“The NHS is open, and there to help you as it always is,” Matt Hancock emphasised on 27 April in the government’s daily coronavirus briefing, as he announced the NHS was to restart vital services the following day.
“As the number of hospitalisations from coronavirus begins to fall, I can announce that, starting tomorrow, we will begin the restoration of other NHS services – starting with the most urgent, like cancer care and mental health support,” the Health Secretary said. He added that the exact scale and pace of the reintroduction will depend on the individual hospital.
It is an important nod to the fact that the pandemic is having a far greater impact on the health of the nation beyond those who directly fall ill from the virus. Doctors fear a ticking time-bomb in our health care system: the wider impact of cancelled operations, the huge drop in A&E attendance and patient reluctance to seek medical help with symptoms, including early signs of cancer and serious cardiac problems.
Ask any epidemiologist or statistician, and they will tell you that ” all cause mortality” – that is, total death rates – is the most important indicator of the true impact of a pandemic. The daily numbers of hospital deaths from coronavirus, although devastating and a partial indicator of the current state of the outbreak in the UK, don’t tell the full story. Rather, it is ONS figures which tell the full picture, albeit with a delay of days or weeks. These figures comprise the total number of all deaths registered in a given week: the total number of “extra deaths” above the mortality rate we would expect in normal times. As Chris Whitty emphasised in the press conference yesterday, “all cause mortality” is the real picture of the impact Covid-19 has had on the UK.
This is important, because a significant proportion of excess mortality during the pandemic isn’t directly attributed to Covid-19. We don’t have enough data to know whether this is down to under-reporting of the virus in care homes, or the impact that not going into hospital for non-coronavirus conditions is already having on mortality rates. It is probably a mixture of both.
But the message from the press conference yesterday was clear: the indirect impact of the virus is equally as important to mitigate as direct Covid-19 deaths. When history looks back at the devastating loss of life caused by this pandemic, the distinction between direct Covid-19 deaths and an increase in deaths from other causes will be largely unnecessary.
This is the difficult task Hancock faces in the coming weeks: reconciling the “stay at home” message (expected soon to be revised within government in favour of a different slogan) with the message that “the NHS is open”.
Common sense will tell you people haven’t stopped going into hospital with serious symptoms purely for the selfless reason that they don’t want to burden the NHS. People watch the news, and see stories of medical staff not being tested and forced to work with inadequate protective equipment, and fear that going into a hospital environment might not be entirely safe: a view compounded by the clear government message that the only way to stay completely safe from the virus is to stay within your own home.
The message that the NHS is open for business is an incredibly important one to prevent further unnecessary loss of life in this period. But it will need to be underpinned by an increase in public confidence that medical staff in hospitals are safe and that the risk of hospital transmission is low. In the end, it comes back to the main pressure on Hancock at the moment: the need to increase PPE supply, and increase testing.