Carl Heneghan

Following the evidence for hospital admissions

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The recent warnings of exponential growth of Covid-19 cases, inevitably followed by a rise in hospital admissions, is one focus of the Government’s Covid messaging. Jeremy Hunt described this spike in admissions as a ‘wake-up call’ for the Government. But while this year the disease is newly identified, warnings of a winter crisis in the NHS occur annually. So should we be worried?

For 20 years, ‘influenza’ has been blamed for putting hospitals under pressure in winter. Now, this fear has been substituted by ‘Covid’. Yet both are one-track, one-pathogen scenarios, which ignores the reality that there are scores of different pathogens that cause respiratory infections across a community at different times of the year. As a consequence, cases of respiratory disease fluctuate throughout the year and so do related hospital admissions and, unfortunately, deaths. This is what gives rise to the seasonal effect where more people die in the winter compared to the summer.

However, causes of admission to hospital for acute respiratory infections are as varied as the pathogens causing them. Few have specific drugs to negate their impact, so we rely on general care and support measures and if there is superimposed bacterial infection, antibiotics. In severe cases of Covid-19, dexamethasone can be used to good effect in those on intensive care.

The question though is this: should we rely on dire warnings that we are heading in the ‘wrong direction’, or do we need to rely on modelling and other forms of predictions to fathom what lays ahead? Or is there an alternative way to look at the data in a context that can help the Government interpret what might happen next? Everyone in the northern hemisphere knows that with the onset of autumn acute respiratory infections go up and so do unplanned hospitalisations.

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