THE decline of the NHS is "a more realistic concern than it has been for decades" due to successive Covid waves, experts have warned.
In a damning editorial published in the BMJ, the journal's editor in chief Kamran Abbasi and Alastair McLellan, editor of the Health Service Journal, said continual high rates of the infection across the UK are "the main reason that the NHS is nowhere near reaching the activity levels needed to begin to recover performance", and called for the reintroduction of free Covid tests and home-working where possible.
It comes as the latest surveillance for by the Office for National Statistics estimated that one in 16 people in Scotland had Covid in the week ending July 7.
Infection rates are also rising across the UK as a whole, driven mainly by the BA.5 sublineage of Omicron.
It is the third Omicron wave since the original BA.1 strain began spreading in the UK in December.
The authors state: "At no other time in the past 50 years have so many parts of the NHS been so close to ceasing to function effectively. The heart of the problem is the failure to recognise that the pandemic is far from over and that a return to some of the measures taken in the past two years is needed.
Existing public health advice to wear masks in crowded places, ensure good ventilation, and test regularly need to be communicated much more powerfully and widely. This should include a return to mask wearing in healthcare settings and on public transport, as well as re-introduction of free tests for the public.
"Vaccination is the fourth pillar of action. Large sections of the population, particularly ethnic minorities and younger age groups, are still not fully vaccinated.
"Other measures might include working from home when possible and restrictions on some types and sizes of gathering."
The winding up of routine Covid testing was precipated by the UK Treasury, which slashed funding earlier this year.
In recent months the focus has been on using Spring boosters and antivirals to limit hospital admissions for severe Covid, but high virus rates in the community have resulted in surges in NHS staff absences and high numbers of Covid positive patients in hospital who have to be kept apart from uninfected patients.
READ MORE: Record flu levels in Australia could signal danger ahead for NHS
In Scotland, total hospital admissions - elective and emergency combined - remained around 10 per cent below pre-pandemic average by the end of June, and the number of planned procedures carried out between March and the end of May had only increased by 7% compared to the same time last year, and remained 29% below 2019 levels.
The Scottish Government's Recovery Plan, published last August, set a target to carry out an extra 27,500 inpatient/day case procedures on the NHS in 2022/23 - equivalent to a 10% uplift on pre-pandemic turnover.
There are concerns that a resurgence of flu this winter, potentially as early as September, could make increasing NHS activity even more challenging.
READ MORE: Omicron BA.5, 'living with Covid', and why we need a Plan B
Mr Abbasi and Mr McLellan write that the "nation’s attempt to 'live with covid' is the straw that is breaking the NHS’s back", but stressed that current situation is also the "culmination of many factors, which include but are not limited to prolonged periods of underfunding in the past decade, lack of an adequate workforce plan, and a cowardly and shortsighted failure to undertake social care reform".
They point to a 'vaccine-plus' strategy outlined in the BMJ in January 2022, in an open letter signed by hundreds of academics, as a possible alternative.
The plan included the promotion of "high-quality facemasks" - such as FFP2s - in "all indoor settings where people mix, and for healthcare workers at all times", and called on the World Health Organisation to "unequivocally declare SARS-CoV-2 an airborne pathogen" - something it has so far resisted, with agencies including Public Health Scotland also continuing to advise that the majority of transmission occurs through close contact and via surfaces.
A 'vaccine-plus' approach would "go beyond opening windows and aim for a paradigm shift to ensure all public buildings are optimally designed, built, adapted, and utilised to maximise clean air for occupants".
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