‘An operational tsunami’: preparing for a winter surge of Covid-19 | World news

During the typical evening bustle of the critical care unit at University hospital, Coventry, two construction workers are hoisting temporary polythene walls into position, dividing the ward into two. Behind them, a young nurse wearing an unconventional mask – one which cloaks her entire head – is providing life-saving care to an unconscious patient.

The second wave of the Covid-19 pandemic has hit the Midlands, with Coventry imposing tier 2 restrictions last week. Plans for a possible surge in admissions to University hospital are being swiftly implemented.

“We’re in the midst of what I’d call an operational tsunami,” says Prof Kiran Patel, the chief medical officer.

Construction workers erect a partition wall in critical care; one side of the unit will house Covid-positive patients, while the other will house ‘clean’ patients.



Tracy Newey attends to a non-Covid patient in critical care.



Tracy Newey, left, and Anda Ivan discuss the welfare of a patient. Both medics are wearing PPE to prevent the risk of infection to or from the patient.



“Winter looks like being a slow burn rather than a rapid acceleration,” says Patel in regards to coronavirus admissions. “But, at the same time, non-Covid activity levels in the hospital have risen back to normal. We’ve got a backlog of elective care [referrals including for surgery] and the tertiary sector is asking us for mutual aid and specialised support. So we’ve got a quadruple-pronged assault on our services which we’re trying to manage.”

Patel says University Hospital Coventry & Warwickshire (UHCW) trust is approaching winter with a “battle rhythm” and recognises that with each passing day the challenge is becoming more acute.

Worry

Last Friday , the hospital had a total of 30 Covid-positive patients, six of them in critical care. Seven days later, those numbers had risen to 28 and 10 respectively.

Back in the spring, when the first wave of the pandemic peaked, the hospital had up to 32 Covid patients in ICU at any one point. Memories of that time are still fresh and a feeling of unease lingers for Dr Tom Billyard, a consultant in critical care.

“I’m worried the health service has been a bit complacent over the summer. We’ve had time to prepare but actually I’m not sure we’ve used it very well. I don’t feel very prepared.

“We normally struggle through winter, so to add more Covid patients on top of that is a big worry.”

Tom Billyard and Rob Green

Billyard says the expectation that hospitals should fulfil 90% of elective surgeries is particularly troublesome because it will prevent the large-scale redeployment of surgical staff that proved so helpful last time.

“The problem isn’t UHCW,” he adds, “it’s the top-down message” from the government and local health authority.

Covidology

However, senior UHCW management says the trust is equipped for a long and taxing second wave.

“We’ve learned a whole new speciality: ‘Covidology’,” says Chris Bassford, clinical lead in critical care. “We’ve learned that Cpap [non-invasive ventilation] works well and that if someone is intubated their outlook is a lot worse, so we now persist with Cpap a lot longer.

“And we’ve learned that although we would normally run anyone with chest diseases on the drier side [keeping them slightly dehydrated, with a negative fluid balance], if they have Covid it’s better to run them a little wetter.”

New safety protocols are also noticeable upon entering the Covid wards. Previously, medical staff would don an abundance of personal protective equipment to shield themselves from the virus, whereas many now wear disposable pinnies and work with bare arms.

A nurse takes medication to patients on ward 30.



A hand sanitiser station on ward 30.



A Covid patient is moved within ward 30.



Staff on ward 30 analyse patient data.



“At first we saw the pictures of people in Korea wearing full E.T. spacesuits,” says Bassford, “and when we started getting patients here it was still two pairs of gloves, a gown, a pinny, an FFP3 mask and a visor. But there were unintended consequences: people found it harder to communicate and there were times – not many – where we passed the infection between patients.

“That’s why you don’t see gowns so much now. It’s a lot easier to wash your hands and skin if you’re bare below the elbows. It’s safer so long as we’re meticulous with our hygiene.”

But the past six months have proven that there is “no magic bullet” for the virus, says Billyard. The drugs remdesivir and hydroxychloroquine proved ineffective, while dexamethasone only helps to reduce mortality in critical care from 40% to 25%.

“We’re still going to see a lot of people dying from this over winter,” Billyard says. “What gets patients better is good quality intensive care.”

Bassford agrees. “You can have as many ventilators as you like but intensive care is not about the number of devices you’ve got. It is exactly what it says: it’s caring for people intensively. Caring is not a machine. It’s the staff who are at the bedside all of the time.”

Surrogate family

Tracy Newey, a healthcare assistant, was one of those redeployed to critical care in the spring. She says of her experience: “When I first went into critical care I was petrified because I’d never been in there before. I was used to dealing with surgical patients. The difference was massive. But the team showed us how to do things and now I love it.

“We feed patients, wash them, roll them, talk to them, get them talking to their relatives with iPads, and we help with them emotionally. We’re like a surrogate family.”

Carole Williams, a senior sister who oversees training of new recruits and redeployed staff, says: “In March, everyone came from everywhere to help us. But this time around we need to be slightly more selective about who we bring in.

“We also have the issue that some of our staff are now self-isolating, so we’re struggling at the moment. But people are working full pelt and they’re absolutely brilliant.”

Jill Ilsley, who has spent 33 years working in the NHS and is now responsible for forward-planning, is confident the trust can manage the demand.

“We will cope. We will keep the beds open and we will staff them safely. It will work because it has to. We can’t say: ‘Oh, I’m sorry, we’re closed today.’”

New recruits

Some medical staff, such as Wilhelmina Bulley and Sadie Orton, have just begun their medical careers in the middle of the pandemic.

Bulley, a nurse who qualified in February, says: “[In three years of training], we never had an induction for a viral pandemic. So it was quite daunting to start the job at the same time as this happened. But comparing today to then, I feel more prepared, I know what’s happening and what to expect. I’m more positive.”

One of her patients on ward 30, John Latham, looks sprightly. The 81-year-old praises those who have helped him beat the virus. “They’ve been so caring and efficient,” he says. But he adds that he has been lucky.

“This disease makes you an old man. The recovery from Covid is going to be slow but I want to get home, get moving, get doing and get my life back.”

John Latham, a patient who is recovering from Covid-19.



Mental health

The pressure of saving – and losing – lives has taken its toll on staff. Rob Green, a consultant in critical care, says he is still recovering from the mental toil of the first wave.

“I’ve been through Schwartz Rounds [mental health forums for healthcare workers] and I just couldn’t bring myself to talk about Covid,” he says. “The first wave was overwhelming and I think I’m still trying to decompress from it.

“We train for mass casualties, and for chemical and biological events with large numbers of patients over a short timescale, but nothing like this.”

Green caught Covid in May. It was a distressing experience, he says, “because I had spent weeks telling people on wards that they had a disease for which there is no cure, then I was in that position myself”.

There was a trivial positive to come from his own recovery, he says: he has been allowed to regrow his facial hair.

“I had a beard for years and I’d always been FFP3 mask-tested with my beard [tight-fitting masks are mandatory in critical care], so when Covid happened I said: ‘I don’t need to be clean shaven to wear a mask.’ But the trust said: ‘No, no, no’, so I shaved my beard off and grew the most magnificent moustache instead, like Joe Exotic on Tiger King. Then I got coronavirus anyway.”

Asad Ali and Carole Williams

Invisible threat

On ward 30, Dr Asad Ali, a consultant physician and de facto lead in respiratory medicine, is checking a patient who has participated in plasma trials.

He sympathises with the experiences of people around the country because he, too, has been personally affected by Covid. Ali flew to Pakistan to visit his ill parents early in the first wave. While he was away, his brother in the UK became seriously ill with Covid.

“I got stranded overseas and had to arrange the ambulance for my brother while sitting 5,000 miles away,” he says. “I was frantically trying to get flights back from Lahore, to no avail. I booked four or five flights and they all got cancelled. When I finally flew into Heathrow, I found a new country.”

Dr Asad Ali examines an unidentified patient who has participated in plasma trials.



Ali acknowledges the sacrifices made by the public in the first wave of the pandemic and is calling on the NHS to “empower” them using hard-hitting messaging. “We don’t need to say ‘protect the NHS’; we need to say ‘protect the public’,” he says.

“If a person doesn’t see how it will affect them directly and none of their family members have got it, how long are they going to be willing to make sacrifices?

“We need to show them. They need to know the virus doesn’t discriminate. We need patients who’ve come out of intensive care and clinicians from hospitals to be part of the messaging. We need to say: this is how it impacted us, it can impact you or your loved ones too.”


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