Covid 19 – update for Vascular Society members – 28/12/20
29 December 2020
The Vascular Society Executive makes the following statement to aid members making difficult decisions during these exceptional working conditions:
- The second CV-19 wave continues. Today, a further 41,385 positive cases were identified in the UK which is a 26% week-on-week increase. Cases are also increasing in the Republic of Ireland where national restrictions now apply.
- Despite the numbers of hospital admissions and deaths not being accurate over the holiday season, we know from the first wave that there is a 2 week lag between testing positive and a proportion requiring hospital admission and a further 2 week lag to the need for critical care or death in some.
- As stated by Dr Katherine Henderson (President of the Royal College of Emergency Medicine) today – the second wave is different. She believes that hospitals may be more stretched in this wave for a number of reasons:
- other Winter pressures
- continuation of some elective services
- better survival rates meaning increased lengths of stay.
- As before, there is geographical variation and rates are increasing in some areas, but have already plateaued in others which means that it would be impossible to mandate a single vascular management policy across the country. It is clear that in some areas (eg South East Wales), hospitals are already at capacity.
- However, it seems prudent that a number of actions are addressed immediately:
- prioritise all patients along RCS guidelines (P1-P4)
- review staffing to ensure rotas are covered
- ensure the well-being of trainees and discourage redeployment unless absolutely vital
- encourage staff (including trainees) to undergo vaccination when available
- lobby Trusts for vaccination of patients awaiting AAA surgery when available locally. I have already written (supported by CRG/GIRFT) to PHE to advocate this.
- In terms of prioritisation, P1 cases will continue to be treated as before. From a vascular perspective, this would include symptomatic/leaking aneurysms, threatened limbs and diabetic foot sepsis. It is advised that purely elective (P3/P4) cases are deferred until the situation has stabilised. More urgent (P2) cases are more subjective and I believe will depend on local circumstances. As stated previously, this group includes patients with symptomatic carotid stenosis, rest pain and large AAAs. Decisions of when/if to intervene must be based on local circumstances taking in to account the following:
- newer Covid strains may be more transmissible
- data from the COVER study revealed vascular patients contracting Covid had a 40% mortality in the first wave
- there is now an option to delay care (where appropriate) to await vaccination
- intervention under surge conditions may not offer patients the optimum outcome bearing in mind changes to anaesthetic staffing and critical care facilities.
- It will be for NAAASP to decide as to whether to suspend AAA screening at a national level. As before, it is likely that the 2 and 8 week targets will remain in place, with the proviso that exception reporting will apply in cases where the local Covid burden means it is unsafe to intervene on such patients within the normal timeframe.
- Please continue to support the COVER study. Latest updates can be seen at https://vascular-research.net/projects/cover-study-covid-19-vascular-service-study/
The VS Executive wishes to offer support to any vascular services that are struggling during this difficult time. There is acceptance that under exceptional circumstances, some patients may need to be transferred to other hospitals with more capacity and where possible this should be done within local networks. Under such extreme circumstances, if individual advice is needed please e mail email@example.com which will allow access to the professional opinion of the VS Executive for support. The VS is not indemnified as an entity and any advice is on a holistic professional basis rather than being legally-binding.
President, Vascular Society Great Britain and Ireland