Reflections of a Respiratory Consultant

Submitted by Luke
Respiratory Consultant, Worthing

I first became aware of COVID in the middle of January 2020 reading articles in the Lancet.

Having known about MERS & SARS outbreaks from over a decade ago, I understood the potential gravity but only when I saw a video from a Wuhan hospital did it become clear what was happening and potentially how underprepared we may be.

As Italy became engulfed, to my amazement, friends were still planning trips there and relatives were considering theatre trips days prior to our eventual lockdown near the end of March. Fellow critical care researchers knew people in Wuhan and Milan and the news was not good.

In hospital, we understood what was coming, however this was not the case elsewhere initially – by the time the first patients arrived we were ready, but aware of the potential to become overwhelmed.

From initial Wuhan reports, survival if ventilated was extremely unlikely. As a group we ensured that our knowledge was informed by experiences worldwide, but also from historical knowledge of similar viruses; I remember putting together evidence that Critical Care was not appropriate for every individual due to the nature of the disease process and a person’s underlying health, which had to be faced by the clinical teams in such scenarios.

Teams in Critical Care quickly worked up surge rotas and explored getting hold of extra ventilators and ensuring adequate oxygen would be available.

We put together flow charts to rapidly assess patients coming through the ED to ensure that appropriate treatment escalation plans were made, which over time became accepted practice.

The vast majority of the staff in the hospital worked together as one to provide the best possible care for our population whilst protecting staff.

For the first week or two of having patients, whether many would survive critical care was not clear – even in the US mortality was being reported at >80%.

Doing night shifts again was not pleasant.

However, as time went on, some people started to slowly recover and with that hope began to rise.

I was determined early on to make sure we delivered the best evidence-based treatments to patients rather than rely on eminence / opinions, which were not lacking.

We therefore took part in the national COVID studies including RECOVERY, which I think helped staff, patients and staff know that we were doing everything we could to help them or their loved ones.

Next we got the next wave which was of care workers, porters and nurses – people who’d got the virus doing their job, which was difficult but we as a team were determined to try and support these people through.

As survivors left the unit, I set-up a research study as part of a new way of following-up survivors during the pandemic, using technology such as a smartwatch, to try to ensure that they would be physically supported in their recovery.

This study provided a focus for doctors and physiotherapists to continue to help people on their journey home and was good for staff morale.

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