One year of Covid: Hospital staff relive working through pandemic
- Credit: BHRUT
"The biggest sentiment everyone feels at the moment is sheer exhaustion. Everyone is absolutely exhausted."
Physiotherapist Charlotte Griffiths sums up the feelings of those working at Queen's and King George hospitals.
Frankly, it's no wonder that staff are so tired. For the past 12 months, they have been on the frontline of caring for patients during a deadly pandemic.
Reporter Michael Cox spoke to three members of staff at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) to discuss what they have been through during the past year.
Wednesday, March 11, 2020. This was the date when the gravity of the Covid-19 pandemic hit Rajesh Jain, who leads the trust's critical care provision.
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The first person died with the virus at one of the trust's hospitals. It was the day before Rajesh's son's birthday, an event his family were planning to celebrate.
Rajesh recalled: "It happened on intensive care. Everybody was very anxious and petrified because nobody knew what to do and how it was going to pan out. There was a fear and anxiety and that's why you can't forget that day when you had the first death."
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The beginning of the pandemic came just three months after he had taken up his position as head of critical care and he admitted it was a responsibility he just wasn't prepared for.
"I tried to keep things simple, I tried to be visible and I tried to solve problems if I could, as soon as I could. I don't think I've taken a day off during the whole pandemic."
Cases continued to mount throughout March.
A WhatsApp group was set up involving every doctor in critical care while, in the space of a week, plans were in place to expand bed capacity on intensive care.
For Magda Smith, chief medical officer, significantly ramping up critical care was just one of many considerations.
"When people are coming to hospital, if we think they've got Covid, we need to completely change the way A & E departments look so that we've got areas for people with Covid and areas for people coming who probably don't.
"We were having to change what our wards looked like, surgical wards were suddenly looking after patients with Covid, staff were having to move around, all sorts of things.
"It was a whole new disease. At the beginning, people said 'it's a virus, it will be a bit like flu'. It was not and is not.
"People were coming into hospital, they were a bit sick, then very sick and then sadly some passed away. But very fast."
Other considerations included provision for cancer patients, with chemotherapy and some cancer surgery moved to a private hospital, Spire Hartswood in Brentwood.
The increase in intensive care patients meant a requirement for more ventilators and other equipment. The trust risk-assessed staff and had to send some home who were most at risk from the virus.
During this first wave, government figures show a high of 245 patients with Covid in BHRUT hospitals on April 22.
The scale of the number of Covid patients saw staff redeployed to contribute towards their care, with more than 500 doing so during the pandemic.
One of those was Charlotte, whose normal role as a trauma rehab co-ordinator means she oversees the management of rehabilitation for trauma patients at Queen's.
A physiotherapist for 22 years, she was moved onto critical care during the first wave, helping to maintain limb mobility in Covid patients and then chest physiotherapy after they had been ventilated.
"It was quite apparent early on that people would need to be redeployed," she said. "I made it quite clear from the beginning that I wanted to be a part of that.
"There was a lot of apprehension, everyone was concerned. But you're there to do a job and you've got to step up to the plate and do it."
Charlotte, who lives in Essex with her husband and two children, aged three and five, had concerns about infecting them.
"You don't want to catch it - it's not so much protecting yourself, you're not bothered about yourself. But you don't want to bring it home to your family."
She said it was hard to switch off from the pandemic when she returned home.
"It was quite difficult to deal with Covid during the day and then to have family at home, well-meaning but saying 'how are you?' and you end up talking about it all of the time.
"You look on social media or you try and read the newspaper and everything was Covid-19. You couldn't get away from it so that was hard-going."
From Magda's point of view, the focus coming out of the first wave was treating patients whose care had been postponed.
Whole sections of King George Hospital, the main elective operating centre, were barriered off and a green zone was created to protect patients coming in for a procedure from Covid.
Despite a sharp fall in cases over the summer, Rajesh said staff were wary of a second wave. He felt they did not get enough of a break between the peaks of the virus.
"We started getting the non-Covid patients which we normally do - that workload never goes. We couldn't go on proper holidays because the lockdown and tier system were in place.
"We were exhausted and looking for recovery. It probably takes four to six months to recover from what we went through and this second wave came in.
"Once we knew this is what was going to happen, everybody got into the same act as we did in the first wave."
In September, the number of patients with Covid at the two hospitals began to rise again but Rajesh said things were better prepared second time around.
Weekly meetings were held among the north east London network of hospitals discussing how to make sure all hospitals in the area were sharing the patient workload.
"We had planned for having enough ventilators and monitors and the equipment we needed. If we were short, we knew where to get it from in a very short span of time.
"Going into the second wave, we had 70 to 80 ventilators and we didn't know where to put them. We were saying to ourselves we wouldn't need them anyway but come December it was a different picture altogether."
The number of Covid patients surged throughout October, November and December, with the emergence of a more transmissible Kent variant of the virus.
Staff testing was introduced, while extra respiratory wards were opened outside of critical care.
The level of patients far exceeded the first wave - at their highest, government figures show BHRUT had 518 patients in hospital with Covid-19 on January 11.
The trust had a total of 160 Covid patients in critical care during December and 146 in January - the two highest monthly figures throughout the pandemic.
It began running into issues with oxygen supplies.
A nurse told this paper in early January that 20 ambulances with patients were parked outside King George on one day, with a similar situation at Queen's.
Magda admitted that during Christmas and New Year, the situation was "really, really tough".
"We had many more patients who needed extra oxygen support with non-invasive breathing machines.
"Could we have prepared for the oxygen (difficulties)? I think we thought we had. But then you just realise it wasn't good enough but we were still able to respond."
She said the trust worked with other hospitals across London to ensure Covid patients got the care and equipment they required - including transfers to other sites.
Staff were once again redeployed, including Charlotte, whose work expanded this time to include non-Covid intensive care patients and the high-dependency unit.
For her, the first wave had been "far, far worse".
"It was the uncertainty. Over the course of the first wave, you got an idea as to how these patients respond to different treatments and things. You get into the routine of how to don and doff your PPE so familiarity puts your mind at ease.
"Obviously the second wave was very upsetting for a huge number of reasons but, in terms of anxiety about going on to ITU, I didn't have much because I had been there and done that."
Visitors have been banned from attending the two hospitals except in certain circumstances such as end-of-life care.
When asked if she and other staff felt a responsibility to be there for patients in their absence, Charlotte said: "During the first wave, we were so busy concentrating on these critically ill patients that we weren't able to pay a lot of attention to that.
"During the second wave, because I'd been moved around a lot more, I've got more time and because I'm not in full PPE some of the time if patients are Covid negative, it affords that little bit of time and interaction with the patients."
Improving communication with families was the main lesson Magda felt was learnt from the first wave.
"At the beginning of the first wave, we had to stop visitors, things ramped up so quickly that it was really challenging to get the right communication with families.
"We listened and we responded and our visiting access has been different in the second wave."
For Rajesh, the most pressure on critical care was between Christmas Day and January 10, when his daily worry was whether there were enough beds.
There were also staffing issues to contend with. The father-of-two said: "At one point I think I had five ITU consultants down with Covid and one of those was quite unwell.
"Fortunately they have all recovered fully but I think we supported them and people on the floor had to then chip in.
"If I had a day off and someone has gone off sick, I would just come into work and cover them. We would cover each other."
The situation is now improving - the trust has fewer than 100 patients in hospital with Covid.
But Magda said she has warned her staff of the difficulties of this phase of the pandemic.
"Sometimes going up the mountain where you've just got to focus on getting to the top, you've got to do everything you can, your kit has got to be right, your adrenaline's flowing.
"You've got to that point and coming down the other side of the mountain is really tough.
"You want to run to get to the bottom but that's when you trip and you fall.
"We want people to be out and about shopping, we want people to be meeting up in parks, but please take it slow. Hands, face, space is so critical at the moment."
A major focus for her moving forward is the wellbeing of staff.
Rajesh believes that hospital workers will have flashbacks about what they have been through.
"We went through a really hard time as clinicians. The number of deaths, we have probably never seen in our careers before.
"It's often the feeling of helplessness. We're doing everything for a patient and still we cannot save them. That was really hard."
He said he couldn't have got through without his family.
"In the first lockdown, people did a lot of things with family, learning new skills like cooking and whatnot. I had absolutely no chance to do any of that because I was working.
"Even when I was at home, I wasn't mentally at home. They knew I wasn't with them. I was at the dining table but I was looking at messages, making sure everything is happening and that patients have the right treatment.
"My family supported me very well and they understood through the whole pandemic that, for me, it is work first and family second."
Psychologists have been brought in to help staff deal with the mental traumas they have faced and the trust is introducing peer training to identify when colleagues are in difficulty.
Magda said: "We're all resilient in different ways and we all react to things in different ways. So the support has got to be tailored for different people."
Charlotte returned to her normal role last week and is trying to concentrate on getting back to that.
"I'm just looking forward to being able to see my family when lockdown eases. I'm looking forward to having my second dose of the vaccine so, when lockdown permits, I can see them without worrying I'm going to be passing something on."
Describing the pandemic as the biggest challenge of her career, Magda became emotional when reflecting on the pressures she has faced.
"It's been a rollercoaster. I am a doctor, I have patients that I look after and some of them have had Covid and died.
"Absolute pride in what people have done. Sometimes you despair and you get to a point where you think 'what are we going to do?' But actually then having colleagues to go 'what are we going to do together?'
"Standing on the doorstep during the Clap for Carers thinking those are my neighbours, they are so supportive."
Even with vaccinations being rolled out, Magda said the trust is planning for the possibility of a third wave of cases.
When asked what her hopes are for the coming weeks and months, she added: "A holiday!"
No-one would begrudge hospital staff one of those after the past year.