'The regret is there' - Inside the coronavirus intensive care unit where every patient is unvaccinated
As Natalie Baker chats to nurses from her hospital bed, she beams with happiness as she talks about being reunited with her young daughters.
The 40-year-old mum-of-two was admitted to Manchester Royal Infirmary (MRI) with coronavirus two weeks ago, after her symptoms became so serious she was unable to manage at home.
Her bubbly tone shifts dramatically as she recalls how gravely unwell she was just a few days ago.
As she lay next to a woman taking her final breaths on the hospital's coronavirus intensive care unit, Natalie was reminded of just how precarious her own life was at that moment.
She knew at that point, there was a good chance she wouldn't make it home to her children.
Natalie is one of the lucky ones, and will most likely be allowed to go home to her family within the next few days, after a brief stint in critical care and a coronavirus ward.
The mum admits she owes her life to the dedicated team of medical professionals here, who have successfully treated the terrifying effects of the virus they have become so accustomed to.
When Natalie contracted Covid-19 at the beginning of August, she hadn't been vaccinated.
"I just wanted more time to see how it worked and how it affected people," she says, speaking from the hospital's Ward 9 COVID.
Natalie is now adamant that she'll be booking her first jab the moment she is able to.
"I'll be doing it for my children," she says. Her eyes are filled with emotion.
"When I was lying there in intensive care I thought - there is a chance my kids are going to be left without a mum.
"I know I need to get the vaccine now so that if I do happen to get the virus again, I won't end up like this."
The Manchester Evening News visited MRI's coronavirus intensive care unit in August as part of our running series, documenting the amazing work of brave NHS staff on the frontline.
When we arrive at the unit - which treats the hospital's sickest covid-positive patients, we are told that every single person is unvaccinated.
"It's a pretty stark fact and it's one of the reasons we are so busy, because we have so many additional patients," says critical care consultant, Dr Henry Morriss.
Unlike during the first and second wave of the pandemic, the demographic of patients being admitted to the hospital's intensive care unit is now much younger.
Dr Morriss' team are now predominantly treating patients from their early 20s to 40s.
Critical Care Ward Manager, Emily Edwards, says the 'saddest' part of what is now being described as the hospital's fourth wave, is seeing patients who aren't vaccinated, even when it's been available.
"When the patients come in to us they are usually awake and they are aware of that, and it's just the regret they've got," she says.
"You ask them why they've not had the vaccine and it's usually that they've prioritised other things like working, and just haven't had the time for it.
"That's what is quite hard to see because as they progress with the illness and get worse; the regret is there.
"We've seen 30-year-olds in here with no previous medical history. There are still a lot of people passing away."
Hooked up to an array of machines, mum-of-four Karen Wilson clutches a teddy bear given to her by her 13-year-old daughter Naimh.
The 46-year-old from Openshaw is one of dozens of patients on MRI's coronavirus intensive care unit - which is full when we visit.
"It (coronavirus) got brought in by my teenager who I was more worried about fighting, but she battled it well and then I started to deteriorate at home so they brought me in here," Karen says.
Her breathing is laboured and she has to take regular pauses to catch up.
"I can't tell you how laid back I was about getting the vaccine," she says candidly.
"I wish I'd never been so laid back because it was one of the scariest times. You are just lying there and you want to get your breath and you can't.
"Being on your own doing that is really scary so these girls, even though they just sit and hold your hand saying it's okay Karen we are here... I couldn't have done it without them.
"All I kept telling myself was that I've got four babies and four grandbabies to get home for."
Karen's condition is now starting to improve, and she will hopefully be stepped down to a covid ward in the next few days.
"From holding my hand to monitoring every breath I take - it's all thanks to them," Karen says as she looks to the nurse standing attentively by her bedside.
"I just want people on the outside to know I'm not against vaccines, but if you are planning on having it please don't put it off because this is scary."
Another upsetting feature for staff during this wave of the pandemic, has been a rise in the number of pregnant women needing to be admitted to intensive care, says Dr Morriss.
Some expecting mums sadly haven't made it.
"Unfortunately we have seen quite a few ladies who are pregnant or have just given birth. That's been much more of a feature in this wave," says Henry.
"I would guess in the latest wave we have seen around 10 to 15 pregnant women and I don't think any of them have been vaccinated.
"I think there has been some uncertainty about whether it's safe for pregnant women to be vaccinated and clearly it is and we have that evidence now. Probably some ladies aren't aware of that.
"I'm not sure the message has been clear enough for those people to realise that it is safe in pregnancy."
Henry believes reopening of society is likely to be behind the increase in pregnant women needing intensive care, coupled with high levels of vaccine hesitancy among this group.
"We saw a lot of pregnant ladies who had just had babies because they weren't sure if the vaccine was good for them at the time," says Junior Sister, Diane King.
"Around six weeks ago we had quite a few pregnant women in intensive care in a short space of time.
"I think people are finding more confidence to get the vaccine now, particularly as it's been publicised that pregnant women getting covid isn't good."
The presentation of younger patients is visibly taking an emotional toll on staff working across the hospital's covid wards - most of whom have been working flat out since March 2020.
Whilst on the outside world doctors and nurses can go to the pub and see their families again, inside the hospital, admissions aren't letting up and people are still dying.
"Nursing younger patients has posed a new challenge for my staff," says Kerri-Anne Folkard, who is ward manager of Ward 9 COVID.
The unit is what is known as a 'base ward' and will take coronavirus patients who have just been admitted to A&E, and care for those who are most sick but don't require intensive care.
"Lots of my staff wouldn't have been used to nursing patients that are younger before the pandemic, so that has given cause for reflection certainly," Kerri-Anne added.
Like in critical care, the majority of the patients being treated on Ward 9 COVID are unvaccinated.
Those who have been vaccinated have been admitted to hospital for other illnesses, but have picked up coronavirus in the community at the same time.
"The ones that are actually sick with Covid - the vast majority are unvaccinated," says Kerri-Anne.
"We do give a little bit of counselling around the vaccine to some patients and hesitancy can be due to lots of issues such as needle phobia or because people are unsure how important it is.
"Many of those that have become unwell with it decide once they are a past a certain period they will then go and get the vaccine."
Candy Gilette, 62, was originally admitted to hospital because of her COPD and stage two respiratory failure, but contracted coronavirus around the same time.
"If I hadn't been double jabbed I probably wouldn't still be here," she says, speaking from her hospital bed on MRI's Ward 9 COVID.
"Some of these people who aren't getting the vaccine aren't taking it seriously enough.
"Everyone needs to because it's not nice. I think if one of their relatives got covid and ended up in here they wouldn't be so blasé."
Respiratory consultant at MRI, Dr Waseem Khan, says vaccine hesitancy and a perception among some people that coronavirus isn't going to effect them, could cause long-term problems for the NHS.
"Young people aren't necessarily dying from Covid-19 but that doesn't mean it's not going to affect them," Dr Khan says.
"Long-covid is going to be a huge issue going forward. It is now and I think in two or three years time it will be an even bigger issue.
"I think there is a lack of education about that. This isn't just about people dying, it's the consequences and the quality of life which people are left with afterwards."
For Dr Morriss and his team, the pressures they are facing are higher than ever, as they attempt to juggle unvaccinated covid patients, normal intensive care admissions and elective surgery.
"We are under immense pressure at the moment," he says frankly.
"We're trying to get through a backlog of people who urgently need cancer surgeries.
"If it's working well our planned surgeries can go ahead and not get impacted by what's going on elsewhere, but in reality if all the other places are full we can't get as many people in.
"We are moving heaven and earth to get these people with delayed cancer surgeries through, but there's only a finite number of beds.
"Clearly that's heartbreaking - if you've worked yourself up for a big operation and being told you can't have it done because there are no beds is very upsetting."
Dr Morriss says he and his team are now preparing for what he calls the 'unknown wave' of patients, who may have put off getting medical treatment during the pandemic.
"Is it that people are too afraid to go, do they think we're too busy to go, actually has our health got worse because we've all been cooped up drinking and eating too much," he says.
"Mental health clearly impacts our workload whether it's overdoses or people with trauma. All those factors are why we are under such immense pressure.
"I think what is interesting to us at the moment is that there is this message that we are back to normal but clearly nothing is normal for us in work.
"What we are seeing now, there's an awareness that this is baseline numbers - possibly because schools are off, people are on holiday and the weather is not too bad.
"What the winter will bring is a fear."
Dr Morriss believes coronavirus numbers will start to go up as questions are raised about how long vaccine immunity will last, coupled with the resurgence of normal viruses like flu and Respiratory syncytial virus (RSV).
"I think we are all anticipating a bad winter - maybe very bad," he says.
"My staff have been working flat out now for a while and that is starting to have an impact. Everyone is working extra hours and hero nurses spend hours in PPE - that takes its toll.
"Have we seen the end of the pandemic? I don’t think so."
Henry and his team say their only hope is that more people will take up the coronavirus vaccine, as they believe they can confidently say it's making a difference on the frontline.
"First hand there is no denying what we see day to day - from how many admissions needed to come before the vaccine was around and how many needed critical care," says Emily Edwards.
"It's different now."