LONDON – As a new and more contagious variant of the coronavirus strikes Britain’s overburdened National Health Service, health professionals say the government’s failure to predict a wave of infections in winter has prompted them to resort to increasingly desperate.
Hundreds of soldiers were sent to transport patients and equipment through London hospitals. Organ transplant centers have stopped performing urgent operations. Doctors reduced the level of oxygen given to patients to avoid overloaded pipes.
And the nurses, desperate to make room for more beds, had to transport seriously ill people to the newly converted Covid-19 wards in the middle of the night, despite barely having enough staff to treat existing patients.
The most irritating thing for doctors and nurses is that Britain’s government and state health system, hit by the virus last spring, failed to heed a series of warnings in the following months about the need to plan for a wave of winter infections, leaving hospitals unprepared when patients began to arrive.
Although Britain is ahead of the United States and other European countries in the race to vaccinate people and signs of deceleration in new cases, deaths are increasing, hospitals continue to fill and, for the second time in a year , healthcare professionals are overwhelmed struggling to keep patients alive.
And this time, they said, the warning signs were even more obvious. “We were horrified – we knew what was coming,” said Dave Carr, an intensive care nurse in South London.
Even so, the government waited to close the country again until January 4, when the health care system was on the brink of crisis and hospitals hesitated to stop elective operations so doctors could prepare.
“We don’t know what to do,” said Carr. “We cannot send patients away. We are practicing medicine in a way never before practiced in the UK. “
For the United States, where cases are declining, although some cities remain flooded by the virus, the distressing scenes in British hospitals are a serious lesson: the health systems that resisted the first wave of the pandemic remain vulnerable to the challenges of a spread fastest variant.
In recent months, British doctors have put in place more sophisticated plans for transferring patients, a crucial escape valve for hard-hit hospitals. And doctors have learned less invasive techniques to help patients breathe.
But in other respects, hospital defenses fell when cases started to rise this winter. Health workers who had left their usual posts to treat coronavirus patients last spring were exhausted, making it more difficult to get backup. Hospitals were trying to fulfill long-overdue commitments for non-Covid illnesses and to treat the types of heart attacks and strokes that prevented hospitals – recklessly, doctors said – last spring.
The heavy wards and the strenuous changes that seemed inevitable in the past year suddenly seemed to doctors and nurses a consequence of poor planning, eroding the solidarity that had once driven health care.
With nearly 40,000 Covid-19 patients in hospitals, almost double the peak from last year, Britain suffered more deaths per capita last week than any other country. More than 101,000 people died of coronavirus in Britain.
“It just didn’t have to be that way,” said Tariq Jenner, a London ER doctor. “The first time, you could say it was inevitable. This seems entirely preventable and is much more difficult to swallow. “
Prime Minister Boris Johnson has repeatedly avoided taking quick steps to halt the spread of the virus. In September, he defied an appeal by government scientists for a brief blockade across England, waiting until November to strengthen national controls. On December 22, government scientists again called for strict measures, including closing schools, a measure that Johnson avoided until January 4.
All the time, doctors and nurses worried in the rest rooms about the spread of the virus. And they pressured hospital leaders to prepare.
Of more concern were the pipes that hospitals use to transport liquid oxygen to the wards and convert it into gas. In August, an agency that supervised groups of British hospitals warned that the pandemic “led to shipments beyond the capacity of the existing pipeline” and called on engineers to carry out repair work.
Britain’s health service said that approximately $ 20 million was spent on upgrading the oxygen infrastructure before the winter.
But industry experts said that not all hospitals received government funding to complete the job. In recent weeks, doctors have allowed some patients’ blood oxygen levels to fall below their usual targets and have moved other patients to different hospitals because of systems overload.
The need for oxygen has increased this winter because doctors are forgoing ventilators in favor of breathing machines that are less invasive but more oxygen-intensive.
“You could have upgraded the tubes,” said Christina Pagel, professor of operations research at University College London. “This type of planning could easily have been done during the summer, but people thought it would not happen again.”
Hospital executives were also reluctant to discontinue elective operations, reducing efforts to convert wards and train hospital staff with less experience in intensive care as cases increased.
In mid-November, staff members from a south London hospital wrote to the council, warning that “it may be unrealistic” to continue dealing with elective surgeries over daily winter illnesses and Covid patients, “given current pressures. about the team and the high rates of illness and burnout. ”Even before coronavirus cases skyrocketed, team members wrote, intensive care nurses were treating more patients than normal, risking” compromising care. ” to the patient “.
The combination of demands deprived health professionals of time to prepare. Some London hospitals have expanded intensive care wards from about 50 to 220 beds.
“We entered this wave less well prepared, with the team more exhausted and overloaded, without the preparation time we had before the last wave,” said Mark Boothroyd, an emergency room nurse. “The danger is that most of the NHS is now depleted, and we still have a few more weeks to go.”
Many health professionals have retired since spring. Others have been reluctant to volunteer in intensive care wards for the second time or are saying they are sick when asked to do so.
Nurses still in the wards of Covid report a litany of physical and mental tensions: joints hurting due to the movement of patients, many of whom are overweight; appetites decreasing again; sleep being interrupted by anxiety about staffing levels.
Some said they started drinking after long shifts. Hospitals have set up dermatological clinics for workers whose masks and hand washing have damaged their skin.
During a recent transfer from the nursing staff, Carr said, he noticed a colleague crying.
“Normally, I would say, ‘Okay, you’re obviously stretched, go home,'” he said. “Instead, I’m saying, ‘You are obviously stretched, I would put my arm around you if I could, and you can’t go home.’ There is all this pressure and a lot of fear. “
With wards full of sedated patients, healthcare professionals are performing a series of dazzling tasks: dispensing medication, monitoring blood pressure and electrolytes, adjusting feeding tubes, preventing infections. In some hospitals, doctors said that the lack of staff meant that they could not wake up ventilated patients as often, accelerating muscle wasting.
And the government has yet to issue clear instructions on how to ration resources in the most dire circumstances.
“The issue of screening is on everyone’s mind,” said Zudin Puthucheary, a doctor and board member of the Intensive Care Society, a professional body. “Who is going to make these decisions? Because we are not trained to do them. “
Hospitals were so busy that the volume of clinical waste produced by the National Health Service more than doubled, according to internal hospital memos. And as cases drop in London, patients are being transported from northern England and Wales to specialist hospitals in the city.
Although the pace of new admissions from Covid patients to British hospitals has slowed in recent days, doctors are preparing for the next few months of work, as they try to help people recover.
“We don’t have a plan for how we are going to rehabilitate these patients and bring them back into their lives,” said Dr. Puthucheary. “This is the next big issue that we have to face.”