In U.Ok. Hospitals, a Determined Battle Towards a Risk Many Noticed Coming

LONDON – As a new and more contagious variant of the coronavirus ravages the overstretched UK National Health Service, health workers say the government has taken increasingly desperate measures due to the government’s failure to expect infection in winter.

Hundreds of soldiers were dispatched to move patients and equipment around London hospitals. Organ transplant centers have stopped performing urgent surgeries. Doctors have reduced patient oxygen levels to save on congested tubes.

And nurses, desperate to make room for more beds, had to move critically ill people to newly converted Covid-19 wards in the middle of the night, even though they barely had enough staff to treat existing patients.

Most annoying for doctors and nurses, the UK government and public health system, which was hit by the virus last spring, ignored a cascade of warnings in the months that followed about the need for a wave of infections in winter and hospitals at the beginning of patients Arrived unprepared.

Although the UK is ahead of the US and other European countries in the race to vaccinate people and signs of slowing down in new cases, deaths are rising, hospitals continue to fill and healthcare workers are overwhelmed for the second time in a year Scrambling 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 ICU nurse in south London.

Even so, the government waited until January 4, when the health system was on the verge of crisis, to re-lock the country and hospitals were reluctant to abandon elective surgeries so doctors could prepare.

“We don’t know what to do,” said Mr. Carr. “We cannot turn patients away. We practice medicine in a way we have never had before in the UK. “

For the United States, where cases are declining even though some cities continue to flood the virus, the harrowing scenes in British hospitals are a sobering lesson: health systems that weathered the first wave of the pandemic remain vulnerable to the challenges of one themselves faster spreading variant.

Over the past few months, doctors in the UK have put in place more sophisticated patient handover plans, a critical safety valve for severely affected hospitals. And doctors have learned less invasive techniques to help patients breathe.

But in other ways, hospitals’ defenses were weakened as cases began to rise that winter. Health care workers who left their usual posts treating coronavirus patients last spring were exhausted, making it harder to get reinforcements. Hospitals tried to keep long-late appointments for non-covidial ailments and to treat the kind of heart attack and stroke sufferers that hospitals avoided last spring – unwise, doctors said -.

The billowing wards and grueling shifts that seemed inevitable last year suddenly looked like a consequence of poor planning to doctors and nurses, undermining the solidarity that once gave rise to health care.

With nearly 40,000 Covid-19 patients in hospitals, almost double what it was last year, 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 the UK.

“It just didn’t have to be like that,” said Tariq Jenner, a London ambulance. “The first time you could say that it was inevitable. It just feels completely avoidable, and it’s a lot harder to take. “

Prime Minister Boris Johnson has repeatedly avoided taking quick action to contain the spread of the virus. In September, he defied a call from government scientists for a brief lockdown across England and waited until November to step up national controls. On December 22nd, government officials again called for tough measures, including school closings, a move Mr Johnson avoided until January 4th.

Meanwhile, doctors and nurses were annoyed in break rooms about the spread of the virus. And they urged the hospital managers to prepare.

Most worrying were the pipes hospitals use to transport liquid oxygen to wards and convert it to gas. In August, a body overseeing British hospital groups warned that the pandemic had “placed stress beyond the capacity of the existing pipelines,” and called on engineers to take remedial action.

Updated

Jan. 21, 2021, 1:05 p.m. ET

The UK health service said roughly that Prior to winter, $ 20 million was spent upgrading the oxygen infrastructure.

However, industry experts said not all hospitals received government funding to complete the work. Over the past few weeks, doctors have allowed some patients’ blood oxygen levels to drop below their normal targets and have moved other patients to other hospitals due to overworked systems.

The need for oxygen has increased this winter because doctors have stopped using ventilators, which are less invasive but more oxygen-intensive.

“You could have upgraded the pipes,” said Christina Pagel, professor of industrial research at University College London. “That kind of planning could easily have been done over the summer, but people just thought it wasn’t going to happen again.”

Hospital executives also hesitated to stop elective operations and put back efforts to rearrange wards and train hospital staff with less ICU experience when cases arose.

In mid-November, staff at a hospital in south London wrote to the board of directors warning that it was “possibly unrealistic” to continue performing elective surgeries in addition to common winter illnesses and Covid patients, “given the current staffing pressures and high disease and burnout rates . “Even before the coronavirus cases increased, the staff in the intensive care unit treated more patients than usual and risked“ compromising on patient care ”.

The combination of requirements allowed health workers time to get ready. Some London hospitals have expanded the intensive care units from around 50 beds to 220.

“We went into this wave less well prepared, and the staff are more exhausted and overworked without the prep time we had before the last wave,” said Mark Boothroyd, an emergency room nurse. “The danger is that most of the NHS is now exhausted and we have a few weeks left.”

Many health workers have retired since the spring. Others have hesitated to volunteer a second time in intensive care units or call in sick when asked to do so.

Nurses who are still on Covid wards report a variety of psychological and physical stresses: joints that ache from moving patients, many of whom are overweight; the appetite decreases again; Sleep is disturbed by fears about the workforce.

Some said they drank after long shifts. Hospitals have set up dermatology clinics for workers whose masks and hand washing have damaged their skin.

During a recent handover to the nursing staff, Mr. Carr said, he noticed a coworker crying.

“Usually I would say, ‘Okay, you’re obviously stretched thin, go home,'” he said. “Instead, I say, ‘You are obviously stretched out, I would put my arm around you if I could and you cannot go home.’ There is all this pressure and a lot of fear. “

In wards full of sedated patients, healthcare workers perform a dizzying array of tasks: delivering medication, monitoring blood pressure and electrolytes, adjusting feeding tubes, and preventing infections. In some hospitals, doctors said that staffing shortages meant they could not wake ventilated patients as often as usual, which accelerated muscle wasting.

And the government has still not given clear instructions on how to ration resources in the worst of circumstances.

“Everyone is talking about triage,” said Zudin Puthucheary, a doctor and councilor for the Intensive Care Society, a professional organization. “Who will make these decisions? Because we are not trained for it. “

Hospitals are so busy that the volume of clinical waste produced by the National Health Service has more than doubled, according to internal hospital notes. And as cases in London decline, patients from northern England and Wales are being moved to specialist hospitals in the city.

While the pace of new admission of Covid patients to UK hospitals has slowed in recent days, doctors are preparing to work for months to help people recover.

“We have no plan how to rehabilitate these patients and bring them back to life,” said Dr. Puthucheary. “This is the next big question we have to ask.”

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