Expect headlines about NHS staffing and beds to dominate over the next few weeks and months, for in times of pandemic medical capacity is all. In Wuhan, entire hospitals have had to be thrown up in weeks. And already in northern Italy some hospitals are “on the verge of collapse”, reports La Stampa, with 95 per cent of intensive care beds now occupied and more than 100 dead. The aim of the Government’s coronavirus strategy is to push back the onset of the encroaching UK epidemic into the warmer Spring months and then flatten its peak in a bid to help prevent the NHS from becoming overwhelmed. Half of all coronavirus cases in Britain are most likely to occur in just a three-week period, with 95 per cent of them over a nine-week period, England’s chief medical officer, Professor Chris Whitty, said yesterday. “Depending on how high the peak, this could be anywhere from a rather bad winter for the NHS to huge numbers, way overtopping the ability of the NHS realistically to put everyone in beds,” he said. There remains a good chance that the peak of the outbreak can be pushed back and flattened. The virus is moving fast but experts say it is not as swift or pervasive as an influenza outbreak, which would have lapped the globe by now. “It can be contained even once it has broken out as they have shown in Germany”, said David Heymann, a former assistant director-general of the World Health Organization (WHO).

Nevertheless NHS capacity, already tight, is likely to come under extreme pressure as the virus gets a grip and there are already signs of a move to rationing. The NHS website, for instance, advises that the symptoms of coronavirus are a “cough, a high temperature and shortness of breath”. But this isn't quite the whole story and may have the effect of curtailing calls to NHS 111. As the WHO says, “the most common symptoms of Covid-19 are fever, tiredness, and dry cough”. Difficulty breathing only occurs in more severe cases - something you don't want to realise too late for your own sake but also family and friends. The “planning principles” in the government’s coronavirus action plan put “dynamic risk assessments” of “potential health and other impacts” in the top slot. Minimising the “potential health impact … and reducing infection, illness and death,” comes second. There is nothing unreasonable here but it signals that the British government, like others, will balance the health impact of the outbreak with other priorities, economic and social. It is in the provision of hospital care and in particular the availability of critical care beds that the crunch is likely to be most keenly felt. And on this, the action plan remains oblique. “Clinicians may recommend a significantly different approach to admissions”, it says. “Some non-urgent care may be delayed to prioritise and triage delivery”. A document published by the John Hopkins Center for Health Security in the US is more direct. Entitled “What US hospitals should do now to prepare for a Covid-19 pandemic”, it calls for limited healthcare resources to be allocated “so as to do the greatest good for the greatest number”.

There should be “a process for triage of patients competing for limited resources, including admission, early discharge, and life support,” it says. “These decisions should not be made solely by one person”. We have a similar protocol developed after the 2009 swine flu pandemic. Known as the “Three Wise Men”, it is designed to give priority to those most likely to survive and recover in the event of a crunch on services. “If you can imagine the real worst-case scenarios where supply is massively outstripped by demand we would have to refuse to admit many people who would normally get ventilated”, one unnamed NHS doctor explained last week. “The Committee on Ethical Aspects of Pandemic Influenza developed Three Wise Men for that circumstance – everyone matters equally, but not everyone gets treatment equally – the goal is to minimise the harm the pandemic causes.” Might it really come to this in the UK? Much, perhaps all, will depend on the success or otherwise of the strategy to push back and flatten the curve of the epidemic. In Wuhan and Italy, where hospitals were caught on the hop and overwhelmed, the death rate is running at more than 3 per cent. Many readers will assume the NHS is in a better position but consider this: Italy has almost twice as many critical care beds per head of the population as us. They are at capacity now but just a few weeks ago only 60 per cent were in use. Critical care beds in NHS are already running at nearly 80 per cent occupancy - and the epidemic here has not even got going yet.