Hospitals have been ordered to free up every possible bed for the growing number of Covid patients amid fears of a high death toll from the disease in January. NHS England warned that the entire health service will have to stay on its highest state of alert until at least the end of March because of the ongoing influx of very sick patients, exacerbated by the new strain of coronavirus. It comes as NHS trust bosses in England said the intense pressures they were facing were “extremely challenging” and that hospitals had almost as many Covid patients now as in April. “As we head into the new year we are seeing a real rise in the pressure on NHS services, particularly across London and the south-east,” said Saffron Cordery, the deputy chief executive of NHS Providers. The London ambulance service said Boxing Day had been one of its “busiest ever” days. It said it was now taking up to 8,000 999 calls a day compared to 5,500 on a typical “busy” day. In a six-page letter to NHS care providers on 23 December, health service chiefs said: “With Covid-19 inpatient numbers rising in almost all parts of the country, and the new risk presented by the variant strain of the virus, you should continue to plan on the basis that we will remain in a level four incident for at least the rest of this financial year and NHS trusts should continue to safely mobilise all of the available surge capacity over the coming weeks.” A consultant at Southampton general hospital said: “Our general intensive care unit footprint is now completely overfull of Covid patients. We have expanded our ICU by 10 extra beds to take ICU patients from both Portsmouth and Kent as they are so hard-pressed. [The situation] is under control so far but unpleasant and scary.” Dr Rupert Pearse, a senior intensive care specialist in London, said the recent rise in infections would inevitably lead to more hospitalisations and deaths in coming weeks. He tweeted: “As with the first wave, the sharp rise in people testing positive for Sars-CoV-2 will be followed by a sharp rise in hospital admissions for Covid-19 and then a similar rise in excess deaths in January.” Hospital doctors warned that the service’s widespread lack of staff could pose a risk to patients. “It is no surprise, but still dismaying, to hear that the NHS will be at ‘level 4’ for months given the rate of infections verses the rate of vaccinations and that it takes probably four weeks from first dose to immunity”, said Dr Nick Scriven, the immediate past president of the Society for Acute Medicine. “Surge will mean mobilising any usable bed area and stretching staff to look after patients there – often outside the staff’s ‘normal comfort zone’ – for example, unwell medical patients on surgical wards, or even less safely opening up ‘mothballed’ areas and spreading staff more thinly than usually considered optimal or even safe. And this will of course mean cancelling elective care again,” Scriven said. In their letter NHS Improvement’s chief executive Amanda Pritchard and Julian Kelly, NHS England’s chief financial officer, told hospitals that where possible they should send patients needing surgery to local private health facilities, discharge as many inpatients as possible and prepare for the Nightingale field hospitals to open. In a vivid illustration of the pressures hospitals are facing, London’s Royal Free hospital – which is receiving about 12 new Covid inpatients every day – has cancelled all non-emergency surgery until mid-February and restricted staff holidays. It has become “overwhelmed”, one doctor there said. “Every staff group, from porters to surgeons, have had their leave cancelled from 21 December. Only a maximum of a five-day-run, including bank holidays, is permitted from now on. Essentially cancelled the staff Christmas holidays. They have also cancelled all non-emergency surgery again until the middle of February. So the hospital is not coping really. The 12 Covid admissions a day has quickly overwhelmed the place,” they said. Basildon hospital in Essex is also understood to be under serious pressure and admitting dozens of Covid-positive patients a day on some days. The Cardiff and Vale University health board in Wales issued a plea on Twitter for medical students and NHS staff to help out in its critical care department. It later said it had got the volunteers it needed but the unit “remains extremely busy due to Covid-19 and winter pressures” and that staffing was still “challenging”. Dr Sonia Adesara, a doctor in London, tweeted: “My hospital has currently no ITU beds. No spare CPAP (non-invasive ventilation) capacity. Spent the past 12 hours caring for people in their 50s, 60s, 70s who are on the highest oxygen we can give. Trying to keep them breathing until we can free up capacity.”