 MNT’s Sunday Supplement: 1 year of COVID-19 in a critical care department | As we approach the first anniversary of the COVID-19 pandemic this week, Medical News Today asked a number of healthcare professionals to provide an insight into the last 12 months.
In today’s email, we’re exclusively previewing the first hand account of Dr. James Evans, a consultant in critical care and anesthetics in the United Kingdom (roughly equivalent to an attending physician in the US).
The virus arrives
It became apparent in January 2020 that the “new virus” was going to be a problem. I can’t remember the timeline exactly, but I do recall the daily reports of cases in Europe, then, eventually, in the U.K
By mid-March, we were seeing the first hints of staff sickness associated with COVID-19, and the meetings were endless. I had rapidly become something of an expert on COVID-19.
I remember walking in slightly late to a departmental clinical governance meeting in March. I was due to present something, and, as I walked in, I realized that not only was it the best-attended governance meeting I had been to but it was also full of surgeons and was video-linked cross-site.
The most worrying thing, though, was that they all seemed to be waiting for me, and I proceeded to do a question-and-answer session on COVID-19 for the next few hours.
The trust (an organisational unit within the National Health Service in England and Wales) was taking this all very seriously, and pretty much all elective work had been canceled. We were seeing how badly London had been affected, and there were the daily pictures of nurses in tears and families grieving.
Making adjustments
By this stage, we had managed to expand our intensive care units on both sites to provide extra capacity to ventilate patients. The work that went into this was a phenomenal effort, and we have forged relationships with staff from electronics and medical engineering, estates, procurement, and housekeeping in the process.
We found ourselves in lockdown and essentially completely occupied by COVID-19. That was all we talked about and thought about at work and at home.
The wave hit, and critical care became busy. Both sites filled up, and for a long period, we only had COVID-19 patients in the intensive care unit (ICU). We often wondered what had happened to the “normal” ICU patients because we didn’t really see any for a few weeks.
Coping and camaraderie
Support from redeployed nurses was great. There was a real camaraderie, and we managed, but it was tough.
The PPE was not great back then; nurses and doctors could not spend longer than 2 hours wearing it without becoming exhausted. I remember seeing a young ICU nurse in tears, collapsed, surrounded by her colleagues at the end of her shift. She was having an asthma attack, and it turns out she had been in full PPE for 5 hours with no break.
It was a unique time, and we were not as badly hit as anticipated. The massive influx of patients never came, and our mortality figures in the trust were excellent compared with the rest of the country.
There remained a trickle of COVID-19 patients, and we started to work a bit more like “normal,” pre-COVID-19 times.
The second wave
I was always very aware that we hadn’t seen the last of COVID-19 and continued to be sent scary-looking graphs predicting a second wave over the winter months. This would be devastating on top of the usual winter pressures.
We continued to plan for the second wave and maintained our new, enlarged critical care footprint within the trust.
We were particularly bad at the end of December and through the whole of January. Both critical care units filled up rapidly. This time, the population we were dealing with was noticeably younger, most with overweight, and included plenty of healthcare workers and some staff members.
It was much busier than the first wave. Much, much busier. The situation resembled the images we saw in Italy during the first wave. Nursing ratios were stretched, we were at the absolute limit of what beds we could provide. We also had to request extra ventilators from NHS England.
The oxygen supply was also an issue. There was a danger that we would lose supply to some areas, so we were using oxygen concentrators on the wards to try to spare the main supply.
We were seeing multiple referrals on the wards, and our nurses were at breaking point. It was the most stressful and difficult time I have ever worked in. The last two weeks of January were particularly horrendous.
I have to say, the critical care nurses were absolutely amazing. I mean, what a bunch of people. They displayed superhuman ability to cope and work in the worst conditions I have seen in the U.K., and they kept coming back, shift after shift. I am in awe of them and can’t express my gratitude to them enough.
We have started to see light at the end of the tunnel now. The rate of infection in the community seems to be improving.
Nonbelievers
I remain cautious and worry we have not yet seen the back of this. This time around, it seems a lot more people know someone affected by COVID-19, but there are still nonbelievers who seem to think this is either a hoax or a government conspiracy.
Well, COVID-19 is very real. It is caused by a nasty little virus that can spread very easily. It affects the young and the old, and there is no clear reason why some people are more badly affected than others. It does not discriminate.
The variations and the mutations are worrying, the younger population is being affected, and its seemingly relentless nature makes this scary. I don’t currently see a way back to normal; maybe I am just cynical and grouchy and have spent too long in the hospital in PPE dealing with this.
I hope the vaccine will make a difference, but we may not see these effects for a while.
Staff involved in this recent wave will have been irreversibly affected by this traumatic experience but have also shown a great strength and compassion that has astounded most of us.
In summary, it has been a difficult year. Sadly, I think it will be commonplace in the future — new viruses, PPE, masks in public, and physical distancing. We need to find a way to deal with it quickly; we need to accept a new normal.
The full article will be published on March 11, and we’ll be back with our regular daily newsletter tomorrow. For more on the pandemic one year later, visit our live updates page, read about some hopeful vaccine research, and dig into another doctor’s perspective. And, as always, we’d love to know what you think of today’s email.
Robin Hough
Editor-in-Chief, Medical News Today
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