Prof Brendan Cooper
Consultant Clinical Scientist, UHBNHSFT
COVID19 (SARS-CoV-2, Coronavirus, CV19, etc.) has been (knowingly) in the UK for over 6 weeks now, with the country in effective lockdown for nearly 3 weeks so far. Whilst there are suggestions that the expected “surge” may be less than expected, it cannot be argued that COVID19 has wreaked devastation on patients, families, the healthcare system and the country as a whole. However, it has also triggered some amazing responses in all our healthcare staff and systems, and produced some wonderful examples of innovation, teamwork, redeployment, re-skilling and an outpouring of cooperation and support for all in the.
As AHCS President, I have along with CSOs in the four nations, the National School for Healthcare Science and allprofessional bodies been not just promoting healthcare scientists, but showcasing examples of why we are an integral part of the healthcare family in fighting COVID. The biggest gain in the may not be that healthcare scientists have been on the front line; it’s that we’ve been able to share our skills, staff, experience and leadership with our frontline clinical colleagues.
How have I seen this? Every morning, one of our lung function team joins the respiratory medicine “huddle” (all 1 metre a part!) on the 5th Floor and participate in a briefing about the respiratory wards. The consultants, ward sisters, physiotherapists and lung function physiologists all share overnight developments, issues, problems, information and updates on our services. We hear about the number of transfers to ITU, deaths, PPE supplies, staffing levels, redeployments and problems such as patient’s relatives phoning the ward all day. Collectively, we share our thoughts, suggestions, advice and understanding and offer things that we can do to help. There is an air of cooperation, openness and constructive challenging of suggestions from all in the team. We are one team.
The lung function team then holds its own “COVID Briefing” where we disseminate the information, check who’s absent/available, sort out our work streams and training for the day and feedback on where we are required to support the rest of the hospital’s respiratory team. Communication is absolutely key to maintaining engagement, staff morale and focus on what we’re doing in these unique times.
One large piece of work done with several UK lung function departments has been investigating the use of nasal continuous positive airways pressure (CPAP) with entrained oxygen as a treatment for COVID19 to be used prior to ICU admission and intubation.
This work has been able to advise respiratory physicians up and down the UK, who do not have enough ventilators to support COVID19 patients currently, to deliver this treatment on the ward. We have collectively figured out that home ventilators set to CPAP mode on 10-15 cm H2O pressure and 10-15 L/min oxygen can deliver inspired oxygen concentrations at the mask of between 50-90%. This is enough (according to the latest NHSE guidance) to treat patients effectively in the early stages of the virus. We have discovered that the point of oxygen entry, the mode of ventilation and the type of machine used, makes a huge difference to oxygen delivery. Indeed,are about to start a clinical trial of CPAP versus high flow nasal oxygen vs standard treatment to answer the question of which is the most effective treatment. The vigour, enthusiasm and professionalism shown by my respiratory physiology colleagues is humbling.
This use of healthcare science skills is helping the frontline teams making clinical decisions in treating COVID19 has been epic. Healthcare scientists are integrated into the frontline, even though some have limited access to delivering measurements and treatments to COVID 19 patients directly, many other departments are very much involved on the frontline.
I am aware of healthcare scientists stepping up to the plate helping nurses on the wards, within ICU and at theNightingale Hospitals delivering frontline patient care. This is of course as well as delivering the usual support services including all aspects of biochemistry, microbiology, COVID19 testing in life sciences. Medical engineering staff has been delivering incredible devotion by procuring/preparing the thousands of new ventilators (traditional and recently developed), the infusion pumps, and other essential equipment to ICUs up and down the UK.
All of us have had to work differently be it, changing shifts to cover 24/7 rotas, working from home doing virtual clinics using VPN, or forming new multi-disciplinary teams to deliver patient facing services. As part of the social-distancing priority we are all now using “Covideo-conferencing” or virtually meeting using speaker phones to conduct (shorter than usual) management meetings. Lots of time that was spent on targets, waiting times and budgets, is now replaced with working more effectively to conquer COVID19, supporting patients, protecting colleagues or finding new methods of treatment.
In my own department, we have struggled for years to establish IT clearance to set up remote monitoring of our patients on CPAP (for obstructive sleep apnoea) or NIV but as part of the “clearing the decks” for COVID out-patient work, we are now using this remote monitoring very effectively and without any IT issues. It just shows that much of the “command and control” beaurocracy that is followed with such zeal is actually fairly futile in times of emergency. As organisations, we need to learn from this going forward post-Covid19.
Physically we’ve changed how we look too. Most staff who work on the wards are switching to “scrubs” and often donning PPE and look very much the same as our medical and nursing colleagues to the patients. I suspect we are seen differently by our nursing/medical colleagues too, so perhaps this is a barrier we overcome moving forwards too. Even within my own team, I now wear scrubs and I feel more part of the team (although may be they just think I missed the alarm and slept in!)
When I wrote my first piece about our “unsung heroes”, we were at the beginning of an epic journey into the world of COVID19. What I have found very difficult to adjust to is the unsettling patterns of change.
Healthcare scientists may feel they are having a “roller-coaster” of emotions regarding the expectations and the realities of whatroles will be to contribute beating COVID19 which has frequently changed. For a workforce who enjoys order, standards and evidence, it has been an unsettling experience, but one which has led to significant adaptation and utilisation of fundamental leadership skills described above. This has been an experience of frustrations, flexibility, listening, fears, and personals circumstances for all.
For example, reading then details of managing COVID19 patients on ventilators/ICU and reading/watching the accounts of clinical colleagues develops exaggerated fears of COVID19, even though our rational mind shows that 80% of the population who catch it will have mild symptoms. Because we work at the forefront of the illness and see the “worst case scenarios” and hear the dreadful personal tragedies, we can often become deeply affected by that experience.
In that way, we again become closer to our other clinical colleagues who face this reality daily and begin to expand our understanding of what healthCARE actually means. It is the sick, scared, lonely patient, cut off from their family, in strange surroundings, surrounded by gowned people in hoods, visors and gloves that we now help to care for. We become their link with humanity……….. their carer…… their attachment to family and friends. How privileged we are to be working in that role. I believe all healthcare scientists will be changed forever post-COVID19 through these career-changing experiences. How wonderful for our STPs experiencing a lot of this close up as they are re-deployed to theNightingale Hospitals.
It is essential in this National Emergency that organisations (Trusts, divisions, clinical teams) communicate clearly to all staff and that this is delivered by localleaders to all their teams. Even if the plans change, at least the workforce can manage their expectations and provide innovative input into any proposed plans. Communication needs to be clearer, although, to be fair to most Trusts and organisations, the plans are often changing hourly but there is also the need for some national standardisation (e.g. the , NHSE guidance) based on best evidence, often gathered at pace, of how we deliver the right care in the right way.
Staff and particularly leaders, shouldn’t be afraid to seek support from professionals such as counsellors or psychologists, but can often confide in other healthcare colleagues to help manage some of the difficult raw emotions staff can experience during this national emergency. Sudden unexpected death, young people in deep trouble and people stories can tear at our emotions.
I hope you are coping well with the changing work and life situation, the bizarre lifestyles (the difficulty in reading anything but COVID19 information), the travelling to work on near empty roads, the pockets of human kindness and decency that is so often lost in our hitherto “normal world”. Your sleep isn’t normal and refreshing (waking up at 5am, reaching for that mobile phone?) , your diet has gone to pot (convenience food, poor appetite, etc.) and your brain is a “mush” unable to easily focus on big tasks. And there’s months more of this to go!”
I am immensely impressed with the stories, tweets, messages and testimony of the tremendous work that healthcare scientists continue to do in this relentless pandemic. You are amazing people, with huge talent, great innovation and most importantly humble humanity. You should be immensely proud of all that you are doing/have done to get theinto shape to be able to tackle COVID19. You should (no doubt very embarrassed) accept the 8pm clapping on Thursday nights – you deserve it! On behalf of the AHCS, thanks so much for being so brilliant.
Prof Brendan Cooper