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‘We Are Frightened’: U.K. Doctors Brace for a Coronavirus Explosion ‘We Are Frightened’: U.K. Doctors Brace for a Coronavirus Explosion
(about 13 hours later)
LONDON — As the coronavirus bears down on Britain’s overstretched National Health Service, doctors say they fear trying days of hard choices and rationed resources.LONDON — As the coronavirus bears down on Britain’s overstretched National Health Service, doctors say they fear trying days of hard choices and rationed resources.
Hospitals are calling off all but the most urgent procedures to prepare for an incoming wave of coronavirus patients. Operating rooms are being converted to house the infected, and specialists are being redeployed or even retrained to deal with patients’ needs.Hospitals are calling off all but the most urgent procedures to prepare for an incoming wave of coronavirus patients. Operating rooms are being converted to house the infected, and specialists are being redeployed or even retrained to deal with patients’ needs.
Front-line medical workers are complaining of inadequate testing and shortages of protective gear, raising fears that doctors and nurses may be spreading the virus or will be forced into isolation as the demand for care peaks.Front-line medical workers are complaining of inadequate testing and shortages of protective gear, raising fears that doctors and nurses may be spreading the virus or will be forced into isolation as the demand for care peaks.
Most worrisome is the limited supply of ventilators to sustain what is expected to be a soaring number of patients in coming weeks, putting doctors in the position of deciding which ones to treat and which ones to let die.Most worrisome is the limited supply of ventilators to sustain what is expected to be a soaring number of patients in coming weeks, putting doctors in the position of deciding which ones to treat and which ones to let die.
“It is a conversation that is happening day in and day out now,” said Dr. Jenny Vaughan, an official with the Doctors Association U.K., an advocacy group. “If you look at the numbers, there are going to be some very difficult decisions.”“It is a conversation that is happening day in and day out now,” said Dr. Jenny Vaughan, an official with the Doctors Association U.K., an advocacy group. “If you look at the numbers, there are going to be some very difficult decisions.”
The ad hoc and often belated preparations have left the nation’s hospitals and health workers in what some doctors described as an eerie calm, like the fatalism soldiers might feel before battle.The ad hoc and often belated preparations have left the nation’s hospitals and health workers in what some doctors described as an eerie calm, like the fatalism soldiers might feel before battle.
[Update: Boris Johnson, U.K. Prime Minister, has the coronavirus.][Update: Boris Johnson, U.K. Prime Minister, has the coronavirus.]
“There’s a sense of just waiting for it to hit,” said Dr. Nick Scriven, a specialist in urgent conditions in northern England and a former president of the Society for Acute Medicine.“There’s a sense of just waiting for it to hit,” said Dr. Nick Scriven, a specialist in urgent conditions in northern England and a former president of the Society for Acute Medicine.
Years of budget pressures have left the N.H.S. ill prepared for the enormous strains that lie ahead, doctors and health advocates say. Even before the pandemic, about 100,000 health systems jobs were unfilled.Years of budget pressures have left the N.H.S. ill prepared for the enormous strains that lie ahead, doctors and health advocates say. Even before the pandemic, about 100,000 health systems jobs were unfilled.
While mostly praising the N.H.S. and the government’s scientific guidance, doctors bemoan Prime Minister Boris Johnson’s reluctance to slow the spread of the disease through social distancing measures like closing schools and limiting mass gatherings.While mostly praising the N.H.S. and the government’s scientific guidance, doctors bemoan Prime Minister Boris Johnson’s reluctance to slow the spread of the disease through social distancing measures like closing schools and limiting mass gatherings.
That has given the hospitals less time to prepare, and may have added thousands of patients to the peak of the epidemic expected later this spring, potentially overwhelming the health system.That has given the hospitals less time to prepare, and may have added thousands of patients to the peak of the epidemic expected later this spring, potentially overwhelming the health system.
“We can only deal with it when an infected patient turns up,” said Mark Boothroyd, a nurse in the emergency department of a central London hospital. “It’s the government making decisions about whether we get 10 infected people a day or 1,000, and now I think we’re on course for the upper end of that.”“We can only deal with it when an infected patient turns up,” said Mark Boothroyd, a nurse in the emergency department of a central London hospital. “It’s the government making decisions about whether we get 10 infected people a day or 1,000, and now I think we’re on course for the upper end of that.”
Tom Gardiner, a doctor on a respiratory ward at St. Mary’s Hospital in London, said the steeply rising number of coronavirus patients had already made clear that the available equipment, beds and staffing levels would be insufficient.Tom Gardiner, a doctor on a respiratory ward at St. Mary’s Hospital in London, said the steeply rising number of coronavirus patients had already made clear that the available equipment, beds and staffing levels would be insufficient.
“We’re managing at the moment, but on the edge,” he said. And as a front-line doctor, he added, he expected to fall sick himself.“We’re managing at the moment, but on the edge,” he said. And as a front-line doctor, he added, he expected to fall sick himself.
“I’m going to get it quite soon. I think it is inevitable,” he said. “I also think what is inevitable is me passing it to someone more vulnerable.”“I’m going to get it quite soon. I think it is inevitable,” he said. “I also think what is inevitable is me passing it to someone more vulnerable.”
For weeks and months, British leaders have lagged behind continental Europe in requiring social distancing. The bet was that the N.H.S. could detect and contain the virus without resorting to such measures.For weeks and months, British leaders have lagged behind continental Europe in requiring social distancing. The bet was that the N.H.S. could detect and contain the virus without resorting to such measures.
But after new research this week forecast a far higher death rate if the virus raged uncontained, the British government reversed course. It, too, began recommending social distancing measures, albeit still in a mostly voluntary fashion. On Wednesday, however, the government took firmer action, saying that all schools in the United Kingdom would close after Friday.But after new research this week forecast a far higher death rate if the virus raged uncontained, the British government reversed course. It, too, began recommending social distancing measures, albeit still in a mostly voluntary fashion. On Wednesday, however, the government took firmer action, saying that all schools in the United Kingdom would close after Friday.
Many doctors and nurses said they wished the government had acted sooner, before the crisis started crashing in on them.Many doctors and nurses said they wished the government had acted sooner, before the crisis started crashing in on them.
“It is really frightening,” said Victoria Holt Eze, a general practitioner in London who is in self-imposed isolation at home — in part because of a lack of available testing to determine whether she had the virus after running a fever last week. “A lot of doctors are very frustrated at how slow the response has been.”“It is really frightening,” said Victoria Holt Eze, a general practitioner in London who is in self-imposed isolation at home — in part because of a lack of available testing to determine whether she had the virus after running a fever last week. “A lot of doctors are very frustrated at how slow the response has been.”
Doctors said their greatest fear centered on a dire shortage of ventilators, which are essential to saving the lives of the most critically ill patients, because the virus attacks the lungs.Doctors said their greatest fear centered on a dire shortage of ventilators, which are essential to saving the lives of the most critically ill patients, because the virus attacks the lungs.
A senior N.H.S. official told a parliamentary hearing on Tuesday that hospitals in England had about 8,200 ventilators on hand and that the health authorities were in the process of getting about 3,800 more.A senior N.H.S. official told a parliamentary hearing on Tuesday that hospitals in England had about 8,200 ventilators on hand and that the health authorities were in the process of getting about 3,800 more.
The government is now urging manufacturers — even those with no experience making ventilators — to ramp up production as fast as possible.The government is now urging manufacturers — even those with no experience making ventilators — to ramp up production as fast as possible.
“We are saying: If you produce a ventilator, then we will buy it,” Matt Hancock, secretary of the Department of Health and Social Care, said in a television interview over the weekend. “No number is too high.”“We are saying: If you produce a ventilator, then we will buy it,” Matt Hancock, secretary of the Department of Health and Social Care, said in a television interview over the weekend. “No number is too high.”
But the process of production and testing is slow, experts say, and the government has acknowledged that there may not be nearly enough ventilators, particularly since more than 75 percent of the machines are already being used for patients unaffected by the epidemic.But the process of production and testing is slow, experts say, and the government has acknowledged that there may not be nearly enough ventilators, particularly since more than 75 percent of the machines are already being used for patients unaffected by the epidemic.
Health officials have said Britain will need 20,000 more ventilators “under a reasonable worst-case scenario.” But an influential study released this week by a team at Imperial College in London indicated that the number of critical care beds required for the British population could exceed 50,000.Health officials have said Britain will need 20,000 more ventilators “under a reasonable worst-case scenario.” But an influential study released this week by a team at Imperial College in London indicated that the number of critical care beds required for the British population could exceed 50,000.
“We are in an exponential curve, and I am worried that we may need to ventilate more people than we have capacity for,” said Mark Latimer, a doctor in Cambridge.“We are in an exponential curve, and I am worried that we may need to ventilate more people than we have capacity for,” said Mark Latimer, a doctor in Cambridge.
The health authorities have asked British hospitals to try to quadruple the number of ventilator beds, Dr. Latimer said, and so far he has seen no shortage in the hospital where he works.The health authorities have asked British hospitals to try to quadruple the number of ventilator beds, Dr. Latimer said, and so far he has seen no shortage in the hospital where he works.
But colleagues in Italy, where the epidemic has raged for weeks, have described carrying out “battlefield triage,” he said, “where, for some patients you make decisions that ‘We do not have the resources to cope with you,’ or those resources should be used elsewhere.”But colleagues in Italy, where the epidemic has raged for weeks, have described carrying out “battlefield triage,” he said, “where, for some patients you make decisions that ‘We do not have the resources to cope with you,’ or those resources should be used elsewhere.”
Even if enough ventilators were available, the machines require round-the-clock attention by trained doctors and nurses, and doctors said they feared a shortage of qualified staff.Even if enough ventilators were available, the machines require round-the-clock attention by trained doctors and nurses, and doctors said they feared a shortage of qualified staff.
Updated June 5, 2020Updated June 5, 2020
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“Ventilating a patient is not something you can teach someone in an afternoon,” said Dr. Helgi Johannsson, a council member of the Royal College of Anesthetists.“Ventilating a patient is not something you can teach someone in an afternoon,” said Dr. Helgi Johannsson, a council member of the Royal College of Anesthetists.
Doctors have also cited inadequate testing capacity. At several hospitals, doctors said they were turning to radiology to scan the chests of suspected patients for indications of the coronavirus, since more precise testing can take up to 48 hours. But the results of such scans are often uncertain.Doctors have also cited inadequate testing capacity. At several hospitals, doctors said they were turning to radiology to scan the chests of suspected patients for indications of the coronavirus, since more precise testing can take up to 48 hours. But the results of such scans are often uncertain.
“It is not going to be an accurate test, necessarily,” said Caroline Rubin, a vice president of the Royal College of Radiologists, which has advised doctors not to use scanners for makeshift virus testing. “And we are not blessed with additional capacity in the U.K. We have fewer scanners than they have in many other countries.”“It is not going to be an accurate test, necessarily,” said Caroline Rubin, a vice president of the Royal College of Radiologists, which has advised doctors not to use scanners for makeshift virus testing. “And we are not blessed with additional capacity in the U.K. We have fewer scanners than they have in many other countries.”
Doctors have complained for weeks that the government has not tested other health care workers for the virus, instructing them to isolate themselves if they showed symptoms like cough or fever.Doctors have complained for weeks that the government has not tested other health care workers for the virus, instructing them to isolate themselves if they showed symptoms like cough or fever.
That absence of testing has led to prolonged absences by doctors and nurses who came down with unrelated colds or fevers. Worse still, it may have allowed undiagnosed patients to infect hospital workers or undiagnosed medical workers to infect patients.That absence of testing has led to prolonged absences by doctors and nurses who came down with unrelated colds or fevers. Worse still, it may have allowed undiagnosed patients to infect hospital workers or undiagnosed medical workers to infect patients.
“If you haven’t got priority health care testing for patients and health care workers, you don’t know, do you?” Dr. Vaughan said. “We really hope the government ramps up priority testing as soon as possible.”“If you haven’t got priority health care testing for patients and health care workers, you don’t know, do you?” Dr. Vaughan said. “We really hope the government ramps up priority testing as soon as possible.”
Mr. Johnson said this week that Britain would begin testing health care workers. On Tuesday, the government said it would also provide hotel rooms to doctors and nurses who would otherwise be forced to self-isolate for 14 days because a family member at home had symptoms of the virus.Mr. Johnson said this week that Britain would begin testing health care workers. On Tuesday, the government said it would also provide hotel rooms to doctors and nurses who would otherwise be forced to self-isolate for 14 days because a family member at home had symptoms of the virus.
But widespread testing has not yet begun, and the health service has yet to set out the criteria or procedures.But widespread testing has not yet begun, and the health service has yet to set out the criteria or procedures.
Doctors are also suspicious of downward revisions in the level of protective gear that the government had recommended.Doctors are also suspicious of downward revisions in the level of protective gear that the government had recommended.
Health officials initially advised workers to wear a full-body suit including an airtight mask, visor and double gloves. But the service now says most health care workers handling coronavirus patients need only a standard face mask, gloves and an apron.Health officials initially advised workers to wear a full-body suit including an airtight mask, visor and double gloves. But the service now says most health care workers handling coronavirus patients need only a standard face mask, gloves and an apron.
“They’re saying it’s evidence-based, but I think it’s also quite pragmatic,” said Dr. Gardiner of St Mary’s Hospital. “They’re running out of protective equipment.”“They’re saying it’s evidence-based, but I think it’s also quite pragmatic,” said Dr. Gardiner of St Mary’s Hospital. “They’re running out of protective equipment.”
For now, doctors said they were largely trying to keep their fears to themselves.For now, doctors said they were largely trying to keep their fears to themselves.
“We are frightened,” said Roshana Mehdian, a trauma and orthopedic surgeon in London. “But at the same time we have to keep up a stern resolve. People are looking to the N.H.S. in hope, and we don’t want to feed into the panic.”“We are frightened,” said Roshana Mehdian, a trauma and orthopedic surgeon in London. “But at the same time we have to keep up a stern resolve. People are looking to the N.H.S. in hope, and we don’t want to feed into the panic.”
Tariq Panja contributed reporting.Tariq Panja contributed reporting.