LONDON — The numbers may be trending downward, but the battle is no less intense. In the land of Winston Churchill, it is likened sometimes to war, the COVID war.
In the latest phase of Britain’s splintered campaign against the coronavirus, Prime Minister Boris Johnson last week laid out a long glide path for England’s gradual reopening from lockdown, from March to June.
But despite a speedy vaccine rollout, the schedule for changes was decidedly protracted — and declared reversible — for good reason.
After almost a year of mixed messages, COVID still divides the land between those who know and dread its fearsome reach, and those seduced by unlikely promises and invented deadlines of redemption.
The disease’s effect has been witnessed most readily in half-empty streets, shuttered shops and missed pints. Its shadow world of suffering remains largely cloistered in cramped intensive care wards, teeming with patients, where doctors and nurses work out of sight to the brink of despair.
It is through their heroism that the toll is not worse than it is already — more than 120,000 dead. The images sometimes evoke those of combat triage units amid the swirl of battle, with noise and chaos and bleeping monitors and medics tightly enfolded in protective garb, a spectral army thronging spaces overfilled with the most threatened of patients.
“One of my biggest feelings in the second wave has been anger at how many people are blatantly ignoring the rules and not really thinking about what they are doing out and about,” said Susan Jain, a specialist in anesthesia and intensive therapy who works with a team of doctors and nurses in the Intensive Care Unit at the Homerton hospital in East London.
“I want people to know how awful it is, how much a threat this is to all of us,” she said.
Haydar Sal will tell you. He survived the intensive care ward Jain oversees.
“The worst thing was seeing the people around me die,” said Sal, who lost more than 65 pounds in his fight. “I saw a lot of people beg every kind of god they could think of to survive.”
Britons often tried to ignore COVID as it advanced inexorably from Asia to northern Italy to the United States, leapfrogging political and geographic boundaries, carried by airline passengers and cruise ship vacationers just as Britain entered the final phase of its departure from the European Union.
But today the battle against the virus is still being waged on myriad fronts.
It is fought from emergency rooms to burial grounds; from the parlors of modest homes to the chanceries of state; from the soaring vault of a cathedral-cum-vaccination center to small-town mortuaries designed to cope with quotidian calculations of mortality, not the crushing onslaught of a pandemic.
The British government casts its fight in superlatives: the fastest authorization of vaccines, the speediest rollout of inoculations. But there is another, more macabre marker: a higher per capita death toll than any other large country in the world.
It finally took the emergence of a much more transmissible variant of the virus in the county of Kent in December to galvanize the country and its government. Last month, Sharon Peacock, head of Britain’s genetic surveillance program, said the variant had “swept the country,” and “it’s going to sweep the world in all probability.”
For years, British physicians say, they have sought funds for the National Health Service to expand intensive care facilities, only to be “laughed out” of committee rooms, as one of them put it. And so, their charges cling to life in crammed theaters, many in induced comas.
The intensive care unit where Jain works had to expand from 10 patients to 30, nearly all of them on ventilators. “We are very packed in our particular unit,” she said. “It isn’t quite as bad as 'M.A.S.H.,' but that’s what comes to mind.”
It is not a place Mohammed Malik, 53, a retired information technology project manager who was discharged in February, recommends visiting. “The ICU is the last place you want to end up,” he said. “There’s nothing after the ICU other than death.”
While he was there, one of his five daughters, Miriam, who was pregnant, was found to be infected, too. The baby was delivered by Cesarean; his daughter was in a coma for 10 days. “It was the darkest of all the darkest moments,” he said.
They survived. But even now, he said, he experiences strange anomalies, like the absence of a detectable pulse on his right side. He had nothing but praise for his doctors.
As elsewhere in Europe, the virus seemed to retreat in late summer. Travel restrictions were eased. In England, the government even offered cash incentives for people to eat out in crowded restaurants. Then the caseload curve veered sharply upward again.
“I never thought it would be so severe,” Jain said.
In this wave, she said, the patients seemed to be younger, possibly because of the new variants, although the government’s data was inconclusive. But the “root is probably in the way it has been handled centrally,” by authorities shying from harsher measures earlier.
“If you let people out of lockdown in December, over Christmas, there was only one way it was going to go,” she said.
By mid-January COVID fatalities were soaring, along with hospitalization and infection rates. On Jan. 20, the daily tally of death peaked at 1,820 patients who perished within 28 days of testing positive.
The fatalities have been especially high among some ethnic minorities.
“Our workload has increased about tenfold,” said Idris Patel, founder and chief executive of the Muslim Patel Burial Trust/Supporting Humanity, a charitable group. “We used to bury two to three a week in summer, four to five in winter. Now it’s six a day.”
His nonprofit group has had to augment its single mechanical digger with two more from rental companies to create new graves. The numbers are not the only change.
“This time round this one seems to have hit a different age group,” Patel said. “We’re burying people a lot younger, from ages of 40 to 63, under pension age.”
Normally, funeral rites begin in a mosque with an imam reciting the Janaza, the Islamic funeral prayer. But these days, Kafil Ahmed, who runs the Al Birr Islamic Trust Funeral Service in Greenwich, southeast London, sometimes performs the rites himself, graveside.
Normal is still a long way off. As in most wars, the most onerous burden falls on those who did not sign up for their unwanted parts in this great 21st-century drama. People like Skye Sunderland, 17, already sick with cancer, who was brought low by COVID in January.
By the time it was discovered in August, the rare sarcoma had already spread from her adrenal glands to her lungs. Physicians concluded she would need 14 cycles of chemotherapy.
“It was only a few cycles in that she found it difficult to tolerate the side effects and other medicines,” said Judith Sunderland, a lecturer in midwifery, who along with her partner Naomi Sunderland adopted Skye a decade ago. “So she stayed at home, apart from one blood transfusion.”
On Dec. 26, the family learned that Skye had contracted the virus. She died Jan. 5 at home in the Newham district of East London. Both the cancer and the COVID were listed as contributory causes. Her parents tested positive, too, but survived.
As the government’s vaccination campaign gathers pace, fatalities and infections have fallen sharply from their January peaks. Infections have dropped across all age groups, not just those who have been vaccinated, said a report by scientists at Imperial College, London, “suggesting the downward trends are due to lockdown rather than the impact of vaccination.”
Medical authorities have encountered some resistance, particularly among minority groups. Rumor and misinformation spread online by anti-inoculation campaigners have raised false alarms about forbidden products such as pork, or even microchips, in the vaccines.
But the vaccination campaign has largely been welcomed as a glimmer of hope and is being expanded.
The process has been accelerated by a decision to limit vaccinations to a single dose in an initial 12-week period, even though the manufacturers of the widely used Pfizer-BioNTech vaccine recommend a second dose after three weeks.
(Full disclosure: The author of this article had a single dose of that vaccine Jan. 15. No date for a second jab was offered.)
With the onslaught of disease seeming to be in retreat, fear of infection is being supplanted by an almost palpable yearning for the counter-vision of a Shangri-La where pints are pulled in sunlit pubs, children gambol in brightly painted classrooms and airlines fly to faraway beaches.
Although Johnson’s latest “road map” out of the lockdown was depicted as cautious by the government, the news made Mike Padgham, managing director of St. Cecilia’s care home in the seaside resort of Scarborough, northeast England, “a little nervous.”
In the first wave, care home residents suffered disproportionate casualties as hospitals moved aging patients into care facilities to free up beds for COVID patients. Up to one-third of all deaths in 2020 occurred in facilities catering to older people, many of them suffering from dementia.
In the current wave, fewer patients recovering from COVID are being taken to care homes, such as Padgham’s, where they have a dedicated floor. The risks remain steep.
Under the government’s new changes — set to take effect March 8, one week before Mother’s Day in Britain — his charges would be allowed visits by a family member under strict conditions. No hugs. No kisses. But hand-holding is OK.
A previous attempt to ease restrictions last year was short-lived because of a spike nationwide in infections, Padgham said.
This time, designated visitors will wear protective clothing and undergo a so-called lateral flow test for COVID before meeting a relative. But, he worries, there could always be “the odd person who would give their mum or dad a hug or a kiss.”
An infection, he said, would “spread like wildfire” through the 110 residents of St. Cecilia’s. Most have received only the first of the prescribed two doses of vaccine, adding to the trepidation.
“I don’t think the government has thought it through as clearly as they ought to,” he said. “We have to take the brakes off very gently.” In an article he wrote recently, he measured the COVID war against Churchillian rhetoric midway through World War II “warning that the war wasn’t over yet.”
“And so we are with COVID-19,” he said.
For others, too, there is an uneasy comparison with the closing phases of distant military conflicts in war-weary lands.
Somewhere, out there, beyond the immediate palisade, the fighting continues. But it has been overtaken by a yearning for normalcy, once implicit in handshakes and embraces, live music concerts and soccer stadiums packed with roaring fans — a shoulder-to-shoulder kind of life, a dream of blinking toward the light after a long sequestration.
“I think I feel quite cynical about it,” Jain said. “I can’t honestly see a time when we’ll be free to roam around, go to cafes, the theater, go to concerts, be all packed in like sardines on the Tube.
“You’d have to get the whole world vaccinated to get back to that — and make sure the vaccine is effective.”
For now, she is a servant to the strange rituals of the pandemic, no less tedious for their familiarity and urgency. The “donning and doffing” of personal protection equipment has assumed an overweening importance in containing infection, said Jain, who cares for two children at home and her aging parents and a nearby aunt.
“At the end of the day, I take a shower at work, and as soon as I come home I won’t let the children come near me until I have showered again,” she said. “How do you know what you bring back?”
“The whole time since it started, especially at the beginning, I was convinced I was going to get it,” she said. “I thought it was inevitable.”
She has not. Health care workers were some of the first to get vaccines. But for the psychic toll there is no inoculation.
When Jack O’Malley opened his family business as an undertaker just four years ago, he expected to confront raw grief, too. But not like this, he said.
Back then, he expected to oversee three cremations or burials a week. Then it might take 10 days or two weeks to arrange the final rites. Then, taking his black top hat and cane, he would — as is the tradition known as paging — march solemnly ahead of the hearse and the cortège of mourners.
Now the pace of loss has both quickened and slowed. In one week in February, he said, there were nine new bereavements to arrange in two days in his corner of the English Midlands in Cannock. Such is the pressure on crematories that the first available appointment for a person who died Feb. 1 was March 19.
“I don’t watch the news anymore, because it’s the same as what I am doing at work,” O’Malley said. “My whole life is just work: I’m spending all the day dealing with families and funerals.” He called it COVID fatigue.
The pandemic has created sheafs of regulations and restrictions on the minutiae of life, and death. Mourners may not touch or place flowers on the coffins of the departed. Family members may not carry the coffins on their shoulders.
No more than 30 may attend funeral services, and fewer if the venue is not roomy enough to enable social distancing. Singing, chanting, blowing horns and raising voices are all limited.
It is not unusual, O’Malley said, for mourners to livestream funeral services from their phones and tablets to enable a broader audience to follow the ceremonies from afar.
Inevitably, those on the front lines — funeral workers, doctors and nurses — are often most exposed. So are their kin.
In December, Ahmed, of Al Birr Islamic Trust Funeral Service, said his younger brother, Zia Ahmed, had sickened. When the ambulance did not arrive, he bundled him up himself and drove him to the emergency room.
“And that’s it,” he said, “from there on they said that he had COVID. So I got myself tested, and I was positive, too.”
His wife, Nasim, who had lost her mother and a brother-in-law to COVID, also tested positive. Neither of them was hospitalized. But it was “very hard,” Kafil Ahmed said. “It breaks you from inside.”
On Friday, Feb. 19, Ahmed said, hospital authorities told him that, “if my younger brother survives the weekend, it will be a miracle.” On Feb. 21, he learned that his brother had died. There had been no miracle.
“COVID,” he said, “has turned everything upside down.”