“We’re once again seeing increasing numbers of Covid patients coming in through A&E. This is translating into admissions to critical care. Nearly half of the beds in our critical care unit are now dedicated to Covid-19 patients. The feeling on the ground is we’re very much at the start of the next wave and that it’s likely to be less of a tsunami, but more protracted.
The patients are younger this time. I’ve been looking after patients aged between 27 and 82 in critical care, but most are in their 30s, 40s and 50s. And the vast majority are either unvaccinated or have had one dose of the jab.
A few patients we are caring for still deny Covid exists, even as we strap oxygen masks to their faces. That is perplexing. Staff find that particularly hard and I think it will be an interesting and difficult part of this next phase. I wonder if we’ll be caring for a select group of patients who think the very disorder we’re treating them for is a sham. How do staff, who are so exhausted, navigate that?
In between previous waves the hospital returned Covid wards to normal wards and increased our elective operating programme. Sadly, we are seeing those wards being turned back into Covid wards again. Although we’ve not yet reduced our elective operations, I cannot see how we’ll cope as Covid admissions increase.
We’re back to planning an increase in critical care capacity and anticipate this will be required to manage the influx of Covid patients. We’re much more adept at pivoting back to Covid measures, having lived through this before. But a number of things are hampering us this time round. We have unprecedented numbers of A&E attendances, with waits in excess of 10 hours. So overall demand has increased massively. The hospital is full, similar to entering a bad winter, so turning wards into Covid wards isn’t easy. There just aren’t enough beds.
Staffing is a perfect storm. Staff are absolutely, genuinely exhausted. After more than a year of Covid, resilience is very low. Covid isolation alerts and school quarantines for staff’s children mean that huge number of colleagues are being required to isolate, leaving those behind picking up more and more shifts in order to run a safe service. It’s a huge testament to the staff that we still have people coming forward, often at the detriment of their own wellbeing, to fill gaps over and over again.
In addition, numerous staff are off sick with physical and mental health problems as a direct result of the pandemic. And large numbers of staff are leaving in the knowledge that even if Covid waves cease, there is a huge amount of pressure to proceed at pace through the backlog of cases, with no respite.
How do I feel about the growing number of infections and what’s coming down the track for hospitals? There has been a huge amount of pride that the NHS has been central to the vaccination programme and that generates hope. Hope that we wouldn’t see the same scenes again – of patients struggling for air and saying goodbye to loved ones via video message.
In some ways, even though we suspected an exit wave would occur, this time round is almost more difficult. Because we had hope, and to some extent that’s been dashed. And at heart we feel that for the majority of the people we’re seeing admitted, this was avoidable.
Unlocking? NHS staff are humans too and we desperately want society to get back to normal. But it seems almost unfathomable that as Covid infections are rising that the last few lines of defence are being torn away. The most bizarre decision is the mask mandate. It seems almost wholly political. And it’s clear already that mask-wearing is going to become a political statement. That’s totally unnecessary. Masks can protect those around you. They don’t prevent businesses from opening, nor do they hamper the economy. So why ditch the mask mandate? I can’t think of a single good explanation.
One key aspect of the current policy has not been discussed at all. The vaccine appears to have broken the link between infections and deaths, which is fantastic. But there are 5.3 million people with non-Covid related diseases waiting for treatment. If Covid infections are left to run rampant, with no policy measures to slow them down, how on earth is the NHS going to address the backlog?
The first thing that will suffer is non-urgent operations. We can’t turn away people needing emergency surgery, so we have to have the beds for them. Elective surgery requires critical care capacity, so when something has to give it is inevitably going to be that. That’s devastating, given the backlog of people waiting for treatment.
As infections rise, so too will admissions. As the hospital beds fill up with Covid patients, we will have to stop other work. There seems to be no planning for this whatsoever. It’s all very well for Sajid Javid to say we need to learn to live with the virus and we need to think about other diseases. But until the government understands that a virus running rampant and filling hospital beds means that other works can’t go on, we’ve got a real problem.
The NHS is going to be facing a war on many fronts over the next weeks and months. A&E attendances aren’t going to slow down because of people with health issues who have not had access to the right care. We are going to face a slower, more insidious but less relenting influx of Covid patients, hampered in the extreme by staff shortages and illness. Paediatricians are expecting an epidemic of viral conditions in children this autumn, which will mean an extra degree of pressure on services.
The real concern is that, without any real suppression methods, and with the opening up, this next wave means there will be no respite before what is likely to be an horrendous winter, when staff will be on our knees physically and emotionally.”
As told to Denis Campbell
* The writer is an intensive care consultant in the north-west of England