Covid: 'We're not looking forward to doing it all again'

London is currently being hit hard by the wave of new Covid infections. Cases in the city are the highest in England and rising fast. Hospital admissions are on the rise too, with so many people becoming infected at the same time. And NHS staff are preparing for things to get worse.

St George's Hospital in Tooting in south London is in one of the boroughs most affected by Covid, and it's bracing for a crisis.

The emergency department - famous from the reality show 24 Hours in A&E - has already started to see a rise in the number of Covid patients, and the hospital is close to being full, with 98-99% of its beds occupied.

"We're quite concerned," says Richard Jennings, St George's chief medical officer. "With the advent of the Omicron variants, we know that many more people are going to get Covid, much faster than we previously anticipated. And that's a serious challenge."

Dr Jennings says it's too early to say whether Omicron is going to make people more or less ill, but what is certain is that it's much more transmissible. "So the wave of Covid that hits the NHS is steeper and faster than it would have been if Omicron had not come along. I think we're preparing for something different to what we saw last year, but something that's really quite challenging," he says.

One major difference with last year is that the vaccine is having an effect, and reducing the number of Covid patients who are being hospitalised or dying.

But not everyone is vaccinated.

"The people who are getting very ill with Covid are quite often people who have not, for whatever reason, had the vaccine," says Dr Jennings.

He says it's a pattern that is repeated across the country. "More than three-quarters of our patients who need life-saving treatments in intensive care have not been vaccinated. And we have had deaths in intensive care - deaths that might have been avoided if they'd had the vaccine. It's a very sad thing to see."

The hospital has increased the number of beds for Covid patients - the 30-bed Covid ward, which briefly closed earlier in the year, is full again, and another is being prepared.

There's a Christmas tree in the intensive care unit (ICU), and an inflatable Santa wearing a mask in the corridor outside. Presents are being wrapped in a side room. The staff are putting on a brave face, but underneath the mood is far from festive.

Patient numbers have already started creeping up and they have been warned to prepare for it to be "at least as bad" as last winter.

"I was hoping we wouldn't need to face any other winters like the one we faced last winter, and in the first wave of Covid," says ICU consultant Dr Rafik Bedair.

"Those were really, really difficult times. The hope was that with the vaccination programme that we would be able to avoid this."

But of the 11 Covid patients now in intensive care, nine have not been vaccinated. And the profile of patients has shifted, says Dr Bedair. They're a lot younger than they were in the previous waves. Rather than frailer, older people, the youngest Covid patient here is 19, but most are in their 40s.

The cardiac intensive care unit has been expanded to deal with Covid patients as well as the backlog of cardiac patients whose treatment had been delayed by the pandemic, on top of any emergency cardiac arrests that come in.

There are 72 ICU beds in the hospital now, 12 more than usual. At the peak of Covid St George's had up to 148 ICU beds - more than double the number they would normally run with the same number of staff. It's nowhere near those numbers yet, but the relentlessness of the past two years has taken its toll.

"People are really tired," says Dr Bedair. "Our staff have gone above and beyond, they work really, really hard. But that does come at a cost."

Intensive care matron Tammy Stracey has worked in ICU throughout the pandemic and is dreading the approach of another big wave.

"It's extremely daunting, especially over Christmas," she says. "People didn't have a Christmas last year. Having to do it all again is not something we're looking forward to. We're just begging people to go and have their vaccines and get their boosters."

Staff absences caused by Covid in the community are adding to the pressure.

"It's a real struggle," she admits. But they're carrying on as best they can.

"I'm just so proud of all the nurses that work here and doctors and allied health professionals and all our support staff, because they've been absolutely incredible."

When asked how she feels, she's overcome with emotion. But a few moments later she comes back to the point she and all her frontline colleagues want to make - please get the jab.

"I just hope that people remember that getting the vaccine is not necessarily just about you, it's about protecting your family, those people that you come into contact with, they could be more vulnerable than you. It really is what's going to help us cope with this crisis."

Omicron is spreading in London, but it usually takes a bit of time for patients to fall ill enough to come into hospital. There is one Omicron case on the Covid ward, but none in intensive care yet.

Dr Bedair says because Omicron is so transmissible, the hospital is expecting a very large number of people to fall ill with the virus, so there's a risk that a lot of people need to be cared for in hospitals and intensive care.

"The main thing to keep in mind is that there will always be a small proportion of people who will become very sick with the virus."

Again, Dr Bedair urges people to get the booster, and to follow precautions to minimise the impact of this wave.

The mood is more buoyant elsewhere in the hospital, where a new Covid pill is being dispensed for the first time to people who have caught the virus.

The drug molnupiravir is being dispatched from the hospital pharmacy by courier to vulnerable patients who will be able to take the pills at home to help prevent serious illness in the hope they won't need hospital care. It offers an added layer of protection - "like a fire blanket" - says one doctor.

St George's is one of the first 70 health care providers rolling out the new drug to 1.3m of the highest risk patients who have tested positive. There's a buzz of excitement among the pharmacists.

"We're trying to prevent patients from coming into hospital, but at the same time, help them with treatment," says Dipen Patel. "People are welcoming the new clinic with open arms."

The pill is for people who might be at higher risk of being hospitalised with Covid - people who are immunosuppressed, or those with cancer, chronic kidney disease and chronic liver disease. It's also for people with some learning difficulties, such as Down syndrome.

In the new Covid medicine delivery unit (CMDU), medical consultant Dr Doraid Alrifai is cold-calling people who have tested positive to find out if they qualify for the drug. An electronic system matches the eligibility list with positive PCR tests.

Not everyone he calls is eligible. "Thankfully for you, you've not been labelled as someone who is at risk," Dr Alrifai comforts a woman who doesn't fit the criteria.

The clinic will also offer a different kind of treatment to mitigate the risk of hospitalisation - a monoclonal antibody treatment. A screened-off area has been set up for outpatients to receive the drug through an intravenous infusion.

But so far it's empty - Omicron has affected plans here, too. The drug they had initially planned to offer doesn't work on the new variant, so now they are switching to sotrovimab, which has much greater effectiveness against Omicron. They will start inviting patients in as soon as supplies arrive.

The drugs are offering hope to frontline staff preparing for the looming wave. But they all plead for people to get a booster jab.

"It's really important that people recognise that the vaccine lessens the chances of being hospitalised or dying of Covid and protects people's loved ones and helps the NHS to be able to cope," says Richard Jennings.