Hospitalisation Rate For Adult Respiratory Conditions (part 2)

Lessons from an undisclosed NHS Trust

In order to understand this post you’ll need to digest part 1 then get the kettle on because we are going for a spin! We are going to set aside vaccines and study what happened to adult respiratory cases who were admitted to the emergency department without the benefit of vaccination over the period Jan – Sep 2021. By all accounts these poor souls should have been hammered by COVID, so we should expect to see elevated rates of hospitalisation for confirmed COVID admissions compared to the normal run of seasonal influenza, bacterial pneumonia, asthma etc. Except this is not the case.

In the slide below we see highly similar rates of hospitalisation for unvaccinated adult respiratory admissions regardless of COVID infection. Remarkably, during week 17 (w/b 24 Apr) and week 22 (w/b 29 May) the hospitalisation rate for COVID admissions drops to zero. This is billed as a super deadly disease folks, and these people didn’t have the benefit of the elixir!

What will be happening over this time is that the age profile of the unvaccinated cohort will be getting younger and younger, so we may expect to see lower and lower rates of hospitalisation. Except this is not the case. The non-COVID hospitalisation rate hovers around 0.40 (40%), with the COVID hospitalisation rate hovering around 0.45 (45%). We may make a case that hospitalisation rates for COVID are slightly higher at this point in time but there’s not going to be much in it, and certainly nothing indicative of anything far more deadly than the panoply of respiratory conditions people usually experience during late summer.

If COVID admissions are appearing in greater numbers at the front door then bed managers should see greater COVID bed use, but what we need to do here is make a distinction between bed use and case severity. The mainstream media are keen to interview surgeons, doctors and senior NHS managers talking about COVID bed use and the public - being logical - are going to confuse this with case severity simply because that is how it is portrayed [cut to flashing blue light]. Yet we can be given a bed for hernia repair and we can be given a bed for open heart surgery! The range for respiratory illness is no different, though experts talk as if everything in COVID world is utterly severe.

In terms of bed counts over the period Jan – Sep 2021 a total of 907 were needed for adult non-COVID respiratory admissions and 1,221 were needed for adult COVID respiratory admissions. NHS managers quite rightly should claim a 35% increase in bed use over normal respiratory illness. However, in terms of case severity the mean hospitalisation rate for unvaccinated adult non-COVID admissions was 0.44 (44%) and the mean hospitalisation rate for unvaccinated adult COVID admissions was 0.43 (43%), this difference failing to reach statistical difference (p=0.711).

More beds does not mean more severe!