Written Evidence Submitted by Matthias Schmid, Chair of NHSE Clinical Reference Group Infectious Diseases
(CLL0088)
My name is, Matthias Schmid. I am a consultant physician and the Head of Department of Infection & Tropical Medicine at Newcastle Hospitals NHS FT.
I am also the national chair for the NHSE specialist commissioning Clinical Reference Group for Infectious Diseases.
I am leading the Newcastle HCID unit, which is one of initially 4 (now 5) centres within England, supporting the whole of UK for airborne High Consequence infectious diseases. I am also the lead for the Trexler unit, which is one of 2 units within the UK commissioned to look after patients with viral haemorrhagic fevers like Ebola.
I was the clinician looking after the first 2 patients acquiring Covid-19 in the UK.
The evidence submitted has been evolving over the last 11 months and focuses on some of the major issues.
Whilst the NHS has a fantastic EPRR response team, the preparedness had been eroded over the preceding years and investments into certain areas had not taken place including lacking investments in levels of PPE for both hospital and community.
The airborne HCID network is a commissioned service for England which was created to deal with serious and rare infections that occur rarely. There were initially 4 units (Guys&StThomas, Royal Free, Liverpool and Newcastle). Sheffield was added in March 2020.
The network was asked in January 2020 to be the front line receiving unit for nCov as it was originally called because of the capacity to safely isolate with safe transport mechanisms in place.
It became clear very early on that in order to be able to do this our bed capacity and laboratory capacity needed to be improved/upgraded. Indeed the network capacity went from 8 beds to around 20 beds and eventually to around 40-50 beds capacity at short notice with either no or very little additional support especially financially.
Centralised testing required transport of samples to Colindale and waiting for results which took in the region of around 48 hours at great expense.
All HCID units should have received central allocation of funds to rapidly have bed capacity, staffing and testing increased. NHS specialised commissioning services did their upmost to support but this was of a developing nature that should have attracted immediate support. Indeed the first patients arrived in Newcastle on the day the Brexit announcement was made and it was clear that this developing problem was bigger than anybody estimated. The warning signs had occurred when Germany and USA reported their first cases 1-2 weeks earlier and the Chinese numbers became much larger.
As the clinician who looked after those first patients in the UK I felt that any response in future requires an improved network made up of different layers:
First the existing HCID units need to be enhanced by having immediate access to the most modern testing/laboratory facilities and in addition they need to have the staffing to sustain prolonged management. PHE, NHSE EPRR, NHS, clinical teams, logistics and waste need to work closely together. This requires further investment into those units.
However it is also clear that these units have a function of regional/national leadership and they should be able to have a network of specialist ID units strategically across the country who work as an additional buffer to support a trace/isolate/treat capacity.
The units must be free of interference from politicians as politicians were interfering with discharge policies early on which were not based on the clinical evidence.
Having such a system of HCID and specialist ID units within a layered network would be a good use of resources as they would in future be an active network that could lead to a better control of potentially future emerging infections with pandemic or at least endemic proportions.
This is part of the first point, in the initial phase there was a rigorous isolate/contact trace/test carried out. This was abandoned as soon as we did not have capacity to test and were overwhelmed.
This was too early abandoned and resources should have been put in place at that time early on to have a joined up isolate/track/test in place which is regionally organised and feeds into national bodies. Spending money without a cohert plan was a wasteful exercise which led to initially complete split between NHS and the private testing created.
As hospital capacities were overwhelmed resources were given to hospital sector but as ever delays in developing testing everywhere meant that we didn’t know what happened and hospitals quickly became overwhelmed.
We knew that travel from other countries not just China became rapidly a risk factor and the half-term holidays were a main cause for returning travellers from European skiing holidays.
All predictions suggested a 2nd wave yet delays, indecisions and inconsistent planning of testing, and how hospitals could build up resilience in preparation have lead to a response which is whilst better than in 1st wave it is now making the NHS force very tired.
Better support, more short term funding/training of staff to work in NHS should have been made available to stem the known issue of fatigue and understaffing due to Covid exposure/disease
Covid-19 is a new disease. We are still learning. “Long”-Covid, post-covid, risks of infections, at-risk-groups, vaccine research, continuation of infection control and antibiotic stewardship are important factors to be included in future. A lot of investment has been made into ITU and respiratory support but infectious diseases which looks at patients holistically, which looks at social and economic factors as well as risk factors both acquired and genetically is a specialty which has not received the accolades. Infectious diseases combines laboratory diagnostics, holistic management of patients, infection control and antibiotic stewardship both within hospital and community and is well integrated to work with public health specialists and epidemiologists. Developing this across the NHS will improve the health of the nation and our preparedness to respond to pandemic threats in future.
(November 2020)