well joining me now via the Internet is
Hugh Montgomery who's professor of
intensive care medicine at University
College London professor we've seen the
highest UK deaths in a single day do you
fear that we're heading for the kind of
scale of suffering that we've seen in
Italy regrettably the answer has to be
yes and the reason for that is the
simple mathematics of doubling and this
has been explained before but if you
assume the worst case that every person
with the disease can infect three more
by the time each of those is infected
people and gone out to ninth or tenth
cycle
you're knocking somewhere in the region
of upwards of fifty five sixty thousand
people infected and people were socially
engaged with each other until only
yesterday with the lockdown we still saw
these completely crazy mass gatherings
of the weekend six days of incubation
six to ten days before people hit
intensive care units and then time on
intensive care units before they die so
this death rates going to go up steeply
intensive care bed use is going to go up
steeply and it's going to follow the
same trajectory as the disease infection
rate did ten days or so ago when it
suddenly took that uptick well you work
in intensive care at a hospital in North
London we've had this warning from 13
trusts that they'll run out of intensive
care capacity next week how are you
doing well at the moment we're doing
well and have to say the NHS you know
particularly people who work in critical
care emergency medicine and so forth are
cut of a cloth that it makes them
somewhat more resilient than others
perhaps there because they've chosen
that path we've done our best these are
extraordinary times and we are certainly
coping at the moment with the patient's
we have but I have no doubt at all that
we will be unable to cope and that's not
because people haven't tried or because
government hasn't tried it's just the
mathematics of the speed of the rise so
I would expect we're seeing doublings of
cases which means we're now seeing
doubling of ITU admissions and if you
can do your own maths if you imagine
there might be
more than a couple of hundred people on
ventilators now or in intensive care in
Britain I don't know the precise number
this evening will be somewhere upwards
of two three hundred I guess if you
imagine that doubles in two days and
then that doubles again in two days and
that doubles again in two days and it
will keep doing that until these impacts
of social isolation bite and start
flattening this curve flattening the
rise so we're in person army of cases in
the next fortnight and so when at what
point do you estimate that you will run
out of capacity at your hospital the
Whittington we've had a benign rise at
the moment I probably inappropriate me
to tell you quite where we are
clinically we're better than some in
London maybe that's because people
associate I say to more I don't know
that either way we're slightly better
off but at the moment and the doubling
rate we would be likely like many other
trusts actually in London to be out of
beds by the end of the weekend I mean
that's very soon that's extra
well we're all trying to do our best at
the moment come up with management plans
that convert helps mitigate perhaps help
mitigates people coming to intensive
care it's also the first thing which
sounds harsh but is not meant to be it's
just the conversations with your frail
and elderly family or if that is you
about what is appropriate for you when
you become critically unwell and this is
something we'd planned as a intensive
care society nationally is to have a
conversation with people nationally this
year about it it's not just about
coronavirus but it does bring it into
focus
that's not rationing that's not the
question of saying if you're old we're
not interested in you not at all but
it's just to say if life is coming to an
end naturally anyway maybe the way that
your life ends shouldn't be on an
intensive care unit the second thing
though is that we're trying to learn
from our colleagues in Italy and China
and elsewhere about the best ways to
manage people without going onto
ventilators and there are some tricks of
the trade that seem to be effective and
we have care pathways to try to do that
too
no I mean this we've never been here
before and people are going to have to
be inventive and the work is going to be
very very hard does this new Excel
Center you know opening up 4,000 beds
that the health secretary has been
talking about does that give you hope I
don't know
and being on it I don't think there's
any any option except to do that because
we are going to run out of beds so
unless we create massive capacity
somewhere somehow we're not going to be
able to cope with the patient's it makes
sense to me to put those people in one
place as much as one can because perhaps
cohorting patients allows more effective
use of staff and more efficiency but
this is a matter of an enormous scale I
mean a hospital requires staff
accommodation food beds drugs pharmacies
oxygen ventilators this is an industrial
scale to achieve I do know one or two of
the people were involved in the clinical
leadership of that and they are
exceptional so if it can be done they
will do it I have no doubt these are
good people and just finally we've seen
people lighting barbecues you know
you've got people going to construction
sites what do you say to them as someone
who's working on the front line right
now trying to save people's lives you
know I've lost my temper now I as you
may know gave an interview for
dispatches for channel 4 a week ago and
I was trying to be polite to encourage
people to do the right thing but this is
criminal and it is not about you if
you're a young person who is reasonably
healthy the odds are overwhelmingly in
your favor that you only get mild
disease but if you pass it on to other
people doing those maps within 10 cycles
and you pass that on and you've infected
60,000 people and one in ten of those
comes to an intensive care unit there
are only or were only a thousand
intensive care and adult beds in this
country and you would have caused a
tsunami that would engulf that
on your own the goodness sakes stop stop
doing this it's wrong
professor Hugh Montgomery thank you so
much for joining us
you