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Five times Prof Kevin Fong broke down in tears in a nondescript hearing room in West London, while giving evidence to the Covid inquiry.
The 53-year-old has the kind of CV that makes you pay attention: a consultant anaesthetist in London who also works for the air ambulance service and specialises in space medicine.
In 2020, as Covid spread around the world, he was seconded to NHS England and sent out to the worst hit areas to support other medics.
We’ve long been told that hospitals were struggling to cope during the pandemic. In January 2021, then prime minister Boris Johnson warned the NHS was “under unprecedented pressure”.
But now many hours of testimony to the Covid inquiry this autumn is offering our clearest understanding yet of what was really going on at the height of the pandemic.
The inquiry restarts its live hearings this week with evidence from doctors and patient groups. Health ministers and senior NHS managers are also expected to appear before the end of the year.
I was at the inquiry the day Prof Fong calmly talked through more than 40 visits he led to intensive care units, his voice cracking at times.
What Prof Fong discovered at the hospitals he visited was something he said could not be found in the official NHS data or the main evening news bulletins at the time.
“It really was like nothing else I’ve ever seen,” he said.
“These people were used to seeing death but not on that scale, and not like that.”
In late 2020, for example, he was sent to a midsize district hospital somewhere in England that was “bursting at the seams”.
This was just as the second wave of Covid was hitting its peak. England was days away from its third national lockdown. The first vaccines were being rolled out but not yet in large numbers.
In that hospital, he found the intensive care unit, the overflow areas and the respiratory wards all full with Covid patients.
The previous night someone had died in an ambulance outside waiting to be admitted. The same thing had happened that morning.
The staff were “in total bits”. Some of the nurses were wearing adult nappies or using patient commodes because there wasn’t time for toilet breaks.
One told him: “It was overwhelming, the things we would normally do to help people didn’t work. It was too much.”
That night, Prof Fong and his team helped to transfer 17 critically ill patients to other NHS sites – an emergency measure unheard of outside the pandemic.
“It is the closest I have ever seen a hospital to being in a state of operational collapse,” he said.
“It was just a scene from hell.”
During the pandemic, hospitals cancelled much of their usual planned work.
On the face of it bed occupancy in England – that’s the total number of hospital beds taken up by all patients – did not hit more than 90% in January 2021, the peak of the largest Covid wave.
That’s above the 85% level considered safe but not any higher than a typical winter outside the pandemic.
At times, the impact on intensive care was so great that some units had to undergo “rapid depressurisation” with dozens of patients transferred out, sometimes over long distances, to other hospitals.
Before the pandemic, from December 2019 to February 2020, only 68 of these capacity transfers had taken place in England. Between December 2020 and February 2021, 2,152 were needed, either by road or air ambulance.
Often it was the most stable patients in smaller district hospitals who would be selected for transfer as – bluntly – they were the most likely to survive in a moving vehicle for several hours.
“But what that meant for the smaller units is that they were left with a cohort of patients who were most likely to die,” said Prof Fong.
“Those units would experience mortality rates in excess of 70% in some cases.”
In normal times between 15% and 20% of ICU patients die in hospital, according to the Faculty of Intensive Care Medicine.
Through the pandemic the NHS did continue to operate and, on a national basis, patients who really needed hospital treatment were not turned away.
But Prof Charlotte Summers, in her evidence, said staff are still “carrying the scars” of that time.
“You cannot see what we’ve seen, hear what we’ve heard, and do what we’ve had to do and be untouched by it,” she said.
“You cannot and be human. And we are very much human.”
Health services in all four UK nations started the pandemic with the number of beds in ICU and staffing levels well below average compared to other rich countries.
Five years on and there are still almost 130,000 job vacancies in the NHS across the UK. Sickness rates among the 1.5 million NHS employees in England are running well above pre-pandemic levels, with days lost to stress, anxiety and mental illness rising from 371,000 in May 2019 to 562,000 in May 2024.
All this comes as the health service struggles to recover from Covid with waiting lists for surgery and other planned treatments still hovering near record levels.
“We coped, but only just,” said Prof Summers and Dr Suntharalingam in their evidence to the inquiry.
“We would have failed if the pandemic had doubled for even one more week, or if a higher proportion of the NHS workforce had fallen sick.
“It is crucial to understand how very close we came to a catastrophic failure of the healthcare system.”
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