Coronavirus doctor's diary: The Yorkshire cemetery struggling to keep up with burials

Bradford's main Muslim cemetery has been struggling to keep up with burials as the second wave of the pandemic has gathered pace. It will take some medical detective work to determine the cause of this increase in deaths, says Dr John Wright of Bradford Royal Infirmary, but multi-generational homes could be a factor.

My friend Zulfi Karim called me on Friday with news about a sharp surge in deaths within Bradford's Muslim community.

"We've got three shifts of gravediggers and bereavement support people working from six in the morning until 10pm, preparing graves. In the last 10 days we've had 38 burials, which would be the figure we'd normally have in a bad winter month," he said.

"As fast as we're digging the graves we're filling them up with dead bodies. It's really really concerning, and my staff are getting to the stage where we're at full capacity. We're having to bring in a construction company to see if we can find new methods to design and prepare for digging a grave."

By Saturday the figure had risen to 44.

Zulfi is the chairman of Bradford's Council of Mosques and the head of the Muslim Bereavement Service. He's attended every funeral, while also coping with long Covid himself.

"From a personal point of view I've never seen anything like it," he told me. "I never thought I'd experience this here in the UK in a non-war situation."

In the Muslim tradition, a person should be buried within 24 hours of death, but Zulfi says it hasn't always been possible to keep up.

It's going to take some work to fully understand what is going on.

According to the Office for National Statistics, Bradford is currently seeing about 100 deaths per week (from all causes), up from 60 or 70 in the summer, but this isn't especially surprising; we expect this number to increase with the onset of winter.

In the hospital, Covid-19 admission rates have surpassed the first peak in April, but the good news is that mortality remains considerably lower - less than a quarter of the rate in spring - as we have become experts in caring for and treating Covid patients. The average length of stay at Bradford Royal Infirmary has more than halved - from 13 days to six.

Zulfi's hunch is that cases of Covid-19 may be going undiagnosed and that more people are dying from it at home than the statistics show.

About 30% of Bradford's population is from the South Asian community

Back in February when the pandemic was hurtling towards us from the other side of the world, we watched how it devastated Italy and Spain and predicted that Bradford would also be badly hit. The city has a high population density and overcrowded housing, but also shares with Italy and Spain a pattern of multi-generational family homes.

One of the notable features in modelling population spread of infectious diseases is that the young have many more daily contacts than the old. The return to school and university in September will have increased these contacts and the resulting viral transmission, but the importance of maintaining education far outweighed the clinical risk from the virus.

In cities like Bradford where school children and students (who often also live at home) were mixing with grandparents, this risk equation was always going to be different than in cities with fewer multi-generational homes. We now have a much clearer understanding about the variables that increase the risk of death from Covid - including ethnicity, gender and co-morbidities - but age is by far the greatest factor. And when grandparents share a house with young people, this heightens the risk.

Over the last couple of weeks I have been hearing of more and more personal tragedies that illustrate this problem.

Gulsoom Akhtar says her father, Akhtar Zaman, appeared at first to have an ordinary cold, but was later diagnosed with Covid-19 and taken to hospital on his GP's advice, with suspected pneumonia.

He was soon placed in intensive care, and died five days later, on 3 November. He was buried the following day.

"It's absolutely awful how many people are dying. My dad was only 63. He'd had an angina attack several years ago but he was well and he had nine beautiful kids. I was just so overwhelmed and shocked," says Gulsoom, a neighbourhood engagement worker, part of whose job is to spread information about Covid-19.

"Our youngest brother is only 17. We are all devastated and my mum has lost her best friend after 35 years of marriage."

As well as extra paving, floodlights will be brought in for late burials and the evening gravedigging shift

Amjad Pervez and his wife did their best to isolate on the third floor of their house, but continued to have some contact with their daughter, a university student, and with their school-age grandchildren. Amjad became ill with Covid in mid-October.

"In the second wave the children are getting Covid and not showing symptoms and particularly in the Asian community, where you have three generations living together, it doesn't work in our favour," he says.

Amjad's mother, Hazran, was living with one of his brothers, in another multi-generational household. Later she moved to stay in the home of a third brother, where no-one was ill, and she could be better isolated. Nonetheless, the woman whom Amjad describes as "fiercely independent" and "a fountain of wisdom" began to show symptoms of Covid and was taken to hospital on Monday. She died on Tuesday evening and was buried the following day.

"I think people know now about the number of deaths, and people are scared witless, and they're being really careful about social distancing. People are petrified," says Amjad, owner of the Seafresh/Adams food retailing and cash-and-carry group.

"I've lived in Bradford since 1969, I've grown up here, my business is here and my social network is huge. I've never in my life seen our community under so much mental stress and so scared."

Shadim Hussain, the father of four girls, had also taken measures to protect his parents, but somehow his mother became infected and was taken into hospital on Thursday. With pre-existing health problems, including chronic pulmonary obstructive disease, she deteriorated quickly, and Shadim was called to the hospital that evening.

"I could see it looked really difficult for Mum and instinctively we're taught as Muslims to say a prayer - there's a special prayer that I said with Mum and she repeated it after me. I could see her lips were still moving and I sensed she knew I was there," says Shadim, the founder of a fostering recruitment and training organisation, My Foster Family.

She died that night and was buried on Friday.

"In the morning we picked up the body and we did the bathing of the body. By midday we got the body prepared for burial and our slot at the cemetery was at 7pm that night," says Shadim.

"It was in the dark and there was something special about it - it felt quite peaceful. I got a call from Zulfi and he said, 'Whatever you need just let me know.' It was like having an army of people around, who wanted to help us."

As we observed the two-minute silence on Remembrance Day the UK was becoming the first country in Europe to surpass 50,000 deaths from Covid-19. There will be no Last Post bugle call for these fallen souls.

The vaccines against coronavirus cannot come soon enough.

Front-line diary

Prof John Wright, a doctor and epidemiologist, is head of the Bradford Institute for Health Research, and a veteran of cholera, HIV and Ebola epidemics in sub-Saharan Africa. He is writing this diary for BBC News and recording from the hospital wards for BBC Radio.

• Listen to the new series of The NHS Front Line in November on BBC Sounds and the BBC World Service

• Or read the previous online diary entry: 'We are first-hand witnesses of this devastation'

• Check out all the diary entries on the BBC Radio 4 website