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Pushpo Hossain is in the eye of the capitalâs Covid storm. The ward where the junior doctor cares for severely ill coronavirus patients is having to limit oxygen and consider who gets the hard-to-come-by non-invasive ventilators.
The number of Covid patients is âgoing up exponentially,â she says in her hospital accommodation after another gruelling 13-hour shift. âWe are so short staffed and we donât have enough of the non-invasive ventilator machines that can hold patients until they can be transferred to intensive care units [ICUs].â
Hossain, 31, and her colleagues in the south-west London hospital where she works have to make almost impossible decisions about who gets what and who gets moved.
âWe do a risk-benefit analysis based on age, number of comorbidities and sometimes based on the amount of resources we have,â she says. â[A patient] could be an ICU candidate, but we donât have a bed. Our hands are tied. It makes me want to cry.â
This weighs heavily on the staff, who are battling fatigue, stress and exhaustion. Hossain rarely has time to eat properly and struggles to stay hydrated because she is so busy. Two of the five doctors on her ward are off with Covid, leaving the remaining three covering their shifts. âThere are times when we just collectively break down. There are times when we canât take it any more,â she says. âI remember me and the nurses just held each other in the clinical room.â
Oxygen for patients has already been limited because the hospitalâs supply system was approaching the point where it would shut down. âWe have the oxygen to give everybody, but we donât have the delivery system. The system would crash if too many people were sucking in oxygen in a high concentration,â Hossain says. âThat would be disastrous, because that would mean the entire hospital oxygen supply would be cut off.â
Her greatest fear is that even more people turn up in need of oxygen, pushing the system over the edge: âWe would possibly have to evacuate and transfer all these patients that need oxygen to some other hospital â and most of the hospitals are in the same situation.â
Epsom and St Helier University Hospitals NHS trust said that pressure on services was very high and had reached the limit of what the 80-year-old infrastructure could cope with.
It added that a new vaporiser, which will treble its piped oxygen supply, is due to be up and running by 11 January.Nurse Laura Duffell: âItâs got very bad, very quickly.â Photograph: Andy Hall/The Observer
It is supposed to be Laura Duffellâs first day off since Christmas Day, but she has been called back in because the major teaching hospital where she works is in danger of being overwhelmed by surging Covid admissions.
âI wasnât supposed to be at work today,â she says. âItâs got very bad, very quickly. Over this last week itâs escalated massively â¦ we went from 130 Covid patients to 500.â
Duffell, who is a paediatric nurse, says the south-east London hospital where she works is full, with intensive care beds being moved into operating theatres and recovery wards.
âWeâre juggling which patients go where constantly: are they sick enough to go to intensive care? Or could we put them in a high-dependency ward? Where are we going to get ventilators from and where are we going to get the nurses trained to use them? Itâs hour by hour,â she says. âItâs far worse than any winter Iâve ever experienced and weâre barely even in January yet.â
Her department worked hard over the summer to get through waiting lists after operations for sick children were cancelled but she fears they may soon be in the same situation again. âUnless something changes, we are going to be in a position where patients that donât have Covid suffer,â she adds.
The new coronavirus variant, which is thought to be behind the spike in cases, appears to be hitting younger people harder. Duffell has been forced to turn over two paediatric wards to children with the disease. âWe had the odd child here and there last time, but in this wave we are getting a lot of positive younger people,â she says. âWe have one Covid ward for children already and we are just setting up a second one.â
The deepening crisis is taking a personal toll on frontline nurses like Duffell, who currently has no days off on her roster. She misses her family intensely: âI feel like Iâve abandoned [them]. My kids are really supportive but they make comments about how Iâm never around. The guilt is immense. But what can you do?â
Gastroenterologist David Higgins usually carries out elective endoscopies, which are a diagnostic pathway for cancer, but he worries that he may soon have to stop so his wards can accommodate more Covid patients.
âThere are more and more demands on our staff to go and cover other wards and ICUs. And ICU has expanded into half of our endoscopy unit, which has massively reduced our capacity to do diagnostic cancer and therapeutic cancer work,â he says. âWe are in the midst of discussions about what we do. How do we maintain the cancer work and deal with Covid?âI donât remember seeing corridors full of people the first time David Higgins
Soon he may have to choose between treating Covid patients or cancer patients. âThatâs effectively what weâre having to think about because the hospital is in meltdown. Do we divert resources and people to deal with the Covid crisis or maintain cancer pathways?â
The consequences for stopping cancer pathways are, however, stark he says â âdelayed diagnoses and poor survivalâ.
The situation in the Hertfordshire hospital where Higgins (not his real name) works is deteriorating fast. âIâve been down to A&E this morning. Itâs proper carnage. Corridors are wards and we are talking about whether we use ambulances as cubicles,â he says. âI had to see someone today in a corridor. It was awful.â
The scale of the crisis is unprecedented and feels worse than even the first wave. âWe expanded into different areas but I donât remember seeing corridors full of people the first time,â he says.
Lots of staff are off sick and demands are growing daily. âWe are being asked to work more and more. Healthcare workers are fairly robust and resilient, but there are limits â weâll find out where they are this winter.â