variant.
In studies, Sotrovimab was shown to tightly bind Omicron. If given in time, it can lower the chance of high-risk patients dying or being hospitalized by as much as 85 percent.
The drug was originally only available in small quantities on trial, but health chiefs now want to accelerate its rollout.
Dr Strain says: ‘Prior to Omicron, my team were expecting we’d have enough of this treatment for perhaps two to three Covid-19 patients a week. But now, we’ll be able to treat as many as 30.’
A breakthrough has been made in the search for medicines that can be used to prevent patients who are extremely vulnerable from needing to visit hospitals.
Two weeks ago, the health authorities approved the use of an antiviral drug known as molnupiravir in this population of hundreds of thousands.
It is recommended that the pill be taken within 12 hours of infection for five days. This has been proven to decrease hospitalisations by one-third.
The NHS has reached out to eligible patients over the last two weeks. They will send PCR tests before January 1.
If symptoms develop, the patient will be instructed to perform PCR testing. A worker from NHS will then contact them and arrange delivery of molnupiravir at their residence within a few days.
Better yet, another similar drug is soon to come on stream – Paxlovid, created by vaccine makers Pfizer. Experts believe it will be just as effective against Omicron and reduce the likelihood of being admitted to hospital for vulnerable patients.
Last week, the Government revealed that 2.5 million doses had been purchased. But it still needs to go through rigorous testing before approval by UK authorities.
VENTILATORS ARE VERY IMPORTANT TO FEWER PATIENTS
Covid-19 patients were afraid to be put on ventilators in 2020.
The figures were stark: 50 per cent of those who require mechanical ventilation – involving a medically induced coma and a procedure to insert a tube into the throat – do not come out of hospital alive. However, doctors now believe that the situation is vastly improved.
A less invasive option is offered to patients who are more seriously ill. Continuous positive airway pressure (CPAP) pushes a stream of a concentrated air-oxygen blend into the nose and mouth. This keeps the airways open, increasing oxygen intake and keeping the patient’s airways open.
Throughout the entire treatment, patients remain alert.
Dr Daniels says: ‘This is an especially good option for frail patients for whom ventilation could be risky.’
The results of a large trial that took place in August found that CPAP significantly reduced the chance of needing more intense treatments such as mechanical ventilation.
The results of a large trial that took place in August showed that CPAP decreased the chance of needing more intense treatments such as mechanical ventilation, by ten percent.
Another study found that the machines can be used earlier in hospitalisation to save up to 20% of the seriously ill Covid patients.
Experts say that the results for those few patients who need mechanical ventilation are generally better than the ones that do not.
Dr Daniels says: ‘There’s lots of different modes on a ventilator, and some work better with Covid-19 patients than others.’
A mode known as airway pressure relief ventilation has been shown to be especially effective for Covid patients in improving oxygen levels and clearing harmful carbon dioxide.
This happens by infusing the lungs for prolonged periods with oxygen-rich, oxygen-rich air, which then inflates fluid-filled sacs, making them splintery and drain.
Dr Daniels adds: ‘Ventilators is one of the areas where we really have learned a lot.’
As for the devastating shortages of oxygen which hospitals battled last spring, Dr Strain says it’s unlikely to be a problem this time around: ‘At the beginning we were throwing as much oxygen as possible at patients. Now we realise there’s a limit to how much is helpful, so we now give specific quantities and we see better outcomes.’
INFECTIONS ARE UNDER CONTROL IN HOSPITALS
One of the most important developments in recent years has been to find new ways to prevent Covid from spreading in hospitals.
A shocking amount of people were hospitalized for non-Covid-related reasons at the start of the epidemic and contracted the virus, eventually resulting in their death.
The Mail on Sunday, November 2013 was the first newspaper to alert the public about the issue.
Our investigations revealed that one-tenth of all Covid deaths between March 2019 and August 2020 in NHS hospitals were caused by patients with the virus.
According to insiders, The Mail was told Sunday by The Mail that staff in healthcare were frequently seen incorrectly wearing PPE. They failed to clean their hands or ensure patients were covered while they moved between wards.
Today, however, it is much less common to get hospital-acquired infections thanks to many factors such as mini-wards that are infection-free, improved understanding between staff, and vaccinations.
Before Omicron’s arrival, at the beginning of November, only seven percent of Covid hospitalized patients were infected. Photo: This is a nurse wearing full-body protective equipment at King’s College Hospital in south east London.
Before Omicron’s arrival, there was a drop in the percentage of Covid-infected patients admitted to hospital at the beginning of November.
The most important change has been an increase in PPE. Most healthcare professionals have swapped in their disposable surgical masks to FFP3 masks, which are specialised face covers that filter out harmful radiation.
They are tight-fitting, multilayered and provide the best protection against viruses than other surgical masks.
A University of Cambridge study published in July found these masks provided hospital staff with ‘most likely 100 per cent’ protection against infection on wards.
Study author Chris Illingworth, an infectious diseases expert, wrote: ‘Once FFP3 masks were introduced, the number of cases attributed to exposure on Covid-19 wards dropped dramatically – in fact, our model suggests FFP3 respirators may have cut ward-based infection to zero.’
There have been other measures that made a significant difference. Dr Killingley thinks that another important advance was faster testing.
He says: ‘Previously we would have to wait two to three days to find out whether a patient or member of staff had Covid, and in that time they could mix with others in the hospital and potentially pass on the disease.
‘Now we know within hours, and during that time we make sure they do not mix.’
Ministers, according to some reports are monitoring hospitalizations in London. A two-week lockdown is being imposed on those who exceed 400 daily.
Some hospitals have been especially innovative, creating ‘mini-hospitals’ to segregate those going in for treatment, keeping them away from Covid patients on wards.
Croydon University Hospital in South London, for instance, created what it called the ‘Elective Centre’, with its own entrance and separate team of hospital staff.
Although some Covid-free clinics were temporarily closed after Covid cases increased following an increase in vaccination, experts believe that these centres could be easily reopened.
Some doctors are worried that Omicron, a highly contagious Omicron variant will cause an increase in hospital-acquired illnesses.
This has been confirmed in some hospitals in London. Even so, doctors are confident we won’t see the shockingly high figures of 2020 again.
‘It’s expected that the number of infections picked up in hospitals will rise, simply because Omicron is so infectious,’ says Dr Strain. ‘But we are much better prepared this time round and have options which we know are effective for limiting spread.
‘We have proper masks now, and we’re testing ourselves and the patients constantly.’
COVID EXPERTS ARE NURSES AND DOCTORS NOW
Not only do healthcare workers know exactly what to do to stop infections spreading among patients, they know exactly what to do when disaster strikes – and, crucially, when to act.
‘When you treat the same disease, day in, day out, for 18 months, you begin to get a sixth sense for it,’ says Dr Strain.
‘Patients never crash [when their health suddenly deteriorates]There are other options available than intensive care. Our staff can identify when patients need additional intensive treatment, before things get very bad.
‘Before, often by the time we’d taken patients to ICU for monitoring and intensive oxygen treatment, it’d be too late. Now we’ve almost become Covid experts.’
Experts believe that no other country has had the same success as Britain. Pictured: Boris Johnson is wearing a mask while visiting Nissan’s Sunderland facility in July
Dr Killingley agrees: ‘Over time we’ve become much more confident treating seriously sick Covid patients. Clinicians feel more comfortable making calls about when a patient needs to go on to a ventilator, and timing can often be the difference between life and death.’
The biggest challenge doctors face now isn’t necessarily Covid per se, but the number of staff available to treat patients when they do arrive in hospital.
YouGov conducted a poll in April and found that 25% thought of quitting their jobs due to stress related to the pandemic.
Dr Killingley says: ‘Staff wellbeing has taking a battering in the past 18 months, so looking after them needs to be a top priority. The main worry is that, if we are sent back into emergency mode, we’ll start losing even more vital staff as the level of burnout increases further.’
Professor Landray believes that staff retention is essential for the UK’s ability to remain a leader in new Covid treatment development.
He adds: ‘We now have a number of drugs we can use to combat this disease thanks to trials completed in British hospitals, with the help of committed NHS staff who dedicate extra time to helping out with studies. It’s made a huge difference and, as a result, hospitals are in a much better position than they were a year ago.
‘Nowhere else in the world has achieved anything close to that – not the World Health Organisation, not the US or China. And that’s because we, unlike other countries, have our NHS.’