How the surge of the omicron variant caught the NHS off guard

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There are two types of healthcare that senior doctors and Whitehall officials like to talk about: health as it relates to each of us as individuals, and “population health” – an approach that aims to gradually lift the health of the entire nation.

In the first phase of the pandemic, before vaccines, we were all focused on the here and now. What will happen to me if I catch the virus? Is my PPE up to scratch? Are there enough oxygen canisters and ventilators to save those who fall seriously ill?

We worried because for many there was significant risk – a 2.3 per cent chance of death for a healthy male aged 60 who caught Covid in the first 12 months, for example.

But today as omicron sweeps the UK, it’s much less personal. The new variant is thought to be about three times milder than delta in terms of hospitalisation risk, but it is infecting at least three times as many people.

At an individual level, this is good news. For those of us who are healthy, jabbed and boosted the risks are now tiny. A milder virus means we can get on with our lives, or so we would like to think.

For politicians and hospital managers, however, omicron is a whole new kind of nightmare – and not one they planned for. 

The maths of a variant with reduced severity but increased transmissibility means they could face the same number of hospitalisations as before, perhaps more.

And with fears waning on an individual level, they can no longer rely on a collective societal effort to flatten the curve. With omicron, it seems, it’s every man, woman and child for themselves.

It is not just here. The variant’s speed has caught planners by surprise the world over. In several US states, hospitalisations and ICU admissions are worse than ever.

“The challenges the hospitals face, at least so far, are less about stockpiling equipment and more about staffing and contagion,” noted the New York Times.

Prof Tim Cook, an intensive care consultant in the South West, said the issues omicron posed in the NHS revolved around staffing, beds and basic logistics.

“There’s comforting news of omicron being less severe and leading to fewer hospitalisations and maybe having a shorter length of stay. And that’s all great,” he said.

“But if we’re getting to 200,000 cases a day, then even if half a per cent of those come into hospital, then we’re going to be overrun.”

He added: “Once you have a ward that is infected with Covid you have to separate it both physically and in staffing terms from the wards that don’t have Covid. And so it makes it much harder to run the hospital. You’re effectively running two hospitals within one.”

Many Covid hospital cases are “incidental”, but they too cause serious problems. They tend to occur in the oldest and sickest patients. This means people stay in hospital longer and “outcomes will not be very good”, said Prof Cook.

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