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“ICUs aren’t full” shout the denialists, shall we unpack that a little? Firstly, ICUs in many hospitals are full to bursting, despite having increased their capacity this year (we have 20% more ICU beds than December 2019, but notably not 20% more staff)
But running at 100% capacity is a sub-optimal way to run an ICU. When someone needs an ICU bed, they need it ‘now’ not in 6-12 hours time- delays in admissions to ICU cost lives, and it’s something we routinely audit as a measure of care quality.
If an ICU is full, the only way to get a new patient in is to discharge an existing patient. Given bed states in many hospitals we frequently have ‘wardable’ patients in ICU- patients who are waiting for ward beds. But moving them out needs a ward bed to go to.
Discharges from ICU are safest of they occur during normal working hours, when they can be handed over to a ward team who don’t need to faff about in the dark to review them, trying not to wake other patients in the ward. Again we audit out-of-hours discharge as marker of quality
And the problems with emergencies is that they are unpredictable, you never know if you will need a bed at 3am, or maybe 2 or 3. Sometimes we can mitigate by keeping patients in theatre after an operation, or in the Emergency Department, but this knocks onto other services.
Now imagine you don’t have any ‘wardable’ patients- how do you decide who to discharge to make way for a new patient, which ‘iffy’ discharge do you make- or do you try to find a bed in another hospital?
And it’s not just ICUs, it’s the hospital more widely. Running at 100% occupancy is not ‘efficient’ it’s dangerous, and leaves the hospital unable to cope with surges in demand. Overcrowded emergency departments lead to deaths too.
Ask any military strategist, or logistics planner- if your ‘normal’ is ‘running flat out’ then you have no resilience, no ability to deal with sudden changes, and collapse and defeat are an ever present risk.
The reality right now in many hospitals is that they are running at more than 100% occupancy, and the number of staffed, useable beds is reduced from headline figures due to staff sickness and need to ‘socially distance’ beds to reduce cross-infection risks.
Covid is also ‘lumpy’ in its distribution, looking at the national or even regional picture tells one little about pressures at individual hospitals. If we get to the point of nationwide 100% bed occupancy then we will be in the midst of a health service meltdown.
Right now the NHS is working hard to offload pressure, transferring patients often many miles from their homes and families, so that they can get care. This is sub-optimal but better than not transferring them.
We can only do those transfers because not all hospitals and not all units are 100% full. But transfers take staff and ambulances away from local services, less able to respond to emergency calls.
So please, before you share bed occupancy numbers or reassure yourself that if we aren’t 100% full it’s all ok, listen to those on the frontline who are telling you it’s not, that we are facing unprecedented demand. And please do what you can to reduce that demand. 
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When I was a medical student, a senior registrar said “Andy, all you need is an airway and secure venous access and you can keep almost anyone alive”, to which I would add “and an ICU bed with the full complement of nursing, physio and pharmacy staff”.
