LONDON – As a new and more contagious variant of the coronavirus that plagues Britain’s vast national health service, health workers believe the government’s failure to anticipate winter infections should make them increasingly desperate.
Hundreds of soldiers were sent to move patients and equipment to London hospitals. Organ transplant centers have stopped performing urgent operations. Doctors cut back on the amount of oxygen patients give to save on congested pipes.
And nurses, desperate to make room for more beds, had to transport critically ill people to newly built Covid-19 wards in the middle of the night, despite having barely enough staff to treat existing patients.
The biggest concern for doctors and nurses is that the British government and the health care system of Britain, which were hit by the virus last year, did not heed warnings in the following months about planning a winter wave of infections, which hospitals left unprepared when patients started. arrive.
Despite the fact that Britain has targeted the United States and other European countries in the race to vaccinate people and signs of a slowdown in new cases, the deaths are dying, the hospitals are still full and for the second time in a year overloaded health workers. scurrying to keep patients alive.
And this time, they said, the warning signs were even clearer. “We were horrified – we knew what was coming,” said Dave Carr, an intensive care nurse in south London.
The government nevertheless waited to close the country again until January 4, when the health system was on the verge of a crisis, and hospitals hesitated to interrupt elective surgeries so doctors could prepare.
“We do not know what to do,” he said. Carr said. “We can not turn patients away. We practice medicine in a way we have never had in the UK. ”
For the United States, where cases are declining, even as some cities are overwhelmed by the virus, the disturbing scenes in British hospitals hold a sobering lesson: health systems that are enduring the first wave of the pandemic remain vulnerable to the challenges of a faster distribution variant.
In recent months, doctors in Britain have launched more sophisticated plans for the transfer of patients, a key safety valve for severely affected hospitals. And doctors have learned less invasive techniques to help patients breathe.
But in other respects, the defense of hospitals was off as matters began to increase this winter. Healthcare workers who left their regular jobs for the treatment of coronavirus patients last year have been depleted, making reinforcements more difficult. Hospitals have tried to honor long-term appointments for non-Covid ailments and treat the forms of patients with a heart attack and stroke that hospitals avoided last week, doctors said.
The heavy wards and grueling shifts that seemed inevitable last year suddenly seemed to doctors and nurses due to poor planning, which undermined the solidarity that had driven the health service in the past.
With nearly 40,000 Covid-19 patients in hospitals, nearly doubling last year’s high, Britain has suffered more deaths per capita in the past week than any other country. More than 101,000 people have died from coronavirus in Britain.
“It just doesn’t have to be that way,” said Tariq Jenner, a doctor in London. ‘The first time you could say it was inevitable. It just feels completely avoidable, and it’s much harder to stomach. ”
Prime Minister Boris Johnson has repeatedly avoided taking swift action to limit the spread of the virus. In September, he challenged a call from government scientists to oppose a brief shutdown in England, waiting until November to strengthen countrywide control. On December 22, government scientists again called for strict measures, including school closures, a move that Mr. Johnson avoided until January 4th.
All the while, doctors and nurses in break-ins struggled over the spread of the virus. And they pushed hospital leaders to prepare.
Most worrying were the pipes that hospitals use to transport liquid oxygen to the ward and convert it into gas. In August, an institution overseeing English hospital groups warned that the pandemic “led to more than existing plumbing,” and asked engineers to do repairs.
Britain’s health service said it roughly $ 20 million was spent before the winter on upgrading oxygen infrastructure.
But industry experts said not all hospitals received government funding to complete the work. In recent weeks, doctors have allowed the oxygen levels of some patients to fall below their normal targets and shift other patients to different hospitals due to congested systems.
The need for oxygen has increased this winter as doctors relinquish ventilators in favor of breathing machines that are less invasive but more oxygen-intensive.
“You could upgrade the pipes,” said Christina Pagel, a professor of operational research at University College London. “This kind of planning could easily have been done during the summer, but people just thought it was not going to happen again.”
Hospital managers were also reluctant to interrupt elective surgeries, putting back their efforts to convert wards and train hospital workers with less experience in intensive care in case of cases.
In mid-November, staff members at a hospital in south London wrote to the board warning that it could be “unrealistic” to retain elective surgery in addition to everyday winter illnesses and Covid patients, “given the current pressure on staff and the high diseases and burnout. ”Even before coronavirus cases skyrocketed, staff members write, intensive care nurses treated more patients than usual, with the risk of ‘compromises in patient care’.
The combination of demands has starved health workers of time to be ready. Some London hospitals have expanded intensive care centers from about 50 beds to 220.
“We entered this wave less well prepared, with staff more exhausted and too much, without the preparation time we had before the last wave,” said Mark Boothroyd, an emergency nurse. “The danger is that most of the NHS is at its peak now, and we still have a few weeks to go.”
Many health workers have retired since the spring. Others were reluctant to present themselves a second time in intensive care units or call sick if asked to do so.
Nurses who are still on Covid wards report a mental and physical strain: joints that ache from moving patients, many of whom are overweight; appetite fades again; sleep is disrupted by concerns about staff levels.
Some said they went to drink after long shifts. Hospitals have set up dermatology clinics for workers whose masks and their hands have been washed.
Mr. Carr noticed a colleague crying during a recent handover of the nursing staff.
“Normally I would say, ‘Okay, you’re thin, of course, go home,’ ‘he said. “Instead, I say, ‘You’re stretched, of course. If I would, I would have put my arm around you, and you can not go home. “There is all the pressure and a lot of fear. ”
With wards full of anesthetized patients, healthcare professionals handle a daunting array of tasks: dispensing medicines, monitoring blood pressure and electrolytes, adjusting feeding tubes, and preventing infections. In some hospitals, doctors said staff shortages mean they could not wake ventilated patients as often as usual, accelerating muscle wasting.
And the government has still not issued clear instructions on how to ration resources in the most dire of circumstances.
“The demand for triage is in everyone’s minds,” said Zudin Puthucheary, a physician and board member of the Intensive Care Society, a professional body. “Who’s going to make the decisions? Because we are not trained to make it. ”
Hospitals have become so busy that the internal clinical waste produced by the national health service has more than doubled. And as the cases in London disappear, patients from as far north as England and Wales are being transported to specialist hospitals in the city.
While the pace of new admissions of Covid patients in UK hospitals has been declining in recent days, doctors have been working for months to help people recover.
“We do not have a plan for how we are going to rehabilitate these patients and bring them back into their lives,” said Dr. Puthucheary said. “This is the next big question we face.”