One of London’s biggest hospitals has warned it is on track to become virtually Covid-only amid a surge in cases in the capital that has left it scrambling to convert operating theatres, surgical recovery areas and stroke wards into intensive care units for the very sick.
As the daily coronavirus case numbers in the UK continued an apparently inexorable rise, hitting a record 55,892, with 23,813 people in hospital and 964 reported deaths, the chief executive of University College London hospitals trust (UCLH), Prof Marcel Levi, said admissions were already spiralling beyond the first wave in the spring.
Every hospital in London was facing the same demands on beds and staff, and University College hospital was taking admissions from other hospitals that were less well able to cope, he told the Guardian.
“This is much more than we had in March and April,” said Levi, an acute medicine doctor. The 500-bed hospital has 220 Covid patients, with the numbers increasing by 5% a day, but the real pressure is on intensive care where there are now 70 very sick patients, as there were in the spring, and the number is rising fast.
“Usually in our ITU we have about 35 patients so we are already doubled in size at UCLH. We are further surging upon the request of London to 92 patients in the next week, and thereafter probably we will have to grow even further,” he said.
At the hospital, whole floors are having to be dismantled and rebuilt to the standards required for intensive care wards. As they did in March, they have had to convert five floors and equip them with oxygen and continuous positive airway pressure (CPAP) machines that help people breathe.
It came as a nearby hospital reportedly told staff it was in “disaster medicine mode”. The Royal London Hospital in Whitechapel, east London, has more than 90 patients in adult critical care units and the “number of people with Covid continues to rise rapidly”, according to an email sent to staff. It adds: “We would like to take this opportunity to reiterate the fact we are now in disaster medicine mode. We are no longer providing high standard critical care, because we cannot. While this is far from ideal, it’s the way things are, and the way they have to be for now.”
Just under half of all major hospital trusts in England – 64 out of 140 – have more Covid-19 patients than at the peak of the first wave of the virus. This includes 11 of the 14 acute trusts in eastern England and 12 of the 19 acute trusts in south-east England. The NHS said on Thursday it was making sure the Nightingale hospitals were “reactivated and ready to admit patients”.
Levi paid tribute to his “amazing” staff, who volunteered to give up their leave over Christmas and the new year to help save lives. But they are severely stretched: intensive care nurses normally work with one patient; now they may have four or five under their care.
Elaine Thorpe, a critical care matron at the hospital, said they set up 20 new intensive care beds on Christmas Eve that were full by New Year’s Eve. “The biggest thing for me is I’m dreadfully worried about my team. Nurses are having to spread themselves thinly. We’re going back to the levels where we were before, where it was one ICU nurse looking after what will be four patients, or more. And we’ve had lots of tears already.
“This is happening all over London. UCLH is not quite feeling it the way that the other hospitals are, but a little stretch on an ICU nurse is too much of a stretch and you know we’re already doing way beyond what we would not want to do. And they’re just terrified as well. We’re living it again already.”
The tears are partly because nurses are unable to give their patients the dedicated care they want to provide, as well as the distress that Covid inflicts on everyone. Thorpe tells of nurses listening to families at home pouring out their hearts via iPads to severely ill relatives in ICU, who may be able to hear but cannot reply.
But there are also tears of frustration that people are still taking risks with the virus. “It’s not about us not stepping up and doing our job. We’ve all sacrificed Christmas and New Year but it’s not about that. We’re here for the patients. But it’s in the hands of the public to stop this, and it’s not listening and tonight [New Year’s Eve] is obviously going to make things even worse,” she said.
She has seen high-profile people on Twitter claiming that hospitals and intensive care units are empty. “I just don’t understand and my team don’t understand it, and that’s the really hard thing,” she said.
We were almost there, she said, with vaccines on the way. If people had given up Christmas and new year, it could have been different, she said, but now “this is going to be weeks. None of us can see this stopping any time soon.”
Levi also thinks people have relaxed too much. The big rise in cases is not just about the variant, he says. “I think it’s fair to say that we’re also seeing the effects of Christmas shopping, where people were crowding into shops and actually not really obeying distancing rules and all that stuff,” he said.
They will cope because they have to. Levi, from the Netherlands, praises the “enormous resilience and the can-do mentality” of people in London and the UK.
“If we have to do more, we will do more, and we will improvise and we will find other ways of providing the care that we need to provide, but it is extremely tight. In my very long experience both as a consultant and as hospital director, I’ve never experienced something like this before,” he said.
They will cope with the flood because of the commitment and dedication of the staff. “I feel that we have no choice. These people need medical care. We have to deliver it. We can deliver it. And we are also quite confident that we can deliver it in a safe and appropriate way,” he said.