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Hello, I'm Neal McGovern on the BBC World Service and this is BBC, those conversations about coronavirus intensive care.

As coronavirus numbers in some countries continue to reach record highs, doctors share their experiences in ICUs as well as predictions for the future. Plus, parents in Kenya and Pakistan discuss the effects of prolonged school closures for children.

My two kids, like the youngest one, is just six. Well, she has no social set up now, no friends around. And she is like a very difficult child nowadays. The successful development of vaccines for covid-19 has made many of us more hopeful for the future, but it is clear that the pandemic still maintains a dangerous grip. The World Health Organization has warned of an alarming situation across Europe. Countries such as the U.S. and South Africa are also among those seeing a surge of cases and hospitalizations.

And this is placing renewed stress on intensive care units or ICUs, which have been on that stressful frontline of the disease since the start of the pandemic. Dr Debbie Baker is a critical care physician in an ICU in South Africa. Dr. Zhao alow, a rheumatologist and physician at Paris State University in Brazil, working with covid patients in Santarem in the Amazon rainforest, and Dr. Joseph Varane, the chief of staff at United Memorial Medical Center in Houston, Texas.

In the United States, a country where over 370000 people have now died from the disease. I began by asking Dr. Joseph what it was like in his hospital's ICU.

The best way to explain it is chaotic between midnight and five o'clock in the morning. Today, I've received six new admissions to my court with ICU patients that are deathly ill, extremely sick. And this is happening day in and day out every single day. My nurses are extremely tired. I mean, they are to the point of breaking down. It's chaotic.

Where do you think it will go from here if those numbers continue to rise?

Well, we are going to overwhelm the health care system in the United States, without question about it. Unfortunately, people have not listened. People continue to go out. People have to go to bars, restaurants, I mean, gathering crowds of places. We are going to overwhelm the health care system just as it happened in late March, early April.

So that's the way it looks where you are. Dr. Debbie, tell us a little bit about your situation. We started sort of on the 1st of April admitting patients and went through a way into August. Just chaos, just so difficult because you taught a certain type of medicine and this is a disease of its own. You having to deal with emotions of doctors, of patients or families. You can't speak directly to families that can't see their loved ones.

It's an emotional physical. It's a combination of just unbelievable enormity. And one wishes you could go and take the public and bring them into your ICU so that they can see what the health care worker is being put through. Yeah, I've heard that echo.

Dr. Zha, what about you? I mean, do you think that the public understands what you are facing? We embrace you.

We are not that bad right now as the US or the UK, but we feel that the second wave is coming and we think in a few weeks we will we will be an accurate consideration. Again, our picture was like in June, May, and nowadays the case has begun to to raise again.

Dr. Joseph, let me turn back to you. I understand you got vaccinated. Have I got that right?

Yes, I was vaccinated on national television and I jumped when the people went in.

Well, I just read about it. I'm going to have to go back and watch that video. But I'm fabulous to hear. I'm really happy to hear that you have been vaccinated.

Could that be what changes this picture of what you're going through right now?

And I'm talking about, of course, the vaccination being rolled out for others.

Yes, it was. But I have a serious problem in the United States and that is that a lot of people don't want the vaccine. Just to give you an idea, 40 percent of my own staff, nurses in my covid unit, they refused to get the vaccine. But it is unreal. I mean, we offer it to them for free. It's available. You have it here and they still don't want it. Why they start telling you that is because of not enough data.

And then you keep on talking to them and eventually you start hearing things that are a little politically mediated, you know, as to why that happened during the Clinton administration and things like that. So it's difficult to understand, but there's a lot of hate for the current administration in the United States.

I find that very difficult that nurses that you've talked about that are exhausted on their feet, that they're caring for covid patients, that they know what the reality of this disease is and can be and yet are refusing the vaccine.

It is incredible. But, you know, it happens in the US also. You have two big. Population is the population of the African-American population, and when you talk to them, for example, with electronics, there is this misconception that once they vaccinate you, you are going to become infertile in the African-American population. You have this misconception that somehow the government is going to be doing some kind of a mind control situation. And this is what my patients are telling me.

So we need to overcome those thoughts in order to be able to achieve more control of this problem.

Gosh, and that is another discussion on exactly how you do that. But let me turn to you, Dr. Debbie. Do you come across any of those fears, concerns?

Our enrollment program has actually just been announced, so people haven't really started speaking about their feelings. But I can just tell you from normal flu vaccines, if you ask an audience of health care workers how many of you have had the flu vaccine, it's often in an audience, not as many as you would expect. Yeah, it's going to be interesting to see how many people want or refusing to be vaccinated. But from the literature, the adverse effects are not as bad as when you can get the disease, if you think of it that way.

I died. I survived the illness. But it's very difficult to explain that to people. Sometimes we work on a lot of evidence based medicine that the public out there doesn't necessarily do. So they listen to social media and are driven by that. Yes.

And of course, leadership as well can play into that, as Dr. Joseph was saying. Which brings me back to Brazil and Dr. Zhao, very controversial, the whole issue of vaccinations with in Brazil.

What are you seeing in November in Brazil are great bull when the whole country is showing us that 20 percent of the Brazilian will refuse the vaccination. Twenty two percent is a lot of people. But when we talk to each other in the hospital, as Dr. Joseph said, the nurses, the other doctors and other professionals, they say like, I want vaccinated or are we all of us that causes obligational here in the hospital. But in the next year, I will not because I don't believe in it.

And it's horrible. I don't know why. I don't know how it's going to get too strong. It's a great thing, a great issue in Brazil, because there's a lot of fake news. One side that is like a communist plot, like you have a microchip with the vaccination, you became a communist. A lot of things that you can't believe. But some people believe it's Dr. Joseph.

Do you feel there is a way to combat those who are refusing to get vaccinated for basically untrue reasons?

I mean, there are two ways one of them would be mandatory. I mean, simple as that. You can't get the vaccine. You don't work with those. That would be one way. But, you know, in the United States, that's a little difficult to do. And the second way is education. I mean, really focus on education and make sure that leadership shows that, you know, everybody gets the vaccine. I was the first one to get the vaccine in my institution so that people would see that, you know, it's safe because that was a concern.

But I think that more people need to know that. I know that a lot of people out there that don't believe in the severity of the illness. I also know that we have not been clear as to the message. The president says one thing, the World Health Organization says another thing. They see this as something that they change their mind three times in two weeks. There has not been a straight and focused message. But my message to the listeners are that coronavirus is real, maintaining your social distance, keeping your mask, avoiding large crowds.

It is step one to controlling this pandemic. Step two is getting vaccinated no matter what.

Make an impassioned plea there from Dr. Joseph Varan in the United States, along with Dr. Debbie Baker in South Africa and Dr. Joe Alow in Brazil, who all work with covid patients at the most critical part of the disease. The production of vaccines is good news, of course, but that doesn't mean that coronavirus cases will disappear immediately around the world or even this year, especially with the appearance of new variants such as those from the UK and South Africa, which are far more infectious.

From my next conversation, I brought together three experts who are spending their working days on this pandemic infectious diseases physician Dr Isaac Bangash and infectious diseases epidemiologist Dr. Maria Sundram, who are both based in Toronto, Canada, and molecular epidemiologist Dr. Emma Hopcroft from Bern in Switzerland.

This is how they think the first few months of 2021 might pan out.

The first voice you'll hear is Dr. Maria, the 2009 H1N1 in. Ones of strain that caused the swine flu pandemic is now kind of a normal part of our yearly vaccination strategy for for flu, and it's something that circulates normally and doesn't cause it kind of like very scary severe disease that we first saw or that we were first really worried about.

And so there is always the potential that this virus could do something very similar to that.

And especially with the changes that may be occurring, especially specifically those changes in the spike protein, there is always a possibility that we may need to employ a strategy similar to the one that we do for flu, where we need to be vaccinated every year. The vaccine needs to change at a certain time points. I certainly hope that's not the case, but it's it's the possibility, certainly. So, you know, I think it's it is really tough to know at this very moment, you know, what the future holds for yearly epidemics, for example, of coronaviruses versus this kind of global pandemic.

There's just such tremendous access to vaccines. And when you have a country where it looks like the biggest limitation will be acceptance of the vaccine, not access to the vaccine, you're almost positioned in a very good place. And truly, people who are most at risk of getting infected and dying will at least have access to this vaccine. You know, you can imagine by April or May or something like that where you could have a scenario where in some countries, anyone that wants one can get what like that's going to have a tremendous impact long before you reach herd immunity, even early on, even as vaccine programs roll out well before you reach herd immunity in a population, I think there can be some significant benefits.

Right. Like if you prioritize the most vulnerable of the vulnerable, know lower deaths, you'll lower suffering, you'll alleviate some of the pressures on your health care system. It doesn't solve all your problems, but it solves a lot of the problems. And, you know, that really starts those countries on that path towards normalcy, whatever that means.

I'm wondering, what is it about this virus that you would still like to know if there was some sort of magic wand that could just bring you the answer, something to do with this pandemic or indeed the virus itself?

Dr. Hammer, I guess from a scientific point of view, I feel like right now the big question on the table is how are the mutations that we see, for example, in these variants? How do they impact how the virus works? So, for example, we know that some of some of these mutations mean that antibodies might not be able to bind as well to the virus. But if you don't have any antibodies in your system, it's not really clear what advantage this would be giving the virus.

Since most of us aren't vaccinated and haven't had the virus, why would these be happening? And what does what might that mean in the future for our ability to adapt to individuals who've been infected or individuals who've been vaccinated? I'm certainly optimistic that these changes will not impact a vaccine, certainly in the short term. But this might really help us understand what what are the long term risks, as was just said, you know what what are the chances that we might have to update the vaccine every year or every few years?

Or will it mean that actually, you know, these these are kind of meaningless just chance mutations and we don't have to worry. So some kind of better understanding of of what these mutations do to the virus and how that might help us prepare for what kind of future lies ahead of us would be great. From a non-scientific point of view, I would definitely love to wave a magic wand and better understand how we can reconcile kind of political and scientific differences to implement better strategies.

Because even though I do think the future looks hopeful, as as Isaac has highlighted beautifully, we still have to get through this winter. Right now, we don't have enough vaccines for everyone. They're being rolled out at a tremendous speed. But the weather is going to stay cold. And those vaccines, it will take a while before even all of the vulnerable people are vaccinated. So we need to pull together and make it through what what is already proving to be a long, hard winter.

And I would love if we could find a magical way to do that so that we could ease some of that suffering even without having to wait for vaccines or for spring doctors.

Emma Chudacoff from Switzerland and Izapa Piggish and Maria Sundram in Canada.

For millions of children, 2020 saw their education disrupted as classrooms shut.

And many countries are now having to decide how their children's education should continue. As we await the mass rollout of vaccinations with the disease still prevalent in the UK, for instance, a lot of younger children were in school for just one day this month before being sent home.

As a result of a worrying rise in cases daily, covid related deaths increased to more than 1000. The.

That is one of the highest figures of the pandemic for the four countries that make up the UK in Ghana and Pakistan, governments have announced they will reopen schools later this month.

Ghana closed its schools in April, while Pakistan was one of the first countries to institute widespread closures. And in Kenya, schoolchildren have just returned to the classroom after an equally lengthy shutdown to parents. Share the concerns with my colleague Chloe Telli. They are Ehsaan, a father of four in Islamabad, Pakistan, and McCamey, who lives in Nairobi, Kenya, with her four year old daughter.

The last time I took my baby to school was in March 20 20. And now the schools have been reopened after a 10 month break that was occasioned by covid-19.

And so how disruptive has it been for you and for your daughter to be out of school that long?

This was her first year. And, you know, the foundation is quite important for growth and education. So when covid-19 came in, the government shut down schools. So this proved a very big challenge to me as a parent, because then you're not even able to understand what's next for your child, because I'm at work. So I have my child with the help. Help who takes care of the household is not able to take care of in terms of education and able to teach her basic things that they are taught in school, writing, spelling or both.

So it's been a very difficult year for me in relation to that. But for other parents, it's been a difficult year because especially in Kenya, there have been a rise in cases of sexual abuse, especially among young girls who are out of school. You know, school somehow is the safe haven for many of the girls. But the closure, of course, duty covid has made cases of sexual violence and abuse go up.

So it's not just the education for some girls.

It's also just personal safety, which is just utterly terrifying, as some tell me about your children.

I mean, having four children anywhere I can imagine is quite a challenge. But have you been able to help them with their education whilst they've been out of school for nine months?

Well, it's a very difficult task, basically, because the only way to help them is online. And we are not satisfied with the online classes here because it's not regular, first of all. And then the other way, because the kids are kids, we can't force them to set you know, they are immature.

And it's hard for parents, isn't it? And I know I was having to home school my children for six months whilst also working. And it's a real challenge, isn't it? Because you you need to work, but you also want your children to have an education and a son, as you say, they don't want to learn. They don't want to be taught by mum and dad, do they? Because I was told by my daughter that I wasn't a very good teacher.

That's true. Actually, you're 100 percent right, because in the outside you told me that you are a mother also and you're good.

So you understand the situation here.

Most probably the most difficult part is for the woman. My wife is a housewife and she faced a real challenge, basically.

Mikami, I wonder, do you see your daughters? Obviously very young, but do you see the effect on her mental health of being at home and not being with her friends?

Yes, because one moment she's at school, she started having friends and then the next moment back home. So it's hard for her to understand another thing. For example, Myanmar working mother and I work from home. So what demands too much time from the moment I want something from me, she wants attention. She she went out. She wants attention from the mother. And then I'm like, no, no, no, please, I'm working. Just give me five.

You can actually see that it's having a mental effect on her. So you as a parent, I'm left with the guilt of feeling like I'm not being there for my child as it should be.

Yes, true to see my most probably my two kids, like the the youngest one is just six. Well, she has no social setup now, no friends around. And she is like a very difficult child nowadays because she wants my attention to be there now because the mother is busy with other things. This is for them is psychologically what you call very damaging. I saw the should I said not only to her, but even my elder one little she is fourteen.

Erm she is now very much, you know, missing her friends.

So if that's the case you're both talking about obviously the downsides of the schools being closed.

Does that mean that both of you. Do you feel pleased that the schools are now reopening in your country's.

Mikami First, I know the government has said that they are full compliance to maintain protocols across the country, across all schools. But, you know, this that fear that, you know, these are small child who cannot control her movements. So the moment she goes back to. Something maybe she forgets to wash her hands doesn't see. So that means maybe she can bring the disease back at home. So that's a challenge.

Can you get a four year old to wear a mask when it's going to take off?

Within 10 minutes? The two of them had their masks on their necks. That could give them a big challenge for me.

Yeah, listen to Pakistan. And Kenya is like the underdeveloped countries. You know, people are living in a common living system like the elders are. There also is not only a safety problem for the kids. I mean, my mother or my father, they are also going to suffer if they just carry the infection to home, you know, it's more likely to give them the infection also. But inside the school, how could you keep the kids having a mask on the day?

So what would you suggest actually to the school administration now? Because over Minister, they give this statement that we are going to open the schools by the 15th of January. We asked them that we can keep the school close to March because, you know, covid will be on the rise during these months. So if you want to open, please open first of March, do it.

We know that children can be incredibly resilient, but do you fear there could be a long term consequence?

Yes, 100 percent for the older ones. I mean, now, my son, actually, he is very much concerned because he is saying that he just want to start practical life here. One year is a big loss for them.

For my younger child, I have a huge advantage because you may not be able to understand what's happening, though. What might affect is, you know, the social activities you surely have with our friends, because covid has made us just great in our homes and not even venture outside and play. So, yeah, it might affect us.

But I feel so much for the call that Lanas McCamey in Kenya and Ehsaan in Pakistan. When the pandemic began, I suspect few people thought we would still be dealing with the coronavirus in 2021. But here we are and we will continue to share its impact around the globe. I'm new to Magavern and you've been listening to BBC OS conversations about coronavirus intensive care. Thank you for listening. There will be more from the documentary podcast soon, the documentary is just one of our BBC World Service podcasts.

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