Scotland is in the “calm before the storm” as a predicted surge in coronavirus cases could be just days away, a top emergency doctor says.

Dr David Chung, who is Vice President of the Royal College of Emergency Medicine, warns medics will have to make tough decisions about “the best way to use critical care places” when the virus escalates.

“We are going to be deciding on a ceiling of care very quickly. Who are you going to put on a mechanical ventilator, considering that we have [currently] properly only got mechanical ventilators for, theoretically, if you didn’t bring age into it, 20% of people who need them?

“We are going to have to think about what is going to be the best way to use critical care places. This is very difficult; people might not be prepared to accept that,” he said.

But he said the experience of working in under-pressure A&E departments meant emergency medics were adept at making these choices and doing the “best for the most”.

Speaking to healthandcare.scot, Dr Chung warned Scotland could be just days away from a rapid increase in cases akin to what is currently happening in London.

Nearly half of the 5,683 confirmed cases in the UK are in London, where one hospital had to declare a major incident after it ran out of intensive care beds. 110 of the 283 UK deaths have been in the capital.

Dr Chung, who works at Crosshouse hospital, said the virus would be like a slow motion “major incident”.

“The emergency department at the moment is in the position of the calm before the storm, we all know it’s coming.

“We all know it’s coming and we know it’s coming because in London it is here. We think London’s maybe about, God willing, six or seven days ahead – maybe even three days, who knows.

“But we had the vanguard of the patients who are Covid positive, we’ve had Covid deaths unfortunately, so we know it’s definitely in the post.”

Once it hits, he said, “it’s not going to be in two weeks or in six weeks, realistically it’s going to be a long haul and we will have to change how we do things.

“It’s very challenging about how we provide services.”

Dr Chung said emergency doctors’ training and experience leaves them well-placed to assess patients rapidly.

“It’s the ability to be able to see patients rapidly and work out where they need to go, take the difficult decisions, which is what we do all the time, on limited data in suboptimal conditions.

“Let’s face facts, many emergency departments have been working in overcrowded and under-resourced conditions for the past few years, and we are used to that.

“It’s about triage – you know you’re overwhelmed, that’s the definition of a major incident, where your capacity is exceeded by demand. That’s all going to happen. Within that you realise the normal rules will not apply which means you have to sort through the patients to make sure you can do the best for the most.

Dr Chung raised fears about Scotland mirroring what is happening in Italy, where younger people who became sick could not be admitted to already full intensive care wards.

“What we are hoping we won’t see, but we may well see, is cohorts of younger people, because we don’t have the equipment in terms of the ventilators and the staff actually able to use it, because it’s not just about machines.

“If you want good outcomes you need people who know how to use them in all the other things that go with their care.”

 

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