Bucharest, Romania – At a temporary COVID-19 intensive care unit at the University Emergency Hospital in Bucharest, set up to cope with the strain of Romania’s devastating fourth wave, a cardiac monitor beeps with a warning.
An elderly, unvaccinated patient, bone-thin and too sick to breathe without the help of machines, is losing his battle with the deadly virus.
There is no family at his side as advanced permission is needed to visit for periods of just 15 minutes.
Despite all the efforts to revive him, the man’s body cannot carry on, and he passes away.
As the Delta variant of the coronavirus swept Romania in October and November, the Eastern European country was hit with its worst spike of COVID infections since the pandemic began.
In October, more than 400,000 positive COVID tests were recorded – almost a quarter of the overall total – as well as the highest death rate in the world per capita with 10,700 people dying.
Case numbers recently have fallen to fewer than 1,000 daily compared with more than 15,000 at the peak in early November.
But for emotionally and physically exhausted medical professionals, there is little time for recovery.
“This is a pause only,” emergency room doctor Silvia Nica, 54, told Al Jazeera. “We are trying to disconnect from the fear and forget the things we have seen. We are also making sure we have all the equipment and things we need so we are not taken by surprise.”
Earlier this month, Romania recorded its first two cases of the new Omicron variant, which is thought to be more contagious than previous strains of the virus and has the ability to evade immunity from previous infections.
The Bucharest hospital is bracing for a fifth wave of an unknown proportion.
While some suggest tougher restrictions would help limit the virus’s spread, especially over the Christmas period when people celebrate with family and friends, Romania announced last week that it is easing its current measures, including eliminating a night curfew.
Yet the country has the second-worst vaccination rate in the European Union at just below 39 percent.
Vaccine scepticism and COVID denial is widespread and fuelled by misinformation, nationalist politicians and the influential Romanian Orthodox Church, analysts and experts have said.
For doctors and nurses, coping with the burden of the fourth wave was harder, given that most deaths could have been prevented.
“I had an unvaccinated patient who was 26 years old,” said Mary, 33, a front-line nurse. She did not want to give her last name due to fear of becoming a target for anti-vaccine campaigners.
“We did everything we could but he died. The impact of something like this is very big; when someone dies in your arms without their family. I feel so much pain for them, there is nothing you can do to help and no one can visit to hold their hand.
“People have to know that this is real, the virus exists, and they have to do everything they can to protect themselves.”
A seventh-floor unit usually used for patients recovering from surgery was turned into a temporary speciality ward in October as the hospital, which takes in both COVID and other patients, became so inundated with the gravely sick.
The area is separated from the rest of the hospital by plastic dividers and is so new that it is strewn with piles of medical supplies that are yet to be organised into storage areas.
Only those who are in a very serious condition are brought here to be intubated or supported with a ventilator.
During the peak of the fourth wave, all 90 beds were full with more people waiting to be brought in.
Staff say that in many cases, the families of patients who have died from the virus continue to refuse vaccination and still do not believe that COVID is the real cause.
One of the reasons for such a high death rate, they say, is patients refusing to accept they have the virus and attempting to treat themselves at home with paracetamol or over-the-counter flu medicines.
“But when things get very bad they change their mind and say, ‘Please help me’,” said Mary.
Volunteer medical students at the hospital told Al Jazeera that they have met people who believe footage of COVID ICUs are full of paid actors pretending to be intubated patients.
In the morgue, refrigerators are marked with a “+” for those who have tested positive.
Even as the daily death rate has dropped – on some recent days, the toll has been about 100 people, on others, about 45. There is little space for the victims to rest, with body bags lined up on trolleys.
Usual Romanian burial traditions would see the deceased sent to the funeral parlour dressed and in an open, satin-lined coffin.
But COVID victims must be nailed shut into their coffins, depriving loved ones of the last goodbye.
The University Emergency Hospital in Bucharest – which treats only adults – lost its youngest COVID patient in mid-November. He was 19.
“My son is the same age. He even looked like my son,” said George Imre, 50, who works in the morgue, tears filling his eyes.
“When his mother came to take him home she was crying on her knees. That image haunts me. Even if you’re very strong it stays with you.”
Romania’s health system has consistently been ranked the worst in the EU and critics say little has been done by the government to ease the strain on already overburdened and underfunded hospitals by countering vaccine scepticism.
In Bucharest, there are frequent protests by people who are hesitant about the vaccines and misinformation about the jabs circulate widely online, particularly on Facebook.
Nica, the emergency room doctor, said she has invited high-profile vaccine deniers to the hospital to witness the devastation COVID has caused first-hand, but they always refuse.
She wants the government to take action over misinformation as a fifth wave looms.
“Nobody thinks about doctors and nurses. We are also human beings. Fake news harms us,” she said. “There will be a moment where we cannot offer treatment any more – we have a limit.”