Hospitals are rationing oxygen and ambulances are waiting outside for as long as nine hours outside to hand over patients as the UK's health system buckles under the growing pressures of Covid-19.
Staff are preparing for the situation to reach its worst point in the coming weeks, with hospitals struggling to cope with the sheer numbers of patients as a highly contagious mutant strain sweeps the region.
Rory O'Connor, College of Paramedics representative and chair of the Paramedics Council in the UK, told news.com.au that the National Health Service (NHS) was facing "extremely challenging" circumstances right across England, Scotland, Wales and Northern Ireland.
"In terms of hospital pressures, unprecedented is used quite a lot, but it is unprecedented," he said.
"What we are seeing is extended hospital turnover time, so ambulances waiting outside hospitals one, two, three, four, five, six, seven, eight, nine hours waiting to hand their patients over," said O'Connor, who is an active paramedic in Northern Ireland.
"The queues are measured in hours and not minutes any longer. So it is not unusual for ambulances to be waiting for three, four, five, six hours to hand their patients over and having to care for them in the back of the ambulance while they're waiting."
There are now more than 32,000 patients in UK hospitals, 20 per cent more than last week and almost double the number in the first peak of the pandemic, and ambulances are being forced to wait outside hospitals that are too busy to take patients.
The UK has now reported more than 3.1 million people cases and 81,000 deaths.
At Headley Court in Surrey, southeast England, bodies were being stored in a temporary mortuary because there was no space at local hospitals.
O'Connor said that hospitals were "completely swamped", and that this has a "domino effect" on ambulances, with patients potentially waiting for hours to be taken to hospitals. "When we are tied up at the hospital, there's nobody there to respond when somebody becomes unwell in the community and it becomes a bit of a vicious cycle."
Southend Hospital in Essex, east of London, is now rationing oxygen by reducing the "target" levels for each adult, according to the Save Southend NHS campaign page on Facebook.
Anyone in an ambulance who requires oxygen is now being diverted from Southend to Basildon Hospital, a strategy that is now in place "indefinitely", the page reported.
"Clearly this is concerning for those patients having a longer journey which is a clinical risk," it added, suggesting that scrutiny was required into how several UK hospitals have been unable to cope with their patient numbers during the pandemic.
Yvonne Blucher, managing director of Southend Hospital, said: "We are experiencing high demand for oxygen because of rising numbers of inpatients with Covid-19 and we are working to manage this."
O'Connor said that oxygen rationing was adding to the pressure on ambulance resources. "When we are caring for a patient for six hours in our ambulance we're doing to need oxygen," he said. "That's going to deplete our supplies as well as the hospital supply."
He said the target levels had been lowered but "always within safe boundaries so we're not putting the patient at risk".
Worst still to come
More than a third of critical care units in England's East are now at or have exceeded their maximum surge capacity, according to leaked information seen by the Health Service Journal.
The HSJ said that beds were running out in London and the South East, and that England's South West and North West regions were "seeing very dramatic and accelerating increases" in patient numbers.
Two health trusts in Northern Ireland had to issue a plea for off-duty staff to work over the weekend to cope with the spike in cases as the UK battles its third wave of coronavirus with most residents in lockdown.
"The next few weeks are going to be the worst weeks of this pandemic in terms of numbers into the NHS," England's chief medical officer Chris Whitty told the BBC on Monday.
He said that until more people were vaccinated under the government's accelerated programme, "we need to really double down" on following the restrictions.
O'Connor echoed this view: "It's going to get worse before it gets better unfortunately," he said.
"In Northern Ireland at the minute, one in four hospitalisations is with Covid and they expect that to increase to about one in two in the next 10 days."
He said that overall, hospitalisations with Covid-19 had already doubled since the new year and were expected to double again in the next few days.
O'Connor said he had not experienced a winter like this one in 10 years in the field. "It's like nothing I've ever seen," he said.
"There's always a number of calls waiting on an ambulance response but the amount has increased significantly over the past few weeks and unfortunately, I can only see it increase in the next few weeks until we get over the worst of what's to come.
"We are now at surge capacity and we're still struggling to cope. It isn't a normal winter, these are challenges that we've never faced before, and hopefully never have to face again."
Staff facing burnout
The UK has now approved three vaccines — Pfizer, AstraZeneca and Moderna — and has vaccinated around 2.4 million people since it started its rollout early last month.
The government is racing to ensure its most vulnerable populations are protected so the four nations can reopen, and hopes to have offered the vaccine to 15 million of a population of 67 million by mid-February.
Health workers, elderly people and the most clinically vulnerable are among the priority groups.
UK Prime Minister Boris Johnson warned against "false confidence [and] false complacency" because of the vaccine, which the government hopes to offer to all adults by the end of October.
He said that Britain was at a "very perilous moment", adding: "Now is the moment for maximum vigilance, maximum observation, observance of the rules."
Many NHS staff have not yet been offered the vaccine, while spending their days in close proximity with Covid-19 patients.
The College of Paramedics estimated in October, before the latest spike, that one in 12 paramedics in the UK had had coronavirus. In Northern Ireland, the ambulance service was running with between a quarter and a third of the staff off sick with the virus, said O'Connor.
"The staff that are left in work are being asked to do more and more," he added. "We are hearing reports of a significant mental health toll as well as staff are just so stressed and so overworked, and they're not getting their breaks and they're not getting finished on time and they're getting sick, and it is just so tough at the moment out there."
With the usual heart attacks and strokes, plus a "tsunami of Covid patients", O'Connor said there was a strain on the service and on staff "who are doing their best in pretty horrendous circumstances".
The next two to three weeks will be key, with officials hoping to simply keep the system functioning, and prevent as many deaths as possible.