LONDON (NYTIMES) - In the hospital in south-west England where Joanna Poole works as an intensive care doctor and anaesthesiologist, the past few weeks have been a blur of cancelled operations for lack of beds and a scramble to plug holes in schedules because of coronavirus cases among the staff.
From day to day she is unsure who will be available to work, including herself. One day this month, she said, most of her department had to go home to take tests after coming into contact with an infected colleague, throwing the staffing schedule into turmoil.
Dr Poole, 32, wants to get back to "normal operating", when she knows her staff roster and has a chance to become familiar with her patients. "And then actually give them the operation, have no one be cancelled and just have a day where I know what I'm doing when I get up in the morning," she said, sighing.
As a surge in coronavirus cases continues to batter Britain, hospitals, clinics and ambulance services say it is winnowing their staffs, especially through the highly contagious Omicron variant. The wave of infections has put severe pressure on the National Health Service, already under strain from worker shortages caused by underfunding, Brexit and the exhaustion from nearly two years of battling the pandemic.
Data projections from the Health Service Journal, a trade publication, indicated that one in three workers in the National Health Service could be absent from work by New Year's Eve if the current case rate continues.
On Wednesday (Dec 22), Britain surpassed 100,000 new cases for the first time since the start of the pandemic.
For the moment, there is not the kind of shortage of beds that plagued hospitals during the peaks of the pandemic. But the pressure on the system caused by staff illnesses is evident across Britain.
One London-based doctor responsible for scheduling said that so many of his colleagues were calling in sick from the virus that he couldn't update the work roster fast enough. A primary care physician based in Leicester found himself the only senior doctor able to work in his practice this week.
On Wednesday, Britain announced that it was reducing to seven from 10 the number of days that people are required to isolate after showing Covid-19 symptoms - a change that officials said was based on updated guidance from health experts, and that could help alleviate the staffing shortages.
As cases surge in their communities, many health care workers are contracting the virus outside their workplaces, from contact with family members or in their day-to-day lives.
Though there is some evidence that the Omicron variant may produce less severe symptoms than Delta, it also appears to be up to twice as transmissible. That is likely to result in a large number of infections, so even a small number of severe cases could still lead to a jump in hospitalisations, public health researchers say.
Coronavirus patients make up around a quarter of all occupied critical care beds in England, according to government statistics, and have for some time. While the number of new admissions has risen slightly nationally, experts expect more in the coming weeks. Last week, the health service advised hospitals to discharge patients as soon as medically possible to make beds available.
In some hospitals, non-urgent surgeries have been cancelled to free up resources, and some staff are being redeployed to more critical departments. The health service has also told officials to prepare for a number of small field hospitals to deal with a potential influx of Covid-19 patients, Health Service Journal, a trade publication, reported.
"We are coming under real pressure in terms of the number of staff that we've got off work," Mr Chris Hopson, the chief executive of NHS Providers, the membership organisation for England's health staff, told the BBC Breakfast show on Tuesday. He said the number of healthcare workers out sick or isolating after coming into close contact with infected people has exploded in recent days.
In London, where the Omicron variant has hit particularly hard, absences jumped from around 1,900 at the beginning of last week to 4,700 by last Thursday, "and we know it's gone up since", Mr Hopson said.
Last week, trying to ease the shortages, the government loosened guidelines for vaccinated health care workers who come in contact with someone with the coronavirus, requiring them to self-isolate only if they test positive.
The pressures from the Omicron variant are also being felt in the United States, where President Joe Biden unveiled plans on Tuesday to deploy 1,000 military medical professionals to help at overburdened hospitals as the country braces for its own surge of cases.
Those working on the front lines of the pandemic, like Dr Poole in Bristol, have already spent months dealing with the most harrowing aspects of the coronavirus, watching patients die as family members were unable to visit. She said the hospital's staff for months worked on emergency schedules to ensure care, but now feels overwhelmed by the prospect of yet another unrelenting wave of cases.
"You can feel that people are very tremulous about this idea that you might have to go back a year, like rewind, and do all of that again," she said. "They don't have the resilience." For some there is also the frustration of knowing that a majority of those who are seriously ill are people who chose not to get vaccinated.
Dr Ian Higginson, a senior doctor and vice-president of the Royal College of Emergency Medicine, a professional association, said that even before the new variant emerged, he was concerned about the general state of emergency care in Britain.
He said that years of under-investment and staff shortages had led to long waits for patients, overcrowding and delayed ambulance services, and staff were already exhausted headed into the winter.
"If we're going to see a whole host of new problems related to Covid, there's a big worry about how the system will cope," he said, "because this wasn't a system that was in a good state to start with."
Ms Carmen Sumadiwiria, 29, a London cardiology nurse, said that her unit had lost half of its staff over the past few weeks because they either had the coronavirus, were isolating or had another illness. As a result, she has had to take on six patients during her shift, when ordinarily she would care for two or three.
"You just feel inadequate when you have so many patients and so little time," Ms Sumadiwiria said.
"Sometimes, I am so disoriented and exhausted I don't even know my left from my right," she added, noting that after her shift that evening she mistakenly removed and donned her scrubs twice before realising it was time to go home.
Some areas of Britain have yet to be hit by the new Omicron surge. Chris Hingston, 46, an intensive care doctor at University Hospital of Wales in Cardiff, said things had so far been manageable.
But the hospital is bracing for its own influx of new cases. Dr Hingston said his department was already coping with a nursing shortage. After months of intense and demanding work during the first few waves of the pandemic, many staff members have suffered psychological trauma, he said.
"It has been a struggle at times to staff the beds as we would want them," he said. "We're already very stretched, and to stretch us further is going to be a big, big challenge."
That weariness extends to areas of the healthcare service that are not treating coronavirus patients, and that have also been dealing with months of strained capacity as a result of the pandemic.
Dr Kamlesh Khunti, a primary care doctor based in Leicester, was the only senior doctor able to work in his practice this week. While he and his colleagues are still managing to deliver care at the moment, the practice has not been able to see as many patients as it normally does.
"People are still continuing to work at an incredible pace and level, so the willingness is still there," he said.
But, he added, the reality is that when a wave of the coronavirus begins in their area, absences will be inevitable.
"If they get the infection, no matter how willing you are, if you're infected, you can't work," he said. "We're preparing for the worst."
Ms Dorcas Gwata, 51, who works as an emergency room nurse specialising in mental health in a London hospital, said that while her hospital is not being overwhelmed by coronavirus cases, she worries about the effects of worker illness and further pressures on her colleagues.
"They are worn out," she said. "They're like soldiers at war." But she said that the system had been innovative in managing the crisis, that workers were coping as best they could and that they deserved recognition for their sacrifices.
"A very big part of my personal concern is that we keep our nurses and doctors and cleaners and porters well looked after and validated," she said. "They are forgotten about now. Nobody's clapping for us."