There’s yellow tape on the chairs, so some patients have to sit on the floor; and we’re trying to encourage them not to bring their relatives.

As the number of people in hospital with coronavirus rises amid a second wave of infections, healthcare workers in England reflect on the seven months since the start of the pandemic and on what has changed.

Demand on healthcare services normally increases at this time of year and with varying coronavirus rates around the country, some frontline staff are facing the impact of the pandemic, while others share their concerns about non-Covid patients not getting the medical help they need.

Paramedic, north-west
The demand for ambulances for patients with a variety of conditions is worse than at the peak of the pandemic. Staff are exhausted, we’ve not had the opportunity to stop and hospitals are filling up. Back in March and April, we had additional support from students and medical professionals in administrative roles – along with extra vehicles, but none of this is available any more, and we have people going off sick. PPE is still not the best, it’s nothing more than what you see people wearing to make a bacon sandwich. In my opinion there’s still not enough PPE, when you’re going from one patient to another.

During the first wave, people weren’t calling unless they were really ill, but we’re getting more calls now because people are increasingly scared of Covid. Everyone thinks they’ve got Covid or winter flu; there’s a fine line between them both. The signs of symptoms are very similar. It’s difficult to say it’s Covid without a test; but is it as bad as they’re making out? How many people die a year from flu? We need to get the message back out there that if it isn’t life threatening, calling an ambulance isn’t the right thing.

Intensive care nurse, central London
The first time round there was a sense of we’re all in this, let’s sort it out, but now there’s a sense of real frustration. It’s very difficult to maintain the same level of working and motivation as before, and NHS staff across the capital are increasingly exhibiting PTSD symptoms. We’ve got three coronavirus patients in ICU, two of whom are intubated, while there are nine on the wards; so our numbers are not big, but obviously everyone is wary that it can change. We largely support other hospitals rather than directly our own resident population. We’re expecting less of a massive surge but fear a second wave could go on for longer.

There’s such a backlog for elective services now, and there’s anxiety among staff that people who didn’t get surgery will have preventable bad outcomes. The worry is that if you delay treatment it becomes inoperable or harder to operate. Everyone who comes in for surgery needs a coronavirus test three or four days before, and then must self-isolate so we can avoid admitting anyone on clean wards with Covid. The logistics around that are enormous, a lot of patients have had to cancel because they haven’t had their results yet.

A&E consultant, south-west

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I wouldn’t diagnose cancer in the emergency department in the normal course of work, but I did so with two people in one week this summer. Other cancer cases have been diagnosed by colleagues even though we would expect those with such symptoms to be identified in primary care. It should be a rare event and it was perhaps a little too late for one of those people. People can’t access their GP service so they’re coming to us, and some have been too scared to seek healthcare.

Meanwhile, two of our nine consultants are off with coronavirus. So we’re a bit thin on the ground, and trying to social distance our patients which isn’t terribly easy. There’s yellow tape on the chairs, so some patients have to sit on the floor; and we’re trying to encourage them not to bring their relatives. There’s a sense of apprehension as we know we tend to get busier into November with normal respiratory viruses anyway.

The restrictions don’t seem to be making any impact on coronavirus infection rates, but I have to say, as yet, Covid is not overwhelming our service. From April to June, we had more than 70 patients who came in with Covid and 21 died. We’re nowhere near those levels again. But staff members have had post-viral fatigue, some haven’t got their sense of smell back. Its not too debilitating but things have certainly had an impact. It’s been difficult for everyone but I feel its been hugely challenging for younger people.

111 responder and retired GP, south-east
I’ve done more than 800 [111] consultations over the phone since April. Originally we had queues of hundreds of people waiting to be talked to, and the system was not in place to catch the peak. Other doctors went onto the reserve list when demand fell away, but I kept working as I was pretty certain this second wave would come and wanted to keep my skills up for when it arrived. The numbers now are probably not as high as in April but a lot of people are still contacting 111 for help and we’re back up to the same level of doctors consulting, as then.

We’re increasingly hearing from people with long Covid, who have had symptoms for more than eight weeks. A higher proportion than during the first wave, who are calling us, are on antidepressants too. There’s a lot of people with anxiety about the virus calling and that’s inevitable really. However, armed with the appropriate information, people are prepared to face things as they come. They’re quite stoic about it. A lot of people calling already have their test arranged, or have had one, though the distribution of testing capacity remains patchy. It’s obvious the system is occasionally getting oversubscribed in places, but it’s less of an issue than back in July.

Walk-in centre clinician, the Midlands

We are a “cold” facility for non-Covid patients only. At the moment we redirect one or two a day on average for testing or to A&E. However, I know local hospitals are seeing more. Although we are an acute centre, so wouldn’t routinely see longstanding conditions, I did encounter this summer the occasional patient who had waited too long to get a problem investigated. A few of them sadly died, such as one man who had a seriously big tumour. Most cases like this should be seen by GPs. During the first wave, I worked at a coronavirus walk-in centre in London but it was wound down in mid-March due to a lack of demand.

It’s routine to have a visor, gloves and a mask – and to screen everyone – it has become part of the new normal. We’ve got more PPE than you can shake a stick at. There doesn’t seem to be a great deal of Covid anxiety among my colleagues. We have a different perspective, we can imagine scarier things. I also have an underlying condition and work with ways to reduce Covid risk daily. The only way to prevent something like this is to stop your pandemic happening in the first place, it is an illness that has – if you look at the figures – somewhere in the same lethality ballpark as flu, but the problem is there is no vaccine and no one has natural immunity. We’ve got to accept this is here to stay and find ways to live with it and work within the constraints it gives us.

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