Health care workers gather in the intensive care unit, which has been reconfigured due to the coronavirus pandemic, at Homerton Hospital. Photo / Andrew Testa, New York Times
A gaggle of masked nurses and doctors in blue paper gowns shuffled from one coronavirus patient to the next offering lifesaving care. Some patients had lingered for days or weeks. Others counted their stays in months.
If there was an end in sight to two years of pandemic, health care workers lamented, you would hardly know it here.
"We live in this parallel universe," said Lucy Jenkins, who leads the team of critical care nurses at Homerton University Hospital in East London, comparing what health care workers on the front line were experiencing with what the general public sees.
Political leaders have moved on to heralding the mild symptoms of the Omicron variant and declaring the pandemic all but over. The British government lifted nearly all coronavirus restrictions in mid-January as infection and hospitalisation rates dropped steeply compared with early last year and as vaccines slashed the number of people falling seriously ill.
But for doctors and nurses, a return to a normal rhythm of work is still a long way off. While Homerton's intensive care units are no longer overflowing, as they were early last year, like many in England, they still face a steady influx of coronavirus patients.
So many people were infected by the coronavirus this northern winter — a record of around 186,000 new daily cases in the first week of January — that even if fewer of them ended up gravely ill, hospitals have remained under intense pressure.
In intensive care units like Homerton's, which treat the most seriously ill, nearly all of those being tended are unvaccinated.
Since the start of the pandemic, the hospital has treated more than 2000 coronavirus patients. Nearly 500 died from Covid, according to hospital data. The pandemic has by now engendered a lasting change in the way its intensive care unit, and many others in the country, work. We visited Homerton on January 21.
10:30am: Morning ward rounds
A team of doctors and nurses make their way around the escalation ward of the intensive care unit, set aside for treating coronavirus patients. They hover over charts and compare notes on the five patients. Each needs nearly constant care.
Four of them are hooked up to ventilators, and the rhythmic beeping of the machines hums steadily in the background.
This area was set up at the height of the pandemic to treat the most critically ill Covid patients. The space was originally a reception area for surgery and was never intended to be used for this specialised care. But since spring 2020, it has never closed.
Dr. Susan Jain, a specialist in anaesthesia and intensive therapy, and a lead doctor, said it was like trying to set up a specialist unit in a living room. The area was not fit for the purpose.
Things have slowed, she said, but the staff are still on emergency footing.
"We haven't seen a point yet where we're convinced that the number of Covid cases that are seriously ill are petering out," she said. "So there's a sort of unpredictability hanging in the air about how much and for how long the pressures continue, but it is there for the foreseeable future."
Mary Connolly, a senior nurse who has worked here for 32 years, moved with ease from bed to bed, rattling off vital details of the care of each patient. Nearly all they are now treating are unvaccinated, she explained. A handful deny that the virus even exists.
"It's the new thing now: People are refusing to be tested at all," she said, shaking her head. A man with a tracheotomy moans as she and another nurse slide him up the bed to prepare him for an X-ray.
"Don't pull it out," she says gently as he grabs for the plastic pipe protruding from his neck.
11:30am: The vaccine-hesitant patient
One of the patients being cared for in the unit is Dean Gray, 47. He has been there for five days and is the only patient not on mechanical ventilation. Tubes run from the cannula inserted in his heavily tattooed hand. An oxygen mask is fixed over his nose and mouth.
I sit at his bedside as he tells me how he had travelled to London to see his family for Christmas. He and his mother became sick with the coronavirus around the same time. She was admitted to the hospital first. He was brought in on the day she died.
"I never got to see her," he said.
Gray chose not to get vaccinated and said his reluctance comes from distrust of the government and worries that the true scale of the pandemic was exaggerated.
"You've got Boris Johnson going to parties, and it's really sort of put me against it," he said, pointing to the recent government scandal amid allegations that the prime minister lied about attending parties during lockdown. "If all of these problems hadn't arose, I probably would have been vaccinated. But if the milk seems to be sour, I am not going to drink it."
2pm: A son visits his father
Visitors are not allowed in areas where coronavirus patients are treated, but an exception has been made in Mohammed Tahir's case. He has been hospitalised for the last six months after contracting the coronavirus in August.
For a time he was doing better and was moved out of intensive care, but he returned in December. His bed stands alone in a separate bay. Unlike everyone else on the ward today, he was vaccinated before getting sick.
When his son, Omar Tahir, arrived for an hour visit, Mohammed Tahir's expression immediately eased. He gets anxious without his family by his side, Omar Tahir explained. So Omar Tahir quit his job and moved home to be closer to the hospital and to be with his mother, he said.
"A job can be replaced, but you can't replace him," he said.
Omar Tahir rubs his father's frail legs with lotion, his hand moving with care over the sharp angle of his shin bone. Mohammed Tahir signals to him to drive safely on his motorbike, his hands gesturing as if gripping handlebars, and he cracks a smile.
Mohammed Tahir looks deep into his son's eyes and smiles, rarely breaking eye contact. When it comes time to say goodbye, Omar Tahir wipes away tears.
5pm: Finding room for more patients
As evening comes, Jenkins, who leads the nurses here, finds out they will be getting three more patients. It is always a logistical stretch.
Adding to the difficulty is the fact that coronavirus patients are treated in a separate part of the unit and the nurse-to-patient ratio is higher in intensive care than other parts of the hospital.
An uptick in patients coupled with a staff shortage — caused mainly by the pandemic, Brexit and burnout — have meant the hospital has to rely on more temporary ICU nurses. So even as patient numbers have dropped, the pressures remain.
"I think people are exhausted; they are burned out," Jain said. "The incentive to work in any of these environments is very little. That's a big problem."
Still, things have improved compared with this time last year when my colleague, Andrew Testa, visited the unit. It was the height of the second wave of coronavirus infections battering Britain, and the unit was brimming with patients. Every bed was full, with 22 Covid patients in total.
Now there are typically between a half-dozen to a dozen coronavirus patients on any given day, the hospital said.
But many health care workers are still grappling with months of observing illness and death on a scale they had never experienced, with some suffering from post-traumatic stress disorder.
"It was the sheer volume," Jain said, adding that it was the same in hospitals across the country. "It was mass death and also it felt like it could have been avoided."
6pm: Leaving the hospital
Outside, banners line the street facing the main entrance with messages for the staff: "Thank you to all the hard workers at Homerton Hospital. We love you," reads one.
The banners' edges are now tattered and blackened by the exhaust of the cars that have passed by since they were first hung in 2020, when the pandemic began.
In many ways, the staff inside feel far from those early days. In some ways, little has changed, but what has changed is profound.
"You know, in wave one, we were heroes," said Jenkins, the leader of the nursing team. "By wave two, we were the enemy. And that's hard."
This article originally appeared in The New York Times.
Written by: Megan Specia
© 2022 THE NEW YORK TIMES
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