It is hard to summarise exactly why I feel so angry. While the third wave is clearly under way, things are definitely different this time around. For the equivalent case numbers, hospitalisations are far lower, and people overall are less unwell. Vaccines have made the difference.
Many of our admissions have not been vaccinated, however. Some want to achieve “natural immunity”; it is unclear whether they realise that the only way to do this is to get the disease instead. Another wants “to see some real data”, as if all the information assessed by the regulatory authorities before approval, and the clear real-world data about the reduction in cases, is somehow fabricated. Someone’s friend got some side-effects from the vaccine so she didn’t have it; guess which one of them ended up in hospital. Most of these people have the decency to look sheepish, or to describe themselves as “one of those idiots”.
Not all, mind: some remain defiant as they are wheeled off to intensive care, and their families deny that Covid itself exists even as their relative is placed on a ventilator.
How can you even begin to have a conversation with that as a starting point?
Conversely, well over half of our Covid admissions have been vaccinated. These patients are a mix of ages, and are less unwell than they used to be, for the most part; very few need admission to intensive care after vaccination. The vaccination clearly works, but is not 100% effective in all people. This much we knew.
There are other problems brewing now. Our paediatricians are seeing a rapid increase in cases of RSV, a seasonal virus that in severe cases causes respiratory distress in children. Children have been mingling much less recently and immunity has dropped, so cases are rocketing. Conversations have already begun about how we are going to share vital equipment – ventilators, Cpap machines – between adults needing it for Covid and children for RSV.
On top of this, other respiratory viruses are starting to rise again in adults. We are starting to see cases of flu, parainfluenza and others that have been almost entirely absent for months. This creates a huge headache as we try to isolate different cohorts from one another. Two cohorts were hard enough – Covid and non-Covid – but now that we have different Covid variants and patients with other respiratory viruses to isolate from one another, we are rapidly running out of side rooms and space in the hospital to do so.
It is hard not to watch the steeply rising curve of daily cases with horror. It is obvious that we are not even near the peak. Current predictions seem to be that this will not occur until later in August, or September. The number of cases we have in hospital is doubling every 14 days or so. At the current rates, that suggests we will need to open new wards and restart our Cpap unit in a couple of weeks. Just the thought makes me feel tired.
We are all still exhausted. Levels of unhappiness among staff are high; I know several consultants who have gone off work with stress and many others who are receiving treatment for mental illness. Planning childcare is a nightmare on the shifting sands of unexpected isolations in children and their caregivers, and this increases the strain. Interestingly, I have sensed an increasing openness and willingness to discuss mental health that has long been lacking for doctors and perhaps this is one small silver lining.
Meanwhile, however, our junior doctors are so close to the edge that minor events regularly bring them to tears. Their training has been hugely disrupted through this, and they have high anxiety levels about the future. The most junior were fast-tracked through to qualification last year and have never worked in a hospital without Covid. They have missed out on so much of the camaraderie, shared experiences, nights out and human contact that formed my coping mechanisms during my first few nervous months as a doctor. No wonder they are struggling. I want to tell them that this is not normal, that it won’t always be like this, but reality bites: it may well be.
We are undoubtedly in for a horrendous winter that is likely to surpass any previous years in terms of the complexity and intensity of work over a prolonged period. The burden of long Covid and patients left broken and damaged after severe Covid infections is not decreasing and will need to be provided for alongside everything else. Vaccines have clearly weakened the link between cases and hospitalisations, with people not getting as ill as they were before, but if cases hit 200,000 a day even a small proportion of these could bring hospitals to their knees. Meanwhile, we are also about to allow all the other respiratory viruses to again flourish in a population whose immunity will be relatively depressed by 18 months’ reduced exposure to them.
In this context, it is hard not to feel undermined by the relaxing of all restrictions. Any pretence of “data not dates” or “following the science” is nonsense; why not hold on a bit longer? I appreciate that we will all have to “learn to live with Covid”, but surely we must continue to mitigate risk, and opening up in the face of exponentially rising case numbers is idiotic. We have to learn to live with the risk of getting run over; that doesn’t mean that we cross the road in front of an articulated lorry. Surely we can at least wait until the curve of new cases is flattish, not steepening, and hospitalisations are not rising? And give a few hundred thousand more vaccinations while we’re waiting?
For the most part, I think that the patients I see have been following the rules. But if people are allowed to do something, they will. And this is what makes me most angry. When rules are relaxed, people will quite reasonably relax their behaviour. Urging caution thereafter is as nonsensical as asking people to “stay alert”. This is a pernicious, contagious, invisible virus that a person can spread for days before they even know they have it. I have met tens, if not hundreds, of careful, cautious, law-abiding people who have been infected despite following the rules. All that the current verbal gymnastics can do is to shift the blame away from those in power – who have access to a wealth of data, the whole picture – on to ordinary people who don’t have the information to make an informed decision. We need to be given simple, clear, safe rules to follow, however unpalatable that may be. It is craven and disingenuous to do otherwise.
Meanwhile, the mood in the hospital is one of weary resignation. We watch the unfolding case numbers with horror and try to carry on as usual. It is hard to escape the feeling that, once again, we will be bearing the brunt of our leaders’ mistakes.