49,000 in Lothian may already have Covid-19 says report

AS many as 49,000 people in Lothian could already have been infected with coronavirus, health chiefs have said as they revealed they expect it to cost up to £125 million to cope with the pandemic in the region.

An NHS Lothian report warned that “total capacity will be under significant strain throughout April and probably beyond”.

But the health board stressed that the “modelling exercise” was a “worst case scenario” which would give the health board the best chance to ensure they were prepared to deal with the expected peak of the Coronavirus outbreak.

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They have already moved vital surgery to specialist and private facilities to free up resources, made plans to almost quadrupled intensive care provision and fast-tracked work to have skilled nurses redeployed to critical care, where there will be the greatest demand.

The report came as the latest figures, published by the Scottish Government at 2pm on Monday, revealed there were 577 confirmed Covid-19 cases in the Lothian area, and 3,961 across Scotland.

Nicola Sturgeon said there had been two more reported deaths in Scotland linked to the virus, bringing the total to 222 – but said this figure was “artificially low” and that numbers would likely rise.

The report notes that estimates of the spread of the virus and the number of people likely to require hospital treatment vary, but it refers to modelling by Imperial College London which has been influential in UK policy and suggested 81 per cent of the total population would become infected, with 4.4 per cent hospitalised and 30 per cent of those hospitalised population needing intensive care.

For Lothian that would translate into approximately 730,000 people infected, 32,000 hospitalised and 9,600 in intensive care.

It continues: “Estimates of the total number of infections in the community vary, but the most recent estimate is from Imperial College London, which estimates that on March 28 somewhere between 1.2 per cent and 5.4 per cent of the population of the UK are currently infected. For Lothian this would equate to between roughly 11,000 and 49,000 residents.”

The report, to be considered by Lothian NHS board tomorrow, says: “We can expect our inpatient capacity to rapidly fill with Covid-19 patients and possible Covid-19 patients.

“Our models are still evolving and such is the rate of change that we cannot be certain over an extended timescale, but it is clear that our total capacity will be under significant strain throughout April and probably beyond.”

The report says estimates of the bill for dealing with coronavirus produced a range of costs between £53m and £125m, with £80m the “most likely” figure.

The report also warns that poor personal protection equipment (PPE) is a major risk, and says a critical supplies group was set up to look at PPE supply and give guidance to staff.

But it adds: “This work has identified a very clear and very high risk associated with the distribution and quality of the PPE provided from the national stockpile.

“It should be noted that this issue has been escalated to the Director-General of the NHS in Scotland, and that this represents the single highest risk to our ability to deliver key actions such as the expansion of critical care.”

The report also reveals NHS Lothian’s executive team is being supported by two liaison officers from the Royal Marines and British Army.

All routine elective inpatient and daycase treatments were cancelled from March 16 – a total of 2,214 appointments up to the end of April. And face-to-face outpatient appointments were also cancelled – a total of 40,333 from mid-March to the end of this month.

Urgent cardiac surgery is now being carried out at the Golden Jubilee National Hospital, Scotland’s specialist heart centre in Clydebank.

And urgent elective surgery for breast, colorectal, and urological cancers have been transferred to use private sector facilities.

Meanwhile, patients who call 111 believing they have coronavirus symptoms and are judged to require face-to-face contact are being sent to designated Covid clinics at the Royal Victoria Building on the Western General Hospital campus, East Lothian Community Hospital and new facilities in Midlothian and West Lothian.

NHS Lothian has made plans to expand intensive care provision from 29 beds to 113, using spaces freed up by reconfiguring wards at the region’s three acute hospitals – the Royal Infirmary, Western General and St John’s Hospital, Livingston.

The health board has also established a rapid training programme for ward nurses who may be redeployed to critical care, and additional free parking for staff has been secured at the acute hospital sites, with local hotels and

Fettes College making parking space available for the Western General and George Watson’s College making its grounds available to staff at the Royal Edinburgh Hospital.

NHS Lothian has also set up a helpline to provide both practical and psychological support to staff.

The report says discussions have taken place with Scottish Government colleagues on NHS Lothian’s mobilisation plan. But it adds that as of April 2, no approval had been given formally for the financial support required for some of the plans.

NHS Lothian stressed that the report had been created through modelling for resilience planning, and that it did not mean they expected these numbers of cases.And they highlighted the fact that “in resilience planning you always take the worst case scenario, and plan for that”, something which would allow the health board to be fully prepared for the challenges ahead.

Lothian MSP and Conservative health spokesman Miles Briggs said coronavirus was adding to a host of existing problems facing NHS Lothian.

He said: “It is very concerning that NHS Lothian is going to be under such significant strain over the next few months.

“NHS Lothian were already facing significant challenges in delivering service before the coronavirus outbreak and are now facing even greater challenges.