What it’s really like being on the covid-19 front line

The hospital is running what is basically an ever-changing plan, as the situation moves from hour to hour, but as a precis:

Of their intensive care doctors, almost 40% are off sick. Approximately one-third of their overall staff are either off sick or are self-isolating. Where there should be one intensive care nurse to one patient, it’s one fully trained nurse to six patients. They have been told that as things worsen, they will need to move to one trained nurse to 10 patients. Those nurses are backed up by physios, who are working as intensive care nurses – scary for all concerned.

Patients are assigned to a ventilator if they are relatively young and have no underlying conditions – otherwise they get a hospital bed and oxygen. Within the hospital there are four doctors, all fit young people, who don’t need a ventilator, but do need hospitalisation and oxygen. Their youngest ventilated patient is 38 and seriously obese. 30-50% of the ventilated patients are obese. It’s a high-risk factor.

Last week she had to plan and run the movement of all fully ventilated Covid patients from one end of the hospital to the other, involving a lift down, several corridors, a lift up, taking them off their proper ventilator, onto a transient one, and back onto a proper one in their new ward. This took all day, with people placed at every intervention point to ensure all doors were fully open, lifts were open and wouldn’t be stopped anywhere else, front doors of the hospital were stopped so that nobody came in.

In the middle of all of this, a poor young man arrived to collect his father’s belongings from the ward where the father had died. It was a difficult experience, to hand over a bright red plastic bag full of the father’s belongings (the colour signifies it’s contaminated material inside) with instructions that the relative couldn’t go through those belongings and must burn or carefully dispose of them. Covid patients die pretty much alone, not allowed to see anyone except hospital staff who are fully gowned up, and they have no connection with relatives.

At the end of the day, she had to carry cardboard boxes of file notes, etc. through to the new ward, just to free up all the hospital from the transfer issues, without protection, so a long way off ideal in terms of her own protection.

In London, they expect the surge to begin today (1 April) and go on for quite a while. They expect to run out of beds on Friday, and then start using the Excel Centre. Only younger, stronger patients will be sent there, so that the seriously ill patients remain in a hospital setting, but what the modelling (and experience) now shows is that ventilated patients can be doing well for the first 10 days, and on day 11 the whole picture changes and they become very seriously ill, with organ failure being an issue – so there is concern about how many seemingly stable patients will be sent to the centre, and might then need to be transferred to a hospital, meaning an ambulance ride which, by then, they may be too sick to survive.

They have nothing like the equipment for the machines that they need, and cannot source any more at the moment. They are having to share pieces of equipment between beds, meaning that some patients will get feeding tubes, or syringe drivers for a few hours, and then have to be given food and drugs by alternative routes while the equipment is sterilised and moved to the next patient.

All of this is hugely time-consuming for staff and, by necessity, will sometimes be done by staff who are not fully trained in all of this.

The PPE equipment is mainly sufficient for now, but they never know when the next round of kit will arrive. Yesterday, she had to put it on and go onto the intensive care ward to fully count each piece of equipment, so that they can know precisely what they’ve got. (This is a very long way off her normal job description, but somebody had to do it, and she runs that ward). It’s not full Hazmat suits: she wore scrubs, over which goes something like a plasticised full apron, two sets of gloves, a full mask and goggles. It takes 15 minutes to get into it all, but she said the plus is that once you’re in it, you feel safe that you’re not going to catch Covid. Some of it gets sterilised afterwards, but most of it is one-use only.

The nurses are doing 12-hour shifts. Her experience was that you sweat profusely inside the gear. They are trying to build in three breaks for them during their 12 hours, to ensure they drink enough water and can get to the bathroom. However, as it takes 15 minutes each time to get into the gear, this doesn’t always happen. The individual can feel themselves breathing in their own sweaty breath, their hands are boiling hot, and it’s uncomfortable. And they are doing 12 hours like that.

Her own contract is three days a week, but she is doing five days, 12 hours long, plus working from home at weekends, or having to go in to help to get things sorted logistically. Last weekend she created two staffing rotas, Plan A for an ideal world, Plan B in case staff went off sick. Both rotas fell over, as people realised they were ill.

This is just one hospital. Their experience is being replicated all over the NHS, or will be as the virus spreads.

Last night she realised she was experiencing Covid symptoms: loss of taste, severe headaches, feeling exhausted. As a key worker, she has been tested today and will receive the results in two-three days’ time. She now has a high temperature and is in bed, but so far this is a mild case. Her anxiety is now about being off sick just at the surge begins, and of introducing it to her husband and children.

NAME AND ADDRESS WITHHELD.