“I’ve been a doctor for more than 20 years and I have never seen anything like this.”
The UK is in the midst of a serious surge in Covid-19 infections for the second time in less than a year.
In November, more than 20,000 cases of coronavirus have been reported in the UK each day, with one early exception. Deaths from the virus are also on the rise once more – on Wednesday, the daily coronavirus death toll neared 600 for the first time since May.
But what is it like on the frontline of the second wave – and how does it compare to the tsunami of infections and deaths faced by the NHS in the spring?
As a major hospital in the north-west of England – one of the hardest hit spots in the UK – it feels as if Covid-19 has never truly left the Royal Bolton Hospital since March, say staff.
“The first wave of coronavirus was a steep, sharp rise,” said Andy Ennis, chief operating officer at the Royal Bolton Hospital, at the end of October.
“The second wave has been different – it has been much slower. But it’s a rising swell – and it’s building each day, each week.”
Official data would suggest the wave is now approaching its crest. The most recent NHS figures reveal that on November 10, there were 146 Covid-19 patients in Bolton NHS Foundation Trust beds – a startlingly similar figure to the peak of 148 patients recorded in April.
However, the number of the very sickest coronavirus patients – those requiring ventilation – has yet to reach the levels seen in the spring, with 14 patients currently in mechanical ventilation beds, compared to a high of 22 in April.
But for Dr Rizwan Ahmed, a respiratory consultant and the hospital’s clinical lead for respiratory medicine, the second wave has already felt more challenging than the first.
Unlike the first surge, Ahmed and his respiratory team are not only treating Covid-19 patients, but carrying out clinics and procedures amid a “big backlog” from the spring.
There has also been an influx of severe non-Covid respiratory patients that Ahmed and his team usually treat – including those with severe pneumonia, asthma and cancer.
“In the first wave, everyone was scared – they didn’t come to hospital. In the second wave, people are coming to hospital, so we have had to maintain a ‘clean’ area for respiratory patients.
“To do this, we have had to expand the bed base, so the number of medical wards has increased.” Meanwhile, there are more and more respiratory patients on other wards that Ahmed and his team of doctors need to help.
It has been an exhausting year, and staff are getting tired – especially junior doctors.
“They are seeing a lot of death, a lot of suffering, which I wouldn’t expect a junior doctor to see in such a short period,” Ahmed continued.
“It [the pandemic] has taken a big toll on the physical and mental wellbeing of staff. That is something that is quite evident.
“I don’t think any of us could have imagined this coming. I haven’t seen this before and I don’t think any of my colleagues have seen this before.”
“I keep thinking I’m in a dream, that I’m on a film set,” said Dr Lucy Bates, a critical care consultant at the hospital. “It’s hideous, it’s really hideous.
“I’ve been a doctor for more than 20 years and I have never seen anything like this.”
As the first wave of the virus subsided, “we kind of thought things might steady out”, Bates said.
“We knew that this disease wasn’t going away and had prepared ourselves for the long haul. But we thought that we had got a little bit of control and things were steadying out.”
But at the start of September, Covid-19 admissions started creeping up once more. With the knowledge gained during the first wave, there are differences in the hospital’s preparation this time.
“We feel more prepared,” said Claire Partridge, the matron of the critical care unit. “We know a lot more about coronavirus – we know how the virus works, there are now treatments.
“So we feel secure knowing what we’re dealing with.” In recent months, treatments such as dexamethasone and remdesivir – a drug once used to try and treat Ebola – have become common.
Bates has also noticed an increase in the number of patients in ICU able to be treated with high flow oxygen and CPAP, rather than ventilation, which is seen as a “last resort”.
“But we are still seeing patients that come into the hospital needing oxygen,” she said. “A fair number of them get so unwell and lacking in oxygen that they end up with us and on a ventilator. Sadly, we are seeing people dying.”
“I just want people to listen. I just want the general public of our country to take a step back and not think: ‘I don’t care if I get it, because I will probably be okay.’
“They should think: ‘What if I do get it and pass it unwittingly to someone at the petrol station or in the supermarket? And what if that person goes into hospital and either dies or prevents another person getting a place in hospital?’.
“There’s such a lot of ramifications to the attitude of: ‘I’ll take my chance, just let it run its course.’ It isn’t as simple as that,” she added.
It’s something that is clear to the hospital’s chief operating officer Ennis – especially as the UK heads into its coldest months.
Unlike the surge of infections in the spring, the NHS is now tackling the joint pressures of winter and the Covid-19 pandemic, he said.
“We are entering our usual winter period now. If you lay Covid on top of that, organisations are going to struggle.”
Ennis continued: “We want to keep as much activity going as possible. We don’t want people waiting long periods for their operations, whether they are for cancer or they’re a hip replacement. They still need doing, because people’s lives are affected by these things.”
The more people comply with the rules, the more services the NHS can keep going for their family members, he said.
As of Monday, the Royal Bolton Hospital, alongside trusts across Greater Manchester, was once again forced to postpone planned, non-urgent operations at the hospital as the joint pressures of Covid and winter hit staff and resources – though urgent treatments and cancer operations will continue as normal.
Since the peak of the first wave, the hospital has made some major changes to make sure it can keep as many surgeries and procedures going as possible through the second surge, Ennis explained.
“We have commissioned a lot of our surgical activity down in the local independent sector hospitals just down the road from us, so we can keep our patients safe that way,” he said.
While the operations are taking place in private hospitals, such as Bolton’s Beaumont Hospital, they are still being carried out by NHS staff. “That just helps to keep things going and away from the Covid site, if you like.”
In some cases, surgical teams will be made up from staff across Greater Manchester as hospitals try and share out the pressures of Covid, he said.
Dr Clare Garnsey, a consultant cancer specialist and surgeon, knows first-hand how vital it is that life-saving treatments and operations continue amid the second wave.
“Throughout the pandemic, we have tried to prioritise cancer care so that people who are diagnosed with cancer or the progression of a cancer do get the treatment they need,” she said.
“Cancer care and the breast unit has never suspended treatment during either wave and we have continued to provide the majority of cancer treatments that we did before the pandemic.”
However, during the first wave, there was a huge drop in the number of people coming forward with cancer symptoms, with NHS figures showing that urgent GP referrals dropped by 60% in April.
“The public seemed reluctant about seeking medical attention – I think they were worried about contracting Covid by attending the hospital,” Garnsey, an oncoplastic breast surgeon, said.
“But early diagnosis of cancer saves lives and it often allows far less invasive treatments.”
During the second wave, there has not been the same drop in cancer referrals to the Royal Bolton Hospital “at all”.
“That’s very good news as we want people to know that cancer services are safe and open for patients to attend,” Garnsey said.
“In the second wave, things are calmer and more organised because we have PPE, we have social distancing set up. We have areas of the hospital where all patients are tested for Covid before they come in.
“So it is very safe now to come into hospital for elective, planned cancer operation.”
But whether it’s in ICU, on the wards or in the hospital’s cancer department, Royal Bolton Hospital staff’s determination to treat patients and keep them safe has had an impact.
“We are really acutely aware of how pressure is on staff,” said Ennis. “Our winter started last October, so we are now a year into this, because we have had no break.
“So we are really acutely conscious of the impact on our nursing and healthcare staff, but also our cleaning staff, our porters – everybody is feeling that pressure.”
“They are remarkable, they astound me everyday in their ability to absorb,” he added.
The hospital has made great efforts to support staff mentally and physically. “But there’s no disguising that it’s tough.”