LONDON – As a new and more contagious variant of the coronavirus pound by the overstretched British National Health Service, health workers say the government’s inability to anticipate a winter outbreak of infections is prompting them to resort to increasingly desperate measures.
Hundreds of soldiers have been sent to move patients and equipment around hospitals in London. Organ transplant centers have stopped performing emergency operations. Doctors have reduced the level of oxygen given to patients to save overloaded tubes.
And the nurses, frantic to make room for more beds, had to drive seriously ill people to newly converted wards of Covid-1
The most worrying thing for doctors and nurses is that the British government and the public health system, eradicated by the virus last spring, failed to heed a cascade of warnings in the coming months about the need to plan a winter wave of infections, leaving hospitals unprepared when patients began arriving.
Although Britain is ahead of the United States and other European countries in the race to vaccinate people and signs of delays in new cases, deaths are rising, hospitals continue to fill and for the second time in a year, overworked health workers are stirring 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 until January 4, when the health care system was on the brink of crisis, and hospitals were reluctant to pause election operations so doctors could prepare.
“We don’t know what to do,” Mr Carr said. “We cannot reject patients. We practice medicine in a way we have never done before in the UK. “
For the United States, where cases are falling even as some cities remain plagued by the virus, the torturous scenes in British hospitals teach a sobering lesson: Health systems that have survived the first wave of the pandemic remain vulnerable to the challenges of the faster-spreading option.
In recent months, doctors in the UK have launched more sophisticated plans to relocate patients, a key safety valve for severely affected hospitals. And doctors have learned less invasive techniques to help patients breathe.
But in other respects, hospital protection declined as cases began to increase this winter. Health workers who left their usual coronavirus treatment posts last spring have been exhausted, making it difficult to find reinforcements. Hospitals tried to meet long-delayed appointments for non-Covid illnesses and treated heart attack and stroke patients who had avoided hospitals – unreasonably, doctors said – last spring.
The rising wards and grueling shifts that seemed inevitable last year suddenly seemed to doctors and nurses as a result of poor planning, undermining the solidarity that the health service once spurred.
With nearly 40,000 Covid-19 patients in hospitals, almost double last year’s peak, the UK has suffered more deaths per capita in the past week than any other country. More than 101,000 people have died from the coronavirus in Britain.
“It just didn’t have to be that way,” said Tariq Jenner, a London emergency doctor. “For the first time, it can be said that it was inevitable. It just feels completely avoidable, and it’s much harder for the stomach. “
Prime Minister Boris Johnson has repeatedly avoided taking swift action to stem the spread of the virus. In September, he opposed a call by government scientists for a brief blockade across England, waiting until November to tighten controls across the country. On December 22, government scholars again called for austerity measures, including the closure of schools, a move Mr Johnson avoided until 4 January.
All the while, doctors and nurses in the rest rooms were worried about the spread of the virus. And they pressured hospital managers to prepare.
The most worrying were the tubes that hospitals use to carry liquid oxygen to wards and convert it to gas. In August, a body overseeing British hospital groups warned that the pandemic “had led to a load beyond the capacity of existing pipelines” and called on engineers to do corrective work.
The British Health Service said this rudely $ 20 million was spent on upgrading oxygen infrastructure before the winter.
But industry experts say not all hospitals have received government funding to complete the work. In recent weeks, doctors have allowed some patients’ blood oxygen levels to fall below their normal targets and moved other patients to different hospitals due to overloaded systems.
The need for oxygen has increased this winter as doctors give up ventilators in favor of breathing machines, which are less invasive but more oxygen-intensive.
“You could have upgraded the pipes,” said Christina Paige, a professor of operational research at University College London. “This kind of planning could easily have been done in the summer, but people just thought it wouldn’t happen again.”
Hospital managers are also reluctant to pause elective operations, limiting efforts to transform wards and train hospital staff with less experience in intensive care, as has been the case.
In mid-November, hospital staff in south London wrote on board, warning that “it may be unrealistic” to continue to deal with elective surgery in addition to daily winter illnesses and Covid patients, “given the current pressure on staff and high levels. of disease and burns. “Even before coronavirus cases jumped,” the staff wrote, intensive care nurses treated more patients than usual, risking “compromises in patient care.”
The combination of demanding hungry health workers to prepare in time. Some London hospitals have expanded intensive care units from about 50 beds to 220.
“We entered this wave less prepared, with more exhausted and overworked staff, without the preparation time we had before the last wave,” said Mark Butroyd, an emergency room nurse. “The danger is that most of the NHS is exhausted now and we have a few more weeks.”
Many health workers have retired since the spring. Others are reluctant to volunteer for resuscitation for a second time or call on patients when asked to do so.
Nurses who are still in Kovid’s wards report a number of mental and physical strains: joint pain from moving patients, many of whom are overweight; appetites decrease again; sleep is disturbed by worries about the level of staff.
Some said they drank after long shifts. Hospitals have set up dermatological clinics for workers whose masks and hand washing have damaged their skin.
During a recent handover to medical staff, Mr Carr said he noticed a colleague crying.
“I would usually say, ‘Okay, you’re obviously stretched, go home,'” he said. “Instead, I say, ‘Obviously you’re tense, I’d hug you if I could and you can’t go home.’ There is all this pressure and a lot of fear. “
With wards filled with sedated patients, healthcare professionals cope with a dizzying set of tasks: dispensing medications, monitoring blood pressure and electrolytes, adjusting the feeding tube, preventing infections. In some hospitals, doctors say staff shortages mean they can’t wake ventilated patients as often as usual, accelerating muscle loss.
And the government has not yet issued clear instructions on how to allocate resources in the most difficult circumstances.
“The issue of triage is on everyone’s mind,” said Zudin Putucheari, a doctor and board member of the Intensive Society, a professional body. “Who will make these decisions?” Because we are not trained to do them. “
Hospitals have become so busy that the amount of clinical waste produced by the National Health Service has more than doubled, according to internal hospital records. And while the cases are receding in London, patients are being transported from the North of England and Wales to specialist hospitals in the city.
As the pace of new admission of Covid patients to British hospitals has slowed in recent days, doctors have been preparing for months as they try to help people recover.
“We have no plan on how to rehabilitate these patients and bring them back to life,” said Dr. Puthucheary. “This is the next big question we have to face.”