Children’s units in hospitals will be particularly vulnerable, researchers predict

The swine flu pandemic could cause a severe shortage of intensive care beds in hospitals, especially in children’s units, experts warned today.

More than double the present number of beds may be needed in some regions, while there could also be shortages of ventilators to help patients breathe.

Facilities for children were likely to become quickly exhausted, while hospitals could face massive extra demand, researchers said in the journal Anaesthesia. Hospitals in the south-east, south-west and east of England, as well as the east Midlands, were likely to be hardest hit.

The predictions came as a pregnant woman from Scotland, critically ill with swine flu, was flown for specialist treatment to Sweden because the five beds at the UK specialist centre for her condition in Leicester were full.

As Alan Hay, an expert in swine flu, suggested that the first wave in the UK may be passing its peak before returning this winter, specialists in intensive care and anaesthesia from the University of Cambridge, the Intensive Care Society and St George’s Healthcare NHS Trust in London said English hospitals might be unable to cope with the number of people who fell ill with swine flu.

At present, the government says 840 people are in hospital in England – 63 in intensive care. An estimated 100,000 people fell ill last week, double the previous week’s total.

The intensive care experts predicted London would have enough beds and ventilators but demand for beds could be 130% above supply in the South East Coast Strategic Health Authority area and 120% above supply in the south-west. Similar levels of demand could occur in the east Midlands and east of England. Across the whole of England, demand for beds could be 60% above numbers available. The government has insisted it can cancel non-emergency operations to free up beds for swine flu patients, but the experts did not believe this would be sufficient.

“Only 10% of critical care beds in England are in specialist paediatric units, but best estimates suggest 30% of patients requiring critical care will be children,” said their paper.

“Paediatric intensive care facilities are likely to be quickly exhausted and suggests that older children should be managed in adult critical care units to allow resource optimisation.”

Ari Ercole, from Cambridge University, who worked on the study, said the researchers recognised the pandemic was in its early stages. “However, based on figures provided by the 10 regional health authorities and using the Flusurge model developed by the Centres for Disease Control and Prevention in the US, we can see that hospitals would face a massive excess demand even if the pandemic lasted an optimistic 12 weeks.

“Paediatric intensive care facilities for children under 15 would be quickly exhausted, as they make up 10% of our current provision but could face 30% of the demand for pandemic related beds. Early experience of the present strain suggests that the attack rate is particularly high in the young and that this virus may severely compromise the immune system of people who contract it.”

The team behind today’s UK research calculated an average of 4.5 critical care beds per 100,000 people in England would be needed. In London, there are 7.5 per 100,000, 5.9 in the north-east, five in the north-west and 4.4 in Yorkshire and the Humber.

The lowest number of beds is in the south-east, which has three per 100,000 people. They said that, using numbers based on historical assumptions, “it has been shown that a flu epidemic could potentially overwhelm critical care bed and ventilator capacity in England”.

While extra beds could be made available by cancelling routine operations, “this would have important implications for ongoing acute and elective service provision”.

They said the total number of critical care beds in England currently stands at 2,030 adult beds and 265 for children.

An additional 1,607 adult high dependency beds are also available alongside 43 high dependency beds for children, which could be used to ventilate people.

“Nevertheless the calculations still show that even this number could be far too small to cope with demand.

“Additionally, since many intensive care units (and acute hospital beds) run at high occupancy, much of this capacity would not be available during a pandemic,” the paper said.

“Whilst regional variations in critical care provision exist, the data suggests that these are small and so inter-hospital transfer is unlikely to provide a solution to an overwhelming pandemic.”

Professor David Menon, one of the authors from the University of Cambridge, said the figures used in the research could fall on the conservative side.

It was possible that four times as many patients would be admitted to hospital as suggested, of whom about half would need intensive care.

He also said that between 10% and 50% of patients in intensive care with swine flu were suffering renal failure and requiring kidney support.

“If it’s 10% then we should be able to cope reasonably well but if it’s 50% then it would be a big task,” he said.

“We don’t have the equipment to deliver that level of support.”

In an accompanying editorial, Dr Jonathan Handy, a consultant at the Chelsea and Westminster hospital in London, said the predicted demand levels suggested immediate action was needed, from stockpiling supplies to looking at how medical students could play an active role in patient care.

A spokeswoman for the Department of Health said: “We can’t be certain how the current pandemic will develop, but we have to prepare for the reasonable worst case.

“As part of our preparations, guidance has been issued which contains information for primary and secondary care services in the UK on managing surge capacity and the prioritisation of services and patients during an influenza widespread outbreak.

“The guidance also identifies how maintaining an essential health service will be a community effort involving self care, support for those for whom hospital admission is not deemed appropriate, and supporting early discharge of patients from hospital.”