The Royal Hampshire County Hospital’s Intensive Care Unit has just a handful of coronavirus patients. The majority of the 42 beds brought in to cope with the predicted demand lie empty. The working day, it appears, has begun a slow return to ‘normal’ – whatever that is now.
“We’re waiting to see what will happen once the lockdown measures are lifted,” says consultant anaesthetist, Dr Geoff Watson. “There is concern that we’ll suddenly have a new influx of coronavirus patients once that happens. We’ve seen fewer than usual seriously ill patients with other conditions over the lockdown partly because of the lack of exposure and a more sedentary lifestyle. Those cases will inevitably go back to the numbers we usually deal with and there are signs of this already happening.”
Since lockdown, the number of patients in the hospital gently climbed to around 30 ICU-level and several hundred general ward patients – not thousands – but enough for around a third of the ICU staff to themselves get the virus too.
It was at the end of February that Geoff saw his first coronavirus patient. “We’d known about the virus for some time,” he says. “We talked about it as a team at length, debated the evidence and got on with it.”
The ten-bed intensive care unit was extended, into separate coronavirus-positive and negative areas, with capacity for 42 patients across the two. Additional ventilators were sourced from operating theatres no longer in use, while others were borrowed from a central Government loan system.
“The rate at which the hospital responded was impressive,” says Geoff. “The most challenging aspect of being practically prepared was getting hold of a consistent supply of PPE. Because of national shortages, protective masks in particular, had to be sourced from multiple suppliers. Each time a slightly different model was issued, we’d have to individually be fitted for it – not only taking up valuable time, but also using up PPE.
“Added to that pressure was the fact that at the start, the advice from Public Health England which provides a national monitoring and advisory role, was regularly changing as the pandemic began to play out.”
And so it began. The severity of the coronavirus cases that came in to ICU meant Geoff and his fellow-consultants began to work 24/7. On-call nights were replaced with 13-hour shifts in the hospital. At its most intense, the team had 16 seriously ill coronavirus patients at one time on the unit.
“Part of the challenge of any new virus is the learning curve of those that are treating it,” says Geoff. “The application of medicine and practice is, in essence, the same for coronavirus patients as it is with every other very sick patient whose lungs are compromised, but the challenges that the virus present often demand split-second, complex decision-making. We’re not just treating the lungs but also the cardiovascular and immune systems too.
“Because post-mortems have been put on hold since lock-down, we are also unable to determine the exact cause of death when it does occur. We have a reputation in Winchester for our research, which helps us all to improve our expertise. Not being able to fully ascertain cause of death with coronavirus patients inevitably holds back key information that we could be using to treat patients.”
Community support has kept the whole team going. “In all my years with the NHS, I’ve never seen such an outpouring of public kindness,” says Geoff. “It’s come to us in drinks and snacks, home-made cakes, ice-lollies, radios for patients, shower gels, cards and letters and in lots of small ways that mean so much. At times, we feel completely humbled by it all.”
Gifts of cold drinks have been particularly welcome. “Wearing PPE for hours at a time, plus a mask, gloves and a face mask means layer upon layer of plastic,” says Geoff. “On the unit we can’t have fans for coronavirus patients – many of whom have high temperatures – and the machines generate heat. We can only take short breaks and can’t go back and forth to the canteen, because of the infection risks, so we get very dehydrated very quickly. Being able to get a cold drink out of the fridge when you really need it is a huge plus.”
The risk to the nursing staff has been real. “A third of ICU staff have been off sick with the virus,” says Geoff. “None of us thankfully needed hospital care. Some of the staff have been in temporary accommodation since lockdown away from their families to protect them against risk. We are well aware that we’re on the front line.”
Death is, and always will be a factor. “We’ve lost six patients to coronavirus,” says Geoff. “The numbers have thankfully been a lot lower than anticipated in Winchester, but each death is a tragedy. We remind ourselves daily that while we have a patient lying there with tubes coming out of them in every direction, hooked up to an array of sophisticated machines, they’re a person.
“They’re someone’s mother, sister, father or brother. In the absence of family visits, they become much more to us than patients. I regularly remind myself that people simply don’t care what you know as a doctor, unless they know that you care.”
So, what will life be like when coronavirus becomes history? “I hope that all the goodwill that has been shown to the NHS and the recognition of what we’ve achieved and the huge sacrifices that have been made don’t get forgotten,” says Geoff. “There is only so long that people will wait for appointments and operations that have been put on hold before getting frustrated by a public health service that will be playing catch-up for some time.”
How will he look back over this time? “I’ll inevitably wish that I’d had had a crystal ball to see what the future brings,” he says. “I’ll probably be like a lot of my colleagues saying ‘I knew that’s what we should have done’. Hindsight is such a powerful thing.”