As the coronavirus bears down on Britain’s overstretched National Health Service, doctors say they fear trying days of hard choices and rationed resources. King’s Hospital in London in 2017. More than 75 percent of the country’s ventilator machines are already being used for patients unaffected by the coronavirus. 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. 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.” 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. “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. 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. “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. “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.” 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. Many doctors and nurses said they wished the government had acted sooner, before the crisis started crashing in on them. Prime Minister Boris Johnson, center, has been reluctant to bring in social distancing measures to slow the spread of the coronavirus. “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. 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. “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. 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. 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.” 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. “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. “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. 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.” A drop-off point for coronavirus testing samples at the Old Medical School in Leeds, England, last week. 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. 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. “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. “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.” Source
