There are so many patients with Covid who are younger this time around. My hospital, however, is complete.

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There can be no debate: this is much, far worse now than the first wave, this NHS consultant says.

Truly, I never thought it was going to be so bad.

Once again, Covid spread across the hospital, one ward after another, the disease greedily taking over.

Surgical, pediatric, obstetric, orthopedic; no distinction between specialties is made by this virus. Outbreaks are occurring also in our “clean” areas and the disease is even more cruelly infectious.

Though the strains are not differentiated by our local samples, I think this is the latest variant.

This time, the patients are younger as well and there are so many of them. They’re so sick. We are complete. No debate will arise: this is much, much worse than the first wave.

We meet with 10 new patients in the morning to take care of. These are just the worst of them; we can’t take care of those who are less ill, but in earlier days they would have frightened us.

They are scattered across the hospital’s general wards, providing as much oxygen through a regular mask as they can.

Many lie on their backs, breathing rapidly and shallowly, too breathless to speak, alarmingly low in their blood oxygen saturation.

The oldest is seventy years old, but the rest of them are much younger.

Everyone is in desperate need of respiratory assistance. This is best provided with a Cpap mask or a very high flow of oxygen through the nose, non-invasively.

We built a new respiratory support unit for this purpose, like most hospitals, but it became completely occupied with patients weeks ago.

Our intensive care unit, which, in addition to these treatments, can provide intrusive ventilation for the critically ill, is now complete, although it operates well beyond its previous capacity. Our neighboring hospitals are under the same or worse pressure; there is no place to admit them, even though patients are well enough to move safely.

We’re splitting and conquering.

In the respiratory support unit and the intensive care unit, some of us race through morning rounds urgently trying to locate patients who are well enough to be transferred to a normal unit, or who can be swapped between the two units when needed.

Some of us go to the newly admitted patients to examine them. We make sure that we have done whatever we can to prevent the need for further help, but our colleagues have been thorough enough. They’re going to have to come to us, and fast.

With some patients who were already more frail before taking Covid and thus less likely to benefit from additional respiratory therapy, we are starting challenging conversations. We no longer have the “just going for it” luxury; we need to ensure that we only choose those who have the best chance of survival.

It can lead to a precious ICU bed being occupied for several days if we go about it the wrong way, sometimes resulting in a difficult and symptomatic death, thus preventing other patients from obtaining proper therapy.

Conversely, we will ensure stronger symptom management and a gentler end of life by knowing those who will not survive.

Weakening, stressful and brutal are these discussions, which are also difficult to understand through our PSAs. We need to explain why we can’t deliver these treatments to anyone, to patients and their families and also to our colleagues.

There is a common misunderstanding about respiratory support and ventilation. These are not treatments; they only prevent individuals from dying until they hopefully recover.

The best medication that we have available for covid is dexamethasone, the steroid that was shown to be effective in reducing mortality in the Recovery Report.

It definitely stops a lot of individuals from dying, but it does not, at least not easily, make them healthier. That’s a huge part of our current issue: people who used to die in a couple of days now need ventilator care for weeks. Our morgue is emptier than it was, but it’s a lot more busy at the hospital.

We are reconvening to decide what to do about the 10 plus two more alluded to in the morning rounds. We agree that three of them have such a bad prognosis that we can’t justify providing more help, leaving nine to accommodate.

A few patients in intensive care are Ges

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