London hospital staff speak out: ‘We’re not here to judge, but please get your Covid vaccines’
On the third floor of one of the country’s biggest hospital trusts, a team of intensive care specialists in masks and visors huddle around a screened bay where a critically ill patient lies unconscious surrounded by cables and tubes.
The elderly man’s breathing is supported by a ventilator and he is connected to an arterial line to measure blood pressure. He is fed by a gastric tube, and a nearby stack of six monitors provide updates on his condition, from oxygen levels to heart rate.
He is one of 14 Covid patients on a critical care ward which is at capacity this weekend. He is receiving some of the best medical care in the world, but his concerned medical team know the long-term prognosis for this patient at the unit in King’s College hospital in south London, and many like him, is uncertain.
Staff who spoke to the Observer during a visit to the Covid wards said most of these dangerously ill patients recently admitted to critical beds were unvaccinated.
Medical teams at King’s are now bracing themselves for a new influx of patients infected by the rapidly spreading Omicron variant. They are urging people to get their jabs.
About a third of patients who are transferred to critical care beds with Covid will die, according to several studies carried out during the pandemic. Most will gradually improve over a week to 10 days, and a small number will require long-term treatment – for three months and longer – in the unit.
Doctors and nurses say they are deeply concerned at the number of seriously ill patients being transferred to critical care beds who are still unvaccinated.
Michael Bartley, a critical care matron at King’s, estimated that “80 to 90%” in the hospital’s critical care beds were unvaccinated.
He said: “We are not here to judge patients – we are here to look after them – but this can be a scary place. If the patient is too unwell, we will take over their breathing, intubating and ventilating them.
“The disease can affect all the organs of the body, and the long-term effects can be devastating. We have a number of patients who have been with us for more than 100 days. The age of those who are unvaccinated is about 35 to 65. The message is ‘please get your vaccines’.”
The proportion of unvaccinated patients in intensive care beds at King’s is particularly high compared with the rest of the country. A report by the charitable Intensive Care National Audit & Research Centre shows the percentage of unvaccinated Covid patients admitted to critical care in England fell from 75% in May to 48% last month as more people were jabbed.
London, however, has the lowest proportion of vaccinated over-12s in England. Nearly a third of Londoners are unvaccinated – and many of them are now seeking urgent medical help as a new wave of the pandemic hits the country.
Dr Laura-Jane Smith, a respiratory consultant who works on a Covid ward at King’s, said on Friday: “I have seen four new patients admitted to the ward this morning aged between 40 and 90. They are all unvaccinated.
“I haven’t sent anyone to intensive care recently who has had any vaccines. Even if people who are vaccinated are getting sick, they’re not getting as sick. The ones we are seeing are going home much quicker and with less complications. It’s hard to hear people who are so sick saying: ‘I just wish I had got the vaccine’.”
Smith and her colleagues now face the prospect of another NHS winter crisis as Omicron spreads across the country. She said: “We are trying to be optimistic that it can’t possibly be as bad as last January, because that was awful.”
Last week (the seven days to Friday 17 December), 5,538 people had a confirmed positive test result for Covid in Southwark, the hospital’s local borough. This is an increase of 188% compared with the previous week.
On Friday, the UK reported a record number of new Covid cases for the third day in a row, with 93,045 new cases. Hospital admissions in London are climbing sharply where Omicron has rapidly taken hold.
Scientists from the London School of Hygiene & Tropical Medicine have warned that Omicron is likely to be the dominant coronavirus variant by the end of the month and, under the most optimistic scenario, there could be 175,000 hospital admissions and 24,700 deaths in England between 1 December and 30 April next year.
At 8.45am on Friday in a groundfloor conference room at King’s, staff hold a daily incident coordination briefing, with 90 staff taking part online from about 20 departments.
The 724-bed hospital already has a 97% occupancy rate and, according to the most recent government data, out of 119 critical care beds, just five are free. Staff are falling ill or isolating at an alarming rate.
Plans are being drawn up to double the number of intensive care beds in two units and convert other wards for Covid patients. The trust is currently looking after 142 Covid patients, compared with 773 during the peak of the second wave in January. Of these, 17 are in critical care beds.
Lesley Powls, head of emergency planning and clinical site operations at King’s, compared the intense preparation to an “incredible moment of calm” before a tsunami.
She said: “It’s my job to write the plans and put the plans in place. And there’s a point where you think: ‘OK – we’re ready.’” Powls said initial indications were that patients who were being admitted were not as sick as in previous waves.
She said: “Last year, going into Christmas and New Year, we were seeing patients presenting at our emergency department who were so unwell they were going to critical care as the first place of admission.
“What we are seeing at the moment is patients who are going to general wards for maybe 24 to 48 hours and are then able to go home. We genotype all of our samples and we are certainly seeing some genotyping highly suggestive of Omicron.”
There may be multiple factors in
volved in this decreased severity: these include the impact of vaccines, better drug treatments and the possible lesser severity of Omicron. This is good news because it means Covid patients can this time be discharged at about the same rate at they are being admitted.
Powls said the initial indications were that the trust would have the capacity to cope, and it wanted to ensure that other services were available for non-Covid patients. She said there was a concern services could be overwhelmed, but she did not consider it a significant risk based on the evidence she had seen to date.
A report by Imperial College London published last week found no evidence of Omicron having lower severity than the Delta variant, but said more data was required. It said booster vaccines would be critical in mitigating the impact of the virus.
Doctors say whatever the severity of the Omicron variant, they are grateful for the range of treatments now available to help patients. These include the anti-inflammatory dexamethasone, the first drug proved to save the lives of people with Covid, and antiviral drugs including remdesivir.
Hospital staff say the speed at which the vaccines and new treatments have been made available is “phenomenal” and are a ray of light in the fight against the disease.
Professor Clive Kay, chief executive of the King’s College Hospital NHS foundation trust, said one of his main concerns was ensuring there were adequate staffing levels to cope with demand. The trust employs nearly 14,000 people, but the number of staff isolating or off sick because of Covid has risen from 160 to 517 in just over a week, on top of usual workforce absences. There were 242 nurses off sick, isolating or caring for a household member last Friday.
Prof Kay said: “It means that we are having to look at scaling back some of the non-urgent routine activity.”
He confirmed that initial data suggested the most recent Covid admissions were “not as sick” compared with previous waves. He said at the peak of the first wave in spring last year about one in four or five patients required critical care, compared with about one in seven or eight now.
Hospital staff – whose efforts have been described by Prof Kay as “truly incredible” – are uncertain what the next few weeks and months will bring, but say they are prepared for whatever comes through the doors.
Prof Kay said: “We can’t say we won’t be able to cope because we have no choice. We’ll just have to cope.”
This view is endorsed by hospital staff, who have had little respite. Critical care matron Bartley said: “We haven’t turned a patient away, and we’re extremely proud of that. We will respond and we will look after patients to the best of our ability every single time.”