At Milton Keynes University Hospital in England, it’s a battle between life and death. For those most ill, death is gaining the upper hand.

The latest Covid-19 wave has hit the hospital northwest of London with even more force than the first: younger patients fill its wards and fewer of the sickest people respond to treatment, Reuters reports.

Doctors and nurses are grappling with the strain of exhaustion and loss.

The official death toll from Covid-19 in the United Kingdom is 93,290, the highest in Europe and the fifth worst in the world after the United States, Brazil, India and Mexico. 39,068 Covid-19 patients are being treated in hospitals. Deaths rose by a record 1,820 people on Wednesday.