TO THOSE WHO receive them, vaccines offer fast protection, with effects kicking in just a few weeks afterwards. For health-care systems, though, the protection takes a little longer—as those working in English hospitals are now acutely aware.
In all 32,689 National Health Service beds are currently occupied by people with covid-19, 50% more than in last year’s peak. Modelling by the Covid-19 Actuaries Response Group suggests that because of the slow start to the roll-out, even if everything goes to plan, hospital admissions will not decline sharply until early February.
Intensive-care admissions will take still longer. The government has jabbed the oldest first. Yet the elderly tend not to end up in intensive-care units, because they don’t do well on ventilators (the average age of covid-19 patients on critical-care wards is a sprightly 60). Thus the actuaries think intensive-care admissions won’t drop much until the end of February.
The modelling is based on the assumption that cases will remain at current levels. That is not too far off what many in the health service are now expecting. Growth in cases seems to have halted, but the lockdown may not force a fast decline in infections, because of the increased transmissibility of the new variant.
The result will be a period of sustained pressure on hospitals. London’s and the south-east’s have so far borne the brunt of this wave. Chris Hopson, chief executive of NHS Providers, a representative group, says he is worried about those in the north-west, which have patients in beds from the autumn, and the south-west, which has low capacity.
Politicians talk of the need to avoid “collapse”, implying a binary outcome where hospitals suddenly go from being able to provide care, to not. In reality there is a gradual ratcheting up of risk well in advance of such a moment. “It’s really important that nobody in the NHS should pretend that you will get the same quality of care or the same outcomes,” says Mr Hopson.
This can be seen in oxygen supplies. Since the first wave there has been a move to less-invasive breathing support, which requires lots of oxygen (as much as 60 litres a minute, compared with 15 for a ventilator). Piping—particularly in older institutions—is struggling, meaning some hospitals have reduced blood-oxygen targets to prevent systems from giving out. William Harrop-Griffiths of the Royal College of Anaesthetists says this is safe in itself, but leaves little wiggle room if, say, there is an interruption in the gas supply or if the patient’s lung function deteriorates.
It is a similar story in other areas of care. Some 6% of London’s ambulances are now delayed for longer than an hour, more than double the rate this time last year. Patient-to-staff ratios in critical care are rising, with reports suggesting three or four intensive-care patients to each specialist nurse in some places. That is lower than during the worst of the first wave, but well above the normal one-to-one ratio.
Efforts to free up capacity are getting increasingly unpleasant; ranging, in the capital, from booking hotel rooms for recuperating patients to cancelling cancer operations. The hope is that this will stop critical-care capacity being breached. Whether it works is still in the balance. Yet even if it does, it will come at a cost. ■
Editor’s note: Some of our covid-19 coverage is free for readers of The Economist Today, our daily newsletter. For more stories and our pandemic tracker, see our hub
This article appeared in the Britain section of the print edition under the headline “Long covid”
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Of the 9.63 lakh Covishield vaccine doses for Maharashtra, a total of 11,240 vaccine doses have been set aside for the Armed Forces Medical Services (AFMS). A total of 7,930 vaccine doses have been allocated for AFMS in Pune while 1,610 have been set aside for Mumbai. Another 15,130 vaccine doses will be set aside for central government healthcare workers and the remaining for state healthcare workers, according to state authorities.
The highest number of vaccine doses have been sent to Mumbai (1,39,500), followed by Pune (1,13,000), Thane (74,000), Nagpur (42,000) Ahmednagar (39,000), Kolhapur (37,500) and Aurangabad (34,000).
A meeting on this issue was held on Wednesday and the allocation of vaccine doses will be made as per the central government’s protocol, said Pune District Collector Dr Rajesh Deshmukh. Accordingly, Pune district has received a total of 1.13 lakh vaccine doses.
Dr Amit Shah, PMC’s immunisation officer, said the civic body has received 48,000 vaccine doses, which have been kept at its vaccine store centre at Narayan Peth. Instead of the 16 vaccination centres identified to inoculate healthcare workers in the first phase, the civic body has now identified eight hospitals, including Sassoon General Hospital, Deenanath Mangeshkar Hospital, Ruby Hall Clinic, Noble Hospital and Bharati Hospital, and the civic body-run Kamala Nehru Hospital, Rajiv Gandhi Hospital and Sutar Hospital.
Private hospitals authorities said they expected the vaccine doses to be sent either by January 15 or on the day of the vaccination, January 16.
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A medical college in western Ukraine has been transformed into a temporary hospital as the coronavirus inundates the Eastern European country.
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Many of the hospitals in Ethiopia’s conflict-hit Tigray region have been struck by artillery during the two months of fighting, according to the first humanitarian assessment of the devastation as aid begins to arrive with desperately needed supplies.
The scale of the damage has been largely unknown while Ethiopian forces pursue and clash with those of the now-fugitive Tigray regional leaders, with the involvement of troops from neighbouring Eritrea.
Transportation and communications links were severed. More than 50,000 people have fled to Sudan, some telling The Associated Press of mass abductions, torture, and killings along ethnic lines.
The United Nations (UN) and rights groups have long emphasised that intentional attacks on hospitals are war crimes. The assessment does not say who fired at hospitals; the UN humanitarian agency said it did not have confirmation of such details.
Tigray leaders dominated Ethiopia’s government for nearly three decades before prime minister Abiy Ahmed came to power and sidelined them amid sweeping reforms that won him the 2019 Nobel Peace Prize. Abiy has rejected international “interference” in the conflict, which continues outside the Tigray capital, Mekele, and in other areas.
The full humanitarian assessment, seen by the AP, was prepared by a joint mission of Ethiopia’s government, UN agencies and aid groups that visited the Mekele and communities in southern Tigray in late December after weeks of pleading by the UN and others for access.
Food, medical supplies and other basics have run alarmingly low across the region. The assessment cites regional authorities as saying more than 4.5 million people – more than two-thirds of the population – need humanitarian assistance.
“The little food stock the affected communities had have either been looted, burned, or damaged,” the assessment says, adding that a locust outbreak has worsened the situation. “Living conditions for both recently displaced people and host communities remain very critical”.
It adds: “As a result of the conflict, many houses, shops, and private stores were burned or damaged”. Schools, health centres, shops, and other buildings were looted.
An even grimmer picture expected from an assessment based on a visit to western Tigray, where some of the fighting first erupted in early November.
The European Union’s foreign policy chief, Josep Borrell, said on Saturday that he had spoken with Ethiopia’s deputy prime minister, Demeke Mekonnen, “and conveyed the EU’s alarm over the situation in Tigray. Full and unrestricted humanitarian access must be granted. This is not an EU demand — this is international law”.
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London Mayor Sadiq Khan has declared a major incident with the city’s hospitals on the brink of being overrun.
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Claims that hospitals are not under pressure from surging numbers of people suffering badly with coronavirus are a “lie”, the chief executive of NHS England has said.
Speaking at a Downing Street briefing, Sir Simon Stevens said false claims on social media could change behaviour in a way that would cause more deaths.
In his condemnation of those who allege the COVID crisis in hospitals is a “hoax”, Sir Simon said: “You are not only responsible for potentially changing behaviour that will kill people.
“But it is an insult to the nurse coming home from 12 hours in critical care, having worked her guts out under the most demanding and trying of circumstances.
“There is nothing more demoralising than having that kind of nonsense spouted when it is most obviously untrue.”
And he was backed by the prime minister, who also hit out at those who were dismissive of the pressures on hospitals.
“The kind of people who stand outside hospitals and say ‘COVID is a hoax’ and this kind of stuff, really I do think they need to grow up,” Boris Johnson said.
“You heard eloquently from the head of NHS England the pressure the NHS is under and we’ve all got to do our bit, responsibly, to protect it.
“For a lot of us, the vast majority of the country, that means making sure we stay at home and protect the NHS.
“For people who are getting invited to get a vaccine, go and get the jab.”
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PM’s targets for vaccination rollout
Sir Simon had earlier outlined the current challenges facing the NHS in England, describing how there are now 50% more coronavirus patients in hospitals now than during the peak of the first wave of infections last April.
“That is true in every region in the country now – more COVID inpatients than back in April,” he said.
“That number is accelerating very, very rapidly.”
Sir Simon said there had been an increase of 10,000 coronavirus patients in hospitals since Christmas Day.
“That’s the equivalent of filling 20 acute hospitals with extra coronavirus patients,” he added.
“And, of course, many of those will be patients who’ve caught the infection between Christmas and New Year, given the delay between catching infection and becoming seriously ill.”
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Compared to last year’s first wave of COVID infections, Sir Simon said the situation was now more severe as hospitals are now also caring for many more non-coronavirus patients than they were last year.
He described a “very serious” situation in London and across parts of the South East, with 800 patients a day admitted to the capital’s hospitals with coronavirus.
“That is the equivalent of a new St Thomas’ hospital full of Covid patients, fully staffed, every day, or a new University College Hospital, full of coronavirus patients every day,” Sir Simon added.
“So it is absolutely vital that the measures that are now in force do begin to have an impact on slowing and cutting the infections across London and the rest of the country.”
He said London hospitals were expanding their number of beds, making use of private hospitals and that London’s NHS Nightingale Hospital is planned to open next week.
The specially-constructed facility, housed at the Excel convention centre, would also soon serve as one of the country’s large vaccination centres, Sir Simon said.
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The coronavirus health crisis facing the United Kingdom is dire, this week forcing the country back into lockdown until at least mid February as authorities brace for the potential of hospitals being completely overwhelmed.
There are routinely more than 50,000 new cases being recorded each day as an aggressive new strain of the virus takes hold.
Health workers are stretched to the limit, and among them are many Australian professionals.
Here, three Australian nurses tell first-hand of their experiences.
Emily Regan, 29
Perth-born nurse Emily works in accident and emergency at a major London hospital
I’m in one of the best, most safely staffed hospitals in the UK, but even we no longer have enough doctors, nurses or beds. On my past three shifts we’ve been between three and six nurses down.
In Accident and Emergency (A&E) we’re seeing 300 to 350 patients a day. That’s about the same as during the first wave, but their acuity has increased, meaning they are sicker and need greater care.
We’ve also got lots of people turning up with non-emergencies because they can’t see their GP.
In April, we had extra doctors redeployed from other areas and a special COVID intubation team. Hypoxic patients could be instantly intubated and in ITU (intensive care) within 30 minutes if necessary. The efficiency was amazing.
But now we have limited extra support because other health services like outpatient clinics and non-emergency surgeries are still running.
We’re also accepting ICU transfers from hospitals that have no capacity. It’s great we can offer that support, but soon we’ll have to stop because we won’t have capacity ourselves.
At one point last night, we had eight ambulances waiting outside to deliver patients, and a wait time of about 1.5 hours.
The anxiety when you’re walking into a shift is huge. We know it’s going to be hard, but just how hard is the question.
There have been times when I felt like I wasn’t able to give my patients the care they needed, or I’d not advocated well enough for them. I’ve just been scrambling all day, not taking toilet breaks — or not even needing a toilet break because I haven’t even had time to drink enough water.
That’s the hardest part: feeling like you’ve not given someone the care they deserve.
Luckily, I’ve stayed healthy so far. I’ve been on the Oxford vaccine trial since June, so I’ve been swabbing weekly for that, as well as doing COVID sensitivity tests twice a week.
‘People don’t want to have an educated discussion’
I am lucky to have good mental health, but it’s been hard to see colleagues struggling. I have seen some brilliant nurses just be done with it all and leave. It is such a loss.
On Boxing Day, morale was really low. We were just so busy and understaffed, and I found myself becoming easily irritated. My colleagues noticed I wasn’t my usual upbeat, joking self. I try to put on a friendly, happy face for my patients but it can be draining, so my colleagues aren’t getting the best version of me when they need it the most.
Occasionally, I run into COVID deniers protesting outside the hospital. It no longer shocks me. I just don’t engage. I originally did but there’s no point anymore. People don’t want to have an educated discussion.
Once someone’s seen a patient who is hypoxic from this virus and is aware of the time and resources directed at saving their life, then they have the right to an opinion. Otherwise, stay in your lane. I’m not going to waste my limited time on you.
‘Things are terrible and it’s only the start’
Seeing everyone at home lead normal lives is difficult at times, but I’ve lived in the UK for four years now and built a life here.
As hard as this past year has been, I love my job and have incredible friendships with my colleagues. I don’t want to walk away from all of that.
But we’re burnt out, and it’s made harder by the necessary restrictions. We can’t socialise and blow off steam outside work like we used to. We can’t visit friends and have them make us a cup of tea and just look after us for a little while.
About 60 per cent of the staff in my department are from overseas, so many of us don’t have families here either. We’re all just really tired. Things are terrible and we know it’s only the start of the next wave.
Louise Faint, 25
Louise is a nurse from Perth and works at a hospital in the West Midlands
I work in A&E in one of the UK’s worst-hit areas.
It’s pretty much as close to the COVID front line as you can get and the situation is deteriorating.
A few weeks ago we could go a few hours without seeing any patients in the “hot” area, where COVID cases are treated, and now we’re seeing 10 or more every shift.
It doesn’t sound like many, but most of those are quite poorly and require lots of care and close monitoring. And like everywhere, we are short staffed.
If hospitals are overwhelmed there’s a greater chance people will die unnecessarily simply because we won’t be unable to provide the care they deserve.
‘Their cries and distress are haunting’
I’ve been a nurse for a little under three years but I only joined A&E last January.
In this past year, I’ve experienced my first CPR, my first resuscitation attempt and my first patient deaths.
Last week, I had two patient deaths over two shifts. One was somewhat expected but the other was a normally fit and well 30-year-old who was brought in in cardiac arrest.
Seeing their families is usually what upsets me the most. Their cries and distress are haunting.
It’s been heartbreaking to see very sick patients go through it all alone because visitors weren’t allowed.
I’ve held the hands of lonely, elderly people while they fought for breath. I’ve tried to reassure families about their loved ones over the phone when I wasn’t even sure myself.
‘I made myself sick from overworking’
I’ve battled loneliness too. The pandemic began not long after I moved over, and then the national lockdown was announced and my boyfriend’s move from Perth was delayed.
I was working seven days a week just so I could be with other people and not alone with my thoughts. It was a really low time. I was stressed, bordering on the edge of depression, and I made myself sick from overworking. In May, my boyfriend arrived and things got better.
Now, though, a lot of staff are totally burnt out. We have short fuses and get worked up over small things that would normally not be an issue, such as doctors requesting another x-ray after we’ve already taken the patient for one.
I struggle to sleep before my shifts and I’ve stopped seeing the good in my day-to-day life. I never feel like I’m rested or have had a break. On my days off I barely have the energy to move off the sofa.
‘Staff often feel like they at risk’
The way the UK Government has handled things has caused a lot of confusion. The tier system is terrible and restrictions change so suddenly that making plans is next to impossible.
Even for medical staff, the rules change a lot. There are constant updates to policies and regulations surrounding PPE, swabbing, results timeframes, admission criteria, and trying to determine what’s potential COVID-19 and what’s asthma.
Staff often feel like they are out of the loop and being put at risk.
But I have a stable job and I have learnt so much.
Travel home out of the question
I came to the UK because I couldn’t get a job as a newly qualified nurse in Western Australia. I went to an NHS nursing expo in Perth in March 2019 and was offered one on the spot.
Living overseas has always been a dream of mine and I knew that if I didn’t take the leap of faith then I never would.
I’d love to go back and see my family soon but with flights costing at least 3,000 pounds ($5,303) it’s not going to happen in the foreseeable future.
Sarah is a nurse from Sydney working at a London hospital
At the start of the year, when it became clear we were facing a pandemic, I was retrained to work in intensive care.
My background is in respiratory nursing but I had never worked a day in an intensive care unit (ICU) before, not even in university rotations.
I was petrified, but it was essential.
‘I went home and just cried’
Intensive care shifts are 10 times more stressful than other shifts.
Patients are so sick, and COVID patients deteriorate so much faster. A normal shift might have one deterioration a day. A COVID ICU shift will have multiple patients deteriorating and multiple patients dying.
Normally, one nurse will look after one or two patients on breathing machines in an open space. That is the safe ratio. During COVID the ratio is more like one to four or five, and now they are all in single rooms, making them effectively invisible if they deteriorate.
My first ICU shift was in the middle of the night. I was meant to be doing a “shadow shift” — following a nurse around to get an introduction — but we had no staff, so as the most senior of the learning nurses I was asked to take a patient.
During the shift my patient deteriorated and could no longer tolerate the breathing machine.
They were intubated at 5:00am. It was a tricky intubation with a lot of different medical professionals involved. I had to quickly learn about new medications, a new breathing machine and complicated new settings. I have never been more stressed in my life.
Sadly, the patient passed away. I went home that morning and just cried.
Scared and angry, but determined to help
The numbers now are higher than they were in April. That is terrifying.
People don’t seem to understand, or care, how dangerous COVID is. They aren’t taking it seriously anymore, or they think they are invincible.
I have one friend who thinks it’s made up. I can’t even bring myself to argue with them now because I get too angry.
The hardest thing has been pretending to loved ones in Australia that I’m fine when really I’ve been very scared and homesick.
I’ve nearly gone home on multiple occasions, but I stay because I feel I have a duty to the NHS and to the sick people of the UK.
Some days it’s almost impossible to be strong for my patients. I’ve cried with husbands and wives, sons and daughters on the telephone. I try to put them at ease when deep down I don’t whether the person they love will survive or not.
It scares me that my own family are so far away and I have no way of getting home to them quickly. But I love my hospital and I’m so proud to be part of the NHS. None of this is their fault.
*Not her real name. Kate Guest is an Australian journalist based in the UK
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In an effort to speed up what has been a sluggish rollout of the coronavirus vaccine, New York’s governor threatened Monday to fine hospitals up to $100,000 if they don’t finish their first round of inoculations by the end of the week. (Jan. 4)
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Batches of the Oxford/AstraZeneca coronavirus vaccine have started arriving at UK hospitals ahead of the jab’s nationwide roll-out.
Some 530,000 doses of the treatment will be available for roll-out across the UK from Monday, with vulnerable groups already identified as the priority for immunisation.
The vaccine has been developed in the UK by Oxford University and the pharmaceutical giant AstraZeneca.
The roll-out will begin after England’s chief medical officer Chris Whitty warned vaccine shortages are likely to cause problems for “several months”.
He added the UK urgently needs to maximise the number of people who are vaccinated, but added a lack of global supplies will likely hamper efforts to protect the nation in the first part of 2021.
Public Health England (PHE) has said it does not recommend mixing coronavirus vaccines from different suppliers amid fears over the possible shortages.
Both the Oxford/AstraZeneca vaccine and the Pfizer BioNTech vaccine, which has been rolled out from December, require two doses.
The UK government had issued guidance telling NHS medics that if a person who has received their first coronavirus jab goes back for their second but the same type is not available, or the first vaccine type is unknown, then it is “reasonable” to offer a dose of another vaccine.
Dr Mary Ramsay, head of immunisations at PHE, has since told Sky News that mixing is not recommended and should only happen on “rare occasions”.
The Princess Royal Hospital in Haywards Heath, which is part of Brighton and Sussex University Hospitals NHS Trust, was one of the first hospitals to take delivery of a batch of the Oxford/AstraZeneca vaccine on Saturday morning.
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First doses of the vaccine will be administered after the UK recorded another 57,725 coronavirus cases on Saturday – its highest ever daily total.
Another 445 deaths were also reported.
The total number of people who have now died of COVID-19 in the UK now stands at 74,570.
Dr George Findlay, chief medical officer and deputy chief executive at the trust, said the vaccination programme gives NHS staff “more confidence” coming into work.
He added the Oxford/AstraZeneca vaccine, which can be kept at normal fridge temperature, is “much easier” to administer when compared with the jab from Pfizer and BioNTech, which needs cold storage of around minus 70C.
More than a million people having already received the first of two jabs of the Pfizer/BioNTech vaccine.
Second doses of either vaccine will now take place within 12 weeks rather than the 21 days that was initially planned with the Pfizer/BioNTech jab, following a change in guidance which aims to accelerate immunisation.
Dr Findlay has said hundreds of people are expected to be vaccinated per day at the Princess Royal Hospital site, with efficiency expected to increase after the first few days of the programme.
He added: “We’ve got a delivery hub set up in the grounds of this hospital, so we’ve got the infrastructure there to invite people in for booked appointments.
“And we will make sure those booked appointments are full every day from Monday going forward.”
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‘Most vulnerable’ to be vaccinated first
NHS staff and social care workers who are at risk are among those who will be vaccinated with the Oxford/AstraZeneca jab from next week.
Dr Findlay said: “We started vaccinating on our other hospital site a few weeks ago, it’s been seen as a really positive step, something that gives staff more confidence to come to work.
“You only have to look at the statistics over the last 10 months about how many staff have suffered illness, or sadly lost their lives.
“This gives staff the confidence to come to work to be able to look after patients.”
Dr Findlay said the hospital has been under “quite a lot of pressure” since the start of December due to a rise in cases amid a new variant of the virus.
He added: “And that’s increased over the past few weeks as cases in the community increase, and then hospitalisations increase, and critical care requirements increase.
“Staff are coping amazingly well, they are working incredibly hard, and we are increasing capacity to deal with the most sick patients.
“So whilst it’s really difficult, and staff are under pressure, the hospitals are coping and we are still providing care to everybody who needs it.”
Dr Findlay said the hospital had decreased planned care, with some routine operations postponed to enable staff to focus on the COVID-19 response.
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NHS staff ‘strained to the point of exhaustion’
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He added that he worries about the physical and mental wellbeing of workers, calling it an “incredibly difficult year”, as fear remains over potential staff burnout.
He added: “We have gone through wave one, which was unknown and hugely pressured.
“We then tried to focus on recovery, so deliver care to the patients that were postponed, and people worked really hard at that.
“And then we’re straight into the next wave so nobody has had a break really for pretty much all year, so we are really worried about fatigue, stress, strain, and we’re doing everything that we can to try and support our staff. But it’s just always a worry.”
Nightingale hospitals across England are being “readied” for use if needed as COVID-19 patient numbers rise.
The NHS in London has been asked to make sure the Excel centre site is “reactivated and ready to admit patients” as hospitals in the capital struggle.
Other Nightingale hospital sites across England include Manchester, Bristol, Sunderland, Harrogate, Exeter and Birmingham.
A spokesman for the NHS said that while staff were going “the extra mile,” hospitals in London were coming under significant pressure from high Covid-19 infection rates.
He added: “The NHS in London is opening more beds in NHS hospitals across the capital to care for the most unwell patients. It is crucial that people do everything they can to reduce transmission of the virus.
“In anticipation of pressures rising from the spread of the new variant infection, NHS London was asked to ensure the London Nightingale was reactivated and ready to admit patients as needed, and that process is under way.”
Defence Secretary Ben Wallace said the military was standing by to staff Nightingale hospitals if the NHS exceeded its capacity of critical care beds.
Speaking to Times Radio, Mr Wallace said: “Of course we stand ready to help with Nightingales if the critical pressures go beyond the capacity of the existing NHS.
“We are on, I think, 17,000 ventilator beds currently being used, of a capacity of 21,000.
“If it starts to tip over there, then of course you’ll see those Nightingales being more active and, yes, we have a number of medical staff.”
He said the Army currently had 5,000 personnel deployed in the Covid-19 response.
Trusts across the country all continue to face pressure, with COVID patient numbers in England having surpassed the April first-wave peak.
And people have been urged to ring in the New Year by staying at home and not mixing. NHS England’s national medical director, Professor Stephen Powis, warned: “COVID loves a crowd.”