Hospitals are straining to cope with a new coronavirus variant, despite warnings last year that more preparations were needed for an expected surge of cases in the winter.
As a new and more contagious variant of the coronavirus pounds Britain's overstretched National Health Service, health care workers say the government's failure to anticipate a wintertime crush of infections has left them resorting to ever more desperate measures.
Hundreds of soldiers have been dispatched to move patients and equipment around London hospitals. Organ transplant centres have stopped performing urgent operations. Doctors have trimmed back the level of oxygen being given to patients to save overloaded pipes.
And nurses, frantic to make space for more beds, have had to cart critically ill people to newly converted Covid-19 wards in the middle of the night, despite having barely enough staff members to treat existing patients.
Most vexing to doctors and nurses is that Britain's government and state health system, hammered by the virus in the spring, failed to heed a cascade of warnings in the following months about needing to plan for a wintertime wave of infections, leaving hospitals unprepared as patients began arriving.
Despite Britain's pulling ahead of the United States and other European countries in the race to vaccinate people and signs of a slowdown in new cases, deaths are soaring, hospitals continue to fill up, and, for the second time in a year, overtaxed health workers are scrambling 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.
Still, the government waited to lock down the country again until January 4, when the health system was on the brink of crisis, and hospitals hesitated to pause elective operations so that doctors could prepare.
"We don't know what to do," Carr said. "We can't turn patients away. We're practicing medicine in a way we never have in the UK ever before."
For the United States, where cases are falling even as some cities remain swamped by the virus, the harrowing scenes in British hospitals hold a sobering lesson: Health systems that withstood the first wave of the pandemic remain vulnerable to the challenges of a faster-spreading variant.
In recent months, doctors in Britain have set in motion more sophisticated plans for transferring patients, a crucial safety valve for hard-hit hospitals. And doctors have learned less invasive techniques to help patients breathe.
But in other respects, hospitals' defences were down when cases began to surge this winter. Health care workers who had left their usual posts to treat coronavirus patients in the spring were depleted, making reinforcements harder to come by. Hospitals were trying to honour long-delayed appointments for non-Covid ailments and treating the sorts of heart attack and stroke patients who had avoided hospitals — unwisely, doctors said — in the spring.
The heaving wards and gruelling shifts that seemed inescapable last year suddenly looked to doctors and nurses like a consequence of poor planning, eroding the solidarity that once buoyed the health service.
With nearly 40,000 Covid-19 patients in hospitals, almost double last year's peak, Britain has suffered more per capita deaths over the last week than any other country. More than 101,000 people have died from the coronavirus in Britain.
"It just didn't have to be like this," said Tariq Jenner, a London emergency room doctor. "The first time, you could say it was unavoidable. This just feels wholly avoidable, and that's a lot more difficult to stomach."
Prime Minister Boris Johnson has repeatedly avoided taking fast action to stanch the spread of the virus. In September, he defied a call from government scientists for a brief England wide lockdown, waiting until November to strengthen countrywide controls. On December 22, government scientists again asked for strict measures, including school closures, a step that Johnson avoided until January 4.
All the while, doctors and nurses fretted in break rooms over the virus's spread. And they pressed hospital leaders to prepare.
Most worrisome were the pipes that hospitals use to carry liquid oxygen into wards and convert it to gas. In August, a body overseeing English hospital groups warned that the pandemic had "led to loadings beyond the capacity of the existing pipework" and called for engineers to conduct remedial work.
Britain's health service has said that roughly US$20 million ($27.7 million) was spent on upgrades to oxygen infrastructure before the winter.
But industry experts said that not all hospitals received government funding to complete the work. In recent weeks, doctors have allowed some patients' blood oxygen levels to fall below their usual targets and moved other patients to different hospitals because of overloaded systems.
The need for oxygen has grown this winter because doctors are forgoing ventilators in favor of breathing machines that are less invasive but more oxygen-intensive.
"You could've upgraded the pipes," said Christina Pagel, a professor of operational research at University College London. "This kind of planning could easily have been done over the summer, but people just thought it wasn't going to happen again."
Hospital executives were also reluctant to pause elective operations, setting back efforts to convert wards and train hospital workers with less experience in intensive care as cases mounted.
In mid-November, staff members at a south London hospital wrote to the board, warning that it "may be unrealistic" to keep handling elective surgeries on top of everyday winter illnesses and Covid patients, "given the current pressures on staffing and the high rates of sickness and burnout." Even before coronavirus cases soared, the staff members wrote, intensive care nurses were treating more patients than usual, risking "compromises in patient care."
The combination of demands starved health workers of time to get ready. Some London hospitals have expanded intensive care wards from roughly 50 beds to 220.
"We've gone into this wave less well-prepared, with staff more exhausted and overstretched, without the preparation time that we had before the last wave," said Mark Boothroyd, an emergency room nurse. "The danger is most of the NHS is maxed out now, and we've still got another few weeks to go."
Many health workers have retired since the spring. Others have been reluctant to volunteer on intensive care wards a second time or are calling in sick when asked to do so.
Nurses still on Covid wards report a litany of mental and physical strains: joints aching from moving patients, many of whom are overweight; appetites waning again; sleep being disrupted by anxieties about staffing levels.
Some said they had taken to drinking after long shifts. Hospitals have set up dermatology clinics for workers whose masks and hand-washing have damaged their skin.
During a recent handover on the nursing staff, Carr said, he noticed a colleague crying.
"Normally I'd say, 'All right, you're obviously stretched thin, go home,' " he said. "Instead of that, I'm saying, 'You're obviously stretched, I'd put my arm around you if I could, and you can't go home.' There's all of that pressure and a lot of fear."
With wards full of sedated patients, health workers are handling a dizzying array of tasks: dispensing medicines, monitoring blood pressure and electrolytes, adjusting feeding tubes, preventing infections. In some hospitals, doctors said staff shortages meant that they could not awaken ventilated patients as often as usual, accelerating muscle wasting.
And the government has still not issued clear instructions for how to ration resources in the most dire circumstances.
"The question of triage is on everyone's mind," said Zudin Puthucheary, a doctor and council member of the Intensive Care Society, a professional body. "Who's going to be making those decisions? Because we're not trained to make them."
Hospitals have become so busy that the volume of clinical waste produced by the National Health Service has more than doubled, according to internal hospital memos. And as cases recede in London, patients are being shuttled from as far as northern England and Wales to specialist hospitals in the city.
While the pace of new admissions of Covid patients to British hospitals has slowed in recent days, doctors are steeling themselves for months of work to come as they try to help people recover.
"We haven't got a plan for how we're going to rehabilitate these patients and get them back to their lives," Puthucheary said. "That's the next big question we have to face."
Written by: Benjamin Mueller
Photographs by: Andrew Testa
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