As England goes into its third national lockdown, National Health Service (NHS) workers are scrambling to accommodate COVID-19 patients in critical condition, warning that the worst is likely still to come as a new variant of the coronavirus spreads across the country.

"Even before Christmas we had to expand and send patients elsewhere because we didn't have enough beds," says Beth Walmsley, a pediatric nurse. The 33-year-old has recently been treating adult patients as well as children, to alleviate the burden from colleagues caring for the influx of COVID patients in critical condition.

Walmsley's hospital is one of the dozens across the country that declared a "major incident" ahead of the holidays — requesting that staff cancel annual leave and holiday plans to work until further notice. Now they're bracing themselves for an unknown number of people who were infected over the holiday season.

1 in 50 households infected

"We are already at such a breaking point and we still have yet to reach the predicted peak from Christmas and New Year's Eve," says Secretary of the Doctor's Association of the United Kingdom Dr. Zainab Najim.

Figures from the Office of National Statistics suggest that as many as 1 million people were infected with the coronavirus last week. That is one in every 50 households in the country, and one in every 30 households in London.

UK Prime Minister Boris Johnson had encouraged people across the country to limit their holiday plans — and urged those in London and the hard-hit southeast to cancel them altogether — with a last-minute lockdown order. But NHS workers are nonetheless anticipating a spike from those who defied the orders.

Given the fact that the virus takes several days to incubate, anyone who was infected over the holiday period likely has yet to develop symptoms.

"We suspect that there will be a spike around the 17th of January," says Penny Louch, a 63-year-old nurse practitioner who gives virtual consultations to COVID patients whose cases are not severe enough to go to the hospital.

"It is definitely going to get worse before it gets better."

Strain on the NHS

"I think there is a feeling of 'here we go again,' and that it is going to be worse than the first time," says Walmsley, describing the mood among healthcare workers who have been responding to the pandemic since March of last year.

"That is hard to wrap your head around," she continues. "The public has no idea how bad it is."

On top of learning new skills, adapting to the changing circumstances and canceling annual leave, healthcare workers are still one of the most at-risk groups for contracting the virus, particularly as the new, more infectious variant makes the rounds.

"Many of the (NHS) trusts have done an incredible job to increase capacity," Dr. Najim says, giving a nod to frontline staff, like Walmsley, who have taken on additional duties as hospitals come under increased pressure.

"Unfortunately, we do not have enough staff," she adds, pointing out that many healthcare workers are getting sick, and having to self-isolate themselves. While the UK is rolling out the vaccine amongst the public, there is yet to be a campaign that aggressively targets and prioritizes healthcare workers.

Dr. Najim fears that the strain on healthcare workers could lead to burnout — and a longer-term mental health crisis.

"It is difficult for staff to take a break from everything," she says. "Patients are much sicker, and there is going to be a big mental health burden once this is all over."

Too little, too late

Could this deadly surge — and strain on the NHS — have been avoided? Healthcare workers argue that the UK government's messaging throughout the pandemic has given the public a false sense of security, and that the numerous national and regional lockdowns have been too little, too late.

"I think that the messages that came across from the government always made it sound like it was going to be really short term," Louch says, pointing out that, historically speaking, most pandemics last for at least two years.

"The public needs to wrap their head around the fact that we are going to be in and out of lockdowns until most people are vaccinated," she continues.

"Instead we are still struggling with people thinking that it isn't COVID or that it isn't going to happen to them."

For those working in the hospitals, the government's lax messaging has a direct impact on the number of cases that they're seeing.

"It infuriates us professionals because it spreads hope and people respond in a way that is careless and unthoughtful," Walmsley adds, arguing that that the government's obsession with easing lockdowns over the holidays impacted the public's behavior, despite the last-minute bait-and-switch.

"Christmas should have been canceled back in October, there should have been a lockdown and the government should have focused on rolling out an intensive vaccination program," she says.

"If we had done that, we would be going into this year very differently."