'Living with Covid' is wrecking the NHS - so where do we go from here?

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There were also warnings from the Royal College of Emergency Medicine that it is becoming "increasingly common" for patients waiting for beds to languish over 24 hours in A&E.

Even Health Secretary Humza Yousaf conceded that, for frontline staff, the last two weeks "have been the toughest in the pandemic so far".

In short, the NHS is paying the price for the freedoms which have seen normal life largely restored for the rest of us at the same time as the fastest-spreading strain of Covid yet took off.

We have reached the point where society as a whole can "live with" Covid thanks to vaccines which mean the disease is now less lethal than flu, even for the over-80s, but the sheer prevalence of the virus is still grinding the health service into a standstill.

Why?

Take care homes. As of Tuesday, 33% of adult care homes in Scotland had a current suspected Covid case - higher than at any point in the pandemic, and nearly double the pre-vaccination peak of 17%.

That has a knock-on effect for hospitals because care homes are closed to new admissions while an outbreak is ongoing.

READ MORE: Omicron BA.2 - how worried should we be?

Unsurprising then that, as of Wednesday, nearly 1,600 patients were delayed in hospital - meaning that roughly one in 10 beds is being occupied by someone ready to leave, but unable to be discharged.

Hospitals are also buckling under record numbers of Covid patients - over 2,300 now . Even if half to two thirds have mild or no symptoms and are in hospital for other reasons, they still need to be isolated in wards which are then closed to non-Covid admissions.

Hundreds of 'Covid hospital admissions' by the end of February were patients who caught the virus while in hospital

Yet even with infection controls, the more Covid patients there are in hospital the more nosocomial transmission there is: by the end of February, figures suggest that roughly 30% of "Covid hospital admissions" were actually people who had contracted the virus while in hospital.

If these patients are elderly, this will slow their recovery - once again meaning that a bed which might have been freed up is occupied much longer.

Then there is the impact of Covid on staffing.

A bed can only be filled if there are enough nurses and doctors to staff it, which is why the 3,240 Covid-related absences among medical, nursing and midwifery staff in particular is such a problem.

Covid-related absences among medical, nursing and midwifery NHS staff are back at levels seen during the first wave

Other than one week in January this year, the absence rate for this staff collective is higher now than at any time since the first wave of Covid back in 2020.

Finally, the people being admitted to hospital now are sicker, partly due to health deteriorating during the pandemic. The average length of stay is one day higher than the historic average, again squeezing bed availability.

All this explains why, downstream in A&E, emergency clinicians are tearing their hair out trying to find a bed for patients urgently requiring admission.

Weekly A&E attendances (25,600) are actually normal for the time of year and emergency admissions are around 1500-a-week lower now than they were in November, yet a record 747 people waited over 12 hours in A&E in the week to March 13. Pre-2020, this would rarely have exceeded double digits, except sometimes in winter.

The problem isn't demand at the front door; it is a chronic lack of beds on wards.

READ MORE: Glasgow father-of-three dies after 40-hour wait for ambulance

As long as this continues, ambulances will stack for hours outside overloaded A&E departments, with fewer emergency crews available to respond to 999 calls.

So what happens next?

There is some optimism that, if Scotland's Omicron BA.2 wave matches Denmark's, the virus will soon run out of people to infect. In Denmark, it took six weeks to fall from a daily peak of 54,000 confirmed cases to around 7000 now, and there is some evidence from wastewater surveillance that the spread of the virus in Scotland is slowing.

The BA.2 wave of Omicron in Denmark fell dramatically after peaking in mid-February

By the end of April and May, warmer weather should drive more people outdoors where transmission is unlikely.

But April/May is also a watershed for testing as universal access to free lateral flow kits comes to an end, PCR hubs close, and self-isolation is left to choice.

If fewer people know they are infected or stay home with symptoms, this could give the virus a new lease of life.

READ MORE: Fears for vulnerable as free LFDs set to be axed for unpaid carers 

On the other hand, policymakers are banking that increased use of Covid antivirals and the rollout of second boosters will keep people out of hospital.

So far over 56,000 of these top-up jags have been administered in Scotland, but 468,000 over-75s alone will need it.

Then there are questions over access to antivirals.

Charities warn that many clinically vulnerable people, such as those with Parkinson's, are not eligible, yet the unpaid carers looking after them will have to pay for their own LFDs from April 18 if they want to make sure they are not infected.

Modelling suggests that the number of Covid positive patients in hospital could still climb dramatically

Given that Scottish Government modelling indicates that as many as 7000 Covid positive patients could be in hospital by April 11, much worse could lie ahead.

Mr Yousaf says all four UK nations are "looking towards developing an exit strategy" for the NHS and "considering what a return to business as usual looks like going forward".

READ MORE: HALF of NHS acute beds could be taken up by Covid patients before Easter 

There are hints this might include reducing the twice weekly testing requirement for asymptomatic NHS and primary care staff, such as GPs, dentists and pharmacists, which might mean fewer Covid absences but a higher chance of infected staff being present in healthcare workplaces.

Reviews of physical distancing requirements in healthcare settings are also likely, and maybe even some relaxation of isolation protocols in certain circumstances to free up beds.

Like society, "living with Covid" for the NHS will necessitate a trade off of risks.